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Dorogan M, Namballa HK, Harding WW. Natural Product-Inspired Dopamine Receptor Ligands. J Med Chem 2024; 67:12463-12484. [PMID: 39038276 PMCID: PMC11320586 DOI: 10.1021/acs.jmedchem.4c00537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/30/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024]
Abstract
Due to their evolutionary bias as ligands for biologically relevant drug targets, natural products offer a unique opportunity as lead compounds in drug discovery. Given the involvement of dopamine receptors in various physiological and behavioral functions, they are linked to numerous diseases and disorders such as Parkinson's disease, schizophrenia, and substance use disorders. Consequently, ligands targeting dopamine receptors hold considerable therapeutic and investigative promise. As this perspective will highlight, dopamine receptor targeting natural products play a pivotal role as scaffolds with unique and beneficial pharmacological properties, allowing for natural product-inspired drug design and lead optimization. As such, dopamine receptor targeting natural products still have untapped potential to aid in the treatment of disorders and diseases related to central nervous system (CNS) and peripheral nervous system (PNS) dysfunction.
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Affiliation(s)
- Michael Dorogan
- Department
of Chemistry, Hunter College, City University
of New York, 695 Park
Avenue, New York, New York 10065, United States
| | - Hari K. Namballa
- Department
of Chemistry, Hunter College, City University
of New York, 695 Park
Avenue, New York, New York 10065, United States
| | - Wayne W. Harding
- Department
of Chemistry, Hunter College, City University
of New York, 695 Park
Avenue, New York, New York 10065, United States
- Program
in Biochemistry, CUNY Graduate Center, 365 Fifth Avenue, New York, New York 10016, United States
- Program
in Chemistry, CUNY Graduate Center, 365 Fifth Avenue, New York, New York 10016, United
States
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2
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Béreau M, Giffard M, Clairet AL, Degenne G, Tatu L, Richfield E, Magnin E, Vérin M, Auffret M. Terminal Care in Parkinson's Disease: Real-Life Use of Continuous Subcutaneous Apomorphine Infusion to Improve Patient Comfort. JOURNAL OF PARKINSON'S DISEASE 2024; 14:209-219. [PMID: 38217611 PMCID: PMC10836545 DOI: 10.3233/jpd-230201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND There are currently no recommendations on the therapeutic management of Parkinson's disease (PD) patients at the end of life. OBJECTIVE To describe a cohort of patients with PD who benefited from continuous subcutaneous apomorphine infusion (CSAI) initiation at the end of their life as comfort care. METHODS This real-life cohort includes 14 PD patients, who benefited from 24-h, low-dose CSAI (0.5-3 mg/h) in the context of terminal care. Patient's comfort (pain, rigidity, and/or ability to communicate) and occurrence of CSAI-related side-effects (nausea/vomiting, cutaneous and behavioral manifestations) were evaluated based on medical records. RESULTS All patients (age 62-94 years, disease duration 2-32 years) presented with late-stage PD and a compromised oral route. Treatment lasted from a few hours to 39 days. CSAI led to substantial functional improvement, with a good safety profile. Overall clinical comfort was deemed improved by the medical team, the patient, and/or caregivers. CONCLUSIONS CSAI might be a promising approach in PD terminal care, as it reduces motor symptoms and overall discomfort, with an apparent good safety profile. Use of the apomorphine pen, sublingual film or a classic syringe pump might be considered when apomorphine pumps are not available. Larger observational cohorts and randomized controlled trials are needed to establish the efficacy and tolerability of apomorphine in the context of terminal care and more broadly, in an advance care planning perspective.
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Affiliation(s)
- Matthieu Béreau
- Neurology Department, CHU Besançon, Besançon, France
- Université de Franche-Comté, UR LINC, Besançon, France
| | - Mathilde Giffard
- Mobile Palliative Care Team, CHU Besançon, Besançon, France
- Inserm CIC 1431, CHU Besançon, Besançon, France
| | - Anne-Laure Clairet
- Department of Pharmacy, University Hospital of Besançon, Besançon, France
| | | | - Laurent Tatu
- Neurology Clinical Electrophysiology Department, CHU Besançon, Besançon, France
- Laboratoire d’Anatomie, Université de Franche-Comté, Besançon, France
| | - Edward Richfield
- North Bristol NHS Trust, Department of Geriatrics, Southmead Road, Southmead, Bristol, UK
| | - Eloi Magnin
- Neurology Department, CHU Besançon, Besançon, France
- Université de Franche-Comté, UR LINC, Besançon, France
- Centre Neurodéveloppemental ⪡Hors Normes⪢, AFTC, Besançon, France
| | - Marc Vérin
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- Behavior & Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital, & University of Rennes, Rennes, France
- Neurology Department, Movement Disorders Unit, Pontchaillou University Hospital, Rennes, France
| | - Manon Auffret
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- Behavior & Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital, & University of Rennes, Rennes, France
- France Développement Electronique (FDE), Monswiller, France
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Henriksen T, Katzenschlager R, Bhidayasiri R, Staines H, Lockhart D, Lees A. Practical use of apomorphine infusion in Parkinson's disease: lessons from the TOLEDO study and clinical experience. J Neural Transm (Vienna) 2023; 130:1475-1484. [PMID: 37658155 PMCID: PMC10645621 DOI: 10.1007/s00702-023-02686-7] [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: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023]
Abstract
Subcutaneous apomorphine infusion is a device-aided therapy for Parkinson's disease that can be considered when motor fluctuations become persistent and are no longer adequately controlled by oral/transdermal medication. Apomorphine infusion is less invasive than enteral levodopa, deep brain stimulation or focused ultrasound, and is often indicated even when neurosurgical approaches are contraindicated. This article aims to provide practical guidance for doctors and nurses initiating and treating patients with apomorphine infusion, and is based on both trial data and clinical experience from movement disorders specialists. A post hoc analysis of data from the TOLEDO randomized clinical trial of apomorphine infusion was conducted along with an analysis of 'real world' experience from 13 movement disorders specialists using a questionnaire that focused on starting patients on apomorphine infusion. Practical guidelines for starting treatment with apomorphine infusion are provided taking into consideration the regional disparities in healthcare. Apomorphine infusion is straightforward to administer but to be successful it requires concordance from the patient and family, and clinical support from an experienced team of doctors and nurses, particularly in the early months of treatment.
