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Fischler PV, Soyka M, Seifritz E, Mutschler J. Off-label and investigational drugs in the treatment of alcohol use disorder: A critical review. Front Pharmacol 2022; 13:927703. [PMID: 36263121 PMCID: PMC9574013 DOI: 10.3389/fphar.2022.927703] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Compounds known to be successful in the treatment of alcohol use disorder include the aversive agent, Disulfiram, the glutamatergic NMDA receptor antagonist, Acamprosate, and the opioid receptor antagonists, Naltrexone and Nalmefene. Although all four are effective in maintaining abstinence or reduction of alcohol consumption, only a small percentage of patients receive pharmacological treatment. In addition, many other medications have been investigated for their therapeutic potential in the treatment of alcohol use disorder. In this review we summarize and compare Baclofen, Gabapentin, Topiramate, Ondansetron, Varenicline, Aripiprazole, Quetiapine, Clozapine, Antidepressants, Lithium, Neuropeptide Y, Neuropeptide S, Corticotropin-releasing factor antagonists, Oxytocin, PF-05190457, Memantine, Ifenprodil, Samidorphan, Ondelopran, ABT-436, SSR149415, Mifepristone, Ibudilast, Citicoline, Rimonabant, Surinabant, AM4113 and Gamma-hydroxybutyrate While some have shown promising results in the treatment of alcohol use disorder, others have disappointed and should be excluded from further investigation. Here we discuss the most promising results and highlight medications that deserve further preclinical or clinical study. Effective, patient-tailored treatment will require greater understanding provided by many more preclinical and clinical studies.
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Affiliation(s)
- Pascal Valentin Fischler
- Department for Gynecology and Obstetrics, Women’s Clinic Lucerne, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- *Correspondence: Pascal Valentin Fischler,
| | - Michael Soyka
- Psychiatric Hospital University of Munich, Munich, Germany
| | - Erich Seifritz
- Director of the Clinic for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Clinic Zürich, Zürich, Switzerland
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Banjac Baljak V, Mihajlovic G, Zivlak-Radulovic N, Nezic L, Miskovic M, Banjac V. Association between Vitamin D and Cognitive Deficiency in Alcohol Dependence. Healthcare (Basel) 2022; 10:healthcare10091772. [PMID: 36141384 PMCID: PMC9498855 DOI: 10.3390/healthcare10091772] [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: 07/14/2022] [Revised: 08/22/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
There are still not enough findings to elucidate how exactly alcohol use impairs cognitive abilities. Some studies have shown that there is a link between alcohol intake and vitamin D levels, but these findings are inconsistent so further research is needed. The aim of this study was to investigate the association between serum vitamin D levels and cognitive impairment in alcohol-dependent individuals. A case-control study was carried out including a total of N = 132 respondents with a medical history of alcoholism, and healthy volunteers. The Montreal Cognitive Assessment (MoCa) and Addenbrooke’s Cognitive Examination-Revised (ACE-R) screening tools were used for cognitive status assessment and serum vitamin D levels analysis (blood samples of respondents). Significant difference (p = 0.022), was found in vitamin D levels in the alcohol-dependent group with cognitive deficiency 13.7 ± 9.4 (ng/mL), alcohol-dependent group without cognitive deficiency 19.5 ± 11.2 (ng/mL) and healthy controls 19.9 ± 11.1 (ng/mL), respectively. Furthermore, vitamin D levels were significantly different across all groups based on MoCa (p = 0.016) and ACE-R (p = 0.004) scores. All three groups exhibited vitamin D deficiency. A significant correlation was found between vitamin D deficiency and cognitive impairment, but it yielded no significant difference in alcohol-dependent individuals.
