Comment développer un antidépresseur au mécanisme d’action innovant : l’exemple de l’agomélatine

Divers axes de recherche ont été suivis pour obtenir de nouveaux traitements de la dépression plus efficaces, mieux tolérés et d’action plus rapide. Parmi ces axes de recherche, la mélatonine, synchronisateur endogène des rythmes biologiques chez les mammifères, suscite un intérêt croissant dans la mesure où la désorganisation des rythmes circadiens est caractéristique d’un grand nombre de troubles de l’humeur. L’agomélatine est un antidépresseur qui se distingue par des propriétés agonistes pour les récepteurs mélatoninergiques (MT1 et MT2) ; ses propriétés agonistes ont été confirmées lors d’études in vivo, l’agomélatine améliorant les perturbations des rythmes circadiens observés dans différents modèles animaux. La propriété antidépressive de l’agomélatine a été mise en évidence dans plusieurs modèles animaux validés, dont les tests de la nage forcée, de la résignation acquise ou du stress chronique modéré. De façon tout à fait intéressante, l’activité antidépressive de l’agomélatine ne repose pas uniquement sur une action chronobiotique : en fait, l’agomélatine présente une activité antagoniste sur les récepteurs 5-HT2C, et ce aux doses antidépressives. Par ailleurs, l’absence d’affinité de l’agomélatine vis-à-vis d’un large éventail de récepteurs lui confère un excellent profil de sécurité, particulièrement avantageux par rapport aux antidépresseurs déjà sur le marché (pas de désordres gastro-intestinaux ni de perturbations de la fonction sexuelle ou du sommeil). L’agomélatine inaugure donc un nouveau concept dans le traitement de la dépression.There are now many potentials for the development of more effective, better tolerated, and more rapidly acting antidepressants acting in association and/or beyond the monoamine hypothesis. One of these possibilities is the development of antidepressant drugs with melatonin agonist property. This holds much promise since various affective disorders, including depression, are characterized by abnormal patterns of circadian rhythms. In line with this, the melatoninergic agonist properties of agomelatine, an antidepressant with proven clinical efficacy, may represent a new concept for the treatment of depression. By way of behavioral studies in rodents, it has been shown that administration of agomelatine can mimic the action of melatonin in the synchronization of circadian rhythm patterns. Interest in agomelatine has increased in recent times due to its prospective use as a novel antidepressant agent, as demonstrated in a number of animal studies using well-validated animal models of depression (including the forced swimming test, the learned helplessness, the chronic mild stress). Interestingly, the melatoninergic agonist property of agomelatine may not, alone, be sufficient to sustain its clear antidepressant-like activity. Recent results from receptor binding and in vivo studies gave support to the notion that agomelatine’s effects are also mediated via its function as a competitive antagonist at the 5-HT2C receptor. Finally, thanks to its absence of binding with a broad range of receptors and enzymes, agomelatine is particularly safe and devoid of all the deleterious effects reported with tricyclics and SSRIs

Beneficial behavioural and neurogenic effects of agomelatine in a model of depression/anxiety

Abstract Agomelatine (S20098) is a novel antidepressant drug with melatonergic agonist and 5-HT 2C receptor antagonist properties, displaying antidepressant/anxiolytic-like properties in animal models and in humans. In a depression/anxiety-like mouse model in which the response of the HPA axis is blunted, we investigated whether agomelatine could reverse behavioural deficits related to depression/anxiety compared to the classical selective serotonin reuptake inhibitor, fluoxetine. Adult mice were treated for 8 wk with either vehicle or corticosterone (35 mg/ml.d) via drinking water. During the final 4 wk, animals were treated with vehicle, agomelatine (10 or 40 mg/kg i.p.) or fluoxetine (18 mg/kg i.p.) and tested in several behavioural paradigms and also evaluated for home-cage activity. Our results showed that the depressive/anxiety-like phenotype induced by corticosterone treatment is reversed by either chronic agomelatine or fluoxetine treatment. Moreover, agomelatine increased the dark/light ratio of home-cage activity in vehicle-treated mice and reversed the alterations in this ratio induced by chronic corticosterone, suggesting a normalization of disturbed circadian rhythms. Finally, we investigated the effects of this new antidepressant on neurogenesis. Agomelatine reversed the decreased cell proliferation in the whole hippocampus in corticosterone-treated mice and increased maturation of newborn neurons in both vehicle-and corticosterone-treated mice. Overall, the present study suggests that agomelatine, with its distinct mechanism of action based on the synergy between the melatonergic agonist and 5-HT 2C antagonist properties, provides a distinct antidepressant/anxiolytic spectrum including circadian rhythm normalization

