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The role of M1 muscarinic receptor agonism of N-desmethylclozapine in the unique clinical effects of clozapine

Weiner, D. M. ; Meltzer, H. Y. ; Veinbergs, I. ; Donohue, E. M. ; Spalding, T. A. ; Smith, T. T. ; Mohell, N. ; Harvey, S. C. ; Lameh, J. and Nash, N. , et al. (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.

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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
  • scopus:19944426901
  • pmid:15258717
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
2020-05-26 05:33:12
@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},
  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},
}