1
|
Silalai P, Jaipea S, Tocharus J, Athipornchai A, Suksamrarn A, Saeeng R. New 1,2,3-Triazole-genipin Analogues and Their Anti-Alzheimer's Activity. ACS OMEGA 2022; 7:24302-24316. [PMID: 35874205 PMCID: PMC9301951 DOI: 10.1021/acsomega.2c01593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A novel series of 1,2,3-triazole-genipin analogues were designed, synthesized, and evaluated for neuroprotective activity, acetylcholinesterase (AChE), and butyrylcholinesterase (BuChE) inhibitory activity. The genipin analogues bearing bromoethyl- and diphenylhydroxy-triazole showed in vitro neuroprotective properties against H2O2 toxicity along with potent inhibitory activity on BuChE with IC50 values of 31.77 and 54.33 μM, respectively, compared with galantamine (IC50 = 34.05 μM). The molecular docking studies of these genipin analogues showed good binding energy and interact well with the key amino acids of BuChE via hydrogen-bonding and hydrophobic interactions. Triazole genipins might be promising lead compounds as anti-Alzheimer's agents.
Collapse
Affiliation(s)
- Patamawadee Silalai
- Department
of Chemistry and Center for Innovation in Chemistry, Faculty of Science, Burapha University, Chonburi 20131, Thailand
| | - Suwichada Jaipea
- Department
of Chemistry and Center for Innovation in Chemistry, Faculty of Science, Burapha University, Chonburi 20131, Thailand
| | - Jiraporn Tocharus
- Department
of Physiology, Faculty of Medicine, Chiang
Mai University, Chiang
Mai 50200, Thailand
| | - Anan Athipornchai
- Department
of Chemistry and Center for Innovation in Chemistry, Faculty of Science, Burapha University, Chonburi 20131, Thailand
| | - Apichart Suksamrarn
- Department
of Chemistry and Center of Excellence for Innovation in Chemistry,
Faculty of Science, Ramkhamhaeng University, Bangkok 10240, Thailand
| | - Rungnapha Saeeng
- Department
of Chemistry and Center for Innovation in Chemistry, Faculty of Science, Burapha University, Chonburi 20131, Thailand
- The
Research Unit in Synthetic Compounds and Synthetic Analogues from
Natural Product for Drug Discovery (RSND), Burapha University, Chonburi 20131, Thailand
| |
Collapse
|
2
|
Jana A, Bhattacharjee A, Das SS, Srivastava A, Choudhury A, Bhattacharjee R, De S, Perveen A, Iqbal D, Gupta PK, Jha SK, Ojha S, Singh SK, Ruokolainen J, Jha NK, Kesari KK, Ashraf GM. Molecular Insights into Therapeutic Potentials of Hybrid Compounds Targeting Alzheimer's Disease. Mol Neurobiol 2022; 59:3512-3528. [PMID: 35347587 PMCID: PMC9148293 DOI: 10.1007/s12035-022-02779-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/21/2022] [Indexed: 02/08/2023]
Abstract
Alzheimer's disease (AD) is one of the most complex progressive neurological disorders involving degeneration of neuronal connections in brain cells leading to cell death. AD is predominantly detected among elder people (> 65 years), mostly diagnosed with the symptoms of memory loss and cognitive dysfunctions. The multifarious pathogenesis of AD comprises the accumulation of pathogenic proteins, decreased neurotransmission, oxidative stress, and neuroinflammation. The conventional therapeutic approaches are limited to symptomatic benefits and are ineffective against disease progression. In recent years, researchers have shown immense interest in the designing and fabrication of various novel therapeutics comprised of naturally isolated hybrid molecules. Hybrid therapeutic compounds are developed from the combination of pharmacophores isolated from bioactive moieties which specifically target and block various AD-associated pathogenic pathways. The method of designing hybrid molecules has numerous advantages over conventional multitarget drug development methods. In comparison to in silico high throughput screening, hybrid molecules generate quicker results and are also less expensive than fragment-based drug development. Designing hybrid-multitargeted therapeutic compounds is thus a prospective approach in developing an effective treatment for AD. Nevertheless, several issues must be addressed, and additional researches should be conducted to develop hybrid therapeutic compounds for clinical usage while keeping other off-target adverse effects in mind. In this review, we have summarized the recent progress on synthesis of hybrid compounds, their molecular mechanism, and therapeutic potential in AD. Using synoptic tables, figures, and schemes, the review presents therapeutic promise and potential for the development of many disease-modifying hybrids into next-generation medicines for AD.
Collapse
Affiliation(s)
- Ankit Jana
- School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT) Deemed To Be University, Campus-11, Patia, Bhubaneswar, Odisha, 751024, India
| | - Arkadyuti Bhattacharjee
- School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT) Deemed To Be University, Campus-11, Patia, Bhubaneswar, Odisha, 751024, India
| | - Sabya Sachi Das
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, 835215, India
| | - Avani Srivastava
- School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT) Deemed To Be University, Campus-11, Patia, Bhubaneswar, Odisha, 751024, India
| | - Akshpita Choudhury
- School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT) Deemed To Be University, Campus-11, Patia, Bhubaneswar, Odisha, 751024, India
| | - Rahul Bhattacharjee
- School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT) Deemed To Be University, Campus-11, Patia, Bhubaneswar, Odisha, 751024, India
| | - Swagata De
- Department of English, DDE Unit, The University of Burdwan, GolapbagBurdwan, West Bengal, 713104, India
| | - Asma Perveen
- Glocal School of Life Sciences, Glocal University, Mirzapur Pole, Saharanpur, Uttar Pradesh, India
| | - Danish Iqbal
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, 11952, Saudi Arabia
| | - Piyush Kumar Gupta
- Department of Life Sciences, School of Basic Sciences and Research (SBSR), Sharda University, Greater Noida, Uttar Pradesh, 201310, India
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering and Technology (SET), Sharda University, Greater Noida, Uttar Pradesh, 201310, India
| | - Shreesh Ojha
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, 15551, Al Ain, United Arab Emirates
| | - Sandeep Kumar Singh
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, 835215, India
| | - Janne Ruokolainen
- Department of Applied Physics, School of Science, Aalto University, 00076, Espoo, Finland
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering and Technology (SET), Sharda University, Greater Noida, Uttar Pradesh, 201310, India.
| | - Kavindra Kumar Kesari
- Department of Applied Physics, School of Science, Aalto University, 00076, Espoo, Finland.
| | - Ghulam Md Ashraf
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia. .,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| |
Collapse
|
3
|
Chen Z, Yu X, Chen L, Xu L, Cai Y, Hou S, Zheng M, Liu F. Design, synthesis, and evaluation of 8-aminoquinoline-melatonin derivatives as effective multifunctional agents for Alzheimer's disease. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:303. [PMID: 35433950 PMCID: PMC9011219 DOI: 10.21037/atm-22-730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/04/2022] [Indexed: 11/19/2022]
Abstract
Background Alzheimer’s disease (AD) is thought to be a complex, multifactorial syndrome with many related molecular lesions contributing to its pathogenesis. Thus, multi-target-directed ligands are considered an effective way of treating AD. This study sought to evaluate 8-aminoquinoline-melatonin derivatives as effective multifunctional agents for AD. Methods Thioflavin-T fluorescence assays were used to detect the inhibitory potency of 8-aminoquinoline-melatonin hybrids (a1–a5, b1–b5, and c1–c5) on self- and acetylcholinesterase (AChE)-induced amyloid-β (Aβ) aggregation. The AChE and butyrylcholinesterase (BuChE) inhibitory potency within the compounds was evaluated by Ellman’s assays. Methyl thiazolyl tetrazolium (MTT) assays were performed to evaluate the cytotoxicity of the compounds to C17.2 cells. MTT assay was used to detect the cell viability of HT22 cells to evaluate the antioxidant effect of the compounds. Metal chelation property was measured by ultraviolet-visible spectrophotometry. Results Compounds c3 and c5 had superior inhibitory activity against self-induced Aβ aggregation (with inhibitory rates of 41.4±2.1 and 25.5±3.2 at 10 µM, respectively) compared to the other compounds. Compounds in the carbamate group (i.e., a4, a5, b4, b5, c4, and c5) showed significant BuChE inhibitory activity and excellent selectivity over AChE. Most of the compounds exhibited low cytotoxicity in the C17.2 cells. Notably, a2, a3, b2, and b3 and series c (c1–c5) exhibited strong protective effects. Additionally, a3 and c1 specifically chelated with copper ions. Conclusions Taking all of the promising results together, 8-aminoquinoline-melatonin hybrids can serve as lead molecules in the further development of new multi-functional anti-AD agents.
Collapse
Affiliation(s)
- Ziwei Chen
- Pharmaceutical Department, Zhejiang Pharmaceutical College, Ningbo, China
| | - Xuefeng Yu
- Pharmaceutical Department, Zhejiang Pharmaceutical College, Ningbo, China
| | - Lei Chen
- Pharmaceutical Department, Zhejiang Pharmaceutical College, Ningbo, China
| | - Lexing Xu
- Pharmaceutical Department, Zhejiang Pharmaceutical College, Ningbo, China
| | - Yu Cai
- Pharmaceutical Department, Zhejiang Pharmaceutical College, Ningbo, China
| | - Shanshan Hou
- Pharmaceutical Department, Zhejiang Pharmaceutical College, Ningbo, China
| | - Miaodan Zheng
- Pharmacy Department, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Fuhe Liu
- Pharmaceutical Department, Zhejiang Pharmaceutical College, Ningbo, China
| |
Collapse
|
4
|
Selective BuChE Inhibitory Activity, Chemical Composition, and Enantiomeric Content of the Essential Oil from Salvia leucantha Cav. Collected in Ecuador. PLANTS 2021; 10:plants10061169. [PMID: 34207496 PMCID: PMC8227987 DOI: 10.3390/plants10061169] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022]
Abstract
The essential oil (EO) of Salvia leucantha Cav. was isolated by steam distillation of the aerial parts collected in the South of Ecuador. Its physical properties were evaluated and the chemical composition of the oil was determined by GC-MS and GC-FID analyses using two chromatographic columns, DB-5ms and HP-INNOWax. Six major compounds were identified, namely, the sesquiterpenes 6.9-guaiadiene (19.14%), (E)-caryophyllene (16.80%), germacrene D (10.22%), (E)-β-farnesene (10.00%), and bicyclogermacrene (7.52%), and the monoterpenoid bornyl acetate (14.74%). Furthermore, four pairs of enantiomers were determined by enantioselective GC-MS of the essential oil. (−)-germacrene D and (+)-α-pinene showed the highest enantiomeric excess (ee%). In an in vitro assay, the essential oil demonstrated an interesting inhibitory activity of the enzyme butyrylcholinesterase (BuChE), with an IC50 = 32.60 µg/mL, which is the highest determined for a Salvia species. In contrast, the oil was weakly active against acetylcholinesterase (AChE) with an IC50 > 250 µg/mL.
