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As his tolerance to a few pills grew, Ali started gulping down a deadly cocktail of Artane, Ativan and Valium. Sometimes he would take as many as 15 pills a day. His addiction grew amid the privations of the Iraqi people after the first Gulf War. As UN sanctions began to take their toll on the economy, Iraqis found solace in anti-depressants sold on the black market. At the time his pharmacist friend was his main supplier. Taken in large quantities, the drugs can cause comas. Withdrawal symptoms include convulsions, sweating and vomiting. They can also damage unborn babies. Before the US-led occupation last March, these drugs were sold at pharmacies on a strictly prescription-only basis. Now they are available from vendors who can barely read the English labels, let alone correctly prescribe them. Much of it comes from the mayhem following the US invasion when looters wreaked havoc in Baghdad. Stolen medication from hospital, clinics and the health ministry are now reappearing on the streets. Insulin, anaesthetic injections, hypertension medications are also available for those seeking a high. Next to it are the rows of carts selling pills, injections, creams and syrups. Stacks of brightly coloured capsules are lined up. Held together with elastic bands, they have been long removed from their boxes. And business is booming. Thirty pills can be purchased for about dinars or 14 US cents. In pharmacies, the same amount is sold for about three times the price. At the market dealers swiftly deny selling tranquillisers or anti-depressants. But one onlooker tells us that such drugs can be found on other stalls. Someone else warns that the pills are sold in the same alleys where arms dealers run their thriving post-occupation businesses. Supplier Hamid is suspicious of the new faces. He defiantly offers a wad of tattered papers he says are the receipts for his merchandise. Hamid claims his brother is a pharmacist who has taught him how to prescribe medications. A pharmacist later tells me it is an antibiotic for sore throats. Customers are unconcerned that the drugs are being kept out in the sun and the expiry date on some is within a few months or unclear on others. Qatham, 10, is manning another stall a few metres from Hamid. When his father, Abu Ali, appears he quickly produces papers which he also says are the receipts for his goods. One pharmacist asked whether a doctor had recommended Artane but did not ask for a prescription. He asked if my hands were shaking. I said yes and he advised me to take two five milligram pills a day. Ali has no intention of buying any more drugs. He wants to get clean. He checked into the Ibn Rushd hospital, which includes a detox ward, where he met with a psychologist and others like himself to discuss his future. Although he has tried to convince his friends to kick their habit, they refuse to listen. While he may be able to supply his addictions more easily today, Ali is determined to change. Published On 19 Feb 19 Feb Sponsored Content. Bitter pill: Drugs are being soldby unqualified street vendors. Bitter pill: Drugs are being sold by unqualified street vendors. Qatham helps his father sell medicines at the market.

‘Like a hug from everyone who loves you’ — how MDMA could help patients with trauma

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Official websites use. Share sensitive information only on official, secure websites. Captagon, known by its genetic name Fenethylline, is an addictive drug that complicates the War on Drugs. Captagon has a strong CNS stimulating effect than its primary metabolite, Amphetamine. However, multi-targets issues associated with the drug and metabolites as well as its underlying mechanisms have not been fully defined. Of note, Amphetamine, an agonist for trace amine-associated receptor 1 TAAR1 with enhancing dopamine signaling increase of irritability, aggression, etc. A2aR in the brain responsible for restlessness and painlessness, may attenuate the behavioral sensitization caused by Amphetamine. We carried out further molecular docking modeling and molecular dynamics simulation to explore the molecular interactions between Amphetamine and Theophylline and their important GPCRs targets, including TAAR1 and adenosine receptors. All of the systems pharmacology analyses and results will shed light insight into a better understanding of Captagon addiction and future drug abuse prevention. Captagon, the trademark name for the synthetic stimulant Fenethylline 1 — 6 , was first reported by a German pharmacist in