ABSTRACT
BACKGROUND: Data on drug-induced reversible cerebral vasoconstriction syndrome (RCVS) are scarce. We aimed to describe RCVS characteristics with drugs previously identified as associated with RCVS and investigate potential signals related to other drugs. METHODS: VigiBase® was queried for all reports of RCVS until 31 May 2023. A descriptive study was performed on reports concerning drug classes known to precipitate RCVS. To identify new drugs, a disproportionality analysis was conducted. RESULTS: In total, 560 reports were included. RCVS occurred in patients aged between 45-64 years (40%) and 18-44 years (35%), mainly in females (72.5%). Drugs were antidepressants (38.4%), triptans (6.4%), nasal decongestants (3.7%) and immunosupressants (8.7%). In 50 cases, antidepressants were in association with drugs known to precipitate RCVS. The median time to onset was 195 days for antidepressants and much shorter (1-10 days) for triptans, nasal decongestants and immunosuppressants. The outcome was favorable in 87% of cases, and fatal in 4.4%. We found a disproportionality signal with 14 drugs: glucocorticoids, bupropion, varenicline, mycophenolic acid, aripiprazole, trazodone, monoclonal antibodies (erenumab, ustekinumab and tocilizumab), leuprorelin and anastrozole. CONCLUSIONS: The present study confirms the role of vasoconstrictors in the onset of RCVS, particularly when used in combination and found potential signals, which may help clinicians envisage an iatrogenic etiology of RCVS.
Subject(s)
Pharmacovigilance , Humans , Female , Middle Aged , Male , Adult , Adolescent , Young Adult , Vasospasm, Intracranial/chemically induced , Vasospasm, Intracranial/epidemiology , Antidepressive Agents/adverse effects , Nasal Decongestants/adverse effects , Immunosuppressive Agents/adverse effects , Tryptamines/adverse effects , AgedABSTRACT
BACKGROUND: Migraine presents a significant global health problem that emphasizes the need for efficient acute treatment options. Triptans, introduced in the early 1990s, have substantially advanced migraine management owing to their effectiveness compared to that of traditional medications. However, data on triptan use in migraine management from Asian countries, where migraines tend to have milder symptoms than those in European and North American countries, are limited. This study aimed to identify the trends in triptan usage in Korea. METHODS: This retrospective cohort study used data from the Korean National Health Insurance Service-National Sample Cohort spanning from 2002 to 2019. Patients with migraine were identified using the International Classification of Diseases 10th revision codes, and triptan prescriptions were evaluated annually in terms of quantity, pills per patient, and associated costs. The distribution of triptan prescriptions across different medical specialties was also examined. Factors contributing to the odds of triptan use were analyzed using multivariable logistic regression. RESULTS: From 2002 to 2019, the total number of triptan tablets, prescriptions, and patients using triptans increased by 24.0, 17.1, and 13.6 times, respectively, with sumatriptan being the most frequently prescribed type of triptan. Additionally, the number of prescriptions and related costs have consistently increased despite stable pricing because of government regulation. By 2019, only approximately one-tenth of all patients with migraines had been prescribed triptans, although there was a notable increase in prescriptions over the study period. These prescription patterns varied according to the physician's specialty. After adjusting for patient-specific factors including age and sex, the odds of prescribing triptans were higher for neurologists than for internal medicine physicians (odds ratio 2.875, P < 0.001), while they were lower for general practitioners (odds ratio 0.220, P < 0.001). CONCLUSION: The findings revealed an increasing trend in triptan use among individuals with migraines in Korea, aligning with global usage patterns. Despite these increases, the overall prescription rate of triptans remains low, indicating potential underutilization and highlighting the need for improved migraine management strategies across all medical fields. Further efforts are necessary to optimize the use of triptans in treating migraines effectively.
Subject(s)
Migraine Disorders , Tryptamines , Humans , Republic of Korea , Migraine Disorders/drug therapy , Female , Tryptamines/therapeutic use , Male , Retrospective Studies , Middle Aged , Adult , Aged , Young Adult , Practice Patterns, Physicians'/trends , Logistic Models , Databases, Factual , Drug Prescriptions/statistics & numerical data , Sumatriptan/therapeutic use , Cohort Studies , Odds Ratio , AdolescentABSTRACT
OBJECTIVE: The objective of this study was to describe and discuss patterns of migraine medication use in the entire Norwegian population. METHODS: In this nationwide, observational study, all individuals with a migraine-related prescription between 2010 and 2020 were identified using the Norwegian Prescription Database. The outcomes of interest were the incidence and 1-year prevalence of migraine medication users, as well as individuals with triptan overuse. Patterns of medication use were statistically compared between women and men adjusted for age, year of treatment start, comorbidities and county of residence calculating adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: We identified 327,904 migraine medication users. The incidence ranged from 0.39% to 0.46%, and the 1-year prevalence increased from 1.99% to 2.99%. Preventive use increased >50% during the study period. Preventives were significantly more often prescribed to women than to men (39.72% vs. 33.75%; aOR 1.41, 95% CI 1.38 to 1.44). Triptan overuse was significantly more common among women, but women with overuse were more often using preventives, as compared to men (56.64% vs 52.69%; aOR = 1.43, 95% CI 1.37 to 1.49). CONCLUSION: The prevalence of medically treated migraine is low. Overuse of triptans is frequent, especially among women. Clinicians should be encouraged to try out different triptans, recognize triptan overuse, and prescribe preventives when indicated.
