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Çorman ME, Cetinkaya A, Armutcu C, Bellur Atici E, Uzun L, Ozkan SA. A sensitive and selective electrochemical sensor based on molecularly imprinted polymer for the assay of teriflunomide. Talanta 2022; 249:123689. [PMID: 35717750 DOI: 10.1016/j.talanta.2022.123689] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
In this work, pyrrole-histidine has been designed, synthesized and, used as a novel functional monomer to fabricate a molecularly imprinted electrochemical sensor for the selective and sensitive detection of teriflunomide (TER). The molecularly imprinted thin film of electrochemical sensor was constructed by directly electropolymerization of co-polymer of pyrrole-histidine (PyHis) with pyrrole in the presence of a template, TER, on a glassy carbon electrode (GCE). After electropolymerization, the structure and morphology of the fabricated MIP sensor were characterized by Fourier-transform infrared spectroscopy (FT-IR) and scanning electron microscopy (SEM) and its electrochemical parameters such as cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS). The poly (pyrrole-co-pyrrole-histidine) [Poly (Py-co-PyHis)]@MIP/GCE sensor have a linear TER concentration in the of 0.1-1.0 pM with a low detection limit of 11.38 fM. The present strategy for electrochemical sensor have been also showed excellent recovery in synthetic serum samples and tablet dosage form with the recoveries 97.56% and 100.35%, respectively. The developed [Poly (Py-co-PyHis)]@MIP/GCE sensor exhibited an excellent electrochemical response for TER due to the synergistic effect of conducting polymer and molecularly imprinting techniques.
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Affiliation(s)
- M Emin Çorman
- Ankara University, Faculty of Pharmacy, Department of Analytical Chemistry, Ankara, Turkey; University of Health Sciences, Gülhane Faculty of Pharmacy, Department of Biochemistry, Ankara, Turkey
| | - Ahmet Cetinkaya
- Ankara University, Faculty of Pharmacy, Department of Analytical Chemistry, Ankara, Turkey
| | - Canan Armutcu
- Hacettepe University, Faculty of Science, Department of Chemistry, Ankara, Turkey
| | | | - Lokman Uzun
- Hacettepe University, Faculty of Science, Department of Chemistry, Ankara, Turkey
| | - Sibel A Ozkan
- Ankara University, Faculty of Pharmacy, Department of Analytical Chemistry, Ankara, Turkey.
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2
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Chuang ST, Conklin B, Stein JB, Pan G, Lee KB. Nanotechnology-enabled immunoengineering approaches to advance therapeutic applications. NANO CONVERGENCE 2022; 9:19. [PMID: 35482149 PMCID: PMC9047473 DOI: 10.1186/s40580-022-00310-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/12/2022] [Indexed: 05/24/2023]
Abstract
Immunotherapy has reached clinical success in the last decade, with the emergence of new and effective treatments such as checkpoint blockade therapy and CAR T-cell therapy that have drastically improved patient outcomes. Still, these therapies can be improved to limit off-target effects, mitigate systemic toxicities, and increase overall efficacies. Nanoscale engineering offers strategies that enable researchers to attain these goals through the manipulation of immune cell functions, such as enhancing immunity against cancers and pathogens, controlling the site of immune response, and promoting tolerance via the delivery of small molecule drugs or biologics. By tuning the properties of the nanomaterials, such as size, shape, charge, and surface chemistry, different types of immune cells can be targeted and engineered, such as dendritic cells for immunization, or T cells for promoting adaptive immunity. Researchers have come to better understand the critical role the immune system plays in the progression of pathologies besides cancer, and developing nanoengineering approaches that seek to harness the potential of immune cell activities can lead to favorable outcomes for the treatment of injuries and diseases.
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Affiliation(s)
- Skylar T Chuang
- Department of Chemistry and Chemical Biology, Rutgers, The State University of New Jersey, Piscataway, NJ, 08854, USA
| | - Brandon Conklin
- Department of Chemistry and Chemical Biology, Rutgers, The State University of New Jersey, Piscataway, NJ, 08854, USA
| | - Joshua B Stein
- Department of Chemistry and Chemical Biology, Rutgers, The State University of New Jersey, Piscataway, NJ, 08854, USA
| | - George Pan
- Department of Chemistry and Chemical Biology, Rutgers, The State University of New Jersey, Piscataway, NJ, 08854, USA
| | - Ki-Bum Lee
- Department of Chemistry and Chemical Biology, Rutgers, The State University of New Jersey, Piscataway, NJ, 08854, USA.
