1. Dual-acting agents for improving cognition and real-world function in Alzheimer’s disease: Focus on 5-HT6 and D3 receptors as hubs
- Author
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David M. Watson, Mauricette Brocco, Kevin C. F. Fone, Anne Dekeyne, Clotilde Mannoury la Cour, Jean-Claude Ortuno, Millan Mark, and Alain P. Gobert
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Social Cognition ,0301 basic medicine ,Psychosis ,medicine.drug_class ,Dopamine Agents ,Neuroprotection ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,Glutamatergic ,Cognition ,0302 clinical medicine ,Alzheimer Disease ,Dopamine receptor D3 ,Monoaminergic ,Animals ,Humans ,Medicine ,Cognitive Dysfunction ,Pharmacology ,business.industry ,Receptors, Dopamine D3 ,Memantine ,Histaminergic ,Recovery of Function ,Receptor antagonist ,medicine.disease ,030104 developmental biology ,Receptors, Serotonin ,Dopamine Antagonists ,Serotonin Antagonists ,business ,Neuroscience ,030217 neurology & neurosurgery ,medicine.drug - Abstract
© 2020 Elsevier Ltd To date, there are no interventions that impede the inexorable progression of Alzheimer's disease (AD), and currently-available drugs cholinesterase (AChE) inhibitors and the N-Methyl-D-Aspartate receptor antagonist, memantine, offer only modest symptomatic benefit. Moreover, a range of mechanistically-diverse agents (glutamatergic, histaminergic, monoaminergic, cholinergic) have disappointed in clinical trials, alone and/or in association with AChE inhibitors. This includes serotonin (5-HT) receptor-6 antagonists, despite compelling preclinical observations in rodents and primates suggesting a positive influence on cognition. The emphasis has so far been on high selectivity. However, for a multi-factorial disorder like idiopathic AD, 5-HT6 antagonists possessing additional pharmacological actions might be more effective, by analogy to “multi-target” antipsychotics. Based on this notion, drug discovery programmes have coupled 5-HT6 blockade to 5-HT4 agonism and inhibition of AchE. Further, combined 5-HT6/dopamine D3 receptor (D3) antagonists are of especial interest since D3 blockade mirrors 5-HT6 antagonism in exerting broad-based pro-cognitive properties in animals. Moreover, 5-HT6 and dopamine D3 antagonists promote neurocognition and social cognition via both distinctive and convergent actions expressed mainly in frontal cortex, including suppression of mTOR over-activation and reinforcement of cholinergic and glutamatergic transmission. In addition, 5-HT6 blockade affords potential anti-anxiety, anti-depressive and anti-epileptic properties, and antagonising 5-HT6 receptors may be associated with neuroprotective (“disease-modifying”) properties. Finally D3 antagonism may counter psychotic episodes and D3 receptors themselves offer a promising hub for multi-target agents. The present article reviews the status of “R and D” into multi-target 5-HT6 and D3 ligands for improved treatment of AD and other neurodegenerative disorders of aging. This article is part of the special issue entitled ‘Serotonin Research: Crossing Scales and Boundaries’.
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- 2020
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