Subject(s)
Migraine Disorders , Registries , Tryptamines , Humans , Migraine Disorders/drug therapy , Migraine Disorders/epidemiology , Norway/epidemiology , Female , Male , Adult , Middle Aged , Aged , Young Adult , Tryptamines/therapeutic use , Adolescent , Prevalence , Analgesics/therapeutic useABSTRACT
Diphenylalanine(FF)-Zn self-assembly (FS) confined in covalent organic polymers (FS@COPs) with efficient fluorescence was synthesized for fluorescence sensing of biogenic amines, which was one of the most important indicators for monitoring food freshness. FS@COPs combined excellent biodegradability of self-assembled dipeptide with chemical stability, porosity and targeted site recognition of COPs. With an optimal excitation wavelength of 360 nm and an optimal emission wavelength of 450 nm, FS@COPs could be used as fluorescence probes to rapidly visualize and highly sensitive determination of tryptamine (Try) within 15 min, and the linear range was from 40 to 900 µg L-1 with a detection limit of 63.08 µg kg-1. Importantly, the FS@COPs showed a high fluorescence quantum yield of 11.28%, and good stability, solubility, and selectivity, which could successfully achieve the rapid, accurate and highly sensitive identification of Try. Furthermore, we revealed the mechanism of FS@COPs for fluorescence sensing of targets. The FS@COPs system was applied to the fluorescence sensing of Try in real samples and showed satisfactory accuracy of 93.02%-105.25%.
Subject(s)
Dipeptides , Fluorescent Dyes , Limit of Detection , Spectrometry, Fluorescence , Tryptamines , Tryptamines/analysis , Tryptamines/chemistry , Dipeptides/chemistry , Dipeptides/analysis , Fluorescent Dyes/chemistry , Spectrometry, Fluorescence/methods , Meat Products/analysis , Polymers/chemistryABSTRACT
Probiotics offer a promising prophylactic approach against various pathogens and represent an alternative strategy to combat biofilm-related infections. In this study, we isolated vaginal commensal microbiota from 54 healthy Indian women to investigate their probiotic traits. We primarily explored the ability of cell-free supernatant (CFS) from Lactobacilli to prevent Uropathogenic Escherichia coli (UPEC) colonization and biofilm formation. Our findings revealed that CFS effectively reduced UPEC's swimming and swarming motility, decreased cell surface hydrophobicity, and hindered matrix production by downregulating specific genes (fimA, fimH, papG, and csgA). Subsequent GC-MS analysis identified Tryptamine, a monoamine compound, as the potent bioactive substance from Lactobacilli CFS, inhibiting UPEC biofilms with an MBIC of 4 µg/ml and an MBEC of 8 µg/ml. Tryptamine induced significant changes in E. coli colony biofilm morphology, transitioning from the Red, Dry, and Rough (RDAR) to the Smooth and White phenotype, indicating reduced extracellular matrix production. Biofilm time-kill assays demonstrated a four-log reduction in UPEC viability when treated with Tryptamine, highlighting its potent antibacterial properties, comparable to CFS treatment. Biofilm ROS assays indicated a significant elevation in ROS generation within UPEC biofilms, suggesting a potential antibacterial mechanism. Gene expression studies with Tryptamine-treated samples showed a reduction in expression of curli gene (csgA), consistent with CFS treatment. This study underscores the potential of Tryptamine from probiotic Lactobacilli CFS as a promising antibiofilm agent against UPEC biofilms.