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Affiliation(s)
- Visnja Banjac Baljak
- Clinic of Psychiatry, University Clinical Center of the Republic of Srpska, 78 000 Banjaluka, Bosnia and Herzegovina
- Correspondence: ; Tel.: +387-65-462-496
| | - Goran Mihajlovic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, 34 000 Kragujevac, Serbia
| | - Nera Zivlak-Radulovic
- Clinic of Psychiatry, University Clinical Center of the Republic of Srpska, 78 000 Banjaluka, Bosnia and Herzegovina
| | - Lana Nezic
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, 78 000 Banja Luka, Bosnia and Herzegovina
| | - Mirjana Miskovic
- Clinic of Psychiatry, University Clinical Center of the Republic of Srpska, 78 000 Banjaluka, Bosnia and Herzegovina
| | - Vesna Banjac
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, 78 000 Banja Luka, Bosnia and Herzegovina
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Abstract
Alcohol use disorder (AUD) is a highly prevalent but severely under-treated disorder, with only three widely-approved pharmacotherapies. Given that AUD is a very heterogeneous disorder, it is unlikely that one single medication will be effective for all individuals with an AUD. As such, there is a need to develop new, more effective, and diverse pharmacological treatment options for AUD with the hopes of increasing utilization and improving care. In this qualitative literature review, we discuss the efficacy, mechanism of action, and tolerability of approved, repurposed, and novel pharmacotherapies for the treatment of AUD with a clinical perspective. Pharmacotherapies discussed include: disulfiram, acamprosate, naltrexone, nalmefene, topiramate, gabapentin, varenicline, baclofen, sodium oxybate, aripiprazole, ondansetron, mifepristone, ibudilast, suvorexant, prazosin, doxazosin, N-acetylcysteine, GET73, ASP8062, ABT-436, PF-5190457, and cannabidiol. Overall, many repurposed and novel agents discussed in this review demonstrate clinical effectiveness and promise for the future of AUD treatment. Importantly, these medications also offer potential improvements towards the advancement of precision medicine and personalized treatment for the heterogeneous AUD population. However, there remains a great need to improve access to treatment, increase the menu of approved pharmacological treatments, and de-stigmatize and increase treatment-seeking for AUD.
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4
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Khom S, Rodriguez L, Gandhi P, Kirson D, Bajo M, Oleata CS, Vendruscolo LF, Mason BJ, Roberto M. Alcohol dependence and withdrawal increase sensitivity of central amygdalar GABAergic synapses to the glucocorticoid receptor antagonist mifepristone in male rats. Neurobiol Dis 2022; 164:105610. [PMID: 34995754 PMCID: PMC9301881 DOI: 10.1016/j.nbd.2022.105610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 11/21/2022] Open
Abstract
Aberrant glucocorticoid signaling via glucocorticoid receptors (GR) plays a critical role in alcohol use disorder (AUD). Acute alcohol withdrawal and protracted abstinence in dependent rats are associated with increased GR signaling and changes in GR-mediated transcriptional activity in the rat central nucleus of the amygdala (CeA). The GR antagonist mifepristone decreases alcohol consumption in dependent rats during acute withdrawal and protracted abstinence. Regulation of CeA synaptic activity by GR is currently unknown. Here, we utilized mifepristone and the selective GR antagonist CORT118335 (both at 10 μM) as pharmacological tools to dissect the role of GR on GABA transmission in male, adult Sprague-Dawley rats using slice electrophysiology. We subjected rats to chronic intermittent alcohol vapor exposure for 5–7 weeks to induce alcohol dependence. A subset of dependent rats subsequently underwent protracted alcohol withdrawal for 2 weeks, and air-exposed rats served as controls. Mifepristone reduced the frequency of pharmacologically-isolated spontaneous inhibitory postsynaptic currents (sIPSC) in the CeA (medial subdivision) without affecting postsynaptic measures in all groups, suggesting decreased GABA release with the largest effect in dependent rats. CORT118335 did not significantly alter GABA transmission in naive, but decreased sIPSC frequency in dependent rats. Similarly, mifepristone decreased amplitudes of evoked inhibitory postsynaptic potentials only in dependent rats and during protracted withdrawal. Collectively, our study provides insight into regulation of CeA GABAergic synapses by GR. Chronic ethanol enhances the efficiency of mifepristone and CORT118335, thus highlighting the potential of drugs targeting GR as a promising pharmacological avenue for the treatment of AUD.
