Investigational drugs for alcohol use disorders: a review of preclinical data

Alcohol use disorders (AUDs) are one of the leading causes of preventable death in the developed world. In the U.S., only three FDA-approved pharmacotherapies for AUDs currently exist, but at a population level they display poor efficacy, low compliance rates, and adverse side effects. Therefore, identifying novel neurobiological targets for pharmacological treatment of AUDs is of urgent concern.

We discuss recent preclinical data on investigational drugs that have been assessed for their therapeutic potential in AUDs. We focus on three neurobiological domains underlying AUDs: neuropeptide systems, neuroinflammatory/neuroimmune mediators, and epigenetic modifications. We iterate the therapeutic potential of ghrelin receptor antagonists, oxytocin, neurokinin 1 receptor antagonists, and glucagon-like peptide-1 receptor agonists. In the context of neuroinflammatory/neuroimmune modulators, we draw attention to P2X4 receptor positive allosteric modulators and phosphodiesterase inhibitors. Finally, we highlight the prospects of histone deacetylase inhibitors and DNA methyltransferases that modulate the dysregulated epigenetic landscape in alcohol dependence.

We propose that several of the compounds discussed may be suitable to be repurposed for AUD treatment. We allude to the possibility of combined pharmacotherapy for AUDs and anticipate the efforts that must be enacted to advance the field of personalised medicine for the treatment of this devastating condition.