Subject(s)
Biofilms , Lactobacillus , Probiotics , Tryptamines , Uropathogenic Escherichia coli , Vagina , Biofilms/drug effects , Biofilms/growth & development , Humans , Tryptamines/pharmacology , Female , Uropathogenic Escherichia coli/drug effects , Uropathogenic Escherichia coli/physiology , Probiotics/pharmacology , Vagina/microbiology , Lactobacillus/drug effects , Lactobacillus/metabolism , Lactobacillus/physiology , Escherichia coli Infections/microbiology , Escherichia coli Infections/drug therapy , Escherichia coli Infections/prevention & control , Adult , Anti-Bacterial Agents/pharmacologyABSTRACT
Mushroom poisoning is a significant contributor to foodborne disease outbreaks in China. This study focuses on two Panaeolus subbalteatus poisoning incidents accompanied by epidemiological investigations, species identification, and toxin detection in Ningxia, northwest China. In these two poisoning incidents, some patients exhibited gastrointestinal or neurological symptoms approximately 0.5 h after ingestion of a large amount of wild mushroom. Specifically, in Case 1, one of the three patients experienced nausea, vomiting, and numbness in the throat and limbs; in Case 2, one patient reported dizziness and an abnormal sense of direction. Through morphological and phylogenetic analyses, mushroom specimens were identified as P. subbalteatus. Psilocybin and psilocin were detected in mushroom samples, and only psilocin was detected in biological samples by liquid chromatography-triple quadrupole-linear ion trap mass spectrometry screening. The average psilocybin and psilocin contents in mushroom samples were 1532.2-1760.7 and 114.5-136.0 mg/kg (n = 3), respectively. Moreover, only psilocin was detected in blood and urine samples, with average concentrations 0.5-1.2 ng/mL (n = 3) and 2.5-3.1 ng/mL (n = 3), respectively. These findings provide technical support for managing similar incidents in the future.
Subject(s)
Mushroom Poisoning , Psilocybin , Mushroom Poisoning/diagnosis , China , Psilocybin/analogs & derivatives , Humans , Tryptamines/analysis , Male , Adult , Female , Phylogeny , Middle AgedABSTRACT
N, N-dimethyltryptamine (DMT) is a psychedelic tryptamine acting on 5-HT2A serotonin receptors, which is associated with intense visual hallucinatory phenomena and perceptual changes such as distortions in visual space. The neural underpinnings of these effects remain unknown. We hypothesised that changes in population receptive field (pRF) properties in the primary visual cortex (V1) might underlie visual perceptual experience. We tested this hypothesis using magnetic resonance imaging (MRI) in a within-subject design. We used a technique called pRF mapping, which measures neural population visual response properties and retinotopic maps in early visual areas. We show that in the presence of visual effects, as documented by the Hallucinogen Rating Scale (HRS), the mean pRF sizes in V1 significantly increase in the peripheral visual field for active condition (inhaled DMT) compared to the control. Eye and head movement differences were absent across conditions. This evidence for short-term effects of DMT in pRF may explain perceptual distortions induced by psychedelics such as field blurring, tunnel vision (peripheral vision becoming blurred while central vision remains sharp) and the enlargement of nearby visual space, particularly at the visual locations surrounding the fovea. Our findings are also consistent with a mechanistic framework whereby gain control of ongoing and evoked activity in the visual cortex is controlled by activation of 5-HT2A receptors.
Subject(s)
Hallucinogens , Magnetic Resonance Imaging , Humans , Hallucinogens/pharmacology , Adult , Male , Female , Young Adult , Visual Cortex/drug effects , Visual Cortex/physiology , Visual Cortex/diagnostic imaging , Perceptual Distortion/drug effects , Perceptual Distortion/physiology , N,N-Dimethyltryptamine/pharmacology , Visual Fields/drug effects , Visual Fields/physiology , Visual Perception/drug effects , Visual Perception/physiology , Tryptamines/pharmacology , Primary Visual Cortex/drug effects , Primary Visual Cortex/physiology , Primary Visual Cortex/diagnostic imaging , Brain Mapping/methodsABSTRACT
ABSTRACT: INTRODUCTION: Nurses have a central role in educating patients and families about treatment options and how to integrate them into action plans for neurologic conditions. In recent years, a growing number of intranasal formulations have become available as rescue therapy for neurologic conditions or symptoms including migraine, opioid overdose, and seizures. Rescue therapies do not replace maintenance medications or emergency care but are designed to enable rapid treatment of urgent or disabling conditions in community settings. Yet, discussion of rescue therapies for neurologic conditions remains limited in nursing literature. CONTENT: Intranasal formulations are specifically formulated for delivery and absorption in the nose and have several characteristics that are well suited as rescue therapies for neurologic conditions. Intranasal formulations include triptans for migraine, naloxone and nalmefene for opioid overdose, and benzodiazepines for seizure clusters in patients with epilepsy. Therapeutic attributes discussed here include ease of use in community settings by nonmedical professionals, relatively rapid onset of action, and favorable safety profile and patient experience. This information is critical for nurses to make informed decisions about rescue therapy options, incorporate these into plans of care, and educate patients, care partners, and other healthcare providers. CONCLUSION: Rescue therapies are increasingly important in the care of people with neurologic conditions. Various formulations are available and continue to evolve, offering easy and quick ways for nurses, patients, and nonmedical care partners to administer critical rescue medications. For nurses overseeing medication management, the attributes of intranasal rescue therapies should be considered in the context of providing patients with the right care at the right time.