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Affiliation(s)
- Tove Henriksen
- Department of Neurology, Movement Disorder Clinic, University Hospital of Bispebjerg, 2400, Copenhagen, Denmark.
| | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Klinik Donaustadt, Vienna, Austria
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | | | - Donna Lockhart
- Britannia Pharmaceuticals Limited, Reading, Berkshire, UK
| | - Andrew Lees
- University College London Institute of Neurology and the National Hospital, Queen Square, London, UK
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4
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Pirtošek Z, Leta V, Jenner P, Vérin M. Should continuous dopaminergic stimulation be a standard of care in advanced Parkinson's disease? J Neural Transm (Vienna) 2023; 130:1395-1404. [PMID: 37930456 DOI: 10.1007/s00702-023-02708-4] [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: 08/09/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023]
Abstract
The standard of care is a term that refers to the level of care, skill, and treatment that a healthcare provider should offer to a patient based on the current scientific evidence and the level of medical knowledge available in the field. For Parkinson's disease (PD), the standard care is mostly considered to be oral treatment with dopaminergic drugs, particularly levodopa which remains the 'gold standard'. However, effective management with levodopa during the later stages of the disease becomes increasingly challenging due to the ongoing neurodegenerative process, the consequences of its pulsatile dopaminergic stimulation, and the gastrointestinal barriers to effective drug absorption. As a result, the concept of applying continuous dopaminergic stimulation has emerged with infusion therapies (continuous subcutaneous apomorphine, levodopa-carbidopa intestinal gel, and levodopa-entacapone-carbidopa intestinal gel infusion). These therapies seek to provide continuous stimulation of striatal dopamine receptors that is efficient not only in alleviating clinical symptoms, but also in delaying, reducing, and possibly preventing the onset of levodopa-related motor (fluctuations, dyskinesia) and non-motor complications; and they are also associated with clinically relevant side effects. Clinical studies and real-life experience support the notion that infusion therapies should be accepted as part of the standard of care for patients with advanced PD who have refractory, severe, and disabling motor complications that affect their quality of life. However, they should be considered based on the needs of individualized patients and the access to these advanced therapies needs to be made more accessible to the general PD population.
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Affiliation(s)
- Z Pirtošek
- Department of Neurology University Medical Centre and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - V Leta
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit Fondazione IRCCS Istituto, Neurologico Carlo Besta Milan, Milan, Italy
| | - P Jenner
- Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 1UL, UK
| | - M Vérin
- Institut Des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- Behavior and Basal Ganglia Research Unit, CIC-IT INSERM 1414, University of Rennes, Rennes, France
- Neurology Department, Pontchaillou University Hospital, rue Henri Le Guilloux, 35000, Rennes, France
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5
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Auffret M, Weiss D, Stocchi F, Vérin M, Jost WH. Access to device-aided therapies in advanced Parkinson's disease: navigating clinician biases, patient preference, and prognostic uncertainty. J Neural Transm (Vienna) 2023; 130:1411-1432. [PMID: 37436446 PMCID: PMC10645670 DOI: 10.1007/s00702-023-02668-9] [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: 05/04/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
Device-aided therapies (DAT), which include deep brain stimulation and pump-based continuous dopaminergic stimulation with either levodopa or apomorphine, are among the major advances in the clinical management of Parkinson's disease (PD). Although DAT are being increasingly offered earlier in the disease course, their classical indication remains advanced PD. Theoretically, every patient should be offered transition to DAT when faced with refractory motor and nonmotor fluctuations and functional decline. Worldwide clinical reality is far from these ideal, and, therefore, question the "real-world" equal opportunity of access to DAT for PD patients with advanced PD-even within a single health care system. Differences in access to care, referral pattern (timing and frequency), as well as physician biases (unconscious/implicit or conscious/explicit bias), and patients' preferences or health-seeking behaviour are to be considered. Compared to DBS, little information is available concerning infusion therapies, as well as neurologists' and patients' attitudes towards them. This viewpoint aims to be thought-provoking and to assist clinicians in moving through the process of DAT selection, by including in their decision algorithm their own biases, patient perspective, ethical concerns as well as the current unknowns surrounding PD prognosis and DAT-related long-term side effects for a given patient.
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Affiliation(s)
- Manon Auffret
- France Développement Electronique (FDE), Monswiller, France.
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France.
- Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France.
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Fabrizio Stocchi
- University San Raffaele Roma and Institute of Research and Medical Care IRCCS San Raffaele Roma, Rome, Italy
| | - Marc Vérin
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France
- Neurology Department, Pontchaillou University Hospital, rue Henri Le Guilloux, 35000, Rennes, France
| | - Wolfgang H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstr. 12-16, 77709, Wolfach, Germany
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6
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Jenner P, Falup-Pecurariu C, Leta V, Verin M, Auffret M, Bhidayasiri R, Weiss D, Borovečki F, Jost WH. Adopting the Rumsfeld approach to understanding the action of levodopa and apomorphine in Parkinson's disease. J Neural Transm (Vienna) 2023; 130:1337-1347. [PMID: 37210460 PMCID: PMC10645644 DOI: 10.1007/s00702-023-02655-0] [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: 04/04/2023] [Accepted: 05/14/2023] [Indexed: 05/22/2023]
Abstract
Dopaminergic therapies dominate the treatment of the motor and non-motor symptoms of Parkinson's disease (PD) but there have been no major advances in therapy in many decades. Two of the oldest drugs used appear more effective than others-levodopa and apomorphine-but the reasons for this are seldom discussed and this may be one cause for a lack of progress. This short review questions current thinking on drug action and looks at whether adopting the philosophy of ex-US Secretary of State Donald Rumsfeld reveals 'unknown' aspects of the actions of levodopa and apomorphine that provide clues for a way forward. It appears that both levodopa and apomorphine have a more complex pharmacology than classical views would suggest. In addition, there are unexpected facets to the mechanisms through which levodopa acts that are either forgotten as 'known unknowns' or ignored as 'unknown unknowns'. The conclusion reached is that we may not know as much as we think about drug action in PD and there is a case for looking beyond the obvious.
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Affiliation(s)
- P Jenner
- Faculty of Life Sciences and Medicine, Institute of Pharmaceutical Sciences, King's College London, London, SE1 1UL, UK.
| | - C Falup-Pecurariu
- Department of Neurology, Transylvania University, 500036, Brasov, Romania
| | - V Leta
- Parkinson's Foundation Center of Excellence at King's College Hospital; Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, Institute of Psychology, Psychiatry and Neurosciences, King's College London, London, UK
| | - M Verin
- Institut des Neurosciences Cliniques de Rennes (INCR); Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France
| | - M Auffret
- Institut des Neurosciences Cliniques de Rennes (INCR); Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France
- France Développement Electronique (FDE), Monswiller, France
| | - Roongroj Bhidayasiri
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, 10330, Thailand
| | - D Weiss
- Department for Neurodegenerative Diseases, Centre for Neurology, Hertie-Institute for Clinical Brain Research, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - F Borovečki
- Division for Neurodegenerative Diseases and Neurogenomics, Department of Neurology, University Hospital Centre Zagreb, 10000, Zagreb, Croatia
| | - W H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstr. 12-16, 77709, Wolfach, Germany
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Cochen De Cock V, Dodet P, Leu‐Semenescu S, Aerts C, Abril B, Castelnovo G, Landragin N, Drapier S, Olivet H, Corbillé A, Leclair‐Visonneau L, Anheim M, Vidailhet M, Arnulf I, Doulazmi M, Roze E. Night-Time Apomorphine Infusion: Who Are the Best Candidates? Mov Disord Clin Pract 2023; 10:1192-1197. [PMID: 37635769 PMCID: PMC10450238 DOI: 10.1002/mdc3.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 08/29/2023] Open
Abstract
Background We recently demonstrated in a randomized controlled trial (APOMORPHEE, NCT02940912) that night-time only subcutaneous apomorphine infusion improves sleep disturbances and insomnia in patients with advanced Parkinson's disease and moderate to severe insomnia. Objectives To identify the best candidates for receiving night-time only subcutaneous apomorphine infusion in routine care. Methods In this post-hoc analysis of APOMORPHEE, we compared the characteristics of patients according to whether they chose to continue night-time only subcutaneous apomorphine infusion at the end of the study period or not. Results Half of the patients (22/42) chose to continue the treatment. Off duration (day or night), painful Off dystonia, and insomnia severity at baseline were associated with night-time only apomorphine continuation. Multivariate analysis retained only Off duration as an independent predictor of continuation. Conclusions The best candidates for night-time only apomorphine are patients with severe and prolonged Off periods (day or night) and severe insomnia.
