Pharmacophore-based design and discovery of (-)-meptazinol carbamates as dual modulators of cholinesterase and amyloidogenesis.

Multifunctional carbamate-type acetylcholinesterase (AChE) inhibitors with anti-amyloidogenic properties like phenserine are potential therapeutic agents for Alzheimer's disease (AD). We reported here the design of new carbamates using pharmacophore model strategy to modulate both cholinesterase and amyloidogenesis. A five-feature pharmacophore model was generated based on 25 carbamate-type training set compounds. (-)-Meptazinol carbamates that superimposed well upon the model were designed and synthesized, which exhibited nanomolar AChE inhibitory potency and good anti-amyloidogenic properties in in vitro test. The phenylcarbamate 43 was highly potent (IC50 31.6 nM) and slightly selective for AChE, and showed low acute toxicity. In enzyme kinetics assay, 43 exhibited uncompetitive inhibition and reacted by pseudo-irreversible mechanism. 43 also showed amyloid-ß (Aß) lowering effects (51.9% decrease of Aß42) superior to phenserine (31% decrease of total Aß) in SH-SY5Y-APP695 cells at 50 µM. The dual actions of 43 on cholinergic and amyloidogenic pathways indicated potential uses as symptomatic and disease-modifying agents.

Determination of a novel carbamate AChE inhibitor meserine in mouse plasma, brain and rat plasma by LC-MS/MS: application to pharmacokinetic study after intravenous and subcutaneous administration.

In this paper a simple and sensitive method for determination of a novel phenylcarbamate AChE inhibitor, meserine, in mouse plasma, brain and rat plasma was evaluated using high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS). Separation was achieved on an Alltech Alltima-C18 column (150mm×2.1mm, 3µm, Deerfield, IL, USA) with isocratic elution at a flow rate of 0.35ml/min. Detection was performed under the multiple reaction monitoring (MRM) mode using an electrospray ionization (ESI) in the positive ion mode. The protein precipitation and liquid-liquid extraction methods were used for the pretreatment of plasma and brain homogenates, respectively. The calibration curves of meserine showed good linearity over the concentration range of 0.5-1000ng/ml for mouse and rat plasma and 0.5-500ng/ml for mouse brain. The intra- and inter-day precision were less than 9.34% and the accuracy was from 95.34% to 107.78% for QC samples. The validated method was successfully applied to a preclinical pharmacokinetic study of meserine in mice and rats after intravenous and subcutaneous administration. The results showed that this novel drug could easily cross the blood-brain barrier to reach the site of drug action. Meserine was rapidly absorbed with a high subcutaneous absolute bioavailability (>90%).

Novel bis-(-)-nor-meptazinol derivatives act as dual binding site AChE inhibitors with metal-complexing property.

The strategy of dual binding site acetylcholinesterase (AChE) inhibition along with metal chelation may represent a promising direction for multi-targeted interventions in the pathophysiological processes of Alzheimer's disease (AD). In the present study, two derivatives (ZLA and ZLB) of a potent dual binding site AChE inhibitor bis-(-)-nor-meptazinol (bis-MEP) were designed and synthesized by introducing metal chelating pharmacophores into the middle chain of bis-MEP. They could inhibit human AChE activity with IC(50) values of 9.63µM (for ZLA) and 8.64µM (for ZLB), and prevent AChE-induced amyloid-ß (Aß) aggregation with IC(50) values of 49.1µM (for ZLA) and 55.3µM (for ZLB). In parallel, molecular docking analysis showed that they are capable of interacting with both the catalytic and peripheral anionic sites of AChE. Furthermore, they exhibited abilities to complex metal ions such as Cu(II) and Zn(II), and inhibit Aß aggregation triggered by these metals. Collectively, these results suggest that ZLA and ZLB may act as dual binding site AChEIs with metal-chelating potency, and may be potential leads of value for further study on disease-modifying treatment of AD.

Determination of Bis(9)-(-)-Meptazinol, a bis-ligand for Alzheimer's disease, in rat plasma by liquid chromatography-tandem mass spectrometry: application to pharmacokinetics study.