Subject(s)
Administration, Intranasal , Nervous System Diseases , Humans , Analgesics, Opioid/adverse effects , Analgesics, Opioid/antagonists & inhibitors , Benzodiazepines/administration & dosage , Benzodiazepines/therapeutic use , Naloxone/administration & dosage , Naloxone/therapeutic use , Narcotic Antagonists/administration & dosage , Narcotic Antagonists/therapeutic use , Nervous System Diseases/chemically induced , Nervous System Diseases/drug therapy , Tryptamines/therapeutic use , Tryptamines/administration & dosageABSTRACT
AIM: To document and assess acute and preventive medication use in people with migraine disease in Aotearoa New Zealand. METHODS: Online survey of people with migraine in Aotearoa New Zealand (n=530), run from 22 August to 7 October 2022, including questions on current and previous acute and preventive medication use, reasons for medication discontinuation and use of new migraine medications. RESULTS: Most respondents had used simple analgesics for acute treatment; 55% were currently using a triptan; 27% were currently using an opioid. Overall, 27% of survey respondents had over-used at least one acute medication in the last month. Half of respondents were taking at least one preventive medication but only 57% of those eligible for preventive treatment were currently taking it. In those who had previously tried preventives, side effects and lack of efficacy were common reasons for stopping. Cost, lack of knowledge and awareness were the main barriers to use of new migraine medications. CONCLUSION: Many people with migraine in Aotearoa New Zealand are not receiving optimal treatment, which increases the burden and cost of migraine disease. More effective and tolerable acute and preventive medications are needed that are affordable and available in Aotearoa New Zealand. Greater awareness of best practice prescribing is also needed.
Subject(s)
Analgesics , Migraine Disorders , Humans , Migraine Disorders/drug therapy , Migraine Disorders/prevention & control , New Zealand , Male , Female , Adult , Middle Aged , Analgesics/therapeutic use , Tryptamines/therapeutic use , Surveys and Questionnaires , Young Adult , Analgesics, Opioid/therapeutic use , Adolescent , AgedABSTRACT
Background: Psilocybin and related tryptamines have come into the spotlight in recent years as potential therapeutics for depression. Research on the mechanisms of these effects has historically focused on the direct effects of these drugs on neural processes. However, in addition to such neural effects, alterations in peripheral physiology may also contribute to their therapeutic effects. In particular, substantial support exists for a gut microbiome-mediated pathway for the antidepressant efficacy of other drug classes, but no prior studies have determined the effects of tryptamines on microbiota. Methods: To address this gap, in this preliminary study, male Long Evans rats were treated with varying dosages of oral psilocybin (0.2 or 2 mg/kg), norbaeocystin (0.25 or 2.52 mg/kg), or vehicle and their fecal samples were collected 1 week and 3 weeks after exposure for microbiome analysis using integrated 16S ribosomal DNA sequencing to determine gut microbiome composition. Results: We found that although treatment with neither psilocybin nor norbaeocystin significantly affected overall microbiome diversity, it did cause significant dose- and time-dependent changes in bacterial abundance at the phylum level, including increases in Verrucomicrobia and Actinobacteria, and decreases in Proteobacteria. Conclusion and Implications: These preliminary findings support the idea that psilocybin and other tryptamines may act on the gut microbiome in a dose- and time-dependent manner, potentially identifying a novel peripheral mechanism for their antidepressant activity. The results from this preliminary study also suggest that norbaeocystin may warrant further investigation as a potential antidepressant, given the similarity of its effects to psilocybin.
Subject(s)
Feces , Gastrointestinal Microbiome , Rats, Long-Evans , Tryptamines , Animals , Gastrointestinal Microbiome/drug effects , Male , Tryptamines/pharmacology , Tryptamines/administration & dosage , Rats , Feces/microbiology , Psilocybin/pharmacology , Psilocybin/administration & dosage , Administration, Oral , Antidepressive Agents/pharmacology , Antidepressive Agents/administration & dosageABSTRACT
Neuroinflammation is an important factor that exacerbates neuronal death and abnormal synaptic function in neurodegenerative diseases (NDDs). Due to the complex pathogenesis and the presence of blood-brain barrier (BBB), no effective clinical drugs are currently available. Previous results showed that N-salicyloyl tryptamine derivatives had the potential to constrain the neuroinflammatory process. In this study, 30 new N-salicyloyl tryptamine derivatives were designed and synthesized to investigate a structure-activity relationship (SAR) for the indole ring of tryptamine in order to enhance their antineuroinflammatory effects. Among them, both in vitro and in vivo compound 18 exerted the best antineuroinflammatory effects by suppressing the activation of microglia, which is the culprit of neuroinflammation. The underlying mechanism of its antineuroinflammatory effect may be related to the inhibition of transcription, expression and phosphorylation of signal transducer and activator of transcription 3 (STAT3) that subsequently regulated downstream cyclooxygenase-2 (COX-2) expression and activity. With its excellent BBB permeability and pharmacokinetic properties, compound 18 exhibited significant neuroprotective effects in the hippocampal region of lipopolysaccharides (LPS)-induced mice than former N-salicyloyl tryptamine derivative L7. In conclusion, compound 18 has provided a new approach for the development of highly effective antineuroinflammatory therapeutic drugs targeting microglia activation.
