Clinical trial: dextofisopam in the treatment of patients with diarrhoea-predominant or alternating irritable bowel syndrome.

BACKGROUND: Dextofisopam modulates stimulated activity in animal models of stress, altered bowel motility, and visceral hypersensitivity. AIM: To evaluate the effects of dextofisopam in men and women with diarrhoea-predominant or alternating irritable bowel syndrome (IBS) (d-IBS or a-IBS). METHODS: In this double-blind, placebo-controlled study, patients were randomly assigned to receive dextofisopam 200 mg b.d. or placebo for 12 weeks. The prospectively defined primary endpoint was number of months of adequate overall relief of IBS symptoms. Bowel function was assessed primarily via stool frequency and consistency. RESULTS: Of 140 enrolled patients, 66 received dextofisopam and 74 placebo; 73% of the patients were women, and 78% had d-IBS. Dextofisopam was superior to placebo on the primary endpoint (P = 0.033). In d-IBS patients treated with dextofisopam, both men and women had improved stool consistency, but stool frequency was reduced only in women. Benefit diminished over time on the primary endpoint, but persisted on frequency and consistency. Dextofisopam and placebo had similar rates and types of adverse events, with more events of worsening abdominal pain with dextofisopam (12% vs. 4%) and more headaches with placebo (12% vs. 5%). Constipation was rare. CONCLUSION: Dextofisopam should be further evaluated as a new treatment for men and women with d-IBS and a-IBS.

The use of venlafaxine in the treatment of major depression and major depression associated with anxiety: a dose-response study. Venlafaxine Investigator Study Group.

This 12-week, double-blind, placebo-controlled study evaluated the efficacy and safety of venlafaxine as first-line therapy for the treatment of major depression and major depression associated with anxiety in 384 adult outpatients. Fixed total daily dosages of 75, 150, and 200 mg of venlafaxine were administered in a twice-a-day regimen. Primary efficacy parameters were the Hamilton Rating Scale for Depression (HAM-D) total score, the HAM-D Depressed Mood Item, the Montgomery-Asberg Depression Rating Scale total score, and the Clinical Global Impressions Scale. Overall, a higher percentage of patients responded to venlafaxine than to placebo. Efficacy data indicated a dose-related response, most evident in the onset of clinical improvement; statistically significant improvements in some primary parameters were seen as early as 1 to 2 weeks after initiation of treatment, especially in the 150-and 200-mg/day groups. These dose-related clinical improvements continued through week 12. Venlafaxine-treated patients who had depression associated with anxiety showed significant dose-related improvements compared with placebo-treated patients; improvement was noted by scores on the HAM-D Anxiety-Psychic Item and Anxiety-Somatization Factor. Few clinically significant changes were observed in laboratory values, vital signs, or electrocardiogram tracings. Venlafaxine was generally well tolerated at all dosages. The most common study events included nausea, dizziness, somnolence, insomnia, dry mouth, and asthenia, which are consistent with findings of previous studies. The current study demonstrated that 75 to 200 mg/day of venlafaxine twice daily produced a dose-related improvement in the primary efficacy parameters and in the onset of significant antidepressant effects, which was noted at weeks 1 to 2 with the highest dosage tested (200 mg/day). The study also demonstrated that these dosages of venlafaxine were safe and effective as first-line therapy for major depression and depression associated with anxiety.

Time course of ethylcholine aziridinium ion (AF64A)-induced cholinotoxicity in vivo.

The time course of the cholinotoxicity of ethylcholine aziridinium ion (AF64A) has been investigated. Rats were injected with AF64A (3 nmols/3 microliters/side, bilateral, i.c.v.) or with vehicle. One day to one year after treatment, the hippocampus, cortex and striatum were analyzed for the activity of choline acetyltransferase (ChAT) and acetylcholinesterase (AchE) and high-affinity transport of choline (HAChT). In addition, the release of K+-stimulated acetylcholine (ACh) from superfused slices of hippocampus was determined. The first parameter affected was high affinity transport of choline. One day after treatment with AF64A, the high affinity transport of choline in the hippocampus was reduced by 23%. This reduction was maximal one week after treatment (-67%) and persisted for at least 6 months. The high affinity transport of choline in the striatum and cortex was not altered by treatment with AF64A. The activity of ChAT and AChE in the hippocampus was reduced by 2 days after treatment with AF64A. These deficits persisted for at least 6 months (AChE) to 1 year (ChAT). The activity of ChAT and AChE in the cortex and striatum was minimally affected up to 1 year after treatment with AF64A, at which time significant reductions were noted. The release of ACh was affected 3 days after treatment with AF64A, and remained attenuated 6 months later. These data indicate that the cholinergic deficit caused by in vivo treatment with AF64A was first apparent at the level of high affinity uptake of choline in the hippocampus HAChT. Subsequently, the activity of ChAT and AChE and release of ACh in the hippocampus were affected.(ABSTRACT TRUNCATED AT 250 WORDS)

Hippocampal electrical activity in relation to behavior following ethylcholine aziridinium ion (AF64A) treatment.