Collapse
|
5
|
da Silva DS, Soares MSP, Teixeira FC, de Mello JE, de Souza AA, Luduvico KP, de Andrade CM, Spanevello RM, Cunico W. Multitarget Effect of 2-(4-(Methylthio)phenyl)-3-(3-(piperidin-1-yl)propyl)thiazolidin-4-one in a Scopolamine-Induced Amnesic Rat Model. Neurochem Res 2021; 46:1554-1566. [PMID: 33755857 DOI: 10.1007/s11064-021-03295-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 01/24/2023]
Abstract
Cholinergic system dysfunction, oxidative damage, and alterations in ion pump activity have been associated with memory loss and cognitive deficits in Alzheimer's disease. 1,3-thiazolidin-4-ones have emerged as a class of compounds with potential therapeutic effects due to their potent anticholinesterase activity. Accordingly, this study investigated the effect of the 2-(4-(methylthio)phenyl)-3-(3-(piperidin-1-yl)propyl)thiazolidin-4-one (DS12) compound on memory, cholinergic and oxidative stress parameters, ion pump activity, and serum biochemical markers in a scopolamine-induced memory deficit model. Male Wistar rats were divided into four groups: I-Control; II-Scopolamine; III-DS12 (5 mg/kg) + scopolamine; and IV-DS12 (10 mg/kg) + scopolamine. The animals from groups III and IV received DS12 diluted in canola oil and administered for 7 days by gavage. On the last day of treatment, scopolamine (1 mg/kg) was administered intraperitoneally (i.p.) 30 min after training in an inhibitory avoidance apparatus. Twenty-four hours after scopolamine administration, the animals were subjected to an inhibitory avoidance test and were thereafter euthanized. Scopolamine induced memory deficits, increased acetylcholinesterase activity and oxidative damage, and decreased Na+/K+-ATPase activity in cerebral cortex and hippocampus. Pretreatment with DS12 prevented these brain alterations. Scopolamine also induced an increase in acetylcholinesterase activity in lymphocytes and whereas butyrylcholinesterase in serum and treatment with DS12 prevented these changes. In animals treated with DS12, no changes were observed in renal and hepatic parameters when compared to the control group. In conclusion, DS12 emerged as an important multitarget compound capable of preventing neurochemical changes associated with memory deficits.
Collapse
Affiliation(s)
- Daniel Schuch da Silva
- Laboratório de Química Aplicada a Bioativos, Centro Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Pelotas, RS, Brasil
| | - Mayara Sandrielly Pereira Soares
- Laboratório de Neuroquímica, Inflamação e Câncer, Centro de Ciências Químicas Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Campus Universitário s/n, Capão do Leão, RS, CEP 96010-900, Brazil
| | - Fernanda Cardoso Teixeira
- Laboratório de Neuroquímica, Inflamação e Câncer, Centro de Ciências Químicas Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Campus Universitário s/n, Capão do Leão, RS, CEP 96010-900, Brazil
| | - Júlia Eisenhardt de Mello
- Laboratório de Neuroquímica, Inflamação e Câncer, Centro de Ciências Químicas Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Campus Universitário s/n, Capão do Leão, RS, CEP 96010-900, Brazil
| | - Anita Avila de Souza
- Laboratório de Neuroquímica, Inflamação e Câncer, Centro de Ciências Químicas Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Campus Universitário s/n, Capão do Leão, RS, CEP 96010-900, Brazil
| | - Karina Pereira Luduvico
- Laboratório de Neuroquímica, Inflamação e Câncer, Centro de Ciências Químicas Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Campus Universitário s/n, Capão do Leão, RS, CEP 96010-900, Brazil
| | - Cinthia Melazzo de Andrade
- Departamento de Clínica de Pequenos Animais, Laboratório de Análises Clínicas Veterinário, Hospital Veterinário, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil
| | - Roselia Maria Spanevello
- Laboratório de Neuroquímica, Inflamação e Câncer, Centro de Ciências Químicas Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Campus Universitário s/n, Capão do Leão, RS, CEP 96010-900, Brazil.
| | - Wilson Cunico
- Laboratório de Química Aplicada a Bioativos, Centro Ciências Químicas, Farmacêuticas e de Alimentos, Universidade Federal de Pelotas, Pelotas, RS, Brasil.
| |
Collapse
|
6
|
Makhaeva GF, Lushchekina SV, Kovaleva NV, Yu Astakhova T, Boltneva NP, Rudakova EV, Serebryakova OG, Proshin AN, Serkov IV, Trofimova TP, Tafeenko VA, Radchenko EV, Palyulin VA, Fisenko VP, Korábečný J, Soukup O, Richardson RJ. Amiridine-piperazine hybrids as cholinesterase inhibitors and potential multitarget agents for Alzheimer's disease treatment. Bioorg Chem 2021; 112:104974. [PMID: 34029971 DOI: 10.1016/j.bioorg.2021.104974] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 02/06/2023]
Abstract
We synthesized eleven new amiridine-piperazine hybrids 5a-j and 7 as potential multifunctional agents for Alzheimer's disease (AD) treatment by reacting N-chloroacetylamiridine with piperazines. The compounds displayed mixed-type reversible inhibition of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). Conjugates were moderate inhibitors of equine and human BChE with negligible fluctuation in anti-BChE activity, whereas anti-AChE activity was substantially dependent on N4-substitution of the piperazine ring. Compounds with para-substituted aromatic moieties (5g, 5h, and bis-amiridine 7) had the highest anti-AChE activity in the low micromolar range. Top-ranked compound 5h, N-(2,3,5,6,7,8-hexahydro-1H-cyclopenta[b]quinolin-9-yl)-2-[4-(4-nitro-phenyl)-piperazin-1-yl]-acetamide, had an IC50 for AChE = 1.83 ± 0.03 μM (Ki = 1.50 ± 0.12 and αKi = 2.58 ± 0.23 μM). The conjugates possessed low activity against carboxylesterase, indicating a likely absence of unwanted drug-drug interactions in clinical use. In agreement with analysis of inhibition kinetics and molecular modeling studies, the lead compounds were found to bind effectively to the peripheral anionic site of AChE and displace propidium, indicating their potential to block AChE-induced β-amyloid aggregation. Similar propidium displacement activity was first shown for amiridine. Two compounds, 5c (R = cyclohexyl) and 5e (R = 2-MeO-Ph), exhibited appreciable antioxidant capability with Trolox equivalent antioxidant capacity values of 0.47 ± 0.03 and 0.39 ± 0.02, respectively. Molecular docking and molecular dynamics simulations provided insights into the structure-activity relationships for AChE and BChE inhibition, including the observation that inhibitory potencies and computed pKa values of hybrids were generally lower than those of the parent molecules. Predicted ADMET and physicochemical properties of conjugates indicated good CNS bioavailability and safety parameters comparable to those of amiridine and therefore acceptable for potential lead compounds at the early stages of anti-AD drug development.
Collapse
Affiliation(s)
- Galina F Makhaeva
- Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka 142432, Russia
| | - Sofya V Lushchekina
- Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka 142432, Russia; Emanuel Institute of Biochemical Physics Russian Academy of Sciences, Moscow 119334, Russia
| | - Nadezhda V Kovaleva
- Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka 142432, Russia
| | - Tatiana Yu Astakhova
- Emanuel Institute of Biochemical Physics Russian Academy of Sciences, Moscow 119334, Russia
| | - Natalia P Boltneva
- Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka 142432, Russia
| | - Elena V Rudakova
- Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka 142432, Russia
| | - Olga G Serebryakova
- Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka 142432, Russia
| | - Alexey N Proshin
- Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka 142432, Russia
| | - Igor V Serkov
- Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka 142432, Russia
| | - Tatiana P Trofimova
- Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka 142432, Russia; Department of Chemistry, Lomonosov Moscow State University, Moscow 119991, Russia
| | - Victor A Tafeenko
- Department of Chemistry, Lomonosov Moscow State University, Moscow 119991, Russia
| | - Eugene V Radchenko
- Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka 142432, Russia; Department of Chemistry, Lomonosov Moscow State University, Moscow 119991, Russia
| | - Vladimir A Palyulin
- Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka 142432, Russia; Department of Chemistry, Lomonosov Moscow State University, Moscow 119991, Russia
| | - Vladimir P Fisenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119881, Russia
| | - Jan Korábečný
- Biomedical Research Centre, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic
| | - Ondrej Soukup
- Biomedical Research Centre, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic
| | - Rudy J Richardson
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109 USA; Department of Neurology, University of Michigan, Ann Arbor, MI 48109 USA; Center of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109 USA.
| |
Collapse
|
7
|
Przybyłowska M, Dzierzbicka K, Kowalski S, Chmielewska K, Inkielewicz-Stepniak I. Therapeutic Potential of Multifunctional Derivatives of Cholinesterase Inhibitors. Curr Neuropharmacol 2021; 19:1323-1344. [PMID: 33342413 PMCID: PMC8719290 DOI: 10.2174/1570159x19666201218103434] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/07/2020] [Accepted: 11/29/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of this work is to review tacrine analogues from the last three years, which were not included in the latest review work, donepezil and galantamine hybrids from 2015 and rivastigmine derivatives from 2014. In this account, we summarize the efforts toward the development and characterization of non-toxic inhibitors of cholinesterases based on mentioned drugs with various interesting additional properties such as antioxidant, decreasing β-amyloid plaque aggregation, nitric oxide production, pro-inflammatory cytokines release, monoamine oxidase-B activity, cytotoxicity and oxidative stress in vitro and in animal model that classify these hybrids as potential multifunctional therapeutic agents for Alzheimer's disease. Moreover, herein, we have described the cholinergic hypothesis, mechanisms of neurodegeneration and current pharmacotherapy of Alzheimer's disease based on the restoration of cholinergic function through blocking enzymes that break down acetylcholine.
