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Wsół A. Cardiovascular safety of psychedelic medicine: current status and future directions. Pharmacol Rep 2023; 75:1362-1380. [PMID: 37874530 PMCID: PMC10661823 DOI: 10.1007/s43440-023-00539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
Psychedelics are powerful psychoactive substances that alter perception and mood processes. Their effectiveness in the treatment of psychiatric diseases was known before their prohibition. An increasing number of recent studies, due to the indisputable resurgence of serotonergic hallucinogens, have shown their efficacy in alleviating depression, anxiety, substance abuse therapies, and existential distress treatment in patients facing life-threatening illness. Psychedelics are generally considered to be physiologically safe with low toxicity and low addictive potential. However, their agonism at serotonergic receptors should be considered in the context of possible serotonin-related cardiotoxicity (5-HT2A/2B and 5-HT4 receptors), influence on platelet aggregation (5-HT2A receptor), and their proarrhythmic potential. The use of psychedelics has also been associated with significant sympathomimetic effects in both experimental and clinical studies. Therefore, the present review aims to provide a critical discussion of the cardiovascular safety of psilocybin, d-lysergic acid diethylamide (LSD), N,N-dimethyltryptamine, ayahuasca, and mescaline, based on the results of experimental research and clinical trials in humans. Experimental studies provide inconsistent information on the potential cardiovascular effects and toxicity of psychedelics. Data from clinical trials point to the relative cardiovascular safety of psychedelic-assisted therapies in the population of "healthy" volunteers. However, there is insufficient evidence from therapies carried out with microdoses of psychedelics, and there is still a lack of data on the safety of psychedelics in the population of patients with cardiovascular disease. Therefore, the exact determination of the cardiovascular safety of psychedelic therapies (especially long-term therapies) requires further research.
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Affiliation(s)
- Agnieszka Wsół
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097, Warsaw, Poland.
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Marcinkowska M, Kubacka M, Zagorska A, Jaromin A, Fajkis-Zajaczkowska N, Kolaczkowski M. Exploring the antiplatelet activity of serotonin 5-HT 2A receptor antagonists bearing 6-fluorobenzo[d]isoxazol-3-yl)propyl) motif- as potential therapeutic agents in the prevention of cardiovascular diseases. Biomed Pharmacother 2021; 145:112424. [PMID: 34785417 DOI: 10.1016/j.biopha.2021.112424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/30/2021] [Accepted: 11/10/2021] [Indexed: 01/19/2023] Open
Abstract
Small drug-like molecules that can block the function of serotonin 5-HT2A receptors have garnered considerable attention due to their ability to inhibit platelet aggregation and the possible prevention of atherosclerotic lesions. Although clinical data provided compelling evidence for the efficacy of this approach in the prevention of various cardiovascular conditions, the chemical space of 5-HT2A receptor antagonists is limited to ketanserin and sarpogrelate. To expand the portfolio of novel chemical motifs with potential antiplatelet activity, we evaluated the antiplatelet activity of a series of 6-fluorobenzo[d]isoxazole derivatives that possess a high affinity for 5-HT2A receptor. Here we describe in vitro studies showing that 6-fluorobenzo[d]isoxazole derivatives exert promising antiplatelet activity in three various in vitro models of platelet aggregation, as well as limit serotonin-induced vasoconstriction. Compound AZ928 showed in vitro activity greater than the clinically approved drug sarpogrelate. In addition to promising antiplatelet activity, the novel series was characterized by a favorable safety profile. Our findings show that the novel series exerts promising antiplatelet efficacy while being deprived of potential side effects, such as hemolytic activity, which render these compounds as potential substances for further investigation in the field of cardiovascular research.
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Affiliation(s)
- Monika Marcinkowska
- Chair of Pharmaceutical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland.
| | - Monika Kubacka
- Chair of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland.
