The place of partial agonism in psychiatry: recent developments

Ethosomes as a carrier for transdermal drug delivery system: methodology and recent developments

Transdermal drug delivery systems (TDDS) have received significant attention in recent years. TDDS are flexible systems that transport active components to the skin for either localized or systemic delivery of drugs through the skin. Among the three main layers of skin, the outermost layer, called the stratum corneum (SC), prevents the entry of water-loving bacteria and drugs with a high molecular weight. The challenge lies in successfully delivering drugs through the skin, which crosses the stratum corneum. The popularity of lipid-based vesicular delivery systems has increased in recent years due to their ability to deliver both hydrophilic and hydrophobic drugs. Ethosomes are specialized vesicles made of phospholipids that can store large amounts of ethanol. Ethosome structure and substance promote skin permeability and bioavailability. This article covers ethosome compositions, types, medication delivery techniques, stability, and safety. In addition to this, an in-depth analysis of the employment of ethosomes in drug delivery applications for a wide range of diseases has also been discussed. This review article highlights different aspects of ethosomes, such as their synthesis, characterization, marketed formulation, recent advancements in TDDS, and applications.

A highly D3R-selective and efficacious partial agonist (S)-ABS01-113 compared to its D3R-selective antagonist enantiomer (R)-ABS01-113 as potential treatments for opioid use disorder

The non-medical use of opioids has become a national crisis in the USA. Developing non-opioid pharmacotherapies for controlling this opioid epidemic is urgent. Dopamine D₃ receptor (D₃R) antagonists and low efficacy partial agonists have shown promising profiles in animal models of opioid use disorders (OUD). However, to date, advancement to human studies has been limited. Here we report the effects of (S)- and (R)-enantiomers of (±)-ABS01-113, structural analogs of the D₃R partial agonist, (±)-VK4-40, in which the 3-OH in the linking chain is replaced by 3-F group. (S)- and (R)-ABS01-113 are identical in chemical structure but with opposite chirality. In vitro receptor binding and functional assays indicate that (S)-ABS01-113 is an efficacious (55%) and potent (EC₅₀ = 7.6 ± 3.9 nM) D₃R partial agonist, while the (R)-enantiomer is a potent D₃R antagonist (IC₅₀ = 11.4 nM). Both (S)- and (R)-ABS01-113 bind with high affinity to D₃R (K_i = 0.84 ± 0.16 and 0.37 ± 0.06 nM, respectively); however, the (S)-enantiomer is more D₃/D₂-selective (>1000-fold). Pharmacokinetic analyses indicate that both enantiomers display excellent oral bioavailability and high brain penetration. Systemic administration of (S)- or (R)-ABS01-113 alone failed to alter open-field locomotion in male rats and mice. Interestingly, pretreatment with (S)- or (R)-ABS01-113 attenuated heroin-enhanced hyperactivity, heroin self-administration, and (heroin + cue)-induced reinstatement of drug-seeking behavior. Together, these findings reveal that both enantiomers, particularly the highly selective and efficacious D₃R partial agonist (S)-ABS01-113, demonstrate promising translational potential for the treatment of OUD.

Dosing Cariprazine Within and Beyond Clinical Trials: Recommendations for the Treatment of Schizophrenia

Although the optimal dosing of an antipsychotic medication is known to be essential in the long-term management of schizophrenia, in case of novel drugs such as cariprazine, determining the right dosing strategy is not that simple. Without decades of experience with a particular compound, evidence regarding dosing and titration comes primarily from double-blind, placebo controlled clinical trials that are not necessarily mirroring the real-life experiences of doctors. Via summarizing data from both clinical data (n = 3275) and real-world evidence (observational study n = 116, case studies n = 29), this perspective paper aims to shed a light on the appropriate dosing strategies of cariprazine from treatment initiation through switching strategies to concomitant medications.

Distress Regulates Different Pathways in the Brain of Common Carp: A Preliminary Study

In this study, a stress trial was conducted with common carp, one of the most important species in aquaculture worldwide, to identify relevant gene regulation pathways in different areas of the brain. Acute distress due to exposure to air significantly activated the expression of the immediate early gene c-fos in the telencephalon. In addition, evidence for regulation of the two corticotropin-releasing factor (crf) genes in relation to their binding protein (corticotropin-releasing hormone-binding protein, crh-bp) is presented in this preliminary study. Inferences on the effects of due to exposure to air were obtained by using point estimation, which allows the prediction of a single value. This constitutes the best description to date of the previously generally unknown effects of stress in different brain regions in carp. Furthermore, principal component analyses were performed to reveal possible regulation patterns in the different regions of the fish brain. In conclusion, these preliminary studies on gene regulation in the carp brain that has been influenced by exposure to a stressor reveal that a number of genes may be successfully used as markers for exposure to unfavourable conditions.

Partial Agonists and Dual Disorders: Focus on Dual Schizophrenia

Dual disorder is a term applied to patients with an addictive disorder and other mental disorder. Epidemiological studies have established that dual disorders are an expectation rather than an exception. They are difficult to diagnose and treat and constitute a huge burden for both patients and their relatives and society. Current treatments are a combination of those needed to treat the addictive disorder with those focused on the co-occurring psychiatric disorder. Focusing specifically on schizophrenia, growing scientific evidence supports the existence of a shared vulnerability for substance use in these patients and those at risk. Various antipsychotics have been found to be useful in the treatment of psychotic symptoms and disorders; however, few effective treatments have been identified until now for substance use disorders in patients with dual schizophrenia. Partial agonism stands as a new pharmacological option available in recent years. Molecules with this kind of action may act as functional agonists or as antagonists, depending on the surrounding levels of the neurotransmitter. Studies have found their efficacy in schizophrenia, addiction, anxiety and depression. Certain partial agonist antipsychotics seem to have a role in the treatment of dual schizophrenia. That could be the case with cariprazine. Because of its higher affinity for dopaminergic D3 receptors compared to D2, a potential to prevent relapse to addiction, added to its antipsychotic efficacy, has been suggested. Here we briefly review current advances and future directions and introduce some personal insights into the role of partial agonists in co-occurring schizophrenia and substance use.

