4-aryl-5-(4-piperidyl)-3-isoxazolol GABAA antagonists: synthesis, pharmacology, and structure-activity relationships.

A series of 4-aryl-5-(4-piperidyl)-3-isoxazolol GABAA antagonists have been synthesized and pharmacologically characterized. The meta-phenyl-substituted compounds 9k and 9m and the para-phenoxy-substituted compound 9l all display high affinities (Ki=10-70 nM) and antagonist potencies in the low nanomolar range (Ki=9-10 nM). These potencies are significantly higher than those of previously reported 4-PIOL antagonists and considerably higher than that of the standard GABAA antagonist SR 95531.

Depression and poor sleep: the effect of monoaminergic antidepressants in a pre-clinical model in rats.

The effects of five antidepressants (escitalopram, paroxetine, duloxetine, venlafaxine, and reboxetine) on the sleep architecture were investigated in freely moving rats in the light phase of a 12:12 h light:dark cycle following a single i.p. dose of antidepressant. Overall, paroxetine and escitalopram exhibited the least sleep disruptive profiles, whereas duloxetine, venlafaxine, and reboxetine increased the time spent awake and suppressed paradoxical sleep. Analysis of the EEG at 1 h intervals revealed only subtle differences from the overall picture. The effect of venlafaxine on disruption of sleep architecture could not be readily explained by its in vitro serotonin (5-HT) and noradrenaline (NA) reuptake inhibitory potencies. In vivo microdialysis experiments in the ventral hippocampus of freely moving rats revealed that venlafaxine affected the 5-HT and NA systems equally at the doses tested. Duloxetine (7.7 mg/kg) induced maximal blockade of the 5-HT transporter and duloxetine 7.7 mg/kg also modulated the noradrenaline system. Thus, in this animal model, the enhancement of noradrenergic activity is more disruptive on the sleep architecture than enhancement of serotonergic activity.

Potent 4-arylalkyl-substituted 3-isothiazolol GABA(A) competitive/noncompetitive antagonists: synthesis and pharmacology.

The GABA(A) agonists muscimol (1), 4,5,6,7-tetrahydroisoxazolo[5,4-c]pyridin-3-ol (THIP, gaboxadol, 3), and the partial GABA(A) agonist 5-(4-piperidyl)-3-isoxazolol (4-PIOL, 6a) and their respective 3-isothiazolol analogues thiomuscimol (2), thio-THIP (4), and thio-4-PIOL (7a) are ligands at the GABA(A) orthosteric (recognition) site. The structure-activity relationships (SARs) between these structures are key elements of a 3D-pharmacophore model for GABA(A) agonists and competitive antagonists [Frølund, B.; Jørgensen, A. T.; Tagmose, L.; Stensbøl, T. B.; Vestergaard, H. T.; Engblom, C.; Kristiansen, U.; Sanchez, C.; Krogsgaard-Larsen, P.; Liljefors, T. J. Med. Chem. 2002, 45, 2454-2468]. Prompted by this model, we now report the synthesis and SAR of a series of analogues of 7a, in which the 4-position of the 3-isothiazolol was substituted by alkyl or bulky aromatic groups such as naphthylmethyl and diphenylalkyl groups (7b-h). The compounds have been pharmacologically characterized using receptor binding assays and two-electrode voltage-clamped Xenopus oocytes expressing alpha1beta3gamma2S- and alpha4beta3delta-containing receptors. The compounds show SARs comparable with those of 6b-h but are generally 5-15 times more potent. The 2-naphthylmethyl, the 1-bromo-2-naphthylmethyl, and the 3,3-diphenylpropyl analogues, compounds 7e, 7f, and 7h, respectively, show affinity in the low-nanomolar range (K(i) 2-10 nM). Interestingly, 7e and 7h exhibited a mixed antagonist profile consisting of a noncompetitive component in the picomolar range and a competitive component at concentrations above 1 nM. This unique profile was shown not to be due to either use dependence or kinetic effects. This antagonist profile of 7e and 7h was particularly pronounced at alpha4beta3delta-containing GABA(A) receptors, which showed three- and 10-fold selectivity for 7h and 6h, respectively.