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3
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Prinz C, Starke L, Ramspoth TF, Kerkering J, Martos Riaño V, Paul J, Neuenschwander M, Oder A, Radetzki S, Adelhoefer S, Ramos Delgado P, Aravina M, Millward JM, Fillmer A, Paul F, Siffrin V, von Kries JP, Niendorf T, Nazaré M, Waiczies S. Pentafluorosulfanyl (SF 5) as a Superior 19F Magnetic Resonance Reporter Group: Signal Detection and Biological Activity of Teriflunomide Derivatives. ACS Sens 2021; 6:3948-3956. [PMID: 34666481 PMCID: PMC8630787 DOI: 10.1021/acssensors.1c01024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/24/2021] [Indexed: 12/30/2022]
Abstract
Fluorine (19F) magnetic resonance imaging (MRI) is severely limited by a low signal-to noise ratio (SNR), and tapping it for 19F drug detection in vivo still poses a significant challenge. However, it bears the potential for label-free theranostic imaging. Recently, we detected the fluorinated dihydroorotate dehydrogenase (DHODH) inhibitor teriflunomide (TF) noninvasively in an animal model of multiple sclerosis (MS) using 19F MR spectroscopy (MRS). In the present study, we probed distinct modifications to the CF3 group of TF to improve its SNR. This revealed SF5 as a superior alternative to the CF3 group. The value of the SF5 bioisostere as a 19F MRI reporter group within a biological or pharmacological context is by far underexplored. Here, we compared the biological and pharmacological activities of different TF derivatives and their 19F MR properties (chemical shift and relaxation times). The 19F MR SNR efficiency of three MRI methods revealed that SF5-substituted TF has the highest 19F MR SNR efficiency in combination with an ultrashort echo-time (UTE) MRI method. Chemical modifications did not reduce pharmacological or biological activity as shown in the in vitro dihydroorotate dehydrogenase enzyme and T cell proliferation assays. Instead, SF5-substituted TF showed an improved capacity to inhibit T cell proliferation, indicating better anti-inflammatory activity and its suitability as a viable bioisostere in this context. This study proposes SF5 as a novel superior 19F MR reporter group for the MS drug teriflunomide.
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Affiliation(s)
- Christian Prinz
- Berlin
Ultrahigh Field Facility (B.U.F.F.), Max
Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße
10, 13125 Berlin, Germany
- Experimental
and Clinical Research Center, a joint cooperation between the Charité
- Universitätsmedizin Berlin and the Max Delbrück Center
for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Ludger Starke
- Berlin
Ultrahigh Field Facility (B.U.F.F.), Max
Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße
10, 13125 Berlin, Germany
| | - Tizian-Frank Ramspoth
- Medicinal
Chemistry, Leibniz-Institut für Molekulare
Pharmakologie (FMP), Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Janis Kerkering
- Experimental
and Clinical Research Center, a joint cooperation between the Charité
- Universitätsmedizin Berlin and the Max Delbrück Center
for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Vera Martos Riaño
- Medicinal
Chemistry, Leibniz-Institut für Molekulare
Pharmakologie (FMP), Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Jérôme Paul
- Medicinal
Chemistry, Leibniz-Institut für Molekulare
Pharmakologie (FMP), Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Martin Neuenschwander
- Screening
Unit, Leibniz-Institut für Molekulare
Pharmakologie (FMP), Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Andreas Oder
- Screening
Unit, Leibniz-Institut für Molekulare
Pharmakologie (FMP), Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Silke Radetzki
- Screening
Unit, Leibniz-Institut für Molekulare
Pharmakologie (FMP), Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Siegfried Adelhoefer
- Berlin
Ultrahigh Field Facility (B.U.F.F.), Max
Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße
10, 13125 Berlin, Germany
| | - Paula Ramos Delgado
- Berlin
Ultrahigh Field Facility (B.U.F.F.), Max
Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße
10, 13125 Berlin, Germany
- Experimental
and Clinical Research Center, a joint cooperation between the Charité
- Universitätsmedizin Berlin and the Max Delbrück Center
for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Mariya Aravina
- Berlin
Ultrahigh Field Facility (B.U.F.F.), Max
Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße
10, 13125 Berlin, Germany
| | - Jason M. Millward
- Berlin
Ultrahigh Field Facility (B.U.F.F.), Max
Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße
10, 13125 Berlin, Germany
- Experimental
and Clinical Research Center, a joint cooperation between the Charité
- Universitätsmedizin Berlin and the Max Delbrück Center
for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Ariane Fillmer
- Physikalisch-Technische
Bundesanstalt (PTB), Abbestraße 2-12, 10587 Berlin, Germany
| | - Friedemann Paul
- Experimental
and Clinical Research Center, a joint cooperation between the Charité
- Universitätsmedizin Berlin and the Max Delbrück Center
for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße 10, 13125 Berlin, Germany