A rapid, simple and sensitive LC-MS/MS method was developed and validated for the determination of Bis(9)-(-)-Meptazinol (B9M) in rat plasma. Protein precipitation method was used for sample preparation, using five volumes of methanol as the precipitation agent. The analytes were separated by a Zorbax Extend-C18 column with the mobile phase of methanol-water (containing 5mM ammonium formate, pH 9.8) (95:5, v/v), and monitored by positive electrospray ionization in multiple reaction monitoring (MRM) mode. Retention time of IS (Bis(5)-(-)-Meptazinol) and B9M were 1.9 min and 3.3 min, respectively. The limit of detection was 0.1 ng/ml and the linear range was 1-500 ng/ml. The relative standard deviation (RSD) of intra-day and inter-day variation was 4.4-6.2% and 6.2-8.9%, respectively. The extraction recoveries of B9M in plasma were over 95%. The method proved to be applicable to the pharmacokinetic study of B9M in rat after intravenous and subcutaneous administration.

Enhancement of systemic and CNS delivery of meptazinol hydrochloride by intranasal administration to rats.

AIM: To investigate the extent of systemic absorption and uptake of meptazinol (MEP) hydrochloride in cerebrospinal fluid (CSF) after intranasal administration on rats and compare with oral administration. METHODS: CSF samples were collected by a serial sampling method. The concentration of MEP in the biological samples was measured by HPLC with fluorescence detector. RESULTS: Rapid and significant levels of MEP in plasma and CSF can be achieved after nasal administration whereas the oral administration resulted in considerably lower drug concentrations. AUC in plasma and CSF from the nasal route are 7.375 and 15.6 folds compared with those of the oral route, respectively. CONCLUSION: Intranasal MEP is able to show quick absorption and improve the bioavailability, which could be a promising alternative to oral administration.

Pharmacokinetic behavior in plasma, cerebrospinal fluid and cerebral cortex after intranasal administration of hydrochloride meptazinol.

The aim of this paper is to investigate the pharmacokinetic behavior of hydrochloride meptazinol (MEP) in plasma, cerebrospinal fluid (CSF) and cerebral cortex after intranasal administration (8 mg/kg) in male Sprague-Dawley rats. The pharmacokinetic study of intravenous administration (8 mg/kg) was also performed in rats. CSF and cerebral cortex samples were collected by serial CSF sampling and intracerebral microdialysis, respectively. The concentration of MEP in the biological samples was measured by high performance liquid chromatography (HPLC). It was determined that the absorption of MEP from the nasal cavity to systemic circulation was rapid and complete. The concentration-time profile showed a prolonged duration of MEP concentration in CSF and cortex following intranasal administration. The ratios of AUC values of intranasal to intravenous administrations were 0.96, 1.07 and 1.81 in plasma, CSF and cortex dialysate, respectively. In conclusion, intranasal administration of MEP is a promising alternative to traditional administration modes. Olfactory mucosa did not present intranasal MEP another pathway, in addition to systemic absorption, for transport to the brain.

Inhibitory effect of intrathecal meptazinol on carrageenan-induced thermal hyperalgesia in rats.

The effect of meptazinol in the spinal cord on carrageenan-induced hyperalgesia was investigated. The latency of paw withdrawal (PWL) to a thermal stimulus was used as an index of inflammatory hyperalgesia in awake rats. Intrathecal (i.t.) injection of 10 and 100 microg meptazinol markedly increased the PWL of the carrageenan-injected paw (P<0.01). The PWL of the non-injected paw was not detectably affected by the administration of meptazinol at the doses tested. I.t. injection of naloxone (5 microg) or atropine (1 microg) alone exhibited no effect on the PWLs of either the carrageenan-injected or non-injected paw. Pretreatment with naloxone, but not atropine, completely blocked the meptazinol-induced anti-hyperalgesia. These observations suggested that mu opioid receptor rather than muscarinic acetylcholine receptor may be involved in the anti-hyperalgesia of meptazinol in the spinal cord.

Post-surgical pain relief with zero-order intravenous infusions of meptazinol and morphine: a double-blind placebo-controlled evaluation of their effects on ventilation.

A double-blind, placebo-controlled study has been made of the analgesic and respiratory effects of constant rate infusions of meptazinol and morphine in 30 patients after abdominal surgery. Group I received meptazinol, loading dose 50 mg followed by i.v. infusion 0.5 mg.kg-1.h-1, Group II received morphine, loading dose 5 mg and then an infusion of 0.05 mg.kg-1.h-1, and Group III received saline. After recovery from inhalation anaesthesia (without opiates or a local anaesthetic) pain relief and chemoreceptor carbon dioxide tolerance were assessed before and at various times after starting the analgesic infusion. A similar degree of pain relief was found after 10 min in Groups I and II, which lasted until the end of observation period (20 h). Heart rate and systolic and diastolic blood pressures were lower in Group II than in Groups I and III, and respiratory rate fell in Groups I and II. After 6 h arterial carbon dioxide tensions (PaCO2) became significantly higher in Group II than Group III. The maximum percentage fall in mean tidal volume (VT) and expired minute volume (VE) from the preinjection values was significant in Groups I and II. End-tidal carbon-dioxide (PETCO2) and PaCO2 were significantly higher after 20 h of infusion in Group II compared to Group I. The slope of VE/PETCO2 (mean value of S) was increased in Group I and it was significantly reduced in Group II. Analysis of derived variables, such as the CO2 intercept (CO2I) and minute ventilation at 7 kPa (VE7), indicated a shift to the right of the slopes in Groups I and II, initially more so in Group I.(ABSTRACT TRUNCATED AT 250 WORDS)