for the potential treatment of hyperactivity, depression and narcolepsy 1. However, due to its addictive and hallucinogenic properties, it was listed as a controlled substance by the United States and the World Health Organization , making it illegal to buy or sell Captagon in most countries. Captagon has been reported to be a central nervous system CNS stimulator with stronger and longer lasting effects on fighting aggression, detachment, cognitive enhancement, and alertness than one of its main metabolites, Amphetamine. Captagon is metabolized into Amphetamine Thus, the pharmacological effect of Captagon is considered the result of the combined action of these two metabolites 3 , 6. It can be used for the treatment of obesity, narcolepsy, and attention deficit hyperactive disorder ADHD 7. Amphetamine is reportedly an agonist on central 5-HT receptors 8 — 10 and may inhibit monoamine oxidase MAO 11 , possibly causing hallucinations, violent behavior, loss of appetite, and more. Theophylline, another metabolite of Captagon, is a weak stimulator resembling caffeine Theophylline has a narrow therapeutic window due to its unwanted side effects including cardia dysrhythmia seizures, gastrointestinal disturbances, and drug-drug interactions Captagon was considered a co-drug or mutual prodrug of Amphetamine and Theophylline. However, the effects of Fenethylline is different from those of Amphetamine qualitatively and quantitatively. First, previous literature 6 , 14 reported that Captagon is more lipophilic than both Theophylline and Amphetamine, resulting in easier absorption into the CNS and a faster stimulating effect than either drug 2. Metabolic scheme of Captagon Fenethylline. Captagon when orally dosed will go through the oxidative metabolism via cytochrome P CYP enzyme, and in final be metabolized into Amphetamine is the main cause of addiction, while Theophylline reduces the behavioral sensitization to repeated Amphetamine exposure, thus explain the less addictiveness of Fenethylline than Amphetamine. Captagon is an addictive drug that fuels conflicts in the Middle East 4. Fighters on Captagon or Amphetamines may feel a sense of well-being, euphoria and invincibility. It is clear that these drugs are favored to suppress pain and increase aggression in soldiers. The use of these drugs is not limited to soldiers but also to the civilian population in areas of prevailing hopelessness or helplessness. Furthermore, in Dubai authorities seized 4. To address the above questions, we performed computational systems pharmacology analyses for Captagon and its metabolites, Amphetamine and Theophylline. First, we analyzed the signaling pathways for both Amphetamine and Theophylline. Finally, to study the side effects of Amphetamine and Captagon, we carried out off-target predictions using our established hallucinogen-related chemogenomics knowledgebase and in-house computational chemogenomics tools. Overall, such drug-drug combinations could potentially be used to treat drug abuse and addiction. Our studies provided a detailed insight into the addiction mechanism of Captagon and its metabolites. We then truncated the residues according to their templates for sequence alignment and homology modeling using our reported protocol The disulfide bridge s was also patched for each homology model. Modeller 9. All of these settings are the same as in our previous works 21 — The main protocols or parameters of docking were addressed in our previous publications 21 — Briefly, the docking parameters used were: a number of starting conformations per ligand set to 10, max conformations per fragment set to 20; b maximum number of rotatable bonds per molecule set to ; c flags were turned on at pre-dock minimization, post-dock minimization, molecule fragmentation, and soft grid treatment; d activate spin alignment method with density of search set to 9. We have constructed a Hallucinogen-Specific Chemogenomics Database 29 that can be used for target, off-target, or additional identification and network systems pharmacology analysis of small molecules and their potential targets. In our work, we applied our HallucinogenPlatform and established chemoinformatics tools such as HTDocking to perform network systems pharmacological analysis on Amphetamine and Captagon. We then matched these predicted target proteins to Amphetamine and Captagon according to their docking scores. Next, we mapped out a pharmacological network of interactions between drug compounds and target proteins at the molecular level 32 , Cytoscape 3. The initial configurations of protein receptors