I'm a psychiatrist and I work with an addiction population. I think many of them would be glad to have this as an option. It's certainly not perfect, but it would provide an additional layer of protection to people who struggle to maintain sobriety. I think it's sad that the first reaction to this is to think of it as something from "dystopian" science fiction. The oral medication disulfram shares a similar mechanism of action, but it has to be taken every day. When a patient begins to struggle they often stop the antabuse, losing the benefit. At least gives them a few months of protection and if after that they choose not to resume it sounds like that's a possibility.<p>With proper informed consent, it's a welcome tool to a common and potentially devastating problem.
The first thing that popped into my mind was a Tintin story - where Captain Haddock finds he can no longer bear the taste of whiskey. The professor had given him something akin to this.<p><a href="http://en.wikipedia.org/wiki/Tintin_and_the_Picaros" rel="nofollow">http://en.wikipedia.org/wiki/Tintin_and_the_Picaros</a><p>Life is stranger than ...
> Normally, the liver breaks down alcohol into an enzyme that’s transformed into the compound acetaldehyde (responsible for that nasty hangover feeling), which in turn is degraded into another enzyme.<p>Replace 1st and 3rd <i>"into"</i> with <i>"by"</i>, <i>please</i>: reading this makes my mind hurt and I'm sure it's the same for anyone with basic biochem knowledge...
So how does it work...<p>The second enzyme mentioned is one possessing acetaldehyde dehydrogenase activity, ALDH2 being the primary actor. This would not be a vaccine in the traditional sense since it would not cause ethanol to prompt an immunological response.<p>The closest paper I could find is this one from 2010, that describes the mechanism of action[1]:<p>"a long-term inhibition of ethanol consumption by reducing ALDH2 levels by the administration of vectors that code for anti-aldh2 antisense RNA molecules that inhibit aldh2 gene expression"<p>Pretty cool; they are using a viral vector to introduce complementary RNA that binds to the mRNA responsible for translation of ALDH2, directly down regulating expression of ALDH2. This reduces the number of ALDH2 enzyme molecules available to interact with acetaldehyde by reducing the number created (compared to disulfiram, which is a competitive inhibitor of ALDH2 itself). It seems the antisense RNA used targets the mitochonrial isoform of ALDH2, mimicking the effect of the "natural" mutation. I wonder if it has cross specificity adequate to inhibit expression of the cytosolic isoform as well.<p>Acetaldehyde is not the only substrate for ALDH2 however. Glyceryl trinitrate (nitroglycerin) and amyl nitrite are also metabolized by ALDH2, so this treatment might not be wise for those taking glyceryl trinitrate for a heart condition or amyl nitrite for cyanide poisoning/heart. It looks like the cells in coronary arteries mainly use cytosolic ALDH2 to metabolize glyceryl trinitrate[2] though, so if this "vaccine" only inhibits the mitochondrial isoform it may not interfere with the effectiveness of these other drugs.<p>1. (Martinez, et al.) <a href="http://www.captura.uchile.cl/bitstream/handle/2250/11147/Martinez_V.pdf?sequence=1" rel="nofollow">http://www.captura.uchile.cl/bitstream/handle/2250/11147/Mar...</a>
Viral vectors for the treatment of alcoholism: Use of metabolic flux analysis for cell cultivation and vector production.<p>2. (Beretta, et al.) <a href="http://www.ncbi.nlm.nih.gov/pubmed/22207712" rel="nofollow">http://www.ncbi.nlm.nih.gov/pubmed/22207712</a> Vascular bioactivation of nitroglycerin is catalyzed by cytosolic aldehyde dehydrogenase-2.
Disulfiram has been known to cause acute sensitivity to alcohol since 1948 and has been used to treat chronic alcoholism:<p><a href="http://en.wikipedia.org/wiki/Disulfiram" rel="nofollow">http://en.wikipedia.org/wiki/Disulfiram</a><p><pre><code> Disulfiram is absorbed slowly through the digestive tract
and eliminated slowly by the body the effects may last
for up to two weeks after the initial intake
</code></pre>
An interesting podcast from NPR on its use in Russia:<p><a href="http://www.marketplace.org/topics/world/russia-rx/killer-cure-alcoholism-russia" rel="nofollow">http://www.marketplace.org/topics/world/russia-rx/killer-cur...</a>
It's a pet peeve of mine when articles quote their own paragraphs in big bold headings immediately below the paragraph itself.<p><pre><code> "It's a pet peeve of mine when articles
quote their own paragraphs"
</code></pre>
After all, didn't I <i>just</i> read that?