Subject(s)
Microglia , Neuroinflammatory Diseases , Neuroprotective Agents , STAT3 Transcription Factor , Tryptamines , Animals , Microglia/drug effects , Microglia/metabolism , Tryptamines/pharmacology , STAT3 Transcription Factor/metabolism , Mice , Neuroinflammatory Diseases/drug therapy , Neuroinflammatory Diseases/metabolism , Neuroprotective Agents/pharmacology , Neuroprotective Agents/chemical synthesis , Signal Transduction/drug effects , Lipopolysaccharides/pharmacology , Blood-Brain Barrier/drug effects , Blood-Brain Barrier/metabolism , Anti-Inflammatory Agents/pharmacology , Mice, Inbred C57BL , Structure-Activity Relationship , Male , Cyclooxygenase 2/metabolism , Hippocampus/drug effects , Hippocampus/metabolismABSTRACT
The landscape of acute migraine medication has changed fundamentally in recent years. It has been a gradual, often unnoticed process characterized less by spectacular introduction of new substances than by changes in patients' access to medications and individualized selection of treatment adapted to the patients' needs. Four triptans are now available over-the-counter in Germany which has a major influence on self-medication. The main new introduction was the 5HT1F-agonist lasmiditan as an alternative to triptans.
Subject(s)
Migraine Disorders , Tryptamines , Migraine Disorders/therapy , Migraine Disorders/drug therapy , Humans , Tryptamines/therapeutic use , Piperidines/therapeutic use , Serotonin Receptor Agonists/therapeutic use , Benzamides/therapeutic use , Pyridines/therapeutic useABSTRACT
Our previous research has shown that melatonin (MLT) can reduce cryopreserved ovarian damage in mice. Yet, the molecular mechanism of MLT protection is still unclear. Some studies have shown that melatonin receptor 1 (MT1) is very important for animal reproductive system. To evaluate whether MLT exerts its protective effect on cryopreserved mice ovarian tissue via MT1, we added antagonist of MT1/MT2 (Luzindor) or antagonist of MT2 (4P-PDOT) to the freezing solution, followed by cryopreservation and thawing of ovarian tissue. The levels of total superoxide dismutase (T-SOD), catalase (CAT), nitric oxide (NO) and malondialdehyde (MDA) were detected. Besides, by using RT-PCR and Western blotting, the expression of Bcl-2, Bax and Nrf2/HO-1 signalling pathway-related proteins was detected. These findings demonstrated that compared with the melatonin group, the addition of Luzindor increased apoptosis, NO and MDA activities, decreased CAT and T-SOD activities and inhibited Nrf2/HO-1 signalling pathway. In conclusion, melatonin can play a protective role in cryopreserved ovarian tissue of mice through MT1 receptor.
Subject(s)
Cryopreservation , Melatonin , NF-E2-Related Factor 2 , Ovary , Oxidative Stress , Receptor, Melatonin, MT1 , Signal Transduction , Animals , Female , Melatonin/pharmacology , Oxidative Stress/drug effects , Ovary/drug effects , Receptor, Melatonin, MT1/metabolism , Receptor, Melatonin, MT1/genetics , Signal Transduction/drug effects , NF-E2-Related Factor 2/metabolism , NF-E2-Related Factor 2/genetics , Mice , Cryopreservation/veterinary , Tryptamines/pharmacology , Apoptosis/drug effects , Heme Oxygenase (Decyclizing)/metabolism , Heme Oxygenase (Decyclizing)/genetics , Nitric Oxide/metabolism , Malondialdehyde/metabolism , Membrane Proteins , Heme Oxygenase-1ABSTRACT
BACKGROUND AND OBJECTIVES: Atogepant is an oral, calcitonin gene-related peptide receptor antagonist approved for the preventive treatment of migraine. We evaluated the efficacy of atogepant for the preventive treatment of chronic migraine (CM) in participants with and without acute medication overuse. METHODS: This subgroup analysis of the phase 3, 12-week, randomized, double-blind, placebo-controlled PROGRESS trial evaluated adults with a ≥1-year history of CM, ≥15 monthly headache days (MHDs), and ≥8 monthly migraine days (MMDs) during the 4-week baseline period. Participants were randomized (1:1:1) to placebo, atogepant 30 mg twice daily (BID), or atogepant 60 mg once daily (QD) for 12 weeks and were analyzed by acute medication overuse status (triptans/ergots for ≥10 days per month, simple analgesics for ≥15 days per month, or combinations of triptans/ergots/simple analgesics for ≥10 days per month). Outcomes included change from baseline in