Long-term theophylline treatment changes the effects of angiotensin II and adenosinergic agents on the seizure threshold

The Potential Therapeutic Capacity of Inhibiting the Brain Renin-Angiotensin System in the Treatment of Co-Morbid Conditions in Epilepsy

Epilepsy is one of the most prevalent neurological diseases and although numerous novel anticonvulsants have been approved, the proportion of patients who are refractory to medical treatment of seizures and have progressive co-morbidities such as cognitive impairment and depression remains at about 20-30%. In the last decade, extensive research has identified a therapeutic capacity of the components of the brain renin-angiotensin system (RAS) in seizure- and epilepsy-related phenomena. Alleviating the activity of RAS in the central nervous system is considered to be a potential adjuvant strategy for the treatment of numerous detrimental consequences of epileptogenesis. One of the main advantages of RAS is associated with its modulatory influence on different neurotransmitter systems, thereby exerting a fine-tuning control mechanism for brain excitability. The most recent scientific findings regarding the involvement of the components of brain RAS show that angiotensin II (Ang II), angiotensin-converting enzyme (ACE), Ang II type 1 (AT₁) and type 2 (AT₂) receptors are involved in the control of epilepsy and its accompanying complications, and therefore they are currently of therapeutic interest in the treatment of this disease. However, data on the role of different components of brain RAS on co-morbid conditions in epilepsy, including hypertension, are insufficient. Experimental and clinical findings related to the involvement of Ang II, ACE, AT₁, and AT₂ receptors in the control of epilepsy and accompanying complications may point to new therapeutic opportunities and adjuvants for the treatment of common co-morbid conditions of epilepsy.

Angiotensin II type 1/adenosine A 2A receptor oligomers: a novel target for tardive dyskinesia

Tardive dyskinesia (TD) is a serious motor side effect that may appear after long-term treatment with neuroleptics and mostly mediated by dopamine D₂ receptors (D₂Rs). Striatal D₂R functioning may be finely regulated by either adenosine A_2A receptor (A_2AR) or angiotensin receptor type 1 (AT₁R) through putative receptor heteromers. Here, we examined whether A_2AR and AT₁R may oligomerize in the striatum to synergistically modulate dopaminergic transmission. First, by using bioluminescence resonance energy transfer, we demonstrated a physical AT₁R-A_2AR interaction in cultured cells. Interestingly, by protein-protein docking and molecular dynamics simulations, we described that a stable heterotetrameric interaction may exist between AT₁R and A_2AR bound to antagonists (i.e. losartan and istradefylline, respectively). Accordingly, we subsequently ascertained the existence of AT₁R/A_2AR heteromers in the striatum by proximity ligation in situ assay. Finally, we took advantage of a TD animal model, namely the reserpine-induced vacuous chewing movement (VCM), to evaluate a novel multimodal pharmacological TD treatment approach based on targeting the AT₁R/A_2AR complex. Thus, reserpinized mice were co-treated with sub-effective losartan and istradefylline doses, which prompted a synergistic reduction in VCM. Overall, our results demonstrated the existence of striatal AT₁R/A_2AR oligomers with potential usefulness for the therapeutic management of TD.

Theophylline-associated seizures and their clinical characterizations

BACKGROUND

To elucidate the basic mechanism of theophylline-associated seizures (TAS), the clinical symptoms, electroencephalogram (EEG) and neuroradiological imaging of eight pediatric patients were all retrospectively evaluated.

METHODS

Patients whose seizures represented their first episode were selected, while patients with cerebrospinal fluid abnormalities including pleocytosis and protein elevation, present illness of head trauma, epilepsy, febrile convulsion or any psychomotor retardation were excluded although they were given theophylline.

RESULTS

Eight patients, 3.5 +/- 1.7 years of age, thus fulfilled the definition of TAS in the past 5 years. Based on their seizure patterns, EEG findings, brain single-photon emission computed tomography and head magnetic resonance imaging, a total of seven of eight patients had either localized or unilateral dominant lesions. They all had fever, > or =38 degrees C, and six of eight patients had a family history of febrile convulsions and/or idiopathic epilepsy. Thereafter none of them had convulsions after the cessation of theophylline administration. Through the TAS event, a 6-year-old female patient was found to have a right deep lateral cerebral venous angioma.

CONCLUSION

In infants with idiopathic low seizure threshold and fever, theophylline administration might possibly trigger a seizure. Moreover, based on these patients' clinical findings, some kind of cerebral vascular involvements is speculated to be related with TAS.