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Affiliation(s)
- Sophia Khom
- Department of Molecular Medicine, Scripps Research, 10550 N. Torrey Pines Rd., La Jolla, CA 92037, United States of America; Department of Pharmaceutical Sciences, University of Vienna, Althanstrasse 14, A-1090 Vienna, Austria
| | - Larry Rodriguez
- Department of Molecular Medicine, Scripps Research, 10550 N. Torrey Pines Rd., La Jolla, CA 92037, United States of America
| | - Pauravi Gandhi
- Department of Molecular Medicine, Scripps Research, 10550 N. Torrey Pines Rd., La Jolla, CA 92037, United States of America
| | - Dean Kirson
- Department of Molecular Medicine, Scripps Research, 10550 N. Torrey Pines Rd., La Jolla, CA 92037, United States of America; Department of Pharmacology, Addiction Science, and Toxicology, University of Tennessee Health Science Center, 71 S Manassas, Memphis, TN 38163, United States of America
| | - Michal Bajo
- Department of Molecular Medicine, Scripps Research, 10550 N. Torrey Pines Rd., La Jolla, CA 92037, United States of America
| | - Christopher S Oleata
- Department of Molecular Medicine, Scripps Research, 10550 N. Torrey Pines Rd., La Jolla, CA 92037, United States of America
| | - Leandro F Vendruscolo
- Integrative Neuroscience Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, 251 Bayview Blvd., Baltimore, MD 21224, United States of America
| | - Barbara J Mason
- Department of Molecular Medicine, Scripps Research, 10550 N. Torrey Pines Rd., La Jolla, CA 92037, United States of America
| | - Marisa Roberto
- Department of Molecular Medicine, Scripps Research, 10550 N. Torrey Pines Rd., La Jolla, CA 92037, United States of America.
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Jiang B, Yang W, Xiu Z, Zhang L, Ren X, Wang L, Chen L, Asakawa T. An in vivo explorative study to observe the protective effects of Puerariae flos extract on chronic ethanol exposure and withdrawal male mice. Biomed Pharmacother 2021; 137:111306. [PMID: 33524786 DOI: 10.1016/j.biopha.2021.111306] [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: 11/19/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 01/28/2023] Open
Abstract
Protective effects of Puerariae flos extract (PFE) on ethanol (EtOH) exposure have been previously verified. This study attempts to explore the protective effects of PEF on EtOH withdrawal models. Sixty male Kunming mice were involved which were randomly divided into five groups (intact control, EtOH group (35-day EtOH exposure), EtOH withdrawal group (28-day exposure + 7-day withdrawal), EtOH withdrawal group + positive control (Deanxit) group, and EtOH withdrawal group + PFE group). The changes of neuropsychological behaviors; hippocampal BDNF expression and CA1 neuronal density; and plasma corticotropin-releasing hormone (CRH), ACTH, and CORT levels were observed. It was found that depression-like behaviors reduced by EtOH exposure and increased by withdrawal under the 28-day EtOH exposure and 7-day withdrawal conditions. In addition, anxiety-like behaviors worsened by EtOH exposure and unchanged by withdrawal. Deanxit and PEF ameliorated such behaviors (vs. withdrawal group). Hippocampal BDNF expression was significantly downregulated by EtOH exposure and upregulated by withdrawal. Deanxit and PEF significantly upregulated the BDNF expression. The hippocampal CA1 neuronal density significantly decreased by EtOH exposure but unchanged by withdrawal and treatments. The plasma CRH, ACTH, and CORT levels show a significant enhancement by EtOH exposure and reduced by withdrawal. They were further reduced by Deanxit and PEF. The protective effects of PEF on EtOH chronic withdrawal mouse models were verified. The results of this study also indicated a complicated scenario of neuropsychological behaviors, hippocampal BDNF expression, and hypothalamic-pituitary-adrenal axis which are affected by the timing of EtOH exposure and withdrawal.
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Affiliation(s)
- Bo Jiang
- School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China.
| | - Wenhui Yang
- School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China
| | - Zhilong Xiu
- School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China
| | - Liuwei Zhang
- School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China
| | - Xinxiu Ren
- School of Life Science and Biotechnology, Dalian University of Technology, Dalian, 116024, China
| | - Lijun Wang
- Radiology Department, the First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Lei Chen
- Radiology Department, the Affiliated Third Hospital of Xiamen, Fujian University of Traditional Chinese Medicine, Xiamen, 361100, China
| | - Tetsuya Asakawa
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China; Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan.
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6
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Wang Q, Dwivedi Y. Advances in novel molecular targets for antidepressants. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110041. [PMID: 32682872 PMCID: PMC7484229 DOI: 10.1016/j.pnpbp.2020.110041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/24/2020] [Accepted: 07/12/2020] [Indexed: 12/18/2022]
Abstract
Depression is the most common psychiatric illness affecting numerous people world-wide. The currently available antidepressant treatment presents low response and remission rates. Thus, new effective antidepressants need to be developed or discovered. Aiming to give an overview of novel possible antidepressant drug targets, we summarized the molecular targets of antidepressants and the underlying neurobiology of depression. We have also addressed the multidimensional perspectives on the progress in the psychopharmacological treatment of depression and on the new potential approaches with effective drug discovery.
