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Pr. Ronald Crystal: A cocaine-vaccine to prevent relapse

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Pr Ronald Crystal: A cocaine-vaccine to prevent relapse





Hello! You’re on MD-FM INSIGHT, the first medical web radio. Today we’ll be devoting our "Question & Answer" program to the development of an anti-cocaine vaccine.


Researchers are working on finding vaccines to help people fight against their addictions: such as cocaine-addiction or nicotine addiction…


Earlier this month, we interviewed Dr. Ronald Crystal, chairman of genetic medicine at Weill Cornell Medical College, in New York. We met with Dr. Crystal during the 2014 annual meeting of the American Psychiatric Association, in New York, where he presented his latest research on a vaccine to fight cocaine addiction.


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Hello Dr. Crystal, first of all, can you tell us about the general idea behind using vaccination to fight cocaine-use…



Many people who are cocaine addicts want to stop but it’s very very addictive and it’s very hard to stop. You know the challenge is that they can stop, for a month, maybe 2 months, but then they may go to a party, and they are exposed again to cocaine and then they get hooked again. And so the strategy is to take those individuals, vaccinate them, and if the vaccine works then, even if they take some more cocaine, they won’t get the high, and hopefully they won’t go back to using cocaine.



So the vaccine stops cocaine from reaching its target in the brain?



That’s the major problem is that all the addictive molecules are small… When you snort some cocaine, it takes 6 to 12 seconds for the cocaine to reach the brain and so, we have to evoke sufficient amounts of antibodies, and with very high avidity, so they catch the cocaine before it reaches its receptors within the brain.



And there are different types of vaccines to do this, aren’t there?



So there’s basically two kinds of vaccines: one is an active vaccine, where we hook a molecule, whether it be cocaine or nicotine, to a carrier and we trick the immune system in thinking that the cocaine, or nicotine, is part of the carrier and evokes antibodies against the small molecule. The second approach is a passive approach, where antibodies are used either directly, or inducing the body to make antibodies genetically. The cocaine vaccines that are the most close to the clinic, or been in the clinic, are the active vaccines. The challenge is making enough of the antibodies to catch the cocaine.



Ok and tell us about your early results of using this vaccine in animals…



With our cocaine vaccine, where we’ve hooked the cocaine to the outside parts of a virus, called the adenovirus (one of the cold viruses), we can invoke very high antibody levels against cocaine in mice and rats and non-human primates. And when we administer cocaine to these animals, after they’ve been vaccinated, it completely prevents the cocaine from reaching the brain. Now, of course, whether that will work in humans, we are going to have to wait and see… And we expect to start a human trial in about 8 months.



What will the trial consist in?



So the strategy will be to take individuals, who are cocaine abusers, who stopped using cocaine, then vaccinate them, and then follow them over time to determine whether or not they go back to using cocaine.



And: could we possibly use this vaccine in people who are still using cocaine, I mean: to help them stop?



The prevention of relapse is an easier challenge than trying to vaccinate people who are already on cocaine and actively using cocaine. If it does work, in terms of relapse, then we would move towards individuals when they are actively taking cocaine, and see if it works in them as well.




I see… And how often do you have to administer the vaccine for it to work?



For our new cocaine vaccine, the active vaccine, we have to administer the vaccine on a monthly basis, because we have to keep the antibody levels high. For a new strategy vaccine, where we’re doing it genetically, where genetically we administer a virus coding for an antibody against the addictive molecule, that, we can give once and it will last forever.




And what are the perspectives in terms of FDA approval and so on?



The FDA is very positive in terms of helping us and others develop these kinds of vaccines. Approval, of course, depends on whether it works. There’s two things that depend on approval: one is safety of course and the other is efficacy. And we have to demonstrate both.



Of course. So what is your take home message for our audience?



The kinds of physicians that see cocaine addicts are a mixture of psychologists, psychiatrists, a variety of public health people, as well and general internal medicine medical people and so, we’re getting our referrals from all of these individuals through a clinic that deals with cocaine addicts. Cocaine addicts come from every part of life, they vary from all levels of economic strata in our society and it’s a terrible problem and, as you know, there is no therapy for cocaine addiction.





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