Discovery and Characterization of AMPA Receptor Modulators Selective for TARP-Γ8

Total Page:16

File Type:pdf, Size:1020Kb

Discovery and Characterization of AMPA Receptor Modulators Selective for TARP-Γ8 Supplemental material to this article can be found at: http://jpet.aspetjournals.org/content/suppl/2016/03/17/jpet.115.231712.DC1 1521-0103/357/2/394–414$25.00 http://dx.doi.org/10.1124/jpet.115.231712 THE JOURNAL OF PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICS J Pharmacol Exp Ther 357:394–414, May 2016 Copyright ª 2016 by The American Society for Pharmacology and Experimental Therapeutics Discovery and Characterization of AMPA Receptor Modulators Selective for TARP-g8 s Michael P. Maher, Nyantsz Wu, Suchitra Ravula, Michael K. Ameriks, Brad M. Savall, Changlu Liu, Brian Lord, Ryan M. Wyatt, Jose A. Matta, Christine Dugovic, Sujin Yun, Luc Ver Donck, Thomas Steckler, Alan D. Wickenden, Nicholas I. Carruthers, and Timothy W. Lovenberg Janssen Research and Development, LLC, Neuroscience Therapeutic Area, San Diego, California (M.P.M., N.W., S.R., M.K.A., B.M.S., C.L., B.L., R.M.W., J.A.M., C.D., S.Y., A.D.W., N.I.C., T.W.L.); and Janssen Research and Development, a Division of Janssen Pharmaceutica NV, Neuroscience Therapeutic Area, Beerse, Belgium (L.V.D., T.S.) Downloaded from Received December 23, 2015; accepted March 11, 2016 ABSTRACT Members of the a-amino-3-hydroxyl-5-methyl-4-isoxazole- pharmacokinetic properties and achieved high receptor occu- propionic acid (AMPA) subtype of ionotropic glutamate recep- pancy following oral administration. This molecule showed jpet.aspetjournals.org tors mediate the majority of fast synaptic transmission within strong, dose-dependent inhibition of neurotransmission within the mammalian brain and spinal cord, representing attractive the hippocampus, and a strong anticonvulsant effect. At high targets for therapeutic intervention. Here, we describe novel levels of receptor occupancy in rodent in vivo models, JNJ- AMPA receptor modulators that require the presence of the 55511118 showed a strong reduction in certain bands on electro- accessory protein CACNG8, also known as transmembrane encephalogram, transient hyperlocomotion, no motor impairment AMPA receptor regulatory protein g8 (TARP-g8). Using calcium on rotarod, and a mild impairment in learning and memory. JNJ- flux, radioligand binding, and electrophysiological assays of 55511118 is a novel tool for reversible AMPA receptor in- wild-type and mutant forms of TARP-g8, we demonstrate that hibition, particularly within the hippocampus, with potential at ASPET Journals on September 27, 2021 these compounds possess a novel mechanism of action therapeutic utility as an anticonvulsant or neuroprotectant. The consistent with a partial disruption of the interaction between existence of a molecule with this mechanism of action demon- the TARP and the pore-forming subunit of the channel. One strates the possibility of pharmacological targeting of acces- of the molecules, 5-[2-chloro-6-(trifluoromethoxy)phenyl]-1,3- sory proteins, increasing the potential number of druggable dihydrobenzimidazol-2-one (JNJ-55511118), had excellent targets. Introduction postsynaptic membranes of excitatory synapses in the central nervous system. AMPA receptors (AMPARs) mediate the Glutamate is the primary excitatory neurotransmitter in majority of fast synaptic transmission within the central mammalian brain. The a-amino-3-hydroxyl-5-methyl-4- nervous system (CNS). Thus, inhibition or negative modula- isoxazole-propionic acid (AMPA) subtype of glutamate recep- tion of AMPARs is an attractive strategy for therapeutic tors are ligand-gated ion channels expressed primarily on intervention in CNS disorders characterized by excessive neuronal activity. With the notable exception of pore blockers (which are selective for calcium-permeable AMPA receptors; dx.doi.org/10.1124/jpet.115.231712. s