Collapse
Affiliation(s)
- Maja Przybyłowska
- Department of Organic Chemistry, Faculty of Chemistry, Gdansk University of Technology, Gdansk, Poland
| | - Krystyna Dzierzbicka
- Department of Organic Chemistry, Faculty of Chemistry, Gdansk University of Technology, Gdansk, Poland
| | - Szymon Kowalski
- Department of Pharmaceutical Pathophysiology, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
| | - Klaudia Chmielewska
- Department of Organic Chemistry, Faculty of Chemistry, Gdansk University of Technology, Gdansk, Poland
| | - Iwona Inkielewicz-Stepniak
- Department of Pharmaceutical Pathophysiology, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
8
|
Makhaeva GF, Kovaleva NV, Rudakova EV, Boltneva NP, Lushchekina SV, Faingold II, Poletaeva DA, Soldatova YV, Kotelnikova RA, Serkov IV, Ustinov AK, Proshin AN, Radchenko EV, Palyulin VA, Richardson RJ. New Multifunctional Agents Based on Conjugates of 4-Amino-2,3-polymethylenequinoline and Butylated Hydroxytoluene for Alzheimer's Disease Treatment. Molecules 2020; 25:molecules25245891. [PMID: 33322783 PMCID: PMC7763995 DOI: 10.3390/molecules25245891] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 01/18/2023] Open
Abstract
New hybrids of 4-amino-2,3-polymethylenequinoline with different sizes of the aliphatic ring linked to butylated hydroxytoluene (BHT) by enaminoalkyl (7) or aminoalkyl (8) spacers were synthesized as potential multifunctional agents for Alzheimer's disease (AD) treatment. All compounds were potent inhibitors of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) with selectivity toward BChE. Lead compound 8c, 2,6-di-tert-butyl-4-{[2-(7,8,9,10- tetrahydro-6H-cyclohepta[b]quinolin-11-ylamino)-ethylimino]-methyl}-phenol exhibited an IC50(AChE) = 1.90 ± 0.16 µM, IC50(BChE) = 0.084 ± 0.008 µM, and 13.6 ± 1.2% propidium displacement at 20 μM. Compounds possessed low activity against carboxylesterase, indicating likely absence of clinically unwanted drug-drug interactions. Kinetics were consistent with mixed-type reversible inhibition of both cholinesterases. Docking indicated binding to catalytic and peripheral AChE sites; peripheral site binding along with propidium displacement suggest the potential of the hybrids to block AChE-induced β-amyloid aggregation, a disease-modifying effect. Compounds demonstrated high antioxidant activity in ABTS and FRAP assays as well as inhibition of luminol chemiluminescence and lipid peroxidation in mouse brain homogenates. Conjugates 8 with amine-containing spacers were better antioxidants than those with enamine spacers 7. Computational ADMET profiles for all compounds predicted good blood-brain barrier distribution (permeability), good intestinal absorption, and medium cardiac toxicity risk. Overall, based on their favorable pharmacological and ADMET profiles, conjugates 8 appear promising as candidates for AD therapeutics.
Collapse
Affiliation(s)
- Galina F. Makhaeva
- Institute of Physiologically Active Compounds Russian Academy of Sciences, 142432 Chernogolovka, Russia; (G.F.M.); (N.V.K.); (E.V.R.); (N.P.B.); (S.V.L.); (I.V.S.); (A.K.U.); (A.N.P.); (E.V.R.); (V.A.P.)
| | - Nadezhda V. Kovaleva
- Institute of Physiologically Active Compounds Russian Academy of Sciences, 142432 Chernogolovka, Russia; (G.F.M.); (N.V.K.); (E.V.R.); (N.P.B.); (S.V.L.); (I.V.S.); (A.K.U.); (A.N.P.); (E.V.R.); (V.A.P.)
| | - Elena V. Rudakova
- Institute of Physiologically Active Compounds Russian Academy of Sciences, 142432 Chernogolovka, Russia; (G.F.M.); (N.V.K.); (E.V.R.); (N.P.B.); (S.V.L.); (I.V.S.); (A.K.U.); (A.N.P.); (E.V.R.); (V.A.P.)
| | - Natalia P. Boltneva
- Institute of Physiologically Active Compounds Russian Academy of Sciences, 142432 Chernogolovka, Russia; (G.F.M.); (N.V.K.); (E.V.R.); (N.P.B.); (S.V.L.); (I.V.S.); (A.K.U.); (A.N.P.); (E.V.R.); (V.A.P.)
| | - Sofya V. Lushchekina
- Institute of Physiologically Active Compounds Russian Academy of Sciences, 142432 Chernogolovka, Russia; (G.F.M.); (N.V.K.); (E.V.R.); (N.P.B.); (S.V.L.); (I.V.S.); (A.K.U.); (A.N.P.); (E.V.R.); (V.A.P.)
- Emanuel Institute of Biochemical Physics Russian Academy of Sciences, 119334 Moscow, Russia
| | - Irina I. Faingold
- Institute of Problems of Chemical Physics of Russian Academy of Sciences, 142432 Chernogolovka, Russia; (I.I.F.); (D.A.P.); (Y.V.S.); (R.A.K.)
| | - Darya A. Poletaeva
- Institute of Problems of Chemical Physics of Russian Academy of Sciences, 142432 Chernogolovka, Russia; (I.I.F.); (D.A.P.); (Y.V.S.); (R.A.K.)
| | - Yuliya V. Soldatova
- Institute of Problems of Chemical Physics of Russian Academy of Sciences, 142432 Chernogolovka, Russia; (I.I.F.); (D.A.P.); (Y.V.S.); (R.A.K.)
| | - Raisa A. Kotelnikova
- Institute of Problems of Chemical Physics of Russian Academy of Sciences, 142432 Chernogolovka, Russia; (I.I.F.); (D.A.P.); (Y.V.S.); (R.A.K.)
| | - Igor V. Serkov
- Institute of Physiologically Active Compounds Russian Academy of Sciences, 142432 Chernogolovka, Russia; (G.F.M.); (N.V.K.); (E.V.R.); (N.P.B.); (S.V.L.); (I.V.S.); (A.K.U.); (A.N.P.); (E.V.R.); (V.A.P.)
| | - Anatoly K. Ustinov
- Institute of Physiologically Active Compounds Russian Academy of Sciences, 142432 Chernogolovka, Russia; (G.F.M.); (N.V.K.); (E.V.R.); (N.P.B.); (S.V.L.); (I.V.S.); (A.K.U.); (A.N.P.); (E.V.R.); (V.A.P.)
| | - Alexey N. Proshin
- Institute of Physiologically Active Compounds Russian Academy of Sciences, 142432 Chernogolovka, Russia; (G.F.M.); (N.V.K.); (E.V.R.); (N.P.B.); (S.V.L.); (I.V.S.); (A.K.U.); (A.N.P.); (E.V.R.); (V.A.P.)
| | - Eugene V. Radchenko
- Institute of Physiologically Active Compounds Russian Academy of Sciences, 142432 Chernogolovka, Russia; (G.F.M.); (N.V.K.); (E.V.R.); (N.P.B.); (S.V.L.); (I.V.S.); (A.K.U.); (A.N.P.); (E.V.R.); (V.A.P.)
- Department of Chemistry, Lomonosov Moscow State University, 119991 Moscow, Russia
| | - Vladimir A. Palyulin
- Institute of Physiologically Active Compounds Russian Academy of Sciences, 142432 Chernogolovka, Russia; (G.F.M.); (N.V.K.); (E.V.R.); (N.P.B.); (S.V.L.); (I.V.S.); (A.K.U.); (A.N.P.); (E.V.R.); (V.A.P.)
- Department of Chemistry, Lomonosov Moscow State University, 119991 Moscow, Russia
| | - Rudy J. Richardson
- Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Center of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
- Michigan Institute for Computational Discovery and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Correspondence: ; Tel.: +1-734-936-0769
| |
Collapse
|
9
|
Jia J, Ji Y, Feng T, Ye Q, Peng D, Kuang W, Ning Y, Liang Z, Fan D, Wei W, Li Y, Xiao S. Sixteen-Week Interventional Study to Evaluate the Clinical Effects and Safety of Rivastigmine Capsules in Chinese Patients with Alzheimer's Disease. J Alzheimers Dis 2020; 72:1313-1322. [PMID: 31744005 DOI: 10.3233/jad-190791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Rivastigmine is a cholinesterase inhibitor, approved for the treatment of mild-to-moderate dementia of Alzheimer's type. OBJECTIVE To explore the efficacy and safety of the maximal tolerated dose of rivastigmine capsules in Chinese patients with mild-to-moderate Alzheimer's disease (AD). METHODS The study was a multicenter, open-label, single-arm, phase IV clinical study in mild-to-moderate drug-naïve AD patients treated with rivastigmine capsules. The primary endpoint was the changes in the total scores of Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) from baseline to week 16. Secondary endpoints included changes in the scores of the following assessment scales and safety: Alzheimer's Disease Cooperative Study; Activities of Daily Living; Mini-Mental Status Examination (MMSE); Neuropsychiatry Index (NPI), and Caregiver Burden Inventory. RESULTS 222 patients were enrolled. Of these, 136 (75.1%) patients received and maintained the effective dose (≥6 mg/d) of rivastigmine for at least 4 weeks. The ADAS-Cog scale score improved in rivastigmine-treated patients at week 16 compared with baseline (p < 0.001) by 2.0 (95% CI: -3.0 to -1.1) points, which met the pre-defined superiority criteria. NPI-10 and NPI-12 scores improved by 3.6 and 4.0 points at week 16 (p = 0.001, p < 0.001), respectively. A total of 107 patients (59.1%) experienced adverse effects (AEs) during the study; common AEs included nausea (20.5%), vomiting (16.6%), anorexia (7.8%), dizziness (7.7%), and diarrhea (7.2%). CONCLUSION This was the first phase IV study on rivastigmine in mainland China. The study preliminarily demonstrated that rivastigmine capsules showed good tolerability and efficacy in mild-to-moderate AD patients with the maximal tolerated dose.
Collapse
Affiliation(s)
- Jianping Jia
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital University of Medical Sciences, Beijing, China
| | - Yong Ji
- Department of Cognitive Disorder, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Tao Feng
- China National Clinical Research Center for Neurological Disease, Beijing, China.,Movement Disorders Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qinyong Ye
- Department of Neurology, The Affiliated Union Hospital of Fujian Medical University, Fuzhou, China
| | - Dantao Peng
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Weihong Kuang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yuping Ning
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Zhihou Liang
- Department of Neurology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Wenshi Wei
- Department of Geriatrics, Huadong Hospital, Fudan University, Shanghai, China
| | - Yansheng Li
- Department of Neurology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shifu Xiao
- Department of Geriatric Psychiatry, Alzheimer's Disease and Related Disorders' Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, China
| |
Collapse
|
10
|
New Hybrids of 4-Amino-2,3-polymethylene-quinoline and p-Tolylsulfonamide as Dual Inhibitors of Acetyl- and Butyrylcholinesterase and Potential Multifunctional Agents for Alzheimer's Disease Treatment. Molecules 2020; 25:molecules25173915. [PMID: 32867324 PMCID: PMC7504258 DOI: 10.3390/molecules25173915] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 01/31/2023] Open
Abstract
New hybrid compounds of 4-amino-2,3-polymethylene-quinoline containing different sizes of the aliphatic ring and linked to p-tolylsulfonamide with alkylene spacers of increasing length were synthesized as potential drugs for treatment of Alzheimer’s disease (AD). All compounds were potent inhibitors of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) with selectivity toward BChE. The lead compound 4-methyl-N-(5-(1,2,3,4-tetrahydro-acridin-9-ylamino)-pentyl)-benzenesulfonamide (7h) exhibited an IC50 (AChE) = 0.131 ± 0.01 µM (five times more potent than tacrine), IC50(BChE) = 0.0680 ± 0.0014 µM, and 17.5 ± 1.5% propidium displacement at 20 µM. The compounds possessed low activity against carboxylesterase, indicating a likely absence of unwanted drug-drug interactions in clinical use. Kinetics studies were consistent with mixed-type reversible inhibition of both cholinesterases. Molecular docking demonstrated dual binding sites of the conjugates in AChE and clarified the differences in the structure-activity relationships for AChE and BChE inhibition. The conjugates could bind to the AChE peripheral anionic site and displace propidium, indicating their potential to block AChE-induced β-amyloid aggregation, thereby exerting a disease-modifying effect. All compounds demonstrated low antioxidant activity. Computational ADMET profiles predicted that all compounds would have good intestinal absorption, medium blood-brain barrier permeability, and medium cardiac toxicity risk. Overall, the results indicate that the novel conjugates show promise for further development and optimization as multitarget anti-AD agents.
