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Cristóbal I, Madoz-Gúrpide J, Manso R, González-Alonso P, Rojo F, García-Foncillas J. Potential anti-tumor effects of FTY720 associated with PP2A activation: a brief review. Curr Med Res Opin 2016; 32:1137-41. [PMID: 26950691 DOI: 10.1185/03007995.2016.1162774] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
FTY720 (Fingolimod, Gilenya (†) ) is an FDA-approved immunosuppressant currently used in the treatment of multiple sclerosis. However, a large number of studies over the last few years have shown that FTY720 shows potent antitumor properties that suggest its potential usefulness as a novel anticancer agent. Interestingly, the restoration of protein phosphatase 2A (PP2A) activity mediated by FTY720 could play a key role in its antitumor effects. Taking into account that PP2A inactivation is a common event that determines poor outcome in several tumor types, FTY720 could serve as an alternative therapeutic strategy for cancer patients with such alterations.
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Affiliation(s)
- Ion Cristóbal
- a Translational Oncology Division , Oncohealth Institute, IIS-Fundacion Jimenez Diaz-UAM, University Hospital 'Fundacion Jimenez Diaz' , Madrid , Spain
| | | | - Rebeca Manso
- b Pathology Department , IIS 'Fundacion Jimenez Diaz' , Madrid , Spain
| | | | - Federico Rojo
- b Pathology Department , IIS 'Fundacion Jimenez Diaz' , Madrid , Spain
| | - Jesús García-Foncillas
- a Translational Oncology Division , Oncohealth Institute, IIS-Fundacion Jimenez Diaz-UAM, University Hospital 'Fundacion Jimenez Diaz' , Madrid , Spain
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152
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Sun N, Shen Y, Han W, Shi K, Wood K, Fu Y, Hao J, Liu Q, Sheth KN, Huang D, Shi FD. Selective Sphingosine-1-Phosphate Receptor 1 Modulation Attenuates Experimental Intracerebral Hemorrhage. Stroke 2016; 47:1899-906. [PMID: 27174529 DOI: 10.1161/strokeaha.115.012236] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 04/07/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Preclinical studies and a proof-of-concept clinical study have shown that sphingosine-1-phosphate receptor (S1PR) modulator, fingolimod, improves the clinical outcome of intracerebral hemorrhage (ICH). However, the specific subtype of the S1PRs through which immune modulation provides protection in ICH remains unclear. In addition, fingolimod-induced adverse effects could limit its use in patients with stroke because of interactions with other S1PR subtypes, particularly with S1PR3. RP101075 is a selective S1PR1 agonist with superior cardiovascular safety profile. In this study, we investigated the impact of RP101075 treatment in a mouse model of ICH. METHODS ICH was induced by injection of autologous blood in 294 male C57BL/6J and Rag2(-/-) mice. ICH mice randomly received vehicle, RP101075, or RP101075 plus S1PR1 antagonist W146 by daily oral gavage for three consecutive days, starting from 30 minutes after surgery. Neurodeficits, brain edema, brain infiltration of immune cells, blood-brain barrier integrity, and cell death were assessed after ICH. RESULTS RP101075 significantly attenuated neurological deficits and reduced brain edema in ICH mice. W146 blocked the effects of RP101075 on neurodeficits and brain edema. RP101075 reduced the counts of brain-infiltrating lymphocytes, neutrophils, and microglia, as well as cytokine expression after ICH. Enhanced blood-brain barrier integrity and alleviated neuronal death were also seen in ICH mice after RP101075 treatment. CONCLUSIONS S1PR1 modulation via RP101075 provides protection in experimental ICH. Together with the advantageous pharmacological features of RP101075, these results warrant further investigations of its mechanisms of action and translational values in ICH patients.
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Affiliation(s)
- Na Sun
- From the Departments of Neurology (N.S., Y.S., K.S., Y.F., J.H., Q.L., F.-D.S.) and Radiology (W.H.), Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (N.S., K.W., Q.L., F.-D.S.); Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); and Department of Clinical Research and Multiple Sclerosis Center, Neurology and Neuroscience Associates, Unity Health Network, Akron, OH (D.H.)
| | - Yi Shen
- From the Departments of Neurology (N.S., Y.S., K.S., Y.F., J.H., Q.L., F.-D.S.) and Radiology (W.H.), Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (N.S., K.W., Q.L., F.-D.S.); Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); and Department of Clinical Research and Multiple Sclerosis Center, Neurology and Neuroscience Associates, Unity Health Network, Akron, OH (D.H.)
| | - Wei Han
- From the Departments of Neurology (N.S., Y.S., K.S., Y.F., J.H., Q.L., F.-D.S.) and Radiology (W.H.), Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (N.S., K.W., Q.L., F.-D.S.); Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); and Department of Clinical Research and Multiple Sclerosis Center, Neurology and Neuroscience Associates, Unity Health Network, Akron, OH (D.H.)
| | - Kaibin Shi
- From the Departments of Neurology (N.S., Y.S., K.S., Y.F., J.H., Q.L., F.-D.S.) and Radiology (W.H.), Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (N.S., K.W., Q.L., F.-D.S.); Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); and Department of Clinical Research and Multiple Sclerosis Center, Neurology and Neuroscience Associates, Unity Health Network, Akron, OH (D.H.)
| | - Kristofer Wood
- From the Departments of Neurology (N.S., Y.S., K.S., Y.F., J.H., Q.L., F.-D.S.) and Radiology (W.H.), Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (N.S., K.W., Q.L., F.-D.S.); Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); and Department of Clinical Research and Multiple Sclerosis Center, Neurology and Neuroscience Associates, Unity Health Network, Akron, OH (D.H.)
| | - Ying Fu
- From the Departments of Neurology (N.S., Y.S., K.S., Y.F., J.H., Q.L., F.-D.S.) and Radiology (W.H.), Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (N.S., K.W., Q.L., F.-D.S.); Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); and Department of Clinical Research and Multiple Sclerosis Center, Neurology and Neuroscience Associates, Unity Health Network, Akron, OH (D.H.)
| | - Junwei Hao
- From the Departments of Neurology (N.S., Y.S., K.S., Y.F., J.H., Q.L., F.-D.S.) and Radiology (W.H.), Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (N.S., K.W., Q.L., F.-D.S.); Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); and Department of Clinical Research and Multiple Sclerosis Center, Neurology and Neuroscience Associates, Unity Health Network, Akron, OH (D.H.)
| | - Qiang Liu
- From the Departments of Neurology (N.S., Y.S., K.S., Y.F., J.H., Q.L., F.-D.S.) and Radiology (W.H.), Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (N.S., K.W., Q.L., F.-D.S.); Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); and Department of Clinical Research and Multiple Sclerosis Center, Neurology and Neuroscience Associates, Unity Health Network, Akron, OH (D.H.)
| | - Kevin N Sheth
- From the Departments of Neurology (N.S., Y.S., K.S., Y.F., J.H., Q.L., F.-D.S.) and Radiology (W.H.), Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (N.S., K.W., Q.L., F.-D.S.); Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); and Department of Clinical Research and Multiple Sclerosis Center, Neurology and Neuroscience Associates, Unity Health Network, Akron, OH (D.H.)
| | - DeRen Huang
- From the Departments of Neurology (N.S., Y.S., K.S., Y.F., J.H., Q.L., F.-D.S.) and Radiology (W.H.), Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (N.S., K.W., Q.L., F.-D.S.); Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); and Department of Clinical Research and Multiple Sclerosis Center, Neurology and Neuroscience Associates, Unity Health Network, Akron, OH (D.H.)
| | - Fu-Dong Shi
- From the Departments of Neurology (N.S., Y.S., K.S., Y.F., J.H., Q.L., F.-D.S.) and Radiology (W.H.), Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ (N.S., K.W., Q.L., F.-D.S.); Department of Neurology, Yale University School of Medicine, New Haven, CT (K.N.S.); and Department of Clinical Research and Multiple Sclerosis Center, Neurology and Neuroscience Associates, Unity Health Network, Akron, OH (D.H.).
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153
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Blanc CA, Grist JJ, Rosen H, Sears-Kraxberger I, Steward O, Lane TE. Sphingosine-1-phosphate receptor antagonism enhances proliferation and migration of engrafted neural progenitor cells in a model of viral-induced demyelination. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 185:2819-32. [PMID: 26435414 DOI: 10.1016/j.ajpath.2015.06.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/22/2015] [Accepted: 06/25/2015] [Indexed: 01/12/2023]
Abstract
The oral drug FTY720 affects sphingosine-1-phosphate (S1P) signaling on targeted cells that bear the S1P receptors S1P1, S1P3, S1P4, and S1P5. We examined the effect of FTY720 treatment on the biology of mouse neural progenitor cells (NPCs) after transplantation in a viral model of demyelination. Intracerebral infection with the neurotropic JHM strain of mouse hepatitis virus (JHMV) resulted in an acute encephalomyelitis, followed by demyelination similar in pathology to the human demyelinating disease, multiple sclerosis. We have previously reported that intraspinal transplantation of mouse NPCs into JHMV-infected animals resulted in selective colonization of demyelinated lesions, preferential differentiation into oligodendroglia accompanied by axonal preservation, and increased remyelination. Cultured NPCs expressed transcripts for S1P receptors S1P1, S1P2, S1P3, S1P4, and S1P5. FTY720 treatment of cultured NPCs resulted in increased mitogen-activated protein kinase phosphorylation and migration after exposure to the chemokine CXCL12. Administration of FTY720 to JHMV-infected mice resulted in enhanced migration and increased proliferation of transplanted NPCs after spinal cord engraftment. FTY720 treatment did not improve clinical disease, diminish neuroinflammation or the severity of demyelination, nor increase remyelination. These findings argue that FTY720 treatment selectively increases NPC proliferation and migration but does not either improve clinical outcome or enhance remyelination after transplantation into animals in which immune-mediated demyelination is initiated by the viral infection of the central nervous system.
