1
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Heilig M, Witkiewitz K, Ray LA, Leggio L. Novel medications for problematic alcohol use. J Clin Invest 2024; 134:e172889. [PMID: 38828724 DOI: 10.1172/jci172889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Alcohol-related harm, a major cause of disease burden globally, affects people along a spectrum of use. When a harmful pattern of drinking is present in the absence of significant behavioral pathology, low-intensity brief interventions that provide information about health consequences of continued use provide large health benefits. At the other end of the spectrum, profound behavioral pathology, including continued use despite knowledge of potentially fatal consequences, warrants a medical diagnosis, and treatment is strongly indicated. Available behavioral and pharmacological treatments are supported by scientific evidence but are vastly underutilized. Discovery of additional medications, with a favorable balance of efficacy versus safety and tolerability can improve clinical uptake of treatment, allow personalized treatment, and improve outcomes. Here, we delineate the clinical conditions when pharmacotherapy should be considered in relation to the main diagnostic systems in use and discuss clinical endpoints that represent meaningful clinical benefits. We then review specific developments in three categories of targets that show promise for expanding the treatment toolkit. GPCRs remain the largest category of successful drug targets across contemporary medicine, and several GPCR targets are currently pursued for alcohol-related indications. Endocrine systems are another established category, and several promising targets have emerged for alcohol indications. Finally, immune modulators have revolutionized treatment of multiple medical conditions, and they may also hold potential to produce benefits in patients with alcohol problems.
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Affiliation(s)
- Markus Heilig
- Center for Social and Affective Neuroscience, Linköping University, and Department of Psychiatry, Linköping University Hospital, Linköping, Sweden
| | - Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
| | - Lara A Ray
- Department of Psychology, UCLA, Los Angeles, California, USA
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, NIH, Baltimore and Bethesda, Maryland, USA
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2
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De Aquino JP, Sloan ME, Nunes JC, Costa GPA, Katz JL, de Oliveira D, Ra J, Tang VM, Petrakis IL. Alcohol Use Disorder and Chronic Pain: An Overlooked Epidemic. Am J Psychiatry 2024; 181:391-402. [PMID: 38706339 DOI: 10.1176/appi.ajp.20230886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Alcohol use disorder (AUD) and chronic pain disorders are pervasive, multifaceted medical conditions that often co-occur. However, their comorbidity is often overlooked, despite its prevalence and clinical relevance. Individuals with AUD are more likely to experience chronic pain than the general population. Conversely, individuals with chronic pain commonly alleviate their pain with alcohol, which may escalate into AUD. This narrative review discusses the intricate relationship between AUD and chronic pain. Based on the literature available, the authors present a theoretical model explaining the reciprocal relationship between AUD and chronic pain across alcohol intoxication and withdrawal. They propose that the use of alcohol for analgesia rapidly gives way to acute tolerance, triggering the need for higher levels of alcohol consumption. Attempts at abstinence lead to alcohol withdrawal syndrome and hyperalgesia, increasing the risk of relapse. Chronic neurobiological changes lead to preoccupation with pain and cravings for alcohol, further entrenching both conditions. To stimulate research in this area, the authors review methodologies to improve the assessment of pain in AUD studies, including self-report and psychophysical methods. Further, they discuss pharmacotherapies and psychotherapies that may target both conditions, potentially improving both AUD and chronic pain outcomes simultaneously. Finally, the authors emphasize the need to manage both conditions concurrently, and encourage both the scientific community and clinicians to ensure that these intertwined conditions are not overlooked given their clinical significance.
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Affiliation(s)
- Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Matthew E Sloan
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Julio C Nunes
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Gabriel P A Costa
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Jasmin L Katz
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Debora de Oliveira
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Jocelyn Ra
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Victor M Tang
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
| | - Ismene L Petrakis
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (DeAquino, Nunes, Ra, Petrakis); Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, Conn. (De Aquino, Ra); VA Connecticut Healthcare System, West Haven, Conn. (De Aquino, Petrakis); Addictions Division, Centre for Addiction and Mental Health, Toronto (Sloan, Katz, Tang); Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto (Sloan); Department of Pharmacology & Toxicology, University of Toronto (Sloan); Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto (Sloan); Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto (Sloan); Institute of Medical Science, University of Toronto (Sloan, Tang); Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto (Sloan, Tang); University of Ribeirao Preto, Ribeirao Preto, São Paulo, Brazil (Costa); St. Elizabeth's Hospital, Washington, D.C. (De Oliveira)
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3
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Colombo G. Positive allosteric modulators of the GABAB receptor: a new class of ligands with therapeutic potential for alcohol use disorder. Alcohol Alcohol 2024; 59:agae018. [PMID: 38566580 DOI: 10.1093/alcalc/agae018] [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] [Received: 12/19/2023] [Revised: 02/22/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Positive allosteric modulators (PAMs) of the GABAB receptor constitute a new class of GABAB-receptor ligands. GABAB PAMs reproduce several pharmacological effects of the orthosteric GABAB receptor agonist, baclofen, although displaying a better safety profile. AIMS This paper reviews the reducing or, frequently, even suppressing effects of all GABAB PAMs tested to date on multiple alcohol-related behaviours in laboratory rodents exposed to validated experimental models of human alcohol use disorder. RESULTS Acute or repeated treatment with CGP7930, GS39783, BHF177, rac-BHFF, ADX71441, CMPPE, COR659, ASP8062, KK-92A, and ORM-27669 reduced excessive alcohol drinking, relapse- and binge-like drinking, operant alcohol self-administration, reinstatement of alcohol seeking, and alcohol-induced conditioned place preference in rats and mice. CONCLUSIONS These effects closely mirrored those of baclofen; notably, they were associated to remarkably lower levels of tolerance and toxicity. The recent transition of ASP8062 to clinical testing will soon prove whether these highly consistent preclinical data translate to AUD patients.
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Affiliation(s)
- Giancarlo Colombo
- Neuroscience Institute, Section of Cagliari, National Research Council of Italy, I-09042, Monserrato (CA), Italy
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4
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Aubin HJ. Repurposing drugs for treatment of alcohol use disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 175:153-185. [PMID: 38555115 DOI: 10.1016/bs.irn.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Repurposing drugs for the treatment of alcohol dependence involves the use of drugs that were initially developed for other conditions, but have shown promise in reducing alcohol use or preventing relapse. This approach can offer a more cost-effective and time-efficient alternative to developing new drugs from scratch. Currently approved medications for alcohol use disorder (AUD) include acamprosate, disulfiram, naltrexone, nalmefene, baclofen, and sodium oxybate. Acamprosate was developed specifically for AUD, while disulfiram's alcohol-deterrent effects were discovered incidentally. Naltrexone and nalmefene were originally approved for opioids but found secondary applications in AUD. Baclofen and sodium oxybate were repurposed from neurological conditions. Other drugs show promise. Topiramate and zonisamide, anticonvulsants, demonstrate efficacy in reducing alcohol consumption. Another anticonvulsant, gabapentin has been disappointing overall, except in cases involving alcohol withdrawal symptoms. Varenicline, a nicotinic receptor agonist, benefits individuals with less severe AUD or concurrent nicotine use. Ondansetron, a 5-HT3 antagonist, has potential for early-onset AUD, especially when combined with naltrexone. Antipsychotic drugs like aripiprazole and quetiapine have limited efficacy. Further investigation is needed for potential repurposing of α1 adrenergic receptor antagonists prazosin and doxazosin, glucocorticoid receptor antagonist mifepristone, the phosphodiesterase inhibitor Ibudilast, the cysteine prodrug N-acetylcysteine, and the OX1R and OX2R blocker Suvorexant. This review supports repurposing drugs as an effective strategy for expanding treatment options for AUD.
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Affiliation(s)
- Henri-Jean Aubin
- Université Paris-Saclay, Inserm, CESP, Villejuif, France; AP-HP, Université Paris Saclay, Villejuif, France.
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5
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de Beaurepaire R, Jaury P. Baclofen in the treatment of alcohol use disorder: tailored doses matter. Alcohol Alcohol 2024; 59:agad090. [PMID: 38266071 PMCID: PMC10807704 DOI: 10.1093/alcalc/agad090] [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] [Received: 10/28/2023] [Revised: 12/03/2023] [Accepted: 12/16/2023] [Indexed: 01/26/2024] Open
Abstract
AIMS To address the question of tailored baclofen prescribing in alcohol use disorder (AUD) in relation to dose-dependent efficacy and the potential danger of high doses and to provide suggestions for the use of high doses of baclofen in the treatment of AUD. The context is the approvement in France of baclofen in the treatment of AUD without dose limitation, making French physicians, who usually prescribe baclofen in a tailored manner, often use high or very high doses. METHODS A narrative review of the results of randomized controlled trials (RCTs) and observational studies that used tailored baclofen prescribing and of the severe adverse effects of baclofen that have been reported in the literature. RESULTS The results show that RCTs using tailored doses of baclofen in AUD are not completely demonstrative, though they are encouraging according to certain meta-analyses, while observational studies that used tailored doses constantly show a good effectiveness of baclofen treatment. The results suggest that many severe adverse effects of baclofen could be related to a nonrespect by physicians of prescription rules and appropriate treatment monitoring. CONCLUSIONS The use of tailored doses shows that the dose required to suppress cravings is highly variable, low or high, depending on each case. Analysis of the circumstances in which severe adverse effects occur suggest that a careful monitoring of baclofen prescribing might prevent a large majority of severe adverse effects. We propose that the education of the patients and the prescription skills, seriousness, and availability of the prescribing physicians are of major importance in the managing of tailored baclofen treatment of AUD.
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Affiliation(s)
- Renaud de Beaurepaire
- Renaud de Beaurepaire, GH Paul-Guiraud, 54 Avenue de La République, 94806 Villejuif, France
| | - Philippe Jaury
- Faculté de Médecine, Université Paris Cité, Paris, France
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6
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Abstract
Alcohol-related liver disease (ALD) is a major cause of liver-related morbidity and mortality. Epidemiological trends indicate recent and predicted increases in the burden of disease. Disease progression is driven by continued alcohol exposure on a background of genetic predisposition together with environmental cofactors. Most individuals present with advanced disease despite a long history of excessive alcohol consumption and multiple missed opportunities to intervene. Increasing evidence supports the use of non-invasive tests to screen for and identify disease at earlier stages. There is a definite role for public health measures to reduce the overall burden of disease. At an individual level, however, the ability to influence subsequent disease course by modifying alcohol consumption or the underlying pathogenic mechanisms remains limited due to a comparative lack of effective, disease-modifying medical interventions. Abstinence from alcohol is the key determinant of outcome in established ALD and the cornerstone of clinical management. In those with decompensated ALD, liver transplant has a clear role. There is consensus that abstinence from alcohol for an arbitrary period should not be the sole determinant in a decision to transplant. An increasing understanding of the mechanisms by which alcohol causes liver disease in susceptible individuals offers the prospect of new therapeutic targets for disease-modifying drugs. Successful translation will require significant public and private investment in a disease area which has traditionally been underfunded when compared to its overall prevalence.
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Affiliation(s)
- Mark Thursz
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Diaz LA, Winder GS, Leggio L, Bajaj JS, Bataller R, Arab JP. New insights into the molecular basis of alcohol abstinence and relapse in alcohol-associated liver disease. Hepatology 2023:01515467-990000000-00605. [PMID: 37862466 DOI: 10.1097/hep.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
Alcohol use disorder remains a significant public health concern, affecting around 5% of adults worldwide. Novel pathways of damage have been described during the last years, providing insight into the mechanism of injury due to alcohol misuse beyond the direct effect of ethanol byproducts on the liver parenchyma and neurobehavioral mechanisms. Thus, the gut-liver-brain axis and immune system involvement could be therapeutic targets for alcohol use disorder. In particular, changes in gut microbiota composition and function, and bile acid homeostasis, have been shown with alcohol consumption and cessation. Alcohol can also directly disrupt intestinal and blood-brain barriers. Activation of the immune system can be triggered by intestinal barrier dysfunction and translocation of bacteria, pathogen-associated molecular patterns (such as lipopolysaccharide), cytokines, and damage-associated molecular patterns. These factors, in turn, promote liver and brain inflammation and the progression of liver fibrosis. Other involved mechanisms include oxidative stress, apoptosis, autophagy, and the release of extracellular vesicles and miRNA from hepatocytes. Potential therapeutic targets include gut microbiota (probiotics and fecal microbiota transplantation), neuroinflammatory pathways, as well as neuroendocrine pathways, for example, the ghrelin system (ghrelin receptor blockade), incretin mimetics (glucagon-like peptide-1 analogs), and the mineralocorticoid receptor system (spironolactone). In addition, support with psychological and behavioral treatments is essential to address the multiple dimensions of alcohol use disorder. In the future, a personalized approach considering these novel targets can contribute to significantly decreasing the alcohol-associated burden of disease.
