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Ren J, Dewey RB, Rynders A, Evan J, Evan J, Ligozio S, Ho KS, Sguigna PV, Glanzman R, Hotchkin MT, Dewey RB, Greenberg BM. Evidence of brain target engagement in Parkinson's disease and multiple sclerosis by the investigational nanomedicine, CNM-Au8, in the REPAIR phase 2 clinical trials. J Nanobiotechnology 2023; 21:478. [PMID: 38087362 PMCID: PMC10717868 DOI: 10.1186/s12951-023-02236-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Impaired brain energy metabolism has been observed in many neurodegenerative diseases, including Parkinson's disease (PD) and multiple sclerosis (MS). In both diseases, mitochondrial dysfunction and energetic impairment can lead to neuronal dysfunction and death. CNM-Au8® is a suspension of faceted, clean-surfaced gold nanocrystals that catalytically improves energetic metabolism in CNS cells, supporting neuroprotection and remyelination as demonstrated in multiple independent preclinical models. The objective of the Phase 2 REPAIR-MS and REPAIR-PD clinical trials was to investigate the effects of CNM-Au8, administered orally once daily for twelve or more weeks, on brain phosphorous-containing energy metabolite levels in participants with diagnoses of relapsing MS or idiopathic PD, respectively. RESULTS Brain metabolites were measured using 7-Tesla 31P-MRS in two disease cohorts, 11 participants with stable relapsing MS and 13 participants with PD (n = 24 evaluable post-baseline scans). Compared to pre-treatment baseline, the mean NAD+/NADH ratio in the brain, a measure of energetic capacity, was significantly increased by 10.4% after 12 + weeks of treatment with CNM-Au8 (0.584 units, SD: 1.3; p = 0.037, paired t-test) in prespecified analyses of the combined treatment cohorts. Each disease cohort concordantly demonstrated increases in the NAD+/NADH ratio but did not reach significance individually (p = 0.11 and p = 0.14, PD and MS cohorts, respectively). Significant treatment effects were also observed for secondary and exploratory imaging outcomes, including β-ATP and phosphorylation potential across both cohorts. CONCLUSIONS Our results demonstrate brain target engagement of CNM-Au8 as a direct modulator of brain energy metabolism, and support the further investigation of CNM-Au8 as a potential disease modifying drug for PD and MS.
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Affiliation(s)
- Jimin Ren
- University of Texas Southwestern Medical Center, Department of Neurology, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Richard B Dewey
- University of Texas Southwestern Medical Center, Department of Neurology, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Parkinson's Disease and Movement Disorders Center, Boca Raton, FL, 33486, USA
| | - Austin Rynders
- Clene Nanomedicine, Inc., 6550 S Millrock Dr., Suite G50, Salt Lake City, UT, 84121, USA
| | - Jacob Evan
- Clene Nanomedicine, Inc., 6550 S Millrock Dr., Suite G50, Salt Lake City, UT, 84121, USA
| | - Jeremy Evan
- Clene Nanomedicine, Inc., 6550 S Millrock Dr., Suite G50, Salt Lake City, UT, 84121, USA
| | - Shelia Ligozio
- Instat Clinical Research, A Veristat Company, 1 Wilson St., Chatham, NJ, 07928, USA
| | - Karen S Ho
- Clene Nanomedicine, Inc., 6550 S Millrock Dr., Suite G50, Salt Lake City, UT, 84121, USA.
