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THE NEUROSCIENCES INSTITUTE Albany Medical Center Center for Neuropharmacology and Neuroscience Ibogaine Analogues: Drug Development for Addictive Disorders Stanley D. Glick, Ph.D., M.D. Drug Abuse / Drug Dependence Drug/substance abuse Self-administered use of any drug/substance in a manner that deviates from the approved medical or social standards within a given culture Addiction or psychological dependence Repeated, compulsive seeking or use of a substance despite adverse social, psychological and/ or physical consequences Chronic relapsing disorder Physical dependence Adaptive, physiological state produced by repeated drug administration that is manifested as a withdrawal syndrome. ADDICTION can occur without PHYSICAL DEPENDENCE PHYSICAL DEPENDENCE can occur without ADDICTION Addicts are desperate for new therapies July 10, 1996 Dr. M.A. Geyer Managing Editor Psychopharmacology Department of Psychiatry School of Medicine University of California San Diego La Jolla, CA 92093-0804 Dear Dr. Geyer: Enclosed are four copies of our revised manuscript (MS96MG-095) entitled, "Ibogaine And The Dopaminergic Response To Nicotine," authored by S.D. Glick, G.L. Mann, C.R. Deibel and myself which we would like to resubmit for publication in Psychopharmacology. 1- We do not think that it would be appropriate to discuss the report of Dworkin et al. (1995) in this manuscript, since we do not report any self-administration results. Dworkin, using Fisher rats, reported that ibogaine alters all reinforcers (food, drug) with limited effects a day later. Our laboratory, using Sprague Dawley rats, showed that ibogaine alters all reinforcers (water, drug) on the day of its administration, but only the drug reinforcers later on (Glick et al. 1991). The strain difference may explain this inconsistency. It should also be noted that Cappendijk and Dzoljic (1993) reported effects of ibogaine on cocaine self-administration that were very similar to our results (Glick et al. 1994). The effects of mecamylamine on DOPAC and HVA increases induced by nicotine are described in the results section and, as requested by the reviewer, plotted as Figure 3. We have incorporated in Figure 2 the dopamine baseline values preceding mecamylamine administration and the 30 min levels prior to nicotine infusion. In the discussion (pages 12-13) the effects of ibogaine and mecamylamine on the dopamine response to nicotine are compared, and the greater efficacy of ibogaine to alter the nicotineinduced increase in dopamine as compared to DOPAC and HVA is addressed. It is true that the phenomenon of nicotine-induced desensitization has been widely studied using numerous techniques. However, direct in vivo neurochemical measurements were made only by Damsma in 1989 who did not observe any acute tolerance to the dopaminergic response to nicotine. In this context, our findings are very interesting. Thank you for your consideration. Sincerely, IShofd Isabelle Maisonneuvebbbbbbb July 10, 1996 Dr. M.A. Geyer Managing Editdggggggggor Psychopharmacology University of California Sa Dear Dr. Geyer: Enclosed are four copies of our revised manuscript (MS96MG-095) entitled, "Ibogaine And The Dopaminergic Response To Nicotine," authored by S.D. Glick, G.L. Mann, C.R. Deibel and myself which we would like to resubmit for publication in Psychopharmacolog1- We do not think that it would be appropriate to discuss the report of Dworkin et al. (1995) in this manuscript, since we do not report any self-administration results. Dworkin, using Fisher rats, reported that ibogaine alters all reinforcers (food, drug) with limited effects a day later. Our laboratory, using Sprague Dawley rats, showed that