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Cholecystokinin and Psychiatric Disorders

Role in Aetiology and Potential of Receptor Antagonists in Therapy

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  • Pharmacology and Pathophysiology
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Summary

Cholecystokinin (CCK) is one of the most abundant neuropeptides in the brain. It is found in the highest levels in cortical and limbic structures and also in the basal ganglia. Two subtypes of CCK receptors have been described in the brain and gastrointestinal tissues. CCKA (alimentary subtype) receptors are mainly located in the gastrointestinal tract, regulating secretion of enzymes from the pancreas and emptying of the gallbladder. However, CCKA receptors are also found in several brain regions, with the highest densities in structures poorly protected by the haematoencephalic barrier (the area postrema, nucleus tractus solitarius and hypothalamus). The distribution of CCKB (brain subtype) receptors overlaps with the localisation of CCK and its mRNA in different brain areas, with the highest densities in the cerebral cortex, basal ganglia, nucleus accumbens and forebrain limbic structures.

Both subtype of CCK receptor belong to the guanine nucleotide-binding protein-(G protein)-linked receptor superfamily containing 7 transmembrane domains. Signal transduction at CCK receptors is mediated via Gq protein-related activation of phospholipase C and the formation of inositol 1,4,5-triphosphate (IP3) and 1,2-diacylglycerol (DAG). Recent cloning of CCKA and CCKB receptors has shown that mRNA for both receptors is distributed in the same tissues as established in radioligand binding and receptor autoradiography studies, with few exceptions.

The existence of multiple CCK receptors has fuelled the development of selective CCKA and CCKB receptor antagonists. These antagonists belong to distinct chemical groups, including dibutyryl derivatives of cyclic nucleotides, amino acid derivatives, partial sequences and derivatives of the -COOH terminal sequence heptapeptides of CCK, benzodiazepine derivatives, ‘peptoids’ based on fragments of the CCK molecule, and pyrazolidinones. At the present time, the compounds of choice for blockade of the CCKA receptor are lorglumide, devazepide and lintitript (SR27897). L-365,260, CI-988, L-740,093 and LY288513 are the drugs most widely used to block CCKB receptors.

Studies with CCK antagonists (and agonists) in animals and humans suggest a role for CCK in the regulation of anxiety and panic. The administration of CCK agonists [ceruletide (caerulein), CCK-4, pentagastrin] has an anxiogenic action in various animal models and in different animal species. However, the anxiogenic action of CCK agonists is restricted to nonconditioned (ethological) models of anxiety, with very limited activity in the ‘classical’ conditioned models. Pharmacological studies have revealed that CCKB receptors are the key targets in the anxiogenic action of CCK agonists. Nevertheless, CCKB antagonists displayed very little activity, if any at all, in these models, but strongly antagonised the effects of CCKB agonists. The anxiogenic/panicogenic action of CCKB agonists (CCK-4, pentagastrin) is even more pronounced in human studies, but the effectiveness of CCKB antagonists as anxiolytics remains unclear. Clinical trials performed to date have provided inconclusive data about the anxiolytic potential of CCKB receptor antagonists, probably because of limiting pharmacokinetic factors.

The results of some animal experiments suggest a role for CCK in depression. The administration of CCKB antagonists causes antidepressant-like action in mouse models of depression. However, human studies replicating this result have yet to be carried out.

A prominent biochemical alteration in schizophrenia is a reduction of CCK levels in the cerebral cortex. This change may be related to the loss of cortical neurons, due to the schizophrenic process itself. In animal studies (mainly in mice), administration of CCK agonists and antagonists has been shown to be effective in several models, reflecting a possible antipsychotic activity of these drugs. However, the data obtained in human studies suggest that CCK agonists and antagonists do not improve the symptoms of schizophrenia. Taking into account the reduced levels of CCK and its receptors found in schizophrenia, treatments increasing, but not blocking, brain CCK activity may be more appropriate.

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Authors and Affiliations

  1. Department of Psychiatry, University of Tartu, Tartu, Estonia

    Jakov Shlik

  2. Department of Physiology, University of Tartu, Tartu, Estonia

    Eero Vasar

  3. Psychobiology and Clinical Trials Research Unit in Anxiety, Clarke Institute of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada

    Jacques Bradwejn

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Shlik, J., Vasar, E. & Bradwejn, J. Cholecystokinin and Psychiatric Disorders. CNS Drugs 8, 134–152 (1997). https://doi.org/10.2165/00023210-199708020-00005

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