Collapse
|
11
|
Makhaeva GF, Kovaleva NV, Boltneva NP, Lushchekina SV, Rudakova EV, Stupina TS, Terentiev AA, Serkov IV, Proshin AN, Radchenko EV, Palyulin VA, Bachurin SO, Richardson RJ. Conjugates of tacrine and 1,2,4-thiadiazole derivatives as new potential multifunctional agents for Alzheimer’s disease treatment: Synthesis, quantum-chemical characterization, molecular docking, and biological evaluation. Bioorg Chem 2020; 94:103387. [DOI: 10.1016/j.bioorg.2019.103387] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/12/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022]
|
12
|
Bai P, Wang K, Zhang P, Shi J, Cheng X, Zhang Q, Zheng C, Cheng Y, Yang J, Lu X, Sang Z. Development of chalcone-O-alkylamine derivatives as multifunctional agents against Alzheimer's disease. Eur J Med Chem 2019; 183:111737. [DOI: 10.1016/j.ejmech.2019.111737] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 01/23/2023]
|
13
|
Blesa R, Toriyama K, Ueda K, Knox S, Grossberg G. Strategies for Continued Successful Treatment in Patients with Alzheimer's Disease: An Overview of Switching Between Pharmacological Agents. Curr Alzheimer Res 2019; 15:964-974. [PMID: 29895249 PMCID: PMC6142408 DOI: 10.2174/1567205015666180613112040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/11/2018] [Accepted: 06/07/2018] [Indexed: 02/07/2023]
Abstract
Introduction: Alzheimer’s disease (AD) is the most common cause of dementia, characterized by a progressive decline in cognition and function. Current treatment options for AD include the cholines-terase inhibitors (ChEIs) donepezil, galantamine, and rivastigmine, as well as the N-methyl-D-aspartate receptor antagonist memantine. Treatment guidelines recommend the use of ChEIs as the standard of care first-line therapy. Several randomized clinical studies have demonstrated the benefits of ChEIs on cogni-tion, global function, behavior and activities of daily living. However, patients may fail to achieve sus-tained clinical benefits from ChEIs due to lack/loss of efficacy and/or safety, tolerability issues, and poor adherence to the treatment. The purpose of this review is to explore the strategies for continued successful treatment in patients with AD. Methods: Literature search was performed for articles published in PubMed and MEDLINE, using pre-specified search terms. Articles were critically evaluated for inclusion based on their titles, abstracts, and full text of the publication. Results and Conclusion: The findings of this review indicate that dose up-titration and switching between ChEIs may help to improve response to ChEI treatment and also address issues such as lack/loss of effica-cy or safety/tolerability in patients with AD. However, well-designed studies are needed to provide robust evidence.
Collapse
Affiliation(s)
- Rafael Blesa
- Memory Unit, Department of Neurology, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | | | - Sean Knox
- Novartis Pharma AG, Basel, Switzerland
| | - George Grossberg
- Department of Psychiatry & Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, United States
| |
Collapse
|
14
|
Tepmongkol S, Hemrungrojn S, Dupont P, Tunvirachaisakul C, Aniwattanapong D, Likitjareon Y, Supasitthumrong T, Tawankanjanachot I, Siritranon N, Chuchuen P, Natsawang B, Tangwongchai S. Early prediction of donepezil cognitive response in Alzheimer's disease by brain perfusion single photon emission tomography. Brain Imaging Behav 2019; 13:1665-1673. [PMID: 31432319 DOI: 10.1007/s11682-019-00182-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Currently, there is no effective means to evaluate donepezil response. We evaluated brain perfusion change at 4 h after donepezil administration (4 h DNPZ) to predict cognitive responses after 6 months of medication. CERAD neuropsychological assessment battery was used to define cognitive response at 6 months. We compared 4 h DNPZ to baseline single photon emission tomography (SPECT) by statistical parametric mapping to identify perfusion changes in responders (N = 16) and non-responders (N = 7). In responders, there were significant relatively increase in perfusion in left parietal lobe (BA39, 7, 1), right superior frontal gyrus (BA6) and right middle occipital gyrus (BA39). In the non-responders, perfusion was relatively increase in the left parietal lobe (BA39) only. In an explorative analysis, we found a significant correlation between perfusion changes in right BA6 and CERAD score changes at 6 months. Different SPECT perfusion changes at 4 h after donepezil administration were demonstrated in the group of responders and non-responders with potential correlation with CERAD score change. Thus, 4 h DNPZ brain perfusion SPECT can be used to predict donepezil response at 6 months.
Collapse
Affiliation(s)
- Supatporn Tepmongkol
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Rama IV Rd., Pathumwan, Bangkok, 10330, Thailand. .,Chulalongkorn University Biomedical Imaging Group (CUBIG), Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Solaphat Hemrungrojn
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - Daruj Aniwattanapong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yuttachai Likitjareon
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thitiporn Supasitthumrong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Itthipol Tawankanjanachot
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Natakorn Siritranon
- Division of Nuclear Medicine, Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Buntipa Natsawang
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | |
Collapse
|
15
|
[Adjusted morbidity groups: Characteristics and comorbidities in patients with chronic conditions according to their risk level in Primary Care]. Aten Primaria 2019; 52:86-95. [PMID: 31153669 PMCID: PMC7025976 DOI: 10.1016/j.aprim.2018.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/05/2018] [Accepted: 12/31/2018] [Indexed: 11/23/2022] Open
Abstract
Objetivos Describir las características de los pacientes crónicos según el nivel de riesgo asignado por los grupos de morbilidad ajustados (GMA). Analizar los factores asociados al nivel de riesgo alto y estudiar el efecto de cada uno de ellos. Diseño Estudio observacional descriptivo transversal con enfoque analítico. Emplazamiento Atención Primaria (AP). Servicio Madrileño de Salud. Participantes Población de 18.107 pacientes estratificados por los GMA integrados en la historia clínica electrónica de AP de la Comunidad de Madrid. Mediciones principales Variables sociodemográficas, clínico-asistenciales y de uso de servicios. Se realizó análisis univariado, bivariado y multivariante. Resultados De los 18.107 pacientes se identificaron 9.866 (54,4%) pacientes crónicos, 444 (4,5%) estratificados como de alto riesgo, 1.784 (18,1%) como de medio riesgo y 7.638 (77,4%) como de bajo riesgo. Los de alto riesgo, comparados con medio y bajo riesgo, tenían una edad media mayor (77,8 [12,9]; 72,1 [12,9]; 50,6 [19,4]), menor porcentaje de mujeres (52,3%, 65%, 61,1%), mayor número de enfermedades crónicas (6,7 [2,4]; 4,3 [1,5]; 1,9 [1,1]), polimedicación (79,1%, 43,3%, 6,2%) y contactos con AP (33,9 [28]; 21,4 [17,3]; 7,9 [9,9]) (p < 0,01). En el multivariante el nivel de riesgo alto se relacionó de manera independiente con la edad > 65 (OR = 1,43; IC 95% = 1,03-1,99), sexo masculino (OR = 3,46; IC 95% = 2,64-4,52), inmovilidad (OR = 6,33; IC 95% = 4,40-9,11), número de enfermedades crónicas (OR = 2,60; IC 95% = 2,41-2,81) (p < 0,01) y número de contactos con AP > 7 (OR = 1,95; IC 95% = 1,36-2,80). Conclusiones Más de la mitad de la población fue clasificada por los GMA como crónica, y se estratificó en 3 niveles de riesgo que presentaban diferencias en sexo, edad, deterioro funcional, necesidad de cuidados, morbilidad, complejidad, polifarmacia y contactos con AP. La edad > 65, el sexo masculino, la inmovilidad, el número de enfermedades crónicas y los contactos con AP > 7 fueron los factores asociados al alto riesgo.
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW The purpose of this review was to discuss therapeutic options available for the treatment of memory difficulties in dementia. RECENT FINDINGS Because of the lack of progress in the availability of new medications, there has been an increased interest in focusing on non-pharmacological means to management cognitive symptoms related to dementia. The clinical management of memory loss should focus both on pharmacological and non-pharmacological approaches. Treatment with medications should usually begin with a cholinesterase inhibitor and then followed by addition of memantine if there is a decline. In addition to medication management, emphasis should be placed on the importance of maintaining a healthy lifestyle that encompasses physical activities, cognitive stimulation, and a healthy diet.
