Anticonvulsant efficacy of the low-affinity partial benzodiazepine receptor agonist ELB 138 in a dog seizure model and in epileptic dogs with spontaneously recurrent seizures.
OBJECTIVE
Ataxia, sedation, amnesia, ethanol and barbiturate potentiation, loss of efficacy (tolerance), development of dependence, and the potential for drug abuse limit the clinical use of benzodiazepines (BZDs) for long-term treatment of epilepsy or anxiety. BZD ligands that are in current use act as full allosteric modulators of gamma-aminobutyric acid (GABA)-gated chloride channels and, on long-term administration, trigger a functional uncoupling between the GABAA and BZD recognition sites. Partial allosteric modulators, which have a low intrinsic activity at the BZD recognition site of the GABAA receptor, might eventually overcome the limitations of full agonists such as diazepam (DZP).


METHODS
In the present study, the new low-affinity partial BZD-receptor agonist ELB 138 [former name AWD 131-138; 1-(4-chlorophenyl)-4-morpholino-imidazolin-2-one] was evaluated in a dog seizure model and in epileptic dogs with spontaneously recurrent seizures.


RESULTS
ELB 138 was shown to increase potently the pentylenetetrazole (PTZ) seizure threshold in dogs. Prolonged oral administration with twice-daily dosing of ELB 138 with either 5 or 40 mg/kg over a 5-week period was not associated with loss of anticonvulsant efficacy in the PTZ dog model. To study whether physical dependence developed during long-term treatment, the BZD antagonist flumazenil was injected after 5 weeks of treatment with ELB 138. Compared with prolonged treatment with DZP, only relatively mild abstinence symptoms were precipitated in dogs treated with ELB 138, particularly at the lower dosage (5 mg/kg, b.i.d.). In a prospective trial in dogs with newly diagnosed epilepsy, ELB 138 markedly reduced seizure frequency and severity without significant difference to standard treatments (phenobarbital or primidone) but was much better tolerated than the standard drugs. In dogs with chronic epilepsy, most dogs exhibited a reduction in seizure frequency and severity during add-on treatment with ELB 138.


CONCLUSIONS
The data demonstrate that the partial BZD receptor agonist ELB 138 exerts significant anticonvulsant efficacy without tolerance in a dog seizure model as well as in epileptic dogs with spontaneously recurrent seizures. These data thus substantiate that partial agonism at the BZD site of GABAA receptors offers advantages versus full agonism and constitutes a valuable approach for treatment of seizures.
Löscher
Wolfgang
W
Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany. wolfgang.loescher@tiho-hannover.de
Potschka
Heidrun
H
Rieck
Susanne
S
Tipold
Andrea
A
Rundfeldt
Chris
C
D000818:Animals; D000927:Anticonvulsants / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D001965:Bromides / Q000627:therapeutic use; D002908:Chronic Disease; D004195:Disease Models, Animal; D004283:Dog Diseases / Q000517:prevention & control; D004285:Dogs; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000517:prevention & control / Q000662:veterinary; D005442:Flumazenil / Q000009:adverse effects / Q000494:pharmacology; D018755:GABA Agonists / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D058785:GABA-A Receptor Agonists; D007093:Imidazoles / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D010433:Pentylenetetrazole; D010634:Phenobarbital / Q000627:therapeutic use; D017680:Potassium Compounds / Q000627:therapeutic use; D011324:Primidone / Q000627:therapeutic use; D011963:Receptors, GABA-A / Q000187:drug effects; D012640:Seizures / Q000139:chemically induced / Q000517:prevention & control* / Q000662:veterinary; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
C116306:AWD 131-138; D000927:Anticonvulsants; D001965:Bromides; D018755:GABA Agonists; D058785:GABA-A Receptor Agonists; D007093:Imidazoles; D017680:Potassium Compounds; D011963:Receptors, GABA-A; D011324:Primidone; D005442:Flumazenil; C039004:potassium bromide; D010433:Pentylenetetrazole; D010634:Phenobarbital