Comparative Evaluation of A Partial Dopamine Agonist with A Preferential D2 and D3 Receptor Antagonist on Ethanol Induced Conditioned Place Preference in Mice

Background:

The role of dopamine receptor sub-families in the rewarding and reinforcing effects of drugs of abuse has been established in numerous studies. </P><P> Objectives: In view of the extensive role of mesolimbic dopaminergic transmission in rewarding and reinforcing effect of abused drugs including ethanol, the present study evaluated three mechanistically different drugs viz a partial dopaminergic agonist (PDA, aripiprazole), preferential D3 (mixed D2/D3) receptor antagonist (nafadotride), and a preferential D2 antagonist (haloperidol), on ethanol-induced conditioned place preference (CPP) in mice. </P><P> Method: The study was carried out in Swiss strain albino mice. Ethanol (20%, 2g/kg) was used to induce CPP in mice. After the acquisition of CPP, behavioral tests (elevated plus maze and locomotor activity) were conducted and effect of drugs on expression and on reinstatement (after extinction) was studied.

Results:

We found that aripiprazole (1 and 2 mg/kg but not 0.5mg/kg), haloperidol (0.2 mg/kg), and nafadotride (4.5 mg/kg) administered for 1 week during the conditioning phase prevented acquisition, expression and reinstatement of ethanol-induced CPP. All the three drugs reduced the ethanol-induced locomotor stimulation and produced antianxiety effects in elevated plus maze following the acquisition of ethanol CPP.

Conclusion:

Partial dopaminergic agonism by aripiprazole was found to be a better strategy for normalizing dopaminergic neurotransmission in alcoholics as seen in rodents.

Transdermal applications of ethosomes - a detailed review

Skin, the largest organ of the body serves as a potential route of drug delivery for local and systemic effects. However, the outermost layer of skin, the stratum corneum (SC) acts as a tough barrier that prevents penetration of hydrophilic and high molecular weight drugs. Ethosomes are a novel phospholipid vesicular carrier containing high ethanol concentrations and offer improved skin permeability and efficient bioavailability due to their structure and composition. This article gives a review of ethosomes including their compositions, types, mechanism of drug delivery, stability, and safety behaviour. This article also provides a detailed overview of drug delivery applications of ethosomes in various diseases.

Acute exposure to waterborne psychoactive drugs attract zebrafish

Psychotropic medications are widely used, and their prescription has increased worldwide, consequently increasing their presence in aquatic environments. Therefore, aquatic organisms can be exposed to psychotropic drugs that may be potentially dangerous, raising the question of whether these drugs are attractive or aversive to fish. To answer this question, adult zebrafish were tested in a chamber that allows the fish to escape or seek a lane of contaminated water. These attraction and aversion paradigms were evaluated by exposing the zebrafish to the presence of acute contamination with these compounds. The zebrafish were attracted by certain concentrations of diazepam, fluoxetine, risperidone and buspirone, which were most likely detected by olfaction, because this behavior was absent in anosmic fish. These findings suggest that despite their deleterious effects, certain psychoactive drugs attract fish.

Noradrenaline-induced release of newly-synthesized accumbal dopamine: differential role of alpha- and beta-adrenoceptors

Previous studies have shown that intra-accumbens infusion of isoproterenol (ISO), a beta-adrenoceptor-agonist, and phenylephrine (PE), an alpha-adrenoceptor-agonist, increase the release of accumbal dopamine (DA). In the present study we analyzed whether the ISO-induced release of DA is sensitive to pretreatment with the DA synthesis inhibitor alpha-methyl-para-tyrosine (AMPT). Earlier studies have shown that the PE-induced release of DA is derived from DA pools that are resistant to AMPT. In addition to PE, the alpha-adrenoceptor-antagonist phentolamine (PA) was also found to increase accumbal DA release. Therefore, we investigated whether similar to the DA-increasing effect of PE, the DA increase induced by PA is resistant to AMPT. Pretreatment with AMPT prevented the ISO-induced increase of accumbal DA. The accumbal DA increase after PA was not reduced by the DA synthesis inhibitor, independently of the amount of DA released. These results show that mesolimbic beta-, but not alpha-adrenoceptors, control the release of accumbal newly-synthesized DA pools. The DA-increasing effects of PE have previously been ascribed to stimulation of presynaptic receptors located on noradrenergic terminals, whereas the DA-increasing effects of PA and ISO have been ascribed to an action of these drugs at postsynaptic receptors on dopaminergic terminals. The fact that AMPT did not affect the accumbal DA response to PE and PA, whereas it did prevent the accumbal DA increase to ISO, supports our previously reported hypothesis that the noradrenergic neurons of the nucleus accumbens containing presynaptic alpha-adrenoceptors impinge upon the dopaminergic terminals in the nucleus accumbens containing postsynaptic adrenoceptors of the alpha but not of the beta type. The putative therapeutic effects of noradrenergic agents in the treatment of DA-related disorders are shortly discussed.

