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Chen X, Zhou YN, Lu XZ, Li RJ, Xiong YF, Sheng X, Zhu WW. Cognitive dysfunction in schizophrenia patients caused by down-regulation of γ-aminobutyric acid receptor subunits. World J Psychiatry 2024; 14:784-793. [PMID: 38984326 PMCID: PMC11230097 DOI: 10.5498/wjp.v14.i6.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND The expression pattern of gamma aminobutyric acid (GABA) receptor subunits are commonly altered in patients with schizophrenia, which may lead to nerve excitation/inhibition problems, affecting cognition, emotion, and behavior. AIM To explore GABA receptor expression and its relationship with schizophrenia and to provide insights into more effective treatments. METHODS This case-control study enrolled 126 patients with schizophrenia treated at our hospital and 126 healthy volunteers who underwent physical examinations at our hospital during the same period. The expression levels of the GABA receptor subunits were detected using 1H-magnetic resonance spectroscopy. The recognized cognitive battery tool, the MATRICS Consensus Cognitive Battery, was used to evaluate the scores for various dimensions of cognitive function. The correlation between GABA receptor subunit downregulation and schizophrenia was also analyzed. RESULTS Significant differences in GABA receptor subunit levels were found between the case and control groups (P < 0.05). A significant difference was also found between the case and control groups in terms of cognitive function measures, including attention/alertness and learning ability (P < 0.05). Specifically, as the expression levels of GABRA1 (α1 subunit gene), GABRB2 (β2 subunit gene), GABRD (δ subunit), and GABRE (ε subunit) decreased, the severity of the patients' condition increased gradually, indicating a positive correlation between the downregulation of these 4 receptor subunits and schizophrenia (P < 0.05). However, the expression levels of GABRA5 (α5 subunit gene) and GABRA6 (α6 subunit gene) showed no significant correlation with schizophrenia (P > 0.05). CONCLUSION Downregulation of the GABA receptor subunits is positively correlated with schizophrenia. In other words, when GABA receptor subunits are downregulated in patients, cognitive impairment becomes more severe.
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Affiliation(s)
- Xi Chen
- Department of Child and Adolescent Psychiatric, Brain Hospital of Hunan Province, The Second People’s Hospital of Hunan Province, Changsha 410007, Hunan Province, China
| | - Ya-Nan Zhou
- Department of Child and Adolescent Psychiatric, Brain Hospital of Hunan Province, The Second People’s Hospital of Hunan Province, Changsha 410007, Hunan Province, China
| | - Xiao-Zi Lu
- Department of Psychiatry, Qingdao Mental Health Center, Qingdao 266034, Shandong Province, China
| | - Ren-Jiao Li
- Department of Child and Adolescent Psychiatric, Brain Hospital of Hunan Province, The Second People’s Hospital of Hunan Province, Changsha 410007, Hunan Province, China
| | - Yi-Fan Xiong
- Department of Psychiatry, Brain Hospital of Hunan Province, The Second People’s Hospital of Hunan Province, Changsha 410007, Hunan Province, China
| | - Xia Sheng
- Department of Child and Adolescent Psychiatric, Brain Hospital of Hunan Province, The Second People’s Hospital of Hunan Province, Changsha 410007, Hunan Province, China
| | - Wei-Wei Zhu
- Department of Sleep Disorders and Neurosis, Brain Hospital of Hunan Province, The Second People’s Hospital of Hunan Province, Changsha 410007, Hunan Province, China
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2
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Daher F, Villalobos NA, Hanley M, Atack JR, Popa MO, Fogaça MV. Basmisanil, an α5-GABA AR negative allosteric modulator, produces rapid and sustained antidepressant-like responses in male mice. Neurosci Lett 2024; 833:137828. [PMID: 38772437 PMCID: PMC11146097 DOI: 10.1016/j.neulet.2024.137828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 05/23/2024]
Abstract
There is a critical need for safer and better-tolerated alternatives to address the current limitations of antidepressant treatments for major depressive disorder. Recently, drugs targeting the GABA system via α5-containing GABAA receptors (α5-GABAAR) as negative allosteric modulators (α5-NAMs) have shown promise in alleviating stress-related behaviors in preclinical studies, suggesting that α5-NAMs may have translational relevance as novel antidepressant medications. Here, we evaluated the efficacy of Basmisanil, an α5-NAM that has been evaluated in Phase 2 clinical studies as a cognitive enhancer, in a battery of behavioral tests relevant to coping strategies, motivation, and aversion in male mice, along with plasma and brain pharmacokinetic measurements. Our findings reveal that Basmisanil induces dose-dependent rapid antidepressant-like responses in the forced swim test and sucrose splash test without promoting locomotor stimulating effects. Furthermore, Basmisanil elicits sustained behavioral responses in the female urine sniffing test and sucrose splash test, observed 24 h and 48 h post-treatment, respectively. Bioanalysis of plasma and brain samples confirms effective blood-brain barrier penetration by Basmisanil and extrapolation to previously published data suggest that effects were observed at doses (10 and 30 mg/kg i.p.) corresponding to relatively modest levels of α5-GABAAR occupancy (40-65 %). These results suggest that Basmisanil exhibits a combination of rapid and sustained antidepressant-like effects highlighting the potential of α5-NAMs as a novel therapeutic strategy for depression.