Collapse
Affiliation(s)
- Po-Heng Tsai
- Cleveland Clinic Lou Ruvo Center for Brain Health, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
| |
Collapse
|
17
|
Dual Inhibition of AChE and BChE with the C-5 Substituted Derivative of Meldrum’s Acid: Synthesis, Structure Elucidation, and Molecular Docking Studies. CRYSTALS 2017. [DOI: 10.3390/cryst7070211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
18
|
Saarelainen L, Taipale H, Koponen M, Tanskanen A, Tolppanen AM, Tiihonen J, Hartikainen S. The Incidence of Benzodiazepine and Related Drug Use in Persons with and without Alzheimer's Disease. J Alzheimers Dis 2016; 49:809-18. [PMID: 26484930 DOI: 10.3233/jad-150630] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Benzodiazepines and related drugs (BZDR) are occasionally used to treat certain symptoms of Alzheimer's disease (AD). However, the risks related to BZDR use are high in older persons. Although frequent BZDR use has been reported in persons with AD, no previous study has focused specifically on the incidence of BZDR use in this population. OBJECTIVE We investigated the incidence of BZDR use in persons with and without AD during a five-year follow-up. METHODS The Finnish nationwide, register-based MEDALZ cohort includes all AD cases who received a clinically verified AD diagnosis in 2005-2011 (n = 70,718) and their matched comparison persons. Incidence of BZDR, including benzodiazepines (lorazepam, oxazepam, temazepam, alprazolam, chlordiazepoxide, diazepam, and nitrazepam) and Z-drugs (zolpidem and zopiclone), use was investigated in the cohort from two years before to three years after the diagnosis of AD. Further, initial BZDRs were investigated. RESULTS The incidence of BZDR use was higher in persons with AD starting from 12 months before the diagnosis and peaked at six months after the diagnosis of AD (incidence rate ratio [IRR] = 2.6, 95% confidence interval [CI] = 2.5-2.8). Benzodiazepines were more frequently initiated by persons with AD, with the incidence peaking at six months after the diagnosis (IRR = 4.5, 95% CI = 4.1-4.9) and remaining over three times higher than in comparison persons until three years after the diagnosis. CONCLUSION Early symptomatic treatment with BZDRs is contrary to AD treatment guidelines. As BZDRs impair cognition, the observed early treatment with BZDRs may complicate the monitoring of AD treatment effectiveness.
Collapse
Affiliation(s)
- Laura Saarelainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Heidi Taipale
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Impact Assessment Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
19
|
Progress in drug development for Alzheimer's disease: An overview in relation to mitochondrial energy metabolism. Eur J Med Chem 2016; 121:774-784. [DOI: 10.1016/j.ejmech.2016.03.084] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 01/21/2016] [Accepted: 03/26/2016] [Indexed: 12/27/2022]
|
20
|
Hwang TY, Ahn IS, Kim S, Kim DK. Efficacy of Galantamine on Cognition in Mild-to-Moderate Alzheimer's Dementia after Failure to Respond to Donepezil. Psychiatry Investig 2016; 13:341-8. [PMID: 27247602 PMCID: PMC4878970 DOI: 10.4306/pi.2016.13.3.341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/31/2015] [Accepted: 09/28/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study compares the efficacy of the cholinesterase inhibitor (ChEI) galantamine on cognition in patients with mild-to-moderate Alzheimer's dementia (AD) who were either naïve to ChEI drugs or who had failed a trial of the ChEI donepezil. METHODS Outpatients with AD were sequentially referred for screening and enrollment. Current outpatients who had taken donepezil for at least 6 months without demonstrated efficacy on cognition were switched to galantamine (switched group). New outpatients with no ChEI prescription history were classified as the naïve group and were given galantamine. The primary outcome measures for the between-group comparison were response rate on cognition at 26 and 52 weeks (categorical) and change on the Korean version of the Alzheimer's Disease Assessment Scale-cognitive subscale (dimensional). Secondary cognitive outcomes were measured using the subset of frontal executive function and the Korean Mini-Mental State Examination. RESULTS Seventy outpatients were enrolled and 66 were analyzed by Intent-to-treat (ITT). There were 42 cases in the naïve group and 24 in the switched group. Response rates did not differ at 26 weeks (71.4% naïve vs. 58.3% switched; p=0.277) or at 52 weeks (59.5% naïve vs. 41.6% switched; p=0.162). No significant differences were observed in the pattern of change over the 52 weeks on the primary and secondary cognitive scales. CONCLUSION As the efficacy of galantamine on cognition was not inferior in the switched group compared to that in the naïve group, switching ChEI drugs is clinically feasible for non-responding patients with mild-to-moderate AD.
Collapse
Affiliation(s)
- Tae-Young Hwang
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Jeonbuk Provincial Maeumsarang Hospital, Wanju, Republic of Korea
| | - Inn-Sook Ahn
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Seonwoo Kim
- Biostatistics Unit, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Doh Kwan Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| |
Collapse
|
21
|
Multitarget strategies in Alzheimer's disease: benefits and challenges on the road to therapeutics. Future Med Chem 2016; 8:697-711. [DOI: 10.4155/fmc-2016-0003] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Alzheimer's disease is a multifactorial syndrome, for which effective cures are urgently needed. Seeking for enhanced therapeutic efficacy, multitarget drugs have been increasingly sought after over the last decades. They offer the attractive prospect of tackling intricate network effects, but with the benefits of a single-molecule therapy. Herein, we highlight relevant progress in the field, focusing on acetylcholinesterase inhibition and amyloid pathways as two pivotal features in multitarget design strategies. We also discuss the intertwined relationship between selected molecular targets and give a brief glimpse into the power of multitarget agents as pharmacological probes of Alzheimer's disease molecular mechanisms.
Collapse
|
22
|
Mizukami K, Akatsu H, Abrahamson EE, Mi Z, Ikonomovic MD. Immunohistochemical analysis of hippocampal butyrylcholinesterase: Implications for regional vulnerability in Alzheimer's disease. Neuropathology 2015; 36:135-45. [PMID: 26293308 DOI: 10.1111/neup.12241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 07/27/2015] [Accepted: 07/27/2015] [Indexed: 11/28/2022]
Abstract
Studies of acetylcholine degrading enzymes acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) in Alzheimer's disease (AD) have suggested their potential role in the development of fibrillar amyloid-β (Aβ) plaques (amyloid plaques). A recent genome-wide association study analysis identified a novel association between genetic variations in the BCHE locus and amyloid burden. We studied BChE immunoreactivity in hippocampal tissue sections from AD and control cases, and examined its relationship with amyloid plaques, neurofibrillary tangles (NFT), dystrophic neurites (DN) and neuropil threads (NT). Compared to controls, AD cases had greater BChE immunoreactivity in hippocampal neurons and neuropils in CA2/3, but not in the CA1, CA4 and dentate gyrus. The majority of amyloid plaques (> 80%, using a pan-amyloid marker X-34) contained discrete neuritic clusters which were dual-labeled with antibodies against BChE and phosphorylated tau (clone AT8). There was no association between overall regional BChE immunoreaction intensity and amyloid plaque burden. In contrast to previous reports, BChE was localized in only a fraction (~10%) of classic NFT (positive for X-34). A similar proportion of BChE-immunoreactive pyramidal cells were AT8 immunoreactive. Greater NFT and DN loads were associated with greater BChE immunoreaction intensity in CA2/3, but not in CA1, CA4 and dentate gyrus. Our results demonstrate that in AD hippocampus, BChE accumulates in neurons and plaque-associated neuritic clusters, but only in a small proportion of NFT. The association between greater neurofibrillary pathology burden and markedly increased BChE immunoreactivity, observed selectively in CA2/3 region, could reflect a novel compensatory mechanism. Since CA2/3 is generally considered more resistant to AD pathology, BChE upregulation could impact the cholinergic modulation of glutamate neurotransmission to prevent/reduce neuronal excitotoxicity in AD hippocampus.
Collapse
Affiliation(s)
- Katsuyoshi Mizukami
- Faculty of Health and Sport Sciences, Tsukuba, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Hiroyasu Akatsu
- Department of Community-based Medicine, Nagoya City University Graduate School of Medicine, Nagoya, Japan.,Choju Medical Institute, Fukushimura Hospital, Toyohashi, Japan
| | - Eric E Abrahamson
- Departments of Neurology, University of Pittsburgh, Pittsburgh, USA.,Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, USA
| | - Zhiping Mi
- Departments of Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Milos D Ikonomovic
- Departments of Neurology, University of Pittsburgh, Pittsburgh, USA.,Psychiatry, University of Pittsburgh, Pittsburgh, USA.,Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, USA
| |
Collapse
|
23
|
Abstract
OPINION STATEMENT Cerebrovascular disease (CVD) is an important cause of cognitive dysfunction and dementia. The term vascular cognitive impairment (VCI) is used to describe the entire spectrum of cognitive dysfunction-ranging from mild impairment to dementia-attributable to all forms of cerebrovascular disease. Accurate assessment and management of vascular risk factors are a top priority in the treatment of VCI, particularly early in the disease when prevention strategies may prove to be more effective. There are limited treatment options to improve cognition and function in VCI. Several acetylcholinesterase inhibitors and the NMDA receptor antagonist memantine have been studied in large, well-designed trials. These agents are safe and provide modest cognitive benefits in vascular dementia (VaD) but have demonstrated inconsistent efficacy on functional measures. Other therapies, such as aspirin, calcium channel blockers, and vitamin supplementation, have less evidence to support their use in improving cognition in VCI. Although primary prevention trials suggest that treatment of hypertension, adherence to a Mediterranean diet, physical activity, and smoking cessation may reduce the risk of cognitive decline, there is limited evidence regarding these interventions in helping improve cognition in VCI. The pathophysiology and treatment of cerebral autosomal dominant arteriopathy with subcortical infarcts (CADASIL), cerebral amyloid angiopathy (CAA), and subcortical white matter disease (SWMD) deserves special consideration.
Collapse
Affiliation(s)
- Aaron Ritter
- Department of Neurology, Lou Ruvo Center for Brain Health, Cleveland Clinic, 888 West Bonneville Avenue, Las Vegas, NV, 89106, USA,
| | | |
Collapse
|
24
|
Pereira H, Custódio L, Rodrigues MJ, de Sousa CB, Oliveira M, Barreira L, Neng NDR, Nogueira JMF, Alrokayan SA, Mouffouk F, Abu-Salah KM, Ben-Hamadou R, Varela J. Biological Activities and Chemical Composition of Methanolic Extracts of Selected Autochthonous Microalgae Strains from the Red Sea. Mar Drugs 2015; 13:3531-49. [PMID: 26047482 PMCID: PMC4483643 DOI: 10.3390/md13063531] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/18/2015] [Accepted: 05/26/2015] [Indexed: 12/22/2022] Open
Abstract
Four lipid-rich microalgal species from the Red Sea belonging to three different genera (Nannochloris, Picochlorum and Desmochloris), previously isolated as novel biodiesel feedstocks, were bioprospected for high-value, bioactive molecules. Methanol extracts were thus prepared from freeze-dried biomass and screened for different biological activities. Nannochloris sp. SBL1 and Desmochloris sp. SBL3 had the highest radical scavenging activity against 1,1-diphenyl-2-picrylhydrazyl, and the best copper and iron chelating activities. All species had potent butyrylcholinesterase inhibitory activity (>50%) and mildly inhibited tyrosinase. Picochlorum sp. SBL2 and Nannochloris sp. SBL4 extracts significantly reduced the viability of tumoral (HepG2 and HeLa) cells with lower toxicity against the non-tumoral murine stromal (S17) cells. Nannochloris sp. SBL1 significantly reduced the viability of Leishmania infantum down to 62% (250 µg/mL). Picochlorum sp. SBL2 had the highest total phenolic content, the major phenolic compounds identified being salicylic, coumaric and gallic acids. Neoxanthin, violaxanthin, zeaxanthin, lutein and β-carotene were identified in the extracts of all strains, while canthaxanthin was only identified in Picochlorum sp. SBL2. Taken together, these results strongly suggest that the microalgae included in this work could be used as sources of added-value products that could be used to upgrade the final biomass value.
