The future potential for cocaine vaccines.
BACKGROUND
Addiction to cocaine is a major problem around the world, but especially in developed countries where the combination of wealth and user demand has created terrible social problems. Although only some users become truly addicted, those who are often succumb to a downward spiral in their lives from which it is very difficult to escape. From the medical perspective, the lack of effective and safe, non-addictive therapeutics has instigated efforts to develop alternative approaches for treatment, including anticocaine vaccines designed to block cocaine's pharmacodynamic effects.


METHODS
This paper discusses the implications of cocaine pharmacokinetics for robust vaccine antibody responses, the results of human vaccine clinical trials, new developments in animal models for vaccine evaluation, alternative vaccine formulations and complementary therapy to enhance anticocaine effectiveness.


CONCLUSIONS
Robust anti-cocaine antibody responses are required for benefit to cocaine abusers, but since any reasonably achievable antibody level can be overcome with higher drug doses, sufficient motivation to discontinue use is also essential so that the relative barrier to cocaine effects will be appropriate for each individual. Combining a vaccine with achievable levels of an enzyme to hydrolyze cocaine to inactive metabolites, however, may substantially increase the blockade and improve treatment outcomes.
Center for Translational Research in Inflammatory Diseases, Baylor College of Medicine, Department of Medicine , Bldg. 109, Rm. 234, 2002 Holcombe Blvd, Houston, TX 77030 , USA +1 713 794 7960 ; +1 713 794 7938 ; forson@bcm.edu.
Frank M
FM
Orson
Rongfu
R
Wang
Stephen
S
Brimijoin
Berma M
BM
Kinsey
Rana Ak
RA
Singh
Muthu
M
Ramakrishnan
Helen Y
HY
Wang
Thomas R
TR
Kosten
D000818:Animals; D000906:Antibodies / Q000378:metabolism; D002986:Clinical Trials as Topic; D003042:Cocaine / Q000276:immunology* / Q000493:pharmacokinetics; D019970:Cocaine-Related Disorders / Q000276:immunology / Q000628:therapy*; D006801:Humans; D007167:Immunotherapy / Q000379:methods / Q000639:trends*; D011485:Protein Binding; D014612:Vaccines / Q000627:therapeutic use*
D000906:Antibodies; D014612:Vaccines; D003042:Cocaine
addiction; adjuvant; antibody; butyrylcholinesterase; cocaine; gene therapy; hydrolase; vaccine