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Affiliation(s)
- Qingzhong Wang
- Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education (MOE) Key Laboratory for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yogesh Dwivedi
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.
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7
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Donoghue K, Rose A, Coulton S, Coleman R, Milward J, Philips T, Drummond C, Little H. Double-blind, placebo-controlled trial of mifepristone on cognition and depression in alcohol dependence. Trials 2020; 21:796. [PMID: 32938477 PMCID: PMC7493392 DOI: 10.1186/s13063-020-04726-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 09/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background Alcohol dependence is a significant issue contributing to disease burden. Changes in cortisol concentrations during alcohol withdrawal are associated with cognitive deficits and symptoms of depression. Current treatments are only successful for a small proportion of people and do not target cognitive deficits and symptoms of depression experienced by those who are alcohol dependent. The aim of this research is to determine the potential efficacy of mifepristone, a type II glucocorticoid receptor antagonist, to prevent symptoms of depression and cognitive deficits following alcohol detoxification. Methods This was a phase 2 therapeutic use trial. It was a double-blind randomised controlled clinical trial of mifepristone versus inactive placebo treatment. The trial aimed to recruit 120 participants who met the inclusion criteria: (1) male, (2) aged 18–60 years inclusive, and (3) alcohol dependent for 5 or more years. Participants were randomised to 600 mg a day mifepristone (200 mg morning, afternoon, and evening) for 7 days and 400 mg for the subsequent 7 days (200 mg morning and evening) or the equivalent number of placebo tablets for 14 days. Primary outcome measures were cognitive function (measured using the Cambridge Neuropsychological Test Automated Battery (CANTAB)) and symptoms of depression (measured using the Beck Depression Inventory (BDI)) at 4 weeks post-randomisation. Results Difficulties recruiting participants due to significant changes in the provision of inpatient care for alcohol dependence resulted in only 27 participants recruited to the trial, with data available for 21 participants. Fourteen participants were randomised to receive mifepristone and 13 to receive placebo. Conclusion Larger trials would be needed to draw conclusions about the efficacy of mifepristone. Trial registration ISRCTN registry ISRCTN54001953. Registered on 29 September 2011.
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Affiliation(s)
- Kim Donoghue
- Addictions Department, National Addiction Centre, Institute of Psychiatry, King's College London, 4 Windsor Walk, London, SE5 8BB, UK.
| | - Abigail Rose
- Department of Psychological Sciences, University of Liverpool, 2.32, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Simon Coulton
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, CT2 7NF, UK
| | - Rachel Coleman
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK
| | - Joanna Milward
- Addictions Department, National Addiction Centre, Institute of Psychiatry, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Thomas Philips
- Addictions Department, National Addiction Centre, Institute of Psychiatry, King's College London, 4 Windsor Walk, London, SE5 8BB, UK.,Institute for Clinical and Applied Health Research, Allam Medical Building,, University of Hull, Hull, HU6 7RX, UK
| | - Colin Drummond
- Addictions Department, National Addiction Centre, Institute of Psychiatry, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Hilary Little
- Addictions Department, National Addiction Centre, Institute of Psychiatry, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
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8
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Shen WW. Anticraving therapy for alcohol use disorder: A clinical review. Neuropsychopharmacol Rep 2019; 38:105-116. [PMID: 30175522 PMCID: PMC7292332 DOI: 10.1002/npr2.12028] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 12/13/2022] Open
Abstract
Aim In this review, the author focused on anticraving therapy for alcohol use disorder (AUD) defined by DMS‐5. A comprehensive review was carried out on the available published papers on anticraving drugs for treating AUD patients. Methods The author described all drugs with anticraving benefits for treating AUD patients approved by the Food and Drug Administration of the United States (US FDA) and European Medicines Agency of the European Union. Then, the commonly prescribed anticraving drugs and those under development were also described. Results The US FDA‐approved anticraving drugs included acamprosate and naltrexone, and those approved by European Medicines Agency were gamma‐hydroxybutyrate and nalmefene. The author also highlighted topiramate, gabapentin, ondansetron, LY196044, ifenprodil, varenicline, ABT‐436, mifepristone, citicoline, and baclofen. The putative mechanisms of action of and the use in clinical practice of those anticraving drugs were also described. Conclusion Although slowly developing, the field of anticraving drugs is getting into shape as a promising entity of a pharmaceutical class of drugs. Then, the author addressed on the underused issues of those recommended, and suggested anticraving drugs by the practice guideline of the American Psychiatric Association. The author urges that clinicians should be more “adventurous” in prescribing those promising drugs because benefits of those anticraving drugs are far‐outweighing the possible side effects of anticraving drugs, or the harms of untreated AUD itself.
