Current Drug Targets-CNS & Neurological Disorders - Volume 1, Issue 5, 2002

Serotonin modulates numerous processes in the central nervous system related to anxiety and fear, mood, aggression, sleep, ingestive behaviors, reward systems, and psychosis. Serotonergic dysfunction has been implicated in several neuropsychiatric conditions but efforts to develop more specific pharmacological agents have been hampered by the complexity of this system at the receptor level. There are at least 14 distinct receptors that mediate the effects of serotonin as well as several enzymes that control its synthesis and metabolism but very few pharmacological agents are able to selectively target a single receptor.Several groups including ours have used a genetic strategy to ablate specific serotonin receptors in an effort to dissect out their functions in the central nervous system. The strength of this approach is the high degree of specificity that can be achieved in the knockout (gene inactivation) approach since a single receptor gene can be selectively targeted. To date several inactivation mutations of specific serotonin receptors have been generated producing interesting behavioral phenotypes related to anxiety, depression, drug abuse, psychosis, and cognition. In many cases knockout mice have been able to confirm what has already been suspected based on pharmacological studies. In other instances, mutations have demonstrated new functions of serotonergic genes in development and behavior. In this review, the current literature regarding phenotypic changes in mice bearing inactivation mutations of serotonin receptors, the serotonin transporter, and the monoamine oxidase A will be discussed and major findings emphasized.

Anxiety and depression are psychiatric disorders that constitute a major health concern worldwide, and new pharmacological approaches with the potential for improved efficacy and decreased side effect profiles relative to currently marketed drugs are desired. Since the identification of corticotropin releasing factor (CRF) by Vale and colleagues in 1981, an extensive research effort has solidified the importance of this 41 amino acid peptide in mediating the body's behavioral, endocrine, and autonomic responses to stress. The further identification of CRF receptor subtypes has provided compelling targets for novel pharmaceutical agents. The present review focuses on the potential of non-peptidic antagonists of the CRF1 receptor subtype as a novel therapeutic approach for the treatment of anxiety and depression. The first section reviews preclinical and clinical evidence implicating CRF, in general, and CRF1 receptors, in particular, in anxiety and depression.Clinical studies have demonstrated a dysfunctional hypothalamic-pituitary-adrenal (HPA) axis and / or elevated CRF levels in depression and in some anxiety disorders. Preclinical data utlilizing correlational methods,genetic models, and exogenous CRF administration techniques in rodents and non-human primates supports a link between hyperactive CRF pathways and anxiogenic and depressive-like symptoms. Studies employing the use of receptor knockouts and selective, non-peptidic antagonists of the CRF1 receptor have demonstrated anxiolytic and antidepressant effects under certain types of laboratory conditions. A Phase II, open-label,clinical trial in major depressive disorder has reported that a CRF1 receptor antagonist was safe and effective in reducing symptoms of anxiety and depression. In the second section, a topological approach is used to describe the design strategies employed to produce potent, non-peptidic CRF1 receptor antagonists. Two main topologies, featuring a center core, a top side-chain, and a pending aromatic ring, can be used to characterize the vast majority of currently known CRF1 receptor antagonists. By exploiting some of these structural elements, pharmacological, physicochemical, and pharmacokinetic properties can be modulated and optimized.However, as a result of a relatively conservative iteration process during the structural optimization, the chemical space presently defined by the existing CRF1 receptor antagonists still remains fairly narrow.Expanding these structural and topological boundaries, while optimizing the “drug-like” properties of the CRF1 receptor antagonists, seems to be a common objective across pharmaceutical companies to maximize the chances for a clinical success in the near future.

Cholecystokinin-8 (CCK-8), the small peptide initially described as a gastric factor involved in the regulation of feeding behavior, is today recognized as one of the most abundant neurotransmitters / neuropeptides in brain and is an important signal factor for the peripheral and central nervous systems. In the past twenty years, many studies have focused on possible clinical applications of this peptide and its receptor ligands in psychiatric diseases and gastrointestinal pathologies. Recently it has been suggested that CCK-8 may also have a neuroprotective role, thus opening a new field of interest around the physiology and the pharmacology of this neuropeptide and its receptors. It has been demonstrated that CCK-8 counteracts neuronal deficit following chemical or surgical lesions in both the central and peripheral nervous systems and that Nerve Growth factor (NGF) is involved in the CCK-induced recovery process. By using selective CCK receptor antagonists it has been demonstrated that CCK-8, when injected intraperitoneally, has the ability to stimulate NGF synthesis in brain and peripheral organs by a mechanism that involves the activation of CCK receptors.As has been widely reported, NGF is an essential survival and differentiative factor for selective neuronal populations of the PNS and CNS and plays a role in the events of degeneration and repair of the nervous system in diseases with different etiologies, e.g. neurodegenerative and autoimmune diseases as well as diabetes-associated pathologies. The possibility of using NGF in therapy has been evaluated and systemic and intracerebral NGF treatment have been tested in patients and animal models. Although the results of these studies are encouraging, the difficultly to predict and / or eliminate the side effects of NGF / NGF antibody treatment has made it difficult to fully evaluate the potential of the beneficial effects. In this context recent results obtained in our laboratories may offer a new prospective for the pharmacological approaches to the diseases associated with altered NGF production and functions. The data of our recent observations on NGF and CCK-8 is covered in this review.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder of the central nervous system (CNS) with an unknown etiology. This disorder is characterized clinically by muscular weakness and wasting, and pathologically by selective degeneration of the corticospinal tracts and motor neurons of the brain stem and spinal cord. Median survival following onset is 3 to 5 years. Riluzole, an antiglutamatergic agent has been shown to have modest beneficial effects on survival. Glutamate is the main excitatory neurotransmitter in the CNS and excessive activation of glutamate receptors is excitotoxic to neurons.Glutamate receptor-mediated excitotoxicity has been proposed to explain the pattern of selective neuronal cell death and clinical manifestation of ALS. Activation of glutamate receptors leading to elevation of intracellular calcium may play a major role. This review will focus on the current understanding of the molecular and cellular mechanisms of glutamate receptors in relation to ALS.

The serotonin transporter is most well known as the site of action of the serotonin reuptake inhibitors, which were initially developed as antidepressants, but now are the most widely used agents in the treatment of many additional neuropsychiatric and related disorders. The discovery that the serotonin transporter gene possesses a functional polymorphism within the promoter region led to many studies examining this polymorphism in individuals with different neuropsychiatric disorders. These observations raise the possibility of developing a new class of agents with different therapeutic and side effect profiles than conventional drugs. This overview of recent studies of the serotonin transporters attempts to open new areas for discussion and define concepts not yet comprehensively reviewed.