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Morimoto S, Takahashi S, Fukushima K, Saya H, Suzuki N, Aoki M, Okano H, Nakahara J. Ropinirole hydrochloride remedy for amyotrophic lateral sclerosis - Protocol for a randomized, double-blind, placebo-controlled, single-center, and open-label continuation phase I/IIa clinical trial (ROPALS trial). Regen Ther 2019; 11:143-166. [PMID: 31384636 PMCID: PMC6661418 DOI: 10.1016/j.reth.2019.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Amyotrophic lateral sclerosis (ALS) is an intractable and incurable neurological disease. It is a progressive disease characterized by muscle atrophy and weakness caused by selective vulnerability of upper and lower motor neurons. In disease research, it has been common to use mouse models carrying mutations in responsible genes for familial ALS as pathological models of ALS. However, there is no model that has reproduced the actual conditions of human spinal cord pathology. Thus, we developed a method of producing human spinal motor neurons using human induced pluripotent stem cells (iPSCs) and an innovative experimental technique for drug screening. As a result, ropinirole hydrochloride was eventually discovered after considering such results as its preferable transitivity in the brain and tolerability, including possible adverse reactions. Therefore, we explore the safety, tolerability and efficacy of ropinirole hydrochloride as an ALS treatment in this clinical trial. Methods The ROPALS trial is a single-center double-blind randomized parallel group-controlled trial of the safety, tolerability, and efficacy of the ropinirole hydrochloride extended-release tablet (Requip CR) at 2- to 16-mg doses in patients with ALS. Twenty patients will be recruited for the active drug group (fifteen patients) and placebo group (five patients). All patients will be able to receive the standard ALS treatment of riluzole if not changed the dosage during this trial. The primary outcome will be safety and tolerability at 24 weeks, defined from the date of randomization. Secondary outcome will be the efficacy, including any change in the ALS Functional Rating Scale-Revised (ALSFRS-R), change in the Combined Assessment of Function and Survival (CAFS), and the composite endpoint as a sum of Z-transformed scores on various clinical items. Notably, we will perform an explorative search for a drug effect evaluation using the patient-derived iPSCs to prove this trial concept. Eligible patients will have El Escorial Possible, clinically possible and laboratory-supported, clinically probable, or clinically definite amyotrophic lateral sclerosis with disease duration less than 60 months (inclusive), an ALSFRS-R score ≥2 points on all items and age from 20 to 80 years. Conclusion Patient recruitment began in December 2018 and the last patient is expected to complete the trial protocol in November 2020. Trial registration Current controlled trials UMIN000034954 and JMA-IIA00397. Protocol version version 1.6 (Date; 5/Apr/2019).
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Key Words
- %FVC, Forced vital capacity
- 6-OHDA, 6-hydroxydopamine
- 8-OHdG, 8-Hydroxydeoxyguanosine
- ADR, Adverse reaction
- AE, Adverse effect
- ALP, Alkaline phosphatase
- ALS, Amyotrophic lateral sclerosis
- ALSAQ-40, Amyotrophic Lateral Sclerosis Assessment Questionnaire-40
- ALSFRS-R, ALS Functional Rating Scale-Revised
- ALT, Alanine aminotransferase
- APTT, Activated partial thromboplastin time
- AST, Aspartate aminotransferase
- Amyotrophic lateral sclerosis
- BUN, Blood urea nitrogen
- CAFS, Combined Assessment of Function and Survival
- CK, Creatine kinase
- CPK, Creatine phosphokinase
- CRP, C-reactive protein
- CTCAE, Common terminology Criteria for Adverse Events
- EDC, Electronic data capture
- FALS, Familial ALS
- FAS, Full analysis set
- GCP, Good clinical practice
- HBs, Hepatitis B surface
- HCG, Human chorionic gonadotropin
- HCV, Hepatitis C virus
- HDL, High-density lipoprotein
- HIV, Human immunodeficiency virus
- HTLV-1, Human T-cell leukemia virus type 1
- IRB, Institutional review board
- LDH, Lactate dehydrogenase
- LDL, Low-density lipoprotein
- MMT, Manual muscle testing
- NfL, Neurofilament light chain
- PPS, Per protocol set
- PT, Prothrombin time
- QOL, Quality of life
- Requip CR
- Ropinirole hydrochloride
- SAE, Severe adverse effect
- SALS, sporadic ALS
- SOD, Superoxide dismutase
- TDP-43, Transactive response DNA-binding protein 43
- TPHA, Treponema pallidum hemagglutination
- iPSC-drug discovery
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Affiliation(s)
- Satoru Morimoto
- Department of Physiology, Keio University School of Medicine, Japan
- Department of Neurology, Keio University School of Medicine, Japan
| | | | - Komei Fukushima
- Department of Physiology, Keio University School of Medicine, Japan
| | - Hideyuki Saya
- Division of Gene Regulation, Institute for Advanced Medical Research, Graduate School of Medicine, Keio University, Japan
| | - Norihiro Suzuki
- Department of Neurology, Keio University School of Medicine, Japan
- Department of Neurology, Shonan Keiiku Hospital, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University, School of Medicine, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, Japan
- Corresponding author. Keio University Graduate School of Medicine, Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. Fax: +81 3 3357 5445.