Unveiling the role of melatonin MT2 receptors in sleep, anxiety and other neuropsychiatric diseases: a novel target in psychopharmacology

BACKGROUND

Melatonin (MLT) is a pleiotropic neurohormone controlling many physiological processes and whose dysfunction may contribute to several different diseases, such as neurodegenerative diseases, circadian and mood disorders, insomnia, type 2 diabetes and pain. Melatonin is synthesized by the pineal gland during the night and acts through 2 G-protein coupled receptors (GPCRs), MT1 (MEL1a) and MT2 (MEL1b). Although a bulk of research has examined the physiopathological effects of MLT, few studies have investigated the selective role played by MT1 and MT2 receptors. Here we have reviewed current knowledge about the implications of MT2 receptors in brain functions.

METHODS

We searched PubMed, Web of Science, Scopus, Google Scholar and articles' reference lists for studies on MT2 receptor ligands in sleep, anxiety, neuropsychiatric diseases and psychopharmacology, including genetic studies on the MTNR1B gene, which encodes the melatonin MT2 receptor.

RESULTS

These studies demonstrate that MT2 receptors are involved in the pathophysiology and pharmacology of sleep disorders, anxiety, depression, Alzheimer disease and pain and that selective MT2 receptor agonists show hypnotic and anxiolytic properties.

LIMITATIONS

Studies examining the role of MT2 receptors in psychopharmacology are still limited.

CONCLUSION

The development of novel selective MT2 receptor ligands, together with further preclinical in vivo studies, may clarify the role of this receptor in brain function and psychopharmacology. The superfamily of GPCRs has proven to be among the most successful drug targets and, consequently, MT2 receptors have great potential for pioneer drug discovery in the treatment of mental diseases for which limited therapeutic targets are currently available.

Dibenzodiazepine derivative quetiapine- and olanzapine-induced chronic interstitial nephritis

The dibenzodiazepine derivative is a so-called "atypical" or second-generation antipsychotic that is widely regarded as one of the most effective drug treatments for schizophrenia and depression. Quetiapine and olanzapine are novel atypical antipsychotic agents that possess much improved tolerability. To the best of our knowledge, FDA has reported three cases of olanzapine-induced interstitial nephritis. Yet there have been no known clinical reports that associate quetiapine treatment with chronic interstitial nephritis (CIN). Here, we report the occurrence of CIN in the presence of edema during quetiapine and olanzapine therapy.

Effects of aripiprazole, an atypical antipsychotic, on the motor alterations induced by acute ethanol administration in mice

Aripiprazole is an antipsychotic that acts as a partial agonist at dopamine receptors. As the effects of most drugs of abuse converge to enhance dopamine-mediated neurotransmission, the present study was designed to test the hypothesis that aripiprazole would inhibit the acute effects of ethanol, a widely abused substance. Male Swiss mice received acute injections and were evaluated for motor activity in three distinct tests. In the open field, ethanol (1.5, 2.5 and 3.5 g/kg) induced an increase in locomotion in a U-shaped dose-related fashion, whereas aripiprazole (0.1, 1 and 10 mg/kg) did not affect this parameter. All the doses of the antipsychotic were able to prevent the stimulant effects of 2.5 g/kg of ethanol. In the rotarod test, ethanol (2.5 and 3.5 g/kg) reduced the latency to fall from the apparatus, an effect also observed with the higher dose of aripiprazole. Contrary to what was observed in the open field, this antipsychotic did not interfere with the effects of ethanol in motor balance. Finally, we tested animals in the wire hang test, in which ethanol, but not aripiprazole, reduced latency to fall at all doses. In this test, aripiprazole did not change ethanol effects. The present data lead to the conclusion that aripiprazole prevents the stimulant effects of ethanol on locomotion, without interfering with the motor impairment induced by this drug.

Buprenorphine: the basic pharmacology revisited

The historical background leading to the current use of buprenorphine as an analgesic and its role in the management of opioid dependence is summarized. The popular description of buprenorphine as a "partial agonist" is discussed in relation to efficacy in animal models of antinociception and clinical analgesia. The latest information on the respiratory depressant effects of buprenorphine and its N-dealkylated metabolite (norbuprenorphine) is presented. New data on the buprenorphine withdrawal syndrome in rats are described.

Psychotic exacerbation and emotional dampening in the daily life of patients with schizophrenia switched to aripiprazole therapy: a collection of standardized case reports

BACKGROUND

Blockade of the dopamine D2 receptor is a key mechanism in the antipsychotic treatment of patients with a psychotic disorder, but may also induce emotional deficits. The partial D2 agonistic profile of aripiprazole has, therefore, been suggested to favor emotional wellbeing compared with the pure dopamine antagonistic properties of traditional antipsychotics.

METHOD

The current study used the experience sampling method (a structured diary technique) to assess the effects of switching from treatment with traditional dopamine antagonist antipsychotics to treatment with the partial dopamine agonist aripiprazole on emotional wellbeing in the daily life of 13 patients with a diagnosis of schizophrenia.

RESULTS

More than half of all patients experienced exacerbation of psychotic symptoms after they had switched to the aripiprazole medication regime, consequently resulting in dropout of the study. Furthermore, switching to aripiprazole treatment, when effective in terms of symptom reduction, was accompanied by decreased feelings of both positive and negative affect in daily life, suggestive of a general state of emotional dampening.

CONCLUSIONS

Although the scale of the current study and the 54% dropout rate call for careful interpretation of the data, implementation of ecological monitoring in psychopharmacological research may open up new avenues for untangling the working mechanisms of compounds with regard to their impact on mental states.

