Nicotine Vaccine

NICOTINE VACCINE

SMOKING  Single leading preventable cause of death.  The WHO estimates: 1.3 billion smokers worldwide 5 million tobacco-related deaths

TOBACCO USE AND HEALTH Smoking harms almost all organs of the body     

Respiratory diseases Heart diseases Cancer Stroke Reproductive complications.

"Quitting smoking is easy I've done it a thousand times“

-Mark Twain

WHY CESSATION ? The single most important step that smokers can take to enhance the length and quality of their lives. “

SMOKING CESSATION

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WHAT MAKES TOBACCO SO ADDICTIVE ?

High concentration of α4β2 nACh receptors.

Mesolimbic area Pleasure, reward

Arousal, reward system

Nicotine distilled from Tobacco Carried to lungs Diffuses into brain Binds to

α4β2 nAchRs

Release of dopamine

Psychoactive effects of Nicotine

CURRENTLY AVAILABLE THERAPY FIRST – LINE AGENTS Nicotine replacement therapy 1.Transdermal patch 2.Gum 3.Nasal spray 4.Lozenge  Bupropion (an atypical antidepressant)  Varenicline (a partial agonist of the α4β2 nAch R)

SECOND – LINE AGENTS  Nortriptyline (a tricyclic antidepressant agent).  Clonidine (a central sympatholytic).

COMMON ADVERSE EFFECTS    

Sleep disturbances Cough Nervousness Mouth and throat irritations

NICOTINE VACCINE

HAPTEN

NICOTINE

CARRIER PROTEIN

Advantages ▪Doesn’t act on brain ▪Longer lasting than oral agents ▪Fewer side effects

Disadvantages  Repeated booster doses needed to maintain maximal antibody levels

Clinical Trials A Phase 2b study, enrolled 301 heavy smokers

Results  12-Months continuous abstinence: Nicotine vaccine 400 μg, 16% (Placebo=6% )p<0.038  12-Months continuous abstinence: Nicotine vaccine 200 μg, 14% (Placebo=6%) p<0.056

CONCLUSION The key to a successful smoking cessation program is to not only stop the urge to smoke,it must prevent relapse by preventing the initial addiction.

A nicotine vaccine may break the cycle that fuels the habit