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Affiliation(s)
- Caroline A Blanc
- Department of Molecular Biology and Biochemistry, Reeve-Irvine Research Center Irvine School of Medicine, University of California, Irvine, California
| | - Jonathan J Grist
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Hugh Rosen
- Department of Chemical Physiology, The Scripps Research Institute, La Jolla, California
| | - Ilse Sears-Kraxberger
- Departments of Anatomy and Neurobiology and Neurobiology and Behavior, Reeve-Irvine Research Center Irvine School of Medicine, University of California, Irvine, California
| | - Oswald Steward
- Departments of Anatomy and Neurobiology and Neurobiology and Behavior, Reeve-Irvine Research Center Irvine School of Medicine, University of California, Irvine, California
| | - Thomas E Lane
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah.
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154
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Sørensen PS. Ozanimod: a better or just another S1P receptor modulator? Lancet Neurol 2016; 15:345-7. [DOI: 10.1016/s1474-4422(16)00041-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
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155
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Baroncini D, Zaffaroni M, Annovazzi PO, Baldini S, Bianchi A, Minonzio G, Comi G, Ghezzi A. A real world experience with fingolimod in active RRMS patients naïve to second-line agents: a 2 years, intention-to-treat, observational, single center study. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40893-016-0002-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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157
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Guerrero M, Urbano M, Roberts E. Sphingosine 1-phosphate receptor 1 agonists: a patent review (2013-2015). Expert Opin Ther Pat 2016; 26:455-70. [DOI: 10.1517/13543776.2016.1157165] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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158
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Abstract
Immunomodulatory and immunosuppressive treatments for multiple sclerosis (MS) are associated with an increased risk of infection, which makes treatment of this condition challenging in daily clinical practice. Use of the expanding range of available drugs to treat MS requires extensive knowledge of treatment-associated infections, risk-minimizing strategies and approaches to monitoring and treatment of such adverse events. An interdisciplinary approach to evaluate the infectious events associated with available MS treatments has become increasingly relevant. In addition, individual stratification of treatment-related infectious risks is necessary when choosing therapies for patients with MS, as well as during and after therapy. Determination of the individual risk of infection following serial administration of different immunotherapies is also crucial. Here, we review the modes of action of the available MS drugs, and relate this information to the current knowledge of drug-specific infectious risks and risk-minimizing strategies.
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159
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Abstract
Life-threatening and benign drug reactions occur frequently in the skin, affecting 8 % of the general population and 2-3 % of all hospitalized patients, emphasizing the need for physicians to effectively recognize and manage patients with drug-induced eruptions. Neurologic medications represent a vast array of drug classes with cutaneous side effects. Approximately 7 % of the United States (US) adult population is affected by adult-onset neurological disorders, reflecting a large number of patients on neurologic drug therapies. This review elucidates the cutaneous reactions associated with medications approved by the US Food and Drug Administration (FDA) to treat the following neurologic pathologies: Alzheimer disease, amyotrophic lateral sclerosis, epilepsy, Huntington disease, migraine, multiple sclerosis, Parkinson disease, and pseudobulbar affect. A search of the literature was performed using the specific FDA-approved drug or drug classes in combination with the terms 'dermatologic,' 'cutaneous,' 'skin,' or 'rash.' Both PubMed and the Cochrane Database of Systematic Reviews were utilized, with side effects ranging from those cited in randomized controlled trials to case reports. It behooves neurologists, dermatologists, and primary care physicians to be aware of the recorded cutaneous adverse reactions and their severity for proper management and potential need to withdraw the offending medication.
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Affiliation(s)
| | | | - Sylvia Hsu
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph S Kass
- Department of Neurology, Baylor College of Medicine, 7200 Cambridge St., 9th Floor, Houston, TX, 77030, USA.
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160
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Chen B, Roy SG, McMonigle RJ, Keebaugh A, McCracken AN, Selwan E, Fransson R, Fallegger D, Huwiler A, Kleinman MT, Edinger AL, Hanessian S. Azacyclic FTY720 Analogues That Limit Nutrient Transporter Expression but Lack S1P Receptor Activity and Negative Chronotropic Effects Offer a Novel and Effective Strategy to Kill Cancer Cells in Vivo. ACS Chem Biol 2016; 11:409-14. [PMID: 26653336 DOI: 10.1021/acschembio.5b00761] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
FTY720 sequesters lymphocytes in secondary lymphoid organs through effects on sphingosine-1-phosphate (S1P) receptors. However, at higher doses than are required for immunosuppression, FTY720 also functions as an anticancer agent in multiple animal models. Our published work indicates that the anticancer effects of FTY720 do not depend on actions at S1P receptors but instead stem from FTY720s ability to restrict access to extracellular nutrients by down-regulating nutrient transporter proteins. This result was significant because S1P receptor activation is responsible for FTY720s dose-limiting toxicity, bradycardia, that prevents its use in cancer patients. Here, we describe diastereomeric and enantiomeric 3- and 4-C-aryl 2-hydroxymethyl pyrrolidines that are more active than the previously known analogues. Of importance is that these compounds fail to activate S1P1 or S1P3 receptors in vivo but retain inhibitory effects on nutrient transporter proteins and anticancer activity in solid tumor xenograft models. Our studies reaffirm that the anticancer activity of FTY720 does not depend upon S1P receptor activation and uphold the promise of using S1P receptor-inactive azacyclic FTY720 analogues in human cancer patients.
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Affiliation(s)
- Bin Chen
- Department
of Chemistry, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montréal, Quebec H3C 3J7, Canada
| | - Saurabh G. Roy
- Department
of Developmental and Cell Biology, University of California, Irvine, 2128 Natural Sciences 1, California 92697-2300, United States
| | - Ryan J. McMonigle
- Department
of Developmental and Cell Biology, University of California, Irvine, 2128 Natural Sciences 1, California 92697-2300, United States
| | - Andrew Keebaugh
- Community & Environmental Medicine, University of California, Irvine, FRF 100, California 92697-1825, United States
| | - Alison N. McCracken
- Department
of Developmental and Cell Biology, University of California, Irvine, 2128 Natural Sciences 1, California 92697-2300, United States
| | - Elizabeth Selwan
- Department
of Developmental and Cell Biology, University of California, Irvine, 2128 Natural Sciences 1, California 92697-2300, United States
| | - Rebecca Fransson
- Department
of Chemistry, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montréal, Quebec H3C 3J7, Canada
| | - Daniel Fallegger
- Institute
of Pharmacology, University of Bern, Inselspital INO-F, CH-3010 Bern, Switzerland
| | - Andrea Huwiler
- Institute
of Pharmacology, University of Bern, Inselspital INO-F, CH-3010 Bern, Switzerland
| | - Michael T. Kleinman
- Community & Environmental Medicine, University of California, Irvine, FRF 100, California 92697-1825, United States
| | - Aimee L. Edinger
- Department
of Developmental and Cell Biology, University of California, Irvine, 2128 Natural Sciences 1, California 92697-2300, United States
| | - Stephen Hanessian
- Department
of Chemistry, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montréal, Quebec H3C 3J7, Canada
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161
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Cohen JA, Arnold DL, Comi G, Bar-Or A, Gujrathi S, Hartung JP, Cravets M, Olson A, Frohna PA, Selmaj KW. Safety and efficacy of the selective sphingosine 1-phosphate receptor modulator ozanimod in relapsing multiple sclerosis (RADIANCE): a randomised, placebo-controlled, phase 2 trial. Lancet Neurol 2016; 15:373-81. [PMID: 26879276 DOI: 10.1016/s1474-4422(16)00018-1] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/04/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Modulation of sphingosine 1-phosphate (S1P) receptors in a non-selective manner decreases disease activity in patients with multiple sclerosis but has potential safety concerns. We assessed the safety and efficacy of the oral selective S1P receptor modulator ozanimod in patients with relapsing multiple sclerosis. METHODS RADIANCE is a combined phase 2/3 trial. Patients with relapsing multiple sclerosis were recruited from 55 academic and private multiple sclerosis clinics in 13 countries across Europe and the USA. Eligible participants were aged 18-55 years, had an Expanded Disability Status Scale (EDSS) score of 0-5·0, and had either one or more relapses in the previous 12 months, or one or more relapses in the past 24 months and one or more gadolinium-enhancing lesions on MRI in the previous 12 months before screening. Participants were assigned by a computer-generated randomisation sequence in a 1:1:1 ratio to ozanimod (0·5 mg or 1 mg) or matching placebo once daily for 24 weeks by an independent, unmasked, statistical team. Trial participants, study site personnel, MRI assessors, steering committee members, and the study statistician were masked to treatment assignment. To attenuate first-dose cardiac effects, ozanimod was up-titrated from 0·25 mg to 0·5 mg or 1 mg over 8 days. The primary endpoint was the cumulative number of total gadolinium-enhancing MRI lesions measured by an independent MRI analysis centre at weeks 12-24 after treatment initiation. Analysis was by intention to treat. Here, we report results from the 24-week phase 2 trial. This trial is registered with ClinicalTrials.gov, number NCT01628393. The 2-year phase 3 trial is ongoing. FINDINGS The first patient was randomised on Oct 18, 2012, and the final visit of the last randomised patient was on May 11, 2014. The intention-to-treat and safety population consisted of 258 participants, 88 were assigned placebo, 87 ozanimod 0·5 mg, and 83 ozanimod 1 mg; 252 (98%) patients completed the assigned treatment. The mean cumulative number of gadolinium-enhancing lesions at weeks 12-24 was 11·1 (SD 29·9) with placebo compared with 1·5 (3·7) with ozanimod 0·5 mg (odds ratio 0·16, 95% CI 0·08-0·30; p<0·0001) and 1·5 (3·4) with ozanimod 1 mg (odds ratio 0·11, 95% CI 0·06-0·21; p<0·0001). Three serious adverse events unrelated to treatment were reported in patients assigned ozanimod 0·5 mg: optic neuritis, somatoform autonomic dysfunction, and cervical squamous metaplasia (HPV-related). No serious infectious or cardiac adverse events were reported, and no cases of macular oedema arose. The most common adverse events in the ozanimod 0·5 mg and 1 mg groups compared with placebo were nasopharyngitis (11 and five vs 12), headache (five and three vs eight), and urinary-tract infections (six and two vs two). The maximum reduction in mean heart rate by Holter monitoring during the first 6 h in ozanimod-treated participants was less than 2 beats per min (bpm) compared with baseline, with no patient having a minimum hourly heart rate less than 45 bpm. Electrocardiograms and 24-h Holter monitoring showed no increased incidence of atrioventricular block or sinus pause with ozanimod. INTERPRETATION Ozanimod significantly reduced MRI lesion activity in participants with relapsing multiple sclerosis, with a favourable safety profile over a period of 24 weeks. These findings warrant phase 3 trials, which are ongoing. FUNDING Receptos, Inc.