Collapse
Affiliation(s)
- Hugo Pereira
- Centre of Marine Sciences, University of Algarve, Faro 8005-139, Portugal.
| | - Luísa Custódio
- Centre of Marine Sciences, University of Algarve, Faro 8005-139, Portugal.
| | | | | | - Marta Oliveira
- Centre of Marine Sciences, University of Algarve, Faro 8005-139, Portugal.
| | - Luísa Barreira
- Centre of Marine Sciences, University of Algarve, Faro 8005-139, Portugal.
| | - Nuno da Rosa Neng
- Department of Chemistry and Biochemistry and Center of Chemistry and Biochemistry, Faculty of Sciences, University of Lisbon, Campo Grande, Ed. C8, Lisbon 1749-016, Portugal.
| | - José Manuel Florêncio Nogueira
- Department of Chemistry and Biochemistry and Center of Chemistry and Biochemistry, Faculty of Sciences, University of Lisbon, Campo Grande, Ed. C8, Lisbon 1749-016, Portugal.
| | - Salman A Alrokayan
- King Abdullah Institute for Nanotechnology, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Fouzi Mouffouk
- King Abdullah Institute for Nanotechnology, King Saud University, Riyadh 11451, Saudi Arabia.
- Department of Chemistry, Faculty of Science, Kuwait University, Safat 13060, Kuwait.
| | - Khalid M Abu-Salah
- King Abdullah Institute for Nanotechnology, King Saud University, Riyadh 11451, Saudi Arabia.
- King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia.
| | - Radhouan Ben-Hamadou
- Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar.
| | - João Varela
- Centre of Marine Sciences, University of Algarve, Faro 8005-139, Portugal.
| |
Collapse
|
25
|
Spalletta G, Caltagirone C, Padovani A, Sorbi S, Attar M, Colombo D, Cravello L. Cognitive and affective changes in mild to moderate Alzheimer's disease patients undergoing switch of cholinesterase inhibitors: a 6-month observational study. PLoS One 2014; 9:e89216. [PMID: 24586603 PMCID: PMC3929703 DOI: 10.1371/journal.pone.0089216] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 01/17/2014] [Indexed: 01/23/2023] Open
Abstract
Patients with Alzheimer’s disease after an initial response to cholinesterase inhibitors may complain a later lack of efficacy. This, in association with incident neuropsychiatric symptoms, may worsen patient quality of life. Thus, the switch to another cholinesterase inhibitor could represent a valid therapeutic strategy. The aim of this study was to investigate the effectiveness of the switch from one to another cholinesterase inhibitor on cognitive and affective symptoms in mild to moderate Alzheimer disease patients. Four hundred twenty-three subjects were included from the EVOLUTION study, an observational, longitudinal, multicentre study conducted on Alzheimer disease patients who switched to different cholinesterase inhibitor due either to lack/loss of efficacy or response, reduced tolerability or poor compliance. All patients underwent cognitive and neuropsychiatric assessments, carried out before the switch (baseline), and at 3 and 6-month follow-up. A significant effect of the different switch types was found on Mini-Mental State Examination score during time, with best effectiveness on mild Alzheimer’s disease patients switching from oral cholinesterase inhibitors to rivastigmine patch. Depressive symptoms, when measured using continuous Neuropsychiatric Inventory values, decreased significantly, while apathy symptoms remained stable over the 6 months after the switch. However, frequency of both depression and apathy, when measured categorically using Neuropsychiatric Inventory cut-off scores, did not change significantly during time. In mild to moderate Alzheimer disease patients with loss of efficacy and tolerability during cholinesterase inhibitor treatment, the switch to another cholinesterase inhibitor may represent an important option for slowing cognitive deterioration. The evidence of apathy stabilization and the positive tendency of depressive symptom improvement should definitively be confirmed in double-blind controlled studies.
Collapse
Affiliation(s)
- Gianfranco Spalletta
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Carlo Caltagirone
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy ; Department of System Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sandro Sorbi
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | | | | | - Luca Cravello
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | | |
Collapse
|
26
|
Nordberg A, Ballard C, Bullock R, Darreh-Shori T, Somogyi M. A review of butyrylcholinesterase as a therapeutic target in the treatment of Alzheimer's disease. Prim Care Companion CNS Disord 2013; 15:PCC.12r01412. [PMID: 23930233 PMCID: PMC3733526 DOI: 10.4088/pcc.12r01412] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 10/11/2012] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To examine the role of butyrylcholinesterase (BuChE) in cholinergic signaling and neurologic conditions, such as Alzheimer's disease (AD). The rationale for inhibiting cholinesterases in the management of AD, including clinical evidence supporting use of the dual acetylcholinesterase (AChE) and BuChE inhibitor rivastigmine, is discussed. DATA SOURCES PubMed searches were performed using butyrylcholinesterase as a keyword. English-language articles referenced in PubMed as of September 2011 were included. Study Selection and Data Synthesis: English-language articles related to BuChE considered to be of clinical relevance to physicians were included. English-language articles specifically related to AChE were not included, as the role of AChE in cholinergic signaling and the underlying pathology of AD is well documented. Reference lists of included publications were used to supplement the search. RESULTS AChE and BuChE play a role in cholinergic signaling; BuChE can hydrolyze acetylcholine and compensate for AChE when levels are depleted. In the AD brain, AChE levels decrease, while BuChE levels are reportedly increased or unchanged, with changes becoming more pronounced during the disease course. Furthermore, BuChE genotype may influence AD risk and rate of disease progression. Strategies that increase acetylcholine levels (eg, cholinesterase inhibitors) demonstrate symptomatic efficacy in AD. Rivastigmine has proven cognitive efficacy in clinical trials, and data suggest that its action is mediated, in part, by inhibition of BuChE. Retrospective analyses of clinical trials provide evidence that BuChE genotype may also influence treatment response. CONCLUSIONS AChE-selective inhibitors and a dual AChE and BuChE inhibitor demonstrate symptomatic efficacy in AD. Mounting preclinical and clinical evidence for a role of BuChE in maintaining normal cholinergic function and the pathology of AD provides a rationale for further studies investigating use of rivastigmine in AD and the influence of BuChE genotype on observed efficacy.
Collapse
Affiliation(s)
- Agneta Nordberg
- Alzheimer Neurobiology Center, Karolinska Institute, Stockholm, Sweden (Drs Nordberg and Darreh-Shori); Wolfson Centre for Age-Related Diseases, King's College, London, United Kingdom (Dr Ballard); Kingshill Research Centre, Victoria Hospital, Swindon, United Kingdom (Dr Bullock); and Novartis Pharmaceuticals Corporation, East Hanover, New Jersey (Dr Somogyi)
| | | | | | | | | |
Collapse
|
27
|
Naidoo V, Karanian DA, Vadivel SK, Locklear JR, Wood JT, Nasr M, Quizon PMP, Graves EE, Shukla V, Makriyannis A, Bahr BA. Equipotent inhibition of fatty acid amide hydrolase and monoacylglycerol lipase - dual targets of the endocannabinoid system to protect against seizure pathology. Neurotherapeutics 2012; 9:801-13. [PMID: 22270809 PMCID: PMC3480564 DOI: 10.1007/s13311-011-0100-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Advances in the understanding of the endogenous cannabinoid system have led to several therapeutic indications for new classes of compounds that enhance cannabinergic responses. Endocannabinoid levels are elevated during pathogenic conditions, and inhibitors of endocannabinoid inactivation promote such on-demand responses. The endocannabinoids anandamide and 2-arachidonoyl glycerol have been implicated in protective signaling against excitotoxic episodes, including seizures. To better understand modulatory pathways that can exploit such responses, we used the new generation compound AM6701 that blocks both the anandamide-deactivating enzyme fatty acid amide hydrolase (FAAH) and the 2-arachidonoyl glycerol-deactivating enzyme monoacylglycerol lipase (MAGL) with equal potency. Also studied was the structural isomer AM6702 which is 44-fold more potent for inhibiting FAAH versus MAGL. When applied before and during kainic acid (KA) exposure to cultured hippocampal slices, AM6701 protected against the resulting excitotoxic events of calpain-mediated cytoskeletal damage, loss of presynaptic and postsynaptic proteins, and pyknotic changes in neurons. The equipotent inhibitor was more effective than its close relative AM6702 at protecting against the neurodegenerative cascade assessed in the slice model. In vivo, AM6701 was also the more effective compound for reducing the severity of KA-induced seizures and protecting against behavioral deficits linked to seizure damage. Corresponding with the behavioral improvements, cytoskeletal and synaptic protection was elicited by AM6701, as found in the KA-treated hippocampal slice model. It is proposed that the influence of AM6701 on FAAH and MAGL exerts a synergistic action on the endocannabinoid system, thereby promoting the protective nature of cannabinergic signaling to offset excitotoxic brain injury.