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Affiliation(s)
- Luis Antonio Diaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institutes of Health, NIDA and NIAAA, Baltimore, Maryland, USA
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Health Care System, Richmond, Virginia, USA
| | - Ramon Bataller
- Liver Unit, Hospital Clinic, Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan Pablo Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Medicine, Division of Gastroenterology, Schulich School of Medicine, Western University, London, Ontario, Canada
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8
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Teng PN, Barakat W, Tran SM, Tran ZM, Bateman NW, Conrads KA, Wilson KN, Oliver J, Gist G, Hood BL, Zhou M, Maxwell GL, Leggio L, Conrads TP, Lee MR. Brain proteomic atlas of alcohol use disorder in adult males. Transl Psychiatry 2023; 13:318. [PMID: 37833300 PMCID: PMC10575941 DOI: 10.1038/s41398-023-02605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/16/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Alcohol use disorder (AUD) affects transcriptomic, epigenetic and proteomic expression in several organs, including the brain. There has not been a comprehensive analysis of altered protein abundance focusing on the multiple brain regions that undergo neuroadaptations occurring in AUD. We performed a quantitative proteomic analysis using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis of human postmortem tissue from brain regions that play key roles in the development and maintenance of AUD, the amygdala (AMG), hippocampus (HIPP), hypothalamus (HYP), nucleus accumbens (NAc), prefrontal cortex (PFC) and ventral tegmental area (VTA). Brain tissues were from adult males with AUD (n = 11) and matched controls (n = 16). Across the two groups, there were >6000 proteins quantified with differential protein abundance in AUD compared to controls in each of the six brain regions. The region with the greatest number of differentially expressed proteins was the AMG, followed by the HYP. Pathways associated with differentially expressed proteins between groups (fold change > 1.5 and LIMMA p < 0.01) were analyzed by Ingenuity Pathway Analysis (IPA). In the AMG, adrenergic, opioid, oxytocin, GABA receptor and cytokine pathways were among the most enriched. In the HYP, dopaminergic signaling pathways were the most enriched. Proteins with differential abundance in AUD highlight potential therapeutic targets such as oxytocin, CSNK1D (PF-670462), GABAB receptor and opioid receptors and may lead to the identification of other potential targets. These results improve our understanding of the molecular alterations of AUD across brain regions that are associated with the development and maintenance of AUD. Proteomic data from this study is publicly available at www.lmdomics.org/AUDBrainProteomeAtlas/ .
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Affiliation(s)
- Pang-Ning Teng
- Women's Health Integrated Research Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Waleed Barakat
- Women's Health Integrated Research Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Sophie M Tran
- Women's Health Integrated Research Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Zoe M Tran
- Women's Health Integrated Research Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Nicholas W Bateman
- Women's Health Integrated Research Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Kelly A Conrads
- Women's Health Integrated Research Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Katlin N Wilson
- Women's Health Integrated Research Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Julie Oliver
- Women's Health Integrated Research Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Glenn Gist
- Women's Health Integrated Research Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Brian L Hood
- Women's Health Integrated Research Center, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Ming Zhou
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - G Larry Maxwell
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Baltimore, Bethesda, Maryland, USA
- Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, Maryland, USA
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, USA
| | - Thomas P Conrads
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA.
| | - Mary R Lee
- Veterans Affairs Medical Center, Washington, DC, USA.
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9
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Morley KC, Peruch S, Adams C, Towers E, Tremonti C, Watt J, Jamshidi N, Haber PS. N acetylcysteine in the treatment of alcohol use disorder: a randomized, double-blind, placebo-controlled trial. Alcohol Alcohol 2023; 58:553-560. [PMID: 37465907 DOI: 10.1093/alcalc/agad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/15/2023] [Accepted: 06/25/2023] [Indexed: 07/20/2023] Open
Abstract
N-acetyl cysteine (NAC) is a potent antioxidant that modulates glutamatergic signalling which is thought to play a role in alcohol use disorder (AUD). There have been no clinical trials investigating NAC for AUD. We aimed to conduct a 28 day double-blind, placebo-controlled (PL) randomized trial of NAC in the treatment of AUD (NCT03879759). A total of 42 participants with AUD (56% alcohol-related liver disease) were randomized to receive placebo or NAC 2400 mg/day. Feasibility outcomes included treatment retention and adverse events. Primary clinical outcomes included alcohol consumption (heavy drinking days, standard drinks per drinking day). Secondary clinical outcome measures included craving, liver tests, and psychological outcomes. There were no significant differences in overall retention between treatment groups (χ2(1) = 0.14, P = 0.71: 86% vs 76% for placebo and NAC, respectively). The most commonly reported adverse event in NAC-treated individuals included headache (14%). For standard drinks per drinking day, there was a significant overall effect of time (F = 9.18, P < 0.001), no significant effect of treatment (F = 0.75, P = 0.79), and a significant time x treatment (NAC vs PL) effect (F = 2.73, P < 0.05). For number of heavy drinks per day, there was a significant overall effect of time (F = 3.16, P < 0.05) but no significant effect of treatment or time x treatment (P = 0.17). There were no significant NAC vs PL effects on secondary clinical outcome measures. In the first trial of NAC for the management of AUD, NAC appears to be feasible and safe. Although there was a significant effect of NAC vs placebo on some alcohol measures such as drinks per drinking day, there does appear to be a variable pattern of effect across time suggesting that a larger trial incorporating a longer treatment duration is now required to determine efficacy.
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Affiliation(s)
- Kirsten C Morley
- Specialty of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Siena Peruch
- Specialty of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Claire Adams
- Specialty of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Ellen Towers
- Specialty of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Chris Tremonti
- Edith Collins Centre for Translational Research, Level6, KGV Buidling, Missenden Road, Sydney Local Health District, Royal Prince Alfred Hospital, NSW, Australia
| | - Joshua Watt
- Edith Collins Centre for Translational Research, Level6, KGV Buidling, Missenden Road, Sydney Local Health District, Royal Prince Alfred Hospital, NSW, Australia
| | - Nazila Jamshidi
- Specialty of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- Edith Collins Centre for Translational Research, Level6, KGV Buidling, Missenden Road, Sydney Local Health District, Royal Prince Alfred Hospital, NSW, Australia
| | - Paul S Haber
- Specialty of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- Edith Collins Centre for Translational Research, Level6, KGV Buidling, Missenden Road, Sydney Local Health District, Royal Prince Alfred Hospital, NSW, Australia
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10
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Mansour D, Masson S, Shawcross DL, Douds AC, Bonner E, Corless L, Leithead JA, Hammond J, Heneghan MA, Rahim MN, Tripathi D, West R, Johnson J, Botterill G, Hollywood C, Ross V, Donnelly M, Compston JE, McPherson S, Grapes A. British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis - part 1: compensated cirrhosis. Frontline Gastroenterol 2023; 14:453-461. [PMID: 37862444 PMCID: PMC10579555 DOI: 10.1136/flgastro-2023-102430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
The prevalence of cirrhosis has risen significantly over recent decades and is predicted to rise further. Widespread use of non-invasive testing means cirrhosis is increasingly diagnosed at an earlier stage. Despite this, there are significant variations in outcomes in patients with cirrhosis across the UK, and patients in areas with higher levels of deprivation are more likely to die from their liver disease. This three-part best practice guidance aims to address outpatient management of cirrhosis, in order to standardise care and to reduce the risk of progression, decompensation and mortality from liver disease. Here, in part one, we focus on outpatient management of compensated cirrhosis, encompassing hepatocellular cancer surveillance, screening for varices and osteoporosis, vaccination and lifestyle measures. We also introduce a compensated cirrhosis care bundle for use in the outpatient setting. Part two concentrates on outpatient management of decompensated disease including management of ascites, encephalopathy, varices, nutrition as well as liver transplantation and palliative care. The third part of the guidance covers special circumstances encountered in managing people with cirrhosis: surgery, pregnancy, travel, managing bleeding risk for invasive procedures and portal vein thrombosis.
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Affiliation(s)
- Dina Mansour
- Newcastle Medical School, Newcastle University, Newcastle upon Tyne, UK
- Gastroenterology and hepatology, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Steven Masson
- Newcastle Medical School, Newcastle University, Newcastle upon Tyne, UK
- Hepatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Andrew C Douds
- Gastroenterology, Queen Elizabeth Hospital, Kings Lynn, UK
| | - Emily Bonner
- Anaesthetics, Freeman Hospital, Newcastle upon Tyne, UK
| | - Lynsey Corless
- Gastroenterology, Hull Royal Infirmary, Hull, UK
- Hull York Medical School, Hull, UK
| | - Joanna A Leithead
- Gastroenterology and Hepatology, Forth Valley Royal Hospital, Larbert, UK
| | - John Hammond
- Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Dhiraj Tripathi
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Jill Johnson
- Dietetics, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | - Coral Hollywood
- Hepatology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Valerie Ross
- Pharmacy, Barts and The London NHS Trust, London, UK
| | | | - Juliet E Compston
- Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Stuart McPherson
- Newcastle Medical School, Newcastle University, Newcastle upon Tyne, UK
- Hepatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Allison Grapes
- Gastroenterology and hepatology, Gateshead Health NHS Foundation Trust, Gateshead, UK
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11
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Staufer K, Stauber RE. Steatotic Liver Disease: Metabolic Dysfunction, Alcohol, or Both? Biomedicines 2023; 11:2108. [PMID: 37626604 PMCID: PMC10452742 DOI: 10.3390/biomedicines11082108] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease (ALD), both of them accounting for fatty liver disease (FLD), are among the most common chronic liver diseases globally, contributing to substantial public health burden. Both NAFLD and ALD share a similar picture of clinical presentation yet may have differences in prognosis and treatment, which renders early and accurate diagnosis difficult but necessary. While NAFLD is the fastest increasing chronic liver disease, the prevalence of ALD has seemingly remained stable in recent years. Lately, the term steatotic liver disease (SLD) has been introduced, replacing FLD to reduce stigma. SLD represents an overarching term to primarily comprise metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), as well as alcohol-related liver disease (ALD), and MetALD, defined as a continuum across which the contribution of MASLD and ALD varies. The present review discusses current knowledge on common denominators of NAFLD/MASLD and ALD in order to highlight clinical and research needs to improve our understanding of SLD.
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Affiliation(s)
- Katharina Staufer
- Division of Transplantation, Department of General Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Rudolf E Stauber
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, 8010 Graz, Austria
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12
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Arab JP, Addolorato G, Mathurin P, Thursz MR. Alcohol-Associated Liver Disease: Integrated Management With Alcohol Use Disorder. Clin Gastroenterol Hepatol 2023; 21:2124-2134. [PMID: 36858144 DOI: 10.1016/j.cgh.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/21/2023] [Accepted: 02/03/2023] [Indexed: 03/03/2023]
Abstract
Alcohol-associated liver disease (ALD) is the most common cause of cirrhosis and liver-related mortality in many regions worldwide. Around 75% of patients with cirrhosis are unaware of their disease until they are referred to the emergency department. An innovative, noninvasive screening approach is required for an earlier diagnosis of liver fibrosis. In patients with ALD the physician is inevitably dealing with 2 major disorders: the liver disease itself and the alcohol use disorder (AUD). Focus only on the liver disease will inevitably lead to failure because transient improvements in liver function are rapidly overturned if the patient returns to alcohol consumption. For this reason, integrated models of care provided by hepatologists and addiction specialists are an effective approach, which are, however, not widely available. There are multiple pharmacologic and non-pharmacologic therapies for AUD. Progress has recently been made in the management of patients with severe AH who have improved survival through better understanding of the concept of response to medical treatment, improved survival prediction, and the advent of early liver transplantation. The emerging concept is that listing for transplantation a patient with severe ALD could lead to adjusting the duration of abstinence according to the severity and evolution of liver dysfunction and the patient's addictive profile.
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Affiliation(s)
- Juan P Arab
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, Ontario, Canada; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Giovanni Addolorato
- Department of Medical and Surgical Sciences, Internal Medicine and Hepatology Unit, Catholic University of Rome, Rome, Italy
| | - Philippe Mathurin
- Service des maladies de l'appareil digestif, Hôpital Huriez, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Mark R Thursz
- Division of Digestive Diseases, Imperial College, London, United Kingdom
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13
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Jeanblanc J, Sauton P, Houdant C, Fernandez Rodriguez S, de Sousa SV, Jeanblanc V, Bodeau S, Labat L, Soichot M, Vorspan F, Naassila M. Sex-related differences in the efficacy of Baclofen enantiomers on self-administered alcohol in a binge drinking pattern and dopamine release in the core of the nucleus accumbens. Front Pharmacol 2023; 14:1146848. [PMID: 37007041 PMCID: PMC10060511 DOI: 10.3389/fphar.2023.1146848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction: Clinical studies on the effectiveness of Baclofen in alcohol use disorder (AUD) yielded mixed results possibly because of differential effects of the enantiomers and sex-related differences. Here we examined the effect of the different Baclofen enantiomers on alcohol intake and on evoked dopamine release in the core of the nucleus accumbens (NAcc) in male and female Long Evans rats.Methods: Rats were trained to chronically self-administer 20% alcohol solution in daily binge drinking sessions and were treated with the different forms of Baclofen [RS(±), R(+) and S(−)]. The effects on the evoked dopamine release within the core of the nucleus accumbens were measured in brain slices from the same animals and the alcohol naïve animals using the fast scan cyclic voltammetry technique.Results: RS(±)-Baclofen reduced alcohol intake regardless of sex but more females were non-responders to the treatment. R(+)-Baclofen also reduced alcohol intake regardless of sex but females were less sensitive than males. S(−)-Baclofen did not have any effect on average but in some individuals, especially in the females, it did increase alcohol intake by at least 100%. There were no sex differences in Baclofen pharmacokinetic but a strong negative correlation was found in females with a paradoxical effect of increased alcohol intake with higher blood Baclofen concentration. Chronic alcohol intake reduced the sensitivity to the effect of Baclofen on evoked dopamine release and S(−)-Baclofen increased dopamine release specifically in females.Discussion: Our results demonstrate a sex-dependent effect of the different forms of Baclofen with no or negative effects (meaning an increase in alcohol self-administration) in subgroup of females that could be linked to a differential effect on dopamine release and should warrant future clinical studies on alcohol use disorder pharmacotherapy that will deeply analyze sex difference.
