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Progress in Understanding and Treating SCN2A-Mediated Disorders.
Advances in gene discovery for neurodevelopmental disorders have identified SCN2A dysfunction as a leading cause of infantile seizures, autism spectrum disorder, and intellectual disability. SCN2A encodes the neuronal sodium channel NaV1.2. Functional assays demonstrate strong correlation between genotype and phenotype. This insight can help guide therapeutic decisions and raises the possibility that ligands that selectively enhance or diminish channel function may improve symptoms. The well-defined function of sodium channels makes SCN2A an important test case for investigating the neurobiology of neurodevelopmental disorders more generally. Here, we discuss the progress made, through the concerted efforts of a diverse group of academic and industry scientists as well as policy advocates, in understanding and treating SCN2A-related disorders
Molecular Pharmacology of Selective Na<sub>V</sub>1.6 and Dual Na<sub>V</sub>1.6/Na<sub>V</sub>1.2 Channel Inhibitors that Suppress Excitatory Neuronal Activity Ex Vivo
Voltage-gated sodium channel (NaV) inhibitors
are used
to treat neurological disorders of hyperexcitability such as epilepsy.
These drugs act by attenuating neuronal action potential firing to
reduce excitability in the brain. However, all currently available
NaV-targeting antiseizure medications nonselectively inhibit
the brain channels NaV1.1, NaV1.2, and NaV1.6, which potentially limits the efficacy and therapeutic
safety margins of these drugs. Here, we report on XPC-7724 and XPC-5462,
which represent a new class of small molecule NaV-targeting
compounds. These compounds specifically target inhibition of the NaV1.6 and NaV1.2 channels, which are abundantly expressed
in excitatory pyramidal neurons. They have a > 100-fold molecular
selectivity against NaV1.1 channels, which are predominantly
expressed in inhibitory neurons. Sparing NaV1.1 preserves
the inhibitory activity in the brain. These compounds bind to and
stabilize the inactivated state of the channels thereby reducing the
activity of excitatory neurons. They have higher potency, with longer
residency times and slower off-rates, than the clinically used antiseizure
medications carbamazepine and phenytoin. The neuronal selectivity
of these compounds is demonstrated in brain slices by inhibition of
firing in cortical excitatory pyramidal neurons, without impacting
fast spiking inhibitory interneurons. XPC-5462 also suppresses epileptiform
activity in an ex vivo brain slice seizure model, whereas XPC-7224
does not, suggesting a possible requirement of Nav1.2 inhibition in
0-Mg2+- or 4-AP-induced brain slice seizure models. The
profiles of these compounds will facilitate pharmacological dissection
of the physiological roles of NaV1.2 and NaV1.6 in neurons and help define the role of specific channels in disease
states. This unique selectivity profile provides a new approach to
potentially treat disorders of neuronal hyperexcitability by selectively
downregulating excitatory circuits
Sexual health risk reduction interventions for people with severe mental illness: a systematic review
Background
Despite variability in sexual activity among people with severe mental illness, high-risk sexual behavior (e.g. unprotected intercourse, multiple partners, sex trade and illicit drug use) is common. Sexual health risk reduction interventions (such as educational and behavioral interventions, motivational exercises, counselling and service delivery), developed and implemented for people with severe mental illness, may improve participantsâ knowledge, attitudes, beliefs behaviors or practices (including assertiveness skills) and could lead to a reduction in risky sexual behavior. This systematic review evaluates the effectiveness of sexual health risk reduction interventions for people with severe mental illness.
Methods
Thirteen electronic databases (including MEDLINE, EMBASE and PsycINFO) were searched to August 2014, and supplemented by hand-searching relevant articles and contacting experts. All controlled trials (randomized or non-randomized) comparing the effectiveness of sexual health risk reduction interventions with usual care for individuals living in the community with severe mental illness were included. Outcomes included a range of biological, behavioral and proxy endpoints. Narrative synthesis was used to combine the evidence.
Results
Thirteen controlled trials (all from the USA) were included. Although there was no clear and consistent evidence that interventions reduce the total number of sex partners or improved behavioral intentions in sexual risk behavior, positive effects were generally observed in condom use, condom protected intercourse and on measures of HIV knowledge, attitudes to condom use and sexual behaviors and practices. However, the robustness of these findings is low due to the large between study variability, small sample sizes and low-to-moderate quality of included studies.
Conclusions
There is insufficient evidence at present to fully support or reject the identified sexual health risk reduction interventions for people with severe mental illness. Given the serious consequences of high-risk sexual behaviors, there is an urgent need for well-designed UK based trials, as well as training and support for staff implementing sexual health risk reduction interventions