This article has supplemental material available at jpet.aspetjournals.org. see Stromgaard and Mellor, 2004), no AMPAR inhibitors have ABBREVIATIONS: ACSF, artificial cerebrospinal fluid; AMPA, a-amino-3-hydroxyl-5-methyl-4-isoxazole-propionic acid; AMPAR, AMPA receptor; ANOVA, analysis of variance; CHO, Chinese hamster ovary; CP-465022, 3-(2-Chlorophenyl)-2-[2-[6-[(diethylamino)methyl]-2-pyridinyl]ethenyl]-6- fluoro-4(3H)-quinazolinone hydrochloride; CNS, central nervous system; CT, carboxyl terminus; DMSO, dimethylsulfoxide; DNMTP, delayed non-match to position; EC50, half-maximal effective concentration; ED50, half-maximal effective dose; EEG, electroencephalogram; EMG, electromyogram; EPSC, excitatory postsynaptic current; EX, extracellular domain; FAM, familiar arm; fEPSP, field excitatory postsynaptic potential; f u, unbound fraction; GluA, AMPA subtype of ionotropic glutamate receptor; GYKI-53655, 1-(4-Aminophenyl)-3-methylcarbamyl-4- methyl-3,4-dihydro-7,8-methylenedioxy-5H-2,3-benzodiazepine hydrochloride; HABG, HibernateA supplemented with B27 and Glutamax; HEK-293, human embryonic kidney 293; HPMC, hydroxypropyl methylcellulose; J values, indirect dipole-dipole coupling constants; JNJ-55511118, 5-[2-chloro-6-(trifluoromethoxy)phenyl]-1,3-dihydrobenzimidazol-2-one; JNJ-56022486, 2-(3-chloro-2-(2-oxo-2,3-dihydro-1H-benzo[d]imidazol- 5-yl)phenyl)acetonitrile; LC-MS/MS, liquid chromatography–tandem mass spectrometry; LY-395153, N-[4-[1-(propan-2-ylsulfonylamino)propan- 2-yl]phenyl]benzamide; MES, maximal electroshock; MWM, Morris water maze; NEW, novel arm; NIH, National Institutes of Health; NMDA, N-methyl-D-aspartate;NREM,non-rapideyemovement;NSB,nonspecificbinding;PAM,positiveallostericmodulator;PCR, polymerase chain reaction; Philanthotoxin-74, (S)-N-[7-[(4-Aminobutyl)amino]heptyl]-4-hydroxy-a-[(1-oxobutyl)amino]benzenepropanamide dihydrochloride; p.o., per os; PTZ, pentylenetetrazole; RED, Rapid Equilibrium Dialysis; REM, rapid eye movement; SB, specific binding; TARP, transmembrane AMPA receptor regulatory protein; TB, total binding; TM, transmembrane domain. 394 TARP-g8–Selective AMPAR Modulators 395 been found to have selectivity among the AMPAR subtypes, or Here, we describe the in vitro and in vivo characterization of to exhibit regional specificity. Since AMPAR activity is 5-[2-chloro-6-(trifluoromethoxy)phenyl]-1,3-dihydrobenzimidazol- ubiquitous within the CNS, general antagonism results in 2-one (JNJ-55511118) and 2-(3-chloro-2-(2-oxo-2,3-dihydro-1H- undesired effects, such as ataxia, sedation, and/or dizziness. benzo[d]imidazol-5-yl)phenyl)acetonitrile (JNJ-56022486). These In clinical use, AMPAR antagonists have very narrow thera- compounds are potent negative modulators of AMPA receptors peutic dosing windows: the doses needed to obtain anticon- containing TARP-g8. They show exquisite selectivity, with no vulsant activity are close to or overlap with doses at which measurable effects upon AMPARs containing other TARPs, or undesired effects are observed (Rogawski, 2011). upon TARP-less receptors. Using chimeric proteins comprising Over the past two decades, investigations into the quater- various segments of TARP-g8and-g4 followed by site-directed nary structure of native AMPA receptors have revealed a mutagenesis, we identified the specific amino acids responsible for remarkably large set of interaction partners. Heterologous this remarkable selectivity. We demonstrate in vivo target expression of individual members of the AMPA subtype of occupancy using ex vivo autoradiography, and provide a pre- ionotropic glutamate receptor (GluA) is sufficient to form liminary investigation of the in vivo pharmacological effects of functional AMPA receptors. However, full recapitulation of TARP-g8–selective AMPA receptor inhibition. the trafficking, localization, gating characteristics, and pharmacology of native AMPA