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Keller DA, Bassan A, Amberg A, Burns Naas LA, Chambers J, Cross K, Hall F, Jahnke GD, Luniwal A, Manganelli S, Mestres J, Mihalchik-Burhans AL, Woolley D, Tice RR. In silico approaches in carcinogenicity hazard assessment: case study of pregabalin, a nongenotoxic mouse carcinogen. FRONTIERS IN TOXICOLOGY 2023; 5:1234498. [PMID: 38026843 PMCID: PMC10679394 DOI: 10.3389/ftox.2023.1234498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
In silico toxicology protocols are meant to support computationally-based assessments using principles that ensure that results can be generated, recorded, communicated, archived, and then evaluated in a uniform, consistent, and reproducible manner. We investigated the availability of in silico models to predict the carcinogenic potential of pregabalin using the ten key characteristics of carcinogens as a framework for organizing mechanistic studies. Pregabalin is a single-species carcinogen producing only one type of tumor, hemangiosarcomas in mice via a nongenotoxic mechanism. The overall goal of this exercise is to test the ability of in silico models to predict nongenotoxic carcinogenicity with pregabalin as a case study. The established mode of action (MOA) of pregabalin is triggered by tissue hypoxia, leading to oxidative stress (KC5), chronic inflammation (KC6), and increased cell proliferation (KC10) of endothelial cells. Of these KCs, in silico models are available only for selected endpoints in KC5, limiting the usefulness of computational tools in prediction of pregabalin carcinogenicity. KC1 (electrophilicity), KC2 (genotoxicity), and KC8 (receptor-mediated effects), for which predictive in silico models exist, do not play a role in this mode of action. Confidence in the overall assessments is considered to be medium to high for KCs 1, 2, 5, 6, 7 (immune system effects), 8, and 10 (cell proliferation), largely due to the high-quality experimental data. In order to move away from dependence on animal data, development of reliable in silico models for prediction of oxidative stress, chronic inflammation, immunosuppression, and cell proliferation will be critical for the ability to predict nongenotoxic compound carcinogenicity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jordi Mestres
- Chemotargets SL, Parc Científic de Barcelona, Barcelona, Spain
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Mestre VDF, Martins CCN, Brito LVD, Zeffa AC, Sestário CS, Salles MJS. Pregabalin alters reproductive performance in male mice and causes congenital anomalies in offspring. Reprod Fertil Dev 2023; 35:750-759. [PMID: 37995339 DOI: 10.1071/rd22287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 10/31/2023] [Indexed: 11/25/2023] Open
Abstract
CONTEXT Pregabalin is an anticonvulsant drug with analgesic activity for the treatment of neuropathic pain. AIMS To valuate the toxicity of pregabalin in reproductive parameters, spermatogenesis, and teratogenicity in the offspring of mice. METHODS Twenty male mice were randomly distributed into two groups: PGB group and group C (n =10 per group). The animals in the PGB group received, via gavage, 200mg/kg of pregabalin diluted in distilled water daily, for a period of 45days. Group C received distilled water under the same experimental design. KEY RESULTS In the paternal parameters of the PGB group, there was a significant increase in the size of the testicles, morphological alterations in the spermatozoa, a decrease in the Johnsen score, an increase in the Leydig cells, and a decrease in the serum level of testosterone. In the intrauterine development parameters of females mated with males from the PGB group, a significant decrease in placental weight, weight and length of fetuses, and fetal viability rate was observed. There was a significant increase in the number of resorptions and post-implantation losses. The significant anomalies observed in the offspring were alteration in the size of the kidneys, absent metacarpals and phalanges, alteration in the sternum, and supernumerary thoracic vertebrae. CONCLUSION Results suggest that pregabalin had toxic effects on the reproductive function of male mice and teratogenic potential. IMPLICATIONS The findings of this study may provide new hypotheses, taking into account the risk-benefit ratio for male reproduction and offspring health.
