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CH2CH-NH2 CH2CH2NH2
COOH
HN N HN N
Histidine Histamine
L-histidine decarboxylase
Synthesized by decarboxylation of histidine
Important role in
Allergic reactions
Regulation of Gastric acidity
Physiologic effects of Histamine
Effects of intradermal injection of histamine
“Triple response”:
“Triple response”:
Enterochromaffin-like
cells in the Gastric mucosa
Histaminergic neurons Continuous release of
in the CNS histamine –
rapid turnover
Regenerating or
rapidly growing tissues
Histamine is metabolized by methylation
and oxidation and secreted in the urine
CH2CH2NH2
HN N
Histamine CH2CH2NH2
N-M CH3N N
ethy
ltra
nsfe
rase N-Methylhistamine
CH2COOH
Mo
noami CH3N N
ne O
xida
s e BN-Methylimidazole
Acetic Acid
CH2CH2NH2
CH3N N
N-Methylhistamine
FcεRI
IgE
Mast cell
What clinical conditions result from
type-1 hypersensitivity?
Hay fever
Initial phase of asthma
Urticaria
Anapylactic shock
Hypersensitivity responses to some drugs
CH3
2-methylhistamine 4(5)-methylhistamine (R)-α-methylhistamine
Brain
Histamine receptors and the effects they mediate
in various organs
CH2CH2NH2
HN N
Histamine
H1 Antagonists
CH3
Cl
O
N C 2nd generation
OC2H5
N
Loratadine
First Generation H1 Antagonists
(Diphenhydramine, Mepyramine)
CH3
CH3
HO CH CH2
+
H3C CH CH CH2 N CH3
O
CH3
Muscarine
Second Generation H1 Antagonists
(Cetirizine, Loratadine Fexofenadine)
Well absorbed
Fewer side effects
Do not cross the blood brain barrier - nonsedating
No antimuscarinic activity - no atropine-like effects
Older drugs (Astemizole, Terfenadine) sometimes
induced fatal arrhythmia, and were withdrawn
from the market
The newer drugs (Loratadine, Fexofenadine) do not
have this side effect.
Fexofenadine is the safer, active metabolite
of Terfenadine
Ketoconazole
OH
C(CH3) 3
Macrolide antibiotics
HO C N CH2CH2CH2CH
Grapefruit juice
Terfenadine
Cyp3A4
OH CH3
HO C N CH2CH2CH2CH C COOH
CH3
Fexofenadine
Therapeutic uses of H1 antagonists
a. Antihistamine
b. Adrenaline
Relative potency
1 Cimetidine
4-10x Ranitidine
20-50x Famotidine
4-10x Nizatidine
H2 Receptor Antagonists
H2 Receptor Antagonists
HO
CH2 CH2NH2
In Periphery
Peristalsis
Vomiting
Functions Regulated by 5-HT
In Periphery
Peristalsis
Vomiting
Platelet aggregation, haemostasis
Microvascular control
Functions Regulated by 5-HT
In Periphery
Peristalsis
Vomiting
Platelet aggregation, haemostasis
Microvascular control
Sensitization of nociceptors (pain,
itch)
Inflammatory mediator
Functions Regulated by 5-HT
In Periphery In CNS
Peristalsis Control of appetite
Vomiting Sleep
Platelet aggregation, haemostasis Mood
Synthesis Reuptake
Enterochromaffin cells
+
Platelets
+
Neurons
+ +
5-HT Synthsized from tryptophan by a pathway
analogous to catecholamine synthesis
COOH Tr
hy ypto
CH2CH dr ph
ox
NH2 yla an
N se
H L-
ar
Tryptophan COOH de om
ca ati
rb
ox c aci
HO
CH2CH
yla d
N
NH2 se
H
5-hydroxytryptophan HO
CH2 CH2NH2
N
H
5-hydroxytryptamine
5-HT is degraded by oxidative deamination -
analogous to Noradrenaline metabolism
M
on
HO
CH2 CH2NH2 Ox oam
ida ine
N
se
H
5-hydroxytryptamine de Alde
hy
HO dr hyde
CH2 CHO og
en
ase
N
H
HO
CH2 COOH
N
H
5-hydroxyindoleacetic acid
(5-HIAA)
The level of 5-HIAA in urine is an indicator of
the rate of 5-HT production in body
N
H
5-hydroxyindoleacetic acid
(5-HIAA)
Carcinoid syndrome
Malignant tumor of enterochromafin cells,
arising in the small intestine and
metastasizing to the liver
Tumor may secrete mediators such as 5-HT
Symptoms include flushing, diarrhoea
bronchoconstrictions, and hypotension, and
sometimes stenosis of heart valves.
Treated with 5-HT2A antagonists
5-HT Receptors -a complex picture
1D ??????!
1B
1A
6 2C
5
4
2B
2A
7 3
5-HT Receptors
5-HT Receptors
More 5-HT Receptors
Still more 5-HT Receptors
Roles of 5-HT in GI tract
CNS Excitation
Inhibition
Presynaptic inhibition of neurotransmitter release
Sleep/Wake Cycle
Aggression and Impulsivity
Anxiety and Depression
Cognition
Sensory Perception
Motor Activity
Temperature Regulation
Nociception
Appetite
Sexual Behavior
Hormone Secretion
5-HT = 5-Hydroxytryptamine = Serotonin
HO
CH2 CH2NH2
N
H
5-hydroxytryptamine
Today known to be involved in many disorders including:
carcinoid syndrome
mood disorders (depression, mania, anxiety)
digestive disorders
(irritable bowel syndrome and acid reflux disorder)
vascular disorders
migraine
The complex (poorly understood, but convincing)
role of 5-HT in many diseases
Act on:
5-HT receptors
adrenoreceptors
dopamine receptor
stimulate smooth muscle
no clear structure/function relationship
Some of the ergot alkaloids have been isolated and are
clinically useful
Structure of ergot alkaloids
Ergotamine
Antagonist/partial agonist at α-adrenergic receptors and
partial agonist at 5-HT1D receptors
– also stimulates smooth muscle
Effective if given early during a migraine attack
Often combined with caffeine, to increase absorption when
given orally
Side effects:
When taken repeatedly, induces long lasting and cumulative
vasoconstriction, which may result in gangrene
=> patient must be well informed as to maxium dose
per attack and per week
may cause uterine contraction => contraindicated in
Methysergide
Weak agonist at α-adrenergic and dopamine receptors
and antagonist/partial agonist at 5-HT2 receptors
Used for prophylaxis of migraine
but ineffective in the treatment of an impending or
active migraine
Lacks cumulative vasospastic toxicity seen with
ergotamine
Chronic use may induce retroperitoneal fibroplasia
and subendocardial fibrosis
=> must go off the drug periodically
Side effects: nausea, vomiting and diarrhea