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Affiliation(s)
- Valérie Cochen De Cock
- Sleep and Neurology DepartmentBeau Soleil ClinicMontpellierFrance
- EuroMov Digital Health in MotionUniv Montpellier, IMT Mines AlèsMontpellierFrance
| | - Pauline Dodet
- Sleep Disorders UnitPitié‐Salpêtrière University HospitalParisFrance
| | | | - Cécile Aerts
- Sleep and Neurology DepartmentBeau Soleil ClinicMontpellierFrance
- EuroMov Digital Health in MotionUniv Montpellier, IMT Mines AlèsMontpellierFrance
| | - Beatriz Abril
- Sleep DepartmentUniversity Hospital of NîmesNîmesFrance
| | | | | | - Sophie Drapier
- Department of NeurologyPontchaillou INSERM CIC1414RennesFrance
| | - Hélène Olivet
- Sleep DepartmentPolyclinique Rennes Saint‐LaurentRennesFrance
| | | | - Laurène Leclair‐Visonneau
- Clinical Neurophysiology DepartmentUniversity Hospital of Nantes, INSERM U1235, Nantes UniversityNantesFrance
| | - Mathieu Anheim
- Department of NeurologyUniversity Hospital of StrasbourgStrasbourgFrance
- Genetic Institute and Molecular and Cellular Biology (IGBMC), INSERM‐U964/CNRS‐UMR7104/ Strasbourg UniversityIllkirchFrance
| | - Marie Vidailhet
- AP‐HP, Salpetriere Hospital, DMU Neuroscience 6ParisFrance
- Sorbonne University, Paris Brain Institute, Inserm, CNRSParisFrance
| | - Isabelle Arnulf
- Sleep Disorders UnitPitié‐Salpêtrière University HospitalParisFrance
- Sorbonne University, Paris Brain Institute, Inserm, CNRSParisFrance
| | - Mohamed Doulazmi
- Adaptation Biologique et Vieillissement (UMR8256), Institut de Biologie Paris Seine, Sorbonne University, CNRSParisFrance
| | - Emmanuel Roze
- AP‐HP, Salpetriere Hospital, DMU Neuroscience 6ParisFrance
- Sorbonne University, Paris Brain Institute, Inserm, CNRSParisFrance
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Preetam S, Jonnalagadda S, Kumar L, Rath R, Chattopadhyay S, Alghamdi BS, Abuzenadah AM, Jha NK, Gautam A, Malik S, Ashraf GM. Therapeutic potential of lipid nanosystems for the treatment of Parkinson's disease. Ageing Res Rev 2023; 89:101965. [PMID: 37268112 DOI: 10.1016/j.arr.2023.101965] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/28/2023] [Accepted: 05/28/2023] [Indexed: 06/04/2023]
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder. The degeneration of dopaminergic neurons in the midbrain is primarily responsible for the onset of the disease. The major challenge faced in the treatment of PD is the blood-brain barrier (BBB), which impedes the delivery of therapeutics to targeted locations. To address this issue, lipid nanosystems have been used for the precise delivery of therapeutic compounds in anti-PD therapy. In this review, we will discuss the application and clinical significance of lipid nanosystem in delivering therapeutic compounds for anti-PD treatment. These medicinal compounds include ropinirole, apomorphine, bromocriptine, astaxanthin, resveratrol, dopamine, glyceryl monooleate, levodopa, N-3,4-bis(pivaloyloxy)- dopamine and fibroblast growth factor, which have significant potential to treat PD in the early stage. This review, in a nutshell, will pave the way for researchers to develop diagnostic and potential therapeutic approaches using nanomedicine to overcome the challenges posed by the BBB in delivering therapeutic compounds for PD.
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Affiliation(s)
- Subham Preetam
- Institute of Advanced Materials, IAAM, Gammalkilsvägen 18, Ulrika, 59053, Sweden; Centre for Biotechnology, Siksha O Anusandhan (SOA-DU), Bhubaneswar 751030, Odisha, India.
| | - Swathi Jonnalagadda
- School of Biology, Indian Institute of Science Education and Research, Thiruvananthapuram, India.
| | - Lamha Kumar
- School of Biology, Indian Institute of Science Education and Research, Thiruvananthapuram, India.
| | - Rajeswari Rath
- Centre for Biotechnology, Siksha O Anusandhan (SOA-DU), Bhubaneswar 751030, Odisha, India.
| | - Soham Chattopadhyay
- Department of Zoology, Maulana Azad College, Kolkata, Kolkata-700013, West Bengal, India.
| | - Badrah S Alghamdi
- Department of Physiology, Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Adel M Abuzenadah
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201310, India; Department of Biotechnology, School of Applied & Life Sciences (SALS), Uttaranchal University, Dehradun 248007, India; School of Bioengineering & Biosciences, Lovely Professional University, Phagwara 144411, India; Department of Biotechnology Engineering and Food Technology, Chandigarh University, Mohali, 140413, India.
| | - Akash Gautam
- Centre for Neural and Cognitive Sciences, University of Hyderabad, Hyderabad 500046, India.
| | - Sumira Malik
- Amity Institute of Biotechnology, Amity University Jharkhand, Ranchi, Jharkhand, 834001, India; Guru Nanak College of Pharmaceutical Sciences, Chakrata Road, Jhajra, Dehradun 248007, India.
| | - Ghulam Md Ashraf
- University of Sharjah, College of Health Sciences, and Research Institute for Medical and Health Sciences, Department of Medical Laboratory Sciences.