ibogaine alters all reinforcers (water, drug) on the day of its administration, but only the drug reinforcers later on (Glick et al. 1991). The strain difference may explain this inconsistency. It should also be noted that Cappendijk and Dzoljic (1993) reported effects of ibogaine on cocaine self-administration that were very similar to our results (Glick et al. 1994). The effects of mecamylamine on DOPAC and HVA increases induced by nicotine are described in the results section and, as requested by the reviewer, plotted as Figure 3. We have incorporated in Figure 2 the dopamine baseline values preceding mecamylamine administration and the 30 min levels prior to nicotine infusion. In the discussion (pages 12-13) the effects of ibogaine and mecamylamine on the dopamine response to nicotine are compared, and the greater efficacy of ibogaine to alter the nicotine-induced increase in dopamine as compared to DOPAC and HVA is addressed. It is true that the phenomenon of nicotine-induced desensitization has been widely studied using numerous techniques. However, direct in vivo neurochemical measurements were made only by Damsma in 1989 who did not observe any acute tolerance to the dopaminergic response to nicotine. In this context, our findings are very interesting. Thank you for your consideration. Sincerely, Wtray Isabelle Maisonneuve, December 9, 1999 “…I am currently married and have a three year old daughter. I have used heroin on and off since I was 16 years old, more on than off… I have attended numerous substances abuse program and detoxes… I started a business and bought a house with my wife. Unfortunately, I am losing both due to my addiction. I crave heroin constantly, only heroin. I overdosed ten days ago and this wasn’t the first time. I’ll try anything that might help me to stay clean and straight. Please consider me as a candidate for your research protocol…” VTA February 16, 2009 “…I am 63 years old and I have been using heroin for well over 25 years, never having the willpower or success to kick the habit once and for all. At this point I know that I must stop and desperately want to. Somehow, I’ve managed to hold onto my county job for the past 13 years, and must continue to keep it for at least 4 more years. We have recently filed for bankruptcy, and our condo is in foreclosure; yet it can become even worse if I don’t get a grip on this habit. I have many reasons to stop, not least of all for the sake of my children, grandchildren and wife who is not at all that well herself. I would be so very grateful sir, if you could take the time to give me some idea, some direction as to how I might go about signing up or at least trying to participate in your research…” Once upon a time in Africa… Tabernanthe iboga shrub Cameroon Eq. Guinea Gabon 2 Congos Ibogaine is contained in the roots of the shrubs. Ibogaine has been used for centuries in rituals of the Bwiti religion. At very high concentrations, side effects are present… Degeneration of Purkinje cells in parasagittal zones of the cerebellar vermis after treatment with ibogaine or harmaline. O'Hearn, E. and Molliver, M.E. Neuroscience 55:303-310 (1993). The search for a better ibogaine… 1. It had to be as effective as ibogaine. 2. It had to lack all the side effects of ibogaine. methyldesethylcoronaridine desethylcoronaridine 18-benzyloxycoronaridine ibogaine albifloranine 18-methoxycoronaridine acetate ibogamine coronaridine tabernanthine noribogaine nortabernanthine CHOH O 3H CC C H OCH H CH 2H 43OCH 2Ph 22H 4 54OAc 3 CH H OH 3O COH2CH3 Is 18-MC a potential treatment for drug dependence? 1. Is 18-MC effective in reducing drug self-administration? 