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Young CB, Cholerton B, Smith AM, Shahid-Besanti M, Abdelnour C, Mormino EC, Hu SC, Chung KA, Peterson A, Rosenthal L, Pantelyat A, Dawson TM, Quinn J, Zabetian CP, Montine TJ, Poston KL. The Parkinson's Disease Composite of Executive Functioning: A Measure for Detecting Cognitive Decline in Clinical Trials. Neurology 2024; 103:e209609. [PMID: 38870440 PMCID: PMC11244747 DOI: 10.1212/wnl.0000000000209609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 05/07/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Executive functioning is one of the first domains to be impaired in Parkinson disease (PD), and the majority of patients with PD eventually develop dementia. Thus, developing a cognitive endpoint measure specifically assessing executive functioning is critical for PD clinical trials. The objective of this study was to develop a cognitive composite measure that is sensitive to decline in executive functioning for use in PD clinical trials. METHODS We used cross-sectional and longitudinal follow-up data from PD participants enrolled in the PD Cognitive Genetics Consortium, a multicenter setting focused on PD. All PD participants with Trail Making Test, Digit Symbol, Letter-Number Sequencing, Semantic Fluency, and Phonemic Fluency neuropsychological data collected from March 2010 to February 2020 were included. Baseline executive functioning data were used to create the Parkinson's Disease Composite of Executive Functioning (PaCEF) through confirmatory factor analysis. We examined the changes in the PaCEF over time, how well baseline PaCEF predicts time to cognitive progression, and the required sample size estimates for PD clinical trials. PaCEF results were compared with the Montreal Cognitive Assessment (MoCA), individual tests forming the PaCEF, and tests of visuospatial, language, and memory functioning. RESULTS A total of 841 participants (251 no cognitive impairment [NCI], 480 mild cognitive impairment [MCI], and 110 dementia) with baseline data were included, of which the mean (SD) age was 67.1 (8.9) years and 270 were women (32%). Five hundred forty five PD participants had longitudinal neuropsychological data spanning 9 years (mean [SD] 4.5 [2.2] years) and were included in analyses examining cognitive decline. A 1-factor model of executive functioning with excellent fit (comparative fit index = 0.993, Tucker-Lewis index = 0.989, and root mean square error of approximation = 0.044) was used to calculate the PaCEF. The average annual change in PaCEF ranged from 0.246 points per year for PD-NCI participants who remained cognitively unimpaired to -0.821 points per year for PD-MCI participants who progressed to dementia. For PD-MCI, baseline PaCEF, but not baseline MoCA, significantly predicted time to dementia. Sample size estimates were 69%-73% smaller for PD-NCI trials and 16%-19% smaller for PD-MCI trials when using the PaCEF rather than MoCA as the endpoint. DISCUSSION The PaCEF is a sensitive measure of executive functioning decline in PD and will be especially beneficial for PD clinical trials.
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Affiliation(s)
- Christina B Young
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brenna Cholerton
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alena M Smith
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marian Shahid-Besanti
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carla Abdelnour
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth C Mormino
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shu-Ching Hu
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathryn A Chung
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amie Peterson
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Liana Rosenthal
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alexander Pantelyat
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ted M Dawson
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph Quinn
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cyrus P Zabetian
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas J Montine
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathleen L Poston
- From the Departments of Neurology and Neurological Sciences (C.B.Y., A.M.S., M.S.-B., C.A., E.C.M., K.L.P.) and (B.C., T.J.M.), Stanford University School of Medicine, CA; Veterans Affairs Puget Sound Health Care System (B.C., S.-C.H., C.P.Z.), Seattle; Department of Neurology (S.-C.H., C.P.Z.), University of Washington School of Medicine, Seattle; Department of Neurology (K.A.C., A. Peterson, J.Q.), Oregon Health and Science University, Portland; Portland Veterans Affairs Health Care System (K.A.C., A. Peterson, J.Q.), Oregon; Department of Neurology (L.R., A. Pantelyat, T.M.D.), Johns Hopkins University School of Medicine, Baltimore, MD
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Chen J, Song Y, Ma L, Jin Y, Yu J, Guo Y, Huang Y, Pu X. Computational insights into diverse binding modes of the allosteric modulator and their regulation on dopamine D1 receptor. Comput Biol Med 2024; 173:108283. [PMID: 38552278 DOI: 10.1016/j.compbiomed.2024.108283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 04/17/2024]
Abstract
Allosteric drugs hold the promise of addressing many challenges in the current drug development of GPCRs. However, the molecular mechanism underlying their allosteric modulations remain largely elusive. The dopamine D1 receptor (DRD1), a member of Class A GPCRs, is critical for treating psychiatric disorders, and LY3154207 serves as its promising positive allosteric modulator (PAM). In the work, we utilized extensive Gaussian-accelerated molecular dynamics simulations (a total of 41μs) for the first time probe the diverse binding modes of the allosteric modulator and their regulation effects, based on the DRD1 and LY3154207 as representative. Our simulations identify four binding modes of LY3154207 (one boat mode, two metastable vertical modes and a novel cleft-anchored mode), in which the boat mode is the most stable while there three modes are similar in the stability. However, it is interesting to observed that the most stable boat mode inversely exhibits the weakest positive allosteric effect on influencing the orthosteric ligand binding and maintaining the activity of the transducer binding site. It should result from its induced weaker correlation between the allosteric site and the orthosteric site, and between the orthosteric site and the transducer binding site than the other three binding modes, as well as its weakened interaction between a crucial activation-related residue (S2025.46) and the orthosteric ligand (dopamine). Overall, the work offers atomic-level information to advance our understanding of the complex allosteric regulation on GPCRs, which is beneficial to the allosteric modulator design and development.