| | - Peter V Sguigna
- University of Texas Southwestern Medical Center, Department of Neurology, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Robert Glanzman
- Clene Nanomedicine, Inc., 6550 S Millrock Dr., Suite G50, Salt Lake City, UT, 84121, USA
| | - Michael T Hotchkin
- Clene Nanomedicine, Inc., 6550 S Millrock Dr., Suite G50, Salt Lake City, UT, 84121, USA
| | - Richard B Dewey
- University of Texas Southwestern Medical Center, Department of Neurology, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Parkinson's Disease and Movement Disorders Center, Boca Raton, FL, 33486, USA
| | - Benjamin M Greenberg
- University of Texas Southwestern Medical Center, Department of Neurology, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Parasoglou P, Osorio RS, Khegai O, Kovbasyuk Z, Miller M, Ho A, Dehkharghani S, Wisniewski T, Convit A, Mosconi L, Brown R. Phosphorus metabolism in the brain of cognitively normal midlife individuals at risk for Alzheimer's disease. NEUROIMAGE. REPORTS 2022; 2:100121. [PMID: 36532654 PMCID: PMC9757821 DOI: 10.1016/j.ynirp.2022.100121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Neurometabolic abnormalities and amyloid-beta plaque deposition are important early pathophysiologic changes in Alzheimer's disease (AD). This study investigated the relationship between high-energy phosphorus-containing metabolites, glucose uptake, and amyloid plaque using phosphorus magnetic resonance spectroscopy (31P-MRS) and positron emission tomography (PET). METHODS We measured 31P-MRS, fluorodeoxyglucose (FDG)-PET, and Pittsburgh Compound B (PiB)-PET in a cohort of 20 cognitively normal middle-aged adults at risk for AD. We assessed 31P-MRS reliability by scanning a separate cohort of 13 healthy volunteers twice each. We calculated the coefficient-of-variation (CV) of metabolite ratios phosphocreatine-to-adenosine triphosphate (PCr/α-ATP), inorganic phosphate (Pi)-to-α-ATP, and phosphomonoesters-to-phosphodiesters (PME/PDE), and pH in pre-defined brain regions. We performed linear regression analysis to determine the relationship between 31P measurements and tracer uptake, and Dunn's multiple comparison tests to investigate regional differences in phosphorus metabolism. Finally, we performed linear regression analysis on 31P-MRS measurements in both cohorts to investigate the relationship of phosphorus metabolism with age. RESULTS Most regional 31P metabolite ratio and pH inter- and intra-day CVs were well below 10%. There was an inverse relationship between FDG-SUV levels and metabolite ratios PCr/α-ATP, Pi/α-ATP, and PME/PDE in several brain regions in the AD risk group. There were also several regional differences among 31P metabolites and pH in the AD risk group including elevated PCr/α-ATP, depressed PME/PDE, and elevated pH in the temporal cortices. Increased PCr/α-ATP throughout the brain was associated with aging. CONCLUSIONS Phosphorus spectroscopy in the brain can be performed with high repeatability. Phosphorus metabolism varies with region and age, and is related to glucose uptake in adults at risk for AD. Phosphorus spectroscopy may be a valuable approach to study early changes in brain energetics in high-risk populations.
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Affiliation(s)
- Prodromos Parasoglou
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ricardo S. Osorio
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Oleksandr Khegai
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Zanetta Kovbasyuk
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Margo Miller
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Amanda Ho
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Seena Dehkharghani
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Neurology, Center for Cognitive Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Thomas Wisniewski
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- Department of Neurology, Center for Cognitive Neurology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Antonio Convit
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- Nathan S Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Ryan Brown
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
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Schultz JL, Brinker AN, Xu J, Ernst SE, Tayyari F, Liu L, Uc EY, Taylor EB, Simmering JE, Magnotta VA, Welsh MJ, Narayanan NS, Narayanan NS. A pilot to assess target engagement of terazosin in Parkinson's disease. Parkinsonism Relat Disord 2022; 94:79-83. [PMID: 34894470 PMCID: PMC8862665 DOI: 10.1016/j.parkreldis.2021.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Impaired brain energy metabolism is a key feature of Parkinson's disease (PD). Terazosin (TZ) binds phosphoglycerate kinase 1 and stimulates its activity, which enhances glycolysis and increases ATP levels. Preclinical and epidemiologic data suggest that TZ may be neuroprotective in PD. We aimed to assess target engagement and safety of TZ in people with PD. METHODS We performed a 12-week pilot study in people with PD. Participants were randomized to receive 5 mg TZ or placebo. Participants and study personnel were blinded. We assessed TZ target engagement by measuring brain ATP with 31P-magnetic resonance spectroscopy (MRS) and whole blood ATP with a luminescence assay. Robust linear regression models compared changes between groups controlling for baseline brain and blood ATP levels, respectively. We also assessed clinical measures of PD and adverse events. RESULTS Thirteen participants were randomized. Mild dizziness/lightheadedness was more common in the TZ group, and three participants taking TZ dropped out because of dizziness and/or orthostatic hypotension. Compared to the placebo group, the TZ group had a significant increase in the ratio of βATP to inorganic phosphate in the brain. The TZ group also had a significant increase in blood ATP levels compared to the placebo group (p < 0.01). CONCLUSIONS This pilot study suggests that TZ may engage its target and change ATP levels in the brain and blood of people with PD. Further studies may be warranted to test the disease-modifying potential of TZ.