receptors requires coassem- bly with a large and diverse set of accessory proteins Materials and Methods Downloaded from (Jackson and Nicoll, 2011; Schwenk et al., 2012; Straub 3-(2-Chlorophenyl)-2-[2-[6-[(diethylamino)methyl]-2-pyridinyl]ethenyl]- and Tomita, 2012). These auxiliary subunits include cyto- 6-fluoro-4(3H)-quinazolinone hydrochloride (CP-465022; Menniti et al., skeletal and anchoring proteins, other signaling proteins, 2000), 1-(4-Aminophenyl)-3-methylcarbamyl-4-methyl-3,4-dihydro- and several intracellular and transmembrane proteins with 7,8-methylenedioxy-5H-2,3-benzodiazepine hydrochloride (GYKI-53655; largely unknown functions. The wide variety of proteins Bleakman et al., 1996), and (S)-N-[7-[(4-Aminobutyl)amino]heptyl]- which can participate in AMPA receptor complexes vastly 4-hydroxy-a-[(1-oxobutyl)amino]benzenepropanamide dihydrochlo- increases the ability of a neuron to tune the response ride (Philanthotoxin-74; Kromann et al., 2002) were purchased from jpet.aspetjournals.org characteristics of its synapses. Here, we demonstrate that Tocris (Bristol, UK). N-[4-[1-(propan-2-ylsulfonylamino)propan- these accessory proteins can be used as novel pharmacological 2-yl]phenyl]benzamide (LY-395153; Linden et al., 2001) was pur- chased from Diverchim (Roissy-en-France, France). Perampanel targets. (Hanada et al., 2011) was purchased from Alsachim (Illkirch- Members of the transmembrane AMPA receptor regula- Graffenstaden, France). Unless otherwise noted, all data analyses, tory protein (TARP) family (CACNG2, 3, 4, 5, 7, and 8) are statistics, and data plots were performed using Origin 2015 or associated with most, if not all, AMPARs in the brain. These OriginPro 2015 (OriginLab, Northampton, MA). Grubbs’ test was proteins were originally discovered and named due to their performed prior to statistical analysis; if identified, a single extreme at ASPET Journals on September 27, 2021 homology to the gamma subunit of voltage-gated calcium
Recommended publications
  • Development of Pain-Free Methods for Analyzing 231 Multiclass Drugs and Metabolites by LC-MS/MS
    Clinical, Forensic & Toxicology Article “The Big Pain”: Development of Pain-Free Methods for Analyzing 231 Multiclass Drugs and Metabolites by LC-MS/MS By Sharon Lupo As the use of prescription and nonprescription drugs grows, the need for fast, accurate, and comprehensive methods is also rapidly increasing. Historically, drug testing has focused on forensic applications such as cause of death determinations or the detection of drug use in specific populations (military, workplace, probation/parole, sports doping). However, modern drug testing has expanded well into the clinical arena with a growing list of target analytes and testing purposes. Clinicians often request the analysis of large panels of drugs and metabolites that can be used to ensure compliance with prescribed pain medication regimens and to detect abuse or diversion of medications. With prescription drug abuse reaching epidemic levels [1], demand is growing for analytical methods that can ensure accurate results for comprehensive drug lists with reasonable analysis times. LC-MS/MS is an excellent technique for this work because it offers greater sensitivity and specificity than immunoassay and—with a highly selective and retentive Raptor™ Biphenyl column—can provide definitive results for a wide range of compounds. Typically, forensic and pain management drug testing consists of an initial screening analysis, which is qualitative, quick, and requires only minimal sample preparation. Samples that test positive during screening are then subjected to a quantitative confirmatory analysis. Whereas screening assays may cover a broad list of compounds and are generally less sensitive and specific, confirmation testing provides fast, targeted analysis using chromatographic conditions that are optimized for specific panels.
