Catechol-O-methyltransferase inhibitor

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Metabolism of levodopa by catechol-O-methyltransferase (COMT) and aromatic L-amino acid decarboxylase (AADC). COMT inhibitors prevent the conversion of levodopa to 3-O-methyldopa. Levodopa metabolism 2.png
Metabolism of levodopa by catechol-O-methyltransferase (COMT) and aromatic L-amino acid decarboxylase (AADC). COMT inhibitors prevent the conversion of levodopa to 3-O-methyldopa.

A catechol-O-methyltransferase inhibitor (COMT inhibitor) is a drug that inhibits the enzyme catechol-O-methyltransferase. This enzyme methylates catecholamines such as dopamine, norepinephrine and epinephrine. It also methylates levodopa. COMT inhibitors are indicated for the treatment of Parkinson's disease in combination with levodopa and an aromatic L-amino acid decarboxylase inhibitor (e.g. carbidopa or benserazide). The therapeutic benefit of using a COMT inhibitor is based on its ability to prevent the methylation of levodopa to 3-O-methyldopa, thus increasing the bioavailability of levodopa. COMT inhibitors significantly decrease off time in people with Parkinson's disease also taking carbidopa/levodopa. [1]

Contents

List of COMT inhibitors

Entacapone and opicapone are peripherally selective inhibitors, unable to cross the blood–brain barrier (BBB), and hence do not inhibit COMT in the brain. Tolcapone also appears to be peripherally selective. [2] However, it has been found to cross the BBB to at least some degree and significantly inhibit COMT in the brain as well. [2] [3] [4] However, the clinical relevance of its COMT inhibition in the brain in Parkinson's disease is uncertain. [3] Instead, the drug seems to exert most of its clinical efficacy in this condition through inhibition of peripheral COMT and is dependent on concomitant use of levodopa. [3]

Tolcapone has been associated with at least three fatal cases of acute liver failure and is thus only rarely prescribed. [5] Patients taking tolcapone must be monitored for hepatic failure. Entacapone and opicapone have not been associated with hepatotoxicity. [6] [7]

Adverse effects

Research

Centrally acting COMT inhibitors like CERC-406 and CERC-425 that inhibit COMT in the brain in addition to the periphery were under investigation for potential treatment of residual cognitive impairment symptoms in Parkinson's disease and of depressive disorders. [8] [9] However, while preclinical research was conducted, development was discontinued. [8] Tolcapone, which acts centrally in addition to peripherally, has shown antidepressant-like effects in animal models of depression. [10] However, these antidepressant-like effects may only occur with combination treatment of tolcapone with levodopa and an aromatic L-amino acid decarboxylase inhibitor. [10] In animals, tolcapone by itself does not increase dopamine levels in the striatum, nucleus accumbens, or frontal cortex, but does augment brain L-DOPA levels when combined with levodopa and benserazide. [11] There may be compensatory activation of the monoamine oxidase dopamine-metabolizing pathway with brain COMT inhibition. [11]

See also

Related Research Articles

Catechol-<i>O</i>-methyltransferase Class of enzymes

Catechol-O-methyltransferase is one of several enzymes that degrade catecholamines, catecholestrogens, and various drugs and substances having a catechol structure. In humans, catechol-O-methyltransferase protein is encoded by the COMT gene. Two isoforms of COMT are produced: the soluble short form (S-COMT) and the membrane bound long form (MB-COMT). As the regulation of catecholamines is impaired in a number of medical conditions, several pharmaceutical drugs target COMT to alter its activity and therefore the availability of catecholamines. COMT was first discovered by the biochemist Julius Axelrod in 1957.

<small>L</small>-DOPA Chemical compound

l-DOPA, also known as l-3,4-dihydroxyphenylalanine and used medically as levodopa, is made and used as part of the normal biology of some plants and animals, including humans. Humans, as well as a portion of the other animals that utilize l-DOPA, make it via biosynthesis from the amino acid l-tyrosine.

