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Pharmacological and behavioral divergence of ketamine enantiomers: implications for abuse liability
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Ketamine, a racemic mixture of (S)-ketamine and (R)-ketamine enantiomers, has been used as an anesthetic, analgesic and more recently, as an antidepressant. However, ketamine has known abuse liability (the tendency of a drug to be used in non-medical situations due to its psychoactive effects), which raises concerns for its therapeutic use. (S)-ketamine was recently approved by the United States' FDA for treatment-resistant depression. Recent studies showed that (R)-ketamine has greater efficacy than (S)-ketamine in preclinical models of depression, but its clinical antidepressant efficacy has not been established. The behavioral effects of racemic ketamine have been studied extensively in preclinical models predictive of abuse liability in humans (self-administration and conditioned place preference [CPP]). In contrast, the behavioral effects of each enantiomer in these models are unknown. We show here that in the intravenous drug self-administration model, the gold standard procedure to assess potential abuse liability of drugs in humans, rats self-administered (S)-ketamine but not (R)-ketamine. Subanesthetic, antidepressant-like doses of (S)-ketamine, but not of (R)-ketamine, induced locomotor activity (in an opioid receptor-dependent manner), induced psychomotor sensitization, induced CPP in mice, and selectively increased metabolic activity and dopamine tone in medial prefrontal cortex (mPFC) of rats. Pharmacological screening across thousands of human proteins and at biological targets known to interact with ketamine yielded divergent binding and functional enantiomer profiles, including selective mu and kappa opioid receptor activation by (S)-ketamine in mPFC. Our results demonstrate divergence in the pharmacological, functional, and behavioral effects of ketamine enantiomers, and suggest that racemic ketamine's abuse liability in humans is primarily due to the pharmacological effects of its (S)-enantiomer.
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“Likewise, similar range of affinity values at μ and κ opioid receptors were recently reported for (S)-ketamine (μ: Ki = 7 μM and κ: Ki = 19 μM) and (R)-ketamine (μ: Ki = 14 μM and κ: Ki = 40 μM) (Bonaventura et al.,”
From Mechanisms of ketamine and its metabolites as antidepressants (2022) · cites this paper as Bonaventura et al., 2021
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“However, this study’s main findings rely on computational analysis and the predicted affinity and G protein recruitment values it reports are not consistent with several prior publications (Bonaventura et al., 2021; Hirota et al., 1999; Nemeth et al., 2010).”
From Mechanisms of ketamine and its metabolites as antidepressants (2022) · cites this paper as Bonaventura et al., 2021
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“conditioned lever responding for (S)-ketamine is rapidly extinguished with fewer than 10 responses over three hours on the first extinction training day”
From Mechanisms of ketamine and its metabolites as antidepressants (2022) · cites this paper as Bonaventura et al., 2021
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“On the other hand, (S) and (R)-ketamine have agonist properties at μ and κ opioid receptors, an interaction which may be necessary for their antidepressant effects (Bonaventura et al., 2021).”
From Mechanisms of ketamine and its metabolites as antidepressants (2022) · cites this paper as Bonaventura et al., 2021
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“preclinical evidence suggests that ketamine therapy may be associated with certain risks, such as increasing drug-dependence-related behaviors like self-administration, conditioned place preference, hyperlocomotion, and prepulse inhibition deficits [155-157]”
From Ketamine in neuropsychiatric disorders: an update (2024) · cites this paper as [155]
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“Preclinically, (R)-ketamine does not induce conditioned place preference, deficits in prepulse inhibition, or hyperlocomotion [155-157]”
From Ketamine in neuropsychiatric disorders: an update (2024) · cites this paper as [155]
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“(S)-ketamine induces conditioned place preference in mice and conditioned operant lever responding for an infusion in rats whereas (R)-ketamine largely does not”
From Mechanisms of ketamine and its metabolites as antidepressants (2022) · cites this paper as Bonaventura et al., 2021
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“this study showed that (S)-ketamine acted as a partial G protein signaling agonist at μ opioid receptors (EC50 = 9 μM, Emax = 48%) and as a full agonist at κ opioid receptors (EC50 = 16 μM, Emax = 84 %)”
From Mechanisms of ketamine and its metabolites as antidepressants (2022) · cites this paper as Bonaventura et al., 2021
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“Interestingly, neither enantiomer activated ß-arrestin.”
From Mechanisms of ketamine and its metabolites as antidepressants (2022) · cites this paper as Bonaventura et al., 2021
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“whereas (R)-ketamine acted as a weak partial agonist at both μ opioid receptors (EC50 = 34 μM, Emax = 39 %) and κ opioid receptors (EC50 > 100 μM, Emax < 50%).”
From Mechanisms of ketamine and its metabolites as antidepressants (2022) · cites this paper as Bonaventura et al., 2021
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“Intriguingly, (R) and (S)-ketamine appear to have agonist properties at μ and κ opioid receptors, with (S)-ketamine having a higher affinity”
From Mechanisms of ketamine and its metabolites as antidepressants (2022) · cites this paper as Bonaventura et al., 2021
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Metadata
- Authors
- Bonaventura, J., Lam, S., Carlton, M., Boehm, M. A., Gomez, J. L., Solís, O., Sánchez-Soto, M., Morris, P. J., Fredriksson, I., Thomas, C. J., Sibley, D. R., Shaham, Y., Zarate, C. A., & Michaelides, M.
- Affiliations
- National Institutes of Health (US)
- National Institute on Drug Abuse (US)
- National Center for Advancing Translational Sciences (US)
- National Institute of Neurological Disorders and Stroke (US)
- National Institute of Mental Health (US)
- Corresponding author
- Bonaventura, Jordi
- Michaelides, Michael
- ORCID
- Venue
- Molecular Psychiatry
- Published
- 2021-04-15
- Volume
- 26
- Issue
- 11
- Pages
- 6704-6722
- ISSN
- 1359-4184 (ISSN-L)
- 1476-5578
- PMC
- PMC8517038
- OpenAlex
- W3156594315
- Cited by
- 271
- References
- 86
- Citations by year
- 2026: 35 · 2025: 46 · 2024: 64 · 2023: 56 · 2022: 53 · 2021: 17
- FWCI
- 27.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Molecular Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Health & Human Services | NIH | National Institute on Drug Abuse (DA000069)
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
- Keywords
- ketamine, enantiomers, esketamine, (R)-ketamine, abuse liability, self-administration, conditioned place preference, locomotor activity, locomotor sensitization, medial prefrontal cortex, dopamine, opioid receptors, mu-opioid receptor, kappa opioid receptor, antidepressant efficacy, treatment-resistant depression
- MeSH terms
- Animals, Antidepressive Agents, Depression, Ketamine, Stereoisomerism, Mice, Rats, Depressive Disorder, Treatment-Resistant
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