Aug 202008
ResearchBlogging.orgIn addition to the adverse consequences of addiction and the inconvenience of serving several years of jail time for possessing it, cocaine can cause a fatal overdose. Although this condition can be treated, no therapy presently exists that attacks the overdose by removing cocaine from the bloodstream. One possible approach to eliminating cocaine from a patient would be to accelerate the process by which it is degraded. Unfortunately, the enzymes that perform this activity in the human body are not very efficient. In an upcoming article in the Journal of the American Chemical Society, however, a group from the University of Kentucky (assisted by researchers at the University of Michigan) have remodeled the active site of butyrylcholinesterase (BChE) to achieve a 2000-fold increase in rate. This raises the possibility of producing therapeutic enzymes as a treatment for cocaine overdose.

A cocaine overdose typically results in an elevated pulse rate, seizures, and hyperthermia, among other possibilities. The usual course of treatment involves addressing the symptoms — diazepam to reduce the heart rate, cooling protocols to address hyperthermia. These steps are proven to work, but they don’t address the core problem: there’s still a lot of cocaine floating around in the bloodstream. Treating with sedatives amounts to using one giant truck to stop another giant truck… both trucks will probably stop, but there might be a lot of collateral damage. Instead, it would be advantageous to either block the receptors that cocaine binds, or clear cocaine from the bloodstream somehow.

Plasma butylcholinesterase does most of the work in metabolizing cocaine, by cleaving it into two products that no longer exert the same pharmacological effects. If BChE was a highly efficient enzyme it’s unlikely that people would experience cocaine overdoses at all, but it breaks down the main form of cocaine quite slowly, with a catalytic rate (kcat) of 4.1 /min, resulting in a very long half-life for this substrate. The chemical mechanism of BChE (Figure 1) will be familiar to anyone who has taken biochemistry, being basically the same as a serine protease. Instead of a peptide bond, however, it is the ester linkage of cocaine that undergoes nucleophilic attack from an activated serine, while hydrogen bonds stabilize the evolving negative charge in an oxyanion hole.

Previous efforts to optimize the activity of BChE by mutation focused on eliminating steric clashes, but Zheng et al. noted that the hydrogen bond lengths in the oxyanion hole were not optimal for stabilizing the putative transition state. They therefore decided to focus their efforts on improving the energetics of this region. To do so, they used combined quantum mechanics/ molecular mechanics (QM/MM) simulations to determine the energy barriers in simulated reaction coordinates for a number of different mutants. This has the advantage of screening potential mutants for a specific effect, which may be quicker than wet lab work, but it requires the researcher to know the catalytic mechanism and to define a region of interest in advance.

By working through a series of mutations, Zheng et al. arrived at one multiple mutant of BChE that had favorable interaction energy for every residue in the oxyanion hole. When they generated this mutant in the lab, they found that it had a vastly increased catalytic rate towards cocaine, with kcat now about 5700 /min. Based on these in vitro results they decided to test the mutant BChE in vivo using mice. They found that injecting mice with 30 µg of BChE protected them from seizure and death due to cocaine overdose. While the n for this experiment is small, and the BChE was injected prior to cocaine exposure rather than after, these results suggest that the mutant BChE has potential as a therapy for cocaine overdose in humans.

Obviously, further improvement would be needed before these protective effects could be realistically equaled in humans. To match the dose used in this experiment, a 180-pound man would need to be injected with 82 mg of the protein, which is a rather large amount. However, if used in conjunction with existing treatments, the required dose of BChE may be lower. If not, then translating these results into a useful therapy will require either further catalytic optimization or an enormous production effort. A significant amount of additional clinical research is required before this or any other mutant of BChE is introduced as a therapy for overdose or addiction. Nonetheless, these results illustrate the promise of enzyme optimization and design as a tool for medicine in the future.

Fang Zheng, Wenchao Yang, Mei-Chuan Ko, Junjun Liu, Hoon Cho, Daquan Gao, Min Tong, Hsin-Hsiung Tai, James H. Woods, Chang-Guo Zhan (2008). Most Efficient Cocaine Hydrolase Designed by Virtual Screening of Transition States Journal of the American Chemical Society DOI: 10.1021/ja803646t

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