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Affiliation(s)
- Jianfang Chen
- College of Chemistry, Sichuan University, Chengdu, 610064, China.
| | - Yuanpeng Song
- College of Chemistry, Sichuan University, Chengdu, 610064, China.
| | - Luhan Ma
- College of Chemistry, Sichuan University, Chengdu, 610064, China.
| | - Yizhou Jin
- College of Chemistry, Sichuan University, Chengdu, 610064, China.
| | - Jin Yu
- Department of Physics and Astronomy, University of California, Irvine, CA, 92697, USA.
| | - Yanzhi Guo
- College of Chemistry, Sichuan University, Chengdu, 610064, China.
| | - Yan Huang
- College of Chemistry, Sichuan University, Chengdu, 610064, China.
| | - Xuemei Pu
- College of Chemistry, Sichuan University, Chengdu, 610064, China.
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Zhang M, Chen T, Lu X, Lan X, Chen Z, Lu S. G protein-coupled receptors (GPCRs): advances in structures, mechanisms, and drug discovery. Signal Transduct Target Ther 2024; 9:88. [PMID: 38594257 PMCID: PMC11004190 DOI: 10.1038/s41392-024-01803-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
G protein-coupled receptors (GPCRs), the largest family of human membrane proteins and an important class of drug targets, play a role in maintaining numerous physiological processes. Agonist or antagonist, orthosteric effects or allosteric effects, and biased signaling or balanced signaling, characterize the complexity of GPCR dynamic features. In this study, we first review the structural advancements, activation mechanisms, and functional diversity of GPCRs. We then focus on GPCR drug discovery by revealing the detailed drug-target interactions and the underlying mechanisms of orthosteric drugs approved by the US Food and Drug Administration in the past five years. Particularly, an up-to-date analysis is performed on available GPCR structures complexed with synthetic small-molecule allosteric modulators to elucidate key receptor-ligand interactions and allosteric mechanisms. Finally, we highlight how the widespread GPCR-druggable allosteric sites can guide structure- or mechanism-based drug design and propose prospects of designing bitopic ligands for the future therapeutic potential of targeting this receptor family.
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Affiliation(s)
- Mingyang Zhang
- Key Laboratory of Protection, Development and Utilization of Medicinal Resources in Liupanshan Area, Ministry of Education, Peptide & Protein Drug Research Center, School of Pharmacy, Ningxia Medical University, Yinchuan, 750004, China
- Medicinal Chemistry and Bioinformatics Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ting Chen
- Department of Cardiology, Changzheng Hospital, Affiliated to Naval Medical University, Shanghai, 200003, China
| | - Xun Lu
- Medicinal Chemistry and Bioinformatics Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaobing Lan
- Key Laboratory of Protection, Development and Utilization of Medicinal Resources in Liupanshan Area, Ministry of Education, Peptide & Protein Drug Research Center, School of Pharmacy, Ningxia Medical University, Yinchuan, 750004, China
| | - Ziqiang Chen
- Department of Orthopedics, Changhai Hospital, Affiliated to Naval Medical University, Shanghai, 200433, China.
| | - Shaoyong Lu
- Key Laboratory of Protection, Development and Utilization of Medicinal Resources in Liupanshan Area, Ministry of Education, Peptide & Protein Drug Research Center, School of Pharmacy, Ningxia Medical University, Yinchuan, 750004, China.
- Medicinal Chemistry and Bioinformatics Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Rajagopal L, Huang M, Mahjour S, Ryan C, Elzokaky A, Svensson KA, Meltzer HY. The dopamine D1 receptor positive allosteric modulator, DETQ, improves cognition and social interaction in aged mice and enhances cortical and hippocampal acetylcholine efflux. Behav Brain Res 2024; 459:114766. [PMID: 38048913 DOI: 10.1016/j.bbr.2023.114766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023]
Abstract
Dopamine (DA) D1 and D2 receptors (Rs) are critical for cognitive functioning. D1 positive allosteric modulators (D1PAMs) activate D1Rs without desensitization or an inverted U-shaped dose response curve. DETQ, [2-(2,6-dichlorophenyl)-1-((1S,3R)-3-(hydroxymethyl)-5-(2-hydroxypropan-2-yl)-1-methyl-3,4-dihydroisoquinolin-2(1H)-yl)ethan-1-one] is highly selective for the human D1Rs as shown in humanized D1R knock-in (hD1Ki) mice. Here, we have ascertained the efficacy of DETQ in aged [13-23-month-old (mo)] hD1Ki mice and their corresponding age-matched wild-type (WT; C57BL/6NTac) controls. We found that in aged mice, DETQ, given acutely, subchronically, and chronically, rescued both novel object recognition memory and social behaviors, using novel object recognition (NOR) and social interaction (SI) tasks, respectively without any adverse effect on body weight or mortality. We have also shown, using in vivo microdialysis, a significant decrease in basal DA and norepinephrine, increase in glutamate (Glu) and gamma-amino butyric acid (GABA) efflux with no significant changes in acetylcholine (ACh) levels in aged vs young mice. In young and aged hD1Ki mice, DETQ, acutely and subchronically increased ACh in the medial prefrontal cortex and hippocampal regions in aged hD1Ki mice without affecting Glu. These results suggest that the D1PAM mechanism is of interest as potential treatment for cognitive and social behavioral deficits in neuropsychiatric disorders including but not restricted to neurodegenerative disorders, such as Parkinson's disease.
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Affiliation(s)
- Lakshmi Rajagopal
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Mei Huang
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Sanaz Mahjour
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Chelsea Ryan
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Ahmad Elzokaky
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Kjell A Svensson
- Neuroscience Discovery, Eli Lilly & Company, Indianapolis, IN, USA
| | - H Y Meltzer
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL 60611, USA.
