W. Lee Hearn

Cocaethylene: a unique cocaine metabolite displays high affinity for the dopamine transporter.

Abstract: Concurrent cocaine and alcohol use is common practice in the general population, as indicated by recent prevalence studies. In the presence of ethyl alcohol, cocaine is metabolized to its ethyl homolog, cocaethylene. The transesterification of cocaine and ethanol to cocaethylene takes place in the liver and represents a novel metabolic reaction. Cocaethylene was detected in postmortem blood, liver, and neurological tissues in concentrations equal to and sometimes exceeding those of cocaine. In vitro binding studies demonstrate that cocaethylene has a pharmacological profile similar but not identical to that of cocaine at monoamine transport sites assayed in the human brain. Cocaethylene was equipotent to cocaine at inhibiting [3H]mazindol binding to the dopamine transporter. The blockade of dopamine reuptake in the synaptic cleft by cocaethylene may account for the enhanced euphoria associated with combined alcohol and cocaine abuse.

Dopamine transport function is elevated in cocaine users.

Dopaminergic transmission has been suggested to be a primary mechanism mediating reinforcement, withdrawal and craving associated with psychostimulant addiction. Pyschostimulants attenuate dopamine transporter (DAT) clearance efficiency, resulting in a net increase in synaptic dopamine levels. Re‐uptake rate is determined by the number of functional DAT molecules at the membrane surface. Previous in vivo imaging studies in humans and in vitro studies in post‐mortem human brain have demonstrated that chronic cocaine abuse results in a neuroadaptive increase in DAT‐binding site density in the limbic striatum. Whether this increase in DAT availability represents an increase in the functional activity of the transporter is unknown. Here, we present evidence that DAT function is elevated by chronic cocaine abuse. The effect of increasing post‐mortem interval on the functional viability of synaptosomes was modeled in the baboon brain. Baboon brains sampled under conditions similar to human brain autopsies yielded synaptosomal preparations that were viable up to 24 h post‐mortem. Dopamine (DA) uptake was elevated twofold in the ventral striatum from cocaine users as compared to age‐matched drug‐free control subjects. The levels of [3H]DA uptake were not elevated in victims of excited cocaine delirium, who experienced paranoia and marked agitation prior to death. In keeping with the increase in DAT function, [3H]WIN 35,428 binding was increased in the cocaine users, but not in the victims of excited delirium. These results demonstrate that DA uptake function assayed in cryopreserved human brain synaptosomes is a suitable approach for testing hypotheses of the mechanisms underlying human brain disorders and for studying the actions of addictive drugs in man.

Fatal Excited Delirium Following Cocaine Use: Epidemiologic Findings Provide New Evidence for Mechanisms of Cocaine Toxicity

We describe an outbreak of deaths from cocaine-induced excited delirium (EDDs) in Dade County, Florida between 1979 and 1990. From a registry of all cocaine-related deaths in Dade County, Florida, from 1969-1990, 58 EDDs were compared with 125 victims of accidental cocaine overdose without excited delirium. Compared with controls, EDDs were more frequently black, male, and younger. They were less likely to have a low body mass index, and more likely to have died in police custody, to have received medical treatment immediately before death, to have survived for a longer period, to have developed hyperthermia, and to have died in summer months. EDDs had concentrations of cocaine and benzoylecgonine in autopsy blood that were similar to those for controls. The epidemiologic findings are most consistent with the hypothesis that chronic cocaine use disrupts dopaminergic function and, when coupled with recent cocaine use, may precipitate agitation, delirium, aberrant thermoregulation, rhabdomyolysis, and sudden death.