- Charité
− Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin, Humboldt-Universität zu Berlin,
and Berlin Institute of Health (BIH), Charitéplatz 1, 10117 Berlin, Germany
| | - Volker Siffrin
- Experimental
and Clinical Research Center, a joint cooperation between the Charité
- Universitätsmedizin Berlin and the Max Delbrück Center
for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Jens-Peter von Kries
- Screening
Unit, Leibniz-Institut für Molekulare
Pharmakologie (FMP), Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Thoralf Niendorf
- Berlin
Ultrahigh Field Facility (B.U.F.F.), Max
Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße
10, 13125 Berlin, Germany
- Experimental
and Clinical Research Center, a joint cooperation between the Charité
- Universitätsmedizin Berlin and the Max Delbrück Center
for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Marc Nazaré
- Medicinal
Chemistry, Leibniz-Institut für Molekulare
Pharmakologie (FMP), Robert Rössle Straße 10, 13125 Berlin, Germany
| | - Sonia Waiczies
- Berlin
Ultrahigh Field Facility (B.U.F.F.), Max
Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße
10, 13125 Berlin, Germany
- Experimental
and Clinical Research Center, a joint cooperation between the Charité
- Universitätsmedizin Berlin and the Max Delbrück Center
for Molecular Medicine in the Helmholtz Association, Robert Rössle Straße 10, 13125 Berlin, Germany
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4
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Unsal Tan O, Zengin M. Insights into the chemistry and therapeutic potential of acrylonitrile derivatives. Arch Pharm (Weinheim) 2021; 355:e2100383. [PMID: 34763365 DOI: 10.1002/ardp.202100383] [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: 10/04/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/20/2022]
Abstract
Acrylonitrile is a fascinating scaffold widely found in many natural products, drugs, and drug candidates with various biological activities. Several drug molecules such as entacapone, rilpivirine, teriflunomide, and so forth, bearing an acrylonitrile moiety have been marketed. In this review, diverse synthetic strategies for constructing desired acrylonitriles are discussed, and the different biological activities and medicinal significance of various acrylonitrile derivatives are critically evaluated. The information gathered is expected to provide rational guidance for the development of clinically useful agents from acrylonitriles.
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Affiliation(s)
- Oya Unsal Tan
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Merve Zengin
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
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5
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Biolato M, Bianco A, Lucchini M, Gasbarrini A, Mirabella M, Grieco A. The Disease-Modifying Therapies of Relapsing-Remitting Multiple Sclerosis and Liver Injury: A Narrative Review. CNS Drugs 2021; 35:861-880. [PMID: 34319570 PMCID: PMC8354931 DOI: 10.1007/s40263-021-00842-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 02/08/2023]
Abstract
In this narrative review, we analyze pre-registration and post-marketing data concerning hepatotoxicity of all disease-modifying therapies (DMTs) available for the treatment of relapsing-remitting multiple sclerosis, including beta interferon, glatiramer acetate, fingolimod, teriflunomide, dimethyl fumarate, cladribine, natalizumab, alemtuzumab, and ocrelizumab. We review the proposed causal mechanisms described in the literature and we also address issues like use of DMTs in patients with viral hepatitis or liver cirrhosis. Most data emerged in the post-marketing phase by reports to national pharmacovigilance agencies and published case reports or case series. Serious liver adverse events are rare, but exact incidence is largely unknown, as are predictive factors. Unfortunately, none of the DMTs currently available for the treatment of multiple sclerosis is free of potential hepatic toxic effects. Cases of acute liver failure have been reported for beta-interferon, fingolimod, natalizumab, alemtuzumab, and ocrelizumab by different mechanisms (idiosyncratic reaction, autoimmune hepatitis, or viral reactivation). Patients with multiple sclerosis should be informed about possible hepatic side effects of their treatment. Most cases of liver injury are idiosyncratic and unpredictable. The specific monitoring schedule for each DMT has been reviewed and the clinician should be ready to recognize clinical symptoms suggestive for liver injury. Not all DMTs are indicated in cirrhotic patients. For some DMTs, screening for hepatitis B virus and hepatitis C virus is required before starting treatment and a monitoring or antiviral prophylaxis schedule has been established. Beta interferon, glatiramer acetate, natalizumab, and alemtuzumab are relatively contraindicated in autoimmune hepatitis due to the risk of disease exacerbation.
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Affiliation(s)
- Marco Biolato
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
- Institute of Internal Medicine, Catholic University of Sacred Heart, 00168, Rome, Italy.