Recommendations for the prevention, diagnosis, and treatment of chronic hepatitis B and C in special population groups (migrants, intravenous drug users and prison inmates)

The global spread of hepatitis B virus (HBV) and hepatitis C virus (HCV), their high chronicity rates and their progression to cirrhosis and hepatocellular carcinoma, are major public health problems. Research and intervention programmes for special population groups are needed in order to assess their infection risk and set up suitable prevention and control strategies. Aim of this paper is to give health care professionals information on HBV and HCV infections amongst migrants, drug users and prison inmates. The manuscript is an official Position Paper on behalf of the following Scientific Societies: Italian Association for the Study of the Liver (A.I.S.F.), Italian Society of Infectious and Tropical Diseases (S.I.M.I.T.), Italian Federation Department's Operators and Addiction Services (FederSerD), Italian Prison Medicine and Healthcare Society (S.I.M.S.Pe.). The considered population groups, having a high prevalence HBV and HCV infections, require specific interventions. In this context, the expression "special population" refers to specific vulnerable groups at risk of social exclusion, such as migrants, prison inmates, and intravenous drug users. When dealing with special population groups, social, environmental and clinical factors should be considered when selecting candidates for therapy as indicated by national and international guidelines.

Evolving therapeutic indications for N-type calcium channel blockers: from chronic pain to alcohol abuse

Clinical exploitation of the therapeutic potential of calcium channels has long been limited to L-type blockers for cardiovascular diseases. Recently, N-type blockers have been fully validated for the treatment of chronic pain, following approval of the intrathecally active ziconotide (Prialt(®)). This review describes the successful efforts to broaden the therapeutic scope of this mechanism to other major CNS indications, based on the discovery of N-type blockers orally active against pain. In animal models, the N-type blocker and pain-reducing NP078585 is efficacious against key elements of ethanol dependency, including self-administration and relapse. NP078585 moderately stimulates brain dopamine release without inducing reward or hyperlocomotion. N-type blockers may emerge as a novel class of 'dopamine stabilizers' for the treatment of drug dependency and other neuropsychiatric disorders without the side effects of current therapies.

Aripiprazole in anorexia nervosa and low-weight bulimia nervosa: case reports

OBJECTIVE

There has been much interest in the use of atypical antipsychotics in anorexia nervosa (AN). However, newer, more weight-neutral medications have not been studied in AN, and there are no reports of the use of antipsychotics in bulimia nervosa (BN).

METHOD

We report on the treatment of eight patients (five with AN and three with BN) with aripiprazole for time periods of four months to more than three years.

RESULTS

All individuals had reduced distress around eating, fewer obsessional thoughts about food, weight and body image, significant lessening of eating-disordered behaviors, and gradual weight restoration where appropriate. Depression, generalized anxiety, and cognitive flexibility improved as well.

DISCUSSION

In summary, these findings support the need to perform controlled trials of aripiprazole in AN and BN.

A double-blind, randomized, and placebo-controlled trial of buspirone added to risperidone in patients with chronic schizophrenia

OBJECTIVE

The role of partial agonism at 5-HT1A receptors in general and of buspirone in particular remains unclear in the treatment of negative symptoms of schizophrenia. This study was designed to investigate the effect of buspirone added to risperidone as augmentation therapy in patients with chronic schizophrenia and prominent negative symptoms in a double-blind randomized clinical trial.

METHODS

The participants were 31 men and 15 women aged 19 to 44 years who were inpatients at 2 psychiatric teaching hospitals in Iran. All patients were inpatients and were in the active phase of the illness and met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for schizophrenia. Patients were allocated in a random fashion: 23 patients to risperidone at 6 mg/d plus buspirone at 60 mg/d and 20 patients to risperidone at 6 mg/d plus placebo. The outcome was measured using the Positive and Negative Syndrome Scale.

RESULTS

The buspirone group had significantly greater improvement in the negative symptoms and positive general psychopathology subscales and Positive and Negative Syndrome Scale total scores over the 8-week trial. Therapy with 60 mg of buspirone per day was well tolerated, and no clinically important adverse effects were observed.

CONCLUSIONS

The present study indicates buspirone as a potential adjunctive treatment strategy for the treatment of schizophrenia, in particular, negative symptoms. Nevertheless, results of larger controlled trials are needed before recommendation for a broad clinical application can be made. This trial is registered with the Iranian Clinical Trials Registry (IRCT138712051556N8).

Maternal buspirone protects against the adverse effects of in utero stress on emotional and pain-related behaviors in offspring

Previous investigations from our laboratory demonstrated that prenatal stress exacerbates inflammatory pain-related behavior in adult rats and that fetal serotonin (5-HT) is involved in this phenomenon. In the present study we test the hypothesis that injections of buspirone, a 5-HT1A agonist, to rat dams before restraint stress during the last week of pregnancy (between pregnant days 15 and 20) can improve the characteristics of emotional and inflammatory pain-related behaviors in the adult offspring. Buspirone was injected to dams between the 9 and 20 days of pregnancy, during restraint stress, five min before it. The depression-like behavior in the forced swim test, formalininduced pain and body weight were investigated in the adult offspring. Prenatal stress exacerbated the licking behavior, the index of formalin-induced pain, and increased the time of immobility, the index of depression-like behavior. Buspirone normalized the licking behavior and profoundly reduced the time of immobility, which indicates differences in the mechanisms of antinociceptive and antidepressant effects of buspirone. The present new findings demonstrate that adverse influences of prenatal stress on emotional and inflammatory pain-related behaviors can be prevented by using prenatal buspirone, which shows long-term anxiolytic, antidepressant and antinociceptive effects. The new fact of body weight decrease in buspirone+stress males is worth noting in the context of the important problem of body weight gain as a common side effect of treatment with antidepressant drugs.