<span class="mw-page-title-main">Carbidopa</span> Chemical compound

Carbidopa (Lodosyn) is a drug given to people with Parkinson's disease in order to inhibit peripheral metabolism of levodopa. This property is significant in that it allows a greater proportion of administered levodopa to cross the blood–brain barrier for central nervous system effect, instead of being peripherally metabolised into substances unable to cross said barrier.

<span class="mw-page-title-main">Benserazide</span> Chemical compound often used as medication

Benserazide is a peripherally acting aromatic L-amino acid decarboxylase or DOPA decarboxylase inhibitor, which is unable to cross the blood–brain barrier.

Carbidopa/levodopa, also known as levocarb and co-careldopa, is the combination of the two medications carbidopa and levodopa. It is primarily used to manage the symptoms of Parkinson's disease, but it does not slow down the disease or stop it from getting worse. It is taken by mouth. It can take two to three weeks of treatment before benefits are seen. Each dose then begins working in about ten minutes to two hours with a duration of effect of about five hours.

<span class="mw-page-title-main">Dopaminergic</span> Substance related to dopamine functions

Dopaminergic means "related to dopamine", a common neurotransmitter. Dopaminergic substances or actions increase dopamine-related activity in the brain.

Bial is a pharmaceutical company headquartered in São Mamede do Coronado, in Trofa, Porto district, Portugal. It was founded in 1924, being among the largest companies of its kind in Portugal. Its products are sold in pharmacies in more than 58 countries in 4 continents: Europe, America, Africa and Asia.

<span class="mw-page-title-main">Entacapone</span> Chemical compound

Entacapone, sold under the brand name Comtan among others, is a medication commonly used in combination with other medications for the treatment of Parkinson's disease. Entacapone together with levodopa and carbidopa allows levodopa to have a longer effect in the brain and reduces Parkinson's disease signs and symptoms for a greater length of time than levodopa and carbidopa therapy alone.

<span class="mw-page-title-main">Tolcapone</span> Chemical compound

Tolcapone, sold under the brand name Tasmar, is a medication used to treat Parkinson's disease (PD). It is a selective, potent and reversible nitrocatechol-type inhibitor of the enzyme catechol-O-methyltransferase (COMT). It has demonstrated significant liver toxicity, which has led to suspension of marketing authorisations in a number of countries.

In the management of Parkinson's disease, due to the chronic nature of Parkinson's disease (PD), a broad-based program is needed that includes patient and family education, support-group services, general wellness maintenance, exercise, and nutrition. At present, no cure for the disease is known, but medications or surgery can provide relief from the symptoms.

<span class="mw-page-title-main">Levodopa</span> Dopaminergic medication

Levodopa, also known as L-DOPA and sold under many brand names, is a dopaminergic medication which is used in the treatment of Parkinson's disease and certain other conditions like dopamine-responsive dystonia and restless legs syndrome. The drug is usually used and formulated in combination with a peripherally selective aromatic L-amino acid decarboxylase (AAAD) inhibitor like carbidopa or benserazide. Levodopa is taken by mouth, by inhalation, through an intestinal tube, or by administration into fat.

<span class="mw-page-title-main">Carbidopa/levodopa/entacapone</span> Anti Parkinson medicine

Carbidopa/levodopa/entacapone, sold under the brand name Stalevo among others, is a dopaminergic fixed-dose combination medication that contains carbidopa, levodopa, and entacapone for the treatment of Parkinson's disease.

Aromatic <small>L</small>-amino acid decarboxylase inhibitor

An aromatic L-amino acid decarboxylase inhibitor (synonyms: DOPA decarboxylase inhibitor, extracerebral decarboxylase inhibitor, DDCI and AAADI) is a medication of type enzyme inhibitor which inhibits the synthesis of dopamine by the enzyme aromatic L-amino acid decarboxylase (AADC, AAAD, or DOPA decarboxylase). It is used to inhibit the decarboxylation of L-DOPA to dopamine outside the brain, i.e. in the blood. This is primarily co-administered with L-DOPA to combat Parkinson's disease. Administration can prevent common side-effects, such as nausea and vomiting, as a result of interaction with D2 receptors in the vomiting center (or cheomoreceptor trigger zone) located outside the blood–brain barrier.