Comment déveloper un antidépresseur au mécanisme d’action innovant : l’exemple de l’agomélatine

Divers axes de recherche ont été suivis pour obtenir de nouveaux traitements de la dépression plus efficaces, mieux tolérés et d’action plus rapide. Parmi ces axes de recherche, la mélatonine, synchronisateur endogène des rythmes biologiques chez les mammifères, suscite un intérêt croissant dans la mesure où la désorganisation des rythmes circadiens est caractéristique d’un grand nombre de troubles de l’humeur. L’agomélatine est un antidépresseur qui se distingue par des propriétés agonistes pour les récepteurs mélatoninergiques (MT1 et MT2) ; ses propriétés agonistes ont été confirmées lors d’études in vivo, l’agomélatine améliorant les perturbations des rythmes circadiens observés dans différents modèles animaux. La propriété antidépressive de l’agomélatine a été mise en évidence dans plusieurs modèles animaux validés, dont les tests de la nage forcée, de la résignation acquise ou du stress chronique modéré. De façon tout à fait intéressante, l’activité antidépressive de l’agomélatine ne repose pas uniquement sur une action chronobiotique : en fait, l’agomélatine présente une activité antagoniste sur les récepteurs 5-HT2C, et ce aux doses antidépressives. Par ailleurs, l’absence d’affinité de l’agomélatine vis-à-vis d’un large éventail de récepteurs lui confère un excellent profil de sécurité, particulièrement avantageux par rapport aux antidépresseurs déjà sur le marché (pas de désordres gastro-intestinaux ni de perturbations de la fonction sexuelle ou du sommeil). L’agomélatine inaugure donc un nouveau concept dans le traitement de la dépression

Anxiolytic-like action of the antidepressant agomelatine (S 20098) after a social defeat requires the integrity of the SCN

In rats, social defeat by an aggressive opponent induces a state of anxiety, shown by a decrease in time spent on active explorative behaviour, an increase in immobility, a clear decrease in frequency of all active behavioural parameters (enhanced passivity). We tested the hypothesis whether acute or sub-chronic agomelatine would antagonize the negative consequences of a social defeat. As many chronobiological actions of melatonin and its receptor agonist agomelatine require the integrity of the suprachiasmatic nuclei (SCN), we examined whether the anxiolytic-like action of agomelatine 1 day after a social defeat is still present in SCN-lesioned rats. Sub-chronic administration of agomelatine caused a clear reduction of the social defeat induced behavioural consequences. A single agomelatine injection prior to the post-defeat test was less effective and a single melatonin injection was hardly effective. SCN lesion did not affect the anxiety reaction after a social defeat. Thus, sub-chronic agomelatine treatment or a single agomelatine injection reduced a state of anxiety and passivity caused by asocial defeat. The defeat-induced behavioural changes do not depend on the SCN but agomelatine showed its anxiolytic action only in sham-lesioned animals, which indicates that the anxiolytic-like action of agomelatine requires the integrity of the SCN. Mechanisms sustaining this activity are discussed.

