Therapeutic Potential and Limitation of Serotonin Type 7 Receptor Modulation

Although a number of mood-stabilising atypical antipsychotics and antidepressants modulate serotonin type 7 receptor (5-HT7), the detailed contributions of 5-HT7 function to clinical efficacy and pathophysiology have not been fully understood. The mood-stabilising antipsychotic agent, lurasidone, and the serotonin partial agonist reuptake inhibitor, vortioxetine, exhibit higher binding affinity to 5-HT7 than other conventional antipsychotics and antidepressants. To date, the initially expected rapid onset of antidepressant effects-in comparison with conventional antidepressants or mood-stabilising antipsychotics-due to 5-HT7 inhibition has not been observed with lurasidone and vortioxetine; however, several clinical studies suggest that 5-HT7 inhibition likely contributes to quality of life of patients with schizophrenia and mood disorders via the improvement of cognition. Furthermore, recent preclinical studies reported that 5-HT7 inhibition might mitigate antipsychotic-induced weight gain and metabolic complication by blocking other monoamine receptors. Further preclinical studies for the development of 5-HT7 modulation against neurodevelopmental disorders and neurodegenerative diseases have been ongoing. To date, various findings from various preclinical studies indicate the possibility that 5-HT7 modifications can provide two independent strategies. The first is that 5-HT7 inhibition ameliorates the dysfunction of inter-neuronal transmission in mature networks. The other is that activation of 5-HT7 can improve transmission dysfunction due to microstructure abnormality in the neurotransmission network-which could be unaffected by conventional therapeutic agents-via modulating intracellular signalling during the neurodevelopmental stage or via loss of neural networks with aging. This review attempts to describe the current and novel clinical applications of 5-HT7 modulation based on preclinical findings.

Automated summary

Although the contributions of 5-HT7 function to clinical efficacy and pathophysiology are not fully understood, lurasidone and vortioxetine have higher binding affinity to 5-HT7 compared to other antipsychotics and antidepressants. While the expected rapid onset of antidepressant effects due to 5-HT7 inhibition has not been observed with these drugs, clinical studies suggest that 5-HT7 inhibition improves the quality of life for patients with schizophrenia and mood disorders by enhancing cognition. Furthermore, 5-HT7 inhibition may mitigate antipsychotic-induced weight gain and metabolic complications. Preclinical studies for the development of 5-HT7 modulation against neurodevelopmental disorders and neurodegenerative diseases are ongoing. Various findings indicate the possibility of using 5-HT7 modifications for improving neuronal transmission and addressing microstructure abnormalities in neurotransmission networks.