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Preventing NMDA antagonist neurotoxicity with sigma antagonists

CrimpJiggler

Bluelighter
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Aug 28, 2011
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I just read this patent on ibogaine:

http://patents.com/us-5925634.html
This invention discloses that ibogaine, a plant derivative, can be used safely to treat neuropathic pain (i.e, pain which does not respond conventionally to opiate drugs such as morphine). Ibogaine functions inside the CNS as an NMDA antagonist which is inherently safe, even at relatively high dosages (including dosages high enough to cause hallucinations). Ibogaine does not cause the neurotoxic side effects caused by other NMDA antagonist drugs; this relative safety of ibogaine is due to antagonist activity at neuronal sigma receptors, which had not been known prior to discovery by the Applicant. Ibogaine can also be used for this purpose in combination with additional drugs such as (1) drugs which activate alpha-2 adrenergic receptors; (2) drugs which block the kainic acid subclass of glutamate receptors; or, (3) anti-cholinergic agents that suppress activity at muscarinic acetylcholine receptors. Such drug combinations can reduce or avoid the hallucinatory effects of ibogaine, if desired.

Anyone know anything about this? I know little or nothing about sigma receptors, only thing I'd heard about them before this is that afobazole acts on them (can't remember if its an agonist or antagonist). I wonder if there is a viable way we can obtain antagonists to experiment with them. Heres wikis list:
https://en.wikipedia.org/wiki/Category:Sigma_antagonists
 
As far as I know there hasn't been a lot of evidence to suggest that NMDA antagonists are neurotoxic in humans. By the same token, PCP is a sigma agonist, but it is considered neurotoxic...
 
I think it was only from PCP that was synthesized via phenylcyclohexanecarbonitrile (an organic cyanide compound & known neurotoxin).

DXM - not neurotoxic in primates. Nor humans.
PCP - ?
Gacyclidine - phenylcyclohexylamine developed as a neuroprotective drug
Ketamine - as far as I know it's only toxic to some people's bladder linings
MXE - as far as i know, not neurotoxic, but it's too early to tell.
MK-801 - not enough human use.
Memantine / Amantidine - "neuroprotective", used in Alzheimer's disease treatment...
Ibogaine - ostensibly non-neurotoxic.
Ethanol - disputed but generally nontoxic in reasonable doses
nitrous oxide / xenon - deprive user of oxygen if inhaled straight, otherwise non-neurotoxic
Delucemine - neuroprotective NMDA blocker/SSRI
Selfotel - possibly enhances mortality in acute stroke patients, considered a possible neurotoxin.

Is there a trend here? You tell me.
 
As far as I know there hasn't been a lot of evidence to suggest that NMDA antagonists are neurotoxic in humans. By the same token, PCP is a sigma agonist, but it is considered neurotoxic...

Well taking preventative measures can't hurt anyway so if it turns out that they do have neurotoxicity, you'll be glad you took them. I've heard some anecdotes about people taking high doses DXMor ketamine every day for months, then CT scans revealing they have brain legions. If that patent I posted is correct, then theres a connection between NMDA antagonism and sigma agonism.
 
I just wondered if NMDA-antagonists wouldn't lead to upregulation of NDMA-receptors in prolonged or heavy (high dosage) use: If the user stops, wouldn't the strong stimulation lead to excitotoxicity?
 
Interesting and alarming paper, thanks for the link @doppelgänger!

So, in people using ketamine heavily enough, we do now have these Olney's lesions (or something like them) confirmed? Probably not much can be said about the mechanism that is causing such damage, if it is really excitotoxicity and if and to what extent the brain is able to repair when quitting..

--

But I have high interest in the whole thing about NMDA antagonist tolerance, possible rebound toxicity and so on. While I never have been at 1g/day by far like these candidates in the paper, I am on Memantine 30-40mg/d for maybe the third year now with occasional use of other dissociatives and have used DXM in adolescence.

While I still think / feel that taking the memantine is beneficial (helps me with some nasty, "treatment-resistant" psychological problems like impulse control, over excitation and fatigue for example) - I fear that I could be addicted to it now. First due to its D2 agonism whose potency I have under rated so much in the past - abrupt cessation brought severe dopamine withdrawal syndrome after day 3 when plasma levels began to drop. Extreme anxiety, fear, tension, exacerbated ADD symptoms, ... maybe like stimulant binge withdrawal but with norepinephrine overload instead of just sleeping for some days.

And then of course that NMDA antagonist thing. Afaik it is not clear yet if and to what extent they up-/downregulate with chronic antagonism (and memantine does not block the channels completely) - but at least how I felt there could well be some nasty glutamate rebound.

On the other side, I did barely respond to even high doses (7-8mg) of lorazepam, while clonidine brought immediate relief.

There are two cases in literature concerning w/d issues from memantine, but as being an Alzheimer's med, no one might have looked at this that much..?

I do appreciate any information about this topic.
 
Hello everyone

Sad to say this is a very complex topic.. NMDA receptors are not just NMDA receptors.. there are various receptor isoforms of them and each of the above mentioned drugs i.e DXM, ketamine, PCP, ibogaine, all have varying affinities at different subunits in the different isoforms of the receptor(note: complicated).. Explained below.. first however I think addressing the study is very important..

First we must recognize the demographic, notably the study's funded statement: (quoted) "This study had consents from patients and was approved by the ethical committee of Sun Yat-sen University, Guang Zhou, China". They used 21 patients and do claim to recognize that possible concomitant drug usage can possibly intensify the damage.. However these studies are very difficult to correctly manage as polysubstance abuse is critically correlated in many populations that abuse dissociative drugs.