Somatodendritic 5-HT1A Autoreceptors Mediate the Anti-Aggressive Actions of 5-HT1A Receptor Agonists in Rats: An Ethopharmacological Study with S-15535, Alnespirone, and WAY-100635

To elucidate the relative contribution of somatodendritic 5-HT1A autoreceptors and postsynaptic 5-HT1A receptors in the specific anti-aggressive properties of 5-HT1A receptor agonists, the influence of the novel benzodioxopiperazine compound S-15535, which behaves in vivo as a competitive antagonist at postsynaptic 5-HT1A receptors and as an agonist at 5-HT1A autoreceptors, upon offensive and defensive aggression was investigated in wild-type rats using a resident-intruder paradigm. S-15535 exerted a potent dose-dependent decrease in offensive, but not defensive, aggressive behavior (inhibitory dose (ID)50 = 1.11 mg/kg). This anti-aggressive profile was roughly similar to that of the potent pre- and postsynaptic 5-HT1A full agonist alnespirone (ID50 = 1.24). The drug’s profound anti-aggressive actions were not accompanied by sedative side effects or signs of the “5-HT1A receptor-mediated behavioral syndrome,” which are characteristically induced by prototypical 5-HT1A receptor agonists like 8-OH-DPAT and buspirone. The selective pre- and postsynaptic 5-HT1A antagonist WAY-100635, which was inactive given alone, abolished the anti-aggressive effects of S-15535 and alnespirone, thereby confirming the involvement of 5-HT1A receptors. Furthermore, combined administration of S-15535 and alnespirone elicited an additive anti-aggressive effect, providing further support for somatodendritic 5-HT1A receptor involvement. Finally, the postsynaptic 5-HT1A antagonistic properties of S-15535 were confirmed by showing blockade of the alnespirone-induced hypothermia, a postsynaptic 5-HT1A mediated response in the rat. These data provide extensive evidence that the anti-aggressive effects of 5-HT1A receptor agonists are expressed via their action on somatodendritic 5-HT1A autoreceptors, thereby most likely attenuating intruder-activated serotonergic neurotransmission.

Chronic agomelatine and fluoxetine induce antidepressant-like effects in H/Rouen mice, a genetic mouse model of depression

International audienceThe novel antidepressant agomelatine behaves as an agonist at melatonergic MT(1) and MT(2) receptors and as an antagonist at serotonin 5-HT(2C) receptors. This study investigated the effects of agomelatine and fluoxetine in a genetic model of depression called H/Rouen mice Male and female H/Rouen (helpless line) and NH/Rouen (nonhelpless line) mice, received once daily for 3 weeks agomelatine (10 and 50 mg/kgi.p.), fluoxetine (10 mg/kgi.p.) or vehicle. Immobility duration in the tail suspension test (TST) was assessed on day 1 (D1), day 8 (D8), day 15 (D15) and day 22 (D22). Locomotor activity in a novel environment was assessed on day 18 (D18) and anhedonia (2-bottle sucrose preference test) was considered after the end of chronic treatment, from days 22 to 25. Agomelatine (50 mg/kg) significantly reduced immobility at D15 (p<0.01), and D22 (p<0.001) in treated H/Rouen mice whereas agomelatine at 10 mg/kg did not induce a statistically significant change. Fluoxetine reduced immobility at D8 (p<0.01), D15 (p<0.001) and D22 (p<0.001). Locomotor activity was unchanged in all treated groups as compared to vehicle groups. In the sucrose test, there was a significant decrease in sucrose preference in H/Rouen mice compared with NH/Rouen mice receiving vehicle. Both agomelatine doses (10 mg/kg (p=0.05) and 50 mg/kg (p<0.001) as well as fluoxetine (p<0.001) significantly increased the sucrose preference in H/Rouen mice as compared with H/Rouen mice that had received vehicle. These data indicate that the novel antidepressant agomelatine has antidepressant-like properties in H/Rouen mice, a genetic model of depression

Markers of D

Positrons Emission Tomography (PET) allows to evaluate the dopaminergic activity of antipsychotic, by measuring post synaptic D2 dopaminergic receptors occupancy. A good correlation was brought forward between a rate of occupancy of 80% of striatal D2 receptors and the occurrence of extrapyramidal effects. These PET studies have also established that at least 60% D2 receptors occupancy was predictive of clinical antipsychotic response. The PET studies in healthy volunteers can then be used to help choose doses to be tested during the clinical trials of new antipsychotic drugs. The increase in prolactin level is one other of the markers of the antagonist dopaminergic activity which concerns D2 receptors of the pituitary gland. The example of S 33138, a potential antipsychotic, preferential D3 versus D2 receptor antagonist will be given to illustrate these data. The results of two PET studies as well as the effects on prolactin and extrapyramidal signs will be presented