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Affiliation(s)
- Jordan L. Schultz
- Department of Psychiatry, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Division of Pharmacy Practice and Sciences, College of Pharmacy, University of Iowa, Iowa City, IA 52242,Department of Neurology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Alivia N. Brinker
- Department of Psychiatry, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Jia Xu
- Department of Radiology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Sarah E. Ernst
- Department of Internal Medicine, Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Howard Hughes Medical Institute, University of Iowa, Iowa City, IA 52242
| | - Fariba Tayyari
- Department of Molecular Physiology and Biophysics, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Lei Liu
- Department of Biochemistry and Molecular Biology, Capital Medical University School of Basic Medicine, Beijing, 100069, China
| | - Ergun Y. Uc
- Department of Neurology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Veteran’s Affairs Medical Center, 601 US-6 W, Iowa City, IA 52246
| | - Eric B. Taylor
- Department of Molecular Physiology and Biophysics, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242, (EBT, JES, VAM, MJW, NSN)
| | - Jacob E. Simmering
- Department of Internal Medicine, Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242, (EBT, JES, VAM, MJW, NSN)
| | - Vincent A. Magnotta
- Department of Neurology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242, (EBT, JES, VAM, MJW, NSN)
| | - Michael J. Welsh
- Department of Neurology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Department of Internal Medicine, Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Department of Molecular Physiology and Biophysics, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242, (EBT, JES, VAM, MJW, NSN),Howard Hughes Medical Institute, University of Iowa, Iowa City, IA 52242
| | - Nandakumar S. Narayanan
- Department of Neurology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242, (EBT, JES, VAM, MJW, NSN)
| | - Nandakumar S Narayanan
- Department of Neurology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA; Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
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Dossi G, Squarcina L, Rango M. In Vivo Mitochondrial Function in Idiopathic and Genetic Parkinson's Disease. Metabolites 2019; 10:metabo10010019. [PMID: 31905632 PMCID: PMC7023121 DOI: 10.3390/metabo10010019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 01/26/2023] Open
Abstract
Parkinson’s disease (PD) is associated with brain mitochondrial dysfunction. High-energy phosphates (HEPs), which rely on mitochondrial functioning, may be considered potential biomarkers for PD. Phosphorus magnetic resonance spectroscopy (31P-MRS) is a suitable tool to explore in vivo cerebral energetics. We considered 10 31P-MRS studies in order to highlight the main findings about brain energetic compounds in patients affected by idiopathic PD and genetic PD. The studies investigated several brain areas such as frontal lobes, occipital lobes, temporoparietal cortex, visual cortex, midbrain, and basal ganglia. Resting-state studies reported contrasting results showing decreased as well as normal or increased HEPs levels in PD patients. Functional studies revealed abnormal PCr + βATP levels in PD subjects during the recovery phase and abnormal values at rest, during activation and recovery in one PD subject with PINK1 gene mutation suggesting that mitochondrial machinery is more impaired in PD patients with PINK1 gene mutation. PD is characterized by energetics impairment both in idiopathic PD as well as in genetic PD, suggesting that mitochondrial dysfunction underlies the disease. Studies are still sparse and sometimes contrasting, maybe due to different methodological approaches. Further studies are needed to better assess the role of mitochondria in the PD development.
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Mortiboys H, Macdonald R, Payne T, Sassani M, Jenkins T, Bandmann O. Translational approaches to restoring mitochondrial function in Parkinson's disease. FEBS Lett 2017; 592:776-792. [PMID: 29178330 DOI: 10.1002/1873-3468.12920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/04/2017] [Accepted: 11/14/2017] [Indexed: 12/22/2022]
Abstract
There is strong evidence of a key role for mitochondrial dysfunction in both sporadic and all forms of familial Parkinson's disease (PD). However, none of the clinical trials carried out with putative mitochondrial rescue agents have been successful. Firm establishment of a wet biomarker or a reliable readout from imaging studies detecting mitochondrial dysfunction and reflecting disease progression is also awaited. We will provide an overview of our current knowledge about mitochondrial dysfunction in PD and related drug screens. We will also summarise previously undertaken mitochondrial wet biomarker studies and relevant imaging studies with particular focus on 31P-MRI spectroscopy. We will conclude with an overview of clinical trials which tested putative mitochondrial rescue agents in PD patients.