and ligands were taken from docking studies. Water molecules were treated with the TIP3P water model First, several minimization steps were carried out for the systems to avoid possible steric crashes. A periodic boundary condition was employed to maintain constant temperature and pressure NPT ensembles. The interaction energies between each residue and ligand were extracted. Amphetamine, a dopamine inducer, has been reported to not only provide a sense of euphoria but also to contribute to addiction. As shown in Fig. TAAR1, a class A GPCR 57 , 60 , is primarily located in peripheral tissues 61 , glial cells 62 , and neurons 63 and is responsible for regulating neurotransmission in dopamine, norepinephrine, and serotonin neurons in the CNS On one hand, the binding of Amphetamine to VMAT2 increases the release of dopamine from vesicles 63 , This activates the D1 dopamine receptor D1R on the post-synaptic neuron. AP-1 and epigenetic regulatory proteins and represses the c-Fos gene. Signaling pathway analysis for Amphetamine, a stimulant with addiction. D1 receptor on the postsynaptic membrane and the following signaling transduction are activated to lead to the addiction factor FosB accumulation. Theophylline, a weak stimulator chemically and pharmacologically resembling caffeine 6 , can inhibit phosphodiesterase causing an increase in cAMP levels and block adenosine receptors. Jiang-Fan Chen et al. Elena Bastia et al. Signaling pathway analysis for Theophylline, an antagonist of adenosine A2a receptor for drug abuse. We hypothesized that the crosstalk of the pathway between Amphetamine and Theophylline, that is, the reduced expression of CREB1 decreasing the FosB accumulation, will help explain the experimental results that Theophylline reduces the behavioral sensitization to repeated amphetamine exposure. Amphetamine directly targets TAAR1 as an agonist. Several important residues formed strong hydrophobic interactions with Amphetamine, including Ile 3. Asp 3. Interestingly, we found an additional hydrogen bond between Asp and Tyr, making the previous two hydrogen bonds more stable. All of these residues in our work are supported by modeling data reported by Tan et al. For further validation of the binding mode, we also carried out a molecular dynamics MD simulation as described below. Using the same protocol, we studied interactions between A2aR and A2bR and Theophylline at a molecular level. We first docked the reported compound caffeine back to the crystal structure of A2aR as a validation of our docking protocol as shown in Supporting Figure S1a. We found that Asn formed strong hydrogen bonding 3. Moreover, six other residues including Val84 3. Moreover, our docking results showed that the docked caffeine yellow sticks overlapped well with the crystallized compound cyan with a root mean square deviation RMSD of 0. We then docked Theophylline into A2aR using the same protocol and compared the binding mode of Theophylline salmon with that of caffeine cyan with their co-crystal structures, as shown in Fig. Our docking data showed that Theophylline salmon overlapped with caffeine cyan very well, with an RMSD of 0. Moreover, these two compounds shared almost the same interactions. Briefly, Asn 2. Detailed interactions between Theophylline and A2aR. Our docking data showed that Theophylline salmon overlapped with caffeine cyan very well, which indicates the reliability of our docking methods. Moreover, these two compounds share almost the same interactions. Briefly, Asn on both caffeine and Theophylline has the hydrophilic bond with Amphetamine in 3. Our docking results showed that both caffeine and Theophylline shared similar binding modes and interactions with these two receptors. Detailed interactions after the MD simulations and the RMSDs of the receptors and ligands compared to their initial configurations were plotted in Fig. Next, Fig. The data showed that the hydrogen bond between Amphetamine and Asp was stable 1. Importantly, an additional hydrogen bond was formed between Amphetamine and Ser 2. Finally, Fig. The hydrophobic interactions kept stable during the simulations. We found that the MD results correlated very well with our previously described docking studies. Some literature reported that Theophylline is the substrate of CYP2D6 80 , 81 , an enzyme involved in many metabolic processes. Thus, some side effects of Theophylline like nausea, diarrhea, and an increase in heart rate may last longer if its plasma concentration is high enough. Because Theophylline only constitutes Importantly, blockage of A2aR by Theophylline