Double-blind, placebo-controlled study of INN 00835 (netamiftide) in the treatment of outpatients with major depression.

This study was designed to determine the safety, efficacy and pharmacokinetics of the antidepressant netamiftide (previously designated name: INN 00835) after 5 or 10 daily doses administered to patients diagnosed with major depression. Netamiftide was administered subcutaneously at a fixed dose of 18 mg/patient per day. Of the 55 enrolled patients, 22 were dosed for 10 days with drug, 11 for 5 days with drug followed by 5 days with placebo and 22 for 10 days with placebo only. The effect of treatment with netamiftide was evaluated by the following psychometric tests: Hamilton Depression Rating, Montgomery-Asberg Depression Rating Scale, Carroll Self-Rating Depression and Clinical Global Impression scales. None of the patients experienced significant adverse effects. A pharmacodynamic correlation (P < 0.05) was found between plasma drug concentrations and response to treatment. Highest plasma concentrations (Cmax) of netamiftide averaging 45.7 ng/ml were observed at 0.25 h after dosing. There were 89% responders in the group with Cmax > or = 45.7 ng/ml (minimum therapeutic concentration) versus 40% in the group with Cmax < 45.7 ng/ml. Onset of action was observed within 48 h after treatment, peak effect was observed at approximately 1 week after treatment and efficacy lasted during a 4-week follow-up period. Netamiftide is a promising antidepressant with rapid onset of action and with an excellent safety profile.

A double-blind, placebo-controlled, efficacy, safety, and pharmacokinetic study of INN 00835, a novel antidepressant peptide, in the treatment of major depression.

BACKGROUND: INN 00835 is a synthetic pentapeptide with a potential for rapid onset of action as an antidepressant. Its efficacy was investigated in a pilot study in patients diagnosed with major depression. METHODS: Fifty two patients received either active drug - INN 00835 (26 patients) - or placebo (26 patients), subcutaneously at 0.2 mg/kg for 5 consecutive days. The patients were evaluated for an additional 4 weeks after treatment. Efficacy was evaluated by the following psychiatric rating scales: HAMD, MADRS, CSRS, CGI, and VAS. The effect of treatment was also evaluated by using a biochemical marker: changes in blood platelet serotonin (5HT) uptake rates in drug-treated patients compared to those in the placebo group. Plasma concentrations of INN 00835 were measured by LC/MS. RESULTS: Statistical analysis indicated a strong pharmacodynamic correlation between plasma drug concentrations at 1 h after dosing and the reduction in the severity of depression as measured by the psychiatric rating scales. A minimum effective plasma concentration (MEC) of INN 00835 was 5 ng/ml. Statistically significant differences in response to treatment (P<0.05) were found between patients with plasma concentrations above MEC and those in the placebo group, as well as between subjects with plasma concentrations above and below the MEC. The peak effect was observed after the 5-day treatment and the response to treatment persisted during the 4-week follow-up period. The change of 5HT uptake rates after treatment was significantly larger in the drug-treated group than in the placebo group. LIMITATIONS: This was a pilot study conducted in a relatively small population (52 patients) and the limited number of blood sampling times did not allow a comprehensive pharmacokinetic analysis. There was a relatively large placebo response. The results have to be confirmed in future, large scale studies. CONCLUSIONS: INN 00835 appears to be a promising drug for the treatment of major depression.

The effect of treatment with a new antidepressant, INN 00835, on platelet serotonin uptake in depressed patients.