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Affiliation(s)
- Jérôme Jeanblanc
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
- GDR3557 Psychiatrie-Addictions, Institut de Psychiatrie, University Hospital Federation (FHU A2M2P), Caen, France
| | - Pierre Sauton
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
- GDR3557 Psychiatrie-Addictions, Institut de Psychiatrie, University Hospital Federation (FHU A2M2P), Caen, France
| | - Charles Houdant
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
- GDR3557 Psychiatrie-Addictions, Institut de Psychiatrie, University Hospital Federation (FHU A2M2P), Caen, France
| | - Sandra Fernandez Rodriguez
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
| | - Sofia Vilelas de Sousa
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
| | - Virginie Jeanblanc
- Animal Facility of the Université de Picardie Jules Verne, Amiens, France
| | - Sandra Bodeau
- MP3CV Laboratory, Department of Clinical Pharmacology, Amiens University Hospital, University of Picardie Jules Verne, Amiens, France
| | - Laurence Labat
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Marion Soichot
- Laboratoire de Toxicologie Biologique, Hôpital Lariboisière, Paris, France
| | - Florence Vorspan
- INSERM UMRS1144, Département de Psychiatrie et de Médecine Addictologique, Assistance Publique—Hôpitaux de Paris, GH Lariboisière—Fernand Widal, GHU NORD, Université de Paris, Paris, France
| | - Mickael Naassila
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
- GDR3557 Psychiatrie-Addictions, Institut de Psychiatrie, University Hospital Federation (FHU A2M2P), Caen, France
- *Correspondence: Mickael Naassila,
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14
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Leggio L, Mellinger JL. Alcohol use disorder in community management of chronic liver diseases. Hepatology 2023; 77:1006-1021. [PMID: 35434815 DOI: 10.1002/hep.32531] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 02/06/2023]
Abstract
Rising rates of alcohol use disorder (AUD) combined with increases in alcohol-related liver disease (ALD) and other liver disease have resulted in the need to develop alcohol management strategies at all levels of patient care. For those with pre-existing liver disease, whether ALD or others, attention to alcohol use treatment and abstinence becomes critical to avoiding worsening liver-related consequences. Modalities to help patients reduce or stop alcohol include screening/brief intervention/referral to treatment, various therapeutic modalities including cognitive behavioral therapy, motivational enhancement therapy and 12-step facilitation, and alcohol relapse prevention medications. Harm reduction approaches versus total abstinence may be considered, but for those with existing ALD, particularly advanced ALD (cirrhosis or acute alcoholic hepatitis), total abstinence from alcohol is the recommendation, given clear data that ongoing alcohol use worsens mortality and liver-related morbidity. For certain populations, alcohol cessation is even more critically important. For those with hepatitis C or NAFLD, alcohol use accelerates negative liver-related outcomes. In women, alcohol use accelerates liver damage and results in worsened liver-related mortality. Efforts to integrate AUD and liver disease care are urgently needed and can occur at several levels, with establishment of multidisciplinary ALD clinics for fully integrated co-management as an important goal.
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Affiliation(s)
- Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section , Translational Addiction Medicine Branch , National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism , National Institutes of Health , Baltimore and Bethesda , Maryland , USA
- Medication Development Program , National Institute on Drug Abuse Intramural Research Program , National Institutes of Health , Baltimore , Maryland , USA
- Center for Alcohol and Addiction Studies , Department of Behavioral and Social Sciences , School of Public Health , Brown University , Providence , Rhode Island , USA
- Division of Addiction Medicine , Department of Medicine , School of Medicine , Johns Hopkins University , Baltimore , Maryland , USA
- Department of Neuroscience , Georgetown University Medical Center , Washington , DC , USA
| | - Jessica L Mellinger
- Department of Internal Medicine , Michigan Medicine , Ann Arbor , Michigan , USA
- Department of Psychiatry , Michigan Medicine , Ann Arbor , Michigan , USA
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15
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Domi E, Xu L, Toivainen S, Wiskerke J, Coppola A, Holm L, Augier E, Petrella M, Heilig M. Activation of GABA B receptors in central amygdala attenuates activity of PKCδ + neurons and suppresses punishment-resistant alcohol self-administration in rats. Neuropsychopharmacology 2023:10.1038/s41386-023-01543-1. [PMID: 36739350 PMCID: PMC10354045 DOI: 10.1038/s41386-023-01543-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 02/06/2023]
Abstract
Alcohol use despite negative consequences is a core phenomenon of alcohol addiction. We recently used alcohol self-administration that is resistant to footshock punishment as a model of this behavior, and found that activity of PKCδ + GABAergic neurons in the central amygdala (CeA) is a determinant of individual susceptibility for punishment resistance. In the present study, we examined whether activation of GABAB receptors in CeA can attenuate the activity of PKCδ + neurons in this region, and whether this will result in suppression of punishment- resistant alcohol self-administration in the minority of rats that show this behavior. Systemic administration of the clinically approved GABAB agonist baclofen (1 and 3 mg/kg) dose- dependently reduced punishment-resistant alcohol self-administration. Bilateral microinjections of baclofen into CeA (64 ng in 0.3 µl/side) reduced the activity of PKCδ + neurons, as measured by Fos expression. This manipulation also selectively suppressed punished alcohol self-administration in punishment-resistant rats. Expression analysis indicated that virtually all CeA PKCδ + neurons express the GABAB receptor. Using in vitro electrophysiology, we found that baclofen induced hyperpolarization of CeA neurons, reducing their firing rate in response to depolarizing current injections. Together, our findings provide a potential mechanism that contributes to the clinical efficacy of baclofen in alcohol addiction. Therapeutic use of baclofen itself is limited by problems of tolerance and need for dose escalation. Our findings support a mechanistic rationale for developing novel, improved alcohol addiction medications that target GABAB receptors, and that lack these limitations, such as e.g., GABAB positive allosteric modulators (PAM:s).
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Affiliation(s)
- Esi Domi
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, S-581 85, Linköping, Sweden. .,School of Pharmacy, Pharmacology Unit, Center for Neuroscience, University of Camerino, Camerino, 62032, Italy.
| | - Li Xu
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, S-581 85, Linköping, Sweden
| | - Sanne Toivainen
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, S-581 85, Linköping, Sweden
| | - Joost Wiskerke
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, S-581 85, Linköping, Sweden
| | - Andrea Coppola
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, S-581 85, Linköping, Sweden
| | - Lovisa Holm
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, S-581 85, Linköping, Sweden
| | - Eric Augier
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, S-581 85, Linköping, Sweden
| | - Michele Petrella
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, S-581 85, Linköping, Sweden
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, S-581 85, Linköping, Sweden
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16
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Agabio R, Saulle R, Rösner S, Minozzi S. Baclofen for alcohol use disorder. Cochrane Database Syst Rev 2023; 1:CD012557. [PMID: 36637087 PMCID: PMC9837849 DOI: 10.1002/14651858.cd012557.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Alcohol use disorder (AUD) is one of the most widespread psychiatric disorders leading to detrimental consequences to people with this disorder and others. Worldwide, the prevalence of heavy episodic drinking (30-day prevalence of at least one occasion of 60 g of pure alcohol intake among current drinkers) is estimated at 20% and the prevalence of AUD at 5% of the adult general population, with highest prevalence in Europe and North America. Therapeutic approaches, including pharmacotherapy, play an important role in treating people with AUD. This is an update of a Cochrane Review first published in 2018. OBJECTIVES To evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was 22 November 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) of at least four weeks' treatment duration and 12 weeks' overall study duration comparing baclofen for AUD treatment with placebo, no treatment or other treatments. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. relapse, 2. frequency of use, 3. amount of use, 4. adverse events, 5. dropouts from treatment and 6. dropouts from treatment due to adverse events. Our secondary outcomes were 7. craving, 8. anxiety, 9. depression and 10. frequency of most relevant adverse events. MAIN RESULTS We included 17 RCTs (1818 participants) with a diagnosis of alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition or International Classification of Diseases 10th edition criteria. Mean age was 46.5 years and 70% were men. Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. We judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg). Compared to placebo, moderate-certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants. High-certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non-detoxified or those who received medium doses. There was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) -0.18, 95% CI -0.48 to 0.11; 13 studies, 840 participants; moderate-certainty evidence); number of drinks per drinking days (MD -0.45, 95% CI -1.20 to 0.30; 9 studies, 392 participants; moderate-certainty evidence); number of participants with at least one adverse event (RR 1.05, 95% CI 0.99 to 1.11; 10 studies, 738 participants; high-certainty evidence); dropouts (RR 0.88, 95% CI 0.74 to 1.03; 17 studies, 1563 participants; high-certainty evidence); dropouts due to adverse events (RR 1.39, 95% CI 0.89 to 2.18; 16 studies, 1499 participants; high-certainty evidence). These results were confirmed by subgroup analyses except than for the dropouts that resulted lower among participants who received high doses of baclofen and studies longer than 12 weeks. Compared to placebo, there was no difference in craving (SMD -0.16, 95% CI -0.37 to 0.04; 17 studies, 1275 participants), anxiety (MD -0.01, 95% CI -0.14 to 0.11; 15 studies, 1123 participants) and depression (SMD 0.07, 95% CI -0.12 to 0.27; 11 studies, 1029 participants). Concerning the specific adverse events, baclofen increases fatigue, dizziness, somnolence/sedation, dry mouth, paraesthesia and muscle spasms/rigidity. There was no difference in the other adverse events. Compared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low-certainty evidence); number of participants with at least one adverse event (RR 0.63, 95% CI 0.23 to 1.69; very low-certainty evidence); dropouts (RR 0.56, 95% CI 0.21 to 1.46; very low-certainty evidence); dropouts due to adverse events (RR 0.33, 95% CI 0.01 to 7.87; very low-certainty evidence) and craving (MD 5.80, 95% CI -11.84 to 23.44); and all the adverse events evaluated. Compared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low-certainty evidence) and decrease the number of participants with at least one adverse event (RR 0.35, 95% CI 0.15 to 0.80; 2 studies, 80 participants; very low-certainty evidence) but the evidence is very uncertain. One study (60 participants) found no difference between baclofen and naltrexone in the dropouts at the end of treatment (RR 1.00, 95% CI 0.32 to 3.10; very low-certainty evidence), craving (MD 2.08, 95% CI -3.71 to 7.87), and all the adverse events evaluated. AUTHORS' CONCLUSIONS Baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study.
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Affiliation(s)
- Roberta Agabio
- Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Monserrato (CA), Italy
| | - Rosella Saulle
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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17
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Effects of baclofen on insular gain anticipation in alcohol-dependent patients - a randomized, placebo-controlled, pharmaco-fMRI pilot trial. Psychopharmacology (Berl) 2023; 240:171-183. [PMID: 36538099 PMCID: PMC9816215 DOI: 10.1007/s00213-022-06291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE One hallmark of addiction is an altered neuronal reward processing. In healthy individuals (HC), reduced activity in fronto-striatal regions including the insula has been observed when a reward anticipation task was performed repeatedly. This effect could indicate a desensitization of the neural reward system due to repetition. Here, we investigated this hypothesis in a cohort of patients with alcohol use disorder (AUD), who have been treated with baclofen or a placebo. The efficacy of baclofen in AUD patients has been shown to have positive clinical effects, possibly via indirectly affecting structures within the neuronal reward system. OBJECTIVES Twenty-eight recently detoxified patients (13 receiving baclofen (BAC), 15 receiving placebo (PLA)) were investigated within a longitudinal, double-blind, and randomized pharmaco-fMRI design with an individually adjusted daily dosage of 30-270 mg. METHODS Brain responses were captured by functional magnetic resonance imaging (fMRI) during reward anticipation while participating in a slot machine paradigm before (t1) and after 2 weeks of individual high-dose medication (t2). RESULTS Abstinence rates were significantly higher in the BAC compared to the PLA group during the 12-week high-dose medication phase. At t1, all patients showed significant bilateral striatal activation. At t2, the BAC group showed a significant decrease in insular activation compared to the PLA group. CONCLUSIONS By affecting insular information processing, baclofen might enable a more flexible neuronal adaptation during recurrent reward anticipation, which could resemble a desensitization as previously observed in HC. This result strengthens the modulation of the reward system as a potential mechanism of action of baclofen. TRIAL REGISTRATION Identifier of the main trial (the BACLAD study) at clinical.gov: NCT0126665.
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18
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Abstract
Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.