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Affiliation(s)
- Fernanda Daher
- Department of Pharmacology and Physiology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Narcy A Villalobos
- Medicines Discovery Institute, Cardiff University, Park Place, CF10 3AT, Cardiff, Wales, United Kingdom
| | - Marcus Hanley
- Medicines Discovery Institute, Cardiff University, Park Place, CF10 3AT, Cardiff, Wales, United Kingdom
| | - John R Atack
- Medicines Discovery Institute, Cardiff University, Park Place, CF10 3AT, Cardiff, Wales, United Kingdom
| | - Mariana O Popa
- Medicines Discovery Institute, Cardiff University, Park Place, CF10 3AT, Cardiff, Wales, United Kingdom
| | - Manoela V Fogaça
- Department of Pharmacology and Physiology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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3
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Thompson SM. Modulators of GABA A receptor-mediated inhibition in the treatment of neuropsychiatric disorders: past, present, and future. Neuropsychopharmacology 2024; 49:83-95. [PMID: 37709943 PMCID: PMC10700661 DOI: 10.1038/s41386-023-01728-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/14/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023]
Abstract
The predominant inhibitory neurotransmitter in the brain, γ-aminobutyric acid (GABA), acts at ionotropic GABAA receptors to counterbalance excitation and regulate neuronal firing. GABAA receptors are heteropentameric channels comprised from subunits derived from 19 different genes. GABAA receptors have one of the richest and well-developed pharmacologies of any therapeutic drug target, including agonists, antagonists, and positive and negative allosteric modulators (PAMs, NAMs). Currently used PAMs include benzodiazepine sedatives and anxiolytics, barbiturates, endogenous and synthetic neurosteroids, and general anesthetics. In this article, I will review evidence that these drugs act at several distinct binding sites and how they can be used to alter the balance between excitation and inhibition. I will also summarize existing literature regarding (1) evidence that changes in GABAergic inhibition play a causative role in major depression, anxiety, postpartum depression, premenstrual dysphoric disorder, and schizophrenia and (2) whether and how GABAergic drugs exert beneficial effects in these conditions, focusing on human studies where possible. Where these classical therapeutics have failed to exert benefits, I will describe recent advances in clinical and preclinical drug development. I will also highlight opportunities to advance a generation of GABAergic therapeutics, such as development of subunit-selective PAMs and NAMs, that are engendering hope for novel tools to treat these devastating conditions.
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Affiliation(s)
- Scott M Thompson
- Center for Novel Therapeutics, Department of Psychiatry, University of Colorado School of Medicine, 12700 E. 19th Ave., Aurora, CO, 80045, USA.