- Centro di ricerca per la Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Assunta Bianco
- Multiple Sclerosis Center, Department of Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Matteo Lucchini
- Multiple Sclerosis Center, Department of Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
- Centro di ricerca per la Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Institute of Internal Medicine, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Department of Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
- Centro di ricerca per la Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Antonio Grieco
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Institute of Internal Medicine, Catholic University of Sacred Heart, 00168, Rome, Italy
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6
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Prinz C, Starke L, Millward JM, Fillmer A, Delgado PR, Waiczies H, Pohlmann A, Rothe M, Nazaré M, Paul F, Niendorf T, Waiczies S. In vivo detection of teriflunomide-derived fluorine signal during neuroinflammation using fluorine MR spectroscopy. Theranostics 2021; 11:2490-2504. [PMID: 33456555 PMCID: PMC7806491 DOI: 10.7150/thno.47130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Magnetic resonance imaging (MRI) is indispensable for diagnosing neurological conditions such as multiple sclerosis (MS). MRI also supports decisions regarding the choice of disease-modifying drugs (DMDs). Determining in vivo tissue concentrations of DMDs has the potential to become an essential clinical tool for therapeutic drug monitoring (TDM). The aim here was to examine the feasibility of fluorine-19 (19F) MR methods to detect the fluorinated DMD teriflunomide (TF) during normal and pathological conditions. Methods: We used 19F MR spectroscopy to detect TF in the experimental autoimmune encephalomyelitis (EAE) mouse model of multiple sclerosis (MS) in vivo. Prior to the in vivo investigations we characterized the MR properties of TF in vitro. We studied the impact of pH and protein binding as well as MR contrast agents. Results: We could detect TF in vivo and could follow the 19F MR signal over different time points of disease. We quantified TF concentrations in different tissues using HPLC/MS and showed a significant correlation between ex vivo TF levels in serum and the ex vivo19F MR signal. Conclusion: This study demonstrates the feasibility of 19F MR methods to detect TF during neuroinflammation in vivo. It also highlights the need for further technological developments in this field. The ultimate goal is to add 19F MR protocols to conventional 1H MRI protocols in clinical practice to guide therapy decisions.
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7
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Selective Binding of Cyclodextrins with Leflunomide and Its Pharmacologically Active Metabolite Teriflunomide. Int J Mol Sci 2020; 21:ijms21239102. [PMID: 33265979 PMCID: PMC7730839 DOI: 10.3390/ijms21239102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022] Open
Abstract
The selectivity of encapsulation of leflunomide and teriflunomide by native α-, β- and γ-cyclodextrins was investigated through 1H NMR and molecular modeling. Thermodynamic analysis revealed the main driving forces involved in the binding. For α-cyclodextrin, the partial encapsulation was obtained while deep penetration was characterized for the other two cyclodextrins, where the remaining polar fragment of the molecule is located outside the macrocyclic cavity. The interactions via hydrogen bonding are responsible for high negative enthalpy and entropy changes accompanying the complexation of cyclodextrins with teriflunomide. These results were in agreement with the molecular modeling calculations, which provide a clearer picture of the involved interactions at the atomic level.
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8
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Gadhave D, Rasal N, Sonawane R, Sekar M, Kokare C. Nose-to-brain delivery of teriflunomide-loaded lipid-based carbopol-gellan gum nanogel for glioma: Pharmacological and in vitro cytotoxicity studies. Int J Biol Macromol 2020; 167:906-920. [PMID: 33186648 DOI: 10.1016/j.ijbiomac.2020.11.047] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/26/2020] [Accepted: 11/07/2020] [Indexed: 12/14/2022]
Abstract
The research work was intended to formulate teriflunomide (TFM) loaded nano lipid-based (TNLC) carbopol-gellan gum in situ gel (TNLCGHG) and to investigate its therapeutic efficacy against glioma, a brain and spine tumor. Nanoformulation was developed using gellan gum and carbopol 974P as gelling and mucoadhesive agents, respectively, Glyceryl di-behenate and Glyceryl mono-linoleate blend as lipids, and Gelucire 44/14: water blend as surfactant system. Globule size, PDI, zeta potential, encapsulation efficiency, mucoadhesive strength, and nasal permeation were found to be 117.80 nm, 0.56, -21.86 mV, 81.16%, 4.80 g, and 904 μg/cm2, respectively. Anticancer efficacy of TFM-loaded nano lipid-based carbopol-gellan gum in situ gel (TNLCGHG) was determined in human U-87MG glioma cell line. IC50 was found 7.0 μg/mL for TNLCGHG, 4.8 μg/mL for pure TFM, and 78.5 μg/mL for TNLC, which approve the superiority of surfactant along with gellan gum as permeation enhancer. Brain Cmax for technetium (99mTC) labeled intranasal (i.n.) 99mTC-TNLCGHG was found 2-folds higher than 99mTC-TNLC (i.n.) and 99mTC-TNLC intravenous (i.v.) because the TNLCGHG formulation contains surfactant with natural gelling polymers, which promisingly improved drug permeability. Finally, this research revealed encouraging outcomes and successfully developed intranasal TNLCGHG nanoformulation as a novel tool for safe delivery of TFM in glioma patients.
