Kantrowitz Joshua T, Grinband Jack, Goff Donald C, Lahti Adrienne C, Marder Stephen R, Kegeles Lawrence S, Girgis Ragy R, Sobeih Tarek, Wall Melanie M, Choo Tse-Hwei, Green Michael F, Yang Yvonne S, Lee Junghee, Horga Guillermo, Krystal John H, Potter William Z, Javitt Daniel C, Lieberman Jeffrey A
Columbia University, New York, NY, USA.
New York State Psychiatric Institute, New York, NY, USA.
Neuropsychopharmacology. 2020 Oct;45(11):1842-1850. doi: 10.1038/s41386-020-0706-z. Epub 2020 May 13.
Glutamate neurotransmission is a prioritized target for antipsychotic drug development. Two metabotropic glutamate receptor 2/3 (mGluR2/3) agonists (pomaglumetad [POMA] and TS-134) were assessed in two Phase Ib proof of mechanism studies of comparable designs and using identical clinical assessments and pharmacoBOLD methodology. POMA was examined in a randomized controlled trial under double-blind conditions for 10-days at doses of 80 or 320 mg/d POMA versus placebo (1:1:1 ratio). The TS-134 trial was a randomized, single-blind, 6-day study of 20 or 60 mg/d TS-134 versus placebo (5:5:2 ratio). Primary outcomes were ketamine-induced changes in pharmacoBOLD in the dorsal anterior cingulate cortex (dACC) and symptoms reflected on the Brief Psychiatric Rating Scale (BPRS). Both trials were conducted contemporaneously. 95 healthy volunteers were randomized to POMA and 63 to TS-134. High-dose POMA significantly reduced ketamine-induced BPRS total symptoms within and between-groups (p < 0.01, d = -0.41; p = 0.04, d = -0.44, respectively), but neither POMA dose significantly suppressed ketamine-induced dACC pharmacoBOLD. In contrast, low-dose TS-134 led to moderate to large within and between group reductions in both BPRS positive symptoms (p = 0.02, d = -0.36; p = 0.008, d = -0.82, respectively) and dACC pharmacoBOLD (p = 0.004, d = -0.56; p = 0.079, d = -0.50, respectively) using pooled across-study placebo data. High-dose POMA exerted significant effects on clinical symptoms, but not on target engagement, suggesting a higher dose may yet be needed, while the low dose of TS-134 showed evidence of symptom reduction and target engagement. These results support further investigation of mGluR2/3 and other glutamate-targeted treatments for schizophrenia.
谷氨酸能神经传递是抗精神病药物研发的一个优先靶点。在两项设计可比、采用相同临床评估和药物功能磁共振成像(pharmacoBOLD)方法的Ib期机制验证研究中,对两种代谢型谷氨酸受体2/3(mGluR2/3)激动剂(泊马谷氨酸[POMA]和TS - 134)进行了评估。在一项双盲条件下的随机对照试验中,以80或320mg/d的POMA剂量与安慰剂(比例为1:1:1)对POMA进行了为期10天的研究。TS - 134试验是一项随机、单盲、为期6天的研究,比较20或60mg/d的TS - 134与安慰剂(比例为5:5:2)。主要结局指标是氯胺酮诱导的背侧前扣带回皮质(dACC)药物功能磁共振成像变化以及简明精神病评定量表(BPRS)所反映的症状。两项试验同时进行。95名健康志愿者被随机分配至POMA组,63名被分配至TS - 134组。高剂量POMA在组内和组间均显著降低了氯胺酮诱导的BPRS总分症状(分别为p < 0.01,d = -0.41;p = 0.04,d = -0.44),但两种POMA剂量均未显著抑制氯胺酮诱导的dACC药物功能磁共振成像。相比之下,使用合并的跨研究安慰剂数据,低剂量TS - 134在组内和组间均使BPRS阳性症状(分别为p = 0.02,d = -0.36;p = 0.008,d = -0.82)和dACC药物功能磁共振成像(分别为p = 0.004,d = -0.56;p = 0.079,d = -0.50)出现中度至大幅降低。高剂量POMA对临床症状有显著影响,但对靶点参与无影响,这表明可能仍需要更高剂量,而低剂量TS - 134显示出症状减轻和靶点参与的证据。这些结果支持对mGluR2/3及其他针对谷氨酸的精神分裂症治疗方法进行进一步研究。