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4
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Potter SN, Reynolds E, Okoniewski KC, Edwards A, Gable J, Hill C, Bakalov V, Zentz S, Whiting C, Cheves E, Garbarini K, Jalazo E, Howell C, Moore A, Wheeler A. Linking Angelman and dup15q data for expanded research (LADDER) database: a model for advancing research, clinical guidance, and therapeutic development for rare conditions. THERAPEUTIC ADVANCES IN RARE DISEASE 2024; 5:26330040241254122. [PMID: 38808315 PMCID: PMC11131393 DOI: 10.1177/26330040241254122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/18/2024] [Indexed: 05/30/2024]
Abstract
Angelman syndrome (AS) and duplication 15q (dup15q) syndrome are rare neurogenetic conditions arising from a common locus on the long arm of chromosome 15. Individuals with both conditions share some clinical features (e.g. intellectual disability, epilepsy) and often require lifelong care. Disease-modifying therapies for both conditions are emerging, resulting in a significant need for a better understanding of the natural history of both AS and dup15q. Patient advocacy groups for both conditions recognized a need for a data repository that would link data on individuals from multiple sources to expand research, increase understanding of natural history, and accelerate the development of treatments, resulting in the Linking Angelman and Dup15q Data for Expanded Research (LADDER) Database. This paper describes the development and functionality of the LADDER Database - including challenges, lessons learned, and preliminary feasibility - and how it can be used as a model for other rare conditions.
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Affiliation(s)
- Sarah Nelson Potter
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709-2194, USA
| | | | | | - Anne Edwards
- RTI International, Research Triangle Park, NC, USA
| | - Julia Gable
- RTI International, Research Triangle Park, NC, USA
| | | | | | | | | | - Emily Cheves
- RTI International, Research Triangle Park, NC, USA
| | - Katie Garbarini
- Angelman Syndrome Foundation, Aurora, IL, USA
- Dup15q Alliance, Matthews, NC, USA
| | - Elizabeth Jalazo
- Department of Pediatrics, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | | | - Anne Wheeler
- RTI International, Research Triangle Park, NC, USA
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5
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Kasaragod VB, Malinauskas T, Wahid AA, Lengyel J, Knoflach F, Hardwick SW, Jones CF, Chen WN, Lucas X, El Omari K, Chirgadze DY, Aricescu AR, Cecere G, Hernandez MC, Miller PS. The molecular basis of drug selectivity for α5 subunit-containing GABA A receptors. Nat Struct Mol Biol 2023; 30:1936-1946. [PMID: 37903907 PMCID: PMC10716045 DOI: 10.1038/s41594-023-01133-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/20/2023] [Indexed: 11/01/2023]
Abstract
α5 subunit-containing γ-aminobutyric acid type A (GABAA) receptors represent a promising drug target for neurological and neuropsychiatric disorders. Altered expression and function contributes to neurodevelopmental disorders such as Dup15q and Angelman syndromes, developmental epilepsy and autism. Effective drug action without side effects is dependent on both α5-subtype selectivity and the strength of the positive or negative allosteric modulation (PAM or NAM). Here we solve structures of drugs bound to the α5 subunit. These define the molecular basis of binding and α5 selectivity of the β-carboline, methyl 6,7-dimethoxy-4-ethyl-β-carboline-3-carboxylate (DMCM), type II benzodiazepine NAMs, and a series of isoxazole NAMs and PAMs. For the isoxazole series, each molecule appears as an 'upper' and 'lower' moiety in the pocket. Structural data and radioligand binding data reveal a positional displacement of the upper moiety containing the isoxazole between the NAMs and PAMs. Using a hybrid molecule we directly measure the functional contribution of the upper moiety to NAM versus PAM activity. Overall, these structures provide a framework by which to understand distinct modulator binding modes and their basis of α5-subtype selectivity, appreciate structure-activity relationships, and empower future structure-based drug design campaigns.
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Affiliation(s)
- Vikram Babu Kasaragod
- Department of Pharmacology, University of Cambridge, Cambridge, UK
- MRC Laboratory of Molecular Biology, Cambridge Biomedical Campus, Cambridge, UK
| | - Tomas Malinauskas
- Division of Structural Biology, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Ayla A Wahid
- Department of Pharmacology, University of Cambridge, Cambridge, UK
| | - Judith Lengyel
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center, Basel, Switzerland
| | - Frederic Knoflach
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center, Basel, Switzerland
| | - Steven W Hardwick
- CryoEM Facility, Department of Biochemistry, University of Cambridge, Cambridge, UK
| | | | - Wan-Na Chen
- Department of Pharmacology, University of Cambridge, Cambridge, UK
| | - Xavier Lucas
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center, Basel, Switzerland
| | - Kamel El Omari
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot, UK
| | - Dimitri Y Chirgadze
- CryoEM Facility, Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - A Radu Aricescu
- MRC Laboratory of Molecular Biology, Cambridge Biomedical Campus, Cambridge, UK
| | - Giuseppe Cecere
- Roche Pharma Research and Early Development, Therapeutic Modalities, Roche Innovation Center, Basel, Switzerland
| | - Maria-Clemencia Hernandez
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center, Basel, Switzerland.