Meptazinol and morphine in postoperative pain assessed with a new method for onset and duration.

Meptazinol, m-(3-ethyl-1-methyl-hexahydro-1-H-azepin-3-yl) phenol hydrochloride is a centrally active opioid analgesic with a specificity for the mu-1 receptor. It has been reported to lack many of the side effects commonly observed with morphine and morphinelike drugs in man. The objective of this study was to assess the analgesic efficacy and safety of meptazinol (50 mg and 100 mg) relative to morphine (5 mg and 10 mg) when administered intramuscularly for the treatment of postoperative pain. In addition, a new clinical method for measuring onset and duration and a statistical technique for evaluating the study data are presented. One hundred and seventeen patients were evaluated for 6 hours in a randomized double blind, single dose, parallel-groups trial. Estimates of relative potency for hourly pain and relief parameters, and the summary variables sum of pain intensity differences (SPID) and total pain relief (TOTPAR) were performed. The estimate of relative potency of meptazinol to morphine for pain relief was 0.19 at 1/2 hour (i.e. 100 mg of meptazinol was approximately equivalent to 20 mg of morphine). Thereafter, there was a rapid decline of efficacy for meptazinol, with a relative potency estimate of 0.12 at 1 hour and 0.06 at 2 hours. The distribution functions for several time related events were estimated including time to onset, duration and time to remedication. The two drugs had approximately equal onset, but meptazinol had significantly shorter duration. More patients on meptazinol required remedication with a rescue analgesic and at an earlier time than patients on morphine.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative aspects of the urinary excretion of meptazinol and its metabolites in human volunteers.

1. The urinary excretion of meptazinol and its metabolites has been studied in five healthy human volunteers following oral administration of 200 mg of the 3H-labelled drug. 2. Meptazinol was well absorbed, with 90% of the radioactivity excreted in the urine; elimination of drug-related material took place rapidly. 3. Metabolism was extensive, no unchanged material being detected in the urine. Following selective enzymic hydrolysis the major metabolites were identified as glucuronide and sulphate conjugates of the parent drug present in an approximate ratio of 4:1. 4. A number of minor metabolites, also present in conjugated form, were tentatively identified.

The systemic availability of meptazinol in man after oral and rectal doses.

We have studied the pharmacokinetics of the centrally-acting analgesic meptazinol after oral and rectal administration to 15 healthy men. Each subject took a standard 200 mg tablet orally and Witepsol H12 suppositories containing 75, 100, and 150 mg of the drug in a cross-over design. Meptazinol plasma concentrations were measured by HPLC using fluorescence detection and the pharmacokinetics determined. The tmax values for the 100 mg and 150 mg suppositories (median = 0.5 h) were statistically significantly shorter than for the tablet (median = 1.13 h), suggesting that meptazinol was more rapidly absorbed via the rectal route. Despite substantial intersubject variation in Cmax the plasma concentrations after rectal dosage were higher than after oral administration. There was a statistically significant (p less than 0.001) improvement in systemic availability for each of the suppository doses (mean approximately 15.5% compared with the oral tablet (mean approximately 4.5%).

The disposition of meptazinol after single and multiple intravenous administration to pregnant and non-pregnant women.

We have studied the disposition of the centrally-acting analgesic meptazinol in a group of age-matched non-pregnant and pregnant (36-38 weeks gestation) women. Ten non-pregnant and nine multiparous pregnant volunteers each received a single i.v. dose of meptazinol hydrochloride (equivalent to 25 mg base). A further group of 9 non-pregnant (including four of the original participants) and 10 multiparous pregnant subjects were given repeated i.v. doses of meptazinol hydrochloride (each equivalent to 10 mg base) at 30-min intervals for 2.5 h. Meptazinol plasma concentrations were determined by HPLC using fluorescence detection and the pharmacokinetic variables investigated. After single dosing there were no statistical differences in half-life, clearance, or apparent volume of distribution between the two groups, suggesting that the disposition of meptazinol was not altered by pregnancy. This was confirmed in the repeated dose study, in which no significant differences occurred in either the plasma concentrations achieved or in areas under the curves between the non-pregnant and pregnant subjects. Furthermore, the steady-state concentrations were comparable with those predicted from the single dose results. This indicates that there should be no requirement for dosage alteration of meptazinol during pregnancy.