<span class="mw-page-title-main">Parkinson's disease</span> Long-term neurodegenerative disease

Parkinson's disease (PD), or simply Parkinson's, is a neurodegenerative disease of mainly the central nervous system that affects both the motor and non-motor systems of the body. The symptoms usually emerge slowly, and, as the disease progresses, non-motor symptoms become more common. Usual symptoms include tremors, slowness of movement, rigidity, and difficulty with balance, collectively known as parkinsonism. Parkinson's disease dementia, falls and neuropsychiatric problems such as sleep abnormalities, psychosis, mood swings, or behavioral changes may also arise in advanced stages.

3-<i>O</i>-Methyldopa Chemical compound

3-O-Methyldopa (3-OMD) is one of the most important metabolites of L-DOPA, a drug used in the treatment of the Parkinson's disease.

Peripherally selective drugs have their primary mechanism of action outside of the central nervous system (CNS), usually because they are excluded from the CNS by the blood–brain barrier. By being excluded from the CNS, drugs may act on the rest of the body without producing side-effects related to their effects on the brain or spinal cord. For example, most opioids cause sedation when given at a sufficiently high dose, but peripherally selective opioids can act on the rest of the body without entering the brain and are less likely to cause sedation. These peripherally selective opioids can be used as antidiarrheals, for instance loperamide (Imodium).

<span class="mw-page-title-main">Opicapone</span> Chemical compound

Opicapone, sold under the brand name Ongentys, is a medication which is administered together with levodopa in people with Parkinson's disease. Opicapone is a catechol-O-methyltransferase (COMT) inhibitor.

<span class="mw-page-title-main">Monoamine precursor</span>

Monoamine precursors are precursors of monoamines and monoamine neurotransmitters in the body. The amino acids L-tryptophan and L-5-hydroxytryptophan are precursors of serotonin and melatonin, while the amino acids L-phenylalanine, L-tyrosine, and L-DOPA (levodopa) are precursors of dopamine, epinephrine (adrenaline), and norepinephrine (noradrenaline).

Disorders of diminished motivation (DDM) are a group of disorders involving diminished motivation and associated emotions. Many different terms have been used to refer to diminished motivation. Often however, a spectrum is defined encompassing apathy, abulia, and akinetic mutism, with apathy the least severe and akinetic mutism the most extreme.

<span class="mw-page-title-main">Melevodopa/carbidopa</span> Combination dopaminergic medication

Melevodopa/carbidopa, sold under the brand name Sirio, is a combination of melevodopa, a prodrug of the dopamine precursor and hence non-selective dopamine receptor agonist levodopa (L-DOPA), and carbidopa, a peripherally selective aromatic L-amino acid decarboxylase (AAAD) inhibitor, which is used in the treatment of Parkinson's disease in Italy. It is taken orally in the form of tablets.