2. Is 18-MC effective in reducing signs of drug withdrawal? Drug self-administration Effect of an ideal treatment number of responses The ideal treatment will not affect responding for a nondrug reinforcer (e.g., water, food, sucrose). The ideal treatment will depress responding for a drug of abuse Treatment dosage Effects of 18-MC on responding for morphine, cocaine and water 18-MC selectively decreases morphine and cocaine selfadministration. 120 * 80 Ibogaine also affects responding for water. * 60 120 * Water 40 20 0 Cocaine 100 * Morphine 0 10 20 30 18-MC (mg/kg, i.p.) * * 40 Percent of baseline Percent of baseline 100 80 60 40 Water Cocaine Morphine 20 0 0 10 20 30 Ibogaine (mg/kg, i.p.) 40 Effects of 18-MC on responding for methamphetamine and nicotine 120 Female rats Percent of baseline 100 80 60 * 40 * * * 20 * * Methamphetamine 0 Nicotine 0 * 10 20 30 18-MC (mg/kg, i.p.) * 40 18-MC selectively decreases methamphetamine and nicotine selfadministration, but is most potent in decreasing nicotine self-administration. Effects of 18-MC on alcohol intake 50 100 Food intake (g/kg/day) 75 30 * * * 20 25 10 0 50 Food intake 0 Alcohol intake 10 20 30 18-MC (mg/kg, i.p.) 40 Alcohol intake (ml/kg/day) 40 18-MC decreases alcohol intake at doses that do not affect food intake. 0 Rezvani et al., Pharmacol. Biochem. Behav., 58:615-619 (1997). 18-MC reduces the efficacy of morphine 18-MC produces a significant downward shift in the doseresponse curve for morphine selfadministration. Infusions/hour 30 20 10 Vehicle 0 0.00 18-MC (40 mg/kg, p.o.) 0.04 0.08 0.12 0.16 Morphine (mg/kg/infusion) I don’t like morphine as much since I took 18-MC Opioid withdrawal morphine 7 days naltrexone •weight loss •wet dog shakes •flinching •teeth chattering •grooming •burying •diarrhea Effects of 18-MC on opioid withdrawal signs 3 * 10 5 0 10 20 18-MC (mg/kg, i.p.) Control 10 20 18-MC (mg/kg, i.p.) 40 Grooming Grooming 60 * 40 20 * 1 0 Control 10 20 18-MC (mg/kg, i.p.) 40 Control 10 20 15 10 5 0 40 Control 10 20 18-MC (mg/kg, i.p.) 40 30 * 20 10 0 2 20 18-MC (mg/kg, i.p.) Teeth chattering Teeth chattering 5 0 40 80 0 10 Control 10 20 18-MC (mg/kg, i.p.) * 40 Burying Burying Wet dog shakes Wet dog shakes 100 Control Diarhea Diarrhea 15 Flinching Flinching Weight loss Weight loss 15 10 5 0 Control 10 20 18-MC (mg/kg, i.p.) * 40 18-MC reduces the intensity of several signs of morphine withdrawal 18-MC is a potentially effective anti-addictive treatment 1. 18-MC decreases the selfadministration of multiple drugs of abuse. 2. 18-MC alleviates several signs of morphine withdrawal. Does 18-MC have side effects? 1. Nerve cell damage? 2. Cardiovascular toxicity? 3. Is 18-MC likely to cause hallucinations? 4. Is 18-MC addictive (i.e., reinforcing)? 18-MC has no cerebellar toxicity Ibogaine 18-MC One month after 3x100mg/kg, i.p. Ibogaine at very high doses damages Purkinje cells. 18-MC at very high doses does not produce any Purkinje cell damage. Percent of baseline Effects of 18-MC and ibogaine on heart rate and blood pressure Systolic 125 Diastolic Heart rate 100 75 18-MC vehicle 0 20 40 60 80 100 120 140 160 18-MC (200 mg/kg, ip) has no apparent effects on heart rate and blood pressure. 180 200 220 240 Percent of baseline Time (minutes) Systolic 125 Diastolic Heart rate Ibogaine (200 mg/kg, ip) decreases heart rate without altering blood pressure. 100 75 vehicle 0 20 ibogaine 40 60 80 100 120 140 Time (minutes) 160 180 200 220 240 18-MC does not increase extracellular serotonin levels 3000 Ibogaine Percent of Baseline 2500 * 18-MC (40 mg/kg, i.p.) ** 2000 * 1500 * 1000 Ibogaine, but not 18-MC, increases extracellular serotonin levels in the nucleus accumbens. * * * 500 0 -60 0 60 Time (minutes) 120 180 So I won’t hallucinate? Cumulative responses cocaine saline 18-MC 40 saline 30 20 10 0 0 10 20 30 40 Time (min) 50 60 Cumulative responses Cumulativeresponses responses Cumulative Cumulative responses 18-MC itself is not reinforcing 40 40 cocaine (0.4 mg/kg/infusion) 30 20 10 0 0 10 20 30 40 Time (min) 50 60 cocaine (0.4mg/kg/infusion) mg/kg/infusion) saline 18-MC (0.8 30 20 10 0 0 10 20 30 40 Time (min) 50 60 18-MC has no apparent side effects 1. Unlike ibogaine, 18-MC does not induce tremors and does not damage the cerebellum. 