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19
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Caniceiro AB, Bueschbell B, Schiedel AC, Moreira IS. Class A and C GPCR Dimers in Neurodegenerative Diseases. Curr Neuropharmacol 2022; 20:2081-2141. [PMID: 35339177 PMCID: PMC9886835 DOI: 10.2174/1570159x20666220327221830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/21/2022] [Accepted: 03/23/2022] [Indexed: 11/22/2022] Open
Abstract
Neurodegenerative diseases affect over 30 million people worldwide with an ascending trend. Most individuals suffering from these irreversible brain damages belong to the elderly population, with onset between 50 and 60 years. Although the pathophysiology of such diseases is partially known, it remains unclear upon which point a disease turns degenerative. Moreover, current therapeutics can treat some of the symptoms but often have severe side effects and become less effective in long-term treatment. For many neurodegenerative diseases, the involvement of G proteincoupled receptors (GPCRs), which are key players of neuronal transmission and plasticity, has become clearer and holds great promise in elucidating their biological mechanism. With this review, we introduce and summarize class A and class C GPCRs, known to form heterodimers or oligomers to increase their signalling repertoire. Additionally, the examples discussed here were shown to display relevant alterations in brain signalling and had already been associated with the pathophysiology of certain neurodegenerative diseases. Lastly, we classified the heterodimers into two categories of crosstalk, positive or negative, for which there is known evidence.
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Affiliation(s)
- Ana B. Caniceiro
- Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal; ,These authors contributed equally to this work.
| | - Beatriz Bueschbell
- PhD Programme in Experimental Biology and Biomedicine, Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Casa Costa Alemão, 3030-789 Coimbra, Portugal; ,These authors contributed equally to this work.
| | - Anke C. Schiedel
- Department of Pharmaceutical & Medicinal Chemistry, Pharmaceutical Institute, University of Bonn, D-53121 Bonn, Germany;
| | - Irina S. Moreira
- University of Coimbra, Department of Life Sciences, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal; ,Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology, 3004-504 Coimbra, Portugal,Address correspondence to this author at the Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology, 3004-504 Coimbra, Portugal; E-mail:
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20
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Paterson LM, Barker D, Cro S, Mozgunov P, Phillips R, Smith C, Nahar L, Paterson S, Lingford-Hughes AR. FORWARDS-1: an adaptive, single-blind, placebo-controlled ascending dose study of acute baclofen on safety parameters in opioid dependence during methadone-maintenance treatment-a pharmacokinetic-pharmacodynamic study. Trials 2022; 23:880. [PMID: 36258248 PMCID: PMC9579625 DOI: 10.1186/s13063-022-06821-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Treatment of opiate addiction with opiate substitution treatment (e.g. methadone) is beneficial. However, some individuals desire or would benefit from abstinence but there are limited options to attenuate problems with opiate withdrawal. Preclinical and preliminary clinical evidence suggests that the GABA-B agonist, baclofen, has the desired properties to facilitate opiate detoxification and prevent relapse. This study aims to understand whether there are any safety issues in administering baclofen to opioid-dependent individuals receiving methadone. Methods Opiate-dependent individuals (DSM-5 severe opioid use disorder) maintained on methadone will be recruited from addiction services in northwest London (NHS and third sector providers). Participants will be medically healthy with no severe chronic obstructive pulmonary disease or type 2 respiratory failure, no current dependence on other substances (excluding nicotine), no current severe DSM-5 psychiatric disorders, and no contraindications for baclofen or 4800 IU vitamin D (placebo). Eligible participants will be randomised in a 3:1 ratio to receive baclofen or placebo in an adaptive, single-blind, ascending dose design. A Bayesian dose-escalation model will inform the baclofen dose (10, 30, 60, or 90 mg) based on the incidence of ‘dose-limiting toxicity’ (DLT) events and participant-specific methadone dose. A range of respiratory, cardiovascular, and sedative measures including the National Early Warning Score (NEWS2) and Glasgow Coma Scale will determine DLT. On the experimental day, participants will consume their usual daily dose of methadone followed by an acute dose of baclofen or placebo (vitamin D3) ~ 1 h later. Measures including oxygen saturation, transcutaneous CO2, respiratory rate, QTc interval, subjective effects (sedation, drug liking, craving), plasma levels (baclofen, methadone), and adverse events will be obtained using validated questionnaires and examinations periodically for 5 h after dosing. Discussion Study outcomes will determine what dose of baclofen is safe to prescribe to those receiving methadone, to inform a subsequent proof-of-concept trial of the efficacy baclofen to facilitate opiate detoxification. To proceed, the minimum acceptable dose is 30 mg of baclofen in patients receiving ≤ 60 mg/day methadone based on the clinical experience of baclofen’s use in alcoholism and guidelines for the management of opiate dependence. Trial registration Clinicaltrials.gov NCT05161351. Registered on 16 December 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06821-9.
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Affiliation(s)
- L M Paterson
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK.
| | - D Barker
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - S Cro
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - P Mozgunov
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - R Phillips
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - C Smith
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - L Nahar
- Toxicology Unit, Imperial College London, London, UK
| | - S Paterson
- Toxicology Unit, Imperial College London, London, UK
| | - A R Lingford-Hughes
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
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21
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Antonelli M, Sestito L, Tarli C, Addolorato G. Perspectives on the pharmacological management of alcohol use disorder: Are the approved medications effective? Eur J Intern Med 2022; 103:13-22. [PMID: 35597734 DOI: 10.1016/j.ejim.2022.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/27/2022] [Accepted: 05/13/2022] [Indexed: 12/18/2022]
Abstract
INTRODUCTION In the last decades, many medications have been tested for the treatment of Alcohol Use Disorder (AUD). Among them, disulfiram, acamprosate, naltrexone, nalmefene, sodium oxybate and baclofen have been approved in different countries, with different specific indications. Topiramate is not approved for the treatment of AUD, however, it is suggested as a therapeutic option by the American Psychiatric Association for patients who do not tolerate or respond to approved therapies. AREAS COVERED In this narrative review we have analyzed the main studies available in literature, investigating the efficacy and safety of these medications, distinguishing whether they were oriented towards abstinence or not. Randomized controlled studies, analyzing larger populations for longer periods were the main focus of our analysis. CONCLUSIONS The medications currently available for the treatment of AUD are quite effective, yet further progress can still be achieved through the personalized strategies. Also, these medications are still markedly underutilized in clinical practice and many patients do not have access to specialized treatment.
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Affiliation(s)
- Mariangela Antonelli
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luisa Sestito
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Tarli
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Addolorato
- Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy.
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22
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Floris G, Asuni GP, Talani G, Biggio F, Pisu MG, Zanda MT, Contu L, Maciocco E, Serra M, Follesa P. Increased Voluntary Alcohol Consumption in Mice Lacking GABA B(1) Is Associated With Functional Changes in Hippocampal GABA A Receptors. Front Behav Neurosci 2022; 16:893835. [PMID: 35755407 PMCID: PMC9218813 DOI: 10.3389/fnbeh.2022.893835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
Gamma-aminobutyric acid type B receptor (GABABR) has been extensively involved in alcohol use disorders; however, the mechanisms by which this receptor modulates alcohol drinking behavior remain murky. In this study, we investigate alcohol consumption and preference in mice lacking functional GABABR using the 2-bottle choice paradigm. We found that GABAB(1), knockout (KO), and heterozygous (HZ) mice drank higher amounts of an alcoholic solution, preferred alcohol to water, and reached higher blood alcohol concentrations (BACs) compared to wild-type (WT) littermates. The GABABR agonist GHB significantly reduced alcohol consumption in the GABAB(1) HZ and WT but not in the KO mice. Next, because of a functional crosstalk between GABABR and δ-containing GABAA receptor (δ-GABAAR), we profiled δ subunit mRNA expression levels in brain regions in which the crosstalk was characterized. We found a loss of the alcohol-sensitive GABAAR δ subunit in the hippocampus of the GABAB(1) KO alcohol-naïve mice that was associated with increased ɣ2 subunit abundance. Electrophysiological recordings revealed that these molecular changes were associated with increased phasic inhibition, suggesting a potential gain of synaptic GABAAR responsiveness to alcohol that has been previously described in an animal model of excessive alcohol drinking. Interestingly, voluntary alcohol consumption did not revert the dramatic loss of hippocampal δ-GABAAR occurring in the GABAB(1) KO mice but rather exacerbated this condition. Finally, we profiled hippocampal neuroactive steroids levels following acute alcohols administration in the GABAB(1) KO and WT mice because of previous involvement of GABABR in the regulation of cerebral levels of these compounds. We found that systemic administration of alcohol (1.5 g/kg) did not produce alcohol-induced neurosteroid response in the GABAB(1) KO mice but elicited an expected increase in the hippocampal level of progesterone and 3α,5α-THP in the WT controls. In conclusion, we show that genetic ablation of the GABAB(1) subunit results in increased alcohol consumption and preference that were associated with functional changes in hippocampal GABAAR, suggesting a potential mechanism by which preference for alcohol consumption is maintained in the GABAB(1) KO mice. In addition, we documented that GABAB(1) deficiency results in lack of alcohol-induced neurosteroids, and we discussed the potential implications of this finding in the context of alcohol drinking and dependence.
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Affiliation(s)
- Gabriele Floris
- Department of Life and Environment Sciences, Section of Neuroscience and Anthropology, University of Cagliari, Cagliari, Italy
| | - Gino Paolo Asuni
- Department of Life and Environment Sciences, Section of Neuroscience and Anthropology, University of Cagliari, Cagliari, Italy
| | - Giuseppe Talani
- Institute of Neuroscience-Cagliari, National Research Council, Cagliari, Italy
| | - Francesca Biggio
- Department of Life and Environment Sciences, Section of Neuroscience and Anthropology, University of Cagliari, Cagliari, Italy
| | | | - Mary Tresa Zanda
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Liliana Contu
- Department of Life and Environment Sciences, Section of Neuroscience and Anthropology, University of Cagliari, Cagliari, Italy
| | - Elisabetta Maciocco
- Institute of Neuroscience-Cagliari, National Research Council, Cagliari, Italy
| | - Mariangela Serra
- Department of Life and Environment Sciences, Section of Neuroscience and Anthropology, University of Cagliari, Cagliari, Italy
| | - Paolo Follesa
- Department of Life and Environment Sciences, Section of Neuroscience and Anthropology, University of Cagliari, Cagliari, Italy
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23
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Ito M, Spence A, Blauwet MB, Heo N, Goldwater R, Maruff P, Marek GJ. A phase 1 study to assess potential interaction between ASP8062 and alcohol in healthy adult subjects. J Psychopharmacol 2022; 36:756-767. [PMID: 34994232 DOI: 10.1177/02698811211058967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND ASP8062 is a novel orally active GABAB receptor positive allosteric modulator in clinical development for the treatment of alcohol use disorder (AUD) and opioid use disorder (OUD). AIMS This study assessed the potential pharmacokinetic/pharmacodynamic interaction between ASP8062 and alcohol under single-dose conditions in healthy adults. METHODS A double-blind, placebo-controlled, crossover phase 1 study was conducted in which 20 subjects were randomly assigned to four treatment sequences (ASP8062 + alcohol; ASP8062 + placebo alcohol; placebo + alcohol; placebo + placebo alcohol) each consisting of four treatment periods, separated by washout periods of at least 14 days. An analysis of variance was used to assess pharmacokinetic interaction and a mixed-effects analysis of covariance was used to assess pharmacodynamic interaction. RESULTS/OUTCOMES After administration of alcohol, a mild to minimal increase in plasma exposure (AUCinf and Cmax) of ASP8062 was observed, but tmax and t½ for ASP8062 remained unchanged after administration of alcohol. In contrast, ASP8062 did not affect the AUClast and Cmax of ethanol. No clinically relevant differences in cognition measurements were observed with ASP8062 compared with placebo, but there were expected impairments in psychomotor and executive function with alcohol alone. ASP8062 in combination with alcohol resulted in worse scores in cognition measurements than alcohol alone, but this potentiation was not consistent. ASP8062 administered alone was safe and well-tolerated and safety findings in subjects administered alcohol alone were not augmented when ASP8062 was administered in combination with alcohol. CONCLUSION/INTERPRETATION The data support further clinical studies investigating ASP8062 in patients with AUD.
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Affiliation(s)
- Mototsugu Ito
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | - Anna Spence
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | - Nakyo Heo
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | | | - Gerard J Marek
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
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24
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Affiliation(s)
- Lorenzo Leggio
- National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - M Katherine Jung
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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25
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Tarli C, Mirijello A, Addolorato G. Treating Alcohol Use Disorder in Patients with Alcohol-Associated Liver Disease: Controversies in Pharmacological Therapy. Semin Liver Dis 2022; 42:138-150. [PMID: 35292951 DOI: 10.1055/a-1798-2872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Alcohol use disorder (AUD) is one of the main causes of global death and disability. The liver represents the main target of alcohol damage, and alcohol-associated liver disease (ALD) represents the first cause of liver cirrhosis in Western countries. Alcohol abstinence is the main goal of treatment in AUD patients with ALD, as treatments for ALD are less effective when drinking continues. Moreover, the persistence of alcohol consumption is associated with higher mortality, increased need for liver transplantation, and graft loss. The most effective treatment for AUD is the combination of psychosocial interventions, pharmacological therapy, and medical management. However, the effectiveness of these treatments in patients with ALD is doubtful even because AUD patients with ALD are usually excluded from pharmacological trials due to concerns on liver safety. This narrative review will discuss the treatment options for AUD-ALD patients focusing on controversies in pharmacological therapy.
