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Nicotine Drugs Hold Promise for Treating Neurological Disease Alzheimer's patients may benefit, scientists say Carl T. Hall, Chronicle Science Writer |
Tuesday, February 22, 2000
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Washington -- Nicotine drugs and skin patches are starting to show remarkable promise in treating neurological diseases that conventional medicines cannot touch, scientists reported yesterday. In one of the more extraordinary twists in modern medicine, the addictive agent in cigarettes -- in patch or gum form to avoid the obvious health risks of smoking -- is now being given in pilot studies to Alzheimer's patients to improve mental prowess and to Parkinson's sufferers to improve motor ability. Nicotine and similar drugs in the same chemical class are also being tested for chronic pain problems, obsessive-compulsive disorder, schizophrenia and cocaine addiction. In some cases, experts say nicotine might even protect precious brain cells whose death causes symptoms in Parkinson's, Alzheimer's and other neurodegenerative diseases. TOURETTE'S SYNDROMEThose studies are all in the early stages, with approved uses many years away. But in at least one case -- Tourette's syndrome -- a treatment could be available as soon as April, if the U.S. Food and Drug Administration approves. Scientists outlined this emerging story of nicotine-as-medicine yesterday at the annual meeting of the American Association for the Advancement of Science. Dr. Paul Sanberg of the University of South Florida, part of a panel of top nicotine experts, reported that the research into nicotine's usefulness for Tourette's had the unexpected result of resurrecting a 1950s- era drug for high blood pressure. The drug, known generically as mecamylamine, appears to give Tourette's sufferers the same relief as nicotine, with fewer side effects. Drugmaker Merck & Co. once sold mecamylamine under the brand name Inversine, and it is still listed as an approved treatment for hypertension in the United States. However, the company stopped making it in the 1970s when more effective blood-pressure drugs were introduced. Known as a nicotinic antagonist, mecamylamine effectively blocks the short-term molecular effects of nicotine, which binds to certain receptor molecules in the brain. Paradoxically, the antagonist drug turns out to have some of the same long-term neurological effects as nicotine, which also shuts down its own receptors in the brain. Sanberg was searching desperately for something to help patients with Tourette's, a condition affecting about 100,000 people in America, marked by facial tics and virtually uncontrollable movements and vocalizations. Symptoms typically arise in childhood, often accompanied by behavioral and other problems that can persist long into adulthood. Scientific investigations pointed to nicotine as a possible therapy because of the peculiar brain chemistry involved. Sanberg first tested nicotine gum, but his youthful patients did not like the bitter taste and had difficulty chewing it correctly. Later, when anti-smoking nicotine skin patches hit the market, Sanberg tried again, but found that the side effects -- nausea and occasional vomiting -- outweighed the benefits. Eventually, he discovered that mecamylamine could achieve the same or even better results as nicotine patches. Most importantly, ``side effects were really minimal,'' Sanberg said. `DON'T SMOKE'Experts at the conference took pains yesterday to emphasize the health risks of nicotine by traditional delivery methods -- cigarettes, chewing tobacco or cigars. ``Don't smoke,'' said Dr. Edward Levin of Duke University, noting that tobacco smoke contains some 4,000 chemicals of which nicotine is only one. The future for medicinal nicotine, however, could be promising. Layton Bioscience Inc., a small biotechnology company based in Sunnyvale, acquired marketing rights to the drug in March 1988 from Merck, which had no interest in pursuing the project on its own given the small size of the market. Layton hopes to win U.S. Food and Drug Administration approval by March 29, which would allow the company to reintroduce the product. Doctors could then prescribe it for any condition they choose, including for Tourette's syndrome. Detailed results of the latest clinical studies are awaiting publication in a medical journal. Based on further studies, meanwhile, Layton eventually plans to seek formal approval for mecamylamine as a Tourette's drug. Other drugs that both block and mimic nicotine are being developed and could also be on the market within a few years.
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