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Affiliation(s)
- Dnyandev Gadhave
- Department of Pharmaceutics, Sinhgad Technical Education Society's, Sinhgad Institute of Pharmacy (affiliated to Savitribai Phule Pune University), Narhe, Pune 411 041, India.
| | - Nishant Rasal
- Department of Chemistry, Baburaoji Gholap College (affiliated to Savitribai Phule Pune University), Sangvi, Pune 411027, Maharashtra, India
| | - Rahul Sonawane
- Department of Pharmaceutics, Sinhgad Technical Education Society's, Sinhgad Institute of Pharmacy (affiliated to Savitribai Phule Pune University), Narhe, Pune 411 041, India
| | - Mahendran Sekar
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Health Sciences, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh-30450, Perak, Malaysia
| | - Chandrakant Kokare
- Department of Pharmaceutics, Sinhgad Technical Education Society's, Sinhgad Institute of Pharmacy (affiliated to Savitribai Phule Pune University), Narhe, Pune 411 041, India
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9
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Malla B, Cotten S, Ulshoefer R, Paul F, Hauser AE, Niesner R, Bros H, Infante-Duarte C. Teriflunomide preserves peripheral nerve mitochondria from oxidative stress-mediated alterations. Ther Adv Chronic Dis 2020; 11:2040622320944773. [PMID: 32850106 PMCID: PMC7425321 DOI: 10.1177/2040622320944773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/02/2020] [Indexed: 12/17/2022] Open
Abstract
Mitochondrial dysfunction is a common pathological hallmark in various inflammatory and degenerative diseases of the central nervous system, including multiple sclerosis (MS). We previously showed that oxidative stress alters axonal mitochondria, limiting their transport and inducing conformational changes that lead to axonal damage. Teriflunomide (TFN), an oral immunomodulatory drug approved for the treatment of relapsing forms of MS, reversibly inhibits dihydroorotate dehydrogenase (DHODH). DHODH is crucial for de novo pyrimidine biosynthesis and is the only mitochondrial enzyme in this pathway, thus conferring a link between inflammation, mitochondrial activity and axonal integrity. Here, we investigated how DHODH inhibition may affect mitochondrial behavior in the context of oxidative stress. We employed a model of transected murine spinal roots, previously developed in our laboratory. Using confocal live imaging of axonal mitochondria, we showed that in unmanipulated axons, TFN increased significantly the mitochondria length without altering their transport features. In mitochondria challenged with 50 µM hydrogen peroxide (H2O2) to induce oxidative stress, the presence of TFN at 1 µM concentration was able to restore mitochondrial shape, motility, as well as mitochondrial oxidation potential to control levels. No effects were observed at 5 µM TFN, while some shape and motility parameters were restored to control levels at 50 µM TFN. Thus, our data demonstrate an undescribed link between DHODH and mitochondrial dynamics and point to a potential neuroprotective effect of DHODH inhibition in the context of oxidative stress-induced damage of axonal mitochondria.
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Affiliation(s)
- Bimala Malla
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute for Medical Immunology, Berlin, Germany
| | - Samuel Cotten
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute for Medical Immunology, Berlin, Germany
| | - Rebecca Ulshoefer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute for Medical Immunology, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin and Experimental & Clinical Research Center (ECRC), Max Delbrueck Center (MDC) for Molecular Medicine, Berlin, Germany and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anja E Hauser
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany Deutsches Rheuma-Forschungszentrum, Berlin, Germany
| | - Raluca Niesner
- Dynamic and Functional in vivo Imaging, Deutsches Rheuma-Forschungszentrum, Berlin, Germany and Veterinary Medicine, Freie Universität Berlin, Germany
| | - Helena Bros
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute for Medical Immunology, Berlin, Germany
| | - Carmen Infante-Duarte
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin and Experimental & Clinical Research Center (ECRC), MDC for Molecular Medicine and Charité - Universitätsmedizin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin 13353, Germany
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10
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Maghzi AH, Houtchens MK, Preziosa P, Ionete C, Beretich BD, Stankiewicz JM, Tauhid S, Cabot A, Berriosmorales I, Schwartz THW, Sloane JA, Freedman MS, Filippi M, Weiner HL, Bakshi R. COVID-19 in teriflunomide-treated patients with multiple sclerosis. J Neurol 2020; 267:2790-2796. [PMID: 32494856 PMCID: PMC7268971 DOI: 10.1007/s00415-020-09944-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
Abstract
The outbreak of a severe acute respiratory syndrome caused by a novel coronavirus (COVID-19), has raised health concerns for patients with multiple sclerosis (MS) who are commonly on long-term immunotherapies. Managing MS during the pandemic remains challenging with little published experience and no evidence-based guidelines. We present five teriflunomide-treated patients with MS who subsequently developed active COVID-19 infection. The patients continued teriflunomide therapy and had self-limiting infection, without relapse of their MS. These observations have implications for the management of MS in the setting of the COVID-19 pandemic.