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Affiliation(s)
- Jeffrey A Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Douglas L Arnold
- NeuroRx Research and Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Giancarlo Comi
- San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Neurology, Milan, Italy
| | - Amit Bar-Or
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | | | | | - Matt Cravets
- Receptos Inc, Clinical Development, San Diego, CA, USA
| | - Allan Olson
- Receptos Inc, Clinical Development, San Diego, CA, USA
| | - Paul A Frohna
- Receptos Inc, Clinical Development, San Diego, CA, USA
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162
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Demont EH, Bailey JM, Bit RA, Brown JA, Campbell CA, Deeks N, Dowell SJ, Eldred C, Gaskin P, Gray JRJ, Haynes A, Hirst DJ, Holmes DS, Kumar U, Morse MA, Osborne GJ, Renaux JF, Seal GAL, Smethurst CA, Taylor S, Watson R, Willis R, Witherington J. Discovery of Tetrahydropyrazolopyridine as Sphingosine 1-Phosphate Receptor 3 (S1P3)-Sparing S1P1 Agonists Active at Low Oral Doses. J Med Chem 2016; 59:1003-20. [DOI: 10.1021/acs.jmedchem.5b01512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Emmanuel H. Demont
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - James M. Bailey
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Rino A. Bit
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Jack A. Brown
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Colin A. Campbell
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Nigel Deeks
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Simon J. Dowell
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Colin Eldred
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Pam Gaskin
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - James R. J. Gray
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Andrea Haynes
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - David J. Hirst
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Duncan S. Holmes
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Umesh Kumar
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Mary A. Morse
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Greg J. Osborne
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Jessica F. Renaux
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Gail A. L. Seal
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Chris A. Smethurst
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Simon Taylor
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Robert Watson
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Robert Willis
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
| | - Jason Witherington
- Immuno Inflammation Therapeutic Area Unit, and ‡Platform Technology
and Science, GlaxoSmithKline, Gunnels Wood Road, Stevenage, SG1 2NY, U.K
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163
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Mazzola MA, Raheja R, Murugaiyan G, Rajabi H, Kumar D, Pertel T, Regev K, Griffin R, Aly L, Kivisakk P, Nejad P, Patel B, Gwanyalla N, Hei H, Glanz B, Chitnis T, Weiner HL, Gandhi R. Identification of a novel mechanism of action of fingolimod (FTY720) on human effector T cell function through TCF-1 upregulation. J Neuroinflammation 2015; 12:245. [PMID: 26714756 PMCID: PMC4696082 DOI: 10.1186/s12974-015-0460-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/15/2015] [Indexed: 12/21/2022] Open
Abstract
Background Fingolimod (FTY720), the first oral treatment for multiple sclerosis (MS), blocks immune cell trafficking and prevents disease relapses by downregulation of sphingosine-1-phosphate receptor. We determined the effect of FTY720 on human T cell activation and effector function. Methods T cells from MS patients and healthy controls were isolated to measure gene expression profiles in the presence or absence of FTY720 using nanostring and quantitative real-time polymerase chain reaction (qPCR). Cytokine protein expression was measured using luminex assay and flow cytometry analysis. Lentivirus vector carrying short hairpin RNA (shRNA) was used to knock down the expression of specific genes in CD4+ T cells. Chromatin immunoprecipitation was performed to assess T cell factor 1 (TCF-1) binding to promoter regions. Luciferase assays were performed to test the direct regulation of interferon gamma (IFN-γ) and granzyme B (GZMB) by TCF-1. Western blot analysis was used to assess the phosphorylation status of Akt and GSK3β. Results We showed that FTY720 treatment not only affects T cell trafficking but also T cell activation. Patients treated with FTY720 showed a significant reduction in circulating CD4 T cells. Activation of T cells in presence of FTY720 showed a less inflammatory phenotype with reduced production of IFN-γ and GZMB. This decreased effector phenotype of FTY720-treated T cells was dependent on the upregulation of TCF-1. FTY720-induced TCF-1 downregulated the pathogenic cytokines IFN-γ and GZMB by binding to their promoter/enhancer regions and mediating epigenetic modifications. Furthermore, we observed that TCF-1 expression was lower in T cells from multiple sclerosis patients than in those from healthy individuals, and FTY720 treatment increased TCF-1 expression in multiple sclerosis patients. Conclusions These results reveal a previously unknown mechanism of the effect of FTY720 on human CD4+ T cell modulation in multiple sclerosis and demonstrate the role of TCF-1 in human T cell activation and effector function. Electronic supplementary material The online version of this article (doi:10.1186/s12974-015-0460-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Antonietta Mazzola
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Radhika Raheja
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Gopal Murugaiyan
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Hasan Rajabi
- Dana Farber Cancer Institute, Boston, MA, 02115, USA.
| | - Deepak Kumar
- Department of Biochemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, 02115, USA.
| | - Thomas Pertel
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Keren Regev
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Russell Griffin
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Lilian Aly
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Pia Kivisakk
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Parham Nejad
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Bonny Patel
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Nguendab Gwanyalla
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Hillary Hei
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Bonnie Glanz
- Partners MS Center, Brigham and Women's Hospital, 1 Brookline Place, Brookline, MA, 02445, USA.
| | - Tanuja Chitnis
- Partners MS Center, Brigham and Women's Hospital, 1 Brookline Place, Brookline, MA, 02445, USA.
| | - Howard L Weiner
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA. .,Partners MS Center, Brigham and Women's Hospital, 1 Brookline Place, Brookline, MA, 02445, USA.
| | - Roopali Gandhi
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
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de Bruin NMWJ, Schmitz K, Schiffmann S, Tafferner N, Schmidt M, Jordan H, Häußler A, Tegeder I, Geisslinger G, Parnham MJ. Multiple rodent models and behavioral measures reveal unexpected responses to FTY720 and DMF in experimental autoimmune encephalomyelitis. Behav Brain Res 2015; 300:160-74. [PMID: 26692368 DOI: 10.1016/j.bbr.2015.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/30/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
Experimental autoimmune encephalomyelitis (EAE) is a widely-used rodent model for multiple sclerosis (MS), but a single model can hardly capture all features of MS. We investigated whether behavioral parameters in addition to clinical motor function scores could be used to assess treatment efficacy during score-free intervals in the relapsing-remitting EAE model in SJL/J mice. We studied the effects of the clinical reference compounds FTY720 (fingolimod, 0.5mg/kg/day) and dimethyl fumarate (DMF, 20-30 mg/kg/day) on clinical scores in several rodent EAE models in order to generate efficacy profiles. SJL/J mice with relapsing-remitting EAE were studied using behavioral tests, including rotarod, gait analysis, locomotor activity and grip strength. SJL/J mice were also examined according to Crawley's sociability and preference for social novelty test. Prophylactic treatment with FTY720 prevented clinical scores in three of the four EAE rodent models: Dark Agouti (DA) and Lewis rats and C57BL/6J mice. Neither prophylactic nor late-therapeutic treatment with FTY720 reduced clinical scores or reversed deficits in the rotarod test in SJL/J mice, but we observed effects on motor functions and sociability in the absence of clinical scores. Prophylactic treatment with FTY720 improved the gait of SJL/J mice whereas late-therapeutic treatment improved manifestations of reduced social (re)cognition or preference for social novelty. DMF was tested in three EAE models and did not improve clinical scores at the dose used. These data indicate that improvements in behavioral deficits can occur in absence of clinical scores, which indicate subtle drug effects and may have translational value for human MS.
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Affiliation(s)
- N M W J de Bruin
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany.
| | - K Schmitz
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - S Schiffmann
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - N Tafferner
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - M Schmidt
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - H Jordan
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - A Häußler
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - I Tegeder
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - G Geisslinger
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany; Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - M J Parnham
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
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165
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Gardner LA, Levin MC. Importance of Apolipoprotein A-I in Multiple Sclerosis. Front Pharmacol 2015; 6:278. [PMID: 26635608 PMCID: PMC4654019 DOI: 10.3389/fphar.2015.00278] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/04/2015] [Indexed: 12/12/2022] Open
Abstract
Jean-Martin Charcot has first described multiple sclerosis (MS) as a disease of the central nervous system (CNS) over a century ago. MS remains incurable today, and treatment options are limited to disease modifying drugs. Over the years, significant advances in understanding disease pathology have been made in autoimmune and neurodegenerative components. Despite the fact that brain is the most lipid rich organ in human body, the importance of lipid metabolism has not been extensively studied in this disorder. In MS, the CNS is under attack by a person's own immune system. Autoantigens and autoantibodies are known to cause devastation of myelin through up regulation of T-cells and cytokines, which penetrate through the blood-brain barrier to cause inflammation and myelin destruction. The anti-inflammatory role of high-density lipoproteins (HDLs) has been implicated in a plethora of biological processes: vasodilation, immunity to infection, oxidation, inflammation, and apoptosis. However, it is not known what role HDL plays in neurological function and myelin repair in MS. Understanding of lipid metabolism in the CNS and in the periphery might unveil new therapeutic targets and explain the partial success of some existing MS therapies.