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Affiliation(s)
- Viviane de Fátima Mestre
- Graduate Program in Health Sciences, State University of Londrina, Londrina, Paraná, Brazil; and Department of General Biology, Center for Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Caio Cezar Nantes Martins
- Department of General Biology, Center for Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Lorrany Victor de Brito
- Department of General Biology, Center for Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Aline Campos Zeffa
- Graduate Program in Health Sciences, State University of Londrina, Londrina, Paraná, Brazil; and Department of General Biology, Center for Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Camila Salvador Sestário
- Graduate Program in Health Sciences, State University of Londrina, Londrina, Paraná, Brazil; and Department of General Biology, Center for Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Maria José Sparça Salles
- Department of General Biology, Center for Biological Sciences, State University of Londrina, Londrina, Brazil
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Ismail OI, Shaltout ES, Abdellah NZ, Hetta DF, Abd El-Ghani WMA, Abdelzaher LA, Mahmoud AMM, Hasan AM, Rashed NA, Ebrahem NE. The teratogenic effect of pregabalin on heart, liver and kidney in rats: a light microscopic, electron microscopic and immunohistochemical study. BMC Pharmacol Toxicol 2022; 23:4. [PMID: 34986900 PMCID: PMC8734350 DOI: 10.1186/s40360-021-00546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregabalin (PGB) was approved as new anti-epileptic drugs with little information about its teratogenic effect. AIM OF THE WORK to evaluate the developmental toxicity of PGB. MATERIALS AND METHODS 60 pregnant albino rats were divided into three groups. PGB (500 mg/kg body weight/day) was given to group II, PGB (1250 mg/kg body weight/day) was given to Group III and no medications were given to group I. The pups were normally delivered. Liver, kidney and heart specimens were prepared for histological, immunohistochemical, and morphometric studies. RESULTS A dose of 500 mg of PGB had minimal toxic effects in the form of mild collagen deposition and moderate positive caspase-3 immunoexpression. PGB dose of 1250 mg/kg induced gross toxic effects in form of degenerated cardiac myofibres, ruptured blood vessels, vacuolations in the renal cortex, fibrosis and strong positive caspase-3 immunoexpression. CONCLUSION PGB at dose of 500 mg/kg revealed minimal toxic changes. PGB cause embryotoxicity in a dose-dependent manner, as the higher dose induced more degenerative changes.
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Affiliation(s)
- Omnia I. Ismail
- Department of Human Anatomy and Embryology, Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Eman S. Shaltout
- Department of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Nora Z. Abdellah
- Department of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Diab F. Hetta
- Department of Anesthesia and Pain Management, South East Institute, Assiut University, Assiut, 71515 Egypt
| | | | - Lobna A. Abdelzaher
- Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | | | - Asmaa M. Hasan
- Department of Neuropsychiatry, Assiut University hospital, Assiut, 71515 Egypt
| | - Noha A. Rashed
- Department of Human Anatomy and Embryology, Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Noha Esmael Ebrahem
- Department of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
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Shokry DA, El Nabrawy N, Yassa HD, Gaber SS, Batiha GES, Welson NN. Pregabalin induced reproductive toxicity and body weight changes by affecting caspase3 and leptin expression: Protective role of wheat germ oil. Life Sci 2020; 260:118344. [PMID: 32853651 DOI: 10.1016/j.lfs.2020.118344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/06/2020] [Accepted: 08/22/2020] [Indexed: 01/23/2023]
Abstract
Pregabalin (PGB) drug abuse is common among the youth. It substituted tramadol before its recent schedule as a controlled drug since April 2019. PGB is an antiepileptic drug acting on the central nervous system. It blocks calcium channels regulating the action of neurotransmitters and causing prolonged depolarization. The present study aimed to investigate the toxic effect of long term pregabalin abuse on the reproductive function and body weight in both male and female albino rats and to evaluate the ameliorative effect of wheat germ oil (WGO). Forty-eight rats were randomly divided into eight groups. The first four groups were males and they were treated as follows: control group (1.5 mL saline), WGO group (1.5 mL L/kg), PGB group (300 mg/kg), and protective group (PGB + WGO). All doses were administrated once per day for 60 days by gastric gavage. The second four groups were females. They were divided and treated the same as the male groups. Pregabalin caused significant weight loss, decreased serum triglyceride level, and increased leptin gene expression in all rats. PGB affected male rats reproduction by decreasing total testosterone serum level and inhibiting spermatogenesis. Reproductive toxicity in females was caused by decreasing pituitary steroids, increasing gonadal hormones, and increasing the number of atretic ovarian follicles. Mechanism of toxicity may be attributed to the PGB oxidative stress effect that induced apoptosis and caused diffuse gonadal atrophy. WGO showed a protective effect on PGB induced toxicity as all measured parameters were relatively improved.