    [Show full text]
  • Autism Multiplex Family with 16P11.2P12.2 Microduplication Syndrome in Monozygotic Twins and Distal 16P11.2 Deletion in Their Brother
    European Journal of Human Genetics (2012) 20, 540–546 & 2012 Macmillan Publishers Limited All rights reserved 1018-4813/12 www.nature.com/ejhg ARTICLE Autism multiplex family with 16p11.2p12.2 microduplication syndrome in monozygotic twins and distal 16p11.2 deletion in their brother Anne-Claude Tabet1,2,3,4, Marion Pilorge2,3,4, Richard Delorme5,6,Fre´de´rique Amsellem5,6, Jean-Marc Pinard7, Marion Leboyer6,8,9, Alain Verloes10, Brigitte Benzacken1,11,12 and Catalina Betancur*,2,3,4 The pericentromeric region of chromosome 16p is rich in segmental duplications that predispose to rearrangements through non-allelic homologous recombination. Several recurrent copy number variations have been described recently in chromosome 16p. 16p11.2 rearrangements (29.5–30.1 Mb) are associated with autism, intellectual disability (ID) and other neurodevelopmental disorders. Another recognizable but less common microdeletion syndrome in 16p11.2p12.2 (21.4 to 28.5–30.1 Mb) has been described in six individuals with ID, whereas apparently reciprocal duplications, studied by standard cytogenetic and fluorescence in situ hybridization techniques, have been reported in three patients with autism spectrum disorders. Here, we report a multiplex family with three boys affected with autism, including two monozygotic twins carrying a de novo 16p11.2p12.2 duplication of 8.95 Mb (21.28–30.23 Mb) characterized by single-nucleotide polymorphism array, encompassing both the 16p11.2 and 16p11.2p12.2 regions. The twins exhibited autism, severe ID, and dysmorphic features, including a triangular face, deep-set eyes, large and prominent nasal bridge, and tall, slender build. The eldest brother presented with autism, mild ID, early-onset obesity and normal craniofacial features, and carried a smaller, overlapping 16p11.2 microdeletion of 847 kb (28.40–29.25 Mb), inherited from his apparently healthy father.
    [Show full text]
  • Regulation of Extracellular Arginine Levels in the Hippocampus in Vivo
    Regulation of Extracellular Arginine Levels in the Hippocampus In Vivo by Joanne Watts B.Sc. (Hons) r Thesis submitted for the degree of Doctor of Philosophy in the Faculty of Science, University of London The School of Pharmacy University of London ProQuest Number: 10105113 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10105113 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Abstract Nitric oxide (NO) has emerged as an ubiquitous signaling molecule in the central nervous system (CNS). NO is synthesised from molecular oxygen and the amino acid L-arginine (L- ARG) by the enzyme NO synthase (NOS), and the availability of L-ARG has been implicated as the limiting factor for NOS activity. Previous studies have indicated that L- ARG is localised in astrocytes in vitro and that the in vitro activation of non-N-methyl-D- aspartate (NMDA) receptors, as well as the presence of peroxynitrite (ONOO ), led to the release of L-ARG. Microdialysis was therefore used in this study to investigate whether this held true in vivo.