I personally disagree with their methods as they actually provide a chart that attempts to correlate time of abuse with regions or areas of damage notably utilizing every addict in the study and not just ones that abused ketamine or had similar usage. The thing is they can do this- they can make figures, draw conclusions on their populace with their data, but everyone else must be careful to interpret their data as what it actually is, a study that shows hyperintensities in addicts that "MAY primarily have abused ketamine and MAY as well have abused many other drugs"...


Regardless, look at the wikipedia page for glutamate receptors

http://en.wikipedia.org/wiki/Glutamate_receptor

You will see the vast amounts of subunits that are recognized now that are metabotropic or ionotropic for different glutamate receptors.. no glutamate receptor is as simple as we believe..

Consider the NMDA receptor family now.. http://en.wikipedia.org/wiki/NMDA_receptor

"The NMDA receptor forms a heterotetramer between two GluN1 and two GluN2 subunits (the subunits were previously denoted as NR1 and NR2), two obligatory NR1 subunits and two regionally localized NR2 subunits. A related gene family of NR3 A and B subunits have an inhibitory effect on receptor activity. Multiple receptor isoforms with distinct brain distributions and functional properties arise by selective splicing of the NR1 transcripts and differential expression of the NR2 subunits."

tldr; NMDA is not just 2(NR1)+2(NR2) it is now known to be 2(NRX1)+2(NRX2): In where NR1 and NR2 can be mutatable.


GLuN1 variants:

  • NR1-1a, NR1-1b; [NR1-1a is the most abundantly expressed form.]
  • NR1-2a, NR1-2b;
  • NR1-3a, NR1-3b;
  • NR1-4a, NR1-4b;

GluN2 variants are more complicated..read the page..Apparently this subunit is directly modified in an important manner during aging..

see the NR2B-NR2A developmental switch---> NR2A eventually outnumbers NR2B


http://en.wikipedia.org/wiki/NMDA_receptor

What makes the NMDA receptor so interesting is that despite the many isoforms the function is literally conserved(unlike serotonin receptors and their blatant subtypes) but we can only identify the changes now due to the ability to bind our man-made ligands, with some having notably high selectivity for binding to various subunits..

All i can say first hand is each of the examples presented originally above are not as simple as they appear and this idea I cannot even consider without seeing some affinity/binding tables for each of the compared drugs at least..
zedsdead
 
Insofar as NMDA antagonists are neurotoxic via a mechanism similarly to that seen with Olney's Lesions, these should not occur at reasonable dosages.

I wonder, though, whether there is excitotoxicity stemming from rebound excitation due to neuroadaptation with chronic dosing...I doubt the proper studies have been run.

ebola
 
I wonder, though, whether there is excitotoxicity stemming from rebound excitation due to neuroadaptation with chronic dosing...I doubt the proper studies have been run.

I think that would be the most likely mechanism, if neurotoxicity is found. This implies that a drug being neuroprotective does not preclude it from also being neurotoxic - it's all about 'when'.
 
Insofar as NMDA antagonists are neurotoxic via a mechanism similarly to that seen with Olney's Lesions, these should not occur at reasonable dosages.

I wonder, though, whether there is excitotoxicity stemming from rebound excitation due to neuroadaptation with chronic dosing...I doubt the proper studies have been run.

ebola

Having gone through physical withdrawal from using PCP every other day for about a year I can say it definitely feels like it results in glutamate rebound. The physical symptoms were so bad I had to go see a doctor who put me on 3600mg gabapentin and 2mg clonazepam and even then I still had burning skin and horrible cramps. I've quit 5mg clonazepam cold turkey before and this felt way worse physically.
 
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That's very interesting Toz. Hope you are ok now! Wasn't aware there were still people out there addicted to PCP.

I thought about the glutamate-rebound-causes-excitotoxicity hypothesis today... wouldn't people in withdrawal be in great danger of seizures then? Has anybody sources about this?
 
That's very interesting Toz. Hope you are ok now! Wasn't aware there were still people out there addicted to PCP.

I thought about the glutamate-rebound-causes-excitotoxicity hypothesis today... wouldn't people in withdrawal be in great danger of seizures then? Has anybody sources about this?

I'm far from fine. I suffer permanent dissociation, memory loss, hallucinations, dyskinesias and cramps still after a whole damn year :/

Anyway not what this thread is about so back to topic: If glutamate rebound is the problem, why does serotonin 5ht1a agonists prevent olney's lesions in lab animals? Do this receptor prevent nmda receptor synaptic/ion currents?
 
If glutamate rebound is the problem, why does serotonin 5ht1a agonists prevent olney's lesions in lab animals? Do this receptor prevent nmda receptor synaptic/ion currents?

Pretty much. 5-HT1 activity reduces adenylate cyclase activity, thereby inhibiting NMDAR activity and preventing excitotoxicity.
 
wouldn't people in withdrawal be in great danger of seizures then?

Maybe, but maybe not: expression of the nmda receptor is highly localized in comparison to sum glutaminergic circuits in the brain, and maybe broad-spectrum glutaminergic activity (or activity localized to a different area) is necessary for rebound excitation to result in seizure.

If glutamate rebound is the problem, why does serotonin 5ht1a agonists prevent olney's lesions in lab animals?

Olney's Lesions are somewhat distinct in mechanism from the type of rebound excitotoxicity we'd expect with habitual use. Also, as Jonneh said above, this effect of 5ht1a agonism affects glutaminergic transmission downstream.

ebola
 
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