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Affiliation(s)
- Winston W Shen
- Department of Psychiatry, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, Taipei Medical University, Taipei, Taiwan
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9
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Goldfarb EV, Sinha R. Drug-Induced Glucocorticoids and Memory for Substance Use. Trends Neurosci 2018; 41:853-868. [PMID: 30170822 PMCID: PMC6204074 DOI: 10.1016/j.tins.2018.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/13/2018] [Accepted: 08/08/2018] [Indexed: 11/29/2022]
Abstract
The biological stress response of the body forms one of the foundations of adaptive behavior, including promoting (and impairing) different forms of memory. This response transcends stressful experiences and underlies reactions to challenges and even reinforcers such as addictive substances. Nevertheless, drug-induced stress responses are rarely incorporated into models of addiction. We propose here that drug-induced stress responses (particularly glucocorticoids) play a crucial role in addictive behavior by modulating the formation of memories for substance-use experiences. We review the contributions of amygdala-, striatum-, and hippocampus-based memory systems to addiction, and reveal common effects of addictive drugs and acute stress on these different memories. We suggest that the contributions of drug-induced stress responses to memory may provide insights into the mechanisms driving addictive behavior.
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Affiliation(s)
- Elizabeth V Goldfarb
- Department of Diagnostic Radiology; Yale Stress Center; Yale University School of Medicine, New Haven, CT, USA.
| | - Rajita Sinha
- Departments of Psychiatry and Neuroscience; Yale Stress Center; Yale University School of Medicine, New Haven, CT, USA
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10
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Walker LC, Lawrence AJ. Investigational drug therapies in phase I and phase II clinical trials for alcohol use disorders. Expert Opin Investig Drugs 2018; 27:1-14. [PMID: 30019949 DOI: 10.1080/13543784.2018.1502269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Alcohol use disorder (AUD) is a complex psychiatric condition characterized by craving, compulsive seeking, loss of control of alcohol consumption as well as the emergence of negative emotional states during withdrawal. Despite the large socioeconomic burden of AUD, therapeutic treatment options lag behind. AREAS COVERED This review covers pharmacotherapies currently in phase I/II clinical trials for the treatment of AUDs listed on clinicaltrials.gov. We discuss drug therapies that modulate monoamine, GABA/Glutamate, neuropeptide and neuroimmune systems. We examine in depth preclinical and clinical evidence of a select range of these compounds and consider their utility in treating AUDs. EXPERT OPINION Current therapeutic options to treat AUD are inadequate at a population level. Currently there are 30 different compounds and one compound combination in phase I/II clinical trials for AUD. These compounds target various aspects of neurotransmitter signaling, neuroimmune modulation, and alcohol metabolism. Almost 75% of these compounds under trial are Food and Drug Administration (FDA) approved for other indications, which may save time and costs in treatment development. Further, development of therapeutics focused on genetic biomarkers and behavioral screening may improve how treatment decisions are made in the future on a case-by-case basis.
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Affiliation(s)
- Leigh C Walker
- a Florey Department of Neuroscience and Mental Health , University of Melbourne , Parkville , VIC , Australia
| | - Andrew J Lawrence
- a Florey Department of Neuroscience and Mental Health , University of Melbourne , Parkville , VIC , Australia
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11
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Ferguson LB, Harris RA, Mayfield RD. From gene networks to drugs: systems pharmacology approaches for AUD. Psychopharmacology (Berl) 2018; 235:1635-1662. [PMID: 29497781 PMCID: PMC6298603 DOI: 10.1007/s00213-018-4855-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/06/2018] [Indexed: 12/29/2022]
Abstract
The alcohol research field has amassed an impressive number of gene expression datasets spanning key brain areas for addiction, species (humans as well as multiple animal models), and stages in the addiction cycle (binge/intoxication, withdrawal/negative effect, and preoccupation/anticipation). These data have improved our understanding of the molecular adaptations that eventually lead to dysregulation of brain function and the chronic, relapsing disorder of addiction. Identification of new medications to treat alcohol use disorder (AUD) will likely benefit from the integration of genetic, genomic, and behavioral information included in these important datasets. Systems pharmacology considers drug effects as the outcome of the complex network of interactions a drug has rather than a single drug-molecule interaction. Computational strategies based on this principle that integrate gene expression signatures of pharmaceuticals and disease states have shown promise for identifying treatments that ameliorate disease symptoms (called in silico gene mapping or connectivity mapping). In this review, we suggest that gene expression profiling for in silico mapping is critical to improve drug repurposing and discovery for AUD and other psychiatric illnesses. We highlight studies that successfully apply gene mapping computational approaches to identify or repurpose pharmaceutical treatments for psychiatric illnesses. Furthermore, we address important challenges that must be overcome to maximize the potential of these strategies to translate to the clinic and improve healthcare outcomes.