If I understand what is being proposed, the recipients of the treatment will essentially suffer from Asian flush (many people of Asian descent have a mutation that makes them less capable of breaking down alcohol and its byproducts). This may discourage the recipient from drinking in the future by essentially preventing the body from protecting itself from the ravaging effects of alcohol. Perhaps there is a better way to set up this vaccine.
<i>"So far, the vaccine has been tested successfully on alcoholic mice."</i><p>How does one raise a mouse to be alcoholic? How would you even diagnose it in mice? Is there a genetic strain, or is it environmental?
> But with the biological piece of the disease taken care of, a big part of the battle is already won.<p>I completely disagree. IMO biology is responsible for a very very small part of the problem of addiction. As somebody who lost his mother to liver disease stemming from her addictions, these types of treatments lead to even more dangerous outcomes.<p>A week in rehab will remove the biological dependence of alcohol.<p>My mom's addictions started as a teenager with food. Food was her indulgence of choice. After years of trying to rid herself of the consequences of that addiction by dieting, she turned to weight loss surgery to help. Sure, she lost a lot of weight but this merely relieved the symptoms of her disease and did nothing the disease itself.<p>Years later she no longer possessed the biological ability to be addicted to food so she turned to alcohol instead. The weight loss surgery combined with only 4 years of alcohol abuse (with several stints of sobriety) was enough to ruin her liver to a point of no return.<p>I don't dispute that this drug could be effective for the newly sober individuals who need a little extra push to remain sober. A doctor that administers this vaccine without careful followup and psychological treatment is doing the patient a disservice.<p>Let's not kid ourselves, this "vaccine" does nothing but mask the symptoms of the disease leaving the patient troubled, alone and without help.<p>Addiction is a lifelong disease and it needs to be treated as such. Without proper treatment (psychological help), the disease will morph and before you know it have ahold of your life once again.
I remember a roommate of my in college who was a heavy smoker and was trying to quit. Friend of his was in Equinox (the multi-level marketing scheme) and gave him some of these "no smoke" tablets to cure him of his smoking habit.<p>He said all it did was give him intolerable diarrhea for a week and then he threw the rest of the tablets away. I would imagine most people would do the same thing with the oral medication if the effects were so drastic.
I am 1/4 Japanese, and have the "natural" genetic version of this. It does not stop me from drinking, though I naturally drink a <i>lot</i> less frequently than my peers because it is unpleasant. I don't drink casually, because the pleasure of a slight buzz is overwhelmed with the discomfort of having a hot face/chest and difficulty breathing (feels a lot like a mild asthma attack - like something heavy is sitting on your chest and making it hard to take a full breath). But at a special event or a party or something, yeah, I can and will still get drunk.<p>Also, as almost anyone of Asian descent can tell you, you can take a Pepcid AC (or the generic equiv) around 30-45 minutes before drinking and it slows the conversion of alcohol into acetaldehyde, making drinking with this condition more tolerable.<p>For someone with an actual, problematic addiction to alcohol, I don't know if the side-effects of an acetaldehyde dehydrogenase deficiency will be enough to stop drinking.
Could someone explain to me how this is a vaccine? In school we were taught inoculations boost immunity and a vaccine is a form of inoculation which works by introducing enough of a bacteria or virus to make a person build antibodies.
Well, we've had similar drugs (though not vaccines) for a while I believe, and they don't always work as they should.<p>A guy I worked with was a recovering alcoholic on a "return-to-work" program. As a part of this program he had to take antabuse to stop him from drinking again. He died from a fatal heart attack within a month after he started working. It turns out he'd secretly still continued to drink even while on antabuse, which put an <i>immense</i> strain on his heart (antabuse gives tachycardia on consuming alcohol), causing the heart attack. Sad story.<p>Alcholics have a really strong urge to drink, even though it causes discomfort.
This is a beautiful example of a strong commitment device! I've been collecting examples of commitment devices at <a href="http://blog.beeminder.com/akrasia/#AUG" rel="nofollow">http://blog.beeminder.com/akrasia/#AUG</a> (my startup, Beeminder, is also an example of a commitment device).
Anyone know (a) whether 23andme will pick up the natural genetic mutation mentioned, and (b) whether you can have varying degress of this condition?<p>Just curious: 60% of the time, alcohol makes me feel terrible every time...