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Foltynie T, Bruno V, Fox S, Kühn AA, Lindop F, Lees AJ. Medical, surgical, and physical treatments for Parkinson's disease. Lancet 2024; 403:305-324. [PMID: 38245250 DOI: 10.1016/s0140-6736(23)01429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 05/09/2023] [Accepted: 07/06/2023] [Indexed: 01/22/2024]
Abstract
Although dopamine replacement therapy remains a core component of Parkinson's disease treatment, the onset of motor fluctuations and dyskinetic movements might require a range of medical and surgical approaches from a multidisciplinary team, and important new approaches in the delivery of dopamine replacement are becoming available. The more challenging, wide range of non-motor symptoms can also have a major impact on the quality of life of a patient with Parkinson's disease, and requires careful multidisciplinary management using evidence-based knowledge, as well as appropriately tailored strategies according to the individual patient's needs. Disease-modifying therapies are urgently needed to prevent the development of the most disabling refractory symptoms, including gait and balance difficulties, cognitive impairment and dementia, and speech and swallowing impairments. In the third paper in this Series, we present the latest evidence supporting the optimal treatment of Parkinson's disease, and describe an expert approach to many aspects of treatment choice where an evidence base is insufficient.
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Affiliation(s)
- Tom Foltynie
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
| | - Veronica Bruno
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Susan Fox
- Edmond J Safra Program in Parkinson Disease, Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada; Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Andrea A Kühn
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany; NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fiona Lindop
- University Hospitals of Derby and Burton NHS Foundation Trust, Specialist Rehabilitation, Florence Nightingale Community Hospital, Derby, UK
| | - Andrew J Lees
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK; Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
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Degirmenci Y, Angelopoulou E, Georgakopoulou VE, Bougea A. Cognitive Impairment in Parkinson's Disease: An Updated Overview Focusing on Emerging Pharmaceutical Treatment Approaches. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1756. [PMID: 37893474 PMCID: PMC10608778 DOI: 10.3390/medicina59101756] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/17/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Cognitive impairment in patients with Parkinson's disease (PD) is one of the commonest and most disabling non-motor manifestations during the course of the disease. The clinical spectrum of PD-related cognitive impairment includes subjective cognitive decline (SCD), mild cognitive impairment (MCI) and PD dementia (PDD). As the disease progresses, cognitive decline creates a significant burden for the family members and/or caregivers of patients with PD, and has a great impact on quality of life. Current pharmacological treatments have demonstrated partial efficacy and failed to halt disease progression, and novel, effective, and safe therapeutic strategies are required. Accumulating preclinical and clinical evidence shows that several agents may provide beneficial effects on patients with PD and cognitive impairment, including ceftriaxone, ambroxol, intranasal insulin, nilotinib, atomoxetine, mevidalen, blarcamesine, prasinezumab, SYN120, ENT-01, NYX-458, GRF6021, fosgonimeton, INT-777, Neuropeptide S, silibinin, osmotin, cordycepin, huperzine A, fibroblast growth factor 21, Poloxamer 188, ginsenoside Rb1, thioredoxin-1, tangeretin, istradefylline and Eugenia uniflora. Potential underlying mechanisms include the inhibition of a-synuclein aggregation, the improvement of mitochondrial function, the regulation of synaptic plasticity, an impact on the gut-brain axis, the modulation of neuroinflammation and the upregulation of neurotrophic factors, as well as cholinergic, dopaminergic, serotoninergic and norepinephrine neurotransmission. In this updated overview, we aim to cover the clinical aspects of the spectrum of PD-related cognitive impairment and discuss recent evidence on emerging treatment approaches that are under investigation at a preclinical and clinical level. Finally, we aim to provide additional insights and propose new ideas for investigation that may be feasible and effective for the spectrum of PD-related cognitive impairment.
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Affiliation(s)
- Yildiz Degirmenci
- Department of Neurology, School of Medicine, Istanbul Health and Technology University, 34093 Istanbul, Turkey;
- Parkinson’s Disease and Movement Disorders Unit, Neurology Clinic, Sisli Kolan International Hospital, 34384 Istanbul, Turkey
| | - Efthalia Angelopoulou
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece;
| | | | - Anastasia Bougea
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 11528 Athens, Greece;
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Goldberg A, Xie B, Shi L. The Molecular Mechanism of Positive Allosteric Modulation at the Dopamine D1 Receptor. Int J Mol Sci 2023; 24:12848. [PMID: 37629030 PMCID: PMC10454769 DOI: 10.3390/ijms241612848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
The dopamine D1 receptor (D1R) is a promising target for treating various psychiatric disorders. While upregulation of D1R activity has shown potential in alleviating motor and cognitive symptoms, orthosteric agonists have limitations, restricting their clinical applications. However, the discovery of several allosteric compounds specifically targeting the D1R, such as LY3154207, has opened new therapeutic avenues. Based on the cryo-EM structures of the D1R, we conducted molecular dynamics simulations to investigate the binding and allosteric mechanisms of LY3154207. Our simulations revealed that LY3154207 preferred the horizontal orientation above intracellular loop 2 (IL2) and stabilized the helical conformation of IL2. Moreover, LY3154207 binding induced subtle yet significant changes in key structural motifs and their neighboring residues. Notably, a cluster of residues centered around the Na+-binding site became more compact, while interactions involving the PIF motif and its neighboring residues were loosened upon LY3154207 binding, consistent with their role in opening the intracellular crevice for receptor activation. Additionally, we identified an allosteric pathway likely responsible for the positive allosteric effect of LY3154207 in enhancing Gs protein coupling. This mechanistic understanding of LY3154207's allosteric action at the D1R paves the way for the rational design of more potent and effective allosteric modulators.
