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Scendoni R, Bury E, Ribeiro ILA, Cameriere R, Cingolani M. Vaccines as a preventive tool for substance use disorder: A systematic review including a meta-analysis on nicotine vaccines' immunogenicity. Hum Vaccin Immunother 2022; 18:2140552. [PMID: 36351881 DOI: 10.1080/21645515.2022.2140552] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The research on substance use disorders is ongoing in the quest to find anti-addiction vaccines to treat drug abuse. This article provides a systematic review of clinical trials that have been conducted on humans to evaluate the efficacy, safety, and abstinence rates of anti-addiction vaccines for different drugs, with useful results regarding cocaine and nicotine vaccines in particular; this study includes also a meta-analysis to establish the antibody-titer production following the nicotine vaccination, while a meta-analysis of cocaine vaccines was not performed due to the small number of included trials. The articles taken into consideration were published between 2002 and 2015, including searches through 2022. Overall, 13 articles were selected with 2,266 participants from different ethnic groups. The meta-analysis of nicotine vaccines showed that vaccinated groups were 50 times more likely to create specific antibodies compared to the non-vaccinated. These results demonstrated how the nicotine vaccine has good immunogenicity.
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Affiliation(s)
- Roberto Scendoni
- Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy
| | - Emanuele Bury
- Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy
| | | | - Roberto Cameriere
- Department of Forensic Medicine, University of Molise, Campobasso, Italy
| | - Mariano Cingolani
- Department of Law, Institute of Legal Medicine, University of Macerata, Macerata, Italy
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Ellison-Barnes A, Galiatsatos P. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. Med Clin North Am 2022; 106:1067-1080. [PMID: 36280333 DOI: 10.1016/j.mcna.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is a strong evidence base for the use of existing pharmacotherapies to support tobacco cessation, alone or in combination, ideally with concurrent behavioral interventions. Future pharmacotherapies under development may assist in the most refractory cases. Incorporating current and future therapies into a longitudinal chronic care model for tobacco dependence will help a diverse range of patients achieve independence from nicotine addiction.
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Affiliation(s)
- Alejandra Ellison-Barnes
- The Tobacco Treatment and Cancer Screening Clinic, The Johns Hopkins Health System, Baltimore, MD, USA; Division of General Internal Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Panagis Galiatsatos
- The Tobacco Treatment and Cancer Screening Clinic, The Johns Hopkins Health System, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
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3
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Vaccines against Drug Abuse—Are We There Yet? Vaccines (Basel) 2022; 10:vaccines10060860. [PMID: 35746468 PMCID: PMC9230984 DOI: 10.3390/vaccines10060860] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Drug abuse is a worldwide problem that is detrimental to public health. The potential for drug abuse extends to both legal and illicit drugs. Drawbacks associated with current treatments include limited effectiveness, potential side effects and, in some instances, the absence of or concerns with approved therapy options. A significant amount of clinical research has been conducted investigating immunotherapy as a treatment option against drug abuse. Vaccines against drug abuse have been the main area of research, and are the focus of this review. Methods: An extensive search using “EBSCOhost (Multiple database collection)” with all 28 databases enabled (including “Academic Search Ultimate”, “CINAHL Plus with Full Text”, and MEDLINE), interrogation of the ClinicalTrials.gov website, and searches of individual clinical trial registration numbers, was performed in February and March of 2022. This search extended to references within the obtained articles. Results: A total of 23 registered clinical trials for treating drug abuse were identified: 15 for treatment of nicotine abuse (all vaccine-based trials), 6 against cocaine abuse (4 were vaccine-based trials and 2 were metabolic-enzyme-based trials), 1 against methamphetamine abuse (a monoclonal-antibody-based trial), and 1 multivalent opioid treatment (vaccine-based trial). As indicated on the ClinicalTrials.gov website (Home—ClinicalTrials.gov), the status of all but two of these trials was “Completed”. Phase 3 clinical trials were completed for vaccine treatments against nicotine and cocaine abuse only. Conclusion: Evidence in the form of efficacy data indicates that vaccines are not an option for treating nicotine or cocaine abuse. Efficacy data are yet to be obtained through completion of clinical trials for vaccines against opioid abuse. These findings align with the absence of regulatory approval for any of these treatments. This review further highlights the need for novel treatment strategies in instances where patients do not respond to current treatments, and while the search for efficacious vaccine-based treatments continues.