Acute encephalopathy with refractory status epilepticus: bilateral mesial temporal and claustral lesions, associated with a peripheral marker of oxidative DNA damage

We describe a 12-year-old girl, who had been medicated with theophylline for bronchial asthma and developed acute encephalopathy with refractory status epilepticus, showing bilateral mesial temporal and claustral lesions, which were evident on fluid-attenuated inversion recovery images, obtained with 1.5 T magnetic resonance imaging. To date, oxidative stress has been implicated in aging or various disorders, including inflammatory or degenerative neurological disorders. One of the oxidative stress markers, 8-hydroxydeoxyguanosine, was increased in our patient's cerebro-spinal fluid, plasma and urine. We speculate that augmented oxidative stress was associated with refractory status epilepticus in our patient, accompanying bilateral mesial temporal, claustral lesions and severe neuronal damage. Serial measurements of oxidative stress markers in acute encephalitis, encephalopathy, or status epilepticus could clarify the relationships between acute brain damage and free radicals.

Effect of acute versus chronic theophylline administration on acute restraint stress-induced increase of pentylenetetrazol seizure threshold in mice

Various stressful paradigms were found to induce anticonvulsant effects in different seizure models. Methylxanthines, such as theophylline might contribute to the reduction of restraint-induced stress. Therefore, in this study the influence of acute restraint stress on pentylenetetrazol (PTZ) seizure thresholds as well as the effect of acute and chronic theophylline pretreatment on stress-induced modulation of the seizure threshold were assessed in mice. The onset of the three consecutive seizure phases: myoclonic twitch (MTW), generalized clonus (GNCL) and tonic hind limb extension (THE) was delayed after exposure to a 2 h restraint stress by 34%, 23% and 24%, respectively. In nonstressed mice, acute theophylline injection (100 mg/kg, i.p.) decreased the threshold only for THE. However, in stressed animals, the pretreatment with the methylxanthine significantly enhanced the dose of the convulsant producing the same seizure phase. In nonstressed mice, long-term theophylline treatment (50 mg/kg, twice daily for 14 days) increased PTZ threshold for all three seizure phases. In contrast, in chronically treated with theophylline mice exposed to restraint stress, significant decrease in the PTZ threshold for all seizure phases compared to control stressed animals have been observed. These results suggest that, depending on the treatment regimen (acute versus chronic), theophylline specifically and differentially modulates the anticonvulsant effect of restraint stress in mice.

Angiotensin peptides modulatory system: how is it implicated in the control of seizure susceptibility?

Accumulated studies support the concept that angiotensin peptides, ANG II, ANG III, and ANG IV act as neurotransmitters or neuromodulators in specific neuronal pathways in the brain stem, the hypothalamus, and the forebrain. They have been implicated in the regulation of several physiological processes, particularly in excitable brain structures that express high concentration of their receptors. With the help of pharmacological approaches it was shown that angiotensin peptides appear to be anticonvulsant in a variety of experimental seizure models. Thus, ANG II increases the threshold for pentylenetetrazol (PTZ)-, bicuculline-and picrotoxin-induced seizures in mice. It also attenuates the intensity of clonic seizures evoked by PTZ and 3-mercaptopropionic acid and is effective in the maximal electroshock test. Furthermore, ANG II, ANG III, and ANG IV protect against the clonic convulsions in the PTZ kindling model of epilepsy in mice. From the accumulated results it could be assumed that the angiotensin peptides appear to realize their effects acting directly on their receptors (AT(1), AT(2) and AT(4)) and through close interaction with different neurotransmitter/neuromodulator systems as dopamine (DA)-, gamma-aminobutyric acid (GABA)-and adenosine. This may contribute to a new potential use of angiotensin drugs either alone or in combination with other neuroprotective agents acting through the above mentioned systems, thus providing a more rational strategy for the treatment of neurodegenerative disorders such as epilepsy.

Up-regulation of adenosine A1 receptor binding in pentylenetetrazol kindling in mice: effects of angiotensin IV

The effects of the hexapeptide angiotensin II (3-8) ANG IV, the selective A(1) receptor agonist cyclohexyladenosine (CHA) and the combination of ANG IV + CHA on pentylenetetrazol (PTZ)-generalized seizures; kindling development and maintenance were studied. By using in vitro quantitative receptor autoradiography, the regulation of adenosine A(1) receptor density at different time points during the kindling procedure and postkindling period was determined. ANG IV and CHA effectively reduced clonic seizures in PTZ-generalized seizure model, in PTZ-kindled mice as well as during kindling development and a week later by rechallenge with PTZ. Furthermore, coadministration of ANG IV and CHA had a strong anticonvulsant effect, both compounds acting synergistically. A significant increase of adenosine A(1) receptor density was detected in somatosensory cortex, hippocampus, amygdala and geniculate nuclei early in the kindling procedure (after the 3rd injection), which persisted at least 1 month after the end of kindling procedure. In addition, a delayed up-regulation of adenosine A(1) receptor binding was observed a week after kindling in the mamillary bodies and a month later in the motor cortex. The pretreatment with ANG IV caused a down-regulation of adenosine A(1) receptor density to the control level in most time points and brain areas. In conclusion, PTZ kindling-induced increase of adenosine A(1) receptor binding at different time points and in specific brain structures might represent an adaptive mechanism for coping with the hyperexcitability typical for this phenomenon. The antiepileptogenic effect of ANG IV could be realized partly through an adenosine-dependent mechanism.