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Affiliation(s)
| | | | - Lei Shi
- Computational Chemistry and Molecular Biophysics Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA
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8
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Goldberg A, Xie B, Shi L. The molecular mechanism of positive allosteric modulation at the dopamine D1 receptor. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.27.550907. [PMID: 37546785 PMCID: PMC10402154 DOI: 10.1101/2023.07.27.550907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
The dopamine D1 receptor (D1R) is a promising target for treating various psychiatric disorders. While upregulation of D1R activity has shown potential in alleviating motor and cognitive symptoms, orthosteric agonists have limitations, restricting their clinical applications. However, the discovery of several allosteric compounds specifically targeting the D1R, such as LY3154207, has opened new therapeutic avenues. Based on the cryo-EM structures of the D1R, we conducted molecular dynamics simulations to investigate the binding and allosteric mechanisms of LY3154207. Our simulations revealed that LY3154207 preferred the horizontal orientation above intracellular loop 2 (IL2) and stabilized the helical conformation of IL2. Moreover, LY3154207 binding induced subtle yet significant changes in key structural motifs and their neighboring residues. Notably, a cluster of residues centered around the Na + binding site became more compact, while interactions involving the PIF motif and its neighboring residues were loosened upon LY3154207 binding, consistent with their role in opening the intracellular crevice for receptor activation. Additionally, we identified an allosteric pathway likely responsible for the positive allosteric effect of LY3154207 in enhancing Gs protein coupling. This mechanistic understanding of LY3154207's allosteric action at the D1R pave the way for the rational design of more potent and effective allosteric modulators.
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Affiliation(s)
- Alexander Goldberg
- Computational Chemistry and Molecular Biophysics Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland 21224
| | - Bing Xie
- Computational Chemistry and Molecular Biophysics Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland 21224
| | - Lei Shi
- Computational Chemistry and Molecular Biophysics Section, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland 21224
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9
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Bayram E, Batzu L, Tilley B, Gandhi R, Jagota P, Biundo R, Garon M, Prasertpan T, Lazcano-Ocampo C, Chaudhuri KR, Weil RS. Clinical trials for cognition in Parkinson's disease: Where are we and how can we do better? Parkinsonism Relat Disord 2023; 112:105385. [PMID: 37031010 PMCID: PMC10330317 DOI: 10.1016/j.parkreldis.2023.105385] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Cognitive impairment is common in Parkinson's disease (PD) and has a substantial impact on quality of life. Despite numerous trials targeting various PD features, we still lack effective treatments for cognition beyond cholinesterase inhibitors. OBJECTIVE To identify the gaps in recent clinical trials with cognitive outcomes in PD and consider areas for improvement. METHODS We examined recent clinical trials with cognitive outcomes in PD registered on ClinicalTrials.gov, excluding trials without cognitive outcomes, non-interventional studies, and in atypical Parkinsonian disorders. Included trials were categorized by treatment approach (investigational medicinal product, behavioral, physical activity, device-based). Details of trial design and outcomes were collected. RESULTS 178 trials at different stages of trial completion were considered. 46 trials were completed, 25 had available results. Mean follow-up duration was 29.9 weeks. Most common cognitive measure was Montreal Cognitive Assessment. Most were performed in North America or Europe. Majority of the participants identified as non-Hispanic and White. Only eight trials showed improvement in cognition, none showed improvement beyond four months. These included trials of international medicinal products, cognitive and physical interventions and devices. GRADE certainty levels ranged from Moderate to Very Low. Only mevidalen had a Moderate certainty for potential clinical effectiveness. CONCLUSIONS Amongst a large number of trials for cognition in PD, only a small proportion were completed. Few showed significant improvement, with no proven long-lasting effects. Trial design, lack of enrichment for at-risk groups, short follow-up duration, insensitive outcome measures likely contribute to lack of detectable benefit and should be considered in future trials.
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Affiliation(s)
- Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA.
| | - Lucia Batzu
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK.
| | - Bension Tilley
- Dementia Research Centre, University College London, London, UK; Department of Brain Sciences, Imperial College London, London, UK
| | - Rhea Gandhi
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Priya Jagota
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Roberta Biundo
- Department of General Psychology, University of Padua, Padua, Italy; Study Center for Neurodegeneration (CESNE), University of Padua, Padua, Italy
| | - Michela Garon
- Parkinson and Movement Disorders Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Tittaya Prasertpan
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Claudia Lazcano-Ocampo
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Neurology, Hospital Sotero del Rio, Santiago, Chile
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Rimona S Weil
- Dementia Research Centre, University College London, London, UK; Movement Disorders Centre, University College London, London, UK
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10
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Abdelnour C, Gonzalez MC, Gibson LL, Poston KL, Ballard CG, Cummings JL, Aarsland D. Dementia with Lewy Bodies Drug Therapies in Clinical Trials: Systematic Review up to 2022. Neurol Ther 2023; 12:727-749. [PMID: 37017910 PMCID: PMC10195935 DOI: 10.1007/s40120-023-00467-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/14/2023] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION Reviews of randomized clinical trials (RCTs) in dementia with Lewy bodies (DLB) are essential for informing ongoing research efforts of symptomatic therapies and potentially disease-modifying therapies (DMTs). METHODS We performed a systematic review of all clinical trials conducted until September 27, 2022, by examining 3 international registries: ClinicalTrials.gov, the European Union Drug Regulating Authorities Clinical Trials Database, and the International Clinical Trials Registry Platform, to identify drugs in trials in DLB. RESULTS We found 25 agents in 40 trials assessing symptomatic treatments and DMTs for DLB: 7 phase 3, 31 phase 2, and 2 phase 1 trials. We found an active pipeline for drug development in DLB, with most ongoing clinical trials in phase 2. We identified a recent trend towards including participants at the prodromal stages, although more than half of active clinical trials will enroll mild to moderate dementia patients. Additionally, repurposed agents are frequently tested, representing 65% of clinical trials. CONCLUSION Current challenges in DLB clinical trials include the need for disease-specific outcome measures and biomarkers, and improving representation of global and diverse populations.
