The role of M1 muscarinic receptor agonism of N-desmethylclozapine in the unique clinical effects of clozapine
(2004) In Psychopharmacology 177(1-2). p.207-216- Abstract
Rationale: Clozapine is a unique antipsychotic, with efficacy against positive symptoms in treatment-resistant schizophrenic patients, and the ability to improve cognition and treat the negative symptoms characteristic of this disease. Despite its unique clinical actions, no specific molecular mechanism responsible for these actions has yet been described. Objectives and methods: To comprehensively profile a large library of neuropsychiatric drugs, including most antipsychotics, at human monoamine receptors using R-SAT, an in vitro functional assay. Results: Profiling revealed that N-desmethylclozapine (NDMC), the principal metabolite of clozapine, but not clozapine itself, is a potent and efficacious muscarinic receptor agonist, a... (More)
Rationale: Clozapine is a unique antipsychotic, with efficacy against positive symptoms in treatment-resistant schizophrenic patients, and the ability to improve cognition and treat the negative symptoms characteristic of this disease. Despite its unique clinical actions, no specific molecular mechanism responsible for these actions has yet been described. Objectives and methods: To comprehensively profile a large library of neuropsychiatric drugs, including most antipsychotics, at human monoamine receptors using R-SAT, an in vitro functional assay. Results: Profiling revealed that N-desmethylclozapine (NDMC), the principal metabolite of clozapine, but not clozapine itself, is a potent and efficacious muscarinic receptor agonist, a molecular property not shared by any other antipsychotic. To further explore the role of NDMC muscarinic receptor agonist properties in mediating the physiological actions of clozapine, systemically administered NDMC was found to stimulate the phosphorylation of mitogen-activated protein kinase (MAP kinase) in mouse CA1 hippocampal neurons, an effect that was blocked by scopolamine, confirming central M1 muscarinic receptor agonist activity in vivo. Lastly, an analysis of clozapine and NDMC serum levels in schizophrenic patients indicated that high NDMC/clozapine ratios better predicted improvement in cognitive functioning and quality of life than the levels of either compound alone. Conclusions: The muscarinic receptor agonist activities of NDMC are unique among antipsychotics, and provide a possible molecular basis for the superior clinical effects of clozapine pharmacotherapy.
(Less)
- author
- Weiner, D. M.
; Meltzer, H. Y.
; Veinbergs, I.
; Donohue, E. M.
; Spalding, T. A.
; Smith, T. T.
; Mohell, N.
; Harvey, S. C.
; Lameh, J.
; Nash, N.
; Vanover, K. E.
; Olsson, R.
LU
; Jayathilake, K.
; Lee, M.
; Levey, A. I.
; Hacksell, U.
; Burstein, E. S.
; Davis, R. E.
and Brann, M. R.
(Less) - publishing date
- 2004-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Agonist, Antipsychotic, Clozapine, Cognition, Muscarinic acetylcholine receptors, N-desmethylclozapine, N-desmethylclozapine/clozapine ratios, Schizophrenia
- in
- Psychopharmacology
- volume
- 177
- issue
- 1-2
- pages
- 207 - 216
- publisher
- Springer
- external identifiers
-
- pmid:15258717
- scopus:19944426901
- ISSN
- 0033-3158
- DOI
- 10.1007/s00213-004-1940-5
- language
- English
- LU publication?
- no
- id
- 5896f3b3-9960-45a1-9474-13ad6c1f5340
- date added to LUP
- 2019-10-02 10:36:57
- date last changed
- 2024-04-16 22:01:16
@article{5896f3b3-9960-45a1-9474-13ad6c1f5340,
abstract = {{<p>Rationale: Clozapine is a unique antipsychotic, with efficacy against positive symptoms in treatment-resistant schizophrenic patients, and the ability to improve cognition and treat the negative symptoms characteristic of this disease. Despite its unique clinical actions, no specific molecular mechanism responsible for these actions has yet been described. Objectives and methods: To comprehensively profile a large library of neuropsychiatric drugs, including most antipsychotics, at human monoamine receptors using R-SAT, an in vitro functional assay. Results: Profiling revealed that N-desmethylclozapine (NDMC), the principal metabolite of clozapine, but not clozapine itself, is a potent and efficacious muscarinic receptor agonist, a molecular property not shared by any other antipsychotic. To further explore the role of NDMC muscarinic receptor agonist properties in mediating the physiological actions of clozapine, systemically administered NDMC was found to stimulate the phosphorylation of mitogen-activated protein kinase (MAP kinase) in mouse CA1 hippocampal neurons, an effect that was blocked by scopolamine, confirming central M1 muscarinic receptor agonist activity in vivo. Lastly, an analysis of clozapine and NDMC serum levels in schizophrenic patients indicated that high NDMC/clozapine ratios better predicted improvement in cognitive functioning and quality of life than the levels of either compound alone. Conclusions: The muscarinic receptor agonist activities of NDMC are unique among antipsychotics, and provide a possible molecular basis for the superior clinical effects of clozapine pharmacotherapy.</p>}},
author = {{Weiner, D. M. and Meltzer, H. Y. and Veinbergs, I. and Donohue, E. M. and Spalding, T. A. and Smith, T. T. and Mohell, N. and Harvey, S. C. and Lameh, J. and Nash, N. and Vanover, K. E. and Olsson, R. and Jayathilake, K. and Lee, M. and Levey, A. I. and Hacksell, U. and Burstein, E. S. and Davis, R. E. and Brann, M. R.}},
issn = {{0033-3158}},
keywords = {{Agonist; Antipsychotic; Clozapine; Cognition; Muscarinic acetylcholine receptors; N-desmethylclozapine; N-desmethylclozapine/clozapine ratios; Schizophrenia}},
language = {{eng}},
number = {{1-2}},
pages = {{207--216}},
publisher = {{Springer}},
series = {{Psychopharmacology}},
title = {{The role of M1 muscarinic receptor agonism of N-desmethylclozapine in the unique clinical effects of clozapine}},
url = {{http://dx.doi.org/10.1007/s00213-004-1940-5}},
doi = {{10.1007/s00213-004-1940-5}},
volume = {{177}},
year = {{2004}},
}