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Affiliation(s)
- Claudia Tarli
- Internal Medicine and Alcohol Related Disease Unit, Department of Medical and Surgical Sciences, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome, Rome, Italy
| | - Antonio Mirijello
- Internal Medicine Unit, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giovanni Addolorato
- Internal Medicine and Alcohol Related Disease Unit, Department of Medical and Surgical Sciences, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Rome, Rome, Italy.,CEMAD Digestive Disease Center, Department of Medical and Surgical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, l.go Gemelli, Rome, Italy.,Internal Medicine Unit, Department of Internal Medicine and Gastroenterology, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
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26
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Morley KC, Louie E, Hurzeler T, Baillie A, Dore G, Phung N, Haber PS. Sex as a Potential Moderator for Baclofen Response in the Treatment of Alcohol Dependence. Front Glob Womens Health 2022; 3:807269. [PMID: 35425938 PMCID: PMC9001901 DOI: 10.3389/fgwh.2022.807269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/07/2022] [Indexed: 12/20/2022] Open
Abstract
Background and Aims Recent studies indicate that sex may moderate the response to baclofen in the treatment of alcohol use disorder (AUD). We conducted a secondary analysis of a double-blind randomized controlled trial, Baclofen in the treatment of Alcohol Liver Disease (BacALD), to examine the moderating role of sex on treatment response to baclofen in reducing alcohol consumption. Methods Alcohol-dependent patients (n = 104 including 74 men and 30 women) were treated for 12 weeks with baclofen (30 mg/day or 75 mg) or placebo. Predefined primary outcomes included time to lapse (any drinking) and relapse (≥ 5 drinks per day in men and ≥ 4drinks per day in women). Other outcomes included drinks per drinking day, the number of heavy drinking days, and percentage of days abstinent. We also examined the frequency of adverse events with an exploratory dose–response analysis. Results There was a main effect of baclofen for days to first lapse for women (Log Rank: χ2 = 6.23, p = 0.01, d = 0.49) but not for men (Log Rank: χ2 = 2.48, p = 0.12, d = 0.22) and a marginal effect of baclofen for days to first relapse for women (Log Rank: χ2 = 3.15, p = 0.08, d = 0.27) but not for men (Log Rank: χ2 = 2.03, p = 0.16, d = 0.17). There were no significant effects of sex on the frequency of adverse events reported for the combined-dose or between-dose analysis (all p > 0.44). Conclusion Baclofen significantly delayed the time to lapse for women but not male participants. These findings provide some support for the hypothesis that sex may be a potential moderator of baclofen response in the treatment of AUD. Trial Registration https://clinicaltrials.gov/ct2/show/NCT01711125, identifier: NCT01711125.
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Affiliation(s)
- Kirsten C. Morley
- Faculty of Medicine and Health, Central Clinical School, Specialty of Addiction Medicine, Sydney Medical School, University of Sydney, Darlington, NSW, Australia
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
- *Correspondence: Kirsten C. Morley
| | - Eva Louie
- Faculty of Medicine and Health, Central Clinical School, Specialty of Addiction Medicine, Sydney Medical School, University of Sydney, Darlington, NSW, Australia
| | - Tristan Hurzeler
- Faculty of Medicine and Health, Central Clinical School, Specialty of Addiction Medicine, Sydney Medical School, University of Sydney, Darlington, NSW, Australia
| | - Andrew Baillie
- Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Darlington, NSW, Australia
| | - Glenys Dore
- Herbert St Alcohol Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nghi Phung
- Centre for Addiction Medicine, Westmead Hospital, Parramatta, NSW, Australia
| | - Paul S. Haber
- Faculty of Medicine and Health, Central Clinical School, Specialty of Addiction Medicine, Sydney Medical School, University of Sydney, Darlington, NSW, Australia
- Edith Collins Centre, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
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The Combination of Galanin (1–15) and Escitalopram in Rats Suggests a New Strategy for Alcohol Use Disorder Comorbidity with Depression. Biomedicines 2022; 10:biomedicines10020412. [PMID: 35203621 PMCID: PMC8962322 DOI: 10.3390/biomedicines10020412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 12/07/2022] Open
Abstract
Alcohol use disorder (AUD) is highly prevalent, and over 50% of AUD patients also suffer major depressive disorders. Selective 5-HT reuptake inhibitors (SSRIs) can reduce rodent ethanol drinking but exert modest clinical efficacy in alcoholic individuals. Finding new pharmacological strategies that could modulate alcohol consumption and depression is necessary. We have analyzed the effect of Galanin (1–15) [GAL(1–15)] on escitalopram (ESC)-mediated effect in alcohol consumption using the alcohol self-administration test, the nuclei involved in the effect, and whether GAL(1–15) + ESC modulated the response in despair or anxiety tests in animals under chronic alcohol intake. GAL(1–15) + ESC combination substantially reduced alcohol intake in the alcohol self-administration test and, moreover, enhanced the reduction of reward capacity of ESC on different reinforcers such as sucrose or saccharine. GAL(1–15) + ESC coadministration significantly decreases the number of C-Fos-IR TH cell bodies in the VTA, and PCA analysis suggests that one functional network, including VTA, RMTg and DR, is involved in these effects. Significantly in rats with chronic alcohol consumption, GAL(1–15) reversed adverse ESC-mediated effects in the depression-related behavioural test and forced swimming test. The results open up the possibility of using GAL(1–15) in combination with the SSRI Escitalopram as a novel strategy in AUD comorbidity with depression.
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Abstract
Alcohol use disorder (AUD) is a highly prevalent but severely under-treated disorder, with only three widely-approved pharmacotherapies. Given that AUD is a very heterogeneous disorder, it is unlikely that one single medication will be effective for all individuals with an AUD. As such, there is a need to develop new, more effective, and diverse pharmacological treatment options for AUD with the hopes of increasing utilization and improving care. In this qualitative literature review, we discuss the efficacy, mechanism of action, and tolerability of approved, repurposed, and novel pharmacotherapies for the treatment of AUD with a clinical perspective. Pharmacotherapies discussed include: disulfiram, acamprosate, naltrexone, nalmefene, topiramate, gabapentin, varenicline, baclofen, sodium oxybate, aripiprazole, ondansetron, mifepristone, ibudilast, suvorexant, prazosin, doxazosin, N-acetylcysteine, GET73, ASP8062, ABT-436, PF-5190457, and cannabidiol. Overall, many repurposed and novel agents discussed in this review demonstrate clinical effectiveness and promise for the future of AUD treatment. Importantly, these medications also offer potential improvements towards the advancement of precision medicine and personalized treatment for the heterogeneous AUD population. However, there remains a great need to improve access to treatment, increase the menu of approved pharmacological treatments, and de-stigmatize and increase treatment-seeking for AUD.
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29
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Maccioni P, Lorrai I, Carai MAM, Gessa GL, Colombo G. Blockade of the GABAB receptor suppressed alcohol self-administration in rats: an effect similar to that produced by GABAB receptor activation. Behav Pharmacol 2022; 33:51-60. [PMID: 34954712 DOI: 10.1097/fbp.0000000000000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Literature data suggest that activation and blockade of the GABAB receptor may produce similar effects on several reward-related behaviours. Accordingly, the present study was designed to investigate whether treatment with the GABAB receptor antagonist, SCH 50911, reproduced the suppressing effect of the GABAB receptor agonist, baclofen, and several positive allosteric modulators of the GABAB receptor on operant oral alcohol self-administration in rats. To this end, Sardinian alcohol-preferring (sP) rats were trained to lever-respond for alcohol (15% v/v) under the fixed ratio (FR) 4 (FR4) schedule of reinforcement. Once lever-responding had stabilized, rats were exposed to test sessions preceded by treatment with SCH 50911 (0, 25, 50, and 100 mg/kg; i.p.). Two independent experiments were conducted, differing solely in the set of rats used. Selectivity of SCH 50911 effect on alcohol self-administration was assessed by evaluating the effect of SCH 50911 (0, 25, 50, and 100 mg/kg; i.p.) on self-administration of a sucrose solution (0.7% w/v) in sP rats exposed to the FR4 schedule. In both 'alcohol' experiments, treatment with SCH 50911 reduced lever-responding for alcohol and amount of self-administered alcohol. SCH 50911 effect was characterized by large interindividual variability, with several instances of dose-unrelated reductions, and frequent occurrence of complete suppression of lever-responding for alcohol. Similar data were collected in the 'sucrose' experiment. These results extend to alcohol self-administration with the notion that activation and blockade of GABAB receptor may produce unidirectional effects on reward-related behaviours; these similarities are discussed in terms of differential contribution of pre- and postsynaptic GABAB receptors.
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Affiliation(s)
- Paola Maccioni
- Neuroscience Institute, Section of Cagliari, National Research Council of Italy, Monserrato
| | - Irene Lorrai
- Neuroscience Institute, Section of Cagliari, National Research Council of Italy, Monserrato
| | | | - Gian Luigi Gessa
- Neuroscience Institute, Section of Cagliari, National Research Council of Italy, Monserrato
| | - Giancarlo Colombo
- Neuroscience Institute, Section of Cagliari, National Research Council of Italy, Monserrato
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30
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Reducing effect of the novel positive allosteric modulator of the GABA B receptor, COR659, on binge-like alcohol drinking in male mice and rats. Psychopharmacology (Berl) 2022; 239:201-213. [PMID: 34812900 DOI: 10.1007/s00213-021-06022-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/04/2021] [Indexed: 01/08/2023]
Abstract
RATIONALE Binge drinking (BD) is a widespread drinkingpattern that may contribute to promote the development of alcohol use disorder (AUD). The comprehension of its neurobiological basis and the identification of molecules that may prevent BD are critical. Preclinical studies demonstrated that positive allosteric modulators (PAMs) of the GABAB receptor effectively reduced, and occasionally suppressed, the reinforcing and motivational properties of alcohol in rodents, suggesting their potential use as pharmacotherapy for AUD, including BD. Recently, we demonstrated that COR659, a novel GABAB PAM, effectively reduced (i) alcohol drinking under the 2-bottle choice regimen, (ii) alcohol self-administration under both fixed and progressive ratio schedules of reinforcement, and (iii) cue-induced reinstatement of alcohol-seeking behavior in Sardinian alcohol-preferring (sP) rats. OBJECTIVES The present study investigated whether the "anti-alcohol" properties of COR659 extend to binge-like drinking in rodents. METHODS COR659 was tested on the "drinking in the dark" (DID) paradigm in C57BL/6J mice and the 4-bottle "alcohol [10%, 20%, 30% (v/v)] versus water" choice regimen with limited and unpredictable access to alcohol in sP rats. RESULTS Acute administration of non-sedative doses of COR659 (10, 20, and 40 mg/kg; i.p.) effectively and selectively suppressed the intake of intoxicating amounts of alcohol (> 2 g/kg) consumed by C57BL/6J mice and sP rats exposed to these binge-like drinking experimental procedures. CONCLUSIONS The present data demonstrate the ability of COR659 to suppress binge-like drinking in rodents and strengthen the hypothesis that GABAB PAMs may represent a potentially effective pharmacotherapy for alcohol misuse.
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Management of alcohol use disorder in patients with cirrhosis in the setting of liver transplantation. Nat Rev Gastroenterol Hepatol 2022; 19:45-59. [PMID: 34725498 PMCID: PMC8559139 DOI: 10.1038/s41575-021-00527-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
The prevalence of alcohol use disorder (AUD) has been steadily increasing over the past decade. In parallel, alcohol-associated liver disease (ALD) has been increasing at an alarming rate, especially among young patients. Data suggest that most patients with ALD do not receive AUD therapy. Although liver transplantation is the only curative therapy for end-stage ALD, transplant candidacy is often a matter of debate given concerns about patients being under-treated for AUD and fears of post-transplantation relapse affecting the allograft. In this Review, we discuss diagnosis, predictors and effects of relapse, behavioural therapies and pharmacotherapies, and we also propose an integrative, multidisciplinary and multimodality approach for treating AUD in patients with cirrhosis, especially in the setting of liver transplantation. Notably, this approach takes into account the utility of AUD pharmacotherapy in patients on immunosuppressive medications and those with renal impairment after liver transplantation. We also propose a comprehensive and objective definition of relapse utilizing contemporary biomarkers to guide future clinical trials. Future research using the proposed approach and definition is warranted with the goal of optimizing AUD treatment in patients with cirrhosis, the transplant selection process and post-transplantation care of patients with AUD.