Long-term treatment with aripiprazole on the waking and postprandial urges to smoke in Chinese heavy smokers

The central dopaminergic system plays a critical role in the reinforcing effects of nicotine, which are key determinants in the urge to smoke. Previous study has demonstrated that immediate administration of 10-mg aripiprazole significantly decreased various subjective responses to smoking. The present study investigated whether 2-week treatment with 10-mg aripiprazole could attenuate waking and postprandial urges to smoke in Chinese male and female heavy smokers. A randomized and placebo-controlled pilot clinical study was conducted to assess the effect of aripiprazole on various responses to smoking. The primary outcomes were subject's ratings on questionnaires of smoking urge, withdrawal syndromes, and cigarette evaluation. All participants were administered either placebo or 10-mg aripiprazole for 2 weeks. Throughout the experiment, participants were required to self-report (1) smoking urge and nicotine withdrawal symptoms before their first cigarette after awakening and after lunch and (2) subjective responses to the first cigarette smoked of the day and after lunch. Aripiprazole was associated with significantly decreased waking and postprandial urges to smoke. Aripiprazole failed to produce a significant effect on overall nicotine withdrawal symptoms after awakening and after lunch. However, waking, but not postprandial, withdrawal craving and syndromes were significantly reduced by aripiprazole. Aripiprazole had no effect on the overall subjective responses to the first cigarette of the day and after lunch. The attenuating effects of aripiprazole on waking and postprandial urges to smoke demonstrate the promising effect of aripiprazole in the treatment of nicotine dependence.

Therapeutic potential for novel drugs targeting the type 1 cholecystokinin receptor

Cholecystokinin (CCK) is a physiologically important gastrointestinal and neuronal peptide hormone, with roles in stimulating gallbladder contraction, pancreatic secretion, gastrointestinal motility and satiety. CCK exerts its effects via interactions with two structurally related class I guanine nucleotide-binding protein (G protein)-coupled receptors (GPCRs), the CCK(1) receptor and the CCK(2) receptor. Here, we focus on the CCK(1) receptor, with particular relevance to the broad spectrum of signalling initiated by activation with the natural full agonist peptide ligand, CCK. Distinct ligand-binding pockets have been defined for the natural peptide ligand and for some non-peptidyl small molecule ligands. While many CCK(1) receptor ligands have been developed and have had their pharmacology well described, their clinical potential has not yet been fully explored. The case is built for the potential importance of developing more selective partial agonists and allosteric modulators of this receptor that could have important roles in the treatment of common clinical syndromes.

Cannabinoids for clinicians: the rise and fall of the cannabinoid antagonists

The endocannabinoid system has emerged as a significant player in the control of energy balance and metabolism, through its direct central and peripheral effects, as well as via its interaction with other appetite-regulating pathways. There is mounting evidence that the endocannabinoid system is overactive in obesity and were it possible to safely dampen-down the elevated endocannabinoid tone, lipid and carbohydrate profiles could be improved and weight loss induced. The series of randomised clinical trials showed reproducible beneficial effects on weight, HbA1c and lipid parameters, in addition to other cardiovascular risk factors. However, to date, clinical developments have been halted because of psychiatric side effects. Although recent evidence has highlighted the importance of an appetite-independent, peripheral mode of action, it is still unclear whether selectively blocking the peripheral system could potentially solve the problem of the central side effects, which thus far has led to the demise of the cannabinoid antagonists as useful pharmaceuticals. In this concise review, we summarise the data on the metabolic effects of the cannabinoid pathway and its antagonists.

Antimanic potency of typical neuroleptic drugs and affinity for dopamine D2 and serotonin 5-HT2A receptors--a new analysis of data from the archives and implications for improved antimanic treatments

Datasets of antimanic potency ratings and receptor-binding affinities [inhibition constants (K(i))] at dopamine D2 and serotonin 5-HT2A brain receptors were accessed from published literature for a large series (n = 24) of typical neuroleptic drugs, many of which are now obsolete and unobtainable. There was a strong positive association between antimanic potency and affinity for D2 receptors, in support of a 'dopamine-blockade hypothesis' of antimanic drug action. Taking the series of neuroleptics as a whole, there was no association between antimanic potency and affinity for 5-HT2A receptors. Despite this, within a subsample of typical neuroleptics with low affinity for D2 receptors resembling new generation atypical antipsychotics, a positive association between antimanic potency and affinity for 5-HT2A receptors emerged. This suggests that blockade of brain 5-HT2A receptors plays at least a subsidiary role in the antimanic effects of some typical neuroleptics. Other considerations also suggest that combining drugs to achieve high affinity for and blockade of both dopamine D2 receptors and serotonin 5-HT2A receptors, possibly with additional direct or indirect stimulation of postsynaptic 5-HT1A receptors, might maximize antimanic efficacy.

Oxidative stress in rat hippocampus caused by pilocarpine-induced seizures is reversed by buspirone

Temporal lobe epilepsy is the most common form of epilepsy in humans. Oxidative stress is a mechanism of cell death induced by seizures. Buspirone presents anxyolitic and antidepressant effects due to their ability to stimulate 5-HT(1A) receptor. We studied the buspirone effects on oxidative stress in rat hippocampus after seizures and status epilepticus (SE) induced by pilocarpine. In pilocarpine group there was a significant increase in lipid peroxidation and nitrite levels. However, no alteration was observed in superoxide dismutase and catalase activities. Buspirone pretreatment produces significantly reduction of the lipid peroxidation level (60%) and nitrite content (44%) as well as increased the superoxide dismutase (47%) and catalase (40%) activities in rat hippocampus after seizures, when compared with the pilocarpine group. The intraperitoneal injection of buspirone prior to pilocarpine suppressed the behavioral seizure occurrence. According to our results, the oxidative stress is present during seizures. Buspirone exerted anticonvulsant effects associated with the inhibition of the development of oxidative stress. These results suggest a therapeutic use potential of buspirone in epilepsy treatment.