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9
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van Vliet EF, Knol MJ, Schiffelers RM, Caiazzo M, Fens MHAM. Levodopa-loaded nanoparticles for the treatment of Parkinson's disease. J Control Release 2023; 360:212-224. [PMID: 37343725 DOI: 10.1016/j.jconrel.2023.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 06/23/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by degeneration of dopaminergic neurons in the substantia nigra pars compacta (SNpc) resulting in dopamine (DA) deficiency, which manifests itself in motor symptoms including tremors, rigidity and bradykinesia. Current PD treatments aim at symptom reduction through oral delivery of levodopa (L-DOPA), a precursor of DA. However, L-DOPA delivery to the brain is inefficient and increased dosages are required as the disease progresses, resulting in serious side effects like dyskinesias. To improve PD treatment efficacy and to reduce side effects, recent research focuses on the encapsulation of L-DOPA into polymeric- and lipid-based nanoparticles (NPs). These formulations can protect L-DOPA from systemic decarboxylation into DA and improve L-DOPA delivery to the central nervous system. Additionally, NPs can be modified with proteins, peptides and antibodies specifically targeting the blood-brain barrier (BBB), thereby reducing required dosages and free systemic DA. Alternative delivery approaches for NP-encapsulated L-DOPA include intravenous (IV) administration, transdermal delivery using adhesive patches and direct intranasal administration, facilitating increased therapeutic DA concentrations in the brain. This review provides an overview of the recent advances for NP-mediated L-DOPA delivery to the brain, and debates challenges and future perspectives on the field.
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Affiliation(s)
- Emile F van Vliet
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, the Netherlands
| | - Maarten J Knol
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, the Netherlands
| | | | - Massimiliano Caiazzo
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, the Netherlands; Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy.
| | - Marcel H A M Fens
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG Utrecht, the Netherlands.
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Gurram PC, Satarker S, Nassar A, Mudgal J, Nampoothiri M. Virtual structure-based docking and molecular dynamics of FDA-approved drugs for the identification of potential IKKB inhibitors possessing dopaminergic activity in Alzheimer’s disease. CHEMICAL PAPERS 2022. [DOI: 10.1007/s11696-022-02598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractIn Alzheimer's disease (AD), neuroinflammation is detrimental in causing neurodegeneration. In the central nervous system, inhibitor of nuclear factor kappa B kinase subunit beta (IKK2/IKKβ/IKKB/IKBKB) signaling is linked to neuroinflammation-mediated learning and memory deficits through canonical pathway, while dopamine agonists have been known to reverse such effects. Our in silico analysis predicted if dopaminergic agonists could have IKKB inhibitory actions, to ameliorate neuroinflammation-associated learning and memory deficits. Here, the FDA-approved Zinc 15 database was screened with IKKB (PDB ID 4KIK). Potential molecules with IKKB inhibition were identified through docking, which also possessed dopaminergic activity. Molecular mechanics—generalized Born and surface area (MMGBSA), induced fit docking (IFD) and molecular dynamic (MD) studies of 100 ns simulation time were done. Apomorphine and rotigotine showed greater non-bonding and bonding interactions with amino acids of IKKB as compared to Aripiprazole in docking studies. The IFD studies predicted improved interactions with IKKB. MMGBSA scores indicated that the complex binding free energies were favorable, and MD studies showed an acceptable root mean square deviation between protein and ligands. The protein–ligand interactions showed hydrogen bonds, water and salt bridges necessary for IKKB inhibition, as well as solvent system stability. On the protein–ligand contact map, the varying color band intensities represented the ligand’s ability to bind with amino acids. Dopamine agonists apomorphine, rotigotine, and aripiprazole were predicted to bind and inhibit IKKB in in silico system.
Graphical Abstract
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11
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De Cock VC, Dodet P, Leu-Semenescu S, Aerts C, Castelnovo G, Abril B, Drapier S, Olivet H, Corbillé AG, Leclair-Visonneau L, Sallansonnet-Froment M, Lebouteux M, Anheim M, Ruppert E, Vitello N, Eusebio A, Lambert I, Marques A, Fantini ML, Devos D, Monaca C, Benard-Serre N, Lacombe S, Vidailhet M, Arnulf I, Doulazmi M, Roze E. Safety and efficacy of subcutaneous night-time only apomorphine infusion to treat insomnia in patients with Parkinson's disease (APOMORPHEE): a multicentre, randomised, controlled, double-blind crossover study. Lancet Neurol 2022; 21:428-437. [DOI: 10.1016/s1474-4422(22)00085-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/13/2022]
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12
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Lima VDA, Esquinelato R, Carmo-Gonçalves P, Nascimento LAD, Lee H, Eliezer D, Romão L, Follmer C. The dopamine receptor agonist apomorphine stabilizes neurotoxic α-synuclein oligomers. FEBS Lett 2022; 596:309-322. [PMID: 34928512 PMCID: PMC8972942 DOI: 10.1002/1873-3468.14263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/13/2021] [Accepted: 12/10/2021] [Indexed: 02/03/2023]
Abstract
The misfolding and aggregation of the protein α-synuclein (aSyn) into potentially neurotoxic oligomers is believed to play a pivotal role in the neuropathogenesis of Parkinson's disease (PD). Herein, we explore how apomorphine (Apo), a nonselective dopamine D1 and D2 receptor agonist utilized in the therapy for PD, affects the aggregation and toxicity of aSyn in vitro. Our data indicated that Apo inhibits aSyn fibrillation leading to the formation of large oligomeric species (Apo-aSyn-O), which exhibit remarkable toxicity in mesencephalic dopaminergic neurons in primary cultures. Interestingly, purified Apo-aSyn-O, even at very low concentrations, seems to be capable of converting unmodified aSyn monomer into neurotoxic species. Collectively, our findings warn for a possible dangerous effect of Apo on aSyn misfolding/aggregation pathway.
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Affiliation(s)
- Vanderlei de Araujo Lima
- Department of Physical Chemistry, Federal University of Rio de Janeiro, Brazil
- Graduate Program in Chemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo Esquinelato
- Department of Physical Chemistry, Federal University of Rio de Janeiro, Brazil
| | - Phelippe Carmo-Gonçalves
- Department of Physical Chemistry, Federal University of Rio de Janeiro, Brazil
- Graduate Program in Chemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Hudson Lee
- Department of Biochemistry, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - David Eliezer
- Department of Biochemistry, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Luciana Romão
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cristian Follmer
- Department of Physical Chemistry, Federal University of Rio de Janeiro, Brazil
- Graduate Program in Chemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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13
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Majali MA, Sunnaa M, Chand P. Emerging Pharmacotherapies for Motor Symptoms in Parkinson's Disease. J Geriatr Psychiatry Neurol 2021; 34:263-273. [PMID: 34219526 DOI: 10.1177/08919887211018275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parkinson's disease (PD) is the second commonest neurodegenerative disorder in the older adult and is characterized by progressive disabling motor symptoms of bradykinesia, tremor, rigidity, postural instability and also non motor symptoms that affect quality of life. The pharmacotherapy of PD consists of oral, transdermal, and subcutaneous medications, as well as invasive advanced therapies at later stages of the disease. PD medications are often started as monotherapy but with the progression of the illness often there is a need to add more medications and frequently comprises of a challenging polypharmacotherapy. Adverse effects of pharmacotherapy often add to the problems of adequate treatment. Patients and physicians have to prioritize treatment goals on the most disabling symptoms and the safest and most effective treatments. Almost every year newer medications and modes of delivery continue to be researched and added to the therapeutic armamentarium. This review article outlines existing and emerging pharmacotherapies for motor symptoms in PD.
