phasic inhibition: nootropics and compounds | sci-wiki

Alfaxalone

Alfaxalone (also spelled alphaxalone) is a synthetic neuroactive steroid of the pregnane class that produces general anesthesia by acting as a positive allosteric modulator (a molecule that amplifies a receptor's response to its own neurotransmitter) at the GABA-A receptor, the principal inhibitory ion channel of the central nervous system. First introduced in 1971 as the main active component of the intravenous anesthetics Althesin (human) and Saffan (veterinary), it was withdrawn from human use in the 1980s because the solubilizing vehicle Cremophor EL provoked anaphylactoid reactions, then reintroduced in a cyclodextrin formulation marketed for veterinary anesthesia as Alfaxan. Because it lacks classical hormonal activity yet retains rapid, non-cumulative central depressant effects, alfaxalone occupies a distinct pharmacological niche among intravenous anesthetics and now serves as a template for a new generation of water-soluble neurosteroid sedatives such as Phaxan.

reference

Anticonvulsant

Ganaxolone

Ganaxolone (research code CCD-1042; brand name Ztalmy) is a synthetic neuroactive steroid, specifically the 3-beta-methyl analog of the endogenous neurosteroid allopregnanolone (a metabolite of progesterone). It is a positive allosteric modulator (a molecule that amplifies a receptor's response to its natural activator) of the GABA-A receptor, the brain's principal inhibitory chloride channel, and it enhances both synaptic (phasic) and extrasynaptic (tonic) inhibition, with particularly strong activity at delta-subunit-containing receptors. In March 2022 it became the first medicine approved by the United States Food and Drug Administration for seizures associated with CDKL5 deficiency disorder (a rare genetic developmental and epileptic encephalopathy caused by mutations in the cyclin-dependent kinase-like 5 gene), and the first synthetic neurosteroid approved as an anticonvulsant. The defining 3-beta-methyl group makes ganaxolone orally bioavailable, metabolically stable, and non-hormonal, distinguishing it from its parent neurosteroid, which requires intravenous administration.

reference

Neurosteroid

SAGE-324

SAGE-324 (also designated BIIB124) is an investigational, orally bioavailable synthetic neuroactive steroid that acts as a positive allosteric modulator (a compound that amplifies a receptor's response to its natural signal) of GABA-A receptors (the brain's principal inhibitory chloride ion channels). Developed on the Sage Therapeutics neuroactive-steroid platform and co-developed with Biogen, it is a next-generation analog engineered for a long duration of action suitable for once-daily oral dosing, distinguishing it from the intravenous and short-acting neurosteroids that preceded it. Its lead clinical indication is essential tremor (a common movement disorder marked by rhythmic shaking of the hands and arms), where the randomized Phase 2 KINETIC trial met its primary endpoint; it has also been explored in the context of epilepsy. As a synthetic congener within the same chemical lineage as brexanolone and zuranolone, SAGE-324 represents an effort to translate the potent inhibitory pharmacology of endogenous neurosteroids into a chronically dosable oral therapeutic.

reference

Neurosteroid

THDOC

THDOC (3-alpha,5-alpha-tetrahydrodeoxycorticosterone) is an endogenous neurosteroid (a steroid that acts rapidly on neuronal membrane receptors rather than on classical nuclear hormone receptors) and the fully reduced 3-alpha,5-alpha metabolite of the adrenal steroid deoxycorticosterone. It is one of the most potent naturally occurring positive allosteric modulators (compounds that amplify a receptor's response to its own transmitter) of the GABA-A receptor, the brain's principal inhibitory chloride ion channel, where it enhances both fast synaptic and sustained extrasynaptic inhibition. Because its synthesis is driven by adrenocorticotropic hormone and by acute stress, THDOC is regarded as a stress-responsive inhibitory neurosteroid that provides negative feedback on the hypothalamic-pituitary-adrenal axis and transiently raises the seizure threshold. Alongside allopregnanolone, it is a prototypical member of the stress-derived GABAergic neurosteroid family.

reference