Aripiprazole blocks reinstatement but not expression of morphine conditioned place preference in rats

Aripiprazole is an atypical antipsychotic drug primarily characterized by partial agonist activity at dopamine(DA) D2 receptors and serotonin-1A (5-hydroxytryptamine, 5-HT1A) receptors and minimal side effects.Based on its pharmacological profile, including stabilization of mesocorticolimbic DA activity (a pathway implicated in drug addiction), we investigated the effects of aripiprazole on relapse to morphine seeking in rats. In experiment 1, rats underwent morphine-induced conditioned place preference (CPP) training with alternate injections of morphine (5 mg/kg, s.c.) and saline (1 ml/kg, s.c.) for 8 consecutive days. To examine the effect of aripiprazole on the expression of morphine-induced CPP, rats received aripiprazole (0, 0.03, 0.1,and 0.3 mg/kg, i.p.) 30 min before testing for the expression of CPP. In experiment 2, rats underwent the same CPP training as in experiment 1 and subsequent extinction training. To examine the effect of aripiprazole on reinstatement of morphine-induced CPP, rats received aripiprazole 30 min before testing for reinstatement of CPP. In experiment 3, to assess the effects of aripiprazole on locomotor activity, aripiprazole was administered 30 min before testing for locomotor activity. Aripiprazole significantly decreased the reinstatement of CPP induced by a priming injection of morphine but had no effect on the expression of morphine-induced CPP or locomotor activity. The D2 and 5-HT1A partial agonist and 5-HT2A antagonist properties of aripiprazole likely account for the blockade of relapse to drug seeking. These findings suggest that aripiprazole may have therapeutic value for reducing craving and preventing relapse to drug seeking.

Subjective, cognitive/psychomotor, and physiological effects of aripiprazole in Chinese light and heavy smokers

BACKGROUND

Drug addiction researchers have begun to study dopamine partial agonists as potential therapeutic agents. The partial dopamine D(2) receptor agonist aripiprazole has recently been tested as a treatment for stimulant and alcohol dependence in both animal and clinical studies.

METHODS

A randomized and placebo-controlled pilot clinical study was conducted in a population of Chinese light and heavy smokers to assess the effect of aripiprazole on various responses to smoking. The primary outcomes were subject's ratings on questionnaires of smoking urge, withdrawal syndromes, and cigarette evaluation. Placebo, 5, and 10mg aripiprazole were acutely administered in all participants, with administrations at least 7 days apart. Subjective responses to a smoked cigarette, working memory, and attention/psychomotor performance were assessed before and after drug administration in each experimental session. Abstinence-induced smoking urge, withdrawal symptoms, blood pressure, and heart rate were also measured every 45 min after drug administration. Finally, a cue-testing session was carried out 4h after each drug administration.

RESULTS

Administration of 10mg aripiprazole significantly decreased both the subjective response and psychological reward derived from smoking a cigarette in heavy smokers. While neither 5 nor 10mg aripiprazole significantly decreased abstinence-induced smoking urges or withdrawal symptoms in light and heavy smokers, these doses substantially attenuated drug cue-induced smoking urges in heavy smokers. Aripiprazole did not affect working memory or attention/psychomotor performance.

CONCLUSIONS

Light and heavy smokers responded differently to aripiprazole across various dependent measures. Aripiprazole may potentially affect various subjective responses to smoking in heavy smokers.

Effects of buspirone on posthypoxic ventilatory behavior in the C57BL/6J and A/J mouse strains

Buspirone, a partial agonist of the serotonergic 5-HT1A receptor, improves breathing irregularities in humans with Rett syndrome or brain stem injury. The purpose of this study was to examine whether buspirone alters posthypoxic ventilatory behavior in C57BL/6J (B6) and A/J mouse strains. Measurements of ventilatory behavior were collected from unanesthetized adult male mice (n=6 for each strain) using the plethysmographic method. Mice were given intraperitoneal injections of vehicle or several doses of buspirone and exposed to 2 min of hypoxia (10% O2) followed by rapid reoxygenation (100% O2). Twenty minutes later, mice were tested for hypercapnic response (8% CO(2)-92% O2). On a separate day, mice were injected with the 5-HT1A receptor antagonist 4-iodo-N-{2-[4-(methoxyphenyl)-1-piperazinyl] ethyl}-N-2-pyridinylbenzamide (p-MPPI) before the injection of buspirone, and measurements were repeated. In separate studies, arterial blood-gas analysis was performed for each strain (n=12 in B6 and 10 in A/J) with buspirone or vehicle. In both strains, buspirone stimulated ventilation at rest. In the B6 mice, the hypoxic response was unchanged, but the response to hypercapnia was reduced with buspirone (5 mg/kg; P<0.05). With reoxygenation, vehicle-treated B6 exhibited periodic breathing and greater variation in ventilation compared with A/J (P<0.01). In B6 animals, >or=3 mg/kg of buspirone reduced variation and prevented the occurrence of posthypoxic periodic breathing. Both effects were reversed by p-MPPI. Treatment effect of buspirone was not explained by a difference in resting arterial blood gases. We conclude that buspirone improves posthypoxic ventilatory irregularities in the B6 mouse through its agonist effects on the 5-HT1A receptor.