mean MMDs, MHDs, and monthly acute medication use days; ≥50% reduction in mean MMDs across 12 weeks; and patient-reported outcome (PRO) measures. RESULTS: Of 755 participants in the modified intent-to-treat population, 500 (66.2%) met baseline acute medication overuse criteria (placebo, n = 169 [68.7%]; atogepant 30 mg BID, n = 161 [63.6%]; atogepant 60 mg QD, n = 170 [66.4%]). The least squares mean difference (LSMD) (95% CI) from placebo in MMDs was -2.7 (-4.0 to -1.4) with atogepant 30 mg BID and -1.9 (-3.2 to -0.6) with atogepant 60 mg QD. Mean MHDs (LSMD [95% CI] -2.8 [-4.0 to -1.5] and -2.1 [-3.3 to -0.8]) and mean acute medication use days (LSMD [95% CI] -2.8 [-4.1 to -1.6] and -2.6 [-3.9 to -1.3]) were reduced and a higher proportion of participants achieved ≥50% reduction in MMDs (odds ratio [95% CI] 2.5 [1.5-4.0] and 2.3 [1.4-3.7]) with atogepant 30 mg BID and atogepant 60 mg QD. There was a 52.1%-61.9% reduction in the proportion of atogepant-treated participants meeting acute medication overuse criteria over 12 weeks. Atogepant improved PRO measures. Similar results were observed in the subgroup without acute medication overuse. DISCUSSION: Atogepant was effective in participants with CM, with and without acute medication overuse, as evidenced by reductions in mean MMDs, MHDs, and acute medication use days; reductions in the proportion of participants meeting acute medication overuse criteria; and improvements in PROs. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov NCT03855137. Submitted: February 25, 2019; first patient enrolled: March 11, 2019. clinicaltrials.gov/ct2/show/NCT03855137. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that atogepant reduces mean MMDs, MHDs, and monthly acute medication use days in adult patients with or without medication overuse.
Subject(s)
Calcitonin Gene-Related Peptide Receptor Antagonists , Migraine Disorders , Humans , Migraine Disorders/drug therapy , Double-Blind Method , Male , Female , Adult , Middle Aged , Calcitonin Gene-Related Peptide Receptor Antagonists/therapeutic use , Calcitonin Gene-Related Peptide Receptor Antagonists/administration & dosage , Chronic Disease , Treatment Outcome , Analgesics/therapeutic use , Analgesics/administration & dosage , Tryptamines/therapeutic use , Headache Disorders, Secondary/drug therapyABSTRACT
In conventional chromatographic ligand screening, underperforming ligands are often dismissed. However, this practice may inadvertently overlook potential opportunities. This study aims to investigate whether these underperforming ligands can be repurposed as valuable assets. Hydrophobic charge-induction chromatography (HCIC) is chosen as the validation target for its potential as an innovative chromatographic mode. A novel dual-ligand approach is employed, combining two suboptimal ligands (5-Aminobenzimidazole and Tryptamine) to explore enhanced performance and optimization prospects. Various dual-ligand HCIC resins with different ligand densities were synthesized by adjusting the ligand ratio and concentration. The resins were characterized to assess appearance, functional groups, and pore features using SEM, FTIR, and ISEC techniques. Performance assessments were conducted using single-ligand mode resins as controls, evaluating the selectivity against human immunoglobulin G and human serum albumin. Static adsorption experiments were performed to understand pH and salt influence on adsorption. Breakthrough experiments were conducted to assess dynamic adsorption capacity of the novel resin. Finally, chromatographic separation using human serum was performed to evaluate the purity and yield of the resin. Results indicated that the dual-ligand HCIC resin designed for human antibodies demonstrates exceptional selectivity, surpassing not only single ligand states but also outperforming certain high-performing ligand types, particularly under specific salt and pH conditions. Ultimately, a high yield of 83.9 % and purity of 96.7 % were achieved in the separation of hIgG from human serum with the dual-ligand HCIC, significantly superior to the single-ligand resins. In conclusion, through rational design and proper operational conditions, the dual-ligand mode can revitalize underutilized ligands, potentially introducing novel and promising chromatographic modes.