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Affiliation(s)
- Amir Hadi Maghzi
- Department of Neurology, Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Mailbox 9002L, Boston, MA, 02115, USA
| | - Maria K Houtchens
- Department of Neurology, Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Mailbox 9002L, Boston, MA, 02115, USA
| | - Paolo Preziosa
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carolina Ionete
- Department of Neurology, University of Massachusetts, Worcester, MA, USA
| | | | - James M Stankiewicz
- Department of Neurology, Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Mailbox 9002L, Boston, MA, 02115, USA
| | - Shahamat Tauhid
- Department of Neurology, Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Mailbox 9002L, Boston, MA, 02115, USA
| | - Ann Cabot
- Department of Neurology, Concord Hospital, Concord, NH, USA
| | | | | | - Jacob A Sloane
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mark S Freedman
- University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Howard L Weiner
- Department of Neurology, Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Mailbox 9002L, Boston, MA, 02115, USA
| | - Rohit Bakshi
- Department of Neurology, Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Mailbox 9002L, Boston, MA, 02115, USA.
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11
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Mei-Jiao G, Shi-Fang L, Yan-Yan C, Jun-Jun S, Yue-Feng S, Ting-Ting R, Yong-Guang Z, Hui-Yun C. Antiviral effects of selected IMPDH and DHODH inhibitors against foot and mouth disease virus. Biomed Pharmacother 2019; 118:109305. [PMID: 31545264 DOI: 10.1016/j.biopha.2019.109305] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/26/2019] [Accepted: 07/31/2019] [Indexed: 01/26/2023] Open
Abstract
Foot-and-mouth disease virus (FMDV) is an important pathogen that affects livestock breeding and causes huge economic losses worldwide. Currently, the development of antiviral agents to combat FMDV infection at the early stages is being explored. As viral replication critically depends on the host for nucleoside supply, host enzymes involved in nucleotides biosynthesis may represent potential targets for the development of antiviral agents. In the present study, the effects of IMP dehydrogenase (AVN-944 and mycophenolate mofetil) and dihydroorotate dehydrogenase (teriflunomide) inhibitors were evaluated both in vitro and in vivo. The results revealed that these compounds were effective in suppressing FMDV (O/MY98/BY/2010 and A/GD/MM/2013) infection. With regard to the antiviral mechanism, time-of-addition experiments revealed that these compounds were effective when added at the early stages of viral lifecycle (0-8 h post infection). However, exogenous guanosine/uridine eliminated the antiviral activity of these compounds. Importantly, treatment AVN-944 and teriflunomide significantly improved the survival of mice that were subcutaneously treated with FMDV. Together, the results of the present study indicate the broad-spectrum activities of anti-FMDV agents targeting IMP dehydrogenase or dihydroorotate dehydrogenase, which could be useful in developing strategies to prevent FMD.
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Affiliation(s)
- Gong Mei-Jiao
- State Key Laboratory of Veterinary Etiological Biology, OIE/National Foot-and-Mouth Disease Reference Laboratory, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730046, Gansu, China
| | - Li Shi-Fang
- State Key Laboratory of Veterinary Etiological Biology, OIE/National Foot-and-Mouth Disease Reference Laboratory, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730046, Gansu, China
| | - Chang Yan-Yan
- State Key Laboratory of Veterinary Etiological Biology, OIE/National Foot-and-Mouth Disease Reference Laboratory, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730046, Gansu, China
| | - Shao Jun-Jun
- State Key Laboratory of Veterinary Etiological Biology, OIE/National Foot-and-Mouth Disease Reference Laboratory, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730046, Gansu, China
| | - Sun Yue-Feng
- State Key Laboratory of Veterinary Etiological Biology, OIE/National Foot-and-Mouth Disease Reference Laboratory, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730046, Gansu, China
| | - Ren Ting-Ting
- State Key Laboratory of Veterinary Etiological Biology, OIE/National Foot-and-Mouth Disease Reference Laboratory, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730046, Gansu, China
| | - Zhang Yong-Guang
- State Key Laboratory of Veterinary Etiological Biology, OIE/National Foot-and-Mouth Disease Reference Laboratory, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730046, Gansu, China
| | - Chang Hui-Yun
- State Key Laboratory of Veterinary Etiological Biology, OIE/National Foot-and-Mouth Disease Reference Laboratory, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730046, Gansu, China.