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de Beaurepaire R, Rolland B. Baclofen in alcohol use disorder: An analysis of the data provided by the French "Temporary Recommendation for Use" 2014-2017 cohort. Front Psychiatry 2022; 13:949750. [PMID: 36311508 PMCID: PMC9597083 DOI: 10.3389/fpsyt.2022.949750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Alcohol use disorder (AUD) is a devastating illness for which effective treatments are lacking. Studies over the last two decades have shown that baclofen, a GABA-B agonist, could be a promising treatment for AUD. However, the efficacy of baclofen is still controversial, and studies have shown that it may be associated with an excess of hospitalizations and deaths. In March 2014, the French Health Safety Agency granted a "Temporary Recommendation for Use" (TRU) regulating the prescription of baclofen in subjects with AUD. The TRU allowed physicians to prescribe high-dose baclofen (up to 300 mg/d). The doses were adjusted, and tailored to the needs of each patient. Between March 2014 and March 2017, TRU clinical data were collected for a total of 6,939 subjects. The recorded data included information on alcohol consumption, the intensity of alcohol cravings, and adverse events. The present article proposes an analysis of the data provided by the TRU. Subjects for which data were missing regarding baclofen daily dosage, alcohol consumption or craving scores were discarded from the analyses. A cohort of two groups of subjects was analyzed. The first group included all TRU subjects suitable for analyses (5,550 subjects), and the second group included subjects followed for at least 365 days (169 subjects). Comparisons were made between baseline and endpoint of the follow-up period. The results show that a majority of subjects in the whole cohort had received doses of over 80 mg/d. The mean dose of baclofen at the endpoint was >110 mg/d in the second group of subjects. Doses of >80 mg/d were not associated with an increase in adverse events after adjustment for the follow-up duration. In terms of efficacy, comparisons between baseline and endpoint show that baclofen treatment significantly decreased alcohol consumption and alcohol cravings, and significantly increased the number of subjects with null or low-risk alcohol consumption according to WHO criteria.
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Affiliation(s)
| | - Benjamin Rolland
- Academic Department of Addiction Medicine in Lyon, Centre Hospitalier Le Vinatier, Hospices Civils de Lyon, Lyon, France
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Liu L, Fan Z, Rovira X, Xue L, Roux S, Brabet I, Xin M, Pin JP, Rondard P, Liu J. Allosteric ligands control the activation of a class C GPCR heterodimer by acting at the transmembrane interface. eLife 2021; 10:70188. [PMID: 34866572 PMCID: PMC8700296 DOI: 10.7554/elife.70188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/02/2021] [Indexed: 01/02/2023] Open
Abstract
G protein-coupled receptors (GPCRs) are among the most promising drug targets. They often form homo- and heterodimers with allosteric cross-talk between receptor entities, which contributes to fine-tuning of transmembrane signaling. Specifically controlling the activity of GPCR dimers with ligands is a good approach to clarify their physiological roles and validate them as drug targets. Here, we examined the mode of action of positive allosteric modulators (PAMs) that bind at the interface of the transmembrane domains of the heterodimeric GABAB receptor. Our site-directed mutagenesis results show that mutations of this interface impact the function of the three PAMs tested. The data support the inference that they act at the active interface between both transmembrane domains, the binding site involving residues of the TM6s of the GABAB1 and the GABAB2 subunit. Importantly, the agonist activity of these PAMs involves a key region in the central core of the GABAB2 transmembrane domain, which also controls the constitutive activity of the GABAB receptor. This region corresponds to the sodium ion binding site in class A GPCRs that controls the basal state of the receptors. Overall, these data reveal the possibility of developing allosteric compounds able to specifically modulate the activity of GPCR homo- and heterodimers by acting at their transmembrane interface.
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Affiliation(s)
- Lei Liu
- Cellular Signaling Laboratory, International Research Center for Sensory Biology and Technology of MOST, Key Laboratory of Molecular Biophysics of MOE, and College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China.,Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Zhiran Fan
- Cellular Signaling Laboratory, International Research Center for Sensory Biology and Technology of MOST, Key Laboratory of Molecular Biophysics of MOE, and College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Xavier Rovira
- MCS, Laboratory of Medicinal Chemistry, Institute for Advanced Chemistry of Catalonia (IQAC-CSIC), Barcelona, Spain
| | - Li Xue
- Cellular Signaling Laboratory, International Research Center for Sensory Biology and Technology of MOST, Key Laboratory of Molecular Biophysics of MOE, and College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China.,Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Salomé Roux
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Isabelle Brabet
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Mingxia Xin
- Cellular Signaling Laboratory, International Research Center for Sensory Biology and Technology of MOST, Key Laboratory of Molecular Biophysics of MOE, and College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Jean-Philippe Pin
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Philippe Rondard
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Jianfeng Liu
- Cellular Signaling Laboratory, International Research Center for Sensory Biology and Technology of MOST, Key Laboratory of Molecular Biophysics of MOE, and College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
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Garbutt JC, Kampov-Polevoy AB, Pedersen C, Stansbury M, Jordan R, Willing L, Gallop RJ. Efficacy and tolerability of baclofen in a U.S. community population with alcohol use disorder: a dose-response, randomized, controlled trial. Neuropsychopharmacology 2021; 46:2250-2256. [PMID: 34155332 PMCID: PMC8580979 DOI: 10.1038/s41386-021-01055-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023]
Abstract
Identification of new medications for alcohol use disorder (AUD) is important for improving treatment options. Baclofen, a GABAB agonist, has been identified as a potential pharmacotherapy for AUD. In a 16-week double-blind, randomized, placebo-controlled trial, we investigated 30 and 90 mg/day of baclofen compared to placebo and examined effects of dose, sex, and level of pretreatment drinking. One hundred and twenty participants with DSM-IV alcohol dependence (age 46.1 (sd = 10.1) years, 51.7% male) were randomized after exclusion for unstable medical/psychiatric illness and/or dependence on drugs other than nicotine. Seventy-three participants completed the trial. A main effect of baclofen was found [%HDD (F(2,112) = 4.16, p = 0.018, d = 0.51 95%CI (0.06-0.95), 13.6 fewer HDD) and %ABST (F(2,112) = 3.68, p = 0.028, d = 0.49 95%CI (0.04-0.93), 12.9 more abstinent days)] and was driven by the 90 mg/day dose. A sex × dose interaction effect was present for both %HDD (F(2,110) = 5.48, p = 0.005) and %ABST (F(2,110) = 3.19, p = 0.045). Men showed a marginally positive effect for 90 mg/day compared to PBO (%HDD t(110) = 1.88, p = 0.063, d = 0.36 95%CI (-0.09-0.80), 15.8 fewer HDD days; %ABST t(110) = 1.68 (p = 0.096, d = 0.32 95%CI (-0.12-0.76), 15.7 more ABST)) with no effect for 30 mg/day. Women showed a positive effect for 30 mg/day (%HDD, t(110) = 3.19, p = 0.002, d = 0.61 95%CI (0.16-1.05), 26.3 fewer HDD days; %ABST t(110) = 2.73, p = 0.007, d = 0.52 95%CI (0.07-0.96), 25.4 more ABST days) with marginal effects for 90 mg/day on %ABST (p = 0.06) with drop-outs/dose reduction from sedative side-effects of 59% in women at 90 mg/day compared to 5% for men. These findings support the hypothesis that baclofen has efficacy in AUD and suggest that dose and sex be further explored as potential moderators of baclofen response and tolerability.
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Affiliation(s)
- James C. Garbutt
- grid.10698.360000000122483208Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.10698.360000000122483208Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Alexei B. Kampov-Polevoy
- grid.10698.360000000122483208Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.10698.360000000122483208Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Cort Pedersen
- grid.10698.360000000122483208Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Melissa Stansbury
- grid.10698.360000000122483208Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Robyn Jordan
- grid.10698.360000000122483208Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Laura Willing
- grid.10698.360000000122483208Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Robert J. Gallop
- grid.268132.c0000 0001 0701 2416Department of Mathematics, Applied Statistics Program, West Chester University, West Chester, PA USA
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Leggio L, Litten RZ. The GABA-B receptor agonist baclofen helps patients with alcohol use disorder: why these findings matter. Neuropsychopharmacology 2021; 46:2228-2229. [PMID: 34400781 PMCID: PMC8581012 DOI: 10.1038/s41386-021-01142-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/25/2021] [Accepted: 08/01/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Baltimore and Bethesda, MD, USA. .,Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, USA. .,Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA. .,Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. .,Department of Neuroscience, Georgetown University Medical Center, Washington, DC, USA.
| | - Raye Z. Litten
- grid.420085.b0000 0004 0481 4802Division of Treatment and Recovery, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD USA
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Haber PS, Riordan BC, Winter DT, Barrett L, Saunders J, Hides L, Gullo M, Manning V, Day CA, Bonomo Y, Burns L, Assan R, Curry K, Mooney-Somers J, Demirkol A, Monds L, McDonough M, Baillie AJ, Clark P, Ritter A, Quinn C, Cunningham J, Lintzeris N, Rombouts S, Savic M, Norman A, Reid S, Hutchinson D, Zheng C, Iese Y, Black N, Draper B, Ridley N, Gowing L, Stapinski L, Taye B, Lancaster K, Stjepanović D, Kay-Lambkin F, Jamshidi N, Lubman D, Pastor A, White N, Wilson S, Jaworski AL, Memedovic S, Logge W, Mills K, Seear K, Freeburn B, Lea T, Withall A, Marel C, Boffa J, Roxburgh A, Purcell-Khodr G, Doyle M, Conigrave K, Teesson M, Butler K, Connor J, Morley KC. New Australian guidelines for the treatment of alcohol problems: an overview of recommendations. Med J Aust 2021; 215 Suppl 7:S3-S32. [PMID: 34601742 DOI: 10.5694/mja2.51254] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Abstract
OF RECOMMENDATIONS AND LEVELS OF EVIDENCE Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A). SUMMARY OF KEY RECOMMENDATIONS AND LEVELS OF EVIDENCE Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A).
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Özgen H, Spijkerman R, Noack M, Holtmann M, Schellekens ASA, van de Glind G, Banaschewski T, Barta C, Begeman A, Casas M, Crunelle CL, Daigre Blanco C, Dalsgaard S, Demetrovics Z, den Boer J, Dom G, Eapen V, Faraone SV, Franck J, González RA, Grau-López L, Groenman AP, Hemphälä M, Icick R, Johnson B, Kaess M, Kapitány-Fövény M, Kasinathan JG, Kaye SS, Kiefer F, Konstenius M, Levin FR, Luderer M, Martinotti G, Matthys FIA, Meszaros G, Moggi F, Munasur-Naidoo AP, Post M, Rabinovitz S, Ramos-Quiroga JA, Sala R, Shafi A, Slobodin O, Staal WG, Thomasius R, Truter I, van Kernebeek MW, Velez-Pastrana MC, Vollstädt-Klein S, Vorspan F, Young JT, Yule A, van den Brink W, Hendriks V. [International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2021; 50:54-67. [PMID: 34397296 DOI: 10.1024/1422-4917/a000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder Abstract. Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.