BACKGROUND: INN 00835 (4-fluoro-L-phenylalanyl-trans-4-hydroxy-L-prolyl-L-arginyl-glycyl-trypt ophanamide ditrifluoroacetate) is a synthetic pentapeptide antidepressant with a potential for rapid onset of action. We were interested to see if such action could be correlated with serotonin uptake by platelets. METHODS: In a phase II clinical trial, unipolar depressed patients were administered active drug, INN 00835 or placebo, subcutaneously, at 0.2 mg/kg, once daily for 5 consecutive days. Efficacy of treatment was evaluated by psychometric tests (HAMD, MADS, CSRS, CGI and total VAS). Changes in platelet uptake rates of serotonin (3H-5HT) were measured in plasma from the patients participating in the phase II clinical trial, prior to and immediately after treatment with INN 00835 (19 patients) or placebo (16 patients), to evaluate the effect of treatment with INN 00835 on the rate of platelet 5-HT uptake. RESULTS: The data evaluated by using the psychometric tests indicated a significant response to treatment with INN 00835 after 5 days of dosing. The rates of platelet 5-HT uptake were lower prior to treatment (baseline), and increased after the 5-day treatment period. The change in the uptake rate (deltaVmax) following treatment was significantly larger in the active group than in the placebo group (P < 0.05). The difference between the placebo group and the patients who responded to treatment was even larger. LIMITATIONS: Small number of subjects. CONCLUSION: The data tend to substantiate the use of platelet serotonin uptake as a biochemical marker of effective treatment of depression.

Improvement in major depression after low subcutaneous doses of MIF-1.

In this double-blind pilot study, 20 significantly depressed patients who all met the DSM-III R criteria for major depression were given a single subcutaneous injection of either 10 mg MIF-1 (Pro-Leu-Gly-NH2) or placebo on each of 5 consecutive days. Treatments were reversed for a second week of 5 consecutive daily injections. At the end of the first week, the group receiving MIF-1 was significantly improved on all rating scales as compared with the group receiving placebo. Eight out of 9 patients receiving MIF-1 showed marked improvement (score < or = 7 on the Hamilton Scale) as compared with only 2 of 11 patients receiving saline (P < 0.01). Administration of MIF-1 during the second week to the patients who had received placebo during the first week resulted in substantial improvement so that by the end of the second week the two groups were indistinguishable.

MIF-1 is active in a chronic stress animal model of depression.

MIF-1 was tested in an animal model of depression that used unpredictable chronic stress. In this paradigm, rats received either no stressors or a daily protocol of a variety of stressors for 20 days, during which time daily, intraperitoneal injections of various compounds were given. The tricyclic antidepressant imipramine (5 mg/kg) and low doses (0.1 and 1.0 mg/kg) of MIF-1 significantly increased activity and decreased defecation in an open field on day 21. No dose of naloxone (0.01-10.0 mg/kg) acted as an antidepressant. A high dose (10.0 mg/kg) of MIF-1 significantly increased the effects of chronic stress and produced hyperalgesia. Chronically-stressed rats were significantly more analgesic than controls. The results indicate that MIF-1 can act as an antidepressant in this model.

Tyr-MIF-1 acts as an opiate antagonist in the tail-flick test.

The naturally occurring brain peptide Tyr-MIF-1 (Tyr-Pro-Leu-Gly-NH2) was tested for its ability to block and reverse the actions of morphine in the tail-flick test. Injected peripherally either 10 minutes before or after morphine, Tyr-MIF-1, like MIF-1, was found to significantly reduce the antinociceptive actions of morphine on thermal pain. The results indicate that Tyr-MIF-1 may act, in part, as an endogenous opiate antagonist.

Antagonism of morphine analgesia by prolyl-leucyl-glycinamide (MIF-1) in humans.

Prolyl-leucyl-glycinamide (MIF-1) has been observed to inhibit the analgesic effect of morphine in a series of animal studies. In the present study, the naloxone-like properties of MIF-1 were assessed in human subjects. Eight men received a capsule containing 60 mg of MIF-1 or placebo followed one hour later by a 10 mg intramuscular injection of morphine in a double-blind, crossover design at two visits 4 weeks apart. Experimental pain was induced by the cold pressor test administered 45, 75, 120 and 180 min after the morphine. Each subject recorded severity of pain on a 100 mm line scale every 5 sec during the 120 sec his foot was immersed in the cold water tank and during the 60 seconds immediately following its removal. On a third visit, baseline values were measured in the absence of morphine, MIF-1 or placebo. Analysis of variance revealed that MIF-1 resulted in significantly higher scores (less analgesia) compared with placebo when measured at 45 and 75 min after morphine during the immersion phase and during all four times the subjects were evaluated during the removal phase. The results indicate that MIF-1 can act in humans as an opiate antagonist.

