CNS & Neurological Disorders - Drug Targets (Formerly Current Drug Targets - CNS & Neurological Disorders) - Volume 5, Issue 3, 2006

In this issue of CNS & Neurological Disorders-Drug Targets, we focus on G protein-coupled receptors (GPCRs) that are involved in regulating body weight. In six reviews, the melanocortins system (including MC4 and MC3 receptors, Agrp, MSH), the NPY receptors (including NPY-Y1, NPY-Y2, and NPY-Y5, PYY3-36), the cannabinoid system (including the development of rimonabant), the ghrelin (GHS, growth hormone secretagogue) system, the monoamine GPCRs (including serotonin, adrenergic and histamine receptors), orexin (hypocretin) system and the galanin receptors are covered. In this overview, an introduction to the GPCRs and the field of central regulation of food intake is provided together with brief mentioning of some other GPCRs that are also implicated in regulation of body weight, such as the melanin-concentrating hormone (MCH), neuromedin U, prolactin-releasing peptide (PrRP), bombesin, cholecystokinin (CCK), Glucagon-like peptide-1 (GLP-1) (and oxyntomodulin), neuropeptide B (NPB) and neuropeptide W (NPW), opioids peptides, free fatty acid (FFA) receptors (GPR40, GPR41). In total over 40 GPCRs are listed that have been implicated to affect regulation of body weight.

There is overwhelming evidence that the brain melanocortin system is a key regulator of energy balance, and dysregulations in the brain melanocortin system can lead to obesity. The melanocortin system is one of the major downstream leptin signaling pathways in the brain. In contrast to leptin, preclinical studies indicate that diet-induced obese animals are still responsive to the anorectic effects of melanocortin receptor agonists, suggesting the melanocortin system is an interesting therapeutic opportunity. Besides regulating energy balance, melanocortins are involved in a variety of other neuroendocrine processes, including inflammation, blood pressure regulation, addictive and sexual behavior, and sensation of pain. This review evaluates the melanocortin system function from the perspective to use specific melanocortin (MC) receptors as drug targets, with a focus on the treatment of obesity and eating disorders in humans, and the implications this may have on mechanisms beyond the control of energy balance.

Neuropeptide Y (NPY) is present in the hypothalamus, where it is believed to play a key role in the control of food intake. Evidence for this assertion has come from studies demonstrating that acute administration of NPY into the hypothalamus or into the brain ventricles leads to increased food intake. In the case of chronic administration, the hyperphagic effects of NPY are prolonged leading to the development of an obese state. NPY levels in the hypothalamus are temporally correlated with food intake and are markedly elevated in response to energy depletion. However, attempts to demonstrate an important role for NPY in the control of food intake using NPY knockout mice, NPY antisense oligodeoxynucleotides and anti-NPY antibodies has produced equivocal results. Despite this many pharmaceutical companies have moved ahead with the search for agonists and antagonists of NPY receptor subtypes as antiobesity agents. Antagonists of the NPY Y1 and NPY Y5 receptor subtype initially looked promising since analogs of NPY with high selectivity for these receptors strongly stimulated food intake. However, attempts to inhibit the signaling of NPY through the NPY Y1 and NPY Y5 receptors has produced equivocal effects on food intake. Recent observations that the gut derived peptide PYY3-36 suppresses appetite by stimulating both peripherally and centrally located NPY Y2 receptors remain controversial in animals but the effects look promising in human studies. Whether this will be the long awaited therapy based on manipulation of NPY receptors will await further studies of long term efficacy and more importantly a favorable side effect profile.

Research into the endocannabinoid 'system' has grown exponentially in recent years, with the discovery of cannabinoid receptors and their endogenous ligands, such as anandamide and 2-arachidonoylglycerol (2-AG). Important advances have been made in our understanding of endocannabinoid transduction mechanisms, their metabolic pathways, and of the biological processes in which they are implicated. A decade of endocannabinoid studies has promoted new insights into neural regulation and mammalian physiology that are as revolutionary as those arising from the discovery of the endogenous opioid peptides in the 1970s. Thus, endocannabinoids have been found to act as retrograde signals: released by postsynaptic neurons, they bind to presynaptic heteroceptors to modulate the release of inhibitory and excitatory neurotransmitters through multiple G-protein-coupled receptor (GPCR)-linked effector mechanisms. The metabolic pathways of anandamide and 2-AG have now been been characterised in great detail, and we can anticipate that these pathways - together with endocannabinoid uptake mechanisms - will complement cannabinoid receptors as targets for the pharmacological analysis of the physiological functions of these substances. Specific insights into the potential role of endocannabinoid-CB1 receptor systems in central appetite control, peripheral metabolism and body weight regulation herald the clinical application of CB1 receptor antagonists in the management of obesity and its associated disorders.

We evaluate the likely utility of drugs that interact, either directly or indirectly, with monoamine binding receptors for the treatment of obesity. We discuss ligands at dopaminergic, adrenergic, serotoninergic and histaminergic receptors and also drugs that either release or inhibit the reuptake of monoamine neurotransmitters. We review evidence from preclinical studies of receptor distribution and function, together with the consequences of gene deletion in transgenic mouse strains and the results from human studies where these are available. In addition we consider the side effect profiles that would be expected of these potential anti-obesity treatments. We conclude that compounds interacting with 5- HT2C, 5-HT6 and histamine H3 receptors may be of particular interest as specific drug development targets for the treatment of appetite disturbance in obesity.

