Aquaretic effect of the stable dynorphin-A analog E2078 in the human

Dynorphin-A is an endogenously released hormone that is now recognized as a kappa-opioid receptor agonist. Because kappa-agonists have been reported to induce water diuresis through negative modulation of antidiuretic hormone release and/or action, in the present study we investigated the aquaretic effects and safety of E2078, a metabolically stable dynorphin-A analog, in 21 healthy subjects after single (1.0, 2.0, 3.0, 5.0, 7.5 and 10.0 mg, i.m.) and repeated (5.0 mg t.i.d. for 4 and 1/3 days) administration. E2078 dose-dependently increased the 0 to 4-hr urine volume, which plateaued between 1032.4 +/- 130.1 and 1286.2 +/- 113.0 ml/4 hr (mean +/- S.E.M.) at doses of between 5.0 and 10.0 mg. The drug decreased urine osmolality (Uosm) markedly, by 17 to 27%, and the free-water clearance (CH2O) became positive, changing from -1.8 +/- 0.2 (placebo) to 0.8 +/- 0.3-2.8 +/- 0.4 ml/min after a single E2078 administration (P < .01). In the repeated-dose study, the first dose of E2078 increased the 0 to 5-hr urine output (1256 +/- 164.9 ml/5 h), lowered Uosm (151.8 +/- 13.3 mOsm/kg) and brought about a positive CH2O (1.9 +/- 0.2 ml/min). These values were similar to those seen after the single dose, but after the subsequent doses these aquaretic effects were attenuated, although the ranges of these same parameters were still significantly greater (P < .01-0.05) (441.4 +/- 102.4-585.3 +/- 131.9 ml/5 hr, 322.8 +/- 21.9-378.2 +/- 47.7 mOsm/kg and -0.2 +/- 0.2-(-)0.6 +/- 0.2 ml/min, respectively) than the day -1 base line (164.1 +/- 41.3 ml/5 hr, 992.0 +/- 80.6 mOsm/kg and -1.2 +/- 0.2 ml/min, respectively). Urinary excretion of electrolytes (Na, K and Cl) was not altered during either study period. A single E2078 administration reduced plasma antidiuretic hormone dose-dependently. On repeated dosing, the plasma concentration had rebounded to approximately 3 pg/ml by the time of the first dose on days 3 and 5, which lowered it again. The present results suggest that E2078 is a safe and effective aquaretic and could be a useful therapeutic tool for patients with water-retaining diseases.