| | - Jin Nakahara
- Department of Neurology, Keio University School of Medicine, Japan
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The Biosynthesis, Signaling, and Neurological Functions of Bile Acids. Biomolecules 2019; 9:biom9060232. [PMID: 31208099 PMCID: PMC6628048 DOI: 10.3390/biom9060232] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/13/2022] Open
Abstract
Bile acids (BA) are amphipathic steroid acids synthesized from cholesterol in the liver. They act as detergents to expedite the digestion and absorption of dietary lipids and lipophilic vitamins. BA are also considered to be signaling molecules, being ligands of nuclear and cell-surface receptors, including farnesoid X receptor and Takeda G-protein receptor 5. Moreover, BA also activate ion channels, including the bile acid-sensitive ion channel and epithelial Na+ channel. BA regulate glucose and lipid metabolism by activating these receptors in peripheral tissues, such as the liver and brown and white adipose tissue. Recently, 20 different BA have been identified in the central nervous system. Furthermore, BA affect the function of neurotransmitter receptors, such as the muscarinic acetylcholine receptor and γ-aminobutyric acid receptor. BA are also known to be protective against neurodegeneration. Here, we review recent findings regarding the biosynthesis, signaling, and neurological functions of BA.
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Birsa N, Bentham MP, Fratta P. Cytoplasmic functions of TDP-43 and FUS and their role in ALS. Semin Cell Dev Biol 2019; 99:193-201. [PMID: 31132467 DOI: 10.1016/j.semcdb.2019.05.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/06/2019] [Accepted: 05/23/2019] [Indexed: 02/08/2023]
Abstract
TAR DNA-binding protein of 43 kDa (TDP-43) and fused in sarcoma (FUS) are RNA binding proteins (RBPs) primarily located in the nucleus, and involved in numerous aspects of RNA metabolism. Both proteins can be found to be depleted from the nucleus and accumulated in cytoplasmic inclusions in two major neurodegenerative conditions, amyotrophic lateral sclerosis and frontotemporal dementia. Recent evidences suggest that, in addition to their nuclear functions, both TDP-43 and FUS are involved in multiple processes in the cytoplasm, including mRNA stability and transport, translation, the stress response, mitochondrial function and autophagy regulation. Here, we review the most recent advances in understanding their functions in the cytoplasm and how these are affected in disease.
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Affiliation(s)
- Nicol Birsa
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
| | - Matthew Peter Bentham
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Pietro Fratta
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK; MRC Centre for Neuromuscular Disease, Queen Square, London, WC1N 3BG, UK.