| | - Agnieszka Zagorska
- Chair of Pharmaceutical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Jaromin
- Department of Lipids and Liposomes, Faculty of Biotechnology, University of Wroclaw, Wroclaw, Poland
| | - Nikola Fajkis-Zajaczkowska
- Chair of Pharmaceutical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Kolaczkowski
- Chair of Pharmaceutical Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Kraków, Poland
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Furlotti G, Alisi MA, Cazzolla N, Ceccacci F, Garrone B, Gasperi T, La Bella A, Leonelli F, Loreto MA, Magarò G, Mangano G, Bettolo RM, Masini E, Miceli M, Migneco LM, Vitiello M. Targeting Serotonin 2A and Adrenergic α 1 Receptors for Ocular Antihypertensive Agents: Discovery of 3,4-Dihydropyrazino[1,2-b]indazol-1(2H)-one Derivatives. ChemMedChem 2018; 13:1597-1607. [PMID: 29873449 DOI: 10.1002/cmdc.201800199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/18/2018] [Indexed: 01/29/2023]
Abstract
Glaucoma affects millions of people worldwide and causes optic nerve damage and blindness. The elevation of the intraocular pressure (IOP) is the main risk factor associated with this pathology, and decreasing IOP is the key therapeutic target of current pharmacological treatments. As potential ocular hypotensive agents, we studied compounds that act on two receptors (serotonin 2A and adrenergic α1 ) linked to the regulation of aqueous humour dynamics. Herein we describe the design, synthesis, and pharmacological profiling of a series of novel bicyclic and tricyclic N2-alkyl-indazole-amide derivatives. This study identified a 3,4-dihydropyrazino[1,2-b]indazol-1(2H)-one derivative with potent serotonin 2A receptor antagonism, >100-fold selectivity over other serotonin subtype receptors, and high affinity for the α1 receptor. Moreover, upon local administration, this compound showed superior ocular hypotensive action in vivo relative to the clinically used reference compound timolol.
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Affiliation(s)
- Guido Furlotti
- Angelini RR&D (Research, Regulatory & Development), Angelini S.p.A., Piazzale della stazione snc, 00071, S. Palomba-Pomezia (Rome), Italy
| | - Maria Alessandra Alisi
- Angelini RR&D (Research, Regulatory & Development), Angelini S.p.A., Piazzale della stazione snc, 00071, S. Palomba-Pomezia (Rome), Italy
| | - Nicola Cazzolla
- Angelini RR&D (Research, Regulatory & Development), Angelini S.p.A., Piazzale della stazione snc, 00071, S. Palomba-Pomezia (Rome), Italy
| | - Francesca Ceccacci
- Chemistry Department "S. Cannizzaro", University of Rome "La Sapienza", P.le Aldo Moro 5, 00185, Rome, Italy.,Current affiliation: Istituto di Metodologie Chimiche-CNR, Unità Organizzativa di Supporto, Sede di Roma, Università degli Studi di Roma "La Sapienza", P. le Aldo Moro 5, 00185, Rome, Italy)
| | - Beatrice Garrone
- Angelini RR&D (Research, Regulatory & Development), Angelini S.p.A., Piazzale della stazione snc, 00071, S. Palomba-Pomezia (Rome), Italy
| | - Tecla Gasperi
- Department of Science, Section of Nanoscience and Nanotechnology, University of Roma Tre, via della Vasca Navale 79, 00146, Rome, Italy
| | - Angela La Bella
- Chemistry Department "S. Cannizzaro", University of Rome "La Sapienza", P.le Aldo Moro 5, 00185, Rome, Italy
| | - Francesca Leonelli
- Chemistry Department "S. Cannizzaro", University of Rome "La Sapienza", P.le Aldo Moro 5, 00185, Rome, Italy.,Dipartimento di Biologia Ambientale, University of Rome "La Sapienza", P.le Aldo Moro 5, 00185, Rome, Italy
| | - Maria Antonietta Loreto
- Chemistry Department "S. Cannizzaro", University of Rome "La Sapienza", P.le Aldo Moro 5, 00185, Rome, Italy
| | - Gabriele Magarò
- Angelini RR&D (Research, Regulatory & Development), Angelini S.p.A., Piazzale della stazione snc, 00071, S. Palomba-Pomezia (Rome), Italy
| | - Giorgina Mangano
- Angelini RR&D (Research, Regulatory & Development), Angelini S.p.A., Piazzale della stazione snc, 00071, S. Palomba-Pomezia (Rome), Italy
| | - Rinaldo Marini Bettolo
- Chemistry Department "S. Cannizzaro", University of Rome "La Sapienza", P.le Aldo Moro 5, 00185, Rome, Italy
| | - Emanuela Masini
- Departments of NEUROFARBA, Section of Pharmacology, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Martina Miceli
- Department of Science, Section of Nanoscience and Nanotechnology, University of Roma Tre, via della Vasca Navale 79, 00146, Rome, Italy
| | - Luisa Maria Migneco
- Chemistry Department "S. Cannizzaro", University of Rome "La Sapienza", P.le Aldo Moro 5, 00185, Rome, Italy
| | - Marco Vitiello
- Angelini RR&D (Research, Regulatory & Development), Angelini S.p.A., Piazzale della stazione snc, 00071, S. Palomba-Pomezia (Rome), Italy
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