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Affiliation(s)
- Carla Abdelnour
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Maria Camila Gonzalez
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
| | - Lucy L Gibson
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Dag Aarsland
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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11
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Carceles-Cordon M, Weintraub D, Chen-Plotkin AS. Cognitive heterogeneity in Parkinson's disease: A mechanistic view. Neuron 2023; 111:1531-1546. [PMID: 37028431 PMCID: PMC10198897 DOI: 10.1016/j.neuron.2023.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/22/2022] [Accepted: 03/13/2023] [Indexed: 04/09/2023]
Abstract
Cognitive impairment occurs in most individuals with Parkinson's disease (PD), exacting a high toll on patients, their caregivers, and the healthcare system. In this review, we begin by summarizing the current clinical landscape surrounding cognition in PD. We then discuss how cognitive impairment and dementia may develop in PD based on the spread of the pathological protein alpha-synuclein (aSyn) from neurons in brainstem regions to those in the cortical regions of the brain responsible for higher cognitive functions, as first proposed in the Braak hypothesis. We appraise the Braak hypothesis from molecular (conformations of aSyn), cell biological (cell-to-cell spread of pathological aSyn), and organ-level (region-to-region spread of aSyn pathology at the whole brain level) viewpoints. Finally, we argue that individual host factors may be the most poorly understood aspect of this pathological process, accounting for substantial heterogeneity in the pattern and pace of cognitive decline in PD.
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Affiliation(s)
- Marc Carceles-Cordon
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dan Weintraub
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alice S Chen-Plotkin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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12
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Castner SA, Zhang L, Yang CR, Hao J, Cramer JW, Wang X, Bruns RF, Marston H, Svensson KA, Williams GV. Effects of DPTQ, a novel positive allosteric modulator of the dopamine D1 receptor, on spontaneous eye blink rate and spatial working memory in the nonhuman primate. Psychopharmacology (Berl) 2023; 240:1033-1048. [PMID: 36961560 PMCID: PMC10102062 DOI: 10.1007/s00213-022-06282-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/23/2022] [Indexed: 03/25/2023]
Abstract
RATIONALE Dopamine (DA) signaling through the D1 receptor has been shown to be integral to multiple aspects of cognition, including the core process of working memory. The discovery of positive allosteric modulators (PAMs) of the D1 receptor has enabled treatment modalities that may have alternative benefits to orthosteric D1 agonists arising from a synergism of action with functional D1 receptor signaling. OBJECTIVES To investigate this potential, we have studied the effects of the novel D1 PAM DPTQ on a spatial delayed response working memory task in the rhesus monkey. Initial studies indicated that DPTQ binds to primate D1R with high affinity and selectivity and elevates spontaneous eye blink rate in rhesus monkeys in a dose-dependent manner consistent with plasma ligand exposures and central D1activation. RESULTS Based on those results, DPTQ was tested at 2.5 mg/kg IM in the working memory task. No acute effect was observed 1 h after dosing, but performance was impaired 48 h later. Remarkably, this deficit was immediately followed by a significant enhancement in cognition over the next 3 days. In a second experiment in which DPTQ was administered on days 1 and 5, the early impairment was smaller and did not reach statistical significance, but statistically significant enhancement of performance was observed over the following week. Lower doses of 0.1 and 1.0 mg/kg were also capable of producing this protracted enhancement without inducing any transient impairment. CONCLUSIONS DPTQ exemplifies a class of D1PAMs that may be capable of providing long-term improvements in working memory.
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Affiliation(s)
- Stacy A Castner
- Department of Comparative Medicine, Yale University, 310 Cedar St, New Haven, CT, 06520, USA
| | - Linli Zhang
- ChemPartner, 99 Lian He North Road, Zhe Lin Town, Fengxian Area, Shanghai, China
| | - Charles R Yang
- ChemPartner, 99 Lian He North Road, Zhe Lin Town, Fengxian Area, Shanghai, China
| | - Junliang Hao
- Eli Lilly & Co, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Jeffrey W Cramer
- Eli Lilly & Co, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Xushan Wang
- Eli Lilly & Co, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Robert F Bruns
- Eli Lilly & Co, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | | | - Kjell A Svensson
- Eli Lilly & Co, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Graham V Williams
- Department of Comparative Medicine, Yale University, 310 Cedar St, New Haven, CT, 06520, USA.
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13
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Parkinson Disease Dementia Management: an Update of Current Evidence and Future Directions. Curr Treat Options Neurol 2023. [DOI: 10.1007/s11940-023-00749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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14
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Chen C, Kowahl NR, Rainaldi E, Burq M, Munsie LM, Battioui C, Wang J, Biglan K, Marks WJ, Kapur R. Wrist-worn sensor-based measurements for drug effect detection with small samples in people with Lewy Body Dementia. Parkinsonism Relat Disord 2023; 109:105355. [PMID: 36905719 DOI: 10.1016/j.parkreldis.2023.105355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Few late-stage clinical trials in Parkinson's disease (PD) have produced evidence on the clinical validity of sensor-based digital measurements of daily life activities to detect responses to treatment. The objective of this study was to assess whether digital measures from patients with mild-to-moderate Lewy Body Dementia demonstrate treatment effects during a randomized Phase 2 trial. METHODS Substudy within a 12-week trial of mevidalen (placebo vs 10, 30, or 75 mg), where 70/344 patients (comparable to the overall population) wore a wrist-worn multi-sensor device. RESULTS Treatment effects were statistically significant by conventional clinical assessments (Movement Disorder Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] sum of Parts I-III and Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change [ADCS-CGIC] scores) in the full study cohort at Week 12, but not in the substudy. However, digital measurements detected significant effects in the substudy cohort at week 6, persisting to week 12. CONCLUSIONS Digital measurements detected treatment effects in a smaller cohort over a shorter period than conventional clinical assessments. TRIAL REGISTRATION clinicaltrials.gov, NCT03305809.
