
Galantamine is an acetylcholinesterase inhibitor. Its primary mode
of protective action is to reversibly bind to acetylcholinesterase
and block the irreversible binding of the organophosphate toxin. The
competitive binding characteristics of galantamine prevent the build-up
of acetylcholine and protect the victim from the potentially fatal effects.
Pre-IND studies have shown galantamine to be effective in protecting
100% of the animals tested at nerve gas exposure levels of two times
the lethal dose. Galantamine not only protects the peripheral nervous
system but due to its nature as a small uncharged molecule, crosses the
blood-brain barrier to protect the central nervous system from longer
term detrimental effects. Guinea pig studies have shown protection from
neurodegeneration in the hippocampus, pyriform cortex, and amygdale by
galantamine against lethal doses of OPs.
Galantamine can be used prophylactically to prepare for anticipated organophosphate poisoning (nerve gas attack and pesticide application). It can also be used after exposure to treat acute cases. Studies by the primary investigator support effective use of galantamine up to 25 minutes post exposure.
Since galantamine is a small molecule, it does not present the immunological problems that larger molecules such as enzymes and antibodies are subject. Multiple doses will not produce immunological sensitivity resulting in a negative immune response such as anaphylactic shock.
Recent data support the use of galantamine without the need for an anti-muscarinic agent such as atropine. As such, significant value is added by eliminating the cost and the adverse effects caused by atropine.
Although galantamine is categorized as an acetylcholinesterase (AChE) inhibitor, it is unique in that it is the only AChE inhibitor that also rescues nicotinic receptors believed to be responsible for its superior antidotal effectiveness.
In comparison to other OP antidotes under development, galantamine is already being produced at economy of scale levels and on the market for another indication. As a result a substantial amount of safety data exists in a broad range of populations and supply of the active pharmaceutical ingredient is readily available.