Tyr-MIF-1 and MIF-1 are active in the water wheel test for antidepressant drugs.

MIF-1 [Pro-Leu-Gly-NH2] and Tyr-MIF-1 [Tyr-Pro-Leu-Gly-NH2] were tested in a system in which antidepressant drugs are known to result in increased wheel turning as mice attempt to escape from a small tank of water. One hr after injection, both peptides were found to cause a significant increase of the number of rotations of the wheel at doses as low as 0.01 mg/kg IP, the dose-response pattern for MIF-1 resembling an inverted-U. DSIP and morphine, by contrast, decreased the number of rotations. Under the conditions tested, neither MIF-1 nor Tyr-MIF-1 reversed the effect of morphine. The results demonstrate that MIF-1 and Tyr-MIF-1 are active in another test for antidepressants.

Similar antagonism of morphine analgesia by MIF-1 and naloxone in Carassius auratus.

Prolyl-leucyl-glycinamide (MIF-1), the C-terminal tripeptide of oxytocin, and naloxone were administered intracranially (IC) to goldfish (Carassius auratus) in doses of 0.001, 0.01, 0.1, 1.0 and 10.0 mg/kg and compared to a diluent control group for their ability to reduce the effects of morphine (30 mg/kg IC) in an assay measuring analgesia to electric shock. Threshold levels of pain were determined by the voltage necessary to produce an agitated swimming response (ASR). Both MIF-1 and naloxone were found to significantly reduce the analgesic effects of morphine when compared to the diluent control group. Similar dose-response curves in an apparent sine-wave pattern were noted with both MIF-1 and naloxone when comparisons were made both at 20 minutes after administration of morphine and over the entire 150 minutes of the experiment. The results support the evidence that MIF-1 can act as an opiate antagonist.

Vasopressin's effects on acquisition and extinction of conditioned avoidance response to smoking.

Lysine-8-vasopressin (LVP) 5 I.U. or NaCl was administered intranasally daily for 5 days in a double blind study to 14 women and 7 men volunteers, 30 minutes prior to aversive conditioning sessions designed to assist them to stop smoking. Subjects were asked to record the number of urges to smoke, the strength of their strongest urge to smoke and the number of cigarettes smoked on a daily basis. Adequate data was obtained from 17 subjects for the Lead-in (pretreatment) week and for the Treatment week. Of these, 10 continued to supply sufficient responses through the sixth week of follow-up. During the week of aversive conditioning those subjects receiving LVP smoked significantly fewer cigarettes than the saline treatment group (p less than 0.01). During the Follow-up period the LVP group had significantly more urges to smoke than the saline group (p less than 0.01). The LVP group also smoked significantly more cigarettes than the saline group 4 weeks (p less than 0.05) and 6 weeks (0.01) after the Treatment week. LVP was associated with a facilitation of the acquisition of the avoidance response to smoking followed by an apparent acceleration of the extinction of the avoidance response compared to saline.

Behavioral and hormonal effects of prolonged high doses of LHRH in male impotency.