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Affiliation(s)
- Mohammad Al Majali
- Department Of Neurology, 12274St Louis University School of Medicine, Spring, St Louis, MO, USA
| | - Michael Sunnaa
- Department Of Neurology, 12274St Louis University School of Medicine, Spring, St Louis, MO, USA
| | - Pratap Chand
- Department Of Neurology, 12274St Louis University School of Medicine, Spring, St Louis, MO, USA
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14
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Meira B, Degos B, Corsetti E, Doulazmi M, Berthelot E, Virbel-Fleischman C, Dodet P, Méneret A, Mariani LL, Delorme C, Cormier-Dequaire F, Bendetowicz D, Villain N, Tarrano C, Mantisi L, Letrillart H, Louapre C, McGovern E, Worbe Y, Grabli D, Vidailhet M, Hainque E, Roze E. Long-term effect of apomorphine infusion in advanced Parkinson's disease: a real-life study. NPJ PARKINSONS DISEASE 2021; 7:50. [PMID: 34117268 PMCID: PMC8196159 DOI: 10.1038/s41531-021-00194-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/09/2021] [Indexed: 02/06/2023]
Abstract
Long-term effects of continuous subcutaneous apomorphine infusion (CSAI) on health-related quality of life (HRQoL) and predictors of CSAI discontinuation are poorly known. Data from consecutive advanced Parkinson’s disease patients treated in routine care were retrospectively collected over 24 months after CSAI initiation, with a focus on the 39-item Parkinson’s disease questionnaire (PDQ-39). We determined predictors of CSAI discontinuation and HRQoL improvement using multiple regression analysis. Of the 110 subjects evaluated over a 2-year period, 35% discontinued CSAI. Of those who continued treatment, HRQoL remained stable with a sustained reduction in motor fluctuations. The observed effect on dyskinesias was mild and transient. Of note, patients with preexisting impulse control disorders showed an overall good tolerability. PDQ-39 was the only baseline predictor of HRQoL improvement after 2 years of treatment. The presence of dyskinesias, poorer psychological status, shorter disease duration, male sex, and worse OFF state were predictors of discontinuation. Best candidates for CSAI are patients with: (i) poor baseline HRQoL and (ii) marked motor fluctuations.
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Affiliation(s)
- Bruna Meira
- Neurology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Bertrand Degos
- Neurology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Elise Corsetti
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Mohamed Doulazmi
- Adaptation Biologique et Vieillissement, Institut de Biologie Paris Seine, Sorbonne University, CNRS, Paris, France
| | - Emeline Berthelot
- Neurology Department, Hôpital Zobda Quitman, Fort-de-France, French West Indies, France
| | - Clara Virbel-Fleischman
- Air Liquide SA, Explor Center (Healthcare), Fort-de-France, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Pauline Dodet
- Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France.,Sleep Disorders (Department "R3S"), Pitié-Salpêtrière Hospital, Paris, France
| | - Aurélie Méneret
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Louise-Laure Mariani
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Cécile Delorme
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Florence Cormier-Dequaire
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - David Bendetowicz
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Nicolas Villain
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France.,Sorbonne Université, GRC no 21, Alzheimer Precision Medicine, Paris, France
| | - Clément Tarrano
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Lise Mantisi
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Hélène Letrillart
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Céline Louapre
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Eavan McGovern
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Yulia Worbe
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Neurophysiology Department, Saint Antoine Hospital, AP-HP, Paris, France
| | - David Grabli
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Marie Vidailhet
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Elodie Hainque
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Emmanuel Roze
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France. .,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France.
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15
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Silva S, Almeida AJ, Vale N. Importance of Nanoparticles for the Delivery of Antiparkinsonian Drugs. Pharmaceutics 2021; 13:508. [PMID: 33917696 PMCID: PMC8068059 DOI: 10.3390/pharmaceutics13040508] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 11/27/2022] Open
Abstract
Parkinson's disease (PD) affects around ten million people worldwide and is considered the second most prevalent neurodegenerative disease after Alzheimer's disease. In addition, there is a higher risk incidence in the elderly population. The main PD hallmarks include the loss of dopaminergic neurons and the development of Lewy bodies. Unfortunately, motor symptoms only start to appear when around 50-70% of dopaminergic neurons have already been lost. This particularly poses a huge challenge for early diagnosis and therapeutic effectiveness. Actually, pharmaceutical therapy is able to relief motor symptoms, but as the disease progresses motor complications and severe side-effects start to appear. In this review, we explore the research conducted so far in order to repurpose drugs for PD with the use of nanodelivery systems, alternative administration routes, and nanotheranostics. Overall, studies have demonstrated great potential for these nanosystems to target the brain, improve drug pharmacokinetic profile, and decrease side-effects.
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Affiliation(s)
- Sara Silva
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal;
- Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, 1649-003 Lisbon, Portugal;
| | - António J. Almeida
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, 1649-003 Lisbon, Portugal;
| | - Nuno Vale
- OncoPharma Research Group, Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal;
- Faculty of Medicine, University of Porto, Al. Hernâni Monteiro, 4200-319 Porto, Portugal
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16
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Prediction of Total Drug Clearance in Humans Using Animal Data: Proposal of a Multimodal Learning Method Based on Deep Learning. J Pharm Sci 2021; 110:1834-1841. [PMID: 33497658 DOI: 10.1016/j.xphs.2021.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/20/2022]
Abstract
Research into pharmacokinetics plays an important role in the development process of new drugs. Accurately predicting human pharmacokinetic parameters from preclinical data can increase the success rate of clinical trials. Since clearance (CL) which indicates the capacity of the entire body to process a drug is one of the most important parameters, many methods have been developed. However, there are still rooms to be improved for practical use in drug discovery research; "improving CL prediction accuracy" and "understanding the chemical structure of compounds in terms of pharmacokinetics". To improve those, this research proposes a multimodal learning method based on deep learning that takes not only the chemical structure of a drug but also rat CL as inputs. Good results were obtained compared with the conventional animal scale-up method; the geometric mean fold error was 2.68 and the proportion of compounds with prediction errors of 2-fold or less was 48.5%. Furthermore, it was found to be possible to infer the partial structure useful for CL prediction by a structure contributing factor inference method. The validity of these results of structural interpretation of metabolic stability was confirmed by chemists.