Collapse
Affiliation(s)
- Vinogran Naidoo
- Biotechnology Research and Training Center, William C. Friday Laboratory, University of North Carolina Pembroke, Pembroke, North Carolina 28372 USA
- Department of Biology, University of North Carolina Pembroke, Pembroke, North Carolina USA
| | - David A. Karanian
- Department of Pharmaceutical Sciences and the Neurosciences Program, University of Connecticut, Storrs, Connecticut USA
- Center for Drug Discovery, Northeastern University, Boston, Massachusetts USA
| | | | - Johnathan R. Locklear
- Biotechnology Research and Training Center, William C. Friday Laboratory, University of North Carolina Pembroke, Pembroke, North Carolina 28372 USA
| | - JodiAnne T. Wood
- Center for Drug Discovery, Northeastern University, Boston, Massachusetts USA
| | - Mahmoud Nasr
- Center for Drug Discovery, Northeastern University, Boston, Massachusetts USA
| | - Pamela Marie P. Quizon
- Biotechnology Research and Training Center, William C. Friday Laboratory, University of North Carolina Pembroke, Pembroke, North Carolina 28372 USA
| | - Emily E. Graves
- Biotechnology Research and Training Center, William C. Friday Laboratory, University of North Carolina Pembroke, Pembroke, North Carolina 28372 USA
| | - Vidyanand Shukla
- Center for Drug Discovery, Northeastern University, Boston, Massachusetts USA
| | | | - Ben A. Bahr
- Biotechnology Research and Training Center, William C. Friday Laboratory, University of North Carolina Pembroke, Pembroke, North Carolina 28372 USA
- Department of Biology, University of North Carolina Pembroke, Pembroke, North Carolina USA
- Department of Pharmaceutical Sciences and the Neurosciences Program, University of Connecticut, Storrs, Connecticut USA
| |
Collapse
|
28
|
Engedal K, Davis B, Richarz U, Han J, Schäuble B, Andreasen N. Two galantamine titration regimens in patients switched from donepezil. Acta Neurol Scand 2012; 126:37-44. [PMID: 21992111 DOI: 10.1111/j.1600-0404.2011.01594.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In addition to inhibiting acetylcholinesterase, galantamine has allosteric-modulating activity at nicotinic receptors. This may make galantamine an attractive option for patients starting treatment for Alzheimer's disease (AD), but also for those who have not benefited from their current therapy. This study explored outcomes in subjects with AD transitioning from donepezil because of insufficient tolerability or efficacy. MATERIALS AND METHODS Subjects previously receiving donepezil for mild-to-moderate AD were enrolled in a 12-week randomized, open-label study. After screening and a 7-day washout, subjects were randomly allocated to galantamine fast (8 mg/week increments) or slow (8 mg/4 week) titration to 16-24 mg. Efficacy outcomes included the Alzheimer's Disease Assessment Scale - cognitive subscale (ADAS-cog/11), Mini-Mental State Examination (MMSE), Clinician's Interview-Based Impression of Change - Plus Caregiver's Input (CIBIC-plus) and Alzheimer's Disease Cooperative Study - Activities of Daily Living Inventory (ADCS-ADL). RESULTS Eighty-six of 89 patients (fast titration, n = 44; slow titration, n = 45) completed the study. At week 12, ADAS-cog/11 score improved from screening by 2.6 and 0.6 in the fast- and slow-titration arms, respectively (overall, -1.6; P = 0.002). MMSE scores improved slightly in both arms (overall, +0.9; P = 0.002). Two-thirds of patients had improvement or no change on the CIBIC-plus at week 12. ADCS-ADL scores did not change significantly from screening in either treatment arm. Galantamine was generally well tolerated; nausea (5.6%) and bradycardia (4.5%) were the most commonly reported adverse events. CONCLUSIONS Patients in whom donepezil is ineffective or poorly tolerated may benefit from a switch to galantamine.
Collapse
Affiliation(s)
- K Engedal
- Norwegian Centre for Dementia Research, Department of Geriatric Medicine, Ullevål University Hospital, Oslo, Norway.
| | | | | | | | | | | |
Collapse
|
29
|
Tasso B, Catto M, Nicolotti O, Novelli F, Tonelli M, Giangreco I, Pisani L, Sparatore A, Boido V, Carotti A, Sparatore F. Quinolizidinyl derivatives of bi- and tricyclic systems as potent inhibitors of acetyl- and butyrylcholinesterase with potential in Alzheimer’s disease. Eur J Med Chem 2011; 46:2170-84. [DOI: 10.1016/j.ejmech.2011.02.071] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 02/23/2011] [Accepted: 02/26/2011] [Indexed: 10/18/2022]
|
30
|
Abstract
BACKGROUND Cholinesterase inhibitors (ChEIs) represent the mainstay of symptomatic treatment in Alzheimer's disease. Three medications belonging to this class are presently widely available. These agents differ in their individual mechanisms of action and pharmacokinetic properties. Switching ChEIs can be a reasonable option in cases of intolerance or lack of clinical benefit. METHODS A systematic literature search of switching ChEIs was conducted, and all studies specifically evaluating this issue were identified. Published consensus guidelines were also searched for recommendations on ChEI switching. RESULTS Eight clinical studies are summarized and discussed. All of these studies are open-label or retrospective and they cannot be readily compared because of heterogeneity in design, number of patients, agents used, and endpoints. Switching in most of these studies was done for both "lack of benefit" or "loss of response" after up to 29 months of treatment. Nevertheless, the majority of studies did not include individuals switched for lack of response after several years of treatment. Lack of satisfactory response or intolerance with the initial agent was not predictive of similar results with the second agent. CONCLUSIONS In light of these findings, we propose the following practical approach to switching ChEIs: (1) in the case of intolerance, switching to a second agent should be done only after the complete resolution of side-effects following discontinuation of the initial agent; (2) in the case of lack of efficacy, switching can be done overnight, with a quicker titration scheme thereafter; (3) switching ChEIs is not recommended in individuals who show loss of benefit several years after initiation of treatment.
Collapse
|
31
|
Patyar S, Prakash A, Medhi B. Dual inhibition: a novel promising pharmacological approach for different disease conditions. ACTA ACUST UNITED AC 2011; 63:459-71. [PMID: 21401597 DOI: 10.1111/j.2042-7158.2010.01236.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To overcome the problems associated with polypharmacy, which include medication non compliance, adverse drug reactions, drug-drug interactions and increased pill-burden, various strategies, such as sustained-release drugs and fixed-dose combination regimens (polypills), have been developed. Out of these, a novel and very much promising approach is the use of dual-action drugs. Amongst the dual-action drugs, there is a class of compounds known as dual inhibitors, which possess the dual inhibitory activity. The most common examples of dual inhibitors are rivastigmine, ladostigil, asenapine, phenserine, amitriptyline, clomipramine, doxepin and desipramine. This review article focuses on the conventional drugs used in different diseases which possess dual inhibition activity as well as those which are still in the preclinical/clinical phase.
Collapse
Affiliation(s)
- Sazal Patyar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, Delhi, India
| | | | | |
Collapse
|
32
|
Sadowsky CH, Dengiz A, Meng X, Olin JT. Switching from oral donepezil to rivastigmine transdermal patch in Alzheimer's disease: 20-week extension phase results. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12. [PMID: 21274364 DOI: 10.4088/pcc.09m00852oli] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 12/29/2009] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the long-term safety, tolerability, and efficacy of 2 strategies for switching from donepezil to rivastigmine transdermal patches in patients with mild to moderate Alzheimer's disease. METHOD This was a prospective, 25-week, randomized, open-label, parallel-group study to evaluate an immediate or delayed switch (7-day withdrawal) from donepezil (5 to 10 mg/d) to rivastigmine transdermal patches (4.6 mg/24 h). Participants included male and female patients, aged ≥ 50 years, with a DSM-IV-TR diagnosis of mild to moderate dementia of the Alzheimer's type, defined as a Mini-Mental State Examination score of 10-24, inclusive. Patients were enrolled between February 2007 and February 2008. The study was split into a 5-week core phase and a 20-week extension phase. Safety and efficacy results from the extension phase are presented. RESULTS Both switching strategies were well tolerated. Rates of discontinuation for any reason were similar between the groups. Discontinuations due to adverse events were also similar, and the incidence of gastrointestinal adverse events was low. Apart from Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale scores, at the end of the study, there was no statistically significant change from baseline in cognitive, behavioral, or global outcomes. Over half of the patients preferred rivastigmine transdermal patches to a tablet. CONCLUSIONS This study suggests that the majority of patients receiving donepezil tablets can be safely switched to rivastigmine transdermal patches without significant deterioration in cognition, behavior, and global functioning. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00305903.
Collapse
Affiliation(s)
- Carl H Sadowsky
- Nova SE University, Fort Lauderdale, and Premiere Research Institute, Palm Beach Neurology, West Palm Beach, Florida, USA.
| | | | | | | | | |
Collapse
|
33
|
McDonald PE, Zauszniewski JA, Bekhet A. Psychometric properties of a measure of acceptance of long-standing health problems. Issues Ment Health Nurs 2011; 32:416-23. [PMID: 21736464 PMCID: PMC3458696 DOI: 10.3109/01612840.2010.551449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acceptance of chronic illness is important for health promotion and for improving the quality of life of elders with chronic conditions. Thus, a reliable and valid measure of acceptance is needed for this population. Currently available measures of acceptance do not focus specifically on accepting chronic conditions. This study of 176 elders with chronic conditions examined the psychometric properties of an adapted measure of acceptance--the Ideas About Long-Standing Health Problems (IALHP) questionnaire. Although the findings provided beginning evidence for internal reliability and construct validity to support its potential usefulness in elders, further scale development is recommended.
Collapse
Affiliation(s)
- Patricia Elaine McDonald
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio 44106-4904, USA.
| | | | | |
Collapse
|
34
|
Korabecny J, Musilek K, Holas O, Binder J, Zemek F, Marek J, Pohanka M, Opletalova V, Dohnal V, Kuca K. Synthesis and in vitro evaluation of N-alkyl-7-methoxytacrine hydrochlorides as potential cholinesterase inhibitors in Alzheimer disease. Bioorg Med Chem Lett 2010; 20:6093-5. [DOI: 10.1016/j.bmcl.2010.08.044] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 08/07/2010] [Accepted: 08/10/2010] [Indexed: 12/01/2022]
|
35
|
Targeting Alzheimer’s disease: Novel indanone hybrids bearing a pharmacophoric fragment of AP2238. Bioorg Med Chem 2010; 18:1749-60. [DOI: 10.1016/j.bmc.2010.01.071] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 01/22/2010] [Accepted: 01/29/2010] [Indexed: 11/21/2022]
|
36
|
Physical activity measurement in older adults: relationships with mental health. J Aging Phys Act 2008; 16:369-80. [PMID: 19033599 DOI: 10.1123/japa.16.4.369] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined the relationship between physical activity (PA) and mental health among older adults as measured by objective and subjective PA-assessment instruments. Pedometers (PED), accelerometers (ACC), and the Physical Activity Scale for the Elderly (PASE) were administered to measure 1 week of PA among 84 adults age 55-87 (mean = 71) years. General mental health was measured using the Positive and Negative Affect Scale (PANAS) and the Satisfaction With Life Scale (SWL). Linear regressions revealed that PA estimated by PED significantly predicted 18.1%, 8.3%, and 12.3% of variance in SWL and positive and negative affect, respectively, whereas PA estimated by the PASE did not predict any mental health variables. Results from ACC data were mixed. Hotelling-William tests between correlation coefficients revealed that the relationship between PED and SWL was significantly stronger than the relationship between PASE and SWL. Relationships between PA and mental health might depend on the PA measure used.
Collapse
|
37
|
More Than SF-36? Using Narratives to Elaborate Health and Well-Being Data in Recent Lower-Limb Amputees. SOCIAL INDICATORS RESEARCH SERIES 2008. [DOI: 10.1007/978-1-4020-8569-7_6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
38
|
Smith AW, Reeve BB, Bellizzi KM, Harlan LC, Klabunde CN, Amsellem M, Bierman AS, Hays RD. Cancer, comorbidities, and health-related quality of life of older adults. J Cancer Surviv 2008; 10:1096-1103. [PMID: 18773613 DOI: 10.1007/s11764-016-0553-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
This study examined the physical and mental health of 126,685 males and females age 65 or over, with and without cancer that completed a Medicare Health Outcomes Survey (MHOS) between 1998-2002. Cancer information was ascertained through the National Cancer Institute's (NCI's) Surveillance, Epidemiology and End Results (SEER) program and linked to MHOS data. Results indicated that across most cancer types, cancer patients reported significantly more comorbid conditions and poorer physical and mental health compared with patients without cancer. Negative associations were most pronounced in those with two or more comorbidities and in those diagnosed with cancer within the past year.