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Affiliation(s)
- Dina A Shokry
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Cairo University, Egypt
| | - Naglaa El Nabrawy
- National Research Center, Faculty of Medicine, Cairo University, Egypt
| | - Hanan D Yassa
- Anatomy and Embryology Department, Faculty of Medicine, Beni-Suef University, Egypt
| | - Shereen S Gaber
- Biochemistry Department, Faculty of Medicine, Minia University, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Egypt
| | - Nermeen N Welson
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Beni-Suef University, Egypt.
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Shahabadi N, Amiri S, Taherpour A(A. Human serum albumin binding studies of a new platinum(IV) complex containing the drug pregabalin: experimental and computational methods. J COORD CHEM 2019. [DOI: 10.1080/00958972.2019.1568419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Nahid Shahabadi
- Department of Chemistry, Faculty of Science, Razi University, Kermanshah, Iran
- Medical Biology Research Center (MBRC), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sara Amiri
- Department of Chemistry, Faculty of Science, Razi University, Kermanshah, Iran
| | - Avat (Arman) Taherpour
- Medical Biology Research Center (MBRC), Kermanshah University of Medical Sciences, Kermanshah, Iran
- Organic Chemistry Department, Chemistry Faculty, Razi University, Kermanshah, Iran
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Induction of hemangiosarcoma in mice after chronic treatment with S1P-modulator siponimod and its lack of relevance to rat and human. Arch Toxicol 2018; 92:1877-1891. [PMID: 29556671 PMCID: PMC5962627 DOI: 10.1007/s00204-018-2189-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/13/2018] [Indexed: 11/30/2022]
Abstract
A high incidence of hemangiosarcoma (HSA) was observed in mice treated for 2 years with siponimod, a sphingosine-1-phosphate receptor 1 (S1P1) functional antagonist, while no such tumors were observed in rats under the same treatment conditions. In 3-month rat (90 mg/kg/day) and 9-month mouse (25 and 75 mg/kg/day) in vivo mechanistic studies, vascular endothelial cell (VEC) activation was observed in both species, but VEC proliferation and persistent increases in circulating placental growth factor 2 (PLGF2) were only seen in the mouse. In mice, these effects were sustained over the 9-month study duration, while in rats increased mitotic gene expression was present at day 3 only and PLGF2 was induced only during the first week of treatment. In the mouse, the persistent VEC activation, mitosis induction, and PLGF2 stimulation likely led to sustained neo-angiogenesis which over life-long treatment may result in HSA formation. In rats, despite sustained VEC activation, the transient mitotic and PLGF2 stimuli did not result in the formation of HSA. In vitro, the mouse and rat primary endothelial cell cultures mirrored their respective in vivo findings for cell proliferation and PLGF2 release. Human VECs, like rat cells, were unresponsive to siponimod treatment with no proliferative response and no release of PLGF2 at all tested concentrations. Hence, it is suggested that the human cells also reproduce a lack of in vivo response to siponimod. In conclusion, the molecular mechanisms leading to siponimod-induced HSA in mice are considered species specific and likely irrelevant to humans.
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Cook JC, Obert LA, Koza-Taylor P, Coskran TM, Opsahl AC, Ziemek D, Roy M, Qian J, Lawton MP, Criswell KA. From the Cover: Fenretinide, Troglitazone, and Elmiron Add to Weight of Evidence Support for Hemangiosarcoma Mode-of-Action From Studies in Mice. Toxicol Sci 2017; 161:58-75. [DOI: 10.1093/toxsci/kfx195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wegner CD, Goodwin A, Cook JC, Allamneni K, Sohn J, McVean M. Why Do Promising Therapies Stall in Development and How Can We Move Them Forward? Int J Toxicol 2017; 36:340-349. [PMID: 28578602 DOI: 10.1177/1091581817709773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are many reasons that molecules fail to progress to market and various principles of risk-benefit decisions that can help drive the molecule through development. This symposium included discussions on global strategies involved in pushing promising molecules to market, what to do when a molecule stalls in its progress to market, and options for rescuing the molecule and pushing it forward again. Innovative partnerships that bring stalled drugs back into clinical development were also addressed. A regulatory perspective on common reasons for a molecule to fail in its forward progress was presented. In addition, situations arise when a third-party advisory committee can provide input to help overcome issues identified by a regulatory agency. Using examples from the private and public domain, presentations centered on how to repurpose a molecule and when more science is needed.