should last longer due to this prolonged elimination time. In turn, the effects of Theophylline on decreasing Amphetamine addiction will last longer than in a scenario without this competitive elimination. Previously, we constructed a Hallucinogen-Specific Chemogenomics Knowledgebase 29 that can be used for target, off target, or additional identification and network systems pharmacology analysis of small molecules and their potential targets. In our current work, we adapted a small but specific dataset with twelve 5-HT receptors in our knowledgebase to explore the side effects e. Here, we docked both Amphetamine and Captagon into 5-HT receptors to predict potential off-targets. Our results showed that most of the docking scores were not high due to the huge size of the binding pocket in the receptor and the small size of the Amphetamine molecule. However, our predicted results correlated well with the known therapeutic targets of Amphetamine. The docking score of Amphetamine with 5-HT1a is 5. Importantly, we predicted two potential targets for Amphetamine, including 5-HT1f docking score of 5. Network systems pharmacology analysis of Amphetamine and the predicted targets. Serotonin or 5-hydroxytryptamine 5-HT receptor family has been linked to the regulation of mood and a series of physical behaviors like hallucination and reward. We predicted Amphetamine can also target at this kind of receptors shown in purple with different affinity using our established knowledgebase and HTDocking target identification program. In terms of Captagon lipophilicity 6 , 14 , we also calculated the docking scores of Captagon before metabolism within these 5-HT receptors, as shown in Table 2. In our present work, we showed the detailed interaction of Captagon with its most probable target, 5-HT7. For comparison, we aligned the predicted binding mode of Amphetamine purple and Captagon slate with 5-HT7, as shown in Fig. Our docking data showed that Amphetamine and Captagon overlapped very well and that Asp D3. For further validation, we will carry out future experiments. Predicted binding mode of Amphetamine purple and Captagon slate within 5HT7. Our docking result showed that Amphetamine and Captagon overlapped very well and that Asp D3. The data analyses are summarized: 1 Captagon when orally dosed will be metabolized into Moreover, A2aR reportedly has antagonistic interactions with the D2 receptor through heterodimer formation Poleszak E et al. This complex exists in neurons found in the nucleus accumbens and ventral and dorsal striatopallidal GABAergic neurons, reportedly the main areas involved in addiction D2 neurons are associated with suppressing addictive drug rewards, opposite to D1-expressing neurons reinforcing rewards Thus, the A2aR-D2 receptor heterodimer theory helps to explain the lessened addictiveness of Captagon versus Amphetamine. On the other hand, Theophylline, another Captagon metabolite that blocks A2aR in the brain, may attenuate the behavioral sensitization caused by Amphetamine. These metabolites make Captagon more potent but less addictive than Amphetamine. The further experiment is on-going, and the data will be published elsewhere. In our present work, we systematically analyzed the addiction mechanism of Captagon and its metabolites, Amphetamine and Theophylline, using our established drug abused chemogenomics knowledgebase systems pharmacology methods. Our data mining analysis of signaling pathways for both Amphetamine and Theophylline, reveals that Amphetamine is the main cause of Captagon addiction and Theophylline can attenuate this behavioral sensitization. In addition, we explored the detailed interactions of Amphetamine and Theophylline with their reported targets using molecular docking studies and molecular dynamics simulation studies. Furthermore, using our established hallucinogen-related chemogenomics knowledgebase and in-house computational chemogenomics tools, we studied the side effects of Amphetamine and Captagon through off-target prediction. Overall, such potential drug-drug combinations are a promising method for developing novel medications to treat drug abuse and addiction. We give thanks to Dr. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Sci Rep. Find articles by Nan Wu. Find articles by Zhiwei Feng. Find articles by Xibing He. Find articles by William Kwon. Find articles by Junmei Wang. Find articles by Xiang-Qun Xie. Contributed equally. Received Apr 25; Accepted Sep 10; Collection date Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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