Pathophysiological aspects of diversity in neuronal inhibition: a new benzodiazepine pharmacology.
Inhibitory interneurons in the brain provide the balance to excitatory signaling. On the basis of brain imaging and human genetics, a deficit in GABAergic inhibition (GABA, γ-aminobuiyric acid) has been identified as contributing to the pathophysiology of anxiety disorders, epilepsy, and schizophrenia. Therapeutically, GABA(A) receptors play a major role as targets for benzodiazepine drugs. The therapeutic relevance of the multitude of structurally diverse GABA(A) receptor subtypes has only recently been identified. α(1)-GABA(A) receptors were found to mediate sedation, anterograde amnesia, and part of the seizure protection of these drugs, whereas α(2)-GABA(A) receptors, but not α(3)-GABA(A) receptors, mediate anxiolysis. Rational drug targeting to specific receptor subtypes has now become possible. Only restricted neuronal networks will be modulated by the upcoming subtype-selective drugs. For instance, anxiolytics devoid of drowsiness and sedation promise more sophisticated interventions in anxiety disorders. A new pharmacology of the benzodiazepine site is on the horizon.
Institute of Pharmacology and Toxicology, University of Zurich and Department of Applied Biosciences, Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.
Hanns
H
Möhler