Update on pharmacologic options for smoking cessation treatment

Although the proportion of the adult population in the United States that smokes has decreased steadily, the rate of successful quit attempts is still low. Smokers develop nicotine dependence that resembles other addictions, and may require multiple attempts and long-term treatment to sustain abstinence. Currently available first-line agents for smoking cessation therapy include nicotine replacement therapy, which is available in several formulations, including transdermal patch, gum, nasal spray, inhaler, and lozenge; bupropion, an atypical antidepressant; and varenicline, a partial agonist of the alpha(4)beta(2) nicotinic acetylcholine receptor that was recently developed and approved specifically for smoking cessation therapy. Second-line agents are nortriptyline, a tricyclic antidepressant agent, and clonidine, an antihypertensive drug. With the exception of varenicline, which has been shown to offer significant improvement in abstinence rates over bupropion, all of the available treatments appear similarly effective. However, the adverse event profiles of nortriptyline and clonidine make them more appropriate for second-line therapy, when first-line treatments have failed or are not tolerated. Rimonabant, a cannabinoid-1 receptor antagonist that was being developed for smoking cessation, received a nonapprovable letter from the FDA in 2006 and there is no further information as to whether development for this indication is continuing for this agent. Nicotine vaccines are under investigation and offer promise, especially for relapse prevention. Ultimately, selection of pharmacologic agent should be based on the patient's comorbidities and preferences, as well as on the agent's adverse event profile.

Atypical antipsychotic-induced metabolic side effects: insights from receptor-binding profiles

Atypical antipsychotic drugs offer several notable benefits over typical antipsychotics, including greater improvement in negative symptoms, cognitive function, prevention of deterioration, and quality of life, and fewer extrapyramidal symptoms (EPS). However, concerns about EPS have been replaced by concerns about other side effects, such as weight gain, glucose dysregulation and dyslipidemia. These side effects are associated with potential long-term cardiovascular health risks, decreased medication adherence, and may eventually lead to clinical deterioration. Despite a greater understanding of the biochemical effects of these drugs in recent years, the pharmacological mechanisms underlying their various therapeutic properties and related side effects remain unclear. Besides dopamine D(2) receptor antagonism, a characteristic feature of all atypical antipsychotic drugs, these agents also bind to a range of non-dopaminergic targets, including serotonin, glutamate, histamine, alpha-adrenergic and muscarinic receptors. This review examines the potential contribution of different receptors to metabolic side effects associated with atypical antipsychotic treatment for all seven agents currently marketed in the United States (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, paliperidone and clozapine) and another agent (bifeprunox) in clinical development at the time of this publication.

Mechanisms underlying agonist efficacy

Agonist efficacy is a measure of how well an agonist can stimulate a response system linked to a receptor. Efficacy can be assessed in functional assays and various parameters (E(max), K(A)/EC(50), E(max).K(A)/EC(50)) determined. The E(max).K(A)/EC(50) parameter provides a good estimate of efficacy across the full range of efficacy. A convenient assay for the efficacy of agonists for some receptors is provided by the [(35)S]GTP[S] (guanosine 5'-[gamma-[(35)S]thio]triphosphate)-binding assay. In this assay, the normal GTP-binding event in GPCR (G-protein-coupled receptor) activation is replaced by the binding of the non-hydrolysable analogue [(35)S]GTP[S]. This assay may be used to profile ligands for their efficacy, and an example here is the D(2) dopamine receptor where an efficacy scale has been set up using this assay. The mechanisms underlying the assay have been probed. The time course of [(35)S]GTP[S] binding follows a pseudo-first-order reaction with [(35)S]GTP[S] binding reaching equilibrium after approx. 3 h. The [(35)S]GTP[S]-binding event is the rate-determining step in the assay. Agonists regulate the maximal level of [(35)S]GTP[S] bound, rather than the rate constant for binding. The [(35)S]GTP[S]-binding assay therefore determines agonist efficacy on the basis of the amount of [(35)S]GTP[S] bound rather than the rate of binding.

Aripiprazole, an atypical antipsychotic, prevents the motor hyperactivity induced by psychotomimetics and psychostimulants in mice

Aripiprazole is an atypical antipsychotic that acts as a partial agonist at the dopamine D(2) receptor. It has been mainly investigated in dopamine-based models of schizophrenia, while its effects on glutamate-based paradigms have remained to be further characterized. Due to its unique mechanism of action, aripiprazole has also been considered as a replacement medication for psychostimulant abuse. Thus, in the present study we tested the hypothesis that aripiprazole would prevent the motor hyperactivity induced by psychostimulant and psychotomimetic drugs that act either by dopaminergic or glutamatergic mechanisms. Male Swiss mice received injections of aripiprazole (0.1-1 mg/kg) followed by drugs that enhance the dopamine-mediated neurotransmission, amphetamine (3 mg/kg) or cocaine (5 mg/kg), or by glutamate NMDA-receptor antagonists, ketamine (60 mg/kg) or MK-801 (0.4 mg/kg). Independent groups also received aripiprazole (0.1-1 mg/kg) or haloperidol (0.5 mg/kg) and were tested for catalepsy. All doses of aripiprazole were effective in preventing the motor stimulant effects of amphetamine and cocaine. Moreover, the higher dose also prevented the effects of ketamine and MK-801. The present study reports the effects of aripiprazole in dopaminergic and glutamatergic models predictive of antipsychotic activity, suggesting that both may be useful for screening novel partial agonists with antipsychotic activity. It also shows that aripiprazole may prevent the acute effects of psychostimulant drugs without significant motor impairment.