| | - Paul S Miller
- Department of Pharmacology, University of Cambridge, Cambridge, UK.
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6
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Frohlich J, Mediano PAM, Bavato F, Gharabaghi A. Paradoxical pharmacological dissociations result from drugs that enhance delta oscillations but preserve consciousness. Commun Biol 2023; 6:654. [PMID: 37340024 DOI: 10.1038/s42003-023-04988-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/26/2023] [Indexed: 06/22/2023] Open
Abstract
Low-frequency (<4 Hz) neural activity, particularly in the delta band, is generally indicative of loss of consciousness and cortical down states, particularly when it is diffuse and high amplitude. Remarkably, however, drug challenge studies of several diverse classes of pharmacological agents-including drugs which treat epilepsy, activate GABAB receptors, block acetylcholine receptors, or produce psychedelic effects-demonstrate neural activity resembling cortical down states even as the participants remain conscious. Of those substances that are safe to use in healthy volunteers, some may be highly valuable research tools for investigating which neural activity patterns are sufficient for consciousness or its absence.
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Affiliation(s)
- Joel Frohlich
- Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Tuebingen, Germany.
| | - Pedro A M Mediano
- Department of Computing, Imperial College London, London, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Francesco Bavato
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Tuebingen, Germany
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7
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Szabó G, Károlyi BI, Vaskó ÁG, Potor A, Vukics K, Kapus GL, Fodor L, Bobok A, Vastag M, Bata I. Identification of Triazolopyridines as Selective α5-GABA A Receptor Negative Allosteric Modulators by a Hybridization Approach. ACS Chem Neurosci 2023; 14:148-158. [PMID: 36524695 DOI: 10.1021/acschemneuro.2c00608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The identification and characterization of novel triazolopyridine derivatives with selective α5 subunit-containing GABAA receptor negative allosteric modulator (NAM) activity are disclosed. As a result of in silico screening of our corporate compound deck, we identified a moderately potent hit that was converted to an advanced hit bearing better physicochemical and pharmacological properties using a hybridization approach. Subsequent optimization led to the identification of in vitro potent and subtype-selective α5-GABAA receptor NAMs representing a new chemotype in this area.
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Affiliation(s)
- György Szabó
- Chemistry Division, Gedeon Richter Plc, P.O. Box 27, Budapest 10H-1475, Hungary
| | | | | | - Attila Potor
- Chemistry Division, Gedeon Richter Plc, P.O. Box 27, Budapest 10H-1475, Hungary
| | - Krisztina Vukics
- Chemistry Division, Gedeon Richter Plc, P.O. Box 27, Budapest 10H-1475, Hungary
| | - Gábor László Kapus
- Proprietary R&D Coordination Department, Gedeon Richter Plc, P.O. Box 27, Budapest 10H-1475, Hungary
| | - László Fodor
- Pharmacological & Drug Safety Research Department, Gedeon Richter Plc, P.O. Box 27, Budapest 10H-1475, Hungary
| | - Amrita Bobok
- Pharmacological & Drug Safety Research Department, Gedeon Richter Plc, P.O. Box 27, Budapest 10H-1475, Hungary
| | - Mónika Vastag
- Pharmacological & Drug Safety Research Department, Gedeon Richter Plc, P.O. Box 27, Budapest 10H-1475, Hungary
| | - Imre Bata
- Chemistry Division, Gedeon Richter Plc, P.O. Box 27, Budapest 10H-1475, Hungary
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8
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Troppoli TA, Zanos P, Georgiou P, Gould TD, Rudolph U, Thompson SM. Negative Allosteric Modulation of Gamma-Aminobutyric Acid A Receptors at α5 Subunit-Containing Benzodiazepine Sites Reverses Stress-Induced Anhedonia and Weakened Synaptic Function in Mice. Biol Psychiatry 2022; 92:216-226. [PMID: 35120711 PMCID: PMC9198111 DOI: 10.1016/j.biopsych.2021.