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17
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Gómez-López A, Sánchez-Sánchez A, Natera-Villalba E, Ros-Castelló V, Beltrán-Corbellini Á, Fanjul-Arbós S, Pareés Moreno I, López-Sendon Moreno JL, Martínez Castrillo JC, Alonso-Canovas A. SURINPARK: Safinamide for Urinary Symptoms in Parkinson's Disease. Brain Sci 2021; 11:57. [PMID: 33418858 PMCID: PMC7825064 DOI: 10.3390/brainsci11010057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Urinary symptoms are common, disabling and generally unresponsive to treatment in Parkinson´s disease (PD). Safinamide is approved as an add-on therapy to levodopa to improve fluctuations. METHODS Retrospective analysis of electronic records of nondemented PD patients seen consecutively in a Movement Disorders Unit (November 2018-February 2019). All were assessed with Scale for Outcomes in Parkinson's disease for Autonomic Symptoms-Urinary subscale (SCOPA-AUT-U) by the attending neurologist, and a month afterwards by an independent researcher blinded to treatment and clinical records in a routine clinical practice setting. Clinical variables were compared among patients who were prescribed safinamide (SA+) for the treatment of motor fluctuations and those with different treatment regimes (SA-). RESULTS From 169 patients screened initially, 54 were excluded due to severe incontinence, absence of urinary symptoms or previous safinamide treatment. Thirty-five patients were included in SA+ and 79 in SA-. Both groups were comparable in terms of clinical variables, except in basal urinary symptoms, with more severity in the SA+ group. In the follow-up assessment, total SCOPA-AUT-U, as well as urgency, incontinence, frequency and nocturia subscales improved significantly in the SA+ group, while the SA- group remained unchanged. CONCLUSIONS Safinamide could be helpful in the improvement of urinary symptoms in PD.
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Affiliation(s)
- Ana Gómez-López
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
| | - Arantxa Sánchez-Sánchez
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
| | - Elena Natera-Villalba
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
| | - Victoria Ros-Castelló
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
| | - Álvaro Beltrán-Corbellini
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
| | - Samira Fanjul-Arbós
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
- Movement Disorder Unit, Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
| | - Isabel Pareés Moreno
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
- Movement Disorder Unit, Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
| | - José Luis López-Sendon Moreno
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
- Movement Disorder Unit, Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
| | - Juan Carlos Martínez Castrillo
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
- Movement Disorder Unit, Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
| | - Araceli Alonso-Canovas
- Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain; (A.S.-S.); (E.N.-V.); (V.R.-C.); (Á.B.-C.); (S.F.-A.); (I.P.M.); (J.L.L.-S.M.); (J.C.M.C.); (A.A.-C.)
- Movement Disorder Unit, Neurology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
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Abstract
Parkinson's disease is a chronic, neurodegenerative disease, which manifests with a mixture of motor, cognitive and behavioural symptoms. Levodopa is the most effective antiparkinsonian treatment to date, although chronic use engenders a mixture of complications in a substantial proportion of patients. Amongst these is the occurrence of episodes of worsening symptoms-'off' phenomena. These episodes can manifest with either motor or non-motor symptoms or a combination of these features and have been found to have profound impacts on patients' quality of life. Although preventative measures are poorly evidenced, avoiding excessive total daily levodopa intake in selected populations that are deemed to be of a higher risk for developing these episodes warrants further exploration. Methods to improve levodopa bioavailability and delivery to the brain are currently available and are of value in addressing these episodes once they have become established. These include modifications to levodopa formulations as well as the use of complimentary agents that improve levodopa bioavailability. The deployment of device-assisted approaches is a further dimension that can be considered in addressing these debilitating episodes. This review summarises the clinical manifestations of 'off' phenomena and the current approaches to treat them. Although we briefly discuss clinical advances on the horizon, the predominant focus is on existing, established treatments.
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19
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Itin C, Komargodski R, Barasch D, Domb AJ, Hoffman A. Prolonged Delivery of Apomorphine Through the Buccal Mucosa, Towards a Noninvasive Sustained Administration Method in Parkinson's Disease: In Vivo Investigations in Pigs. J Pharm Sci 2020; 110:1824-1833. [PMID: 33333142 DOI: 10.1016/j.xphs.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/20/2020] [Accepted: 12/09/2020] [Indexed: 01/01/2023]
Abstract
In the current work, prolonged systemic delivery of apomorphine via buccal mucosa was shown to be a promising treatment for Parkinson's disease as a substitute for clinically utilized subcutaneous infusions. Due to extensive 'first-pass' metabolism, apomorphine is administered parenterally to bypass liver metabolism. Drawbacks of parenteral administration cause low patient compliance and adherence to treatment. On the other hand, while also bypassing the liver, delivery through buccal mucosa has a superior safety profile, is less costly, lacks pain and discomfort, and possesses excellent accessibility, overall augmenting patient compliance. Current in vivo study in pigs showed: (1) steady plateau levels of apomorphine in plasma were obtained 30 min following administration and remained constant for 8 h until a delivery device was removed, (2) bioavailability of apomorphine was 55%-80% as opposed to <2% peroral and (3) simulation of the pharmacokinetic profile obtained in pigs predicted therapeutically relevant levels of apomorphine in human. Furthermore, antipyrine was incorporated as a permeation marker to enable mechanistic investigation of apomorphine release from the delivery device and its permeation through the buccal mucosa. In addition, limitations of an Ussing diffusion chamber as an ex vivo research tool were also discussed.
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Affiliation(s)
- Constantin Itin
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel
| | - Rinat Komargodski
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel
| | - Dinorah Barasch
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel
| | - Abraham J Domb
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel
| | - Amnon Hoffman
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, P.O. Box 12065, Jerusalem 91120, Israel.
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20
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Rota S, Boura I, Batzu L, Titova N, Jenner P, Falup-Pecurariu C, Chaudhuri KR. 'Dopamine agonist Phobia' in Parkinson's disease: when does it matter? Implications for non-motor symptoms and personalized medicine. Expert Rev Neurother 2020; 20:953-965. [PMID: 32755243 DOI: 10.1080/14737175.2020.1806059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Dopamine agonists have been widely used to treat patients with Parkinson's disease, but concerns related to their well-known side effects might prevent their use even when indicated. In this review, the authors describe for the first time the concept of 'Dopamine Agonist Phobia', a pharmacophobia that the authors believe might affect clinicians, and they provide evidence of the benefits of dopamine agonists, focusing on non-motor symptoms. AREAS COVERED The authors performed an extensive literature research, including studies exploring the use of dopamine agonists for the treatment of non-motor symptoms. The authors indicate the highest level of evidence in each section. EXPERT OPINION 'Dopamine Agonist Phobia' may preclude valid therapeutic options in selected cases, specifically for the treatment of non-motor symptoms. Thus, the authors propose a personalized approach in Parkinson's disease treatment, and encourage a thoughtful use of dopamine agonists, rather than an overall nihilism.