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Affiliation(s)
- Lidia A. Gardner
- Research Service, VA Medical Center, Memphis, TN, USA
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael C. Levin
- Research Service, VA Medical Center, Memphis, TN, USA
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
- Neuroscience Institute, University of Tennessee Health Science Center, Memphis, TN, USA
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166
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Cavone L, Felici R, Lapucci A, Buonvicino D, Pratesi S, Muzzi M, Hakiki B, Maggi L, Peruzzi B, Caporale R, Annunziato F, Amato MP, Chiarugi A. Dysregulation of sphingosine 1 phosphate receptor-1 (S1P1) signaling and regulatory lymphocyte-dependent immunosuppression in a model of post-fingolimod MS rebound. Brain Behav Immun 2015; 50:78-86. [PMID: 26130058 DOI: 10.1016/j.bbi.2015.06.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 10/24/2022] Open
Abstract
Fingolimod affords protection from MS by sequestering lymphocytes in secondary lymphoid organs via down regulation of their sphingosine 1 phosphate receptor (S1P1). Unexpectedly, accumulating evidence indicates that patients who discontinue fingolimod treatment may be at risk of rehearsal of magnetic resonance (MR) and clinical disease activity, sometimes featuring dramatic rebound. We therefore developed in vivo and in vitro models of post-fingolimod MS rebound to unravel its cellular and molecular mechanisms. The impact of fingolimod withdrawal on T regulatory lymphocytes was also investigated by means of cytofluorimetric analysis and antigen-specific lymphocyte proliferation assays. We show that mice with relapsing-remitting experimental autoimmune encephalomyelitis (EAE) undergo extremely severe, chronic disease rebound upon discontinuation of fingolimod. Remarkably, rebound is preceded by a burst of S1P1 overexpression in lymph node-entrapped lymphocytes that correlates with subsequent massive lymphocyte egress and widespread CNS immune infiltration. Also, consistent with the ability of S1P1 to counteract polarization and function of T regulatory lymphocytes their number and suppression of effector T cells is reduced by fingolimod suspension. Data disclose the first pathogenic mechanisms of post-fingolimod rebound that may be targeted for therapeutic intervention.
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Affiliation(s)
- Leonardo Cavone
- Headache Center and Clinical Pharmacology Unit, Department of Health Sciences, Careggi University Hospital, Italy; Pharmacology and Oncology Unit, Department of Health Sciences, University of Florence, Italy.
| | - Roberta Felici
- Pharmacology and Oncology Unit, Department of Health Sciences, University of Florence, Italy
| | - Andrea Lapucci
- Pharmacology and Oncology Unit, Department of Health Sciences, University of Florence, Italy
| | - Daniela Buonvicino
- Pharmacology and Oncology Unit, Department of Health Sciences, University of Florence, Italy
| | - Sara Pratesi
- Department of Experimental and Clinical Medicine and DENOTHE Center, University of Florence, Florence 50134, Italy; Regenerative Medicine Unit of Azienda Ospedaliera Careggi, Italy
| | - Mirko Muzzi
- Pharmacology and Oncology Unit, Department of Health Sciences, University of Florence, Italy
| | - Bahia Hakiki
- Department NEUROFARBA, Section Neurosciences, University of Florence, Italy
| | - Laura Maggi
- Department of Experimental and Clinical Medicine and DENOTHE Center, University of Florence, Florence 50134, Italy; Regenerative Medicine Unit of Azienda Ospedaliera Careggi, Italy
| | - Benedetta Peruzzi
- General Laboratory Unit (Microscopy and Clinical Cytometry Unit), Careggi University Hospital, Italy
| | - Roberto Caporale
- General Laboratory Unit (Microscopy and Clinical Cytometry Unit), Careggi University Hospital, Italy
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine and DENOTHE Center, University of Florence, Florence 50134, Italy; Regenerative Medicine Unit of Azienda Ospedaliera Careggi, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Italy
| | - Alberto Chiarugi
- Headache Center and Clinical Pharmacology Unit, Department of Health Sciences, Careggi University Hospital, Italy; Pharmacology and Oncology Unit, Department of Health Sciences, University of Florence, Italy
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167
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Samuvel DJ, Saxena N, Dhindsa JS, Singh AK, Gill GS, Grobelny DW, Singh I. AKP-11 - A Novel S1P1 Agonist with Favorable Safety Profile Attenuates Experimental Autoimmune Encephalomyelitis in Rat Model of Multiple Sclerosis. PLoS One 2015; 10:e0141781. [PMID: 26513477 PMCID: PMC4626178 DOI: 10.1371/journal.pone.0141781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/13/2015] [Indexed: 12/22/2022] Open
Abstract
Sphingosine-1-phosphate receptor 1 (S1P1) mediated regulation of lymphocyte egress from lymphoid organs is recognized as the mechanism of FTY720 (Fingolimod, Gilenya) efficacy in relapsing-remitting forms of multiple sclerosis (RRMS). In this study we describe a novel S1P1 agonist AKP-11, next generation of S1P1 agonist, with immunomodulatory activities in cell culture model and for therapeutic efficacy against an animal model of MS, i.e. experimental autoimmune encephalomyelitis (EAE) but without the adverse effects observed with FTY720. Like FTY720, AKP-11 bound to S1P1 is internalized and activates intracellular AKT and ERKs cellular signaling pathways. In contrast to FTY720, AKP-11 mediated S1P1 downregulation is independent of sphingosine kinase activity indicating it to be a direct agonist of S1P1. The S1P1 loss and inhibition of lymphocyte egress by FTY720 leads to lymphopenia. In comparison with FTY720, oral administration of AKP-11 caused milder and reversible lymphopenia while providing a similar degree of therapeutic efficacy in the EAE animal model. Consistent with the observed reversible lymphopenia with AKP-11, the S1P1 recycled back to cell membrane in AKP-11 treated cells following its withdrawal, but not with withdrawal of FTY720. Accordingly, a smaller degree of ubiquitination and proteolysis of S1P1 was observed in AKP-11 treated cells as compared to FTY720. Consistent with previous observations, FTY720 treatment is associated with adverse effects of bradycardia and lung vascular leaks in rodents, whereas AKP-11 treatment had undetectable effects on bradycardia and reduced lung vascular leaks as compared to FTY720. Taken together, the data documents that AKP-11 treatment cause milder and reversible lymphopenia with milder adverse effects while maintaining therapeutic efficacy similar to that observed with FTY720, thus indicating therapeutic potential of AKP-11 for treatment of MS and related autoimmune disorders.
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Affiliation(s)
- Devadoss J. Samuvel
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Nishant Saxena
- Charles P. Darby Children’s Research Institute, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Jasdeep S. Dhindsa
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Avtar K. Singh
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Gurmit S. Gill
- Akaal Pharma Pty Ltd., 310E Thomas Cherry Building, Bundoora, Australia
| | | | - Inderjit Singh
- Charles P. Darby Children’s Research Institute, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States of America
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
- * E-mail:
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168
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Exogenous S1P Exposure Potentiates Ischemic Stroke Damage That Is Reduced Possibly by Inhibiting S1P Receptor Signaling. Mediators Inflamm 2015; 2015:492659. [PMID: 26576074 PMCID: PMC4630407 DOI: 10.1155/2015/492659] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/18/2015] [Accepted: 09/28/2015] [Indexed: 01/31/2023] Open
Abstract
Initial and recurrent stroke produces central nervous system (CNS) damage, involving neuroinflammation. Receptor-mediated S1P signaling can influence neuroinflammation and has been implicated in cerebral ischemia through effects on the immune system. However, S1P-mediated events also occur within the brain itself where its roles during stroke have been less well studied. Here we investigated the involvement of S1P signaling in initial and recurrent stroke by using a transient middle cerebral artery occlusion/reperfusion (M/R) model combined with analyses of S1P signaling. Gene expression for S1P receptors and involved enzymes was altered during M/R, supporting changes in S1P signaling. Direct S1P microinjection into the normal CNS induced neuroglial activation, implicating S1P-initiated neuroinflammatory responses that resembled CNS changes seen during initial M/R challenge. Moreover, S1P microinjection combined with M/R potentiated brain damage, approximating a model for recurrent stroke dependent on S1P and suggesting that reduction in S1P signaling could ameliorate stroke damage. Delivery of FTY720 that removes S1P signaling with chronic exposure reduced damage in both initial and S1P-potentiated M/R-challenged brain, while reducing stroke markers like TNF-α. These results implicate direct S1P CNS signaling in the etiology of initial and recurrent stroke that can be therapeutically accessed by S1P modulators acting within the brain.
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169
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Yazdi A, Baharvand H, Javan M. Enhanced remyelination following lysolecithin-induced demyelination in mice under treatment with fingolimod (FTY720). Neuroscience 2015; 311:34-44. [PMID: 26475743 DOI: 10.1016/j.neuroscience.2015.10.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 01/24/2023]
Abstract
Multiple sclerosis (MS) is a chronic, progressive demyelinating disorder which affects the central nervous system (CNS) and is recognized as the major cause of nervous system disability in young adults. Enhancing myelin repair by stimulating endogenous progenitors is a main goal in efforts for MS treatment. Fingolimod (FTY720) which is administrated as an oral medicine for relapsing-remitting MS has direct effects on neural cells. In this study, we hypothesized if daily treatment with FTY720 enhances endogenous myelin repair in a model of local demyelination induced by lysolecithin (LPC). We examined the response of inflammatory cells as well as resident OPCs and evaluated the number of newly produced myelinating cells in animals which were under daily treatment with FTY720. FTY720 at doses 0.3 and 1mg/kg decreased the inflammation score at the site of LPC injection and decreased the extent of demyelination. FTY720 especially at the lower dose increased the number of remyelinated axons and newly produced myelinating cells. These data indicate that repetitive treatment with FTY720, behind an anti-inflammatory effect, exerts beneficial effects on the process of endogenous repair of demyelinating insults.
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Affiliation(s)
- A Yazdi
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - H Baharvand
- Department of Stem Cells and Developmental Biology at Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran; Department of Developmental Biology, University of Science and Culture, ACECR, Tehran, Iran
| | - M Javan
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Department of Stem Cells and Developmental Biology at Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
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170
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Subei AM, Ontaneda D. Risk Mitigation Strategies for Adverse Reactions Associated with the Disease-Modifying Drugs in Multiple Sclerosis. CNS Drugs 2015; 29:759-71. [PMID: 26407624 PMCID: PMC4621807 DOI: 10.1007/s40263-015-0277-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Over the past several years, the number of disease-modifying therapies (DMTs) for the treatment of multiple sclerosis (MS) has doubled in number. The 13 approved agents have shown a wide range of efficacy and safety in their clinical trials and post-marketing experience. While the availability of the newer agents allows for a wider selection of therapy for clinicians and patients, there is a need for careful understanding of the benefits and risks of each agent. Several factors such as the medication efficacy, side-effect profile, patient's preference, and co-morbidities need to be considered. An individualized treatment approach is thus imperative. In this review, risk stratification and mitigation strategies of the various disease-modifying agents are discussed.