Double-blind comparison of the efficacy and safety of single doses of meptazinol as a suppository and morphine by i.m. injection.

The analgesic efficacy of a 150-mg meptazinol suppository was compared with that of morphine 10 mg i.m. in the treatment of moderate postoperative pain. Two groups of 15 female patients took part in a 4-h, randomized double-blind, double-dummy study on the first day after elective abdominal hysterectomy. Meptazinol did not provide satisfactory analgesia in five patients (P less than 0.05). A decrease in mean pain scores (linear analogue scale and verbal rating scale) was seen after the administration of meptazinol, but this was not as great as that produced by morphine i.m., nor was it as long in duration. Significant changes in arterial pressure, heart rate and ventilatory rates were not seen in association with the administration of meptazinol, but were observed after the administration of morphine.

Feasibility of self-administration analgesia by the intramuscular route in labour.

The feasibility of patient-controlled on-demand analgesia by the intramuscular route during labour was tested on 10 primigravid mothers. Pethidine 50 mg or meptazinol 75 mg was available double-blind at minimum intervals of 20 min. The mean dose demanded was 190 (SD 96.2) mg of pethidine and 285 (SD 97.8) mg of meptazinol. The dose of pethidine is similar to that demanded by the intravenous route. Pain evaluations were not significantly different, but one mother who had meptazinol opted for epidural analgesia, and 2 wished they had done so. The system could be easily managed by all the mothers and there were not technical difficulties. Self-administered intramuscular analgesia could be instituted by a midwife with a dosage scheme similar to current practice. A field trial by midwives of self-administered intramuscular analgesia with pethidine is indicated.

The clinical pharmacokinetics and metabolism of the analgesic meptazinol.

1. The analgesic drug meptazinol is rapidly and completely absorbed after oral, intramuscular (i.m.) and rectal dosage. However, the absolute bioavailability of the drug following oral dosage is low (4.5-8.7%). Rectal administration leads to a higher bioavailability (15.5%) while after i.m. dosage the drug is totally systemically available. 2. Meptazinol is widely distributed outside the vasculature (Vd*area 5.9 l/kg) partly due to the low degree of binding to plasma proteins (27% bound) and also the relatively high lipophilicity of the unionized species (log P = 2.7). 3. Elimination of the drug from plasma proceeds rapidly (t1/2 2 h) largely as the result of glucuronidation and sulphation of the phenolic function in the molecule. The major route of excretion is via the urine, greater than 70% of the dose appearing in the 0-24 h urine collection almost entirely as conjugated metabolites. 4. After multiple dosing, orally or parenterally, there is no accumulation above that predicted from single dose kinetics. 5. The pharmacokinetics of the drug are generally unaltered by age (neonates to geriatrics) and pregnancy. Renal disease also has no effect in this respect, although cirrhotic liver disease results in up to a 4-fold increase in oral bioavailability. 6. Only limited data are available on the pharmacokinetics of meptazinol when given with other drugs. Alcohol appears to have no effect, while general anaesthesia appears to reduce clearance of the drug.

Disposition and pharmacokinetics of meptazinol in the CSF. Studies after intrathecal administration in the non-human primate Erythrocebus patas.

A preliminary study is reported on the kinetics of meptazinol following intrathecal and i.m. administration in the Patas monkey. Following intrathecal administration (single dose of 0.5 mg) at T12/L1, meptazinol rapidly disappeared from the CSF with a T1/2 of 35 min. At 240 min after intrathecal injection, most of the meptazinol had been distributed within the spinal tissue near the region of the injection, with minimal amounts reaching the brain (less than 5% of the concentrations present in the lumbar and thoracic tissue). Following i.m. administration (16 mg kg-1) peak concentrations were present in the CSF and plasma within 60 min. Appreciable concentrations persisted in the CSF up to 180 min after i.m. administration. The results would suggest that meptazinol should give rapid but short acting pain relief following intrathecal injection with minimal CNS-related side effects.

Meptazinol for postoperative pain relief in man. Comparison of extradural and i.m. administration.