Interaction of angiotensin II and adenosine A1 and A2A receptor ligands on the writhing test in mice

The effects of adenosine A1 and A2A receptor agonists and antagonists administered intraperitoneally (i.p.) and their interaction with angiotensin II (Ang II) administered intracerebroventricularly (i.c.v.) were studied in mice using the acetic acid-induced abdominal constriction test. Ang II (0.1 microg/mouse) induced antinociception in this model. The adenosine A1 receptor agonist N6-cyclopentyladenosine (CPA; 0.05, 0.25 and 0.5 mg/kg) also showed a well-developed antinociceptive effect. Ang II (0.1 microg/mouse) administered 5 min before CPA (0.25 mg/kg) decreased the number of writhes, i.e., it enhanced the antinociceptive effect of CPA. Losartan, an AT1 receptor antagonist (25 microg/mouse i.c.v.), enhanced the antinociceptive effect of CPA, while the AT2 receptor antagonist 1-[-4-(dimethylamino)-3-methylphenylmethyl]-5-diphenylacetyl)-4,5,6,7-tetrahydro 1H-4-imidazol [4,5c]pyridine-6 carboxylic acid, ditrifluoroacetate, dihydrate (PD 123319; 10 microg/mouse) had less effect. 8-Cyclopentyl-1,3-dipropylxanthine (DPCPX; 0.1 mg/kg), an adenosine A1 receptor antagonist, exhibited a pronociceptive effect and did not change the antinociceptive effect of Ang II. The adenosine A2A receptor agonist PD-125944 (DPMA; 0.1, 0.5 and 1 mg/kg) showed pronounced antinociceptive effect. Ang II (0.1 microg/mouse) did not significantly influence the antinociceptive effect of DPMA (0.1 mg/kg). The A2A receptor antagonist 3,7-dimethyl-1-propargilxanthine (DMPX; 0.1 mg/kg) had no effect on the number of writhes and did not influence the effect of Ang II. These data indicate that the antinociceptive effect of Ang II interacts with that produced by adenosine A1 receptor agonist.

Interaction of angiotensin II and III with adenosine A(1) receptor-related drugs in passive avoidance conditioning in rats

The present study examines the functional interaction between angiotensins (ANG II and III) and adenosine A(1) receptor-related drugs on passive avoidance (step-through) conditioning in rats. ANG II and III were administered intracerebroventricularly (i.c.v.) while N(6)-cyclohexyladenosine (CHA) and theophylline-intraperitoneally (i.p.), immediately after the training trial. ANG II (0.1,0.5,1 microg) induced dose-dependent (inverted-U) increase of the retention while ANG III in the same doses decreased it upon re-testing of rats 24 h and 7 days later. The selective adenosine A(1) receptor agonist CHA (0.1 mg/kg) attenuated memory-enhancing effect of ANG II (0.1 microg) 24 h but not 7 days after the training session. Conversely, CHA had opposite i.e. facilitating effect on ANG III (0.1 microg) response upon re-testing 24 h and 7 days later. The pretreatment with ANG III attenuated the retention-improving effect exerted by the non-specific adenosine A(1)/A(2) receptor antagonist theophylline (75 mg/kg) 24 h and 7 days after the training trial. Taken together, the results show a mutual interaction of the drugs belonging to the adenosine and angiotensin modulatory systems in memory consolidation of rats.

Interaction between angiotensin IV and adenosine A1 receptor related drugs in passive avoidance conditioning in rats

The functional interaction between ANG (3--8) (ANG IV) and adenosine A(1) receptor related drugs in passive avoidance (step-through) task in rats was studied in Wistar rats. ANG IV exerted dose-dependent (inverted-U) improvement of the retention while sarilesin (an angiotensin II analog) impaired this effect. Co-administration of theophylline and ANG IV, both in ineffective doses, enhanced the retention. The selective adenosine A(1) receptor agonist cyclopentyladenosine (CPA) attenuated ANG IV-induced memory enhancement.