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Affiliation(s)
- Adnan M Subei
- Mellen Center for MS Treatment and Research, Cleveland Clinic Foundation, 9500 Euclid Avenue/U10, Cleveland, OH, 44195, USA.
| | - Daniel Ontaneda
- Mellen Center for MS Treatment and Research, Cleveland Clinic Foundation, 9500 Euclid Avenue/U10, Cleveland, OH, 44195, USA.
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171
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Abstract
Approaches for the effective management of acute stroke are sparse, and many measures for brain protection fail. However, our ability to modulate the immune system and modify the progression of multiple sclerosis is increasing. As a result, immune interventions are currently being explored as therapeutic interventions in acute stroke. In this Review, we compare the immunological features of acute stroke with those of multiple sclerosis, identify unique immunological features of stroke, and consider the evidence for immune interventions. In patients with acute stroke, microglial activation and cell death products trigger an inflammatory cascade that damages vessels and the parenchyma within minutes to hours of the ischaemia or haemorrhage. Immune interventions that restrict brain inflammation, vascular permeability and tissue oedema must be administered rapidly to reduce acute immune-mediated destruction and to avoid subsequent immunosuppression. Preliminary results suggest that the use of drugs that modify disease in multiple sclerosis might accomplish these goals in ischaemic and haemorrhagic stroke. Further elucidation of the immune mechanisms involved in stroke is likely to lead to successful immune interventions.
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Affiliation(s)
- Ying Fu
- Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China (Y.F., Q.L., F.-D.S.); Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 525 East 68th Street, PO Box 117, New York, NY 10065, USA. (J.A.)
| | - Qiang Liu
- Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China (Y.F., Q.L., F.-D.S.); Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 525 East 68th Street, PO Box 117, New York, NY 10065, USA. (J.A.)
| | - Josef Anrather
- Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China (Y.F., Q.L., F.-D.S.); Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 525 East 68th Street, PO Box 117, New York, NY 10065, USA. (J.A.)
| | - Fu-Dong Shi
- Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China (Y.F., Q.L., F.-D.S.); Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, 525 East 68th Street, PO Box 117, New York, NY 10065, USA. (J.A.)
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172
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Huang D. Disseminated cryptococcosis in a patient with multiple sclerosis treated with fingolimod. Neurology 2015; 85:1001-3. [PMID: 26291283 DOI: 10.1212/wnl.0000000000001929] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/12/2015] [Indexed: 01/20/2023] Open
Affiliation(s)
- DeRen Huang
- From the Multiple Sclerosis Center, Neurology and Neuroscience Associates, Unity Health Network, Akron, OH.
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173
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Winkelmann A, Löbermann M, Reisinger EC, Hartung HP, Zettl UK. [Immunotherapy and infectious issues in multiple sclerosis. Self-injectable and oral drugs for immunotherapy]. DER NERVENARZT 2015; 86:960-970. [PMID: 26187544 DOI: 10.1007/s00115-015-4369-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Immunotherapy is generally associated with an increased risk for the development of infections. Due to the continuously expanding spectrum of new and potent immunotherapy treatment options for multiple sclerosis (MS), this article describes the currently known risks for treatment-related infections and the current recommendations for prevention of corresponding problems with drugs used in treatment strategies for MS and their mechanisms of action. The new treatment options in particular are linked to specific and severe infections; therefore, intensive and long-lasting monitoring is required before, during and after treatment and multidisciplinary surveillance of patients is needed. This article gives a detailed review of drug-specific red flags and current recommendations for the prophylaxis of infections associated with treatment of relapsing-remitting MS and when using self-injectable and oral disease-modifying immunotherapeutic drugs.
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Affiliation(s)
- A Winkelmann
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Deutschland,
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174
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Zhu Z, Fu Y, Tian D, Sun N, Han W, Chang G, Dong Y, Xu X, Liu Q, Huang D, Shi FD. Combination of the Immune Modulator Fingolimod With Alteplase in Acute Ischemic Stroke: A Pilot Trial. Circulation 2015. [PMID: 26202811 DOI: 10.1161/circulationaha.115.016371] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inflammatory and immune responses triggered by brain ischemia worsen clinical outcomes of stroke and contribute to hemorrhagic transformation, massive edema, and reperfusion injury associated with intravenous alteplase. We assessed whether a combination of the immune-modulator fingolimod and alteplase is safe and effective in attenuating reperfusion injury in patients with acute ischemic stroke treated within the first 4.5 hours of symptom onset. METHODS AND RESULTS In this multicenter trial, we randomly assigned 25 eligible patients with hemispheric ischemic stroke stemming from anterior or middle cerebral arterial occlusion to receive alteplase alone and 22 patients to receive alteplase plus oral fingolimod 0.5 mg daily for 3 consecutive days within 4.5 hours of the onset of ischemic stroke. Compared with patients who received alteplase alone, patients who received the combination of fingolimod with alteplase exhibited lower circulating lymphocytes, smaller lesion volumes (10.1 versus 34.3 mL; P=0.04), less hemorrhage (1.2 versus 4.4 mL; P=0.01), and attenuated neurological deficits in National Institute of Health Stroke Scales (4 versus 2; P=0.02) at day 1. Furthermore, restrained lesion growth from day 1 to 7 (-2.3 versus 12.1 mL; P<0.01) with a better recovery at day 90 (modified Rankin Scale score 0-1, 73% versus 32%; P<0.01) was evident in patients given fingolimod and alteplase. No serious adverse events were recorded in all patients. CONCLUSIONS In this pilot study, combination therapy of fingolimod and alteplase was well tolerated, attenuated reperfusion injury, and improved clinical outcomes in patients with acute ischemic stroke. These findings need to be tested in further clinical trials. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02002390.
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Affiliation(s)
- Zilong Zhu
- Departments of Neurology, Immunology, Radiology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.,Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
| | - Ying Fu
- Departments of Neurology, Immunology, Radiology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Decai Tian
- Departments of Neurology, Immunology, Radiology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Na Sun
- Departments of Neurology, Immunology, Radiology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Han
- Departments of Neurology, Immunology, Radiology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Guoqiang Chang
- Departments of Neurology, Immunology, Radiology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Yinhua Dong
- Department of Neurology, Tianjin Forth Central Hospital, Tianjin, China
| | - Xiaolin Xu
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Qiang Liu
- Departments of Neurology, Immunology, Radiology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.,Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
| | - Deren Huang
- Neurology and Neuroscience Associates, Unity Health Network, Akron, OH
| | - Fu-Dong Shi
- Departments of Neurology, Immunology, Radiology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.,Department of Neurology, Tianjin HuanHu Hospital, Tianjin, China
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175
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Spampinato SF, Obermeier B, Cotleur A, Love A, Takeshita Y, Sano Y, Kanda T, Ransohoff RM. Sphingosine 1 Phosphate at the Blood Brain Barrier: Can the Modulation of S1P Receptor 1 Influence the Response of Endothelial Cells and Astrocytes to Inflammatory Stimuli? PLoS One 2015. [PMID: 26197437 PMCID: PMC4511229 DOI: 10.1371/journal.pone.0133392] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The ability of the Blood Brain Barrier (BBB) to maintain proper barrier functions, keeping an optimal environment for central nervous system (CNS) activity and regulating leukocytes’ access, can be affected in CNS diseases. Endothelial cells and astrocytes are the principal BBB cellular constituents and their interaction is essential to maintain its function. Both endothelial cells and astrocytes express the receptors for the bioactive sphingolipid S1P. Fingolimod, an immune modulatory drug whose structure is similar to S1P, has been approved for treatment in multiple sclerosis (MS): fingolimod reduces the rate of MS relapses by preventing leukocyte egress from the lymph nodes. Here, we examined the ability of S1P and fingolimod to act on the BBB, using an in vitro co-culture model that allowed us to investigate the effects of S1P on endothelial cells, astrocytes, and interactions between the two. Acting selectively on endothelial cells, S1P receptor signaling reduced cell death induced by inflammatory cytokines. When acting on astrocytes, fingolimod treatment induced the release of a factor, granulocyte macrophage colony-stimulating factor (GM-CSF) that reduced the effects of cytokines on endothelium. In an in vitro BBB model incorporating shear stress, S1P receptor modulation reduced leukocyte migration across the endothelial barrier, indicating a novel mechanism that might contribute to fingolimod efficacy in MS treatment.
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Affiliation(s)
- Simona F. Spampinato
- Neuroinflammation Research Center, Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Birgit Obermeier
- Neuroinflammation Research Center, Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Anne Cotleur
- Neuroinflammation Research Center, Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Anna Love
- Neuroinflammation Research Center, Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Yukio Takeshita
- Neuroinflammation Research Center, Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Yasuteru Sano
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Richard M. Ransohoff
- Neuroinflammation Research Center, Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
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176
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Mayor Ibarguren A, Gómez Fernández C, Tallón Barranco A, Fernández Fournier M, González Ramos J, Romero Gómez MP, Herranz Pinto P. Herpes zoster: a potential risk associated with fingolimod treatment. Int J Dermatol 2015; 54:e373-5. [PMID: 26173466 DOI: 10.1111/ijd.12878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 09/22/2014] [Accepted: 09/25/2014] [Indexed: 11/30/2022]
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177
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Tomohiko U, Mori M, Akiyuki U, Masuda S, Mutho M, Masuda H, Kuwabara S. Change in vital signs after fingolimod initiation in patients with multiple sclerosis: the possible need for 24 h monitoring. Br J Clin Pharmacol 2015; 80:607-8. [PMID: 26077133 DOI: 10.1111/bcp.12697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 06/04/2015] [Accepted: 06/08/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Uchida Tomohiko
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Masahiro Mori
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Uzawa Akiyuki
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Saeko Masuda
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Mayumi Mutho
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hiroki Masuda
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
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178
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Abstract
Sphingosine 1-phosphate (S1P) receptor modulators possess a unique mechanism of action as disease-modifying therapy for multiple sclerosis (MS). Subtype 1 S1P receptors are expressed on the surfaces of lymphocytes and are important in regulating egression from lymph nodes. The S1P receptor modulators indirectly antagonize the receptor's function and sequester lymphocytes in lymph nodes. Fingolimod was the first S1P agent approved in the USA in 2010 for relapsing MS after two phase III trials (FREEDOMS and TRANSFORMS) demonstrated potent efficacy, and good safety and tolerability. Post-marketing experience, as well as a third phase III trial (FREEDOMS II), also showed favorable results. More selective S1P receptor agents-ponesimod (ACT128800), siponimod (BAF312), ozanimod (RPC1063), ceralifimod (ONO-4641), GSK2018682, and MT-1303-are still in relatively early stages of development, but phase I and II trials showed promising efficacy and safety. However, these observations have yet to be reproduced in phase III clinical trials.