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12
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Gadhave DG, Kokare CR. Nanostructured lipid carriers engineered for intranasal delivery of teriflunomide in multiple sclerosis: optimization and in vivo studies. Drug Dev Ind Pharm 2019; 45:839-851. [PMID: 30702966 DOI: 10.1080/03639045.2019.1576724] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is one of the most severe autoimmune disorder of the central nervous system (CNS). OBJECTIVE The present research work was aimed to formulate and investigate teriflunomide (TFM)-loaded intranasal (i.n.) nanostructured lipid carriers (NLC) for the treatment of multiple sclerosis (MS). METHODS The TFM-loaded NLC (TFM-NLC) nanoparticles were prepared by melt emulsification ultrasonication method using biodegradable and biocompatible polymers. The Box-Behnken statistical design was applied to optimize the formulation. The optimized NLC formulation was subjected to evaluate for particle size, entrapment efficiency (%), in vitro and ex vivo permeation. The safety and efficacy of optimized formulations were demonstrated using pharmacodynamic, subacute toxicity and hepatotoxicity data. RESULTS Experimental data demonstrated that optimized NLC formulation (F17) showed significant size (99.82 ± 1.36 nm), zeta potential (-22.29 ± 1.8 mV) and % entrapment efficiency (83.39 ± 1.24%). Alternatively, ex vivo permeation of TFM mucoadhesive NLC (TFM-MNLC) and TFM-NLC was observed 830 ± 7.6 and 651 ± 9.8 µg/cm2, respectively. Whereas, TFM-MNLC shows around 2.0-folds more Jss than the TFM-NLC. Finally, TFM-MNLC (i.n.) formulation produced the rapid remyelination in cuprizone-treated animals and decreases the number of entries in open compartment of EPM when compared with negative control and TFM-NLC (oral) animals. Simultaneously, the nanoformulation did not reflect any gross changes in hepatic biomarkers and subacute toxicity when compared with control. CONCLUSIONS Hence it can be inferred that the nose-to-brain delivery of TFM-MNLC can be considered as effective and safe delivery for brain disorders.
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Affiliation(s)
- Dnyandev G Gadhave
- a Department of Pharmaceutics , STES's Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University) , Narhe, Pune , India
| | - Chandrakant R Kokare
- a Department of Pharmaceutics , STES's Sinhgad Institute of Pharmacy (Affiliated to Savitribai Phule Pune University) , Narhe, Pune , India
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13
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Abstract
Current multiple sclerosis (MS) therapies are effective in reducing relapse rate, short-term measures of disability, and magnetic resonance imaging (MRI) measures of inflammation in relapsing remitting MS (RRMS), whereas in progressive/degenerative disease phases these medications are of little or no benefit. Therefore, the development of new therapies aimed at reversing neurodegeneration is of great interest. Remyelination, which is usually a spontaneous endogenous process, is achieved when myelin-producing oligodendrocytes are generated from oligodendrocyte precursor cells (OPCs). Even though these precursor cells are abundant in MS brains, their regeneration capacity is limited. Enhancing the generation of myelin-producing cells is therefore a major focus of MS research. Here we present an overview of the different advancements in the field of remyelination, including suitable animal models for testing remyelination therapies, approved medications with a proposed role in regeneration, myelin repair treatments under investigation in clinical trials, as well as future therapeutics aimed at facilitating myelin repair.
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Affiliation(s)
- David Kremer
- Department of Neurology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Rainer Akkermann
- Department of Neurology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Patrick Küry
- Department of Neurology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Ranjan Dutta
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio-44195
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14
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Arnould S, Rodier G, Matar G, Vincent C, Pirot N, Delorme Y, Berthet C, Buscail Y, Noël JY, Lachambre S, Jarlier M, Bernex F, Delpech H, Vidalain PO, Janin YL, Theillet C, Sardet C. Checkpoint kinase 1 inhibition sensitises transformed cells to dihydroorotate dehydrogenase inhibition. Oncotarget 2017; 8:95206-95222. [PMID: 29221122 PMCID: PMC5707016 DOI: 10.18632/oncotarget.19199] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/17/2017] [Indexed: 12/17/2022] Open
Abstract
Reduction in nucleotide pools through the inhibition of mitochondrial enzyme dihydroorotate dehydrogenase (DHODH) has been demonstrated to effectively reduce cancer cell proliferation and tumour growth. The current study sought to investigate whether this antiproliferative effect could be enhanced by combining Chk1 kinase inhibition. The pharmacological activity of DHODH inhibitor teriflunomide was more selective towards transformed mouse embryonic fibroblasts than their primary or immortalised counterparts, and this effect was amplified when cells were subsequently exposed to PF477736 Chk1 inhibitor. Flow cytometry analyses revealed substantial accumulations of cells in S and G2/M phases, followed by increased cytotoxicity which was characterised by caspase 3-dependent induction of cell death. Associating PF477736 with teriflunomide also significantly sensitised SUM159 and HCC1937 human triple negative breast cancer cell lines to dihydroorotate dehydrogenase inhibition. The main characteristic of this effect was the sustained accumulation of teriflunomide-induced DNA damage as cells displayed increased phospho serine 139 H2AX (γH2AX) levels and concentration-dependent phosphorylation of Chk1 on serine 345 upon exposure to the combination as compared with either inhibitor alone. Importantly a similar significant increase in cell death was observed upon dual siRNA mediated depletion of Chk1 and DHODH in both murine and human cancer cell models. Altogether these results suggest that combining DHODH and Chk1 inhibitions may be a strategy worth considering as a potential alternative to conventional chemotherapies.
