GABAA receptor positive allosteric modulator

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GABAA Receptor Positive Allosteric Modulator

Structure of gamma-aminobutyric acid (GABA)

GABAA receptor positive allosteric modulators are a class of drugs that enhance the activity of the GABAA receptor, a type of ligand-gated ion channel in the central nervous system. These modulators do not activate the receptor directly but increase the receptor's response to the neurotransmitter gamma-aminobutyric acid (GABA).

Mechanism of Action

Structure of a GABAA receptor

GABAA receptors are pentameric complexes composed of various subunits, typically including alpha (α), beta (β), and gamma (γ) subunits. Positive allosteric modulators bind to specific sites on the receptor, distinct from the GABA binding site, and enhance the receptor's response to GABA. This results in increased chloride ion conductance through the receptor channel, leading to hyperpolarization of the neuron and a decrease in neuronal excitability.

Types of Positive Allosteric Modulators

Benzodiazepines

Synthesis and discovery of chlordiazepoxide, the first benzodiazepine

Benzodiazepines are a well-known class of GABAA receptor positive allosteric modulators. They bind to the benzodiazepine site on the GABAA receptor and enhance the effect of GABA. Common benzodiazepines include diazepam, lorazepam, and alprazolam.

Barbiturates

Original synthesis of barbituric acid
Current synthesis of barbituric acid

Barbiturates are another class of positive allosteric modulators that act on the GABAA receptor. They have a broader range of effects compared to benzodiazepines and can directly activate the receptor at high concentrations. Examples include phenobarbital and thiopental.

Neurosteroids

Neurosteroids such as allopregnanolone and tetrahydrodeoxycorticosterone (THDOC) are endogenous modulators of the GABAA receptor. They bind to distinct sites on the receptor and modulate its activity.

Clinical Uses

GABAA receptor positive allosteric modulators are used in the treatment of various conditions, including:

Side Effects

Common side effects of these modulators include drowsiness, dizziness, and cognitive impairment. Long-term use can lead to tolerance and dependence.

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Contributors: Prab R. Tumpati, MD