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Affiliation(s)
- Chen Chen
- Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, USA.
| | - Nathan R Kowahl
- Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, USA.
| | - Erin Rainaldi
- Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, USA.
| | - Maximilien Burq
- Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, USA.
| | - Leanne M Munsie
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - Chakib Battioui
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - Jian Wang
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - Kevin Biglan
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - William J Marks
- Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, USA.
| | - Ritu Kapur
- Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, USA.
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15
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Wang X, Hembre EJ, Goldsmith PJ, Beck JP, Svensson KA, Willard FS, Bruns RF. Mutual Cooperativity of Three Allosteric Sites on the Dopamine D1 Receptor. Mol Pharmacol 2023; 103:176-187. [PMID: 36804203 DOI: 10.1124/molpharm.122.000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
An amine-containing molecule called Compound A has been reported by a group from Bristol-Myers Squibb to act as a positive allosteric modulator (PAM) at the dopamine D1 receptor. We synthesized the more active enantiomer of Compound A (BMS-A1) and compared it with the D1 PAMs DETQ and MLS6585, which are known to bind to intracellular loop 2 and the extracellular portion of transmembrane helix 7, respectively. Results from D1/D5 chimeras indicated that PAM activity of BMS-A1 tracked with the presence of D1 sequence in the N-terminal/extracellular region of the D1 receptor, a unique location compared with either of the other PAMs. In pairwise combinations, BMS-A1 potentiated the small allo-agonist activity of each of the other PAMs, while the triple PAM combination (in the absence of dopamine) produced a cAMP response about 64% of the maximum produced by dopamine. Each of the pairwise PAM combinations produced a much larger leftward shift of the dopamine EC50 than either single PAM alone. All three PAMs in combination produced a 1000-fold leftward shift of the dopamine curve. These results demonstrate the presence of three non-overlapping allosteric sites that cooperatively stabilize the same activated state of the human D1 receptor. SIGNIFICANCE STATEMENT: Deficiencies in dopamine D1 receptor activation are seen in Parkinson disease and other neuropsychiatric disorders. In this study, three positive allosteric modulators of the dopamine D1 receptor were found to bind to distinct and separate sites, interacting synergistically with each other and dopamine, with the triple combination causing a 1000-fold leftward shift of the response to dopamine. These results showcase multiple opportunities to modulate D1 tone and highlight new pharmacological approaches for allosteric modulation of G-protein-coupled receptors.
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Affiliation(s)
- Xushan Wang
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana
| | - Erik J Hembre
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana
| | - Paul J Goldsmith
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana
| | - James P Beck
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana
| | - Kjell A Svensson
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana
| | - Francis S Willard
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana
| | - Robert F Bruns
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana
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16
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Bayram E, Holden SK, Fullard M, Armstrong MJ. Race and Ethnicity in Lewy Body Dementia: A Narrative Review. J Alzheimers Dis 2023; 94:861-878. [PMID: 37355902 PMCID: PMC10448838 DOI: 10.3233/jad-230207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
Lewy body dementia is the third most common and costliest type of dementia. It is an umbrella term for dementia with Lewy bodies and Parkinson's disease dementia, both of which place a substantial burden on the person and society. Recent findings outline ethnoracial differences in dementia risk. Delayed and misdiagnosis across ethnoracial groups contribute to higher levels of burden. In this context, we aimed to summarize current knowledge, gaps, and unmet needs relating to race and ethnicity in Lewy body dementia. In this narrative review, we provide an overview of studies on Lewy body dementia focusing on differences across ethnoracial groups and outline several recommendations for future studies. The majority of the findings comparing different ethnoracial groups were from North American sites. There were no differences in clinical prevalence and progression across ethnoracial groups. Compared to people identifying as non-Hispanic White, co-pathologies were more common and clinical diagnostic accuracy was lower for people identifying as Black. Co-morbidities (e.g., diabetes, hypertension) were more common and medication use rates (e.g., antidepressants, antiparkinsonian agents) were lower for people identifying as Black or Hispanic compared to people identifying as White. More than 90% of clinical trial participants identified as non-Hispanic White. Despite increasing efforts to overcome disparities in Alzheimer's disease and related dementias, inclusion of individuals from minoritized communities in Lewy body dementia studies continues to be limited and the findings are inconclusive. Representation of diverse populations is crucial to improve the diagnostic and therapeutic efforts in Lewy body dementia.