Collapse
|
39
|
Butini S, Campiani G, Borriello M, Gemma S, Panico A, Persico M, Catalanotti B, Ros S, Brindisi M, Agnusdei M, Fiorini I, Nacci V, Novellino E, Belinskaya T, Saxena A, Fattorusso C. Exploiting Protein Fluctuations at the Active-Site Gorge of Human Cholinesterases: Further Optimization of the Design Strategy to Develop Extremely Potent Inhibitors. J Med Chem 2008; 51:3154-70. [DOI: 10.1021/jm701253t] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Stefania Butini
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Giuseppe Campiani
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Marianna Borriello
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Sandra Gemma
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Alessandro Panico
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Marco Persico
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Bruno Catalanotti
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Sindu Ros
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Margherita Brindisi
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Marianna Agnusdei
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Isabella Fiorini
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Vito Nacci
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Ettore Novellino
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Tatyana Belinskaya
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Ashima Saxena
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| | - Caterina Fattorusso
- European Research Centre for Drug Discovery and Development (NatSynDrugs), Università di Siena, 53100 Siena, Italy, Dipartimento Farmaco Chimico Tecnologico, via Aldo Moro, Università di Siena, 53100 Siena, Italy Dipartimento di Chimica delle Sostanze Naturali e Dipartimento di Chimica Farmaceutica e Tossicologica Università di Napoli Federico II, via D. Montesano 49, 80131 Napoli, Italy, and Division of Biochemistry, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910
| |
Collapse
|
40
|
Seltzer B. Is long-term treatment of Alzheimer's disease with cholinesterase inhibitor therapy justified? Drugs Aging 2008; 24:881-90. [PMID: 17953456 DOI: 10.2165/00002512-200724110-00001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The cholinesterase inhibitors (ChEIs) donepezil, rivastigmine and galantamine are the current mainstays in the drug treatment of Alzheimer's disease (AD). There is convincing evidence that these agents provide at least modest cognitive, behavioural and functional benefit for 6-12 months at all stages of the disease. Longer term benefits cannot be directly examined by placebo-controlled trials. Nevertheless, the results of virtually all open-label extensions of the pivotal trials, studies of patients with AD at different levels of severity and clinical trials using other designs favour treatment over no treatment for periods of up to 5 years. There are plausible biological reasons why ChEIs might be expected to work over a prolonged period of time although, to date, studies using various markers to chart the effects of medication on long-term disease progression have yielded mixed results. The most contentious issue regarding long-term treatment is economic, but the majority of available economic analyses suggest net savings over the long term if patients with AD receive persistent treatment with ChEIs.
Collapse
Affiliation(s)
- Ben Seltzer
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
41
|
Cerbai F, Giovannini MG, Melani C, Enz A, Pepeu G. N1phenethyl-norcymserine, a selective butyrylcholinesterase inhibitor, increases acetylcholine release in rat cerebral cortex: a comparison with donepezil and rivastigmine. Eur J Pharmacol 2007; 572:142-50. [PMID: 17643410 DOI: 10.1016/j.ejphar.2007.06.053] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 06/13/2007] [Accepted: 06/21/2007] [Indexed: 11/26/2022]
Abstract
The effects of (-)-N(1)phenethyl-norcymserine (PEC, 5 mk/kg, i.p.) on acetylcholine release and cholinesterase activity in the rat cerebral cortex were compared with those of donepezil (1 mg/kg, i.p.), a selective acetylcholinesterase inhibitor, and rivastigmine (0.6 mg/kg, i.p.), an inhibitor of acetylcholinesterase and butyrylcholinesterase. Acetylcholine extracellular levels were measured by microdialysis coupled with HPLC; acetylcholinesterase and butyrylcholinesterase activity were measured with colorimetric and radiometric methods. It was found that comparable 2-3 fold increases in cortical extracellular acetylcholine level, calculated as areas under the curve, followed the administration of the three drugs at the doses used. At the peak of acetylcholine increase, a 27% acetylcholinesterase inhibition and no butyrylcholinesterase inhibition was found after donepezil (1 mg/kg, i.p) administration. At the same time point, rivastigmine (0.6 mg/kg, i.p.) inhibited acetylcholinesterase by 40% and butyrylcholinesterase by 25%. After PEC (5 mg/kg, i.p.) administration, there was a 39% butyrylcholinesterase inhibition and no effect on acetylcholinesterase. Since in the present study it was also confirmed that in the brain butyrylcholinesterase activity is only about 10% of acetylcholinesterase activity, it is surprising that its partial inhibition is sufficient to increase extracellular acetylcholine levels. The importance of butyrylcholinesterase as a "co-regulator" of synaptic acetylcholine levels should thus be reconsidered.
Collapse
Affiliation(s)
- Francesca Cerbai
- Department of Pharmacology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | | | | | | | | |
Collapse
|
42
|
Abstract
Currently, there are no disease-modifying therapies available for Alzheimer's disease (AD). Acetylcholinesterase inhibitors and memantine are licensed for AD and have moderate symptomatic benefits. Epidemiological studies have suggested that NSAIDs, estrogen, HMG-CoA reductase inhibitors (statins) or tocopherol (vitamin E) can prevent AD. However, prospective, randomised studies have not convincingly been able to demonstrate clinical efficacy. Major progress in molecular medicine suggests further drug targets. The metabolism of the amyloid-precursor protein and the aggregation of its Abeta fragment are the focus of current studies. Abeta peptides are produced by the enzymes beta- and gamma-secretase. Inhibition of gamma-secretase has been shown to reduce Abeta production. However, gamma-secretase activity is also involved in other vital physiological pathways. Involvement of gamma-secretase in cell differentiation may preclude complete blockade of gamma-secretase for prolonged times in vivo. Inhibition of beta-secretase seems to be devoid of serious adverse effects according to studies with knockout animals. However, targeting beta-secretase is hampered by the lack of suitable inhibitors to date. Other approaches focus on enzymes that cut inside the Abeta sequence such as alpha-secretase and neprilysin. Stimulation of the expression or activity of alpha-secretase or neprilysin has been shown to enhance Abeta degradation. Furthermore, inhibitors of Abeta aggregation have been described and clinical trials have been initiated. Peroxisome proliferator activated receptor-gamma agonists and selected NSAIDs may be suitable to modulate both Abeta production and inflammatory activation. On the basis of autopsy reports, active immunisation against Abeta in humans seems to have proven its ability to clear amyloid deposits from the brain. However, a first clinical trial with active vaccination against the full length Abeta peptide has been halted because of adverse effects. Further trials with vaccination or passive transfer of antibodies are planned.
Collapse
Affiliation(s)
- Michael Hüll
- Department of Psychiatry and Psychotherapy, University of Freiburg, Hauptstrasse 5, D-79108 Freiburg, Germany.
| | | | | |
Collapse
|
43
|
Waldemar G, Dubois B, Emre M, Georges J, McKeith IG, Rossor M, Scheltens P, Tariska P, Winblad B. Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline. Eur J Neurol 2007; 14:e1-26. [PMID: 17222085 DOI: 10.1111/j.1468-1331.2006.01605.x] [Citation(s) in RCA: 336] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The aim of this international guideline on dementia was to present a peer-reviewed evidence-based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists, and other specialist physicians responsible for the care of patients with dementia. It covers major aspects of diagnostic evaluation and treatment, with particular emphasis on the type of patient often referred to the specialist physician. The main focus is Alzheimer's disease, but many of the recommendations apply to dementia disorders in general. The task force working group considered and classified evidence from original research reports, meta-analysis, and systematic reviews, published before January 2006. The evidence was classified and consensus recommendations graded according to the EFNS guidance. Where there was a lack of evidence, but clear consensus, good practice points were provided. The recommendations for clinical diagnosis, blood tests, neuroimaging, electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, genetic testing, tissue biopsy, disclosure of diagnosis, treatment of Alzheimer's disease, and counselling and support for caregivers were all revised when compared with the previous EFNS guideline. New recommendations were added for the treatment of vascular dementia, Parkinson's disease dementia, and dementia with Lewy bodies, for monitoring treatment, for treatment of behavioural and psychological symptoms in dementia, and for legal issues. The specialist physician plays an important role together with primary care physicians in the multidisciplinary dementia teams, which have been established throughout Europe. This guideline may contribute to the definition of the role of the specialist physician in providing dementia health care.
Collapse
Affiliation(s)
- G Waldemar
- Memory Disorders Research Group, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Wolters EC. PD-related psychosis: pathophysiology with therapeutical strategies. JOURNAL OF NEURAL TRANSMISSION. SUPPLEMENTUM 2006:31-7. [PMID: 17447413 DOI: 10.1007/978-3-211-33328-0_4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Parkinson's disease (PD) is a chronic, neurodegenerative disease with degeneration of the central dopaminergic neurons in the substantia nigra, leading to a depletion of dopamine (DA) in the striatum. This depletion causes the clinical hallmarks of this disease: bradykinesia, hypokinesia, rigidity, tremor and postural instability. Besides these well known motor symptoms, non-motor symptoms may develop, such as hyposmia, sleep disorders, autonomic disturbances, depression, cognitive impairment and psychosis. Pathophysiological mechanisms underlying these symptoms not only comprise Lewy body pathology in the central dopaminergic system, but also in the noradrenergic, serotinergic and cholinergic transmittersystems. Indeed, in Parkinson's disease, about 30-40% of the patients suffers fluctuating psychotic symptoms, mainly paranoid delusions and/or visual or acoustic hallucinations, symptoms considered to represent major contributors to patient and caregiver distress and nursing home placement. Endogenous (related to the disease process itself) as well as exogenous (related to therapeutical interventions) psychotogenic factors may contribute to the development of psychotic symptoms in PD. Therapeutical strategies, therefore, are aimed to reduce both endogenous and exogenous factors. To reduce endogenous psychotogenic factors, cholinesterase inhibitors, suggested to reduce cognitive deterioration, now seem to be the drugs of choice. In exogenously induced psychotic symptoms, atypical antipsychotics are considered the most effective. However, as psychotic symptoms in PD are often influenced by both endogenous and exogenous factors, a combination of both strategies may be preferred.
Collapse
Affiliation(s)
- E Ch Wolters
- Department of Neurology, Research Institute Neurosciences Vrije Universiteit, VU University Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|