R-citalopram functionally antagonises escitalopram in vivo and in vitro: evidence for kinetic interaction at the serotonin transporter.

1. Clinical observations with the selective serotonin reuptake inhibitor (SSRI), S-citalopram, indicate that S-citalopram is more efficacious and produces earlier symptom relief than RS-citalopram. Since R-citalopram is at least 20-fold weaker than S-citalopram as inhibitor of the 5-HT transporter (SERT) in preclinical studies, the clinical data suggest an unexpected antagonistic interaction between the two enantiomers. We therefore characterised the interaction of R- and S-citalopram with the SERT in in vivo and in vitro assays. 2. In both behavioural (potentiation of 5-hydroxytryptophan (5-HTP)-induced behaviour) and electrophysiological studies (inhibition of 5-HT-elicited ion currents in Xenopus oocytes expressing the human SERT (hSERT) R-citalopram inhibited the effects of S-citalopram in a dose-dependent manner. With S-citalopram : R-citalopram ratios of 1 : 2 and 1 : 4, 5-HTP potentiation was significantly smaller than with S-citalopram alone. 3. R-citalopram did not antagonise the effects of another SSRI (fluoxetine) in either behavioural or electrophysiological studies. 4. In oocytes, inhibition of hSERT-mediated currents by R-citalopram was almost completely reversible and characterised by fast on- and off-sets of action. In contrast, the off-set for S-citalopram was 35-fold slower than for R-citalopram. 5. Kinetic analysis of the oocyte experiments suggests that S-citalopram binding to SERT induces a long-lasting, inhibited state of the transporter and that coapplication of R-citalopram partially relieves SERT of this persistent inhibition. 6. We propose that the kinetic interaction of R- and S-citalopram with SERT is a critical factor contributing to the antagonistic effects of R-citalopram on S-citalopram in vitro and in vivo.

Gaboxadol: in vitro interaction studies with benzodiazepines and ethanol suggest functional selectivity.

The interaction of gaboxadol (THIP; 4,5,6,7-tetrahydroisoxazolo-[5,4-c]pyridin-3-ol), ethanol and a series of benzodiazepine site agonists including diazepam, flunitrazepam, lorazepam, indiplon, zaleplon and zolpidem has been characterized at human alpha(1)beta(3)gamma(2S) gamma-aminobutyric acid type A (GABA(A)) receptors expressed in Xenopus oocytes and in the rat cortical wedge preparation. At the expressed receptors, gaboxadol and the benzodiazepine site agonists interacted synergistically and ethanol did not further enhance this potentiation. In contrast, in the rat cortical wedge preparation, where the inhibition of spontaneous activity was assessed, much weaker effects of the benzodiazepine site agonists were seen. Furthermore, ethanol did not further potentiate the effects of gaboxadol. These findings suggest that gaboxadol in functionally intact tissue may interact with a receptor population, which is insensitive to the modulation by benzodiazepines.

A 2-week efficacy and safety study of gaboxadol and zolpidem using electronic diaries in primary insomnia outpatients.

OBJECTIVES: To evaluate the efficacy and safety profile of gaboxadol, a selective extrasynaptic GABA(A) agonist (SEGA) previously in development for the treatment of insomnia. METHODS: This was a randomised, double-blind, placebo-controlled, parallel-group, 2-week, Phase III study of gaboxadol 5, 10 and 15mg in outpatients meeting the DSM-IV criteria of primary insomnia (N=742). Zolpidem 10mg was used as active reference. RESULTS: At weeks 1 and 2, significant improvement in total sleep time (sTST) compared to placebo was seen for all doses of gaboxadol (all p<0.05). In addition, gaboxadol 10 and 15mg decreased the number of awakenings (sNAW) (p<0.05) while only gaboxadol 15mg improved wakefulness after sleep onset (sWASO) (p<0.05). At week 1, all doses of gaboxadol significantly improved time-to-sleep onset (sTSO) (p<0.05). At week 2, a sustained effect on sTSO was observed for gaboxadol 15mg. Zolpidem also showed effect on all of these variables. Gaboxadol and zolpidem improved sleep quality, freshness after sleep, daytime function and energy at both weeks. Transient rebound insomnia was observed following discontinuation of treatment with zolpidem, but not gaboxadol. CONCLUSIONS: Gaboxadol 15mg treatment for 2 weeks significantly improved sleep onset and maintenance variables as well as sleep quality and daytime function, as did zolpidem. Gaboxadol 5 and 10mg also showed benefits on most efficacy variables. Gaboxadol was generally safe and well tolerated, with no evidence of withdrawal symptoms or rebound insomnia after discontinuation of short-term treatment. For zolpidem, transient rebound insomnia was observed.