α2- and β2-Adrenoreceptor-Mediated Efficacy of the Atypical Antidepressant Agomelatine Combined With Gabapentin to Suppress Allodynia in Neuropathic Rats With Ligated Infraorbital or Sciatic Nerve

Previous data showed that neuropathic pain induced by mechanical lesion of peripheral nerves has specific characteristics and responds differently to alleviating drugs at cephalic versus extracephalic level. This is especially true for tricyclic antidepressants currently used for alleviating neuropathic pain in humans which are less effective against cephalic neuropathic pain. Whether this also applies to the antidepressant agomelatine, with its unique pharmacological properties as MT1/MT2 melatonin receptor agonist and 5-HT2B/5-HT2C serotonin receptor antagonist, has been investigated in two rat models of neuropathic pain. Acute treatments were performed 2 weeks after unilateral chronic constriction (ligation) injury to the sciatic nerve (CCI-SN) or the infraorbital nerve (CCI-ION), when maximal mechanical allodynia had developed in ipsilateral hindpaw or vibrissal pad, respectively, in Sprague–Dawley male rats. Although agomelatine (45 mg/kg i.p.) alone was inactive, co-treatment with gabapentin, at an essentially ineffective dose (50 mg/kg i.p.) on its own, produced marked anti-allodynic effects, especially in CCI-ION rats. In both CCI-SN and CCI-ION models, suppression of mechanical allodynia by ‘agomelatine + gabapentin’ could be partially mimicked by the combination of 5-HT2C antagonist (SB 242084) + gabapentin, but not by melatonin or 5-HT2B antagonist (RS 127445, LY 266097), alone or combined with gabapentin. In contrast, pretreatment by idazoxan, propranolol or the β2 antagonist ICI 118551 markedly inhibited the anti-allodynic effect of ‘agomelatine + gabapentin’ in both CCI-SN and CCI-ION rats, whereas pretreatment by the MT1/MT2 receptor antagonist S22153 was inactive. Altogether these data indicate that ‘agomelatine + gabapentin’ is a potent anti-allodynic combination at both cephalic and extra-cephalic levels, whose action implicates α2- and β2-adrenoreceptor-mediated noradrenergic neurotransmission

Behavioural and neuroplastic effects of the new-generation antidepressant agomelatine compared to fluoxetine in glucocorticoid receptor-impaired mice.

International audienceMajor depression is associated with reduced hippocampal volume linked to stress and high glucocorticoid secretion. Glucocorticoid receptor-impaired (GR-i) mice, a transgenic model for affective disorders with hypothalamic-pituitary-adrenal (HPA) axis feedback control deficit, were used to assess the antidepressant-like effects of the mixed melatonin receptor agonist/5-HT(2C) receptor antagonist, agomelatine, compared to the selective 5-HT reuptake inhibitor (SSRI), fluoxetine, on hippocampal neurogenesis, GR and BDNF expression and antidepressant-responsive behaviour (tail suspension test, TST). GR-i and paired wild-type (WT) mice were given acute or chronic (21 d) treatment with these drugs. Both hippocampal cell proliferation and BDNF mRNA expression were down-regulated in GR-i mice, and these alterations were reversed by chronic agomelatine and fluoxetine treatments, whereas GR mRNA down-regulation was reversed only by agomelatine. Furthermore, chronic agomelatine, but not fluoxetine, increased survival of newly formed cells in the ventral part of the hippocampus without changing their phenotypic differentiation into neurons. In the TST, the enhanced immobility of GR-i mice was reduced to WT level by acute (but not chronic) fluoxetine and chronic (but not acute) agomelatine. These results indicate that agomelatine reversed the neuroplastic changes and helpless behaviour associated with HPA axis alterations in GR-i mice, suggesting neurobiological and behavioural effects mostly similar to those typically seen with classical antidepressants such as fluoxetine, but through clearly distinct mechanisms