Medication Development of Ibogaine as a Pharmacotherapy for Drug Dependencea

ABSTRACT: The potential for deriving new psychotherapeutic medications from natural sources has led to renewed interest in rain forest plants as a source of lead compounds for the development of antiaddiction medications. Ibogaine is an indole alkaloid found in the roots of Tabernanthe iboga (Apocynaceae family), a rain forest shrub that is native to equatorial Africa. Ibogaine is used by indigenous peoples in low doses to combat fatigue, hunger and in higher doses as a sacrament in religious rituals. Members of American and European addict self‐help groups have claimed that ibogaine promotes long‐term drug abstinence from addictive substances, including psychostimulants and cocaine. Anecdotal reports attest that a single dose of ibogaine eliminates withdrawal symptoms and reduces drug cravings for extended periods of time. The purported antiaddictive properties of ibogaine require rigorous validation in humans. We have initiated a rising tolerance study using single administration to assess the safety of ibogaine for the treatment of cocaine dependency. The primary objectives of the study are to determine safety, pharmacokinetics and dose effects, and to identify relevant parameters of efficacy in cocaine‐dependent patients. Pharmacokinetic and pharmacodynamic characteristics of ibogaine in humans are assessed by analyzing the concentration‐time data of ibogaine and its desmethyl metabolite (noribogaine) from the Phase I trial, and by conducting in vitro experiments to elucidate the specific disposition processes involved in the metabolism of both parent drug and metabolite. The development of clinical safety studies of ibogaine in humans will help to determine whether there is a rationale for conducting efficacy trials in the future.

Identification of a primary metabolite of ibogaine that targets serotonin transporters and elevates serotonin.

Ibogaine is a hallucinogenic indole with putative efficacy for the treatment of cocaine, stimulant and opiate abuse. The purported efficacy of ibogaine following single dose administrations has led to the suggestion that a long-acting metabolite of ibogaine may explain in part how the drug reduces craving for psychostimulants and opiates. We report here that 12-hydroxyibogamine, a primary metabolite of ibogaine, displays high affinity for the 5-HT transporter and elevates extracellular 5-HT. In radioligand binding assays, 12-hydroxyibogamine was 50-fold more potent at displacing radioligand binding at the 5-HT transporter than at the DA transporter. Ibogaine and 12-hydroxyibogamine were equipotent at the dopamine transporter. In vivo microdialysis was used to evaluate the acute actions of ibogaine and 12-hydroxyibogamine on the levels of DA and 5-HT. Administration of 12-hydroxyibogamine produced a marked dose-related elevation of extracellular 5-HT. Ibogaine and 12-hydroxyibogamine failed to elevate DA levels in the nucleus accumbens over the dose range tested. The elevation in synaptic levels of 5-HT by 12-hydroxyibogamine may heighten mood and attenuate drug craving. The effects of the active metabolite on 5-HT transmission may account in part for the potential of ibogaine to interrupt drug-seeking behavior in humans.

Chapter 8 Ibogaine in the treatment of heroin withdrawal

Publisher Summary The chapter presents a study on the role of ibogaine in the treatment of heroin withdrawal. Pharmacological treatments for heroin addiction currently employ two treatment strategies: detoxification followed by drug-free abstinence or maintenance treatment with an opioid agonist. Because agonist maintenance with methadone usually has the goal of eventual detoxification to a drug-free state, the use of medications to facilitate this transition is a clinically important treatment strategy. Anecdotal reports suggest that ibogaine has promise as an alternative medication approach for making this transition. Ibogaine has an added benefit to other detoxification strategies in that the treatment experience seems to bolster the patients own motivational resources for change. Ibogaine is a drug with complex pharmacokinetics and an uncertain mechanism of action with regards to its alleged efficacy for the treatment of opiate dependence. Ibogaine is metabolized to noribogaine, which has a pharmacological profile that is different from that of the parent drug. The chapter presents that ibogaine is effective in blocking opiate withdrawal, providing an alternative approach for opiate-dependent patients who have failed other conventional treatments. Identifying noribogaines mechanism of action may explain the way ibogaine promotes rapid detoxification from opiates after only a single dose. Ibogaine, like most central nervous system (CNS) drugs, is highly lipophilic and is subject to extensive biotransformation. The Opiate-Symptom Checklist (OP-SCL) was developed for the present study as a subtle assessment of withdrawal symptoms.