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Abnormal reward processing, typically anhedonia, is a hallmark of human depression and is accompanied by altered functional connectivity in reward circuits. Negative allosteric modulators of GABAA (gamma-aminobutyric acid A) receptors (GABA-NAMs) have rapid antidepressant-like properties in rodents and exert few adverse effects, but molecular targets underlying their behavioral and synaptic effects remain undetermined. We hypothesized that GABA-NAMs act at the benzodiazepine site of GABAA receptors containing α5 subunits to increase gamma oscillatory activity, strengthen synapses in reward circuits, and reverse anhedonia. METHODS Anhedonia was induced by chronic stress in male mice and assayed by preferences for sucrose and female urine (n = 5-7 mice/group). Hippocampal slices were then prepared for electrophysiological recording (n = 1-6 slices/mouse, 4-6 mice/group). Electroencephalography power was quantified in response to GABA-NAM and ketamine administration (n = 7-9 mice/group). RESULTS Chronic stress reduced sucrose and female urine preferences and hippocampal temporoammonic-CA1 synaptic strength. A peripheral injection of the GABA-NAM MRK-016 restored hedonic behavior and AMPA-to-NMDA ratios in wild-type mice. These actions were prevented by pretreatment with the benzodiazepine site antagonist flumazenil. MRK-016 administration increased gamma power over the prefrontal cortex in wild-type mice but not α5 knockout mice, whereas ketamine promoted gamma power in both genotypes. Hedonic behavior and AMPA-to-NMDA ratios were only restored by MRK-016 in stressed wild-type mice but not α5 knockout mice. CONCLUSIONS α5-Selective GABA-NAMs exert rapid anti-anhedonic actions and restore the strength of synapses in reward regions by acting at the benzodiazepine site of α5-containing GABAA receptors. These results encourage human studies using GABA-NAMs to treat depression by providing readily translatable measures of target engagement.
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Affiliation(s)
- Timothy A. Troppoli
- Department of Physiology, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201,Molecular Medicine Program, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201
| | - Panos Zanos
- Department of Psychiatry, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201,Current address: Department of Psychology, University of Cyprus, 1 Panepistimiou Avenue, Aglantzia, 2109, PO Box 1678, Nicosia, Cyprus
| | - Polymnia Georgiou
- Department of Psychiatry, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201
| | - Todd D. Gould
- Department of Psychiatry, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201,Department of Anatomy & Neurobiology, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201,Department of Pharmacology, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201,Veterans Affairs Maryland Health Care System, Baltimore, MD, 21201
| | - Uwe Rudolph
- Department of Comparative Biosciences and Carl R. Woese Institute for Genomic Biology, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, 2001 S Lincoln Ave, Urbana, IL 61802-6178
| | - Scott M. Thompson
- Department of Physiology, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201,Department of Psychiatry, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201,To whom correspondence should be addressed:
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9
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Szabó G, Éliás O, Erdélyi P, Potor A, Túrós GI, Károlyi BI, Varró G, Vaskó ÁG, Bata I, Kapus GL, Dohányos Z, Bobok AÁ, Fodor L, Thán M, Vastag M, Komlódi Z, Soukupné Kedves RÉ, Makó É, Süveges B, Greiner I. Multiparameter Optimization of Naphthyridine Derivatives as Selective α5-GABA A Receptor Negative Allosteric Modulators. J Med Chem 2022; 65:7876-7895. [PMID: 35584373 DOI: 10.1021/acs.jmedchem.2c00414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The discovery and characterization of novel naphthyridine derivatives with selective α5-GABAAR negative allosteric modulator (NAM) activity are disclosed. Utilizing a scaffold-hopping strategy, fused [6 + 6] bicyclic scaffolds were designed and synthesized. Among these, 1,6-naphthyridinones were identified as potent and selective α5-GABAAR NAMs with metabolic stability, cardiac safety, and beneficial intellectual property (IP) issues. Relocation of the oxo acceptor function and subsequent modulation of the physicochemical properties resulted in novel 1,6-naphthyridines with improved profile, combining good potency, selectivity, ADME, and safety properties. Besides this, compound 20, having the most balanced profile, provided in vivo proof of concept (POC) for the new scaffold in two animal models of cognitive impairment associated with schizophrenia (CIAS).