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Affiliation(s)
- Ece Bayram
- Parkinson and Other Movement Disorders Center, Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michelle Fullard
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
- Fixel Institute for Neurological Diseases, Gainesville, FL, USA
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17
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Sabbagh MN, Taylor A, Galasko D, Galvin JE, Goldman JG, Leverenz JB, Poston KL, Boeve BF, Irwin DJ, Quinn JF. Listening session with the US Food and Drug Administration, Lewy Body Dementia Association, and an expert panel. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12375. [PMID: 36873923 PMCID: PMC9983146 DOI: 10.1002/trc2.12375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 02/11/2023]
Abstract
The regulatory path for drug approval is increasingly well defined. Drugs for the treatment of Alzheimer disease (AD) need to show statistically significant benefit over placebo with respect to cognitive and functional measures, with the Clinical Dementia Rating scale and Alzheimer's Disease Assessment Scale-Cognitive Subscale being among the most often used instruments in AD clinical trials. In contrast, there are no validated instruments for use in clinical trials of drugs for the treatment of dementia with Lewy bodies. This poses challenges for drug development because the regulatory pathway to drug approval requires demonstrable efficacy measures. In December 2021, the Lewy Body Dementia Association advisory group met with representatives from the US Food and Drug Administration to discuss the lack of approved drugs and treatments, discernment of efficacy measures, and identification of biomarkers. Highlights The Lewy Body with Dementia Association convened a listening session with the US Food and Drug Administration on dementia with Lewy bodies (DLB) and clinical trial design.Gaps include DLB-specific measures, alpha synuclein biomarkers, and coexisting pathologies.DLB clinical trial design should focus on clinical value and disease specificity.
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Affiliation(s)
- Marwan N. Sabbagh
- Department of NeurologyAlzheimer's and Memory Disorders DivisionBarrow Neurological InstituteSt. Joseph's Hospital and Medical CenterPhoenixArizonaUSA
| | | | - Douglas Galasko
- University of California San Diego Shiley‐Marcos Alzheimer's Disease Research Center and Department of NeurosciencesUniversity of California San DiegoLa JollaCaliforniaUSA
| | - James E. Galvin
- Comprehensive Center for Brain HealthDepartment of NeurologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Jennifer G. Goldman
- Parkinson's and Movement DisordersShirley Ryan Ability Lab and Departments of Physical Medicine and Rehabilitation and NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - James B. Leverenz
- Cleveland Alzheimer's Disease Research Center and Cleveland Clinic Center for Brain HealthClevelandOhioUSA
| | | | - Bradley F. Boeve
- Mayo Alzheimer's Disease Research Center and Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - David J. Irwin
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Joseph F. Quinn
- Department of NeurologyOregon Health Sciences UniversityPortlandOregonUSA
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18
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Targeting G Protein-Coupled Receptors in the Treatment of Parkinson's Disease. J Mol Biol 2022:167927. [PMID: 36563742 DOI: 10.1016/j.jmb.2022.167927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disease characterized in part by the deterioration of dopaminergic neurons which leads to motor impairment. Although there is no cure for PD, the motor symptoms can be treated using dopamine replacement therapies including the dopamine precursor L-DOPA, which has been in use since the 1960s. However, neurodegeneration in PD is not limited to dopaminergic neurons, and many patients experience non-motor symptoms including cognitive impairment or neuropsychiatric disturbances, for which there are limited treatment options. Moreover, there are currently no treatments able to alter the progression of neurodegeneration. There are many therapeutic strategies being investigated for PD, including alternatives to L-DOPA for the treatment of motor impairment, symptomatic treatments for non-motor symptoms, and neuroprotective or disease-modifying agents. G protein-coupled receptors (GPCRs), which include the dopamine receptors, are highly druggable cell surface proteins which can regulate numerous intracellular signaling pathways and thereby modulate the function of neuronal circuits affected by PD. This review will describe the treatment strategies being investigated for PD that target GPCRs and their downstream signaling mechanisms. First, we discuss new developments in dopaminergic agents for alleviating PD motor impairment, the role of dopamine receptors in L-DOPA induced dyskinesia, as well as agents targeting non-dopamine GPCRs which could augment or replace traditional dopaminergic treatments. We then discuss GPCRs as prospective treatments for neuropsychiatric and cognitive symptoms in PD. Finally, we discuss the evidence pertaining to ghrelin receptors, β-adrenergic receptors, angiotensin receptors and glucagon-like peptide 1 receptors, which have been proposed as disease modifying targets with potential neuroprotective effects in PD.
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Weintraub D, Aarsland D, Biundo R, Dobkin R, Goldman J, Lewis S. Management of psychiatric and cognitive complications in Parkinson's disease. BMJ 2022; 379:e068718. [PMID: 36280256 DOI: 10.1136/bmj-2021-068718] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neuropsychiatric symptoms (NPSs) such as affective disorders, psychosis, behavioral changes, and cognitive impairment are common in Parkinson's disease (PD). However, NPSs remain under-recognized and under-treated, often leading to adverse outcomes. Their epidemiology, presentation, risk factors, neural substrate, and management strategies are incompletely understood. While psychological and psychosocial factors may contribute, hallmark PD neuropathophysiological changes, plus the associations between exposure to dopaminergic medications and occurrence of some symptoms, suggest a neurobiological basis for many NPSs. A range of psychotropic medications, psychotherapeutic techniques, stimulation therapies, and other non-pharmacological treatments have been studied, are used clinically, and are beneficial for managing NPSs in PD. Appropriate management of NPSs is critical for comprehensive PD care, from recognizing their presentations and timing throughout the disease course, to the incorporation of different therapeutic strategies (ie, pharmacological and non-pharmacological) that utilize a multidisciplinary approach.