The effects of intracerebroventricular (ICV) injections of ethylcholine aziridinium ion (AF64A; 3 nmol/3 microliters/side) on the pattern of hippocampal electrical activity were studied in freely moving and urethane anesthetized rats. AF64A treated rats showed a significantly smaller increase in 6-12 Hz hippocampal rhythmical slow activity (RSA) with struggling in the no drug condition in comparison to the vehicle injected rats. However, neither AF64A treatment nor a control injection abolished the presumed cholinergic form of RSA that is present during urethane anesthesia. Systemic injection of atropine in waking rats did not significantly alter RSA in either the AF64A or vehicle injected rats. Analysis of histological brain sections revealed extensive damage to the fimbria-fornix, CA3 of the hippocampus, corpus callosum, neocortex and striatum. Acetylcholinesterase staining of the remaining hippocampus appeared normal in the AF64a treated rats. The data indicate that the depletion of cholinergic markers in the hippocampus following ICV administration of AF64A is not sufficient to disrupt the cholinergic form of RSA. Further, the question is discussed as to whether AF64A produces its cholinoselective effects via a specific pharmacological action or through a nonspecific destruction of the fimbria-fornix.

The effect of cigarette smoking during pregnancy on the cholinergic system in isolated term human placental tissue.

Mothers who smoke cigarettes during pregnancy give birth to babies with lower birth weights than do nonsmoking mothers. One hypothesis to explain this finding is that nicotine depresses the activity of the placental cholinergic system, which has been linked to the placental transport of amino acids and other substances. The levels and activities of several components of the term placental cholinergic system were determined in smokers and nonsmokers to investigate whether this system is involved in the effect of smoking. There were no statistically significant differences in the levels, synthesis or release of acetylcholine in the tissues from smoking and nonsmoking mothers, nor in the activities of the choline uptake system or the enzymes choline acetyltransferase, cholinesterase or sodium/potassium adenosine triphosphatase. The results do not support the hypothesis that the lower birth weights of babies born to smoking mothers is mediated by an effect of nicotine or other tobacco components on the placental cholinergic system.

Regional differences in ethylcholine mustard aziridinium ion (AF64A)-induced deficits in presynaptic cholinergic markers for the rat central nervous system.

Several highly selective biochemical markers were used to assess the persistent central cholinergic dysfunction which accompanies administration of the cholinergic neurotoxin ethylcholine mustard aziridinium ion (AF64A). Rats received a single bilateral intracerebroventricular injection of AF64A (3 nmol/3 microliter/side) or vehicle and measurements were carried out in the cerebral cortices, hippocampi and corpora striata at 7 and 21 days postinjection. The drug binding sites of muscarinic cholinergic receptors, as revealed by high-affinity binding of (-)-[3H]quinuclidinyl benzilate (a classical muscarinic antagonist), [3H]pirenzepine (a selective antagonist of the putative M1 muscarinic receptor subclass) and (+)-[3H]cis-methyldioxolane (a potent muscarinic agonist), were not significantly affected by AF64A treatment. As reported previously, activity of the cholinergic synthetic enzyme choline acetyltransferase was reduced markedly (60-65%) in the hippocampi of AF64A-treated rats. A similar reduction was noted in high-affinity binding of [3H]hemicholinium-3 (a putative radioligand for sodium-dependent high-affinity choline uptake sites on cholinergic nerve terminals) in hippocampal membranes (59-65%). However, in the cerebral cortex, these presynaptic cholinergic markers were differentially altered by AF64A pretreatment (choline acetyltransferase, unchanged; [3H]hemicholinium-3 binding, reduced by 59-65%). These results indicate that a single intracerebroventricular injection of AF64A promotes biochemical and possibly functional deficits in presynaptic cholinergic nerve terminals distal from the injection site while having minimal influences upon muscarinic cholinergic receptor populations.

Investigation of the rate-limiting step in the synthesis of acetylcholine by the human placenta.