    [Show full text]
  • Transcriptomic Analysis of Native Versus Cultured Human and Mouse Dorsal Root Ganglia Focused on Pharmacological Targets Short
    bioRxiv preprint doi: https://doi.org/10.1101/766865; this version posted September 12, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY-ND 4.0 International license. Transcriptomic analysis of native versus cultured human and mouse dorsal root ganglia focused on pharmacological targets Short title: Comparative transcriptomics of acutely dissected versus cultured DRGs Andi Wangzhou1, Lisa A. McIlvried2, Candler Paige1, Paulino Barragan-Iglesias1, Carolyn A. Guzman1, Gregory Dussor1, Pradipta R. Ray1,#, Robert W. Gereau IV2, # and Theodore J. Price1, # 1The University of Texas at Dallas, School of Behavioral and Brain Sciences and Center for Advanced Pain Studies, 800 W Campbell Rd. Richardson, TX, 75080, USA 2Washington University Pain Center and Department of Anesthesiology, Washington University School of Medicine # corresponding authors [email protected], [email protected] and [email protected] Funding: NIH grants T32DA007261 (LM); NS065926 and NS102161 (TJP); NS106953 and NS042595 (RWG). The authors declare no conflicts of interest Author Contributions Conceived of the Project: PRR, RWG IV and TJP Performed Experiments: AW, LAM, CP, PB-I Supervised Experiments: GD, RWG IV, TJP Analyzed Data: AW, LAM, CP, CAG, PRR Supervised Bioinformatics Analysis: PRR Drew Figures: AW, PRR Wrote and Edited Manuscript: AW, LAM, CP, GD, PRR, RWG IV, TJP All authors approved the final version of the manuscript. 1 bioRxiv preprint doi: https://doi.org/10.1101/766865; this version posted September 12, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity.
    [Show full text]
  • Altered Stress-Induced Regulation of Genes in Monocytes in Adults with a History of Childhood Adversity
    Neuropsychopharmacology (2016) 41, 2530–2540 © 2016 American College of Neuropsychopharmacology. All rights reserved 0893-133X/16 www.neuropsychopharmacology.org Altered Stress-Induced Regulation of Genes in Monocytes in Adults with a History of Childhood Adversity Marion Schwaiger1, Marianna Grinberg2, Dirk Moser1, Johannes CS Zang1, Markus Heinrichs3,4, Jan G Hengstler5, Jörg Rahnenführer2, Steve Cole6 and Robert Kumsta*,1 1 2 Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany; Department of Statistics, TU Dortmund University, Dortmund, Germany; 3Department of Psychology, Laboratory for Biological and Personality Psychology, University of Freiburg, Freiburg, Germany; 4Freiburg Brain Imaging Center, University Medical Center, University of Freiburg, Freiburg, Germany; 5Leibniz Research Centre for 6 Working Environment and Human Factors at the Technical University of Dortmund (IfADo), Dortmund, Germany; David Geffen School of Medicine, University of California, Los Angeles, CA, USA Exposure to serious or traumatic events early in life can lead to persistent alterations in physiological stress response systems, including enhanced cross talk between the neuroendocrine and immune system. These programming effects may be mechanistically involved in mediating the effects of adverse childhood experience on disease risk in adulthood. We investigated hormonal and genome-wide mRNA = expression responses in monocytes to acute stress exposure, in a sample of healthy adults (n 30) with a history of early childhood = adversity, and a control group (n 30) without trauma experience. The early adversity group showed altered hypothalamus-pituitary- adrenal axis responses to stress, evidenced by lower ACTH and cortisol responses. Analyses of gene expression patterns showed that stress-responsive transcripts were enriched for genes involved in cytokine activity, cytokine–cytokine receptor interaction, chemokine activity, and G-protein coupled receptor binding.