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Arora R, Haile CN, Kosten TA, Wu Y, Ramakrishnan M, Hawkins LD, Orson FM, Kosten TR. Preclinical efficacy of an anti-methamphetamine vaccine using E6020 adjuvant. Am J Addict 2019; 28:119-126. [PMID: 30701618 DOI: 10.1111/ajad.12867] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/02/2019] [Accepted: 01/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Methamphetamine (MA) substance use disorder (SUD) does not have an efficacious pharmacotherapy. We developed a MA vaccine and investigated its potential to attenuate MA induced responses. METHODS We examined a novel adjuvant, E6020, a Toll-like receptor-4 (TLR-4) agonist combined with tetanus-toxoid conjugated to succinyl-methamphetamine (TT-SMA) adsorbed on aluminum hydroxide (alum). Adult BALB/c female mice received the vaccine and booster injections at weeks 0, 3, and 6. The efficacy of the vaccine was assessed by the level and affinity of anti-MA antibodies elicited, its ability to attenuate MA induced locomotor activation and its reduction in the amount of MA entering the brains of vaccinated mice. RESULTS The TT-SMA vaccine containing alum and E6020 adjuvant produced anti-MA antibodies with nanomolar affinities and showed threefold greater peak titer levels than without E6020 (700 vs 250 μg/ml). These antibodies significantly decreased MA-induced locomotor activation (p < .05), and reduced the brain (p < .005) MA levels following MA administration in actively immunized mice. CONCLUSIONS Thus, this anti-MA vaccine formulated with E6020 demonstrated effective functional protection against behavioral disruptions induced by MA. SCIENTIFIC SIGNIFICANCE Together, anti-MA vaccine showing a promising improvement in the efficacy of the vaccine that could be an effective candidate vaccine for methamphetamine use disorder (MUD). Furthermore, combinations of adjuvants may be a tool to design vaccines for MA dependence in humans. (Am J Addict 2019;XX:1-8).
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Affiliation(s)
- Reetakshi Arora
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,The Michael E DeBakey Veteran's Affairs Medical Center, Houston, Texas
| | - Colin N Haile
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,The Michael E DeBakey Veteran's Affairs Medical Center, Houston, Texas.,Department of Psychology, University of Houston, Houston, Texas
| | - Therese A Kosten
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,The Michael E DeBakey Veteran's Affairs Medical Center, Houston, Texas.,Department of Psychology, University of Houston, Houston, Texas
| | - Yan Wu
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,The Michael E DeBakey Veteran's Affairs Medical Center, Houston, Texas
| | - Muthu Ramakrishnan
- The Michael E DeBakey Veteran's Affairs Medical Center, Houston, Texas.,Immunology Allergy & Rheumatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Frank M Orson
- The Michael E DeBakey Veteran's Affairs Medical Center, Houston, Texas.,Immunology Allergy & Rheumatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Thomas R Kosten
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.,The Michael E DeBakey Veteran's Affairs Medical Center, Houston, Texas
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Abstract
‘Drug promiscuity’ refers to a drug that can act on multiple molecular targets, exhibiting similar or different pharmacological effects. Drugs may interact with unwanted targets, leading to off-target effects (one of the main reasons for side effects). Thus, intervention to prevent off-target effects in the early stages of drug discovery could reduce the risk of failure. The conversion between target and off-target effects is important for drug repurposing. Drug repurposing strategies could reduce research and development costs. This review details the research progress in the rational application of drug promiscuity for the discovery of multi-target drugs, drug repurposing and improving druggability in medicinal chemistry over the last 5 years.
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Micoli A, De Simone A, Russo D, Ottonello G, Colombano G, Ruda GF, Bandiera T, Cavalli A, Bottegoni G. Aryl and heteroaryl N-[4-[4-(2,3-substituted-phenyl)piperazine-1-yl]alkyl]carbamates with improved physico-chemical properties as dual modulators of dopamine D3 receptor and fatty acid amide hydrolase. MEDCHEMCOMM 2016. [DOI: 10.1039/c5md00590f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Improving the physico-chemical profile of a MTDL series.
