Synthesis and structure-activity relationships of neuromuscular blocking agents.

The first use of neuromuscular blocking agents (muscle relaxants) in clinical practice (1942) revolutionised the practice of anaesthesia and started the modern era of surgery. Since 1942 introduction of tubocurarine (18) neuromuscular blocking agents have been used routinely to provide skeletal muscle relaxation during surgical procedures allowing access to body cavities without hindrance from voluntary or reflex muscle movement. After the introduction of tubocurarine and the depolarizing suxamethonium chloride (4) (1949) several nondepolarizing steroidal and nonsteroidal neuromuscular blocking agents with different onset time and duration of effect were introduced e.g. gallamine triethiodide (1) (1949), methocurine (2) (1949), alcuronium chloride (3) (1963), pancuronium bromide (9) (1968), vecuronium bromide (11) (1982), pipecuronium bromide (10) (1982), atracurium besylate (5) (1982), doxacurium chloride (6) (1991), mivacurium chloride (8) (1992), rocuronium bromide (12) (1994) cisatracurium besylate (7) (1996), and rapacuronium bromide (13) (2000). SZ 1677 (14) a steroid type nondepolarizing neuromuscular blocking agent under development (preclinical phase). This review article deals with a comprehensive survey of the progress in chemical, pharmacological and, in some respects, of clinical studies of neuromuscular blocking agents used in the clinical practice and under development, including the synthesis, structure elucidation, pharmacological actions, structure activity relationships studies of steroidal and nonsteroidal derivatives.

Functional determinants by which snake and cone snail toxins block the alpha 7 neuronal nicotinic acetylcholine receptors.

Snakes and cone snails produce toxins which block muscular and/or neuronal nicotinic acetylcholine receptors (AChRs). This paper mostly focuses on the determinants by which a snake long chain curaremimetic toxin and the cone snail toxin ImI bind specifically to the alpha 7 neuronal receptor. In both cases, the site involves a small turn-like structure constrained by two half-cystines.

Novel miniproteins engineered by the transfer of active sites to small natural scaffolds.

Small multidisulfide-containing proteins are attractive structural templates to produce a biologically active conformation that mimics the binding surface of natural large proteins. In particular, the structural motif that is evolutionary conserved in all scorpion toxins has a small size (30-40 amino acid residues), a great structural stability, and high permissiveness for sequence mutation. This motif is composed of a beta-sheet and an alpha-helix bridged in the interior core by three disulfides. We have used this motif successfully to transfer within its beta-sheet new functional sites, including the curaremimetic loop of a snake neurotoxin and the CDR2-like site of human CD4. Accumulated evidence indicated that the two miniproteins produced, the curaremimetic miniprotein and the CD4 mimetic, contain the alpha/beta fold that is characteristic of the scaffold used and bind respectively to the acetylcholine receptor and to the envelope gp120 of HIV-1. Furthermore, the latter was shown to prevent viral infection of lymphocytes. These examples illustrate that, by the transfer of active sites to small and stable natural scaffolds, it is possible to engineer miniproteins reproducing, in part, the function of much larger proteins. Such miniproteins may be of great utility as tools in structure-function studies and as leads in drug design.

A patch-clamp study of the partial agonist actions of tubocurarine on rat myotubes.

Single channels activated by (+)-tubocurarine (curare) were recorded from rat myotubes using the patch-clamp technique. The agonist-like action of curare does not result from a contaminant molecule, as the same effects were observed with curare purified by high-performance liquid chromatography. A curare-activated channel can adopt two levels of conductance: full (F) or partial (P). The F state has a slope conductance of 40 pS (identical to that of the acetylcholine (ACh)-activated channel) and the P state has a conductance of 13 pS. At low concentrations of agonist (ACh or curare), the distribution of channel open times is biphasic. The briefer channels may result from the binding of a single agonist molecule whereas the longer-lived channels probably occur following the binding of two agonist molecules. The mean open time of the F state decreases with increasing curare concentration. It is shown that band-width limitations are likely to account for only a very small part of this observed reduction. In contrast, the mean open time of the P state is independent of the concentration of curare. A simple interpretation is that the F state is susceptible to channel blockade by curare, whereas the P state is not. The P state preceded the F state almost as often as it followed the F state; it can also be observed separately from the F state. The fraction of events including a P state increases from about 4% in the presence of 1 microM-curare to 30% at 100 microM-curare. This fraction is also increased by hyperpolarization. When the curare concentration is increased, the F-state frequency first increases and then decreases at higher concentration. This frequency is also decreased by hyperpolarization. The decrease in F-state frequency is probably related to channel blockade by curare; it cannot be wholly accounted for by problems associated with limited time resolution. A synthetic analogue of curare, (+)- tubocurine dimethiodide presents an agonist activity similar to that of curare but with a faster closing rate for both F and P states. The various actions of curare are summarized in two possible models where the P state is interpreted as either a partially open channel or a channel which is partially blocked.

Dequaternization of curare bases with sodium thiophenoxide and ethanolamine.

To prepare (+)-tubocurine and O,O-dimethyl-(+)-tubocurine, the commonly used dequaternization procedures with sodium theophenoxide and ethanolamine were investigated. The quaternary compounds were (+)-tubocurarine chloride and the chloride and iodide salts of O,O-dimethyl-(+)-chondocurarine. The results obtained with ethanolamine indicate that Hofmann elimination is a major pathway and that N-demethylation is minor. The elimination products of O,O-dimethyl-(+)-chondocurarine iodide with ethanolamine were identified as O,O-dimethyltubocurinemethine, O,O-dimethyltubocurineisomethine, and O,O-dimethyltubocurinedimethine. N-Demethylation was the primary reaction with sodium thiophenoxide. Thus, dequaternization of (+)-tubocurarine chloride with sodium thiophenoxide provided (+)-tubocurine which, on diazomethylation, yielded O,O-dimethyl-(+)-tubocurine, identical to the compound obtained by N-demethylation of O,O-dimethyl-(+)-chondocurarine chloride with the same reagent.

Peinamine, a new bisbenzylisoquinoline alkaloid from arrow tips (pei-namô) of the Upper Orinoco.

A new bisbenzylisoquinoline alkaloid has been isolated from a curare of the Upper Orinoco region. The curare is made by Indians from an unknown plant (probably Menispermacea) and is kept on arrow tips. The structure of the alkaloid, named peinamine, has been elucidated on the basis of its chemical reactions and spectroscopic data (N.M.R., M.S. and O.R.D.).