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Affiliation(s)
- Heval Özgen
- Diese Autor_innen haben zu gleichen Teilen zu diesem Beitrag beigetragen.,Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, Den Haag, Niederlande.,Curium, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, Niederlande
| | - Renske Spijkerman
- Diese Autor_innen haben zu gleichen Teilen zu diesem Beitrag beigetragen.,Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, Den Haag, Niederlande
| | - Moritz Noack
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Hamm, Deutschland
| | - Martin Holtmann
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Hamm, Deutschland
| | - Arnt S A Schellekens
- Department of Psychiatry, Donders institute, Radboud UMC, Nijmegen, Niederlande.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud UMC, Nijmegen, Niederlande
| | - Geurt van de Glind
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud UMC, Nijmegen, Niederlande.,International Collaboration on ADHD and Substance Abuse (ICASA) Foundation, Nijmegen, Niederlande
| | - Tobias Banaschewski
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland
| | - Csaba Barta
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Ungarn.,Institute of Psychology, Faculty of Humanities and Social Sciences, Pázmány Péter Catholic University, Budapest, Ungarn
| | | | - Miguel Casas
- Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spanien
| | - Cleo L Crunelle
- Department of Psychiatry, University Hospital Brussels, Brüssel, Belgien
| | - Constanza Daigre Blanco
- Department of Psychiatry, Mental Health and Addictions, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spanien.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spanien.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spanien
| | - Søren Dalsgaard
- Department of Economics and Business Economics, Aarhus University, Aarhus, Dänemark
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
| | | | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerpen, Belgien
| | - Valsamma Eapen
- Academic Unit of Infant, Child, Adolescent Psychiatry South West Sydney, University of New South Wales, Sydney, New South Wales, Australien
| | - Stephen V Faraone
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Johan Franck
- Child- and Adolescent Department, Piteå Hospital, Region Norrbotten, Piteå, Schweden
| | - Rafael A González
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, London, Vereinigtes Königreich.,East London NHS Foundation Trust, Child and Adolescent Mental Health Service (CAMHS) - ADHD clinic, London, Vereinigtes Königreich
| | - Lara Grau-López
- Department of Psychiatry, Mental Health and Addictions, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spanien.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spanien.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spanien.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spanien
| | - Annabeth P Groenman
- Department of Psychology, University of Amsterdam, Amsterdam, Niederlande.,Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Niederlande
| | - Malin Hemphälä
- Child- and Adolescent Department, Piteå Hospital, Region Norrbotten, Piteå, Schweden
| | - Romain Icick
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris, Frankreich.,INSERM U1144, Paris, Frankreich.,Inserm UMR-S1144, Université de Paris, Paris, Frankreich
| | - Brian Johnson
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Michael Kaess
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz.,Klinik für Kinder- und Jugendpsychiatrie, Zentrum für psychosoziale Medizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Máté Kapitány-Fövény
- Faculty of Health Sciences, Semmelweis University, Budapest, Ungarn.,Drug Outpatient Centre, Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Ungarn
| | - John G Kasinathan
- Adolescent Mental Health, Justice Health and Forensic Mental Health Network, Sydney, New South Wales, Australien
| | - Sharlene S Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australien
| | - Falk Kiefer
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland
| | - Maija Konstenius
- Child- and Adolescent Department, Piteå Hospital, Region Norrbotten, Piteå, Schweden
| | - Frances R Levin
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York, USA
| | - Mathias Luderer
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt, Goethe Universität, Frankfurt am Main, Deutschland
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italien
| | - Frieda I A Matthys
- Department of Psychiatry, UZ Brussel, Vrije Universiteit Brussel (VUB), Brüssel, Belgien
| | - Gergely Meszaros
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Ungarn
| | - Franz Moggi
- Universitätsklinik für Psychiatrie, Universität Bern, Bern, Schweiz
| | - Ashmita P Munasur-Naidoo
- Department of Pharmacy, Nelson Mandela University, Port Elizabeth, Südafrika.,Cipla Medpro Pharmaceuticals, Durban, Südafrika
| | - Marianne Post
- Brijder Youth Addiction Treatment, Parnassia Psychiatric Institute, Den Haag, Niederlande
| | - Sharon Rabinovitz
- School of Criminology and The Unit for Excellence in Research & Study of Addiction (ERSA), The Center for Rehabilitation Research, University of Haifa, Haifa, Israel
| | - J Antoni Ramos-Quiroga
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spanien.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spanien.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spanien.,Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spanien
| | - Regina Sala
- Centre for Psychiatry, Wolfson Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, Vereinigtes Königreich
| | - Abu Shafi
- East London NHS Foundation Trust, London, Vereinigtes Königreich
| | - Ortal Slobodin
- Department of Education, Ben-Gurion University, Beer-Sheva, Beer-Sheva, Israel
| | - Wouter G Staal
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Niederlande.,Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Niederlande
| | - Rainer Thomasius
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, Port Elizabeth, Südafrika
| | - Michiel W van Kernebeek
- Department of Psychiatry, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brüssel, Belgien
| | | | - Sabine Vollstädt-Klein
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland
| | - Florence Vorspan
- INSERM U1144, Paris, Frankreich.,Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Paris, Frankreich.,Faculté de Médecine, Université de Paris, Paris, Frankreich.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, Frankreich
| | - Jesse T Young
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australien.,Murdoch Children's Research Institute, Melbourne, Victoria, Australien.,School of Population and Global Health, The University of Western Australia, Perth, Washington, Australien.,National Drug Research Institute, Curtin University, Perth, Washington, Australien
| | - Amy Yule
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Wim van den Brink
- International Collaboration on ADHD and Substance Abuse (ICASA) Foundation, Nijmegen, Niederlande.,Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, Niederlande
| | - Vincent Hendriks
- Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, Den Haag, Niederlande.,Curium, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, Niederlande
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Romito JW, Turner ER, Rosener JA, Coldiron L, Udipi A, Nohrn L, Tausiani J, Romito BT. Baclofen therapeutics, toxicity, and withdrawal: A narrative review. SAGE Open Med 2021; 9:20503121211022197. [PMID: 34158937 PMCID: PMC8182184 DOI: 10.1177/20503121211022197] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
Baclofen is an effective therapeutic for the treatment of spasticity related to multiple sclerosis, spinal cord injuries, and other spinal cord pathologies. It has been increasingly used off-label for the management of several disorders, including musculoskeletal pain, gastroesophageal reflux disease, and alcohol use disorder. Baclofen therapy is associated with potential complications, including life-threatening toxicity and withdrawal syndrome. These disorders require prompt recognition and a high index of suspicion. While these complications can develop following administration of either oral or intrathecal baclofen, the risk is greater with the intrathecal route. The management of baclofen toxicity is largely supportive while baclofen withdrawal syndrome is most effectively treated with re-initiation or supplementation of baclofen dosing. Administration of other pharmacologic adjuncts may be required to effectively treat associated withdrawal symptoms. This narrative review provides an overview of the historical and emerging uses of baclofen, offers practical dosing recommendations for both oral and intrathecal routes of administration, and reviews the diagnosis and management of both baclofen toxicity and withdrawal.
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Affiliation(s)
- Jia W Romito
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
- Department of Neurological Surgery, The
University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, The University
of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Emily R Turner
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - John A Rosener
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Landon Coldiron
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Ashutosh Udipi
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Linsey Nohrn
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Jacob Tausiani
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
| | - Bryan T Romito
- Department of Anesthesiology and Pain
Management, The University of Texas Southwestern Medical Center, Dallas, TX,
USA
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GABA B Receptor Chemistry and Pharmacology: Agonists, Antagonists, and Allosteric Modulators. Curr Top Behav Neurosci 2021; 52:81-118. [PMID: 34036555 DOI: 10.1007/7854_2021_232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The GABAB receptors are metabotropic G protein-coupled receptors (GPCRs) that mediate the actions of the primary inhibitory neurotransmitter, γ-aminobutyric acid (GABA). In the CNS, GABA plays an important role in behavior, learning and memory, cognition, and stress. GABA is also located throughout the gastrointestinal (GI) tract and is involved in the autonomic control of the intestine and esophageal reflex. Consequently, dysregulated GABAB receptor signaling is associated with neurological, mental health, and gastrointestinal disorders; hence, these receptors have been identified as key therapeutic targets and are the focus of multiple drug discovery efforts for indications such as muscle spasticity disorders, schizophrenia, pain, addiction, and gastroesophageal reflex disease (GERD). Numerous agonists, antagonists, and allosteric modulators of the GABAB receptor have been described; however, Lioresal® (Baclofen; β-(4-chlorophenyl)-γ-aminobutyric acid) is the only FDA-approved drug that selectively targets GABAB receptors in clinical use; undesirable side effects, such as sedation, muscle weakness, fatigue, cognitive deficits, seizures, tolerance and potential for abuse, limit their therapeutic use. Here, we review GABAB receptor chemistry and pharmacology, presenting orthosteric agonists, antagonists, and positive and negative allosteric modulators, and highlight the therapeutic potential of targeting GABAB receptor modulation for the treatment of various CNS and peripheral disorders.
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40
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Liu SY, Tsai IT, Hsu YC. Alcohol-Related Liver Disease: Basic Mechanisms and Clinical Perspectives. Int J Mol Sci 2021; 22:5170. [PMID: 34068269 PMCID: PMC8153142 DOI: 10.3390/ijms22105170] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Alcohol-related liver disease (ALD) refers to the liver damage occurring due to excessive alcohol consumption and involves a broad spectrum of diseases that includes liver steatosis, steatohepatitis, hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). The progression of ALD is mainly associated with the amount and duration of alcohol usage; however, it is also influenced by genetic, epigenetic, and environmental factors. The definite diagnosis of ALD is based on a liver biopsy, although several non-invasive diagnostic tools and serum biomarkers have emerging roles in the early detection of ALD. While alcohol abstinence and nutritional support remain the cornerstone of ALD treatment, growing evidence has revealed that the therapeutic agents that target oxidative stress or gut-liver axis, inflammatory response inhibition, and liver regeneration enhancement also play a role in ALD management. Furthermore, microRNAs modulation and mesenchymal stem cell-based therapy have emerging potential as ALD therapeutic options. This review summarizes the updated understanding of the pathophysiology, diagnosis, and novel therapeutic approaches for ALD.
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Affiliation(s)
- Szu-Yi Liu
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (S.-Y.L.); (I.-T.T.)
| | - I-Ting Tsai
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (S.-Y.L.); (I.-T.T.)
- School of Medicine for International Student, I-Shou University, Kaohsiung 82445, Taiwan
| | - Yin-Chou Hsu
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan; (S.-Y.L.); (I.-T.T.)
- School of Medicine for International Student, I-Shou University, Kaohsiung 82445, Taiwan
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung 82445, Taiwan
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41
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Logge WB, Morris RW, Baillie AJ, Haber PS, Morley KC. Baclofen attenuates fMRI alcohol cue reactivity in treatment-seeking alcohol dependent individuals. Psychopharmacology (Berl) 2021; 238:1291-1302. [PMID: 30788529 DOI: 10.1007/s00213-019-05192-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/04/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE Baclofen has been shown to effect fMRI alcohol cue reactivity in alcohol dependence, but potential varying effects related to baclofen dose levels have not been examined. OBJECTIVE This study investigated whether baclofen attenuates craving and alcohol cue-elicited activation in alcohol-dependent treatment seekers, and the relationship between this response and clinical outcomes (Morley et al. 2018; Morley et al. 2013). METHODS Participants included 30 alcohol-dependent individuals who had received daily baclofen 30 mg (n = 11), 75 mg (n = 8) or placebo (n = 11) for at least 2 weeks. Using functional magnetic resonance imaging (fMRI), we examined alcohol cue-elicited neural activation during a visual alcohol cue reactivity task 120 min following treatment administration, and alcohol cue reactivity and percentage of heavy drinking days (% HDD) associations were assessed. RESULTS Both baclofen-treated groups reported fewer post-scan % HDD when compared to the placebo-treated group, but no subjective craving group differences were found. Increased alcohol cue-elicited activation was seen in placebo compared to the 75 mg/day baclofen participants in two clusters spanning prefrontal regions implicated in cue reactivity, chiefly frontal regions (i.e., frontal and precentral gyri, anterior cingulate cortex), but no observed alcohol cue reactivity differences between placebo and 30 mg/day baclofen groups. Post-scan % HDD was positively correlated with increased alcohol cue-elicited activation in a cluster encompassing the bilateral caudate nucleus and dorsal anterior cingulate cortex when comparing placebo versus 75 mg/day baclofen groups, and several clusters including prefrontal and mesolimbic regions when comparing placebo versus 30 mg/day baclofen groups. CONCLUSIONS Baclofen administration attenuates alcohol cue-elicited activation and reduced the association in baclofen-treated participants between increased activity in key drug cue reactivity regions and higher post-scan % HDD observed in placebo-treated participants, suggesting a dose-specific response effect that may lead to reduced heavy drinking in chronic alcohol-dependent individuals. TRIAL REGISTRATION ClinicalTrials.gov , NCT01711125, https://clinicaltrials.gov/ct2/show /NCT01711125.
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Affiliation(s)
- Warren B Logge
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Lv 6, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia.
| | - Richard W Morris
- Central Clinical School, Faculty of Medicine and Health, & Centre for Translational Data Science, University of Sydney, Sydney, NSW, Australia
| | - Andrew J Baillie
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Paul S Haber
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Lv 6, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirsten C Morley
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Lv 6, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia
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Morley KC, Logge WB, Fraser I, Morris RW, Baillie AJ, Haber PS. High-dose baclofen attenuates insula activation during anticipatory anxiety in treatment-seeking alcohol dependant individuals: Preliminary findings from a pharmaco-fMRI study. Eur Neuropsychopharmacol 2021; 46:28-36. [PMID: 33735709 DOI: 10.1016/j.euroneuro.2021.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/28/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023]
Abstract
The GABA B agonist, baclofen, has been shown to reduce alcohol consumption in patients with alcohol use disorder and also those with comorbid anxiety. This study aimed to evaluate the effect of baclofen versus placebo on the BOLD response during an anticipatory anxiety fMRI task in treatment seeking alcohol patients. Participants included 28 alcohol dependant individuals who had received daily baclofen 30 mg (n = 10), 75 mg (n = 8) or placebo (n = 10) for at least 2 week on a randomized controlled trial (Morley, Leung et al. 2013, Morley, Baillie et al. 2018). Using functional magnetic resonance imaging (fMRI), we examined threat cue-elicited neural activation during a threat reactivity task 120 min following administration of BAC (30 mg or 75 mg) or placebo. Whole-brain analyses revealed no significant differences between the combined BAC doses versus PL. However, there were significant decreases in anticipatory threat cue-elicited activation observed in BAC 75 mg/day compared to PL participants in the insula. In response to threat cues, high dose (75 mg/day) baclofen administration attenuates activation in the insula and inferior frontal gyrus, relative to placebo. These preliminary findings suggests that modulating emotional regulation and attentional allocation during high threat stimuli may be mediated by GABA B receptors and may be a potential mechanism of action for baclofen's beneficial treatment effects for alcohol use disorder.
