The risk of relapse is greatest for certain groups with substance abuse disorders such as those battling the vulnerable periods after detoxification. For such at-risk patients, immunotherapy may prove to be significantly effective for the treatment of substance abuse in the future.
These conclusions are based on the findings of a new experimental study conducted at the Norwegian Institute of Public Health. The study explored the potentiality of a specific antibody to reduce the acute effects of heroin.
Immunotherapy is a treatment specifically designed to employ the ability of the body’s immune system to fight infection or disease. Such therapy might produce either an immune response to the disease or enhance the immune system’s resistance to active diseases such as cancer. Immunotherapy often makes use of elements referred to as biological response modifiers (BRMs). The body usually produces only small amounts of these substances in response to infection or disease, but in the laboratory, large amounts of these BRMs can be generated to provide therapy for cancer, rheumatoid arthritis and other diseases.
Researchers investigated the potential of a monoclonal antibody to block heroin’s effects. Heroin is itself known to have a minor intoxicant effect, but it is the metabolism of heroin by the body that causes the intoxicant effect.
“Designing a vaccine against heroin is particularly challenging since heroin is converted rapidly to several substances,” said Inger Lise Bogen, a researcher at the Department of Drug Research and Method Development.
Previous studies illustrated heroin’s first metabolite, 6-MAM (6-monoacetylmorphine), to cause rapid and intense heroin effects. Researchers further discovered the conversion of heroin to 6-MAM to occur primarily in the bloodstream, before the drug reached the brain. Based on this, the researchers continued to investigate the potential of binding antibodies to 6-MAM to prevent heroin’s intoxicant effects.
Such potential of immunotherapy was first investigated in the 1970s. The introduction and availability of methadone and buprenorphine, however, put a halt to the investigation. Recent years have witnessed a rising interest in drug vaccines. Several attempts have been made to create vaccines for heroin, morphine, cocaine, methamphetamine, nicotine and oxycodone, but only the vaccines against cocaine and nicotine have made it to human testing.
Drug vaccines can be categorized into passive vaccines (including the use of pre-formed antibodies) and active vaccines (stimulating the immune system to produce antibodies). The antibodies circulate in the blood and bind to the drug upon intake. Due to antibodies being too big to cross the blood-brain barrier, the bound substance is unable to reach the brain and as a consequence, limits the drug’s effect. It was also shown that an antibody given after intake of a drug could reduce the risk of death from overdose.
In animal studies, researchers were able to confirm a clear relationship between the amount of 6-MAM antibody supplied, the blocked transmission of 6-MAM to the brain and fewer heroin effects. The results suggested future vaccines against heroin to be targeted towards 6-MAM.
Bogen, however, added that “drug vaccines will not be a simple solution to treat substance abuse but can be a useful supplement to existing treatment.” The results derived from animal studies looked promising. However, extensive research and development is required for human testing.
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