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Affiliation(s)
- Laura B Ferguson
- Waggoner Center for Alcohol and Addiction Research, University of Texas at Austin, 1 University Station A4800, Austin, TX, 78712, USA
- Intitute for Neuroscience, University of Texas at Austin, Austin, TX, 78712, USA
| | - R Adron Harris
- Waggoner Center for Alcohol and Addiction Research, University of Texas at Austin, 1 University Station A4800, Austin, TX, 78712, USA
| | - Roy Dayne Mayfield
- Waggoner Center for Alcohol and Addiction Research, University of Texas at Austin, 1 University Station A4800, Austin, TX, 78712, USA.
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12
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Abstract
Animal models provide rapid, inexpensive assessments of an investigational drug's therapeutic potential. Ideally, they support the plausibility of therapeutic efficacy and provide a rationale for further investigation. Here, I discuss how the absence of clear effective-ineffective categories for alcohol use disorder (AUD) medications and biases in the clinical and preclinical literature affect the development of predictive preclinical alcohol dependence (AD) models. Invoking the analogical argument concept from the philosophy of science field, I discuss how models of excessive alcohol drinking support the plausibility of clinical pharmacotherapy effects. Even though these models are not likely be completely discriminative, they are sensitive to clinically effective medications and have revealed dozens of novel medication targets. In that context, I discuss recent preclinical work on GLP-1 receptor agonists, phosphodiesterase inhibitors, glucocorticoid receptor antagonists, nociception agonists and antagonists, and CRF1 antagonists. Clinically approved medications are available for each of these drug classes. I conclude by advocating a translational approach in which drugs are evaluated highly congruent preclinical models and human laboratory studies. Once translation is established, I suggest the burden is to develop hypothesis-based therapeutic interventions maximizing the impact of the confirmed pharmacotherapeutic effects in the context of additional variables falling outside the model.
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Affiliation(s)
- Mark Egli
- Division of Neuroscience and Behavior, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
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13
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Gil-Hernandez S, Mateos P, Porras C, Garcia-Gomez R, Navarro E, Garcia-Moreno LM. Alcohol Binge Drinking and Executive Functioning during Adolescent Brain Development. Front Psychol 2017; 8:1638. [PMID: 29046650 PMCID: PMC5632721 DOI: 10.3389/fpsyg.2017.01638] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/06/2017] [Indexed: 01/15/2023] Open
Abstract
Alcohol consumption in adolescents causes negative effects on familiar, social, academic life, as well as neurocognitive alterations. The binge drinking (BD) pattern of alcohol is characterized by the alternation of episodes of heavy drinking in a short interval of time, and periods of abstinence, a practice that can result in important brain alterations; even more than regular alcohol consumption. The prefrontal cortex, which acts as neural support for the executive processes, is particularly affected by alcohol; however, not all studies are in agreement about how BD alcohol consumption affects executive functioning. Some research has found that alcohol consumption in adolescence does not significantly affect executive functioning while others found it does. It is possible that these discrepancies could be due to the history of alcohol consumption, that is, at what age the subjects started drinking. The aim of our study is to assess the performance on executive functioning tasks of 13–19-year-old adolescents according to their pattern of alcohol consumption. We hypothesize that BD adolescents will perform worse than non-BD subjects in tasks that evaluate executive functions, and these differences will increase depending on how long they have been consuming alcohol. Three hundred and twenty-two students (48.14% females; age range 13–22 years; mean aged 16.7 ± 2.59) participated in the study; all of them had begun drinking at the age of 13 years. Participant were divided into three groups, according to their age range (13–15, 16–18, and 19–22 years) and divided according to their pattern of alcohol consumption (BD and control groups). Then, the subjects were evaluated with neuropsychological tasks that assess executive functions like working memory, inhibition, cognitive flexibility, or self-control among others. The entire sample showed a normal improvement in their executive performance, but this improvement was more stable and robust in the control group. Regarding the executive performance among age groups, control subjects only obtained better results than BDs in the 19–22-year-old range, whereas the performance was quite similar at younger ages. Considering that all the BD subjects started drinking at the same age (13 years old), it is possible that a kind of compensation mechanism exists in the adolescent brain which allows them to reach a normal performance in executive tasks. This theoretical mechanism would depend upon neuronal labor, which could lose efficacy over time with further alcohol ingestion. This process would account for the differences in neuropsychological performance, which were only observed in older students with a longer history of alcohol consumption.
