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纳洛酮经鼻给药能迅速占据人体脑内μ-阿片受体。

Intranasal naloxone rapidly occupies brain mu-opioid receptors in human subjects.

机构信息

Turku PET Centre, University of Turku, Turku, Finland.

Department of Radiation Sciences, Umeå University, Umeå, Sweden.

出版信息

Neuropsychopharmacology. 2019 Aug;44(9):1667-1673. doi: 10.1038/s41386-019-0368-x. Epub 2019 Mar 13.

Abstract

Nasal spray formulations of naloxone, a mu-opioid receptor (MOR) antagonist, are currently used for the treatment of opioid overdose. They may have additional therapeutic utility also in the absence of opioid agonist drugs, but the onset and duration of action at brain MORs have been inadequately characterized to allow such projections. This study provides initial characterization of brain MOR availability at high temporal resolution following intranasal (IN) naloxone administration to healthy volunteers in the absence of a competing opioid agonist. Fourteen participants were scanned twice using positron emission tomography (PET) and [C]carfentanil, a selective MOR agonist radioligand. Concentrations of naloxone in plasma and MOR availability (relative to placebo) were monitored from 0 to 60 min and at 300-360 min post naloxone. Naloxone plasma concentrations peaked at ~20 min post naloxone, associated with slightly delayed development of brain MOR occupancy (half of peak occupancy reached at ~10 min). Estimated peak occupancies were 67 and 85% following 2 and 4 mg IN doses, respectively. The estimated half-life of occupancy disappearance was ~100 min. The rapid onset of brain MOR occupancy by IN naloxone, evidenced by the rapid onset of its action in opioid overdose victims, was directly documented in humans for the first time. The employed high temporal-resolution PET method establishes a model that can be used to predict brain MOR occupancy from plasma naloxone concentrations. IN naloxone may have therapeutic utility in various addictions where brain opioid receptors are implicated, such as gambling disorder and alcohol use disorder.

摘要

纳洛酮鼻腔喷雾剂是一种μ-阿片受体(MOR)拮抗剂,目前用于治疗阿片类药物过量。在没有阿片类激动剂药物的情况下,它可能还有其他治疗用途,但在大脑 MOR 中的作用起始和持续时间尚未得到充分描述,无法进行此类预测。本研究在健康志愿者中,在没有竞争阿片类激动剂的情况下,首次在高时间分辨率下描述了经鼻(IN)给予纳洛酮后大脑 MOR 可及性。14 名参与者使用正电子发射断层扫描(PET)和 [C]carfentanil(一种选择性 MOR 激动剂放射性配体)两次进行扫描。监测了纳洛酮在血浆中的浓度和 MOR 可及性(相对于安慰剂),时间从纳洛酮给药后 0 分钟到 60 分钟,以及 300-360 分钟。纳洛酮的血浆浓度在纳洛酮给药后约 20 分钟达到峰值,与大脑 MOR 占有率的延迟发展相关(达到峰值的一半约在 10 分钟)。2 和 4mg IN 剂量分别引起 67%和 85%的估计峰值占有率。占有率消失的半衰期约为 100 分钟。IN 纳洛酮对大脑 MOR 占有率的快速作用,如在阿片类药物过量患者中的快速作用,首次在人体中得到直接证实。所采用的高时间分辨率 PET 方法建立了一种模型,可用于根据血浆纳洛酮浓度预测大脑 MOR 占有率。IN 纳洛酮可能在各种涉及大脑阿片受体的成瘾性疾病中具有治疗用途,例如赌博障碍和酒精使用障碍。

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