    [Show full text]
  • NINDS Custom Collection II
    ACACETIN ACEBUTOLOL HYDROCHLORIDE ACECLIDINE HYDROCHLORIDE ACEMETACIN ACETAMINOPHEN ACETAMINOSALOL ACETANILIDE ACETARSOL ACETAZOLAMIDE ACETOHYDROXAMIC ACID ACETRIAZOIC ACID ACETYL TYROSINE ETHYL ESTER ACETYLCARNITINE ACETYLCHOLINE ACETYLCYSTEINE ACETYLGLUCOSAMINE ACETYLGLUTAMIC ACID ACETYL-L-LEUCINE ACETYLPHENYLALANINE ACETYLSEROTONIN ACETYLTRYPTOPHAN ACEXAMIC ACID ACIVICIN ACLACINOMYCIN A1 ACONITINE ACRIFLAVINIUM HYDROCHLORIDE ACRISORCIN ACTINONIN ACYCLOVIR ADENOSINE PHOSPHATE ADENOSINE ADRENALINE BITARTRATE AESCULIN AJMALINE AKLAVINE HYDROCHLORIDE ALANYL-dl-LEUCINE ALANYL-dl-PHENYLALANINE ALAPROCLATE ALBENDAZOLE ALBUTEROL ALEXIDINE HYDROCHLORIDE ALLANTOIN ALLOPURINOL ALMOTRIPTAN ALOIN ALPRENOLOL ALTRETAMINE ALVERINE CITRATE AMANTADINE HYDROCHLORIDE AMBROXOL HYDROCHLORIDE AMCINONIDE AMIKACIN SULFATE AMILORIDE HYDROCHLORIDE 3-AMINOBENZAMIDE gamma-AMINOBUTYRIC ACID AMINOCAPROIC ACID N- (2-AMINOETHYL)-4-CHLOROBENZAMIDE (RO-16-6491) AMINOGLUTETHIMIDE AMINOHIPPURIC ACID AMINOHYDROXYBUTYRIC ACID AMINOLEVULINIC ACID HYDROCHLORIDE AMINOPHENAZONE 3-AMINOPROPANESULPHONIC ACID AMINOPYRIDINE 9-AMINO-1,2,3,4-TETRAHYDROACRIDINE HYDROCHLORIDE AMINOTHIAZOLE AMIODARONE HYDROCHLORIDE AMIPRILOSE AMITRIPTYLINE HYDROCHLORIDE AMLODIPINE BESYLATE AMODIAQUINE DIHYDROCHLORIDE AMOXEPINE AMOXICILLIN AMPICILLIN SODIUM AMPROLIUM AMRINONE AMYGDALIN ANABASAMINE HYDROCHLORIDE ANABASINE HYDROCHLORIDE ANCITABINE HYDROCHLORIDE ANDROSTERONE SODIUM SULFATE ANIRACETAM ANISINDIONE ANISODAMINE ANISOMYCIN ANTAZOLINE PHOSPHATE ANTHRALIN ANTIMYCIN A (A1 shown) ANTIPYRINE APHYLLIC
    [Show full text]
  • Absence of S100A4 in the Mouse Lens Induces an Aberrant Retina-Specific Differentiation Program and Cataract
    www.nature.com/scientificreports OPEN Absence of S100A4 in the mouse lens induces an aberrant retina‑specifc diferentiation program and cataract Rupalatha Maddala1*, Junyuan Gao2, Richard T. Mathias2, Tylor R. Lewis1, Vadim Y. Arshavsky1,3, Adriana Levine4, Jonathan M. Backer4,5, Anne R. Bresnick4 & Ponugoti V. Rao1,3* S100A4, a member of the S100 family of multifunctional calcium‑binding proteins, participates in several physiological and pathological processes. In this study, we demonstrate that S100A4 expression is robustly induced in diferentiating fber cells of the ocular lens and that S100A4 (−/−) knockout mice develop late‑onset cortical cataracts. Transcriptome profling of lenses from S100A4 (−/−) mice revealed a robust increase in the expression of multiple photoreceptor‑ and Müller glia‑specifc genes, as well as the olfactory sensory neuron‑specifc gene, S100A5. This aberrant transcriptional profle is characterized by corresponding increases in the levels of proteins encoded by the aberrantly upregulated genes. Ingenuity pathway network and curated pathway analyses of diferentially expressed genes in S100A4 (−/−) lenses identifed Crx and Nrl transcription factors as the most signifcant upstream regulators, and revealed that many of the upregulated genes possess promoters containing a high‑density of CpG islands bearing trimethylation marks at histone H3K27 and/or H3K4, respectively. In support of this fnding, we further documented that S100A4 (−/−) knockout lenses have altered levels of trimethylated H3K27 and H3K4. Taken together,
    [Show full text]
  • FYCOMPA® • Severe Hepatic Impairment: Not Recommended (2.4) ® Safely and Effectively
    HIGHLIGHTS OF PRESCRIBING INFORMATION mg (mild) and 4 mg (moderate) once daily at bedtime (2.4) ® These highlights do not include all the information needed to use FYCOMPA • Severe Hepatic Impairment: Not recommended (2.4) ® safely and effectively. See full prescribing information for FYCOMPA . • Severe Renal Impairment or on Hemodialysis: Not recommended (2.5) ® • Elderly: Increase dose no more frequently than every 2 weeks (2.6) FYCOMPA (perampanel) tablets, for oral use, CIII FYCOMPA® (perampanel) oral suspension, CIII ----------------------DOSAGE FORMS AND STRENGTHS-----------------­ Initial U.S. Approval: 2012 • Tablets: 2 mg, 4 mg, 6 mg, 8 mg, 10 mg, and 12 mg (3) WARNING: SERIOUS PSYCHIATRIC AND BEHAVIORAL REACTIONS • Oral Suspension: 0.5 mg/mL (3) See full prescribing information for complete boxed warning. ----------------------------------CONTRAINDICATIONS----------------------­ None (4) • Serious or life-threatening psychiatric and behavioral adverse reactions including aggression, hostility, irritability, anger, and homicidal ideation -----------------------WARNINGS AND PRECAUTIONS--------------------­ and threats have been reported in patients taking FYCOMPA (5.1) • Suicidal Behavior and Ideation: Monitor for suicidal thoughts or • Monitor patients for these reactions as well as for changes in mood, behavior (5.2) behavior, or personality that are not typical for the patient, particularly • Neurologic Effects: Monitor for dizziness, gait disturbance, somnolence, during the titration period and at higher doses (5.1) and fatigue
    [Show full text]
  • "Bouncy Gait" in Lance-Adams Syndrome with Perampanel
    Open Access Case Report DOI: 10.7759/cureus.6773 Improvement of "Bouncy Gait" in Lance-Adams Syndrome with Perampanel Shen-Yang Lim 1 , Dushyanth Babu Jasti 2 , Ai Huey Tan 1 1. Division of Neurology and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson’s & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, MYS 2. Division of Neurology, Kasturba Medical College, Manipal, IND Corresponding author: Shen-Yang Lim, [email protected] Abstract Lance-Adams syndrome (LAS) is chronic post-hypoxic myoclonus that is often associated with sudden lapses in muscle tone (negative myoclonus) in the legs, causing a disabling "bouncy gait." Given its relative rarity, there are no controlled treatment studies of LAS. The majority of cases require polypharmacy management, with an incomplete response. "Bouncy gait," in particular, is notoriously medication-refractory. Here, we report a patient with long-standing LAS who improved markedly when low-dose perampanel was added to his existing treatment regime consisting of clonazepam, levetiracetam, sodium valproate, and acetazolamide. Categories: Internal Medicine, Neurology, Physical Medicine & Rehabilitation Keywords: lance-adams syndrome, perampanel, myoclonus, negative myoclonus, bouncy gait Introduction Lance-Adams syndrome (LAS) is chronic post-hypoxic myoclonus with onset days to weeks after a hypoxic episode, when the patient has regained consciousness [1]. The myoclonus is typically multifocal, worse with action, and associated with sudden lapses in muscle tone in the legs, causing a "bouncy gait" [1]. Additional features may include cognitive impairment, seizures, dysarthria, and ataxia [1]. Given its relative rarity, there are no controlled treatment studies of LAS. The majority of cases require polypharmacy management, with an incomplete response.
    [Show full text]
  • A Translaminar Genetic Logic for the Circuit Identity of Intracortically-Projecting Neurons
    bioRxiv preprint doi: https://doi.org/10.1101/290395; this version posted March 28, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. Title A translaminar genetic logic for the circuit identity of intracortically-projecting neurons Authors Esther Klingler1, Andres De la Rossa1,3, Sabine Fièvre1, Denis Jabaudon1,2 1Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland. 2Clinic of Neurology, Geneva University Hospital, Geneva, Switzerland. 3Present address: Department of Cell Biology, University of Geneva, Geneva, Switzerland. Correspondence should be addressed to D.J. ([email protected]). Abstract Distinct subtypes of intracortically-projecting neurons (ICPN) are present in all layers, allowing propagation of information within and across cortical columns. How the molecular identities of ICPN relate to their defining anatomical and functional properties is unknown. Here we show that the transcriptional identities of ICPN primarily reflect their input-output connectivities rather than their birth dates or laminar positions. Thus, conserved circuit-related transcriptional programs are at play across cortical layers, which may preserve canonical circuit features across development and evolution. bioRxiv preprint doi: https://doi.org/10.1101/290395; this version posted March 28, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. Introduction Neurons of the neocortex are organized into six radial layers, which have appeared at different times during evolution, with the superficial layers representing a more recent acquisition. Input to the neocortex predominantly reaches superficial layers (SL, i.e.