2. Unlike ibogaine, 18-MC has no ill effect on the heart. 3. 18-MC may not be hallucinogenic. 4. 18-MC is not reinforcing and should not be liable to abuse. What is the mechanism of action of 18-MC? PFC NAC 18-MC may interact with the “reward pathways”. VTA PFC = prefrontal cortex NAC = nucleus accumbens VTA = ventral tegmental area dopaminergic neurons In vivo microdialysis Effect of 18-MC on sensitized cocaine-induced dopamine release 2500 2500 Percent of baseleine Acute Chronic cocaine: 2000 2000 Vehiclepretreated 18-MC1500 1500 pretreated 1000 1000 After chronic administration cocaine Acute cocainethe 18-MC abolishes releases much more increases dopamine sensitization of dopamine in the release in the nucleus cocaine-induced nucleus accumbens. accumbens. dopamine This is release. called sensitization. Cocaine (20 mg/kg, i.p.) 500 500 0 -60 0 60 60 Time (min) (min) 120 120 150 150 18-MC abolishes drug sensitization. Why is this important? relapse craving abstinence use abuse addiction Drug sensitization may underlie craving and the cyclic nature of addiction. By abolishing drug sensitization 18-MC may prevent relapse and promote abstinence. Ibogaine and 18-MC binding affinities (Ki in mM) Ibogaine Kappa opioid Mu opioid Delta opioid Nociceptin NMDA D1 D2 D3 M1 M2 5-HT1A 5-HT1B 5-HT1C 5-HT1D 5-HT2A 5-HT2C 5-HT3 Sodium channel Sigma 1 Sigma 2 GABA B NE uptake 5-HT uptake 18-MC 2.2 ± 0.10 5.1 ± 0.50 2.0 ± 0.15 1.1 ± 0.30 >10 3.5 ± 0.05 >100 >100 3.1 ± 0.30 >100 >10 >100 >10 16 ± 0.60 70 ± 1.7 25 ± 2.5 16 ± 1.0 32 ± 3 31 ± 3.4 >100 >100 46 ± 4.9 >100 >100 >100 >100 >100 >10 16 40 ± 3.4 >10 >100 2.6 ± 0.23 3.8 ± 0.067 3.6 ± 0.35 6.4 ± 0.68 2.5 ± 0.6 >100 0.4 ± 0.036 13 ± 1.2 >100 >100 >100 >10 4.1 ± 0.83 >10 With which receptors does 18-MC interact? 18-MC has no affinity for NMDA receptors. 18-MC has very low affinity for sigma receptors. 18-MC has no affinity for 5-HT uptake sites. Effect of 18-MC on nicotine-induced dopamine release 350 Vehicle 18-MC, administered 19 hours beforehand, abolishes nicotine-induced dopamine release in the nucleus accumbens. 18-MC (40 mg/kg, i.p.) Percent of Baseline 300 250 200 So 18-MC may block nicotinic receptors. But which ones? * * * 150 100 50 Nicotine (80 mg, i.v., 5 min) -30 0 30 Time (minutes) 60 Patch-clamp electrophysiology Whole-cell recording In the presence of receptor agonist Recording system Patch-pipette Cell Receptor Movement of positive ions from the outside to the inside of the cell is an INWARD current and is shown as a DOWNWARD deflection. This is due to receptor desensitization. 18-MC interacts with 34 nicotinic receptors 1 sec Ach 1 mM 18-MC 20 mM IBO 20 mM 200 pA 200 pA 200 pA 1 sec 1 sec 18-MC and ibogaine block the nAch receptor currents in cells cotransfected with rat 3 and 4 receptor subunits. 18-MC does not interact with 42 nicotinic receptors 50% inhibition Ach 300 mM 18-MC 5 mM IBO 5 mM 10 sec 250 pA 250 pA 10 sec Ibogaine, but not 18-MC, blocks the nAch receptor currents in cells co-transfected with rat 4 and 2 receptor subunits. Where are 34 nicotinic receptors located ? medial habenula interpeduncular nucleus Connections between habenulointerpeduncular and mesolimbic systems mHb NAC IP VTA PFC NAC mHb MD VTA IP NAC mHb R VTA IP mHb = medial habenula IP = interpeduncular nucleus VTA = ventral tegmental area NAC = nucleus accumbens R = raphe nuclei PFC = prefrontal cortex MD = medial dorsal thalamic nucleus Is 18-MC blockade of 34 nicotinic receptors relevant to its anti-addictive effects? 