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Affiliation(s)
- Adnan M. Subei
- Mellen Center for MS Treatment and Research, Cleveland Clinic Foundation, 9500 Euclid Avenue/U10, Cleveland, OH 44195, Phone: 216-445-8110, Fax: 216-445-7013
| | - Jeffrey A. Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic Foundation, 9500 Euclid Avenue/U10, Cleveland, OH 44195, Phone: 216-445-8110, Fax: 216-445-7013
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179
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Prager B, Spampinato SF, Ransohoff RM. Sphingosine 1-phosphate signaling at the blood–brain barrier. Trends Mol Med 2015; 21:354-63. [DOI: 10.1016/j.molmed.2015.03.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/24/2015] [Accepted: 03/27/2015] [Indexed: 12/20/2022]
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180
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Krösser S, Wolna P, Fischer TZ, Boschert U, Stoltz R, Zhou M, Darpo B. Effect of ceralifimod (ONO-4641) on lymphocytes and cardiac function: Randomized, double-blind, placebo-controlled trial with an open-label fingolimod arm. J Clin Pharmacol 2015; 55:1051-60. [PMID: 25855155 DOI: 10.1002/jcph.513] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 12/12/2022]
Abstract
This randomized, double-blind, placebo-controlled, 6-arm, parallel-design study investigated cardiac and hematological pharmacodynamic effects of ceralifimod (ONO-4641), a selective sphingosine-1-phosphate (S1P) receptor modulator, over a broad dose range in direct comparison with the nonselective S1P modulator fingolimod. Healthy subjects were assigned to ceralifimod (0.01, 0.025, 0.05, or 0.10 mg), fingolimod (0.5 mg), or placebo once daily for 14 days (n = 24 per group). After 14 days of treatment, mean absolute lymphocyte count percentage change from baseline was greatest in the fingolimod (-62%) and ceralifimod 0.10 mg (-56%) groups. On treatment cessation, lymphocyte recovery was faster in the ceralifimod versus the fingolimod group. Ceralifimod showed dose- and concentration-dependent chronotropic effect. Cardiac effects in the fingolimod group were dependent on fingolimod-P concentrations. Maximum mean heart rate (HR) effect on day 1 was larger with fingolimod (placebo-adjusted change from time-matched baseline HR [ΔΔHR], -14.9 beats per minute [bpm]) versus ceralifimod (ΔΔHR, -6.2 and -12.0 bpm for the 0.05- and 0.10-mg doses, respectively). Ceralifimod's effect on the PR interval was minor. Safety biomarker results suggest that potential therapeutic doses of ceralifimod, in particular the 0.05-mg dose, might result in reduced occurrence of bradycardia, atrioventricular block absolute lymphocyte count and grade 3/4 lymphopenia compared with fingolimod 0.5 mg.
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Affiliation(s)
| | | | | | | | | | | | - Borje Darpo
- iCardiac Technologies, Rochester, NY, USA.,Karolinska Institute, Department of Clinical Sciences, Danderyd's Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
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181
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Fox RJ. Disability progression in relapsing MS is more than just lesions: The lesson of fingolimod. Mult Scler 2015; 21:843-4. [PMID: 25948627 DOI: 10.1177/1352458515584813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Robert J Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, USA
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182
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Fujiwara M, Anstadt EJ, Khanna KM, Clark RB. Cbl-b-deficient mice express alterations in trafficking-related molecules but retain sensitivity to the multiple sclerosis therapeutic agent, FTY720. Clin Immunol 2015; 158:103-13. [PMID: 25829233 PMCID: PMC4420730 DOI: 10.1016/j.clim.2015.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/08/2015] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Abstract
The variable response to therapy in multiple sclerosis (MS) suggests a need for personalized approaches based on individual genetic differences. GWAS have linked CBLB gene polymorphisms with MS and recent evidence demonstrated that these polymorphisms can be associated with abnormalities in T cell function and response to interferon-β therapy. Cbl-b is an E3 ubiquitin ligase that regulates T cell activation and Cbl-b-deficient (Cbl-b(-/-)) mice show T cell abnormalities described in MS patients. We now show that Cbl-b(-/-) T cells demonstrate significant lymph node trafficking abnormalities. We thus asked whether the MS-approved drug, FTY720, postulated to trap T cells in lymphoid tissues, is less effective in the context of Cbl-b dysfunction. We now report that FTY720 significantly inhibits EAE in Cbl-b(-/-) mice. Our results newly document a role for Cbl-b in T cell trafficking but suggest nevertheless that MS patients with Cbl-b abnormalities may still be excellent candidates for FTY720 treatment.
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Affiliation(s)
- Mai Fujiwara
- Department of Immunology, University of Connecticut Health Center, Farmington, CT 06032, USA
| | - Emily J Anstadt
- Department of Immunology, University of Connecticut Health Center, Farmington, CT 06032, USA
| | - Kamal M Khanna
- Department of Immunology, University of Connecticut Health Center, Farmington, CT 06032, USA
| | - Robert B Clark
- Department of Immunology, University of Connecticut Health Center, Farmington, CT 06032, USA; Department of Medicine, University of Connecticut Health Center, Farmington, CT 06032, USA.
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183
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Klineova S, Mitiku N, Miller AE. Disease-modifying therapy for multiple sclerosis. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.15.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Remarkable expansion of new diagnostic criteria and disease-modifying treatments for multiple sclerosis has occurred in the last two decades. Revision of diagnostic criteria and characterization of disease course has allowed earlier diagnosis and better characterization of individual patients. With the current treatment armamentarium in the USA offering 11 agents, patients can now benefit from increasingly individualized therapy. The therapeutic decision-making process has become more complex, with the availability of multiple medications. Relative efficacy, potentially severe adverse events, tolerability issues and patient's preferences must now all be considered so that increasingly disease management more frequently involves physicians with multiple sclerosis subspecialty expertise. This article aims to provide a clinically oriented and concise review of currently available, as well as emerging, disease-modifying treatment therapies in multiple sclerosis.
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Affiliation(s)
- Sylvia Klineova
- The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Suite 1138, New York, NY 10029, USA
| | - Nesanet Mitiku
- The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Suite 1138, New York, NY 10029, USA
| | - Aaron E Miller
- The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Suite 1138, New York, NY 10029, USA
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184
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Mirendil H, Thomas EA, De Loera C, Okada K, Inomata Y, Chun J. LPA signaling initiates schizophrenia-like brain and behavioral changes in a mouse model of prenatal brain hemorrhage. Transl Psychiatry 2015; 5:e541. [PMID: 25849980 PMCID: PMC4462599 DOI: 10.1038/tp.2015.33] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/15/2015] [Accepted: 02/09/2015] [Indexed: 12/13/2022] Open
Abstract
Genetic, environmental and neurodevelopmental factors are thought to underlie the onset of neuropsychiatric disorders such as schizophrenia. How these risk factors collectively contribute to pathology is unclear. Here, we present a mouse model of prenatal intracerebral hemorrhage--an identified risk factor for schizophrenia--using a serum-exposure paradigm. This model exhibits behavioral, neurochemical and schizophrenia-related gene expression alterations in adult females. Behavioral alterations in amphetamine-induced locomotion, prepulse inhibition, thigmotaxis and social interaction--in addition to increases in tyrosine hydroxylase-positive dopaminergic cells in the substantia nigra and ventral tegmental area and decreases in parvalbumin-positive cells in the prefrontal cortex--were induced upon prenatal serum exposure. Lysophosphatidic acid (LPA), a lipid component of serum, was identified as a key molecular initiator of schizophrenia-like sequelae induced by serum. Prenatal exposure to LPA alone phenocopied many of the schizophrenia-like alterations seen in the serum model, whereas pretreatment with an antagonist against the LPA receptor subtype LPA1 prevented many of the behavioral and neurochemical alterations. In addition, both prenatal serum and LPA exposure altered the expression of many genes and pathways related to schizophrenia, including the expression of Grin2b, Slc17a7 and Grid1. These findings demonstrate that aberrant LPA receptor signaling associated with fetal brain hemorrhage may contribute to the development of some neuropsychiatric disorders.
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Affiliation(s)
- H Mirendil
- Department of Molecular and Cellular Neuroscience, Dorris Neuroscience Center, The Scripps Research Institute, La Jolla, CA, USA
| | - E A Thomas
- Department of Molecular and Cellular Neuroscience, Dorris Neuroscience Center, The Scripps Research Institute, La Jolla, CA, USA
| | - C De Loera
- Department of Molecular and Cellular Neuroscience, Dorris Neuroscience Center, The Scripps Research Institute, La Jolla, CA, USA
| | - K Okada
- Advanced Medical Research Laboratories, Research Division, Mitsubishi Tanabe Pharma Corporation, Toda-shi, Saitama, Japan
| | - Y Inomata
- Pharmacology Research Laboratories I, Research Division, Mitsubishi Tanabe Pharma Corporation, Yokohama, Japan
| | - J Chun
- Department of Molecular and Cellular Neuroscience, Dorris Neuroscience Center, The Scripps Research Institute, La Jolla, CA, USA
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185
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Aguiar C, Batista S, Pacheco R. Cardiovascular effects of fingolimod: Relevance, detection and approach. Rev Port Cardiol 2015; 34:279-85. [PMID: 25843307 DOI: 10.1016/j.repc.2014.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 11/15/2014] [Indexed: 01/10/2023] Open
Abstract
Fingolimod, a structural analogue of sphingosine, is the first oral treatment available for multiple sclerosis. The presence of sphingosine-1-phosphate receptors in the sinus and atrioventricular nodes, myocardial cells, endothelial cells and arterial smooth muscle cells is responsible for fingolimod's cardiovascular effects. We provide a comprehensive review of the mechanisms of these effects and characterize their clinical relevance.