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Obál I, Nógrádi B, Meszlényi V, Patai R, Ricken G, Kovacs GG, Tripolszki K, Széll M, Siklós L, Engelhardt JI. Experimental Motor Neuron Disease Induced in Mice with Long-Term Repeated Intraperitoneal Injections of Serum from ALS Patients. Int J Mol Sci 2019; 20:ijms20102573. [PMID: 31130623 PMCID: PMC6566871 DOI: 10.3390/ijms20102573] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/02/2019] [Accepted: 05/23/2019] [Indexed: 01/18/2023] Open
Abstract
In an earlier study, signs of commencing degeneration of spinal motor neurons were induced in mice with short-term intraperitoneal injections of immunoglobulin G (IgG) taken from patients with amyotrophic lateral sclerosis (ALS). Since in that study, neither weakness nor loss of motor neurons was noted, to test whether the ALS IgG in this paradigm has the potential to evoke relentless degeneration of motor neurons, treatment with repeated injections over a longer period was carried out. Mice were systematically injected intraperitoneally with serum taken from ALS patients over a 75-day period. At selected time points, the isometric force of the limbs, number of spinal motor neurons and their intracellular calcium levels were determined. Furthermore, markers of glial activation and the motoneuronal uptake of human IgG were monitored. During this period, gliosis and progressive motoneuronal degeneration developed, which led to gradual loss of spinal motor neurons, more than 40% at day 21, along with decreasing muscle strength in the limbs. The inclusion-like accumulation of IgG appeared in the perikarya with the increase of intracellular calcium in the cell bodies and motor nerve terminals. Our results demonstrate that ALS serum can transfer motor neuron disease to mice.
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Affiliation(s)
- Izabella Obál
- Department of Neurology, University of Szeged, H-6725 Szeged, Hungary.
- Department of Neurology, Aalborg University Hospital, DK-9000 Aalborg, Denmark.
| | - Bernát Nógrádi
- Department of Neurology, University of Szeged, H-6725 Szeged, Hungary.
- Foundation for the Future of Biomedical Sciences in Szeged, Szeged Scientist Academy, H-6721 Szeged, Hungary.
| | - Valéria Meszlényi
- Department of Neurology, University of Szeged, H-6725 Szeged, Hungary.
- Foundation for the Future of Biomedical Sciences in Szeged, Szeged Scientist Academy, H-6721 Szeged, Hungary.
| | - Roland Patai
- Institute of Biophysics, Biological Research Centre of the Hungarian Academy of Sciences, H-6726 Szeged, Hungary.
| | - Gerda Ricken
- Clinical Institute of Neurology, Medical University of Vienna, Vienna A-1090, Austria.
| | - Gabor G Kovacs
- Clinical Institute of Neurology, Medical University of Vienna, Vienna A-1090, Austria.
| | - Kornélia Tripolszki
- Department of Medical Genetics, University of Szeged, H-6720 Szeged, Hungary.
| | - Márta Széll
- Department of Medical Genetics, University of Szeged, H-6720 Szeged, Hungary.
- Hungarian Academy of Sciences - University of Szeged, Dermatological Research Group, H-6720 Szeged, Hungary.
| | - László Siklós
- Institute of Biophysics, Biological Research Centre of the Hungarian Academy of Sciences, H-6726 Szeged, Hungary.
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Franz CK, Joshi D, Daley EL, Grant RA, Dalamagkas K, Leung A, Finan JD, Kiskinis E. Impact of traumatic brain injury on amyotrophic lateral sclerosis: from bedside to bench. J Neurophysiol 2019; 122:1174-1185. [PMID: 31116639 DOI: 10.1152/jn.00572.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by the loss of upper and lower motor neurons, which manifests clinically as progressive weakness. Although several epidemiological studies have found an association between traumatic brain injury (TBI) and ALS, there is not a consensus on whether TBI is an ALS risk factor. It may be that it can cause ALS in a subset of susceptible patients, based on a history of repetitive mild TBI and genetic predisposition. This cannot be determined based on clinical observational studies alone. Better preclinical models are necessary to evaluate the effects of TBI on ALS onset and progression. To date, only a small number of preclinical studies have been performed, mainly in the superoxide dismutase 1 transgenic rodents, which, taken together, have mixed results and notable methodological limitations. The more recent incorporation of additional animal models such as Drosophila flies, as well as patient-induced pluripotent stem cell-derived neurons, should facilitate a better understanding of a potential functional interaction between TBI and ALS.
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Affiliation(s)
- Colin K Franz
- Biologics Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Divya Joshi
- Biologics Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Elizabeth L Daley
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rogan A Grant
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kyriakos Dalamagkas
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, TIRR Memorial Hermann, Houston, Texas
| | - Audrey Leung
- Biologics Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John D Finan
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Evangelos Kiskinis
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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