References

  1. "Entacapone improves motor fluctuations in levodopa-treated Parkinson's disease patients. Parkinson Study Group". Annals of Neurology. 42 (5): 747–755. Nov 1997. doi:10.1002/ana.410420511. ISSN   0364-5134. PMID   9392574. S2CID   975995.
  2. 1 2 Keating GM, Lyseng-Williamson KA (2005). "Tolcapone: a review of its use in the management of Parkinson's disease". CNS Drugs. 19 (2): 165–184. doi:10.2165/00023210-200519020-00006. PMID   15697329. The efficacy of tolcapone as an adjunct to levodopa in patients with Parkinson's disease has primarily been attributed to its ability to inhibit peripheral it is thought that tolcapone enters the CNS to a minimal extent only.[16] However, results [17] of a study in patients with Parkinson's disease, as well as results of animal studies,[18-21] suggest that tolcapone also has central activity.
  3. 1 2 3 Truong DD (2009). "Tolcapone: review of its pharmacology and use as adjunctive therapy in patients with Parkinson's disease". Clin Interv Aging. 4: 109–13. doi: 10.2147/cia.s3787 . PMC   2685232 . PMID   19503773. Tolcapone is a potent, selective and reversible inhibitor of COMT in the periphery.8 It also exerts COMT inhibition in the brain, but the relevance of this effect to its efficacy in PD is less clear.9 [...] Although tolcapone has been shown to inhibit central COMT, its clinical efficacy seems to be mainly mediated through inhibition of peripheral COMT and depends on concomitant use of exogenous levodopa.17
  4. Lang, Anthony E.; Connolly, Barbara S. (2014-04-23). "Pharmacological Treatment of Parkinson Disease: A Review". JAMA. 311 (16): 1670–1683. doi:10.1001/jama.2014.3654. ISSN   0098-7484. PMID   24756517.
  5. Olanow, C. Warren; Watkins, Paul B. (Sep 2007). "Tolcapone: an efficacy and safety review". Clinical Neuropharmacology. 30 (5): 287–294. doi:10.1097/wnf.0b013e318038d2b6. ISSN   0362-5664. PMID   17909307. S2CID   19148461.
  6. Scott, Lesley J. (2016-08-06). "Opicapone: A Review in Parkinson's Disease". Drugs. 76 (13): 1293–1300. doi:10.1007/s40265-016-0623-y. ISSN   0012-6667. PMID   27498199. S2CID   5787752.
  7. Watkins, P (2000). "COMT inhibitors and liver toxicity". Neurology. 55 (11 Suppl 4): S51-2. PMID   11147510.
  8. 1 2 "Research programme: COMT inhibitors (Alternative Names: AVTX-406; CERC 425; CERC-406)". AdisInsight. 28 January 2022. Retrieved 10 July 2024.
  9. "Prospectus Supplement No. 45" (PDF). May 11, 2018. Retrieved 10 July 2024. CERC-406 and CERC-425: Residual Motoric and Cognitive Impairment. CERC-406 and CERC-425 are preclinical candidates from our proprietary platform of compounds that inhibit catechol-O-methyltransferase, or COMT, within the brain, which we refer to as our COMTi platform. We believe they may have the potential to be developed for the treatment of residual cognitive impairment symptoms such as Parkinson's disease.
  10. 1 2 Finberg JP (April 2019). "Inhibitors of MAO-B and COMT: their effects on brain dopamine levels and uses in Parkinson's disease". J Neural Transm (Vienna). 126 (4): 433–448. doi:10.1007/s00702-018-1952-7. PMID   30386930. In accord with its ability to enhance CNS catecholamine levels, tolcapone has been shown to possess antidepressant-like behavioral effect in a rat model of chronic stress with production of an anhedonic state produced by self-stimulation of the ventral tegmental area (Moreau et al. 1994), but others, using a standard chronic stress test, found that antidepressant effect appeared only with a combination of COMT-I, l-DOPA and AAADC-I treatment (Mannisto et al. 1995). Tolcapone, and potentially other CNS-active COMTI, could theoretically be useful in treatment of both depressive and motor symptoms of PD, but further developmental work is necessary to establish this joint treatment.
  11. 1 2 Müller T, Kuhn W, Przuntek H (1993). "Therapy with central active catechol-O-methyltransferase (COMT)-inhibitors: is addition of monoamine oxidase (MAO)-inhibitors necessary to slow progress of neurodegenerative disorders?". J Neural Transm Gen Sect. 92 (2–3): 187–195. doi:10.1007/BF01244877. PMID   8369108.

[1]

  1. Govindasamy, Hunday; Magudeeswaran, Sivanandam; Poomani, Kumaradhas (2020-12-11). "Identification of novel flavonoid inhibitor of Catechol-O-Methyltransferase enzyme by molecular screening, quantum mechanics/molecular mechanics and molecular dynamics simulations". Journal of Biomolecular Structure and Dynamics. 38 (18): 5307–5319. doi:10.1080/07391102.2019.1699446. ISSN   0739-1102. PMID   31779524. S2CID   208356889.