Orexins were initially recognized as regulators of feeding behavior due to their exclusively production in the lateral hypothalamic area (LHA), a feeding center. Subsequently, the finding that orexin deficiency causes narcolepsy in humans and animals suggested that these hypothalamic neuropeptides play a critical role in regulating and maintaining sleep/wakefulness states. Proper maintenance of arousal during food searching and intake is essential for an animal's survival. Therefore, feeding behavior and sleep/wakefulness states are appropriately coordinated. For example, when faced with reduced food availability, animals adapt with a longer wakefulness period, which disrupts the normal circadian pattern of activity. The discovery that orexin neurons are regulated by peripheral metabolic cues, including ghrelin, leptin and glucose, suggests that they might have important roles as a link between energy homeostasis and sleep/wakefulness states. Recent studies on afferent (input) systems of orexin neurons further suggest roles of orexin and orexin receptors in the coordination of feeding, arousal and emotion.

Galanin is a 29/30 amino acid peptide neurotransmitter that is widely distributed throughout the central nervous system and periphery. There are three well-characterized G-protein coupled galanin receptors subtypes (GalR1-3). A more recently discovered 60 amino acid galanin-like peptide (GALP) shares amino acid sequence homology with galanin (1-13) in position 9-21 and has high binding affinity for GalR1-3, with highest affinity for GalR3. Considerable evidence has accumulated that implicates both galanin and GALP as playing important roles in regulating food and water intake behavior and related neuroendocrine functions. Pharmacological tools are emerging that will allow dissociation of specific roles for the peptides and their associated receptor subtypes in mediating the homeostatic processes of energy and fluid balance.

The growth hormone secretagogue receptor (GHS-R) is expressed in several tissues and seems to mediate the different actions of the synthetic growth hormone secretagogues (GHS) and the endogenous ligand of this receptor, ghrelin. The GHS-R belongs to the family of G-protein coupled receptors (GPCR). Two different receptor variants, type 1a and 1b, have been described and they seem to mediate different actions in different tissues. In addition to their functions on growth hormone (GH) secretion and food intake, ghrelin and its receptor are involved in several cardiovascular mechanisms, pancreatic functions, adipogenesis, gonadal function, immune system actions or tumoral cells. This review will summarize data regarding the structure of the GHS-R gene, reports investigating the expression, control and functions of the GHS-R in various tissues, and studies of the underlying transcriptional mechanisms and the genetic manipulation of both ghrelin and GHS-R. Thus, it seems clear the possibility that ghrelin and/or GHS analogs, acting as either agonists or antagonists on different activities, might have clinical impact.

Parkinson's disease (PD) is a progressive neurodegenerative disorder that results in major motor disturbances due primarily to loss of midbrain dopamine neurons. The mainstream treatment has been dopaminergic replacement therapy aimed at symptomatic relief, with the gold standard drug being the dopamine precursor levodopa. The general dogma has been that levodopa works primarily by indirectly activating the D2 family of dopamine receptors. Recently, a number of direct dopamine agonists that target the D2 and D3 dopamine receptors have been used as dopaminergic replacement strategies. Although these direct D2 and D3 drugs cause only modest improvement in motor function compared to levodopa, they can delay the initiation of levodopa and can act synergistically with levodopa. In addition, they can delay the onset of levodopa-related motor complications. Recent imaging data also suggest that they may have neuroprotective effects. Whereas D2/D3 agonists have received much attention as several drugs are available for clinical trials and usage, there has been a large body of data showing that the D1 receptor actually may play a larger role in restoration of normal motor function. This review examines the current use of dopamine D2/D3 agonists in treatment of PD and their potential for providing neuroprotection. Furthermore, we also examine the potential that D1 agonists might have in neuroprotective actions in the disease progression.

The accumulation of amyloid β peptide (Aβ) is believed to be an early and critical event leading to synapse and neuronal cell loss in Alzheimer's Disease (AD). Aβ itself is toxic to neurons in vitro and the load of Aβ in vivo causes the loss of synapses and neurons in brain in animal models. Therefore, there has been considerable interest in elucidating the mechanism(s) of Aβ neurotoxicity. Here, we review the molecular signaling pathways involved in Aβ-induced cell death, including signaling through the neuronal nicotinic receptor and the Aβ-triggered generation of reactive oxygen species (ROS) leading to the activation of the c-jun N-terminal kinase (JNK), and the ensuing phosphorylation of p66Shc and inactivation of the Forkhead transcription factors. This focused review not only provides a better understanding of the signaling mechanisms involved in Aβ-induced cell death, but also underscores the potential of JNK, p66Shc, Forkhead proteins, p25/cdk5, and neuronal nicotinic receptor, as therapeutic targets for AD.

Vitamin D is a seco-steroid hormone with multiple functions in the nervous system. Physiological brain mechanisms of vitamin D and its receptors include neuroprotection, antiepileptic effects, immunomodulation, possible interplay with several brain neurotransmitter systems and hormones, as well as the regulation of behaviours. Here we review the important role of the vitamin D neuroendocrine system in the brain, and outline perspectives for the search for novel neurotropic drugs to treat various vitamin D-related dysfunctions.

Vitamin D is a seco-steroid hormone with multiple functions in the nervous system. Physiological brain mechanisms of vitamin D and its receptors include neuroprotection, antiepileptic effects, immunomodulation, possible interplay with several brain neurotransmitter systems and hormones, as well as the regulation of behaviours. Here we review the important role of the vitamin D neuroendocrine system in the brain, and outline perspectives for the search for novel neurotropic drugs to treat various vitamin D-related dysfunctions.