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Affiliation(s)
- Craig D Wegner
- 1 AstraZeneca Pharmaceuticals, IMED Biotech Unit, Waltham, MA, USA
| | - Andrew Goodwin
- 2 US Food and Drug Administration, Silver Spring, MD, USA
| | - Jon C Cook
- 3 Pfizer Worldwide Research and Development, Groton, CT, USA
| | | | - Jane Sohn
- 2 US Food and Drug Administration, Silver Spring, MD, USA
| | - Maralee McVean
- 5 PreClinical Research Services, Inc, Fort Collins, CO, USA
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Coelho VR, Sousa K, Pires TR, Papke DKM, Vieira CG, de Souza LP, Leal MB, Schunck RVA, Picada JN, Pereira P. Genotoxic and mutagenic effects of vigabatrin, a γ-aminobutyric acid transaminase inhibitor, in Wistar rats submitted to rotarod task. Hum Exp Toxicol 2016; 35:958-65. [DOI: 10.1177/0960327115611970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vigabatrin (VGB) is an antiepileptic drug thatincreases brain γ-aminobutyric acid (GABA) levels through irreversible inhibition of GABA transaminase. The aim of this study was to evaluate neurotoxicological effects of VGB measuring motor activity and genotoxic and mutagenic effects after a single and repeated administration. Male Wistar rats received saline, VGB 50, 100, or 250 mg/kg by gavage for acute and subchronic (14 days) treatments and evaluated in the rotarod task. Genotoxicity was evaluated using the alkaline version of the comet assay in samples of blood, liver, hippocampus, and brain cortex after both treatments. Mutagenicity was evaluated using the micronucleus test in bone marrow of the same animals that received subchronic treatment. The groups treated with VGB showed similar performance in rotarod compared with the saline group. Regarding the acute treatment, it was observed that only higher VGB doses induced DNA damage in blood and hippocampus. After the subchronic treatment, VGB did not show genotoxic or mutagenic effects. In brief, VGB did not impair motor activities in rats after acute and subchronic treatments. It showed a repairable genotoxic potential in the central nervous system since genotoxicity was observed in the acute treatment group.
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Affiliation(s)
- VR Coelho
- Laboratory of Neuropharmacology and Preclinical Toxicology, Department of Pharmacology, Institute of Basic Health Sciences, Federal University of Rio Grande doSul, Porto Alegre, Brazil
| | - K Sousa
- Laboratory of Genetic Toxicology, Lutheran University of Brazil, Canoas, Brazil
| | - TR Pires
- Laboratory of Genetic Toxicology, Lutheran University of Brazil, Canoas, Brazil
| | - DKM Papke
- Laboratory of Genetic Toxicology, Lutheran University of Brazil, Canoas, Brazil
| | - CG Vieira
- Laboratory of Neuropharmacology and Preclinical Toxicology, Department of Pharmacology, Institute of Basic Health Sciences, Federal University of Rio Grande doSul, Porto Alegre, Brazil
| | - LP de Souza
- Laboratory of Neuropharmacology and Preclinical Toxicology, Department of Pharmacology, Institute of Basic Health Sciences, Federal University of Rio Grande doSul, Porto Alegre, Brazil
| | - MB Leal
- Laboratory of Pharmacology and Toxicology of Natural Products, Department of Pharmacology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - RVA Schunck
- Laboratory of Pharmacology and Toxicology of Natural Products, Department of Pharmacology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - JN Picada
- Laboratory of Genetic Toxicology, Lutheran University of Brazil, Canoas, Brazil
| | - P Pereira
- Laboratory of Neuropharmacology and Preclinical Toxicology, Department of Pharmacology, Institute of Basic Health Sciences, Federal University of Rio Grande doSul, Porto Alegre, Brazil
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Verma V, Singh N, Singh Jaggi A. Pregabalin in neuropathic pain: evidences and possible mechanisms. Curr Neuropharmacol 2014; 12:44-56. [PMID: 24533015 PMCID: PMC3915349 DOI: 10.2174/1570159x1201140117162802] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/02/2013] [Accepted: 09/25/2013] [Indexed: 12/13/2022] Open
Abstract
Pregabalin is an antagonist of voltage gated Ca2+ channels and specifically binds to alpha-2-delta subunit to produce antiepileptic and analgesic actions. It successfully alleviates the symptoms of various types of neuropathic pain and presents itself as a first line therapeutic agent with remarkable safety and efficacy. Preclinical studies in various animal models of neuropathic pain have shown its effectiveness in treating the symptoms like allodynia and hyperalgesia. Clinical studies in different age groups and in different types of neuropathic pain (peripheral diabetic neuropathy, fibromyalgia, post-herpetic neuralgia, cancer chemotherapy-induced neuropathic pain) have projected it as the most effective agent either as monotherapy or in combined regimens in terms of cost effectiveness, tolerability and overall improvement in neuropathic pain states. Preclinical studies employing pregabalin in different neuropathic pain models have explored various molecular targets and the signaling systems including Ca2+ channel-mediated neurotransmitter release, activation of excitatory amino acid transporters (EAATs), potassium channels and inhibition of pathways involving inflammatory mediators. The present review summarizes the important aspects of pregabalin as analgesic in preclinical and clinical studies as well as focuses on the possible mechanisms.