Eight married men with secondary impotency on a nonorganic, non-psychiatric disease basis injected themselves with placebo subcutaneously (SC) twice a day (b.i.d.) for the first week in a single blind design followed by two periods of four weeks with LHRH (3 mg b.i.d. for four weeks) and placebo (b.i.d. for four weeks) in a double blind crossover design. Outcome was assessed by daily questionnaires. There were no significant differences between the effects of LHRH and placebo on frequency of intercourse, spontaneous erections, and wife's rating of her husband's libido. On these measurements, small, non-significant, trends toward improvement were associated with LHRH. The patients' rating of their own libido was higher (p less than 0.05) during the first week on LHRH compared to the first week of the four weeks of placebo, but the magnitude of the differences was minimal. Frequency of masturbation did not increase with LHRH. In contrast to other studies, men with premasturbatory activity improved less and there was no improvement in potency in the two month follow-up after LHRH. Baseline LH, FSH, testosterone and prolactin were all within normal limits. The LH and FSH response to LHRH decreased over the 28 days but testosterone levels and response to LHRH increased. Since there was a small trend toward improvement after LHRH, clinical trials with LHRH analogs should be explored.

Naloxone-like actions of MIF-1 do not require the presence of the pituitary.

The actions of peripherally administered MIF-1 (Pro-Leu-Gly-NH2) and naloxone in blocking the effects of morphine in the tail-flick test were measured across a wide range of five doses in hypophysectomized and intact mice. The presence of the pituitary gland failed to influence the response to MIF-1 or naloxone. Both hypophysectomized and intact mice were significantly affected by these two compounds at doses of 0.01, 0.1, 1.0, and 10.0 mg/kg IP. The greatest effect of MIF-1 occurred at 100 mg/kg, but naloxone was lethal at this dose. Preliminary experiments with other tests showed that at 10 mg/kg, naloxone, but not MIF-1, was effective in preventing the Straub-tail reflex and in precipitating withdrawal-jumping in mice implanted with morphine pellets. Only minimal activity was shown by MIF-1 in preventing blockade of electrically induced contractions of the guinea pig ileum by morphine. Neither compound was active in the frog-righting test. In summary, the results emphasize the differential actions of MIF-1 as an opiate antagonist and demonstrate that the pituitary is not required for their mediation.

MIF-I's differential actions as an opiate antagonist.

The effects of MIF-I (Pro-Leu-Gly-NH2) were examined in three experimental conditions in which the opiate antagonist naloxone is active. MIF-I was found to block the analgesic effects of enkephalins and also morphine in the tail-flick test but not in the vas deferens assay. Unlike naloxone, MIF-I did not seem to reduce food intake in VMH-lesioned rats. The results suggest the possibility that MIF-I may represent a class of naturally occurring opiate antagonists with varying activities in independent situations.

Enkephalin and other peptides reduce passiveness.

Enkephalin and other brain peptides previously have been shown to be active in the dopa potentiation test which may be considered an animal model of mental depression. A recently described model of passive immobility during swimming, also sensitive to tricyclic antidepressants, was therefore used to study a large number of naturally occurring peptides and some of their analogues. It was found that several enkephalins with no opiate activity after peripheral injection reduced the immobility and thus increased the activity of swimming rats. alpha-MSH, but not its 4--10 core or a 4--9 analogue, also caused significantly more swimming than did the diluent control. As we have previously found in several animal and clinical studies, a smaller dose of MIF-I was more effective than larger doses. The results confirm our concept of the CNS actions of brain peptides and support the suggestion that some of them, like the enkephalins, might be useful after peripheral administration in mental depression or other CNS disorders.

Dose-related biphasic effect of prolyl-leucyl-glycinamide (MIF-I) in depression.

Five of 8 patients with unipolar or bipolar endogenous depressions taking prolyl-leucyl-glycinamide (MIF-I), 75 mg/day, showed substantial improvement within a few days of beginning treatment compared with similar improvement in only 1 of 10 receiving 750 mg/day of MIF-I and only 1 of 5 patients taking placebo. The lower dose of MIF-I was associated with significantly greater improvement than both the higher dose and placebo on all of the rating scales used. The authors suggest that an even lower dose of MIF-I, on the order of 0.1 mg/kg, may have a greater effect as an antidepressant.