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Affiliation(s)
- Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
| | - Roberta Biundo
- Department of General Psychology, University of Padua, Padua, Italy
- Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Roseanne Dobkin
- Department of Psychiatry, Rutgers-The State University of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jennifer Goldman
- Shirley Ryan AbilityLab, Parkinson's Disease and Movement Disorders, Chicago, IL
- Departments of Physical Medicine and Rehabilitation and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
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Wang J, Battioui C, McCarthy A, Dang X, Zhang H, Man A, Zou J, Kyle J, Munsie L, Pugh M, Biglan K. Evaluating the Use of Digital Biomarkers to Test Treatment Effects on Cognition and Movement in Patients with Lewy Body Dementia. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1991-2004. [PMID: 35694933 PMCID: PMC9535589 DOI: 10.3233/jpd-213126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: PRESENCE was a Phase 2 trial assessing mevidalen for symptomatic treatment of Lewy body dementia (LBD). Participants received daily doses (10, 30, or 75 mg) of mevidalen (LY3154207) or placebo for 12 weeks. Objective: To evaluate if frequent cognitive and motor tests using an iPad app and wrist-worn actigraphy to track activity and sleep could detect mevidalen treatment effects in LBD. Methods: Of 340 participants enrolled in PRESENCE, 238 wore actigraphy for three 2-week periods: pre-, during, and post-intervention. A subset of participants (n = 160) enrolled in a sub-study using an iPad trial app with 3 tests: digital symbol substitution (DSST), spatial working memory (SWM), and finger-tapping. Compliance was defined as daily test completion or watch-wearing ≥23 h/day. Change from baseline to week 12 (app) or week 8 (actigraphy) was used to assess treatment effects using Mixed Model Repeated Measures analysis. Pearson correlations between sensor-derived features and clinical endpoints were assessed. Results: Actigraphy and trial app compliance was > 90% and > 60%, respectively. At baseline, daytime sleep positively correlated with Epworth Sleepiness Scale score (p < 0.01). Physical activity correlated with improvement on Movement Disorder Society –Unified Parkinson Disease Rating Scale (MDS-UPDRS) part II (p < 0.001). Better scores of DSST and SWM correlated with lower Alzheimer Disease Assessment Scale –Cognitive 13-Item Scale (ADAS-Cog13) (p < 0.001). Mevidalen treatment (30 mg) improved SWM (p < 0.01), while dose-dependent decreases in daytime sleep (10 mg: p < 0.01, 30 mg: p < 0.05, 75 mg: p < 0.001), and an increase in walking minutes (75 mg dose: p < 0.001) were observed, returning to baseline post-intervention. Conclusion: Devices used in the LBD population achieved adequate compliance and digital metrics detected statistically significant treatment effects.
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Affiliation(s)
- Jian Wang
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | - Hui Zhang
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Albert Man
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Jasmine Zou
- Eli Lilly and Company, Indianapolis, IN, USA
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Jones-Tabah J, Mohammad H, Paulus EG, Clarke PBS, Hébert TE. The Signaling and Pharmacology of the Dopamine D1 Receptor. Front Cell Neurosci 2022; 15:806618. [PMID: 35110997 PMCID: PMC8801442 DOI: 10.3389/fncel.2021.806618] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/23/2021] [Indexed: 12/30/2022] Open
Abstract
The dopamine D1 receptor (D1R) is a Gαs/olf-coupled GPCR that is expressed in the midbrain and forebrain, regulating motor behavior, reward, motivational states, and cognitive processes. Although the D1R was initially identified as a promising drug target almost 40 years ago, the development of clinically useful ligands has until recently been hampered by a lack of suitable candidate molecules. The emergence of new non-catechol D1R agonists, biased agonists, and allosteric modulators has renewed clinical interest in drugs targeting this receptor, specifically for the treatment of motor impairment in Parkinson's Disease, and cognitive impairment in neuropsychiatric disorders. To develop better therapeutics, advances in ligand chemistry must be matched by an expanded understanding of D1R signaling across cell populations in the brain, and in disease states. Depending on the brain region, the D1R couples primarily to either Gαs or Gαolf through which it activates a cAMP/PKA-dependent signaling cascade that can regulate neuronal excitability, stimulate gene expression, and facilitate synaptic plasticity. However, like many GPCRs, the D1R can signal through multiple downstream pathways, and specific signaling signatures may differ between cell types or be altered in disease. To guide development of improved D1R ligands, it is important to understand how signaling unfolds in specific target cells, and how this signaling affects circuit function and behavior. In this review, we provide a summary of D1R-directed signaling in various neuronal populations and describe how specific pathways have been linked to physiological and behavioral outcomes. In addition, we address the current state of D1R drug development, including the pharmacology of newly developed non-catecholamine ligands, and discuss the potential utility of D1R-agonists in Parkinson's Disease and cognitive impairment.
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22
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Veselinović T, Neuner I. Progress and Pitfalls in Developing Agents to Treat Neurocognitive Deficits Associated with Schizophrenia. CNS Drugs 2022; 36:819-858. [PMID: 35831706 PMCID: PMC9345797 DOI: 10.1007/s40263-022-00935-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 12/11/2022]
Abstract
Cognitive impairments associated with schizophrenia (CIAS) represent a central element of the symptomatology of this severe mental disorder. CIAS substantially determine the disease prognosis and hardly, if at all, respond to treatment with currently available antipsychotics. Remarkably, all drugs presently approved for the treatment of schizophrenia are, to varying degrees, dopamine D2/D3 receptor blockers. In turn, rapidly growing evidence suggests the immense significance of systems other than the dopaminergic system in the genesis of CIAS. Accordingly, current efforts addressing the unmet needs of patients with schizophrenia are primarily based on interventions in other non-dopaminergic systems. In this review article, we provide a brief overview of the available evidence on the importance of specific systems in the development of CIAS. In addition, we describe the promising targets for the development of new drugs that have been used so far. In doing so, we present the most important candidates that have been investigated in the field of the specific systems in recent years and present a summary of the results available at the time of drafting this review (May 2022), as well as the currently ongoing studies.
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Affiliation(s)
- Tanja Veselinović
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich, Jülich, Germany.
| | - Irene Neuner
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich, Jülich, Germany
- JARA-BRAIN, Aachen, Germany
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