Pharmacological characterization of agonists at delta-containing GABAA receptors: Functional selectivity for extrasynaptic receptors is dependent on the absence of gamma2.

Several groups have characterized the pharmacology of alpha4- or alpha6beta3delta-containing GABA(A) receptors expressed in different cell systems. We have previously demonstrated that the pharmacological profiles of a series of GABA(A) receptor agonists are highly dependent on the alpha subunit and little on the beta and gamma subunits, so to further understand the contribution of the different subunits in the GABA(A) receptor complex, we characterized a series of full agonists, partial agonists, and antagonists at alpha4beta3, alpha4beta3delta, and alpha6beta3delta receptors expressed in Xenopus oocytes. Little or no difference was seen when the compounds were compared at alphabeta- and alphabetadelta-containing receptors, whereas a significant reduction in both potency and relative efficacy was observed compared with alphabetagamma-containing receptors described in the literature. These data clearly confirm that the presence of the delta subunit in heterotrimeric receptors is a strong determinant of the increased pharmacological activity of compounds with agonist activity. The very similar agonist pharmacology of alphabeta- and alphabetadelta-containing receptors, which is significantly different from that of alphabetagamma-containing receptors, shows that whereas the presence of a gamma subunit impairs the response to an agonist stimulation of the alphabeta receptor complex, the delta subunit does not affect this in any way. Taken together, these data are well in line with the idea that alpha4beta3delta may contribute to the pharmacological action of exogenously applied agonists and may explain why systemically active compounds such as gaboxadol and muscimol in vivo appear to act as selective extrasynaptic GABA(A) agonists.

The delta subunit of gamma-aminobutyric acid type A receptors does not confer sensitivity to low concentrations of ethanol.

GABA(A) receptors (GABA(A)Rs) are usually formed by alpha, beta, and gamma or delta subunits. Recently, delta-containing GABA(A)Rs expressed in Xenopus oocytes were found to be sensitive to low concentrations of ethanol (1-3 mM). Our objective was to replicate and extend the study of the effect of ethanol on the function of alpha4beta3delta GABA(A)Rs. We independently conducted three studies in two systems: rat and human GABA(A)Rs expressed in Xenopus oocytes, studied through two-electrode voltage clamp; and human GABA(A)Rs stably expressed in the fibroblast L(tk-) cell line, studied through patch-clamp electrophysiology. In all cases, alpha4beta3delta GABA(A)Rs were only sensitive to high concentrations of ethanol (100 mM in oocytes, 300 mM in the cell line). Expression of the delta subunit in oocytes was assessed through the magnitude of the maximal GABA currents and sensitivity to zinc. Of the three rat combinations studied, alpha4beta3 was the most sensitive to ethanol, isoflurane, and 5alpha-pregnan-3alpha,21-diol-20-one (THDOC); alpha4beta3delta and alpha4beta3gamma(2S) were very similar in most aspects, but alpha4beta3delta was more sensitive to GABA, THDOC, and lanthanum than alpha4beta3gamma(2S) GABA(A)Rs. Ethanol at 30 mM did not affect tonic GABA-mediated currents in dentate gyrus reported to be mediated by GABA(A)Rs incorporating alpha4 and delta subunits. We have not been able to replicate the sensitivity of alpha4beta3delta GABA(A)Rs to low concentrations of ethanol in four different laboratories in independent studies. This suggests that as yet unidentified factors may play a critical role in the ethanol effects on delta-containing GABA(A)Rs.