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Affiliation(s)
- Vivek Verma
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala-147002, India
| | - Nirmal Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala-147002, India
| | - Amteshwar Singh Jaggi
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala-147002, India
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Lee SK, Dawson J, Lee JA, Osman G, Levitin MO, Guzel RM, Djamgoz MB. Management of cancer pain: 1. Wider implications of orthodox analgesics. Int J Gen Med 2014; 7:49-58. [PMID: 24470767 PMCID: PMC3891517 DOI: 10.2147/ijgm.s42187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In this review, the first of two parts, we first provide an overview of the orthodox analgesics used commonly against cancer pain. Then, we examine in more detail the emerging evidence for the potential impact of analgesic use on cancer risk and disease progression. Increasing findings suggest that long-term use of nonsteroidal anti-inflammatory drugs, particularly aspirin, may reduce cancer occurrence. However, acetaminophen may raise the risk of some hematological malignancies. Drugs acting upon receptors of gamma-aminobutyric acid (GABA) and GABA “mimetics” (eg, gabapentin) appear generally safe for cancer patients, but there is some evidence of potential carcinogenicity. Some barbiturates appear to slightly raise cancer risks and can affect cancer cell behavior in vitro. For cannabis, studies suggest an increased risk of squamous cell carcinoma of the tongue, larynx, and possibly lung. Morphine may stimulate human microvascular endothelial cell proliferation and angiogenesis; it is not clear whether this might cause harm or produce benefit. The opioid, fentanyl, may promote growth in some tumor cell lines. Opium itself is an emerging risk factor for gastric adenocarcinoma and possibly cancers of the esophagus, bladder, larynx, and lung. It is concluded that analgesics currently prescribed for cancer pain can significantly affect the cancer process itself. More futuristically, several ion channels are being targeted with novel analgesics, but many of these are also involved in primary and/or secondary tumorigenesis. Further studies are needed to elucidate possible cellular and molecular effects of orthodox analgesics and their possible long-term impact, both positive and negative, and thus enable the best possible clinical gain for cancer patients.
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Affiliation(s)
| | - Jill Dawson
- Healthcare Communications Consultancy, Danville, CA, USA
| | - Jack A Lee
- College of Arts and Sciences, Vanderbilt University, Nashville, TN, USA
| | - Gizem Osman
- Department of Chemical Engineering, Loughborough University, Loughborough, UK
| | - Maria O Levitin
- Division of Cell and Molecular Biology, Neuroscience Solutions to Cancer Research Group, South Kensington Campus, Imperial College London, London, UK
| | - Refika Mine Guzel
- Division of Cell and Molecular Biology, Neuroscience Solutions to Cancer Research Group, South Kensington Campus, Imperial College London, London, UK
| | - Mustafa Ba Djamgoz
- Division of Cell and Molecular Biology, Neuroscience Solutions to Cancer Research Group, South Kensington Campus, Imperial College London, London, UK ; Cyprus International University, Biotechnology Research Centre, Haspolat, North Cyprus, Mersin, Turkey
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Baldwin DS, Ajel K, Masdrakis VG, Nowak M, Rafiq R. Pregabalin for the treatment of generalized anxiety disorder: an update. Neuropsychiatr Dis Treat 2013; 9:883-92. [PMID: 23836974 PMCID: PMC3699256 DOI: 10.2147/ndt.s36453] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A PREVIOUS REVIEW SUMMARIZED WHAT WAS THEN KNOWN ABOUT THE POTENTIAL ROLE OF PREGABALIN IN THE TREATMENT OF PATIENTS WITH GENERALIZED ANXIETY DISORDER (GAD): this review provides an update on its pharmacological properties and presumed mechanism of action, the liability for abuse, and efficacy and tolerability in patients with GAD. Pregabalin has a similar molecular structure to the inhibitory neurotransmitter gamma amino butyric acid (GABA) but its mechanism of action does not appear to be mediated through effects on GABA. Instead, its anxiolytic effects may arise through high-affinity binding to the alpha-2-delta sub-unit of the P/Q type voltage-gated calcium channel in "over-excited" presynaptic neurons, thereby reducing the release of excitatory neurotransmitters such as glutamate. The findings of randomized controlled trials and meta-analyses together indicate that pregabalin is efficacious in both acute treatment and relapse prevention in GAD, with some evidence of an early onset of effect, and broad efficacy in reducing the severity of psychological and physical symptoms of anxiety. It also has efficacy as an augmenting agent after non-response to antidepressant treatment in GAD. Continuing vigilance is needed in assessing its potential abuse liability but the tolerability profile of pregabalin may confer some advantages over other pharmacological treatments in the short term for treatment in patients with GAD.