1. Effects of combination of low doses of nonspecific 34 nicotinic receptors on drug selfadministration 2. Effects of interpeduncular and intrahabenular infusion of 18-MC on drug self-administration 3. Correlations between potencies of 18-MC congeners to block 34 nicotinic receptors and their effects on drug self-administration Non-specific 34 nicotinic antagonists DRUG IC50 (mM) mecamylamine bupropion dextromethorphan 0.09-1.0 (Papke et al., 2001; Hernandez et al., 2000) 1.4 (Fryer and Lukas, 1999) 8.9 (Hernandez et al., 2000) 18-MC 0.75 (Glick et al., 2002) Mecamylamine, an antihypertensive agent (Inversine®), is a nonspecific nicotinic receptor antagonist. Bupropion, an antidepressant (Wellbutrin®) and an anti-smoking aid (Zyban®), is also a dopamine uptake blocker. Dextromethorphan, an antitussive in many OTC cough medicines (Benylin®, Delsym®, DexAlone™, Pertussin®, Robitussin®, Sucrets®), is also a NMDA receptor antagonist. Effects of 34 drug combinations on morphine self-administration 45 40 Baseline Treatment Morphine Infusions/hour 35 30 * 25 * * 20 15 * 10 * * 5 0 Mec1 Bup5 DM5 MC1 Mec1 = mecamylamine (1 mg/kg, i.p.) Bup5 = bupropion (5 mg/kg, i.p.) Mec1 Mec1 Mec1 DM5 DM5 MC1 + + + + + + Bup5 DM5 MC1 Bup5 MC1 Bup5 DM5 = dextromethorphan (5 mg/kg, s.c.) MC1 = 18-methoxycoronaridine (1 mg/kg, i.p.) At low doses, NONE of these agents affected morphine selfAll drug administration. combinations REDUCED morphine selfadministration. Effects of 34 drug combinations on methamphetamine self-administration Methamphetamine Infusions/hour 35 30 Baseline Treatment 25 20 * * * * * * 15 All drug combinations REDUCED methamphetamine selfadministration. 10 5 0 Mec1 Bup10 DM10 MC5 Mec1 Mec1 Mec1 DM10 DM5 MC5 + + + + + + Bup10 DM5 MC2 Bup10 MC2 Bup10 Mec1 = mecamylamine (1 mg/kg, i.p.) Bup10 = bupropion (10 mg/kg, i.p.) DM5 = dextromethorphan (5 mg/kg, s.c.) DM10 = dextromethorphan (10 mg/kg, s.c.) MC2 = 18-methoxycoronaridine (2 mg/kg, i.p.) MC5 = 18-methoxycoronaridine (5 mg/kg, i.p.) Effects of 34 drug combinations on nicotine self-administration 40 Nicotine Infusions/hour 35 Baseline Treatment 30 25 * 20 15 * * * * * All drug combinations REDUCED nicotine selfadministration. 10 5 0 Mec.1 Bup5 DM.5 MC.1 Mec.1 Mec.1 Mec.1 DM.5 DM.5 MC.1 + + + + + + Bup5 DM.5 MC.1 Bup5 MC.1 Bup5 Mec.1 = mecamylamine (0.1 mg/kg, i.p.) Bup5 = bupropion (5 mg/kg, i.p.) DM.5 = dextromethorphan (0.5 mg/kg, s.c.) MC.1 = 18-methoxycoronaridine (0.1 mg/kg, i.p.) Effects of 34 drug combinations on water responding 1200 Baseline Treatment Water Bar Presses/hour 1000 NONE of the drug combinations had an effect on responding for water. 800 600 400 200 0 Mec1 Bup10 DM10 MC5 Mec1 Mec1 Mec1 DM10 DM5 MC5 + + + + + + Bup10 DM5 MC2 Bup10 MC2 Bup10 Mec1 = mecamylamine (1 mg/kg, i.p.) Bup10 = bupropion (10 mg/kg, i.p.) DM5 = dextromethorphan (5 mg/kg, s.c.) DM10 = dextromethorphan (10 mg/kg, s.c.) MC2 = 18-methoxycoronaridine (2 mg/kg, i.p.) MC5 = 18-methoxycoronaridine (5 mg/kg, i.p.) Effects of interpeduncular administration of 18-MC on drug self-administration Local administration of 18-MC (5-10 µg in 1 µl) into both interpeduncular nuclei decreased responding for morphine (and also methamphetamine); similar results occurred with the medial habenula. Morphine Infusions/hour 30 25 IPN IPN VTA 20 * 15 * * * 10 5 0 0 10 18-MC (mg) 0 1 2 5 8 10 20 18-MC (mg) 0 10 Mecamylamine (mg) interpeduncular nucleus 100 80 60 40 20 morphine r = -.67 p < 0.05 85 90 95 100 Percent of 3 4 inhibition Percent of baseline: self-administration Percent of baseline: self-administration Correlations between blockade of 34 nicotinic receptors and drug self-administration 100 80 How much a congener of 18-MC decreases drug self-administration is related to how well it can block 34 nicotinic receptors. 