Subject(s)
Hydrophobic and Hydrophilic Interactions , Immunoglobulin G , Ligands , Humans , Adsorption , Immunoglobulin G/chemistry , Immunoglobulin G/blood , Tryptamines/chemistry , Chromatography, Liquid/methods , Benzimidazoles/chemistry , Hydrogen-Ion ConcentrationABSTRACT
Migraine is a common brain condition characterised by disabling attacks of headache with sensory sensitivities. Despite increasing understanding of migraine neurobiology and the impacts of this on therapeutic developments, there remains a need for treatment options for patients underserved by currently available therapies. The first specific drugs developed to treat migraine acutely, the serotonin-5-hydroxytryptamine [5-HT1B/1D] receptor agonists (triptans), seem to require headache onset in order to have an effect, while early treatment during mild pain before headache escalation improves short-term and long-term outcomes. Some patients find treating in the early window once headache has started but not escalated difficult, and migraine can arise from sleep or in the early hours of the morning, making prompt treatment after pain onset challenging. Triptans may be deemed unsuitable for use in patients with vascular disease and in those of older age and may not be effective in a proportion of patients. Headache is also increasingly recognised as being just one of the many facets of the migraine attack, and for some patients it is not the most disabling symptom. In many patients, painless symptoms can start prior to headache onset and can reliably warn of impending headache. There is, therefore, a need to identify therapeutic targets and agents that may be used as early as possible in the course of the attack, to prevent headache onset before it starts, and to reduce both headache and non-headache related attack burden. Early small studies using domperidone, naratriptan and dihydroergotamine have suggested that this approach could be useful; these studies were methodologically less rigorous than modern day treatment studies, of small sample size, and have not since been replicated. The emergence of novel targeted migraine treatments more recently, specifically calcitonin gene-related peptide (CGRP) receptor antagonists (gepants), has reignited interest in this strategy, with encouraging results. This review summarises historical and emerging data in this area, supporting use of the premonitory phase as an opportunity to intervene as early as possible in migraine to prevent attack-related morbidity.
Subject(s)
Migraine Disorders , Migraine Disorders/drug therapy , Migraine Disorders/prevention & control , Humans , Tryptamines/therapeutic use , Serotonin Receptor Agonists/therapeutic useABSTRACT
Results from randomized clinical trials of psilocybin in depressive disorders highlight the therapeutic potential of serotonergic psychedelic compounds in mental health disorders. The synthetic 5-hydroxytryptamine 2A receptor agonist 4-hydroxy-N,N-diisopropyltryptamine (4-OH-DiPT) is structurally similar to psilocin but is reported to have a shorter duration (2-3 h) of psychedelic effects, suggesting the potential for psilocybin-like therapeutic activity with reduced clinical resource burden. Here, we describe the preclinical and translational characterization of RE104, a 4-OH-DiPT prodrug comprising a glutarate moiety designed to cleave rapidly in situ and thus provide reasonable bioavailability of the active drug. Plasma concentration of 4-HO-DiPT over time in PK experiments in rats was correlated with head-twitch intensity. The half-life of 4-OH-DiPT was 40 min after subcutaneous administration of RE104 in rats. In a forced swim test, a single dose of RE104 (1 mg/kg) significantly reduced mean immobility time at 1 week compared with vehicle (P < 0.001), confirming translational antidepressant potential. Taken together, these data with RE104 show that the glutarate ester can act as an efficient prodrug strategy for 4-HO-DiPT, a unique short-duration psychedelic with potential in depressive disorders.
Subject(s)
Hallucinogens , Prodrugs , Rats, Sprague-Dawley , Animals , Prodrugs/pharmacology , Prodrugs/chemical synthesis , Hallucinogens/pharmacology , Hallucinogens/chemical synthesis , Male , Rats , Tryptamines/pharmacology , Tryptamines/chemical synthesis , Tryptamines/chemistry , Antidepressive Agents/pharmacology , Antidepressive Agents/chemical synthesisABSTRACT
Tryptamine is a biogenic amine that affects organoleptic quality through the generation of off-odours in foods. Herein, imine-based covalent organic frameworks (COFs) were synthesized via Schiff base reactions and postmodified with click chemistry to generate azide-functionalized COFs with tunable azide units on the walls. The combination of molecular imprinting with COFs enabled the specific recognition of the targets. The resulting optosensing system (azide-functionalized COFs@MIPs) was used as a sample-to-answer analyser for detecting tryptamine (detection time within 10 min). A linear relationship was observed for the fluorescence response to tryptamine concentrations in the range of 3-120 µg L-1, with a limit of detection of 1.74 µg L-1. The recoveries for spiked samples were satisfactory, with relative standard deviations <9.90%. The optosensing system is a potential tool for the quantitative detection of tryptamine in meat products because of its lower cost, shorter processing time, and simpler processing steps compared to conventional chromatographic techniques.