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Affiliation(s)
- David S Baldwin
- Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Khalil Ajel
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Vasilios G Masdrakis
- First Department of Psychiatry, Eginition Hospital, Athens University Medical School, Athens, Greece
| | - Magda Nowak
- Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rizwan Rafiq
- Southern Health NHS Foundation Trust, Southampton, UK
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Criswell KA, Wojcinski Z, Pegg D, Albassam M, Duddy S, Olsen E, Bailie M, Foote S, Anderson T. Key components of the mode of action for hemangiosarcoma induction in pregabalin-treated mice: evidence of increased bicarbonate, dysregulated erythropoiesis, macrophage activation, and increased angiogenic growth factors in mice but not in rats. Toxicol Sci 2012; 128:22-41. [PMID: 22539625 DOI: 10.1093/toxsci/kfs147] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In carcinogenicity studies, pregabalin increased hemangiosarcoma incidence in mice but not in rats. Investigative studies, ranging in length from 24 h to 12 months, were conducted in mice (1000 or 5000 mg/kg) and rats (900 mg/kg) to evaluate a potential mode-of-action scheme for tumor formation. Three areas were evaluated: (1) hematopoiesis (because endothelial and hematopoietic cells arise from the same precursor and hemangiosarcomas are primarily located in mouse hematopoietic tissues), (2) angiogenic growth factors (because increased angiogenic growth factors may stimulate vascular tumors), and (3) pulmonary/blood gas parameters (because hypoxia is a known driver for endothelial cell proliferation). In mice, pregabalin rapidly increased platelet and megakaryocyte counts, activated platelets and bone marrow erythrophages, decreased the myeloid-to-erythroid (M:E) ratio (49%), and produced bone marrow and splenic congestion and extramedullary hematopoiesis (EMH). Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor immunohistochemical staining were also increased in mouse bone marrow and spleen and vascular endothelial growth factor receptor 2 immunolabeling was increased in liver. Serum bicarbonate was increased within 24 h of pregabalin administration, persisted over time, and was accompanied by decreased respiratory rate (up to 34%) and increased partial pressure of carbon dioxide (pCO(2)), resulting in sustained metabolic alkalosis and elevated blood pH in mice. In contrast, in rats, pregabalin decreased overall bone marrow cellularity, including decreased number of megakaryocytes (24%) with no evidence of erythrophages, no change in M:E ratio, no EMH, and no increase in angiogenic growth factors or blood pH. Persistent alterations in serum bicarbonate, respiratory function, and blood gas parameters in mice, without adequate compensatory mechanisms, has the potential to create chronic tissue hypoxia, an accepted driver of endothelial cell proliferation.
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Affiliation(s)
- Kay A Criswell
- Pfizer Worldwide Research and Development, Drug Safety Research and Development, Groton, Connecticut 06340, USA.
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Criswell KA, Cook JC, Morse D, Lawton M, Somps C, Obert L, Roy M, Sokolowski S, Koza-Taylor P, Colangelo J, Navetta K, Brady J, Pegg D, Wojcinski Z, Rahbari R, Duddy S, Anderson T. Pregabalin Induces Hepatic Hypoxia and Increases EndothelialCell Proliferation in Mice, a Process Inhibited by DietaryVitamin E Supplementation. Toxicol Sci 2012; 128:42-56. [DOI: 10.1093/toxsci/kfs148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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