1. Molecular mechanisms of serotonergic action of the HIV-1 antiretroviral efavirenz
- Author
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Shahnawaz M. Amdani, Dhwanil A. Dalwadi, Seongcheol Kim, John A. Schetz, Zhenglan Chen, and Ren-Qi Huang
- Subjects
0301 basic medicine ,Cyclopropanes ,Time Factors ,HIV Infections ,Pharmacology ,Membrane Potentials ,chemistry.chemical_compound ,Radioligand Assay ,0302 clinical medicine ,immune system diseases ,Receptor ,GABAA receptor ,virus diseases ,Brain ,Receptors, Muscarinic ,Drug Partial Agonism ,Alkynes ,Reverse Transcriptase Inhibitors ,Serotonin Antagonists ,medicine.drug ,Protein Binding ,Agonist ,Efavirenz ,Nevirapine ,Monoamine Oxidase Inhibitors ,medicine.drug_class ,Anti-HIV Agents ,Guinea Pigs ,CHO Cells ,Emtricitabine ,Transfection ,Partial agonist ,Binding, Competitive ,Article ,03 medical and health sciences ,Cricetulus ,medicine ,Inverse agonist ,Animals ,Humans ,Calcium Signaling ,Dose-Response Relationship, Drug ,Benzoxazines ,030104 developmental biology ,HEK293 Cells ,chemistry ,Receptors, Serotonin ,HIV-1 ,030217 neurology & neurosurgery ,HeLa Cells - Abstract
Efavirenz is highly effective at suppressing HIV-1, and the WHO guidelines list it as a component of the first-line antiretroviral (ARV) therapies for treatment-naive patients. Though the pharmacological basis is unclear, efavirenz is commonly associated with a risk for neuropsychiatric adverse events (NPAEs) when taken at the prescribed dose. In many patients these NPAEs appear to subside after several weeks of treatment, though long-term studies show that in some patients the NPAEs persist. In a recent study focusing on the abuse potential of efavirenz, its receptor psychopharmacology was reported to include interactions with a number of established molecular targets for known drugs of abuse, and it displayed a prevailing behavioral profile in rodents resembling an LSD-like activity. In this report, we discovered interactions with additional serotonergic targets that may be associated with efavirenz-induced NPAEs. The most robust interactions were with 5-HT3A and 5-HT6 receptors, with more modest interactions noted for the 5-HT2B receptor and monoamine oxidase A. From a molecular mechanistic perspective, efavirenz acts as a 5-HT6 receptor inverse agonist of Gs-signaling, 5-HT2A and 5-HT2C antagonist of Gq-signaling, and a blocker of the 5-HT3A receptor currents. Efavirenz also completely or partially blocks agonist stimulation of the M1 and M3 muscarinic receptors, respectively. Schild analysis suggests that efavirenz competes for the same site on the 5-HT2A receptor as two known hallucinogenic partial agonists (±)-DOI and LSD. Prolonged exposure to efavirenz reduces 5-HT2A receptor density and responsiveness to 5-HT. Other ARVs such as zidovudine, nevirapine and emtricitabine did not share the same complex pharmacological profile as efavirenz, though some of them weakly interact with the 5-HT6 receptor or modestly block GABAA currents.
- Published
- 2016