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Affiliation(s)
- György Szabó
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - Olivér Éliás
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - Péter Erdélyi
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - Attila Potor
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - György I Túrós
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | | | - Gábor Varró
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - Ágnes Gy Vaskó
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - Imre Bata
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - Gábor L Kapus
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - Zoltán Dohányos
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - Amrita Á Bobok
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - László Fodor
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - Márta Thán
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - Mónika Vastag
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | - Zsolt Komlódi
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | | | - Éva Makó
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
| | | | - István Greiner
- Gedeon Richter Plc., 19-21. Gyömrői út, Budapest, 1103 Hungary
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10
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The Case for Clinical Trials with Novel GABAergic Drugs in Diabetes Mellitus and Obesity. Life (Basel) 2022; 12:life12020322. [PMID: 35207609 PMCID: PMC8876029 DOI: 10.3390/life12020322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
Obesity and diabetes mellitus have become the surprising menaces of relative economic well-being worldwide. Gamma amino butyric acid (GABA) has a prominent role in the control of blood glucose, energy homeostasis as well as food intake at several levels of regulation. The effects of GABA in the body are exerted through ionotropic GABAA and metabotropic GABAB receptors. This treatise will focus on the pharmacologic targeting of GABAA receptors to reap beneficial therapeutic effects in diabetes mellitus and obesity. A new crop of drugs selectively targeting GABAA receptors has been under investigation for efficacy in stroke recovery and cognitive deficits associated with schizophrenia. Although these trials have produced mixed outcomes the compounds are safe to use in humans. Preclinical evidence is summarized here to support the rationale of testing some of these compounds in diabetic patients receiving insulin in order to achieve better control of blood glucose levels and to combat the decline of cognitive performance. Potential therapeutic benefits could be achieved (i) By resetting the hypoglycemic counter-regulatory response; (ii) Through trophic actions on pancreatic islets, (iii) By the mobilization of antioxidant defence mechanisms in the brain. Furthermore, preclinical proof-of-concept work, as well as clinical trials that apply the novel GABAA compounds in eating disorders, e.g., olanzapine-induced weight-gain, also appear warranted.
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Goeldner C, Kishnani PS, Skotko BG, Casero JL, Hipp JF, Derks M, Hernandez MC, Khwaja O, Lennon-Chrimes S, Noeldeke J, Pellicer S, Squassante L, Visootsak J, Wandel C, Fontoura P, d’Ardhuy XL, De La Torre Fornell R, Glue P, Hoover-Fong J, Uhlmann S, Malagón Valdez J, Marshall A, Martinón-Torres F, Redondo-Collazo L, Rodriguez-Tenreiro C, Marquez Chin V, Michel Reynoso AG, Mitchell EA, Slykerman RF, Wouldes T, Loveday S, Moldenhauer F, Novell R, Ochoa C, Rafii MS, Rebillat AS, Sanlaville D, Sarda P, Shankar R, Pulsifer M, Evans CL, Silva AM, McDonough ME, Stanley M, McCary LM, Vicari S, Wilcox W, Zampino G, Zuddas A. A randomized, double-blind, placebo-controlled phase II trial to explore the effects of a GABAA-α5 NAM (basmisanil) on intellectual disability associated with Down syndrome. J Neurodev Disord 2022; 14:10. [PMID: 35123401 PMCID: PMC8903644 DOI: 10.1186/s11689-022-09418-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background There are currently no pharmacological therapies to address the intellectual disability associated with Down syndrome. Excitatory/inhibitory imbalance has been hypothesized to contribute to impairments in cognitive functioning in Down syndrome. Negative modulation of the GABAA-α5 receptor is proposed as a mechanism to attenuate GABAergic function and restore the excitatory/inhibitory balance. Methods Basmisanil, a selective GABAA-α5 negative allosteric modulator, was evaluated at 120 mg or 240 mg BID (80 or 160 mg for 12–13 years) in a 6-month, randomized, double-blind, placebo-controlled phase II trial (Clematis) for efficacy and safety in adolescents and young