Topic: orexin

A Double-Blind Randomized Controlled Trial of Daridorexant for Alcohol Use Disorder

Project Summary/Abstract This R01 application proposes integrating a randomized, double-blinded, placebo-controlled clinical trial into a real-world treatment setting to test whether the dual orexin receptor antagonist (DORA) daridorexant reduces alcohol craving and use and improves total sleep time among patients with alcohol use disorder (AUD) and co-occurring sleep disturbance. DORAs have shown promise in modulating reward and reducing alcohol self- administration in preclinical models. Further, DORAs are FDA-approved for insomnia, are highly efficacious for treatment of sleep disturbance, have a favorable safety profile, and demonstrate low abuse liability. Thus, DORAs are a highly promising treatment for AUD, particularly among persons that have co-occurring sleep disturbance. To this end, the proposed study will recruit individuals from a residential treatment facility, following completion of medically managed withdrawal and stabilization. Eligible participants will be randomized to daridorexant to placebo, and will complete measures of alcohol craving, total sleep time (assessed through both wireless electroencephalography and biometric data collection), and adverse events. Following discharge from residential treatment, participants will continue taking the study medication for two weeks while submitting daily reports of alcohol use, alcohol craving, sleep diaries, and biometric sleep data. Participants will also be prompted to submit three-times weekly random breath alcohol level using a portable BACtrack S80 breathalyzer, and will attend weekly check-in visits to assess adverse events and to confirm daily alcohol reports. A one-month follow-up assessment will be conducted to collect long-term data on alcohol use, AUD symptoms, and sleep. Ultimately, this study has the potential to identify a novel treatment for co- occurring AUD and sleep disturbance, and will address the following specific aims: (1) Test whether daridorexant reduces alcohol craving and post-treatment alcohol use relative to placebo. (2) Test whether daridorexant improves objectively measured total sleep time relative to placebo. (3) Examine the frequency of adverse events in persons assigned to daridorexant relative to placebo. If these aims are supported, then we will also explore whether effects are moderated by insomnia severity. We will also examine if the effects replicate across residential environments (with structured sleep/wake times and close monitoring of medication adherence) and outpatient environments (with self-imposed sleep/wake times and self-dosing). Currently, there are no FDA approved medications indicated for both AUD and insomnia. This innovative strategy aims to address a critical gap by investigating the effectiveness of daridorexant in modulating alcohol craving and alcohol use. This study will contribute to a growing literature on the role of the orexin system in reward and alcohol use.

Neuromodulation of sleep integrity

The arousal construct underlies a spectrum of behaviors that include sleep, exploration, feeding, sexual activity and adaptive stress. Pathological arousal conditions include stress, anxiety disorders, and addiction. The dynamics between arousal state transitions are modulated by norepinephrine neurons in the locus coeruleus, histaminergic neurons in the hypothalamus, dopaminergic neurons in the mesencephalon and cholinergic neurons in the basal forebrain. The hypocretin/orexin system in the lateral hypothalamus I will also present a new mechanism underlying sleep fragmentation during aging. Hcrt neurons are hyperexcitable in aged mice. We identify a potassium conductance known as the M-current, as a critical player in maintaining excitability of Hcrt neurons. Genetic disruption of KCNQ channels in Hcrt neurons of young animals results in sleep fragmentation. In contrast, treatment of aged animals with a KCNQ channel opener restores sleep/wake architecture. These data point to multiple circuits modulating sleep integrity across lifespan.

Mechanisms of sleep-seizure interactions in tuberous sclerosis and other mTORpathies

An intriguing, relatively unexplored therapeutic avenue to investigate epilepsy is the interaction of sleep mechanisms and seizures. Multiple lines of clinical observations suggest a strong, bi-directional relationship between epilepsy and sleep. Epilepsy and sleep disorders are common comorbidities. Seizures occur more commonly in sleep in many types of epilepsy, and in turn, seizures can cause disrupted sleep. Sudden unexplained death in epilepsy (SUDEP) is strongly associated with sleep. The biological mechanisms underlying this relationship between seizures and sleep are poorly understood, but if better delineated, could offer novel therapeutic approaches to treating both epilepsy and sleep disorders. In this presentation, I will explore this sleep-seizure relationship in mouse models of epilepsy. First, I will present general approaches for performing detailed longitudinal sleep and vigilance state analysis in mice, including pre-weanling neonatal mice. I will then discuss recent data from my laboratory demonstrating an abnormal sleep phenotype in a mouse model of the genetic epilepsy, tuberous sclerosis complex (TSC), and its relationship to seizures. The potential mechanistic basis of sleep abnormalities and sleep-seizure interactions in this TSC model will be investigated, focusing on the role of the mechanistic target of rapamycin (mTOR) pathway and hypothalamic orexin, with potential therapeutic applications of mTOR inhibitors and orexin antagonists. Finally, similar sleep-seizure interactions and mechanisms will be extended to models of acquired epilepsy due to status epilepticus-related brain injury.

The role of orexin/hypocretin in social behaviour

My lab is focused on how brain encodes and modulates social interactions. Intraspecific social interactions are integral for survival and maintenance of society among all mammalian species. Despite the importance of social interactions, we lack a complete understanding of the brain circuitry involved in processing social behaviour. My lab investigates how the hypothalamic orexin (hypocretin) neurons and their downstream circuits participate in social interaction behaviours. These neurons are located exclusively in the hypothalamus that regulates complex and goal-directed behaviours. We recently identified that orexin neurons differentially encode interaction between familiar and novel animals. We are currently investigating how chronic social isolation, a risk factor for the development of social-anxiety like behaviours, affects orexin neuron activity and how we can manipulate the activity of these neurons to mitigate isolation-induced social deficits.

Amygdalar CB2 cannabinoid receptor mediates fear extinction deficits induced by Orexin-A

Chronic intracerebroventricular administration of orexin-A does not modify behavioural outcomes following repetitive mild traumatic brain injury in rats

Epigenetic regulation of orexin neurons by miRNAs

Evaluation of the circadian expression of orexin receptors in the mouse brain by RNAscope®

Insulin-like growth factor I mitigates post-traumatic stress by inhibiting AMP-kinase in orexin neurons

Orexin neuromodulation of the dopaminergic system: behavioral correlates and mechanistic insights

Oxytocin and orexin systems bidirectionally regulate the ability of opioid cues to bias choice during relapse

A Role for Orexin in REM Sleep Regulation

Sleep and orexinergic pathway alterations in mice models of amyotrophic lateral sclerosis

Transient developmental window for orexin action on the visual thalamus

Visualizing input-output architecture of orexin neurons with retrograde tracing vectors