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Affiliation(s)
- Heather Mortiboys
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, UK
| | - Ruby Macdonald
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, UK
| | - Thomas Payne
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, UK
| | - Matilde Sassani
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, UK
| | - Thomas Jenkins
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, UK
| | - Oliver Bandmann
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, UK
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Hattingen E, Magerkurth J, Pilatus U, Mozer A, Seifried C, Steinmetz H, Zanella F, Hilker R. Phosphorus and proton magnetic resonance spectroscopy demonstrates mitochondrial dysfunction in early and advanced Parkinson's disease. ACTA ACUST UNITED AC 2010; 132:3285-97. [PMID: 19952056 DOI: 10.1093/brain/awp293] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mitochondrial dysfunction hypothetically contributes to neuronal degeneration in patients with Parkinson's disease. While several in vitro data exist, the measurement of cerebral mitochondrial dysfunction in living patients with Parkinson's disease is challenging. Anatomical magnetic resonance imaging combined with phosphorus and proton magnetic resonance spectroscopic imaging provides information about the functional integrity of mitochondria in specific brain areas. We measured partial volume corrected concentrations of low-energy metabolites and high-energy phosphates with sufficient resolution to focus on pathology related target areas in Parkinson's disease. Combined phosphorus and proton magnetic resonance spectroscopic imaging in the mesostriatal region was performed in 16 early and 13 advanced patients with Parkinson's disease and compared to 19 age-matched controls at 3 Tesla. In the putamen and midbrain of both Parkinson's disease groups, we found a bilateral reduction of high-energy phosphates such as adenosine triphophosphate and phosphocreatine as final acceptors of energy from mitochondrial oxidative phosphorylation. In contrast, low-energy metabolites such as adenosine diphophosphate and inorganic phosphate were within normal ranges. These results provide strong in vivo evidence that mitochondrial dysfunction of mesostriatal neurons is a central and persistent phenomenon in the pathogenesis cascade of Parkinson's disease which occurs early in the course of the disease.
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Affiliation(s)
- Elke Hattingen
- Institute of Neuroradiology, J.W. Goethe University Schleusenweg 2-16, 60528 Frankfurt/Main, Germany.
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Barbiroli B, Martinelli P, Patuelli A, Lodi R, Iotti S, Cortelli P, Montagna P. Phosphorus magnetic resonance spectroscopy in multiple system atrophy and Parkinson's disease. Mov Disord 1999; 14:430-5. [PMID: 10348465 DOI: 10.1002/1531-8257(199905)14:3<430::aid-mds1007>3.0.co;2-s] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We performed in vivo phosphorus magnetic resonance spectroscopy on the occipital lobes of 15 patients with multiple system atrophy (MSA; eight with olivopontocerebellar atrophy [OPCA] and seven with the striatonigral degeneration variant [SND]), 13 patients with idiopathic Parkinson's disease (PD), and 16 age-matched healthy subjects. The MSA group showed significantly reduced phosphocreatine (PCr), increased inorganic phosphate (Pi), and unchanged cytosolic free [Mg2+], and pH. We did not find any significant difference between the OPCA and SND variants. However, patients with PD showed significantly increased content of Pi, decreased cytosolic free [Mg2+], and unchanged [PCr] and pH. Comparing the MSA and PD groups, [PCr] was significantly lower in MSA than in PD, whereas cytosolic free [Mg2+] was significantly lower in PD. Despite a certain degree of overlap of [PCr] and [Mg2+] values between the two groups, by considering both variables at the same time it was possible to classify correctly 93% of cases by discriminant analysis. We conclude that phosphorus magnetic resonance spectroscopy discloses abnormal phosphate metabolite and ion contents in both MSA and PD, respectively, and may provide noninvasive diagnostic help to differentiate MSA from PD.
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Affiliation(s)
- B Barbiroli
- Biochimica Clinica, Dipartimento di Medicina Clinica e Biotecnologia Applicata D. Campanacci, Università di Bologna, Italy
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