adults with Down syndrome. The primary endpoint was based on a composite analysis of working memory (Repeatable Battery for the Assessment of Neuropsychological Scale [RBANS]) and independent functioning and adaptive behavior (Vineland Adaptive Behavior Scales [VABS-II] or the Clinical Global Impression-Improvement [CGI-I]). Secondary measures included the Behavior Rating Inventory of Executive Functioning-Preschool (BRIEF-P), Clinical Evaluation of Language Fundamentals (CELF-4), and Pediatric Quality of Life Inventory (Peds-QL). EEG was conducted for safety monitoring and quantitatively analyzed in adolescents. Results Basmisanil was safe and well-tolerated; the frequency and nature of adverse events were similar in basmisanil and placebo arms. EEG revealed treatment-related changes in spectral power (increase in low ~ 4-Hz and decrease in high ~ 20-Hz frequencies) providing evidence of functional target engagement. All treatment arms had a similar proportion of participants showing above-threshold improvement on the primary composite endpoint, evaluating concomitant responses in cognition and independent functioning (29% in placebo, 20% in low dose, and 25% in high dose). Further analysis of the individual measures contributing to the primary endpoint revealed no difference between placebo and basmisanil-treated groups in either adolescents or adults. There were also no differences across the secondary endpoints assessing changes in executive function, language, or quality of life. Conclusions Basmisanil did not meet the primary efficacy objective of concomitant improvement on cognition and adaptive functioning after 6 months of treatment, despite evidence for target engagement. This study provides key learnings for future clinical trials in Down syndrome. Trial registration The study was registered on December 31, 2013, at clinicaltrials.gov as NCT02024789. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-022-09418-0.
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Nuwer JL, Brady ML, Povysheva NV, Coyne A, Jacob TC. Sustained treatment with an α5 GABA A receptor negative allosteric modulator delays excitatory circuit development while maintaining GABAergic neurotransmission. Neuropharmacology 2021; 197:108724. [PMID: 34284042 DOI: 10.1016/j.neuropharm.2021.108724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 01/02/2023]
Abstract
α5 subunit GABA type A receptor (GABAAR) preferring negative allosteric modulators (NAMs) are cognitive enhancers with antidepressant-like effects. α5-NAM success in treating mouse models of neurodevelopmental disorders with excessive inhibition have led to Phase 2 clinical trials for Down syndrome. Despite in vivo efficacy, no study has examined the effects of continued α5-NAM treatment on inhibitory and excitatory synapse plasticity to identify mechanisms of action. Here we used L-655,708, an imidazobenzodiazepine that acts as a highly selective but weak α5-NAM, to investigate the impact of sustained treatment on hippocampal neuron synapse and dendrite development. We show that 2-day pharmacological reduction of α5-GABAAR signaling from DIV12-14, when GABAARs contribute to depolarization, delays dendritic spine maturation and the NMDA receptor (NMDAR) GluN2B/GluN2A developmental shift. In contrast, α5-NAM treatment from DIV19-21, when hyperpolarizing GABAAR signaling predominates, enhances surface synaptic GluN2A while decreasing GluN2B. Despite changes in NMDAR subtype surface levels and localization, total levels of key excitatory synapse proteins were largely unchanged, and mEPSCs were unaltered. Importantly, 2-day α5-NAM treatment does not alter the total surface levels or distribution of α5-GABAARs, reduce the gephyrin inhibitory synaptic scaffold, or impair phasic or tonic inhibition. Furthermore, α5-NAM inhibition of the GABAAR tonic current in mature neurons is maintained after 2-day α5-NAM treatment, suggesting reduced tolerance liability, in contrast to other clinically relevant GABAAR-targeting drugs such as benzodiazepines. Together, these results show that α5-GABAARs contribute to dendritic spine maturation and excitatory synapse development via a NMDAR dependent mechanism without perturbing overall neuronal excitability.
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Affiliation(s)
- Jessica L Nuwer
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Megan L Brady
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nadya V Povysheva
- Department of Neuroscience and Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amanda Coyne
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tija C Jacob
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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