Ganglioside treatment of alcoholic neuropathies: experimental and clinical aspects

Alcohol consumption enhances antiretroviral painful peripheral neuropathy by mitochondrial mechanisms

A major dose-limiting side effect of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) chemotherapies, such as the nucleoside reverse transcriptase inhibitors (NRTIs), is a small-fiber painful peripheral neuropathy, mediated by its mitochondrial toxicity. Co-morbid conditions may also contribute to this dose-limiting effect of HIV/AIDS treatment. Alcohol abuse, which alone also produces painful neuropathy, is one of the most important co-morbid risk factors for peripheral neuropathy in patients with HIV/AIDS. Despite the prevalence of this problem and its serious impact on the quality of life and continued therapy in HIV/AIDS patients, the mechanisms by which alcohol abuse exacerbates highly active antiretroviral therapy (HAART)-induced neuropathic pain has not been demonstrated. In this study, performed in rats, we investigated the cellular mechanism by which consumed alcohol impacts antiretroviral-induced neuropathic pain. NRTI 2',3'-dideoxycytidine (ddC; 50 mg/kg) neuropathy was mitochondrial-dependent and PKCε-independent, and alcohol-induced painful neuropathy was PKCε-dependent and mitochondrial-independent. At low doses, ddC (5 mg/kg) and alcohol (6.5% ethanol diet for 1 week), which alone do not affect nociception, together produce profound mechanical hyperalgesia. This hyperalgesia is mitochondrial-dependent but PKCε-independent. These experiments, which provide the first model for studying the impact of co-morbidity in painful neuropathy, support the clinical impression that alcohol consumption enhances HIV/AIDS therapy neuropathy, and provide evidence for a role of mitochondrial mechanisms underlying this interaction.

Changes in tardive dyskinesia symptoms in elderly patients treated with ganglioside GM1 or placebo

The unique role of ganglioside GM1 in neuronal plasticity led two centers, New York University and McLean Hospital, to study the effect of GM1 or placebo in patients with tardive dyskinesia. Results from the NYU cohort have already been published. We now present data from the entire cohort, allowing us to evaluate the effects of GM1 in the elderly compared to young adults. Subjects with tardive dyskinesia were randomly assigned to single-blind placebo injections for 1 week, followed by 1 month of double-blind intramuscular placebo or GM1 100 mg. The final sample included 29 patients: 12 younger than 55 years of age and 17 older. There was no GM1-versus-placebo difference observed in either age group, or in the total group. However, whether on placebo or GM1, repeated measures analysis of variance (RANOVA) found a significant difference in response between Abnormal Involuntary Movement Scale scores, taken baseline and week 4, in the elderly compared to young adults. Scores for the young adults show initial improvement then deterioration back to baseline, and those for the elderly show continuing improvement during the 4-week trial. The importance of the placebo effect in the elderly and its meaning for studies of GM1 in tardive dyskinesia are discussed.

Gangliosides in the nervous system during development and regeneration

Gangliosides are present in nervous tissues of echinoderms and chordates, but the amounts and patterns differ widely. There are changes in the ganglioside contents of nervous tissues during development in most animals studied. To a large extent, regional differences and changes with development and degeneration in ganglioside composition reflect changing and different proportions of cellular types and subcellular organelles within the tissue. GM1 and GM4 are enriched in myelin; GD1a may be a marker for dendritic arborization. During regeneration of fish optic nerve and rat sciatic nerve there is an increased amount of ganglioside proximal to the regenerating axon tips, which may largely be a result of accumulation. This could provide a relatively large reservoir of ganglioside to become incorporated into the sprouting axolemma. Gangliosides added exogenously to growth medium can induce neuritogenesis of several types of neurons. The mechanisms of this action are unknown but may be related to nerve growth factor, microskeletal organization, membrane fluidity, and other factors. Gangliosides injected into young animals affect brain development, but further studies are required to determine these effects more specifically. Ganglioside administration increases the number of sprouts in regenerating peripheral nerves, but does not seem to accelerate axonal elongation. Parenterally administered gangliosides alter the recovery of brain tissue from a variety of types of lesions, and clinical trials are in progress to determine if they are of benefit in human neurological disorders. The biochemical mechanisms of these in vivo ganglioside effects are poorly understood, but may involve modulation of several enzyme systems as well as other properties of neural membranes, such as fluidity. It is possible that gangliosides may play similar roles and operate through some of the same mechanisms in developing and regenerating nervous tissues.

Ethanol and membrane lipids

Although ethanol is known to exert its primary mode of action on the central nervous system, the exact molecular interaction underlying the behavioral and physiological manifestations of alcohol intoxication has not been elucidated. Chronic ethanol administration results in changes in organ functions. These changes are reflective of the adaptive mechanisms in response to the acute effects of ethanol. Biophysical studies have shown that ethanol in vitro disorders the membrane and perturbs the fine structural arrangement of the membrane lipids. In the chronic state, these membranes develop resistance to the disordering effects. Tolerance development is also accompanied by biochemical changes. Although ethanol-induced changes in membrane lipids have been implicated in both biophysical and biochemical studies, measurements of membrane lipids, such as cholesterol content, fatty acid unsaturation, phospholipid distribution, and ganglioside profiles, have not produced conclusive evidence that any of these parameters are directly involved in the action of ethanol. On the other hand, there is increasing evidence indicating that although ethanol in vitro produces a membrane-fluidizing effect, the chronic response to this effect is not to change the membrane bulk lipid composition. Instead, changes in membrane lipids may pertain to small metabolically active pools located in certain subcellular fractions. Most likely, these lipids are involved in important membrane functions. For example, the increase in PS in brain plasma membranes may provide an explanation for the adaptive increase in synaptic membrane ion transport activity, especially (Na,K)-ATPase. There is also evidence that the lipid pool involved in the deacylation-reacylation mechanism (i.e., PI and PC with 20:4 groups) is altered after ethanol administration. An increase in metabolic turnover of these phospholipid pools may have important implications for the membrane functional changes. Obviously, there are other lipid-metabolizing enzyme systems that may exert similar effects but have not yet been investigated in detail. From the results of these studies, it is concluded that the multiple actions of ethanol are associated with changes in enzymic systems important in the functional expression of the membranes.