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Affiliation(s)
- Kirsten C Morley
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.
| | - Warren B Logge
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Drug Health Services, Royal Prince Alfred Hospital, NSW, Australia; Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Isabel Fraser
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Richard W Morris
- Psychological Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Andrew J Baillie
- Faculty of Health Sciences, University of Sydney, NSW, Australia
| | - Paul S Haber
- Discipline of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Drug Health Services, Royal Prince Alfred Hospital, NSW, Australia; Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
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43
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Buchanan R, Sinclair JMA. Alcohol use disorder and the liver. Addiction 2021; 116:1270-1278. [PMID: 32710592 DOI: 10.1111/add.15204] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/19/2020] [Accepted: 07/17/2020] [Indexed: 12/23/2022]
Abstract
Alcohol use disorders (AUD) cause a range of physical harms, but the major cause of alcohol-related mortality is alcohol-related liver disease (ALD), in some countries accounting for almost 90% of alcohol-related deaths. The risk of ALD has an exponential relationship with increasing alcohol consumption, but is also associated with genetic factors, other life-style factors and social deprivation. ALD includes a spectrum of progressive pathology, from liver steatosis to fibrosis and liver cirrhosis. There are no specific treatments for liver cirrhosis, but abstinence from alcohol is key to limit progression of the disease. Over time, cirrhosis can progress (often silently) to decompensated cirrhosis and hepatocellular carcinoma (HCC). Liver transplantation may be suitable for patients with decompensated liver cirrhosis and may also be used as a curative intervention for HCC, but only for a few selected patients, and complete abstinence is a prerequisite. Patients with AUD are also at risk of developing alcoholic hepatitis, which has a high mortality and limited evidence for effective therapies. There is a strong evidence base for the effectiveness of psychosocial and pharmacological interventions for AUD, but very few of these have been trialled in patients with comorbid ALD. Integrated specialist alcohol and hepatology collaborations are required to develop interventions and pathways for patients with ALD and ongoing AUD.
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Affiliation(s)
- Ryan Buchanan
- Department of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Julia M A Sinclair
- Department of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Domi E, Domi A, Adermark L, Heilig M, Augier E. Neurobiology of alcohol seeking behavior. J Neurochem 2021; 157:1585-1614. [PMID: 33704789 DOI: 10.1111/jnc.15343] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 12/29/2022]
Abstract
Alcohol addiction is a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse consequences. A main challenge of addiction treatment is to prevent relapse, which occurs in more than >50% of newly abstinent patients with alcohol disorder within 3 months. In people suffering from alcohol addiction, stressful events, drug-associated cues and contexts, or re-exposure to a small amount of alcohol trigger a chain of behaviors that frequently culminates in relapse. In this review, we first present the preclinical models that were developed for the study of alcohol seeking behavior, namely the reinstatement model of alcohol relapse and compulsive alcohol seeking under a chained schedule of reinforcement. We then provide an overview of the neurobiological findings obtained using these animal models, focusing on the role of opioids systems, corticotropin-release hormone and neurokinins, followed by dopaminergic, glutamatergic, and GABAergic neurotransmissions in alcohol seeking behavior.
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Affiliation(s)
- Esi Domi
- Center for Social and Affective Neuroscience, BKV, Linköping University, Linköping, Sweden
| | - Ana Domi
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Adermark
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Markus Heilig
- Center for Social and Affective Neuroscience, BKV, Linköping University, Linköping, Sweden
| | - Eric Augier
- Center for Social and Affective Neuroscience, BKV, Linköping University, Linköping, Sweden
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Pharmacotherapy of substance use disorders in the neuroscience-based nomenclature (NbN). Therapie 2021; 76:127-136. [DOI: 10.1016/j.therap.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022]
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46
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Morley KC, Perry CJ, Watt J, Hurzeler T, Leggio L, Lawrence AJ, Haber P. New approved and emerging pharmacological approaches to alcohol use disorder: a review of clinical studies. Expert Opin Pharmacother 2021; 22:1291-1303. [PMID: 33615945 DOI: 10.1080/14656566.2021.1892641] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
introduction: The number of medications approved for AUD is small and they generally have limited efficacy. We need new pharmacotherapies for the management of AUD.Areas covered: In this review, the authors aim to synthesise literature for new approved and emerging pharmacotherapies for AUD. Recently approved medications include nalmefene, which was approved in Europe and Australia for the purposes of controlled drinking. Baclofen has also been approved in France but not in other countries. Off label medications including topiramate and gabapentin have received significant attention with multiple RCTs and meta-analyses and have widespread use in several countries including the USA. Several novel medications have emerged over the last decade but further work is required to determine their efficacy and safety for the widespread management of AUD.Expert opinion: Despite significant advances in our understanding of the neurobiological basis of factors that contribute to the development and maintenance of AUD, there have been few new AUD medications approved for almost 20 years. There are many challenges to the development and introduction of new pharmacotherapies for AUD. Strategies for improving the translational pipeline include drug repurposing and utilisation of human acute laboratory models.
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Affiliation(s)
- Kirsten C Morley
- Central Clinical School, Sydney School of Medicine, Faculty of Medicine & Health, University of Sydney, NSW, Australia.,Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Christina J Perry
- University of Melbourne, Mental Health Theme, Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Joshua Watt
- Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Tristan Hurzeler
- Central Clinical School, Sydney School of Medicine, Faculty of Medicine & Health, University of Sydney, NSW, Australia
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Baltimore and Bethesda, USA.,Department of Neuroscience, Georgetown University Medical Center, Washington, USA.,Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, USA
| | - Andrew J Lawrence
- University of Melbourne, Mental Health Theme, Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, USA
| | - Paul Haber
- Central Clinical School, Sydney School of Medicine, Faculty of Medicine & Health, University of Sydney, NSW, Australia.,Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, USA
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Echeverry‐Alzate V, Jeanblanc J, Sauton P, Bloch V, Labat L, Soichot M, Vorspan F, Naassila M. Is R(+)-Baclofen the best option for the future of Baclofen in alcohol dependence pharmacotherapy? Insights from the preclinical side. Addict Biol 2021; 26:e12892. [PMID: 32146727 DOI: 10.1111/adb.12892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 12/16/2022]
Abstract
For several decades, studies conducted to evaluate the efficacy of RS(±)-Baclofen in the treatment of alcohol dependence yielded contrasting results. Human and animal studies recently questioned the use of the racemic drug in patients since a potential important role of the different enantiomers has been revealed with an efficacy thought to reside with the active R(+)-enantiomer. Here we conducted experiments in the postdependent rat model of alcohol dependence to compare the efficacy of R(+)-Baclofen or S(-)-Baclofen to that of RS(±)-Baclofen on ethanol intake, seeking, and relapse. R(+)-Baclofen was more effective than RS(±)-Baclofen in reducing ethanol intake and seeking during acute withdrawal and during relapse after abstinence. We also used an original population approach in order to identify drug responders. We found a significant proportion of responders to S(-)-Baclofen and RS(±)-Baclofen, displaying an increase in ethanol intake, and this increasing effect on alcohol intake was not seen in the R(+)-Baclofen group. At an intermediate dose of R(+)-Baclofen, devoid of any motor side effects, we identified a very large proportion of responders (75%) with a large decrease in ethanol intake (90% decrease). Finally, the response to RS(±)-Baclofen on ethanol intake was correlated to plasma level of Baclofen. R(+)-Baclofen and RS(±)-Baclofen were effective in reducing sucrose intake. Our study has important clinical implication since it suggests that the wide variability in the therapeutic responses of patients to RS(±)-Baclofen may come from the sensitivity to the R(+)-Baclofen but also to the one of the S(-)-Baclofen that can promote an increase in ethanol intake.
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Affiliation(s)
- Victor Echeverry‐Alzate
- INSERM UMR 1247‐Research Group on Alcohol and Pharmacodependences (GRAP) Université de Picardie Jules Verne Amiens France
- Instituto de Investigación Biomédica de Málaga (IBIMA) Hospital Regional Universitario de Málaga Spain
- Department of Psychobiology & Behavioral Sciences Methods, School of Psychology Complutense University of Madrid Spain
| | - Jérôme Jeanblanc
- INSERM UMR 1247‐Research Group on Alcohol and Pharmacodependences (GRAP) Université de Picardie Jules Verne Amiens France
| | - Pierre Sauton
- INSERM UMR 1247‐Research Group on Alcohol and Pharmacodependences (GRAP) Université de Picardie Jules Verne Amiens France
| | - Vanessa Bloch
- INSERM UMR‐S 1144 Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie Paris France
- Faculté de Médecine Université de Paris Paris France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal Assistance Publique – Hôpitaux de Paris Paris France
| | - Laurence Labat
- INSERM UMR‐S 1144 Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie Paris France
- Faculté de Médecine Université de Paris Paris France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal Assistance Publique – Hôpitaux de Paris Paris France
| | - Marion Soichot
- Laboratoire de Toxicologie Biologique – Hôpital Lariboisière Paris France
| | - Florence Vorspan
- INSERM UMR‐S 1144 Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie Paris France
- Faculté de Médecine Université de Paris Paris France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal Assistance Publique – Hôpitaux de Paris Paris France
| | - Mickael Naassila
- INSERM UMR 1247‐Research Group on Alcohol and Pharmacodependences (GRAP) Université de Picardie Jules Verne Amiens France
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Affiliation(s)
- Michael C Reade
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Joint Health Command, Australian Defence Force, Canberra, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
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49
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Augier E. Recent Advances in the Potential of Positive Allosteric Modulators of the GABAB Receptor to Treat Alcohol Use Disorder. Alcohol Alcohol 2021; 56:139-148. [PMID: 33561865 PMCID: PMC7906877 DOI: 10.1093/alcalc/agab003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 12/11/2022] Open
Abstract
Aims The effects of alcohol on gamma-aminobutyric acid (GABA) transmission are key for the development and maintenance of alcohol use disorder (AUD). Previous research consistently indicates that GABAB receptor agonists such as baclofen can attenuate addiction-related behaviors in preclinical models of AUD. More importantly, baclofen has also shown promise in clinical studies, particularly in severely alcohol-dependent patients. However, despite this promise, other clinical studies have not confirmed its efficacy and chiefly, larger clinical trials have not been conducted. Therefore, with the exception of France, baclofen is not approved for the treatment of AUD in any other country. Furthermore, it is also important to keep in mind that some patients treated with baclofen may experience important side-effects, including sedation, drowsiness and sleepiness. Methods This short review will first discuss the history of baclofen for AUD treatment. We will then summarize preclinical behavioral results that have investigated the efficacy of GABAB PAMs for addiction treatment, with a special focus on our recent work that investigated the effects of ADX71441, a novel GABAB PAM, on several alcohol-related behaviors in rats that model important aspects of human AUD. Finally, in light of the recent criticism about the translational value of animal models of addiction, the specific translational potential of our work and of other preclinical studies that have unanimously reported the efficacy of GABAB PAMs to attenuate multiple alcohol-related behaviors will be discussed. Results Positive allosteric modulators (PAMs) of the GABAB receptor offer an attractive alternative approach to baclofen and have the potential to achieve mechanistic and therapeutic effects similar to GABAB agonists, while avoiding the tolerance and toxicity issues associated with baclofen. To date, all preclinical behavioral results have invariably shown the efficacy of GABAB PAMs for addiction treatment. Conclusions Preclinical studies indicate that GABAB PAMs have a higher therapeutic index than orthosteric agonists, at least in terms of mitigating the sedative effects of GABAB agonism. This predicts that GABAB PAMs have a high translational potential in humans and merit being tested clinically, in particular in patients with severe AUD.
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Affiliation(s)
- Eric Augier
- Center for Social and Affective Neuroscience, BKV, Linköping University, Linköping 58183, Sweden
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50
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Peng SY, Shi Z, Zhou DS, Wang XY, Li XX, Liu XL, Wang WD, Lin GN, Pan BX, Voon V, Grace AA, Heilig M, Wong ML, Yuan TF. Reduced motor cortex GABA BR function following chronic alcohol exposure. Mol Psychiatry 2021; 26:383-395. [PMID: 33432190 DOI: 10.1038/s41380-020-01009-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 01/29/2023]
Abstract
The GABAB receptor (GABABR) agonist baclofen has been used to treat alcohol and several other substance use disorders (AUD/SUD), yet its underlying neural mechanism remains unclear. The present study aimed to investigate cortical GABABR dynamics following chronic alcohol exposure. Ex vivo brain slice recordings from mice chronically exposed to alcohol revealed a reduction in GABABR-mediated currents, as well as a decrease of GABAB1/2R and G-protein-coupled inwardly rectifying potassium channel 2 (GIRK2) activities in the motor cortex. Moreover, our data indicated that these alterations could be attributed to dephosphorylation at the site of serine 783 (ser-783) in GABAB2 subunit, which regulates the surface expression of GABABR. Furthermore, a human study using paired-pulse-transcranial magnetic stimulation (TMS) analysis further demonstrated a reduced cortical inhibition mediated by GABABR in patients with AUD. Our findings provide the first evidence that chronic alcohol exposure is associated with significantly impaired cortical GABABR function. The ability to promote GABABR signaling may account for the therapeutic efficacy of baclofen in AUD.
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Affiliation(s)
- Shi-Yu Peng
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhe Shi
- Division of Stem Cell Regulation and Application, Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | | | - Xin-Yue Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xing-Xing Li
- Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Xiao-Li Liu
- Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Wei-Di Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guan-Ning Lin
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Bing-Xing Pan
- Institute of Life Sciences, Nanchang University, Nanchang, Jiangxi, China
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Anthony A Grace
- Center for Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences,, Linköping University, Linköping, Sweden
| | - Ma-Li Wong
- Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China. .,Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China. .,TianQiao and Chrissy Chen Institute for Translational Research, Shanghai, China. .,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China.
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