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Affiliation(s)
- Soledad Gil-Hernandez
- Department of Didactics and School Organization, Faculty of Education, Complutense University of Madrid, Madrid, Spain
| | - Patricia Mateos
- Department of Psychobiology, Faculty of Education, Complutense University of Madrid, Madrid, Spain
| | - Claudia Porras
- Department of Psychobiology, Faculty of Education, Complutense University of Madrid, Madrid, Spain
| | - Raquel Garcia-Gomez
- Department of Psychobiology, Faculty of Education, Complutense University of Madrid, Madrid, Spain
| | - Enrique Navarro
- Department of Methodology, Research, and Diagnosis in Education, Faculty of Education, Complutense University of Madrid, Madrid, Spain
| | - Luis M Garcia-Moreno
- Department of Psychobiology, Faculty of Education, Complutense University of Madrid, Madrid, Spain
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Lefevre EM, Medley GA, Reeks T, Alexander S, Burne THJ, Eyles DW. Effect of the glucocorticoid receptor antagonist RU486 on MK-801 induced behavioural sensitisation. PLoS One 2017; 12:e0176156. [PMID: 28430805 PMCID: PMC5400269 DOI: 10.1371/journal.pone.0176156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/06/2017] [Indexed: 02/04/2023] Open
Abstract
Stress is known to modulate sensitisation to repeated psychostimulant exposure. However, there is no direct evidence linking glucocorticoids and sensitisation achieved by repeated administration of the NMDA receptor antagonist MK-801. We tested the hypothesis that co-administration of RU486, a glucocorticoid receptor (GR) antagonist, prior to repeated daily MK-801 injections would block the expression of locomotor sensitisation due to its dual effects on corticosterone and dopamine. We employed a repeated MK-801 administration locomotor sensitisation paradigm in male Sprague Dawley rats. RU486 or a dimethyl sulfoxide (DMSO) vehicle was co-administered with MK-801 or saline during the induction phase. Subsequent to withdrawal, rats were challenged with MK-801 alone to test for the expression of sensitisation. In a separate cohort of rats, plasma corticosterone levels were quantified from blood samples taken on the 1st, 4th and 7th day of induction and at expression. One day after challenge, nucleus accumbens tissue levels of dopamine and its metabolites DOPAC and HVA were measured. During the induction phase, RU486 progressively enhanced locomotor sensitisation to MK-801. RU486 and MK-801 both showed stimulatory effects on corticosterone levels and this was further augmented when given in combination. Contrary to our hypothesis, RU486 did not block the expression of locomotor sensitisation to MK-801 and actually increased levels of dopamine, DOPAC and HVA in nucleus accumbens tissue. Our results showed that RU486 has augmentative rather than inhibitory effects on MK-801-induced sensitisation. This study indicates a divergent role for glucocorticoids in sensitisation to MK-801 compared to sensitisation with other psychostimulants.