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Affiliation(s)
- Carlos Aguiar
- Cardiology Department, Hospital Santa Cruz, CHLO, Carnaxide, Portugal.
| | - Sónia Batista
- Multiple Sclerosis Outpatient Clinic, Coimbra University, Coimbra, Portugal
| | - Ricardo Pacheco
- Medical Department, Novartis Farma S.A., Porto Salvo, Portugal
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186
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Aguiar C, Batista S, Pacheco R. Cardiovascular effects of fingolimod: Relevance, detection and approach. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2014.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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187
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Fingolimod treatment promotes proliferation and differentiation of oligodendrocyte progenitor cells in mice with experimental autoimmune encephalomyelitis. Neurobiol Dis 2015; 76:57-66. [DOI: 10.1016/j.nbd.2015.01.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/24/2014] [Accepted: 01/29/2015] [Indexed: 12/12/2022] Open
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188
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Smith CJ, Denes A, Tyrrell PJ, Di Napoli M. Phase II anti-inflammatory and immune-modulating drugs for acute ischaemic stroke. Expert Opin Investig Drugs 2015; 24:623-43. [PMID: 25727670 DOI: 10.1517/13543784.2015.1020110] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Stroke is the second leading cause of death worldwide and the leading cause of adult neurological disability. Despite advances in stroke unit care, and increasing use of thrombolysis, there remains an urgent need for safe and effective treatments for acute ischaemic stroke. However, this is against a backdrop of multiple failures in translational drug development. Cerebral ischaemia initiates a complex cascade of immune and inflammatory pathways in the brain microvasculature and periphery, which contribute to the evolution of cerebral injury, resolution and repair. Targeting specific inflammatory or immune pathways, therefore, represents an attractive treatment strategy in acute ischaemic stroke. Although anti-inflammatory drugs have already failed in clinical trial development, several are currently at the Phase II developmental stage. AREAS COVERED The authors highlight several candidate drugs, which modulate a range of inflammatory and immune pathways, and have been investigated in pre-clinical and Phase II studies to date. EXPERT OPINION Drugs targeting inflammatory and immune pathways offer theoretical advantages including potentially longer therapeutic time windows and effects complementary to thrombolysis (ameliorating reperfusion injury). Fundamental changes in the approach to pre-clinical and clinical drug development are required to facilitate successful translation of promising candidate drugs into clinical practice.
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Affiliation(s)
- Craig J Smith
- Greater Manchester Comprehensive Stroke Centre, Department of Medical Neurosciences, Salford Royal Foundation Trust , Salford , UK
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189
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Abstract
The interface of multiple sclerosis (MS) and infection occurs on several levels. First, infectious disease has been postulated as a potential trigger, if not cause, of MS. Second, exacerbation of MS has been well-documented as a consequence of infection, and, lastly, infectious diseases have been recognized as a complication of the therapies currently employed in the treatment of MS. MS is a disease in which immune dysregulation is a key component. Examination of central nervous system (CNS) tissue of people affected by MS demonstrates immune cell infiltration, activation and inflammation. Therapies that alter the immune response have demonstrated efficacy in reducing relapse rates and evidence of brain inflammation on magnetic resonance imaging (MRI). Despite the altered immune response in MS, there is a lack of evidence that these patients are at increased risk of infectious disease in the absence of treatment or debility. Links between infections and disease-modifying therapies (DMTs) used in MS will be discussed in this review, as well as estimates of occurrence and ways to potentially minimize these risks. We address infection in MS in a comprehensive fashion, including (1) the impact of infections on relapse rates in patients with MS; (2) a review of available infection data from pivotal trials and postmarketing studies for the approved and experimental DMTs, including frequency, types and severity of infections; and (3) relevant risk minimization strategies, particularly as they pertain to progressive multifocal leukoencephalopathy (PML).
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190
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Srinivasan M, Lahiri DK. Significance of NF-κB as a pivotal therapeutic target in the neurodegenerative pathologies of Alzheimer's disease and multiple sclerosis. Expert Opin Ther Targets 2015; 19:471-87. [PMID: 25652642 DOI: 10.1517/14728222.2014.989834] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Advances in molecular pathogenesis suggest that the chronic inflammation is a shared mechanism in the initiation and progression of multiple neurodegenerative diseases with diverse clinical manifestations such as Alzheimer's disease (AD) and Multiple sclerosis (MS). Restricted cell renewal and regenerative capacity make the neural tissues extremely vulnerable to the uncontrolled inflammatory process leading to irreversible tissue damage. AREAS COVERED A predominant consequence of increased inflammatory signaling is the upregulation of the transcription factor, NF-κB with subsequent neuroprotective or deleterious effects depending on the strength of the signal and the type of NF-κB dimers activated. We discuss the interplay between neuroinflammation and neurodegeneration keeping in focus NF-κB signaling as the point of convergence of multiple pathways associated with the development of the neurodegenerative pathologies, AD and MS. EXPERT OPINION Considerable interest exists in developing efficient NF-κB inhibitors for neurodegenerative diseases. The review includes an overview of natural compounds and rationally designed agents that inhibit NF-κB and mediate neuroprotection in AD and MS. The key chemical moieties of the natural and the synthetic compounds provide efficient leads for the development of effective small molecule inhibitors that selectively target NF-κB activation; this would result in the desired benefit to risk therapeutic effects.
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Affiliation(s)
- Mythily Srinivasan
- Indiana University School of Dentistry, Oral Pathology, Radiology and Medicine , Indianapolis, IN , USA +1 317 278 9686 ; +1 317 278 3018 ;
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Ward MD, Jones DE, Goldman MD. Overview and safety of fingolimod hydrochloride use in patients with multiple sclerosis. Expert Opin Drug Saf 2015; 13:989-98. [PMID: 24935480 DOI: 10.1517/14740338.2014.920820] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Fingolimod (Gilenya®, FTY720) is an oral sphingosine-1-phosphate analogue that was approved by the FDA in 2010 for the treatment of relapsing forms of multiple sclerosis (MS). Fingolimod's mechanism of action is primarily related to lymphocyte sequestration in primary and secondary lymphoid tissues. Phase III trials demonstrated a reduction in annualized relapse rate and MRI progression in fingolimod-treated subjects compared with both placebo and IFN-β-treated subjects. Frequent adverse effects include fatigue, gastrointestinal disturbance, headache and upper respiratory tract infection. More serious, but rare, adverse events associated with fingolimod include atrioventricular block, symptomatic bradycardia, herpetic viral infections and macular edema. AREAS COVERED We discuss the mechanism of action, pharmacokinetics, clinical efficacy and safety profile of fingolimod in patients with relapsing MS. EXPERT OPINION Fingolimod is an effective treatment for relapsing MS and its oral route of administration may be preferred by some. Fingolimod is generally well tolerated but requires diligence in patient selection and monitoring. Additional information is needed regarding risk of infection, malignancy and rebound disease with long-term use of fingolimod.
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Affiliation(s)
- Melanie D Ward
- University of Virginia, Department of Neurology , PO Box 800394, Charlottesville, VA 22908 , USA
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192
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Signoriello E, Sagliocchi A, Fratta M, Lus G. Fingolimod efficacy in multiple sclerosis associated with Sjogren syndrome. Acta Neurol Scand 2015; 131:140-3. [PMID: 25622658 DOI: 10.1111/ane.12357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sjogren syndrome (SS) is a common autoimmune disease characterized by lymphocytic infiltration of the exocrine glands with neurological involvement in about 20% of patients. The neurological manifestations in the central nervous system CNS may vary and include a multiple sclerosis (MS)-like disease, and the treatments with immunosuppressive drugs have been undertaken. CASE PRESENTATION We describe a case of 40-year-old woman with clinical and instrumental evidence of an MS characterized by numerous relapses and demyelinating lesions prevailing in the infratentorial and spinal cord. Immunological analysis showed biological data that were consistent with an SS. The treatment with fingolimod showed not only an optimal response to the demyelinating events but also biological parameters. CONCLUSION These data allow us to hypothesize possible combined efficacy of treatment with fingolimod in SS associated with definite MS.
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Affiliation(s)
- E. Signoriello
- Multiple Sclerosis Center; II Division of Neurology; Department of Clinical and Experimental Medicine; Second University of Naples; Naples Italy
| | - A. Sagliocchi
- Multiple Sclerosis Center; II Division of Neurology; Department of Clinical and Experimental Medicine; Second University of Naples; Naples Italy
| | - M. Fratta
- Multiple Sclerosis Center; II Division of Neurology; Department of Clinical and Experimental Medicine; Second University of Naples; Naples Italy
| | - G. Lus
- Multiple Sclerosis Center; II Division of Neurology; Department of Clinical and Experimental Medicine; Second University of Naples; Naples Italy
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193
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Airas L, Dickens AM, Elo P, Marjamäki P, Johansson J, Eskola O, Jones PA, Trigg W, Solin O, Haaparanta-Solin M, Anthony DC, Rinne J. In Vivo PET Imaging Demonstrates Diminished Microglial Activation After Fingolimod Treatment in an Animal Model of Multiple Sclerosis. J Nucl Med 2015; 56:305-10. [DOI: 10.2967/jnumed.114.149955] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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194
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Kim W, Zandoná ME, Kim SH, Kim HJ. Oral disease-modifying therapies for multiple sclerosis. J Clin Neurol 2015; 11:9-19. [PMID: 25628732 PMCID: PMC4302185 DOI: 10.3988/jcn.2015.11.1.9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 08/31/2014] [Accepted: 09/01/2014] [Indexed: 12/31/2022] Open
Abstract
Classical multiple sclerosis (MS) treatments using first-line injectable drugs, although widely applied, remain a major concern in terms of therapeutic adherence and efficacy. New oral drugs recently approved for MS treatment represent significant advances in therapy. The oral route of administration clearly promotes patient satisfaction and increases therapeutic compliance. However, these drugs may also have safety and tolerability issues, and a thorough analysis of the risks and benefits is required. Three oral drugs have been approved by regulatory agencies for MS treatment: fingolimod, teriflunomide, and dimethyl fumarate. This article reviews the mechanisms of action, safety, and efficacy of these drugs and two other drugs that have yielded positive results in phase III trials: cladribine and laquinimod.