Pharmacological screen for activities of 12=hydroxyibogamine: a primary metabolite of the indole alkaloid ibogaine

The purported efficacy of ibogaine for the treatment of drug dependence may be due in part to an active metabolite. Ibogaine undergoes first pass metabolism and isO-demethylated to 12-hydroxyibogamine (12-OH ibogamine). Radioligand binding assays were conducted to identify the potency and selectivity profiles for ibogaine and 12-OH ibogamine. A comparison of 12-OH ibogamine to the primary molecular targets identified previously for ibogaine demonstrates that the metabolite has a binding profile that is similar, but not identical to the parent drug. Both ibogaine and 12-OH ibogamine demonstrated the highest potency values at the cocaine recognition site on the 5-HT transporter. The same rank order (12-OH ibogamine > ibogaine), but lower potencies were observed for the [3H]paroxetine binding sites on the 5-HT transporter. Ibogaine and 12-OH ibogamine were equipotent at vesicular monoamine and dopamine transporters. The metabolite demonstrated higher affinity at the kappa-1 receptor and lower affinity at the NMDA receptor complex compared to the parent drug. Quantitation of the regional brain levels of ibogaine and 12-OH ibogamine demonstrated micromolar concentrations of both the parent drug and metabolite in rat brain. Drug dependence results from distinct, but inter-related neurochemical adaptations, which underlie tolerance, sensitization and withdrawal. Ibogaine’s ability to alter drug-seeking behavior may be due to combined actions of the parent drug and metabolite at key pharmacological targets that modulate the activity of drug reward circuits.

Metabolism of monofluoro- and monochlorobenzoates by a denitrifying bacterium

Monofluoro- and monochlorobenzoates did not support the growth of Pseudomonas PN-1, either aerobically or anaerobically (nitrate respiration), when supplied as sole sources of carbon and energy. Anaerobic growth yields on nonfluorinated substrates were increased by p-fluorobenzoate (pFBz) with a utilization of pFBz and release of F-. Cell suspensions grown on p-hydroxybenzoate (pOHBz), either aerobically or anaerobically, only degraded o-fluorobenzoate (oFBz) and pFBz of the monohalogenated benzoates tested. Both compounds were catabolized anaerobically, but not aerobically, with a release of F-. oFBz was immediately attacked, by cells grown anaerobically on pOHBz, whereas pFBz was only degraded after a lag phase; chloramphenicol inhibited the breakdown of pFBz, but not oFBz, thereby indicating the need for additional enzyme(s) to attack pFBz. o-Chlorobenzoate (oClBz) inhibited the anaerobic, but not aerobic, oxidation of pOHBz and stopped anaerobic growth on pOHBz. A mutant was isolated which metabolized pOHBz in the presence of oClBz but it was defective in its anaerobic metabolism of benzoate (Bz). Comparative studies, of the mutant and Pseudomonas PN-1, indicated that the mutation involved a metabolic site common to Bz, oClBz and the monofluorobenzoates. The dependence of the oxidation rate of Bz and oFBz on their concentrations at a millimolar level, in the mutant but not Pseudomonas PN-1, suggested a defect at the permease level: the uptake of 14C-labelled Bz by the mutant was also concentration-dependent. The response of the organism to the inhibitory effect of oClBz on pOHBz catabolism is discussed with respect to its significance in the perturbation of natural degradative processes by unnatural chemicals in the environment.

Analysis of drugs in human tissues by supercritical fluid extraction/immunoassay

A rapid, readily automated method has been developed for the quantitative analysis of phenobarbital from human liver tissues based on supercritical carbon dioxide extraction followed by fluorescence enzyme immunoassay. The method developed significantly reduces sample handling and utilizes the entire liver homogenate. The current method yields comparable recoveries and precision and does not require the use of an internal standard, although traditional GC/MS confirmation can still be performed on sample extracts. Additionally, the proposed method uses non-toxic, inexpensive carbon dioxide, thus eliminating the use of halogenated organic solvents.

Possible Metabolites of Dieldrin in the Sailfin Mollie (Poecilia latipinna)

Conclusions Two products, thought to be metabolites of dieldrin, have been detected in extracts of the liver and of various organs of the sailfin mollie P. latipinna, after the fish had been exposed to dilute solutions of dieldrin in sea water for 1 hr. Some properties of these substances are different from those described for dieldrin metabolites in other animals. We suggest that they may be partially dechlorinated cyclo-diene fragments of the dieldrin originally administered.