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Affiliation(s)
- Emilia M. Lefevre
- Queensland Brain Institute, The University of Queensland, St Lucia, Queensland, Australia
| | - Gregory A. Medley
- Queensland Brain Institute, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Richlands, Queensland, Australia
| | - Timothy Reeks
- Queensland Brain Institute, The University of Queensland, St Lucia, Queensland, Australia
| | - Suzy Alexander
- Queensland Brain Institute, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Richlands, Queensland, Australia
| | - Thomas H. J. Burne
- Queensland Brain Institute, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Richlands, Queensland, Australia
| | - Darryl W. Eyles
- Queensland Brain Institute, The University of Queensland, St Lucia, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Richlands, Queensland, Australia
- * E-mail:
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15
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Pahng AR, McGinn MA, Paulsen RI, Edwards S. The Prefrontal Cortex as a Critical Gate of Negative Affect and Motivation in Alcohol Use Disorder. Curr Opin Behav Sci 2017; 13:139-143. [PMID: 28111628 PMCID: PMC5242235 DOI: 10.1016/j.cobeha.2016.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The prefrontal cortex (PFC) represents and executes the highest forms of goal-directed behavior, and has thereby attained a central neuroanatomical position in most pathophysiological conceptualizations of motivational disorders, including alcohol use disorder (AUD). Excessive, intermittent exposure to alcohol produces an allostatic dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis along with heightened forebrain glucocorticoid signaling that can damage PFC architecture and function. Negative affective states intimately associated with the transition to alcohol dependence result not only from a dysregulated HPA axis, but also from the inability of a damaged PFC to regulate subcortical stress and reinforcement centers, including the ventral striatum and amygdala. Several cognitive symptoms commonly associated with severe AUD, ranging from poor risk management to the cognitive/affective dimension of pain, are likely mediated by altered function of key anatomical elements that modulate PFC executive function, including contributions from the cingulate cortex and insula. Future therapeutic strategies for severe AUD should focus on attenuating the deleterious effects of excessive stress hormone activity on cognitive/affective and motivational behaviors gated by the PFC.
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Affiliation(s)
- Amanda R Pahng
- Department of Physiology, Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA
| | - M Adrienne McGinn
- Department of Physiology, Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Rod I Paulsen
- Department of Physiology, Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Scott Edwards
- Department of Physiology, Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA
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Drew CJG, Poile V, Trubey R, Watson G, Kelson M, Townson J, Rosser A, Hood K, Quinn L, Busse M. Integrating technology into complex intervention trial processes: a case study. Trials 2016; 17:551. [PMID: 27855710 PMCID: PMC5114753 DOI: 10.1186/s13063-016-1674-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 10/31/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Trials of complex interventions are associated with high costs and burdens in terms of paperwork, management, data collection, validation, and intervention fidelity assessment occurring across multiple sites. Traditional data collection methods rely on paper-based forms, where processing can be time-consuming and error rates high. Electronic source data collection can potentially address many of these inefficiencies, but has not routinely been used in complex intervention trials. Here we present the use of an on-line system for managing all aspects of data handling and for the monitoring of trial processes in a multicentre trial of a complex intervention. We custom built a web-accessible software application for the delivery of ENGAGE-HD, a multicentre trial of a complex physical therapy intervention. The software incorporated functionality for participant randomisation, data collection and assessment of intervention fidelity. It was accessible to multiple users with differing levels of access depending on required usage or to maintain blinding. Each site was supplied with a 4G-enabled iPad for accessing the system. The impact of this system was quantified through review of data quality and collation of feedback from site coordinators and assessors through structured process interviews. RESULTS The custom-built system was an efficient tool for collecting data and managing trial processes. Although the set-up time required was significant, using the system resulted in an overall data completion rate of 98.5% with a data query rate of 0.1%, the majority of which were resolved in under a week. Feedback from research staff indicated that the system was highly acceptable for use in a research environment. This was a reflection of the portability and accessibility of the system when using the iPad and its usefulness in aiding accurate data collection, intervention fidelity and general administration. CONCLUSIONS A combination of commercially available hardware and a bespoke online database designed to support data collection, intervention fidelity and trial progress provides a viable option for streamlining trial processes in a multicentre complex intervention trial. There is scope to further extend the system to cater for larger trials and add further functionality such as automatic reporting facilities and participant management support. TRIAL REGISTRATION ISRCTN65378754 , registered on 13 March 2014.
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Affiliation(s)
- Cheney J. G. Drew
- South East Wales Trials Unit, Centre For Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Vincent Poile
- South East Wales Trials Unit, Centre For Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Rob Trubey
- South East Wales Trials Unit, Centre For Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Gareth Watson
- South East Wales Trials Unit, Centre For Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Mark Kelson
- South East Wales Trials Unit, Centre For Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Julia Townson
- South East Wales Trials Unit, Centre For Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Anne Rosser
- School of Biosciences, Cardiff University, Biosciences 3, Park Place, Cardiff, CF10 3BB UK
| | - Kerenza Hood
- South East Wales Trials Unit, Centre For Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY USA
- School of Health Care Sciences, Cardiff University, 35-43 Eastgate House, Newport Road, Cardiff, CF24 0AB UK
| | - Monica Busse
- South East Wales Trials Unit, Centre For Trials Research, College of Biomedical and Life Sciences, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
- School of Health Care Sciences, Cardiff University, 35-43 Eastgate House, Newport Road, Cardiff, CF24 0AB UK
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