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Affiliation(s)
- Woojun Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Manuella Edler Zandoná
- Pontifical Catholic University of Rio Grande do Sul, Science Without Borders, Porto Alegre, Brazil. ; Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
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195
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Lee JM, Han MH. Patient experience and practice trends in multiple sclerosis - clinical utility of fingolimod. Patient Prefer Adherence 2015; 9:685-93. [PMID: 26056436 PMCID: PMC4446999 DOI: 10.2147/ppa.s57354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Targeting sphingosine-1-phosphate pathway with orally available immune-modulatory fingolimod (Gilenya™) therapy ameliorates relapsing-remitting multiple sclerosis (RRMS) by decreasing relapse rate as shown in FREEDOMS and TRANSFORMS. Fingolimod has also been shown to be superior to interferon-beta therapy as evidenced by TRANSFORMS. Albeit multiple benefits in treatment of multiple sclerosis including high efficacy and ease of administration, potential untoward effects such as cardiotoxicity, risk of infection, and cancer exist, thus mandating careful screening and frequent monitoring of patients undergoing treatment with fingolimod. This review outlines mechanism of action, observations, side effects, and practice guidelines on use of fingolimod in treatment of RRMS.
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Affiliation(s)
- Jong-Mi Lee
- Stanford Healthcare, Multiple Sclerosis Center, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - May H Han
- Stanford Healthcare, Multiple Sclerosis Center, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Correspondence: May H Han, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University, 1201 Welch Road, Stanford, CA 94305, USA, Email
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196
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Pieragostino D, D'Alessandro M, di Ioia M, Rossi C, Zucchelli M, Urbani A, Di Ilio C, Lugaresi A, Sacchetta P, Del Boccio P. An integrated metabolomics approach for the research of new cerebrospinal fluid biomarkers of multiple sclerosis. MOLECULAR BIOSYSTEMS 2015; 11:1563-72. [DOI: 10.1039/c4mb00700j] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
(1) Lipid profiling in MuS and OND patients. (2) Search of alterations associated with MuS. (3) Characterization of differences.
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197
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Habib J, Deng J, Lava N, Tyor W, Galipeau J. Blood B Cell and Regulatory Subset Content in Multiple Sclerosis Patients. ACTA ACUST UNITED AC 2015; 2. [PMID: 26137596 PMCID: PMC4484600 DOI: 10.4172/2376-0389.1000139] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE B cell targeted therapies have been effective in slowing multiple sclerosis (MS) disease progression suggesting a direct causal link for this lymphoid subset. A small subset of B cells with regulative properties (Bregs) exists in peripheral blood, and induction of Bregs ameliorates experimental autoimmune encephalomyelitis (EAE), the murine model for MS. Therefore the frequency of B cell subsets and regulatory B cells in particular in peripheral blood of MS patients is of interest. METHODS The phenotype and frequency of B cell subsets in peripheral blood from 32 MS patients and 34 healthy controls (HC) were examined using flow cytometry. RESULTS We found that there is an increase in CD19+ cell number in MS 1347 ± 159 cells/μL, (average ± SEM) compared to HC, 935 ± 129 cells/μL and no apparent deficiency in B-cells with a regulatory phenotype. In addition, we observed a loss of correlation between CD19+ B cells and total lymphocyte count in MS. CONCLUSION These findings suggest altered blood B-cell homeostasis in MS patients.
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Affiliation(s)
- Jakob Habib
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, 1365 Clifton Rd NE, Atlanta, Georgia 30322, USA
| | - Jiusheng Deng
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, 1365 Clifton Rd NE, Atlanta, Georgia 30322, USA
| | - Neil Lava
- Department of Neurology, Emory MS Center, 1365 Clifton Rd NE, Atlanta, Georgia, 30322, USA
| | - William Tyor
- Department of Neurology, Emory MS Center, 1365 Clifton Rd NE, Atlanta, Georgia, 30322, USA ; Department of Neurology (GEC), Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA 30033
| | - Jacques Galipeau
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, 1365 Clifton Rd NE, Atlanta, Georgia 30322, USA
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198
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Bösche K, Weissenborn K, Christians U, Witzke O, Engler H, Schedlowski M, Hadamitzky M. Neurobehavioral consequences of small molecule-drug immunosuppression. Neuropharmacology 2014; 96:83-93. [PMID: 25529273 DOI: 10.1016/j.neuropharm.2014.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 12/29/2022]
Abstract
60 years after the first successful kidney transplantation in humans, transplant patients have decent survival rates owing to a broad spectrum of immunosuppressive medication available today. Not only transplant patients, but also patients with inflammatory autoimmune diseases or cancer benefit from these life-saving immunosuppressive and anti-proliferative medications. However, this success is gained with the disadvantage of neuropsychological disturbances and mental health problems such as depression, anxiety and impaired quality of life after long-term treatment with immunosuppressive drugs. So far, surprisingly little is known about unwanted neuropsychological side effects of immunosuppressants and anti-proliferative drugs from the group of so called small molecule-drugs. This is partly due to the fact that it is difficult to disentangle whether and to what extent the observed neuropsychiatric disturbances are a direct result of the patient's medical history or of the immunosuppressive treatment. Thus, here we summarize experimental as well as clinical data of mammalian and human studies, with the focus on selected small-molecule drugs that are frequently employed in solid organ transplantation, autoimmune disorders or cancer therapy and their effects on neuropsychological functions, mood, and behavior. These data reveal the necessity to develop immunosuppressive and anti-proliferative drugs inducing fewer or no unwanted neuropsychological side effects, thereby increasing the quality of life in patients requiring long term immunosuppressive treatment. This article is part of a Special Issue entitled 'Neuroimmunology and Synaptic Function'.
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Affiliation(s)
- Katharina Bösche
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital, Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Uwe Christians
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Oliver Witzke
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital, Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital, Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Martin Hadamitzky
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital, Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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199
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Skidmore J, Heer J, Johnson CN, Norton D, Redshaw S, Sweeting J, Hurst D, Cridland A, Vesey D, Wall I, Ahmed M, Rivers D, Myatt J, Giblin G, Philpott K, Kumar U, Stevens A, Bit RA, Haynes A, Taylor S, Watson R, Witherington J, Demont E, Heightman TD. Optimization of sphingosine-1-phosphate-1 receptor agonists: effects of acidic, basic, and zwitterionic chemotypes on pharmacokinetic and pharmacodynamic profiles. J Med Chem 2014; 57:10424-42. [PMID: 25431977 DOI: 10.1021/jm5010336] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The efficacy of the recently approved drug fingolimod (FTY720) in multiple sclerosis patients results from the action of its phosphate metabolite on sphingosine-1-phosphate S1P1 receptors, while a variety of side effects have been ascribed to its S1P3 receptor activity. Although S1P and phospho-fingolimod share the same structural elements of a zwitterionic headgroup and lipophilic tail, a variety of chemotypes have been found to show S1P1 receptor agonism. Here we describe a study of the tolerance of the S1P1 and S1P3 receptors toward bicyclic heterocycles of systematically varied shape and connectivity incorporating acidic, basic, or zwitterionic headgroups. We compare their physicochemical properties, their performance in in vitro and in vivo pharmacokinetic models, and their efficacy in peripheral lymphocyte lowering. The campaign resulted in the identification of several potent S1P1 receptor agonists with good selectivity vs S1P3 receptors, efficacy at <1 mg/kg oral doses, and developability properties suitable for progression into preclinical development.
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Affiliation(s)
- John Skidmore
- Neurology Center of Excellence for Drug Discovery, GlaxoSmithKline , New Frontiers Science Park, Harlow CM19 5AW, U.K
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Abstract
Peripheral lymphocytes entering brain ischemic regions orchestrate inflammatory responses, catalyze tissue death, and worsen clinical outcomes of acute ischemic stroke (AIS) in preclinical studies. However, it is not known whether modulating brain inflammation can impact the outcome of patients with AIS. In this open-label, evaluator-blinded, parallel-group clinical pilot trial, we recruited 22 patients matched for clinical and MRI characteristics, with anterior cerebral circulation occlusion and onset of stroke that had exceeded 4.5 h, who then received standard management alone (controls) or standard management plus fingolimod (FTY720, Gilenya, Novartis), 0.5 mg per day orally for 3 consecutive days. Compared with the 11 control patients, the 11 fingolimod recipients had lower circulating lymphocyte counts, milder neurological deficits, and better recovery of neurological functions. This difference was most profound in the first week when reduction of National Institutes of Health Stroke Scale was 4 vs. -1, respectively (P = 0.0001). Neurological rehabilitation was faster in the fingolimod-treated group. Enlargement of lesion size was more restrained between baseline and day 7 than in controls (9 vs. 27 mL, P = 0.0494). Furthermore, rT1%, an indicator of microvascular permeability, was lower in the fingolimod-treated group at 7 d (20.5 vs. 11.0; P = 0.005). No drug-related serious events occurred. We conclude that in patients with acute and anterior cerebral circulation occlusion stroke, oral fingolimod within 72 h of disease onset was safe, limited secondary tissue injury from baseline to 7 d, decreased microvascular permeability, attenuated neurological deficits, and promoted recovery.
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