The novel vasopressin receptor (V1aR) antagonist SRX246 reduces anxiety in an experimental model in humans: a randomized proof-of-concept study

  • Psychopharmacology (Berl). 2021 Sep;238(9):2393-2403. doi: 10.1007/s00213-021-05861-4.
Tiffany R Lago  1  2  3 ,  Michael J Brownstein  4 ,  Emily Page  5 ,  Emily Beydler  5 ,  Adrienne Manbeck  5 ,  Alexis Beale  5 ,  Camille Roberts  5 ,  Nicholas Balderston  5  6 ,  Eve Damiano  4 ,  Suzanne L Pineles  7  8 ,  Neal Simon  4  9 ,  Monique Ernst  5 ,  Christian Grillon  5
Affiliations
  • 1. National Institute of Mental Health, Bethesda, MD, USA. [email protected].
  • 2. VA Boston Healthcare System, Boston, MA, USA. [email protected].
  • 3. Boston University School of Medicine, Boston, MA, USA. [email protected].
  • 4. Azevan Pharmaceuticals Inc, Bethlehem, PA, USA.
  • 5. National Institute of Mental Health, Bethesda, MD, USA.
  • 6. University of Pennsylvania, Philadelphia, PA, USA.
  • 7. Boston University School of Medicine, Boston, MA, USA.
  • 8. National Center, PTSD At VA Boston Healthcare System, Boston, MA, USA.
  • 9. Lehigh University, Bethelhem, PA, USA.
PMID: 33970290 DOI: 10.1007/s00213-021-05861-4
Abstract

Rationale: Arginine vasopressin (AVP) is a neuropeptide that modulates both physiological and emotional responses to threat. Until recently, drugs that target vasopressin receptors (V1a) in the human central nervous system were unavailable. The development of a novel V1a receptor antagonist, SRX246, permits the experimental validation of vasopressin's role in the regulation of anxiety and fear in humans.

Objectives: Here, we examined the effects of SRX246 in a proof-of-concept translational paradigm of fear (phasic response to imminent threat) and anxiety (prolonged response to potential threat).

Methods: Healthy volunteers received both SRX246 and placebo in a randomized, double-blind, counter-balanced order separated by a 5-7-day wash-out period. Threat consisted of unpleasant electric shocks. The "NPU" threat test probed startle reactivity during predictable threat (i.e., fear-potentiated startle) and unpredictable threat (i.e., anxiety-potentiated startle).

Results: As predicted, SRX246 decreased anxiety-potentiated startle independent of fear-potentiated startle.

Conclusions: As anxiety-potentiated startle is elevated in anxiety and trauma-associated disorders and decreased by traditional anxiolytics such as SSRIs and benzodiazepines, the V1a receptor is a promising novel treatment target.

Keywords
Anxiety-potentiated startle; Fear-potentiated startle; NPU threat test; Threat of shock; V1a receptor.