Subject(s)
Azides , Food Contamination , Meat Products , Molecularly Imprinted Polymers , Tryptamines , Tryptamines/analysis , Tryptamines/chemistry , Azides/chemistry , Meat Products/analysis , Food Contamination/analysis , Molecularly Imprinted Polymers/chemistry , Animals , Metal-Organic Frameworks/chemistry , Limit of DetectionABSTRACT
BACKGROUND: Triptans are anti-migraine drugs with a potential central site of action. However, it is not known to what extent triptans cross the blood-brain barrier (BBB). The aim of this study was therefore to determine if triptans pass the brain capillary endothelium and investigate the possible underlying mechanisms with focus on the involvement of the putative proton-coupled organic cation (H+/OC) antiporter. Additionally, we evaluated whether triptans interacted with the efflux transporter, P-glycoprotein (P-gp). METHODS: We investigated the cellular uptake characteristics of the prototypical H+/OC antiporter substrates, pyrilamine and oxycodone, and seven different triptans in the human brain microvascular endothelial cell line, hCMEC/D3. Triptan interactions with P-gp were studied using the IPEC-J2 MDR1 cell line. Lastly, in vivo neuropharmacokinetic assessment of the unbound brain-to-plasma disposition of eletriptan was conducted in wild type and mdr1a/1b knockout mice. RESULTS: We demonstrated that most triptans were able to inhibit uptake of the H+/OC antiporter substrate, pyrilamine, with eletriptan emerging as the strongest inhibitor. Eletriptan, almotriptan, and sumatriptan exhibited a pH-dependent uptake into hCMEC/D3 cells. Eletriptan demonstrated saturable uptake kinetics with an apparent Km of 89 ± 38 µM and a Jmax of 2.2 ± 0.7 nmol·min-1·mg protein-1 (n = 3). Bidirectional transport experiments across IPEC-J2 MDR1 monolayers showed that eletriptan is transported by P-gp, thus indicating that eletriptan is both a substrate of the H+/OC antiporter and P-gp. This was further confirmed in vivo, where the unbound brain-to-unbound plasma concentration ratio (Kp,uu) was 0.04 in wild type mice while the ratio rose to 1.32 in mdr1a/1b knockout mice. CONCLUSIONS: We have demonstrated that the triptan family of compounds possesses affinity for the H+/OC antiporter proposing that the putative H+/OC antiporter plays a role in the BBB transport of triptans, particularly eletriptan. Our in vivo studies indicate that eletriptan is subjected to simultaneous brain uptake and efflux, possibly facilitated by the putative H+/OC antiporter and P-gp, respectively. Our findings offer novel insights into the potential central site of action involved in migraine treatment with triptans and highlight the significance of potential transporter related drug-drug interactions.
Subject(s)
Blood-Brain Barrier , Brain , Endothelial Cells , Mice, Knockout , Pyrrolidines , Tryptamines , Tryptamines/pharmacology , Tryptamines/metabolism , Tryptamines/pharmacokinetics , Animals , Endothelial Cells/metabolism , Endothelial Cells/drug effects , Humans , Blood-Brain Barrier/metabolism , Blood-Brain Barrier/drug effects , Brain/metabolism , Cell Line , Mice , Mice, Inbred C57BL , Biological Transport/physiology , ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism , Male , Antiporters/metabolism , Pyrilamine/metabolism , Pyrilamine/pharmacology , ATP Binding Cassette Transporter, Subfamily B/metabolismABSTRACT
Eletriptan (ETR), a selective pharmaceutical agent agonist of the 5-hydroxytryptamine1 receptor subtype, are primarily used to treat acute migraine attacks. ETR is a triptan-class medication that works by narrowing cerebral blood vessels and reducing chemicals that produce headache pain, light and sound sensitivity, and nausea. Due to its effectiveness in reducing migraine symptoms, it is a worthwhile choice for those looking for quick and efficient treatment. A green, raid, one-pot and straightforward fluorescence spectrometric method was employed to evaluate ETR in tablets and biological samples. By introducing the ETR drug and the fluorescent ligand, Acid red 87, in an acidic buffer, a quenching of the ligand native fluorescent was promptly produced. The quenching action was simply attributed to the selective ion-pair complex generation between the cationic target and the selected ligand. An increase in ETR concentration was linearly proportional to the quenching response in the 50.0 - 500.0 ng/mL range. The optimal configurations for adjusting the system's variable parameters were determined by examining the ETR-Acid red 87 system's response. Additionally, the sensor that was developed met the standards set by the International Council for Harmonisation of Technical Requirements of Pharmaceuticals for Human Use. The sensitivity thresholds of the approach were 13.8 and 42.0 ng/mL for the detection and quantification parameters, respectively, LOD and LOQ. This approach proficiently evaluated the pharmaceutical and biological samples of ETR. Finally, the proposed approach not only simplifies the analysis process but also limits the badimpact on the environment, making it a promising technique for analytical applications.