Versatility of GPCR recognition by drugs: from biological implications to therapeutic relevance

Most drugs acting on G-protein-coupled receptors (GPCRs) are classically defined as agonists, partial agonists or antagonists. This simplified classification seems sufficient to explain most of their therapeutic properties. The more recent description of inverse agonism has helped to revise theoretical models of GPCR function, but the therapeutic implications of the new concepts remain clearly restricted. Further complexity has arisen with demonstrations that a given receptor can adopt various conformations that support coupling with distinct G proteins. Because the related signaling pathways seem to be differentially affected by some ligands, the concept of 'functional selectivity' has been proposed, calling for a revision of the definitions of agonism and intrinsic efficacy. Evidence of complexity in G-protein coupling and examples of functional selectivity are accumulating, opening perspectives for drug development. Although such complexity should be regarded as an opportunity to gain pharmacological specificity, unraveling the physiological implications of these concepts is essential before their therapeutic relevance can be defined.

Usefulness of the dopamine system-stabilizer aripiprazole for reducing morphine-induced emesis

In the management of pain, nausea and vomiting are some of the most distressing adverse effects induced by opioids. In the present study, we investigated the effect of the dopamine system-stabilizer aripiprazole on morphine-induced emesis. Morphine induced retching and vomiting in a dose-dependent manner in ferrets. The emetic effect of morphine was significantly suppressed by pretreatment with either the dopamine receptor antagonist haloperidol or aripiprazole. These results suggest that the co-administration of aripiprazole may be useful for reducing the severity of morphine-induced emesis.

Activation of dopamine D2 receptors in the CNS inhibits sympathetic cutaneous vasomotor alerting responses (SCVARs), contributing to clozapine's SCVAR-inhibiting action

Sympathetic neural outflow to thermoregulatory cutaneous vascular beds is selectively activated when the individual is aroused, so that cutaneous blood flow is characterized by sudden alerting-related falls to near zero levels ("SCVARs", sympathetic cutaneous vasomotor alerting responses). Our previous work shows that clozapine, an atypical antipsychotic drug used in schizophrenia, profoundly inhibits SCVARs. Clozapine, conventionally assumed to have a dopamine D(2) receptor antagonist action, also increases baseline cutaneous blood flow and lowers body temperature. However dopamine D(2) receptor agonists lower temperature, suggesting that a dopamine D(2)agonist action might also reduce SCVARs. The present study determined whether a dopamine D(2)agonist action contributes to clozapine's SCVAR-inhibiting effect. SCVARs were measured in conscious rats with a Doppler ultrasonic flow probe chronically implanted around the base of the artery, with probe wires passing subcutaneously to a headpiece. Doppler signals were monitored via a flexible connection between the headpiece and a swivel device in the roof of the cage. Apomorphine (0.1-0.5 mg/kg), quinpirole (0.05-0.25 mg/kg) and 7-OH-DPAT (0.02-0.5 mg/kg) dose-dependently reduced SCVARs. Pre-treatment with the dopamine receptor antagonist spiperone (20 microg/kg) but not the D(1) antagonist SCH-23390 or the peripheral dopamine D(2) antagonist domperidone, abolished this effect. Spiperone pre-treatment reduced the SCVAR-inhibiting action of clozapine (0.06-1.0 mg/kg). Chlorpromazine (0.1-10 mg/kg) also dose-dependently inhibited SCVARs, but this effect was not reduced by pre-treatment with spiperone. Mechanisms underlying clozapine's SCVAR-inhibiting effect include dopamine D(2) receptor agonism, not dopamine D(2) receptor antagonism, calling into question the mechanism of the drug's therapeutic action in schizophrenia.

Management of agitation in the acute psychotic patient--efficacy without excessive sedation

Rapid-acting intramuscular (IM) formulations of atypical antipsychotics offer a significant advance over IM haloperidol in the short-term management of acute schizophrenic episodes. Several short-term open-label randomised studies, typically enrolling two- to three-hundred patients, have compared an atypical antipsychotic with haloperidol. These studies show that IM ziprasidone, IM olanzapine and IM aripiprazole are at least as effective and better tolerated than IM haloperidol, with lower extrapyramidal side effects. Successful transitions from an IM to oral formulation of the same agent have been performed in double-blind randomised trials assessing haloperidol, olanzapine, ziprasidone and aripiprazole. Avoiding over-sedation is now recognised as important, and randomised clinical trial data indicate that oral ziprasone, quetiapine, and IM olanzapine have high dose-related sedative potential while oral risperidone and IM aripiprazole have low sedative potential. In summary, IM formulations of atypical antipsychotics are recommended as first-line treatment of acute agitation with subsequent transition to an oral formulation of the same agent for ongoing management.

The mu opioid receptor is involved in buprenorphine-induced locomotor stimulation and conditioned place preference

The analgesic effect of buprenorphine is mediated via the mu opioid receptor (MOP). In the present study, using mice lacking the MOP and their wild-type littermates, we determined the role of the MOP in buprenorphine-induced locomotor stimulation and conditioned place preference (CPP). Buprenorphine (3 mg/kg) increased motor activity in wild-type but not in MOP knockout mice, showing the motor stimulatory action of buprenorphine is mediated via the MOP. When the mice were given the same treatment once daily for 5 consecutive days and challenged with buprenorphine on day 11, the motor stimulatory action of buprenorphine was enhanced in wild-type but not in MOP knockout mice, showing sensitization developed to the motor stimulatory action of buprenorphine and this phenomenon was mediated via the MOP. Likewise, buprenorphine induced CPP in wild-type mice after four alternate-day saline/buprenorphine (3 mg/kg) injections paired with olfactory and visual cues. However, buprenorphine failed to induce CPP in MOP knockout mice. In contrast, amphetamine (1 mg/kg) induced a comparable CPP in wild-type and MOP knockout mice. Together, the present results suggest that the ability of buprenorphine to increase motor activity and induce locomotor sensitization and CPP is mediated via the MOP.