    [Show full text]
  • BOARD MEETING AGENDA Meeting Location: Portland State Office Building 800 NE Oregon Street, Portland, OR 97232 June 6-7, 2018 Updated 6.4.18
    Oregon Board of Pharmacy BOARD MEETING AGENDA Meeting Location: Portland State Office Building 800 NE Oregon Street, Portland, OR 97232 June 6-7, 2018 Updated 6.4.18 The mission of the Oregon State Board of Pharmacy is to promote, preserve and protect the public health, safety and welfare by ensuring high standards in the practice of pharmacy and by regulating the quality, manufacture, sale and distribution of drugs. Wednesday, June 6, 2018 @ 8:30AM – Conference Rm A Thursday, June 7, 2018 @ 8:30AM – Conference Room A ≈ If special accommodations are needed for you to attend or participate in this Board Meeting, please contact Loretta Glenn at: (971) 673-0001. ≈ WEDNESDAY, JUNE 6, 2018 I. 8:30AM OPEN SESSION, Penny Reher, R.Ph, Presiding A. Roll Call B. Agenda Review and Approval Action Necessary II. Contested Case Deliberation pursuant to ORS 192.690(1) - Not Open to the Public III. EXECUTIVE SESSION – NOT OPEN TO THE PUBLIC, pursuant to ORS 676.175, ORS 192.660 (1) (2) (f) (k). A. Items for Consideration and Discussion: 1. Deliberation on Disciplinary Cases and Investigations 2. Personal Appearances 3. Deficiency Notifications 4. Case Review B. Employee Performance Review pursuant to ORS 192.660(2)(i). IV. OPEN SESSION - PUBLIC MAY ATTEND - At the conclusion of Executive Session, the Board may convene Open Session to begin some of the following scheduled agenda items - time permitting at approximately 3:30PM. V. Approve Consent Agenda* Action Necessary *Items listed under the consent agenda are considered to be routine agency matters and will be approved by a single motion of the Board without separate discussion.
    [Show full text]
  • DIURETICS Diuretics Are Drugs That Promote the Output of Urine Excreted by the Kidneys
    DIURETICS Diuretics are drugs that promote the output of urine excreted by the Kidneys. The primary action of most diuretics is the direct inhibition of Na+ transport at one or more of the four major anatomical sites along the nephron, where Na+ reabsorption takes place. The increased excretion of water and electrolytes by the kidneys is dependent on three different processes viz., glomerular filtration, tubular reabsorption (active and passive) and tubular secretion. Diuretics are very effective in the treatment of Cardiac oedema, specifically the one related with congestive heart failure. They are employed extensively in various types of disorders, for example, nephritic syndrome, diabetes insipidus, nutritional oedema, cirrhosis of the liver, hypertension, oedema of pregnancy and also to lower intraocular and cerebrospinal fluid pressure. Therapeutic Uses of Diuretics i) Congestive Heart Failure: The choice of the diuretic would depend on the severity of the disorder. In an emergency like acute pulmonary oedema, intravenous Furosemide or Sodium ethacrynate may be given. In less severe cases. Hydrochlorothiazide or Chlorthalidone may be used. Potassium-sparing diuretics like Spironolactone or Triamterene may be added to thiazide therapy. ii) Essential hypertension: The thiazides usually sever as primary antihypertensive agents. They may be used as sole agents in patients with mild hypertension or combined with other antihypertensives in more severe cases. iii) Hepatic cirrhosis: Potassium-sparing diuretics like Spironolactone may be employed. If Spironolactone alone fails, then a thiazide diuretic can be added cautiously. Furosemide or Ethacrymnic acid may have to be used if the oedema is regractory, together with spironolactone to lessen potassium loss. Serum potassium levels should be monitored periodically.
    [Show full text]