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Affiliation(s)
- A. Micoli
- CompuNet
- Istituto Italiano di Tecnologia
- 16163 Genova
- Italy
| | - A. De Simone
- School of Chemistry
- The University of Edinburgh
- Edinburgh
- UK
| | - D. Russo
- PharmaChemistry
- Istituto Italiano di Tecnologia
- 16163 Genova
- Italy
| | - G. Ottonello
- PharmaChemistry
- Istituto Italiano di Tecnologia
- 16163 Genova
- Italy
| | - G. Colombano
- Cancer Research UK Cancer Therapeutics Unit
- The Institute of Cancer Research
- Sutton
- UK
| | - G. F. Ruda
- Structural Genomics Consortium (SGC)
- University of Oxford
- Oxford OX3 7DQ
- UK
- Target Discovery Institute (TDI)
| | - T. Bandiera
- PharmaChemistry
- Istituto Italiano di Tecnologia
- 16163 Genova
- Italy
| | - A. Cavalli
- CompuNet
- Istituto Italiano di Tecnologia
- 16163 Genova
- Italy
- FaBit
| | - G. Bottegoni
- CompuNet
- Istituto Italiano di Tecnologia
- 16163 Genova
- Italy
- BiKi Technologies S.r.l
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Sivadasan Pillai H, Ganapathi S. Tobacco Cessation Approaches and Impact on CVD. Glob Heart 2015; 7:129-38. [PMID: 25691309 DOI: 10.1016/j.gheart.2012.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 06/06/2012] [Indexed: 12/30/2022] Open
Affiliation(s)
- Harikrishnan Sivadasan Pillai
- Department of Cardiology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India; Correspondence: S. Harikrishnan
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De Simone A, Ruda GF, Albani C, Tarozzo G, Bandiera T, Piomelli D, Cavalli A, Bottegoni G. Applying a multitarget rational drug design strategy: the first set of modulators with potent and balanced activity toward dopamine D3 receptor and fatty acid amide hydrolase. Chem Commun (Camb) 2014; 50:4904-7. [PMID: 24691497 PMCID: PMC4038168 DOI: 10.1039/c4cc00967c] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Combining computer-assisted drug design and synthetic efforts, we generated compounds with potent and balanced activities toward both D3 dopamine receptor and fatty acid amide hydrolase (FAAH) enzyme. By concurrently modulating these targets, our compounds hold great potential toward exerting a disease-modifying effect on nicotine addiction and other forms of compulsive behavior.
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Affiliation(s)
- Alessio De Simone
- Dept. of Drug Discovery and Development, Istituto Italiano di Tecnologia, via Morego n.30, 16163 Genova, Italy.
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Wynn WP, Stroman RT, Almgren MM, Clark KJ. The pharmacist "toolbox" for smoking cessation: a review of methods, medicines, and novel means to help patients along the path of smoking reduction to smoking cessation. J Pharm Pract 2013; 25:591-9. [PMID: 23222855 DOI: 10.1177/0897190012460823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Annually there are 500 000 preventable deaths in the United States caused by smoking; as health care professionals, pharmacists have a unique opportunity to advise, assess, and assist patients to quit smoking. This review article provides pharmacists with a "toolbox" containing an overview of pharmacologic and nonpharmacologic methods for smoking cessation. Currently approved over-the-counter (OTC) and prescription medications (nicotine replacement therapy, varenicline, and bupropion) are summarized, and nonpharmacologic therapies discussed include cognitive therapy and hypnosis. In addition to traditional therapies some potential approaches to smoking cessation are addressed, including nicotine immunizations and electronic cigarettes.
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Affiliation(s)
- William P Wynn
- Department of Pharmacy Practice, South University, Columbia, SC 29203, USA.
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Goniewicz ML, Delijewski M. Nicotine vaccines to treat tobacco dependence. Hum Vaccin Immunother 2012; 9:13-25. [PMID: 23108361 DOI: 10.4161/hv.22060] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Tobacco smoking is globally far more widespread than use of any other substance of abuse. Nicotine is an important tobacco constituent that is responsible for addictive properties of smoking. The currently available medications for the treatment of nicotine addiction have limited efficacy. A challenging novel therapeutic concept is vaccination against nicotine. An efficient vaccine would generate antibodies that sequester nicotine in the blood and prevent its access to the brain. The vaccine would have great potential for treating nicotine addiction and for relapse prevention. We reviewed the current status of vaccines against nicotine addiction that are undergoing clinical trials or are in preclinical development. We discuss problems associated with the development of nicotine vaccines, their efficacy in addiction treatment, challenges and ethical concerns. Existing evidence indicates that nicotine vaccination is well tolerated and capable of inducing an immune response but its effectiveness in increasing smoking abstinence has not been shown so far.