60 40 20 methamphetamine r = -.75 p < 0.02 85 90 95 100 Percent of 3 4 inhibition Is 18-MC blockade of 34 nicotinic receptors relevant to its anti-addictive effects? 1. Combinations of low doses of non-specific 34 nicotinic receptor antagonists decrease drug self-administration. 2. Interpeduncular or intrahabenular infusion of 18-MC decreases morphine self-administration. 3. There are significant correlations between potencies of 18-MC congeners to block 34 nicotinic receptors and their effects on drug self-administration. Conclusions 1. 18-MC may be useful in treating many forms of drug addiction, including opioid (e.g., heroin) and stimulant (e.g., cocaine, methamphetamine) abuse, alcoholism and smoking. 2. 18-MC should lack all of ibogaine’s prominent side effects. 3. 18-MC abolishes the dopamine sensitization that occurs with chronic drug administration and that may underlie craving and relapse. 4. An antagonist action at 34 nicotinic receptors appears to be 18-MC’s most important action. 18-MC has greater selectivity for this site than either ibogaine or other existing agents. Clinical application Antagonism of acetylcholine’s actions at 34 nicotinic receptors may constitute a novel mechanism and strategy for reducing addiction to multiple drugs. Low dose combinations of existing agents (i.e., dextromethorphan, mecamylamine and bupropion) may be viable therapies, and readily testable, in lieu of single agents acting specifically at this site. But… developing an anti-addictive medication is difficult. …So we began the search for another clinical use of 18-MC. Is 18-MC a potential treatment for obesity? Rationale: • Consumption of sucrose and other sweet substances is related to the development of obesity. • 18-MC (40 mg/kg) decreases the selfadministration of oral sucrose. Percent of baseline 100 80 60 40 Water Sucrose 20 0 0 10 20 18-MC (mg/kg) 30 40 Percent of baseline consumption Effect of 18-MC on consumption of sucrose water 250 sucrose 18-MC decreases sucrose intake but not water intake (*p<0.02-0.01). 200 150 100 50 0 0 10 * * * 20 18-MC (mg/kg) 40 Effect of 18-MC on sucrose-induced weight gain 290 sucrose-vehicle (n=8) sucrose-18MC (n=8) Weight, g 280 270 260 250 240 0 *** ** * * ****** 2 4 6 8 10 12 Days 14 * **** 16 18 * 20 * 18-MC (20 mg/kg for 14 days) blocks the development of sucrose-induced obesity (*p<0.05-0.001). 22 Effect of repeated administration of 18-MC (20 mg/kg i.p. for 14 days) on body fat depots. On the eighth day after the last injection of 18-MC, animals were euthanized, and necropsies were performed to remove periovarian, perirenal and inguinal fat pads. 20 Fat depot weight, g 15 * 10 5 0 Vehicle 18-MC Conclusion 18-MC is potentially useful in the treatment of obesity. Follow-up (recent data) 18-MC also blocks the development of obesity induced by a high fat diet. 18-MC reduces ghrelin-induced sucrose intake. 18-MC’s anti-obesity effects are centrally mediated (e.g., intraventricular 18-MC decreases fat depots). • New start-up company focused on development of 18-MC and related treatments for drug addiction • 18-MC to be synthesized and supplied by Obiter Research (medicinal chemistry company) • Combinations of generic drugs to be tested first (rationale based on 18-MC’s mechanism of action) COLLABORATORS Isabelle Maisonneuve Martin Kuehne PFC Lindsay Hough Helen Molinari VTA Milt Teitler Katharine Herrick-Davis Mark Fleck Christopher Pace NAC Karen Szumlinski Olga Taraschenko Sarah McCallum