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Affiliation(s)
- Silvia Rota
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London , London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital , London, UK
| | - Iro Boura
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London , London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital , London, UK
| | - Lucia Batzu
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London , London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital , London, UK
| | - Nataliya Titova
- Department of Neurology, Neurosurgery and Medical Genetics, Federal State Autonomous Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Ministry of Health of the Russian Federation , Moscow, Russia.,Department of Neurodegenerative Diseases, Federal State Budgetary Institution «federal Center of Brain and Neurotechnologies» of the Ministry of Health of the Russian Federation , Moscow, Russia
| | - Peter Jenner
- Neurodegenerative Diseases Research Group, School of Cancer and Pharmaceutical Sciences, Faculty of Life Science and Medicine, King's College London , London, UK
| | - Cristian Falup-Pecurariu
- Department of Neurology, County Emergency Clinic Hospital, Faculty of Medicine, Transilvania University Brasov , Brasov, Romania
| | - K Ray Chaudhuri
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London , London, UK.,Parkinson's Foundation Centre of Excellence, King's College Hospital , London, UK
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21
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Itin C, Komargodski R, Domb AJ, Hoffman A. Controlled Delivery of Apomorphine Through Buccal Mucosa, Towards a Noninvasive Administration Method in Parkinson's Disease: A Preclinical Mechanistic Study. J Pharm Sci 2020; 109:2729-2734. [DOI: 10.1016/j.xphs.2020.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
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Bhidayasiri R, Phokaewvarangkul O, Sakdisornchai K, Boonpang K, Chaudhuri KR, Parsons J, Lolekha P, Chairangsaris P, Srivanitchapoom P, Benedierks S, Panyakaew P, Boonmongkol T, Thongchuam Y, Kantachadvanich N, Phumphid S, Evans AH, Viriyavejakul A, Pisarnpong A, van Laar T, Jagota P. Establishing apomorphine treatment in Thailand: understanding the challenges and opportunities of Parkinson's disease management in developing countries. Expert Rev Neurother 2020; 20:523-537. [PMID: 32421371 DOI: 10.1080/14737175.2020.1770598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The increasing global burden of Parkinson's disease (PD) poses a particular challenge for developing countries, such as Thailand, when delivering care to a geographically diverse populace with limited resources, often compounded by a lack of expertise in the use of certain PD medications, such as device-aided therapies (DAT). AREAS COVERED A panel of local, regional, and international PD experts convened to review the unmet needs of PD in Thailand and share insights into effective delivery of DAT, focusing on experience with apomorphine infusion. Despite its proven efficacy and safety, implementation of apomorphine infusion as a new option was not straightforward. This has prompted a range of health-care professional and patient-focused initiatives, led by the Chulalongkorn Center of Excellence for Parkinson's Disease and Related Disorders in Bangkok, to help establish a more coordinated approach to PD management throughout the country and ensure patients have access to suitable treatments. EXPERT OPINION Overcoming the challenges of education, proficiency, resource capacity and standard of care for PD patients in developing countries requires a coordinated effort both nationally and beyond. The best practices identified in Thailand following the introduction of apomorphine infusion might be helpful for other countries when implementing similar programs.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Karn Sakdisornchai
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Kamolwan Boonpang
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - K Ray Chaudhuri
- The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Parkinson Foundation Centre of Excellence, King's College Hospital , London, UK
| | - Jan Parsons
- The Walton Centre for Neurology and Neurosurgery , Liverpool, UK
| | - Praween Lolekha
- Division of Neurology, Department of Medicine, Thammasat University Hospital , Pathumthani, Thailand
| | - Parnsiri Chairangsaris
- Division of Neurology, Department of Medicine, Phra Mongkutklao Hospital , Bangkok, Thailand
| | - Prachaya Srivanitchapoom
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | | | - Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Thanatat Boonmongkol
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Yuwadee Thongchuam
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Nitinan Kantachadvanich
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Saisamorn Phumphid
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
| | - Andrew H Evans
- Department of Neurology, Royal Melbourne Hospital , Melbourne, Australia
| | | | - Apichart Pisarnpong
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | - Teus van Laar
- Department of Neurology, University of Groningen , Groningen, The Netherlands
| | - Priya Jagota
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok, Thailand
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Metta V, Borgohain R, L Kukkle P, Mridula R, Agarwal P, Kishore A, Goyal V, Chaudhuri R. Subcutaneous apomorphine in advanced Parkinson’s disease and its use in Indian population. ANNALS OF MOVEMENT DISORDERS 2020. [DOI: 10.4103/aomd.aomd_16_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The next chapter in symptomatic Parkinson disease treatments. Parkinsonism Relat Disord 2019; 59:39-48. [DOI: 10.1016/j.parkreldis.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/01/2018] [Accepted: 01/02/2019] [Indexed: 01/19/2023]
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Sesar Á, Fernández-Pajarín G, Ares B, Relova JL, Arán E, Rivas MT, Gelabert-González M, Castro A. Continuous subcutaneous apomorphine in advanced Parkinson's disease patients treated with deep brain stimulation. J Neurol 2019; 266:659-666. [PMID: 30617907 DOI: 10.1007/s00415-019-09184-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/24/2018] [Accepted: 01/03/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is an effective therapy for patients with advanced Parkinson's disease (PD). However, sometimes, it is not sufficient to adequately control motor symptoms. We describe our experience with continuous subcutaneous apomorphine infusion (APO) in patients with DBS. METHODS We undertook a retrospective analysis of all patients treated with DBS and APO at our centre over 12 years. Subjects were allocated to four groups: (1) APO temporarily before DBS, (2) APO after DBS complications before a new DBS, (3) APO after definitive DBS removal, and (4) APO in patients with DBS and declining response. Motor state and other parameters were analysed and compared for the different treatments. RESULTS Data for 71 patients were evaluated. Group 1: (n = 18) patients improved their motor function significantly with both APO and DBS (off-hours before APO 5.4 ± 1.4; after APO 1.4 ± 1.2, p > 0.001; after DBS 0.7 ± 0.8, p < 0.001). Group 2: (n = 11) patients were found to have mild but significant worsening of motor state between the first DBS treatment (off-hours 0.7 ± 1.0) and APO (2.2 ± 1.5, p = 0.02), and improvement between APO and the second DBS treatment (off-hours 0.6 ± 0.8, p = 0.03). Group 3: (n = 12) patients had mild but significant worsening of motor function between DBS (off-hours 1.1 ± 1.0) and APO (2.0 ± 0.9, p = 0.03). Group 4: (n = 13) significant improvement in motor function was observed between DBS alone (off-hours 3.9 ± 2.6) and DBS combined with APO (2.2 ± 1.3, p = 0.03). CONCLUSION In advanced PD, DBS may be not sufficient or may fail to control motor symptoms adequately. In these cases, APO, whether alone or in combination with DBS, is a good choice to improve the disease control.
