Positive AMPA receptor modulation in the treatment of neuropsychiatric disorders: A long and winding road
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Glutamatergic transmission is widely implicated in neuropsychiatric disorders, and the discovery that ketamine elicits rapid-acting antidepressant effects by modulating α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor (AMPAR) signaling has spurred a resurgence of interest in the field. This review explores agents in various stages of development for neuropsychiatric disorders that positively modulate AMPARs, both directly and indirectly. Despite promising preclinical research, few direct and indirect AMPAR positive modulators have progressed past early clinical development. Challenges such as low potency have created barriers to effective implementation. Nevertheless, the functional complexity of AMPARs sets them apart from other drug targets and allows for specificity in drug discovery. Additional effective treatments for neuropsychiatric disorders that work through positive AMPAR modulation may eventually be developed.
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AMPAkines, a series of AMPAR positive allosteric modulators, were assessed for indications such as TRD, cognitive decline, and Alzheimer's disease, but later-stage clinical trials often failed to meet their primary endpoints.
“AMPAkines, a series of AMPAR positive allosteric modulators (PAMs) that increase the amplitude and duration of AMPA currents and include CX516, CX546, CX614, CX691, and tulrampator, were assessed for indications such as TRD, cognitive decline, and Alzheimer's disease, but later-stage clinical trials often failed to meet their primary endpoints [198]”
From Ketamine in neuropsychiatric disorders: an update (2024) · cites this paper as [198]
The Ampakines section (page not provided) identifies AMPAkines as AMPAR positive allosteric modulators, describes CX516 testing for cognitive impairment and Alzheimer’s disease, and reports largely negative clinical results. It also says ORG-26576 missed endpoints in Phase 2 trials for major depressive disorder, but does not establish trials specifically for treatment-resistant depression. The Unsolved challenges section says clinical failures often prevented agents from reaching Phase 3, so the claim’s broad reference to later-stage trials overstates the evidence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPreclinical AMPAkine studies provide the most direct evidence that excitatory synaptic plasticity is critical in depression treatment.
“Perhaps the most direct evidence of the critical role that plasticity of excitatory synaptic transmission plays in the treatment of depression comes from preclinical studies of positive allosteric AMPAR modulators (i.e., AMPAkines) [162].”
From Plasticity of synapses and reward circuit function in the genesis and treatment of depression (2023) · cites this paper as [162]
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- Authors
- Kadriu, B., Musazzi, L., Johnston, J. N., Kalynchuk, L. E., Caruncho, H. J., Popoli, M., & Zarate, C. A.
- Affiliations
- National Institutes of Health (US)
- University of Milano-Bicocca (IT)
- University of Victoria (CA)
- University of Milan (IT)
- Corresponding author
- Kadriu, Bashkim
- ORCID
- Venue
- Drug Discovery Today
- Publisher
- Elsevier BV
- Published
- 2021-12
- Volume
- 26
- Issue
- 12
- Pages
- 2816-2838
- ISSN
- 1359-6446 (ISSN-L)
- PMC
- PMC9585480
- OpenAlex
- W3192479465
- Cited by
- 62
- References
- 181
- Citations by year
- 2026: 13 · 2025: 14 · 2024: 11 · 2023: 12 · 2022: 9 · 2021: 3
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug Discovery Today (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Funders
- National Institutes of Health (Z99 MH999999)
- National Institute of Mental Health (ZIAMH002857, ZIAMH002927)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Amino Acid Enzymes and Metabolism
- Keywords
- neuropsychiatric disorders, ketamine, rapid-acting antidepressants, glutamatergic neurotransmission, drug development, drug potency, drug discovery
- MeSH terms
- Drug Development, Animals, Antidepressive Agents, Mental Disorders, Humans, Ketamine, Receptors, AMPA, Drug Discovery
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