The uptake of [3H]choline and its conversion to [3H]acetylcholine were investigated in term human placental tissue in vitro. Although the net uptake of [3H]choline increased throughout a 45 min incubation period, intracellular [3H]choline levels reach a plateau after 2 min. There was a constant increase in [3H]acetylcholine levels throughout the incubation period. After 45 min, 36.5 per cent of the total intracellular tritium was recovered as acetylcholine by high-voltage electrophoresis. The effects of the choline acetyltransferase inhibitors, 2-benzoylethyltrimethyl-ammonium chloride (BETA) and 4-naphthylvinyl pyridine (NVP), and an inhibitor of choline uptake, hemicholinium-3 (HC-3), were also investigated for their influence on the uptake and metabolism of [3H]choline. A significant depression in both [3H]choline uptake and [3H]acetylcholine synthesis could be demonstrated with all three compounds, although with somewhat different time courses and activities. An analysis of the accumulation of [3H]acetylcholine in relation to the uptake and intracellular levels of [3H]choline as well as the patterns of inhibition produced by the inhibitors indicates that, unlike nervous tissue, the rate-limiting step in the synthesis of acetylcholine in human placental tissue is the transacetylation reaction catalysed by choline acetyltransferase.

Phencyclidine-induced inhibition of striatal acetylcholine release: comparisons with mu, kappa, and sigma opiate agonists.

The effects of phencyclidine (PCP) on ACh release were compared to those of morphine, ethylketocyclazocine (EKC), and N-allylnormetazocine (SKF10047) in a superfused striatal slice preparation. The (+)-isomer of the prototypic sigma opiate agonist, SKF10047, and the prototypic kappa opiate agonist, EKC, had essentially the same pharmacological profile as did PCP. That is, they each inhibited ACh release in a concentration dependent manner (with EKC being the most potent) and this effect was antagonized by 0.1 microM naloxone. Since morphine was without effect on ACh release, it is unlikely that these drugs inhibit ACh release by acting at mu receptors. In addition, we observed that the inhibitory effect of PCP, (+) SKF10047, and EKC on ACh release was reversed by 0.1 microM haloperidol. Given that PCP has been shown to stimulate basal DA release in this preparation, it is possible that PCP, EKC and (+) SKF10047 inhibit ACh release indirectly by stimulating DA release. The naloxone-induced blockade of the effect of PCP and these benzomorphans is discussed in relation to the effects of naloxone on other systems known to influence ACh release.

Effects of phencyclidine on the release of radioactivity from rat striatal slices labeled with [3H]choline.

Phencyclidine (PCP) has been shown to antagonize the effects of acetylcholine (ACh) in a variety of systems and to inhibit the binding of muscarinic antagonists to brain membranes. Therefore, we have studied the effects of PCP on ACh release from rat striatal slices in order to characterize the effect of PCP in a central cholinergic system. After incubation with [3H]choline, striatal slices were superfused and the superfusate was assayed for radioactivity. The presence of PCP led to dose-related inhibition of K+-stimulated ACh release. This may be due to the reported ability of PCP to enhance dopamine release as both direct (pergolide) and indirect (amphetamine) dopamine agonists also inhibited striatal ACh release. Haloperidol blocked the inhibitory effects of PCP, amphetamine and pergolide on ACh release, supporting the notion that the decrease in ACh release produced by PCP is mediated indirectly via the release of dopamine onto cholinergic neurons.

The effect of choline acetyltransferase inhibition on acetylcholine synthesis and release in term human placenta.

The synthesis and release of acetylcholine (ACh) was studied in term human placental villous mince in vitro. During a 140-min incubation the placental tissue synthesized ACh at a rate of 2.59 nmol/g/min and released ACh into the medium at a rate of 0.78 nmol/g/min. Consequently there was an increase in tissue levels of ACh from an initial value of 83 to 321 nmol/g. Inhibition of choline acetyltransferase by 2-benzoylethyl trimethylammonium or 4-(1-naphthylvinyl)pyridine depressed the synthesis of ACh by over 75% and blocked the increase in tissue levels of ACh. The IC50 values for the inhibition of ACh synthesis and decrease in tissue levels were close to the IC50 values determined for inhibition of choline acetyltransferase in situ. Neither 2-benzoylethyl trimethylammonium nor 4-(1-naphthylvinyl)pyridine caused a significant effect on ACh release. 2-benzoylethyl trimethylammonium and 4-(1-naphthylvinyl)pyridine were quite effective in inhibiting the uptake of the neutral amino acid, alpha-aminoisobutyric acid, into the tissue. The inhibition of alpha-aminoisobutyric acid uptake paralleled the inhibition of ACh synthesis. These results support the hypothesis of an association between placental cholinergic activity and amino acid transport in the human placenta.