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Affiliation(s)
- Ángel Sesar
- Servicio de Neurología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain.
| | - Gustavo Fernández-Pajarín
- Servicio de Neurología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Begoña Ares
- Servicio de Neurología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - José-Luis Relova
- Servicio de Neurofisiología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Eduardo Arán
- Servicio de Neurocirugía, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - María-Teresa Rivas
- Servicio de Neurología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Miguel Gelabert-González
- Servicio de Neurocirugía, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Alfonso Castro
- Servicio de Neurología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
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Carbone F, Djamshidian A, Seppi K, Poewe W. Apomorphine for Parkinson's Disease: Efficacy and Safety of Current and New Formulations. CNS Drugs 2019; 33:905-918. [PMID: 31473980 PMCID: PMC6776563 DOI: 10.1007/s40263-019-00661-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Satisfactory management of Parkinson's disease is a challenge that requires a tailored approach for each individual. In the advanced phase of the disease, patients may experience motor complications despite optimized pharmacological therapy. Apomorphine, a short-acting D1- and D2-like receptor agonist, is the only drug proven to have an efficacy equal to that of levodopa, albeit with a shorter time to onset and effect duration. Clinical trials have shown that intermittent apomorphine injections provide rapid and effective relief from unpredictable "off" periods. Continuous apomorphine infusion reduced around 50% of the daily "off" time in several studies. Dopaminergic side effects such as nausea, somnolence and hypotonia, as well as administration site reactions, are often mild or treatable, but somnolence and skin reactions in particular can sometimes be reasons for premature discontinuation. We provide an overview of the pharmacological mechanism of action of the drug in light of its effects on Parkinson's disease symptoms. We then summarize the evidence regarding the efficacy and tolerability of apomorphine, both in its established formulations (subcutaneous intermittent injection and continuous infusion) and in the new preparations currently under investigation.
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Affiliation(s)
- Federico Carbone
- grid.5361.10000 0000 8853 2677Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Atbin Djamshidian
- grid.5361.10000 0000 8853 2677Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Klaus Seppi
- grid.5361.10000 0000 8853 2677Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria.
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Auffret M, Drapier S, Vérin M. New tricks for an old dog: A repurposing approach of apomorphine. Eur J Pharmacol 2018; 843:66-79. [PMID: 30395851 DOI: 10.1016/j.ejphar.2018.10.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023]
Abstract
Apomorphine is a 150-year old nonspecific dopaminergic agonist, currently indicated for treating motor fluctuations in Parkinson's disease. At the era of drug repurposing, its pleiotropic biological functions suggest other possible uses. To further explore new therapeutic and diagnostic applications, the available literature up to July 2018 was reviewed using the PubMed and Google Scholar databases. As many of the retrieved articles consisted of case reports and preclinical studies, we adopted a descriptive approach, tackling each area of research in turn, to give a broad overview of the potential of apomorphine. Apomorphine may play a role in neurological diseases like restless legs syndrome, Huntington's chorea, amyotrophic lateral sclerosis, Alzheimer's disease and disorders of consciousness, but also in sexual disorders, neuroleptic malignant(-like) syndrome and cancer. Further work is needed in both basic and clinical research; current developments in novel delivery strategies and apomorphine derivatives are expected to open the way.
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Affiliation(s)
- Manon Auffret
- Behavior and Basal Ganglia Research Unit (EA 4712), University of Rennes 1, Rennes, France; Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France.
| | - Sophie Drapier
- Behavior and Basal Ganglia Research Unit (EA 4712), University of Rennes 1, Rennes, France; Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France; Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France
| | - Marc Vérin
- Behavior and Basal Ganglia Research Unit (EA 4712), University of Rennes 1, Rennes, France; Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France; Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France
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Abstract
Parkinson disease is a common neurodegenerative disorder that causes progressive motor and nonmotor disability. It is diagnosed clinically and requires a detailed history and neurologic examination to exclude alternative diagnoses. Although disease-modifying therapies do not exist for Parkinson disease, effective symptomatic therapies, including dopaminergic medications and surgery, allow patients to maintain good quality of life for many years. Nonmotor symptoms, including mood, cognitive, sleep, autonomic, and gastrointestinal symptoms, should be managed by a multidisciplinary team of clinicians. Recent advances include new diagnostic criteria from the Movement Disorder Society and the addition of new symptomatic therapies for treating motor complications and nonmotor symptoms in advanced disease.
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Affiliation(s)
- Houman Homayoun
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (H.H.)
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Auffret M, Drapier S, Vérin M. The Many Faces of Apomorphine: Lessons from the Past and Challenges for the Future. Drugs R D 2018; 18:91-107. [PMID: 29546602 PMCID: PMC5995787 DOI: 10.1007/s40268-018-0230-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Apomorphine is now recognized as the oldest antiparkinsonian drug on the market. Though still underused, it is increasingly prescribed in Europe for patients with advanced Parkinson's disease (PD) with motor fluctuations. However, its history is far from being limited to movement disorders. This paper traces the history of apomorphine, from its earliest empirical use, to its synthesis, pharmacological development, and numerous indications in human and veterinary medicine, in light of its most recent uses and newest challenges. From shamanic rituals in ancient Egypt and Mesoamerica, to the treatment of erectile dysfunction, from being discarded as a pharmacological tool to becoming an essential antiparkinsonian drug, the path of apomorphine in the therapeutic armamentarium has been tortuous and punctuated by setbacks and groundbreaking discoveries. Throughout history, three main clinical indications stood out: emetic (gastric emptying, respiratory disorders, aversive conditioning), sedative (mental disorders, clinical anesthesia, alcoholism), and antiparkinsonian (fluctuations). New indications may arise in the future, both in PD (palliative care, nonmotor symptoms, withdrawal of oral dopaminergic medication), and outside PD, with promising work in neuroprotection or addiction.
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Affiliation(s)
- Manon Auffret
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France.
| | - Sophie Drapier
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France
- Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France
| | - Marc Vérin
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France
- Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France
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Huang F, Zhang L, Wang Q, Yang Y, Li Q, Wu Y, Chen J, Qu J, Zhou X. Dopamine D1 Receptors Contribute Critically to the Apomorphine-Induced Inhibition of Form-Deprivation Myopia in Mice. ACTA ACUST UNITED AC 2018; 59:2623-2634. [PMID: 29847669 DOI: 10.1167/iovs.17-22578] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Furong Huang
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Lishuai Zhang
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Qiongsi Wang
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Yanan Yang
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Qihang Li
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Yi Wu
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Jiangfan Chen
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Jia Qu
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
| | - Xiangtian Zhou
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang, China
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Abstract
Apomorphine is a non-specific dopamine receptor agonist that has been used in the treatment of some diseases and mental disorders. Its use has particularly well documented in Parkinson's disease (PD). The dopaminergic agonists like apomorphine are related to oxidative processes that could induce cell damage and the functional impairment of some structures in the brain. However, most information about apomorphine in literature is focused on the improvement of the motor problems characteristic of PD, but little is known about the effects on cognitive behaviors and brain structures indirectly related to motor function. The presence of dopaminergic receptors in the hippocampus has recently been discovered, in connection with cognitive behaviors like learning and memory, these receptors are needed in neuronal plasticity. There has been a growing interest to know if this structure could be compromised by the effect of apomorphine and elucidate if part of the cognitive impairment present in the PD is due to the effect of apomorphine. In this mini-review, we summarized how apomorphine has been used since its creation, we discuss the latest information about its effect on the hippocampus and also the future perspectives to fully understand the effects of this compound.
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Affiliation(s)
- Luis Enrique Arroyo-Garcia
- Laboratorio de Neuropsiquiatría, Instituto de Fisiología, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | | | - Gonzalo Flores
- Laboratorio de Neuropsiquiatría, Instituto de Fisiología, Benemérita Universidad Autónoma de Puebla, Puebla, México
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