The analgesic and cardiorespiratory effects of meptazinol 90 mg, given by the extradural or the i.m. route, were studied in 32 postoperative patients. Plasma meptazinol concentrations were measured in five patients in each treatment group. Evaluation using a linear analogue scale indicated that there were significant differences between the groups in the onset, quality and duration of pain relief, with the extradural route being superior to the i.m. route in each instance. The difference in quality of pain relief was not related to the resultant plasma meptazinol concentrations, which were similar in the two groups. Ventilatory rate was decreased equally in both groups in parallel with pain relief, but no incidence of overt respiratory depression was noted. Meptazinol produced no meaningful changes in measured cardiovascular variables, and side effects were minimal in both groups.

Prevention of physostigmine-induced lethality by the opioid analgesic meptazinol in the mouse.

The prophylactic action of meptazinol against physostigmine- and neostigmine-induced lethality was evaluated in mice. Meptazinol proved to be effective against physostigmine (1 mg kg-1 i.p.), but not against neostigmine (0.5 mg kg-1 i.p.). The antagonism by meptazinol of physostigmine-induced poisoning was maximal when the drug was administered 15 min before physostigmine. Under these conditions the ED50 (95% confidence limits) of meptazinol was 24 (22.0-26.1) mg kg-1 s.c. A 30 mg kg-1 dose of the drug prevented lethality in 89% of the animals. The action of meptazinol was not antagonized by naloxone hydrochloride (2 mg kg-1 i.p.), injected 10 min before meptazinol. Pretreatment of mice with 30 mg kg-1 meptazinol 15 min before physostigmine (1 mg kg-1) poisoning increased brain acetylcholinesterase (AChE) activity on average, from 8 to 31% of control values. The protection of cholinesterases against physostigmine- and neostigmine-induced inactivation was demonstrated in vitro directly on purified preparations of the enzymes using a dilution method. The ED50 values (95% confidence limits) for the protective effect of meptazinol of electric eel AChE against 1 and 3 microM physostigmine and 1 microM neostigmine were 2.6 (1.4-4.9), 9.5 (5-18) and 3 (1.6-5.7) microM, respectively, while for protection of horse serum butyrylcholinesterase (BuChE) against the same inhibitors, the ED50 values were 12 (5.4-26.4), 42 (27-65.1) and 8 (3.6-17.6) microM, respectively. It is suggested that prevention of physostigmine-induced lethality by meptazinol is a consequence of its protective action on AChE in the central nervous system.

Enhanced oral bioavailability of meptazinol in cirrhosis.

Kinetic analysis was carried out after single intravenous (25 mg) and oral (200 mg) doses of the novel partial opioid agonist meptazinol (Meptid) in patients with non-cirrhotic liver disease (NCLD) and biopsy proven cirrhosis. Comparison was made with a group of patients with normal hepatic function. Elimination half-lives after the intravenous dose were slightly prolonged in the cirrhotics (n = 10; 4.2 +/- 0.6 h) compared with the control (n = 8; 2.7 +/- 0.2 h: p less than 0.05) and NCLD (n = 8; 3.2 +/- 0.5 h) groups. There was no significant difference in meptazinol plasma clearance between the groups (cirrhotics = 72 +/- 8 l/h; NCLD = 89 +/- 9 l/h; control = 83 +/- 10 l/h). After the oral dose, seven of 15 cirrhotic patients vomited but only one patient in each of the other groups was unable to tolerate the drug (p = 0.06). This may be explained by very much higher peak meptazinol concentrations in the cirrhotic (n = 8; 184 +/- 37 ng/ml, p less than 0.01) and NCLD (n = 8; 131 +/- 38 ng/ml, p less than 0.05) patients than those of the controls (n = 7; 53 +/- 12 ng/ml) reflecting a mean four-fold and two-fold increase in oral bioavailability respectively (cirrhotics: n = 8; 27.9 +/- 5.3%: p less than 0.001; NCLD: n = 7; 13.7 +/- 3.9% p less than 0.05; controls: n = 7; 6.5 +/- 1.3%). There was no evidence of accumulation after chronic dosing with 200 mg meptazinol four times daily for 13 doses in seven control, seven NCLD and six cirrhotic patients. There were no detectable differences in psychomotor function measured objectively using the Leeds Psychomotor Tester of subjectively by linear analogue scoring between the groups in all three parts of the study. The oral use of meptazinol in patients with chronic liver disease is associated more with the development of nausea and vomiting rather than excessive sedation. These data suggest that dosage reduction in cirrhotic patients is advisable particularly if the drug is taken by mouth.