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Affiliation(s)
- Maciej L Goniewicz
- Tobacco Dependence Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
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LeSage MG, Shelley D, Pravetoni M, Pentel PR. Enhanced attenuation of nicotine discrimination in rats by combining nicotine-specific antibodies with a nicotinic receptor antagonist. Pharmacol Biochem Behav 2012; 102:157-62. [PMID: 22503967 DOI: 10.1016/j.pbb.2012.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 03/23/2012] [Accepted: 03/28/2012] [Indexed: 11/24/2022]
Abstract
Tobacco addiction requires activation by nicotine of a variety of central nicotinic acetylcholine receptors (nAChRs). In animals, both nAChR antagonists and immunization against nicotine can reduce nAChR activation by nicotine and block a variety of addiction-relevant behaviors. However, clinical use of nAChR antagonists for smoking cessation is limited by dose-related side effects, and immunization does not reliably produce sufficient antibody levels in smokers to enhance smoking cessation rates. Combining these approaches may be one way of addressing the limitations of each while enhancing overall efficacy. This study examined the individual and combined effects of passive immunization with the monoclonal nicotine-specific antibody Nic311 and the nicotinic receptor antagonist mecamylamine (MEC) on nicotine's discriminative stimulus effects. Rats were trained to discriminate 0.4 mg/kg of nicotine from saline using a two-lever operant discrimination procedure. Antagonism of nicotine discrimination by Nic311 (160 mg/kg i.v.) and ascending doses of MEC (0.03, 0.1, 0.3, and 1.0 mg/kg s.c.) was assessed across four consecutive daily 2-min extinction test sessions using a 2×2 design. Nic311 alone produced a 24-48% reduction in % nicotine-lever responding (%NLR) across all four test sessions. MEC produced a dose-dependent decrease in %NLR, with no effect at the two lowest doses and 80-93% attenuation at the two highest doses. Nic311 combined with MEC significantly suppressed %NLR at every MEC dose (85-92% reduction across all four test sessions). Very low doses of MEC that were ineffective alone completely blocked nicotine discrimination when combined with Nic311. These data demonstrate that nicotine-specific antibodies and MEC can work synergistically to suppress the subjective effects of nicotine and suggest that low doses of MEC may significantly enhance the efficacy of immunotherapy.
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Affiliation(s)
- Mark G LeSage
- Department of Medicine, Minneapolis Medical Research Foundation, Minneapolis, MN, United States.
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Abstract
The pharmacokinetic treatment strategy targets the drug molecule itself, aiming to reduce drug concentration at the site of action, thereby minimizing any pharmacodynamic effect. This approach might be useful in the treatment of acute drug toxicity/overdose and in the long-term treatment of addiction. Phase IIa controlled clinical trials with anticocaine and antinicotine vaccines have shown good tolerability and some efficacy, but Phase IIb and III trials have been disappointing because of the failure to generate adequate antibody titers in most participants. Monoclonal antibodies against cocaine, methamphetamine and phencyclidine have shown promise in animal studies, as has enhancing cocaine metabolism with genetic variants of human butyrylcholinesterase, with a bacterial esterase, and with catalytic monoclonal antibodies. Pharmacokinetic treatments offer potential advantages in terms of patient adherence, absence of medication interactions and benefit for patients who cannot take standard medications.
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Affiliation(s)
- David A Gorelick
- Chemistry & Drug Metabolism Section Intramural Research Program, National Institute on Drug Abuse, NIH, 251 Bayview Boulevard, Baltimore, MD 21224, USA.
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Abstract
Nicotine replacement therapy (NRT) is a valuable, proven, and U.S. Food and Drug Administration-approved tool for smoking cessation. However, the discoveries of functional nicotinic acetylcholine receptors (nAChR) on lung epithelial and cancer cells and of nAChR polymorphisms associated with lung cancer risk, in addition to a large number of preclinical studies indicating that nicotine may promote or facilitate cancer development and growth, have prompted concern that NRT, although important for smoking cessation, may actually augment lung carcinogenesis. Therefore, it is of great public health interest that two independent studies reported in this issue of the journal (Murphy and colleagues, beginning on page 1752, and Maier and colleagues, beginning on page 1743) showed that nicotine given in drinking water at a dose to achieve blood concentrations in mice similar to those achieved in people receiving NRT did not enhance lung carcinogenesis or tumor growth in several mouse models of lung cancer. Effective non-nicotine alternatives to NRT, such as varenicline and bupropion, are also available and perhaps better than NRT for smoking cessation therapy. In the near future, nicotine vaccines will likely be added to the smoking cessation armamentarium. However, the normal and pathophysiologic role of nicotine, nAChRs, and the signaling pathways they activate in lung epithelial cells and lung cancer still requires elucidation.
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Affiliation(s)
- David C.L. Lam
- Department of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - John D. Minna
- Hamon Center for Therapeutic Oncology Research & Simmons Cancer Center, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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