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Affiliation(s)
- Stéphanie Arnould
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Geneviève Rodier
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Gisèle Matar
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Charles Vincent
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Nelly Pirot
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
- Réseau d'Histologie Expérimentale de Montpellier, BioCampus, UMS3426 CNRS-US009 INSERM-UM, Montpellier, France
| | - Yoann Delorme
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Charlène Berthet
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
- Réseau d'Histologie Expérimentale de Montpellier, BioCampus, UMS3426 CNRS-US009 INSERM-UM, Montpellier, France
| | - Yoan Buscail
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
- Réseau d'Histologie Expérimentale de Montpellier, BioCampus, UMS3426 CNRS-US009 INSERM-UM, Montpellier, France
| | - Jean Yohan Noël
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
- Réseau d'Histologie Expérimentale de Montpellier, BioCampus, UMS3426 CNRS-US009 INSERM-UM, Montpellier, France
| | - Simon Lachambre
- Montpellier RIO Imaging, BioCampus, UMS3426 CNRS-US009 INSERM-UM, Montpellier, France
| | - Marta Jarlier
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Florence Bernex
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
- Réseau d'Histologie Expérimentale de Montpellier, BioCampus, UMS3426 CNRS-US009 INSERM-UM, Montpellier, France
| | - Hélène Delpech
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Pierre Olivier Vidalain
- Laboratoire de Chimie et Biochimie Pharmacologiques et Toxicologiques, Equipe Chimie and Biologie, Modélisation et Immunologie pour la Thérapie, CNRS UMR 8601 CNRS-Université Paris Descartes, Paris, France
| | - Yves L. Janin
- Institut Pasteur, Unité de Chimie et Biocatalyse, CNRS UMR3523, Paris, France
| | - Charles Theillet
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Claude Sardet
- Institut de Recherche en Cancérologie de Montpellier, Montpellier, France
- INSERM U1194, Montpellier, France
- Université de Montpellier, Montpellier, France
- Institut Régional du Cancer de Montpellier, Montpellier, France
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15
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Klotz L, Berthele A, Brück W, Chan A, Flachenecker P, Gold R, Haghikia A, Hellwig K, Hemmer B, Hohlfeld R, Korn T, Kümpfel T, Lang M, Limmroth V, Linker RA, Meier U, Meuth SG, Paul F, Salmen A, Stangel M, Tackenberg B, Tumani H, Warnke C, Weber MS, Ziemssen T, Zipp F, Wiendl H. [Monitoring of blood parameters under course-modified MS therapy : Substance-specific relevance and current recommendations for action]. DER NERVENARZT 2017; 87:645-59. [PMID: 26927677 DOI: 10.1007/s00115-016-0077-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With the approval of various substances for the immunotherapy of multiple sclerosis (MS), treatment possibilities have improved significantly over the last few years. Indeed, the choice of individually tailored preparations and treatment monitoring for the treating doctor is becoming increasingly more complex. This is particularly applicable for monitoring for a treatment-induced compromise of the immune system. The following article by members of the German Multiple Sclerosis Skills Network (KKNMS) and the task force "Provision Structures and Therapeutics" summarizes the practical recommendations for approved immunotherapy for mild to moderate and for (highly) active courses of MS. The focus is on elucidating the substance-specific relevance of particular laboratory parameters with regard to the mechanism of action and the side effects profile. To enable appropriate action to be taken in clinical practice, any blood work changes that can be expected, in addition to any undesirable laboratory findings and their causes and relevance, should be elucidated.
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Affiliation(s)
- L Klotz
- Department für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - A Berthele
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - W Brück
- Institut für Neuropathologie, Universitätsmedizin Göttingen der Georg-August-Universität, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - A Chan
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - P Flachenecker
- Neurologisches Rehabilitationszentrum Quellenhof in Bad Wildbad GmbH, Kuranlagenallee 2, 75323, Bad Wildbad, Deutschland
| | - R Gold
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - A Haghikia
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - K Hellwig
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - B Hemmer
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - R Hohlfeld
- Institut für Klinische Neuroimmunologie, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - T Korn
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - T Kümpfel
- Institut für Klinische Neuroimmunologie, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - M Lang
- NeuroTransConcept GmbH, Centers of Excellence, Pfauengasse 8, 89073, Ulm, Deutschland
| | - V Limmroth
- Klinik für Neurologie und Palliativmedizin, Kliniken der Stadt Köln, Ostmerheimer Str. 200, 51109, Köln - Merheim, Deutschland
| | - R A Linker
- Neurologische Klinik, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland
| | - U Meier
- Berufsverband Deutscher Neurologen BDN, Am Ziegelkamp 1f, 41515, Grevenbroich, Deutschland
| | - S G Meuth
- Department für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - F Paul
- Institut für Neuroimmunologie, Universitätsklinikum Charité, Schumannstr. 20/21, 10117, Berlin, Deutschland
| | - A Salmen
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - M Stangel
- Klinik für Neurologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - B Tackenberg
- Klinik für Neurologie, Philipps-Universität und Universitätsklinikum Marburg, Baldingerstr. 1, 35043, Marburg, Deutschland
| | - H Tumani
- Neurologische Universitätsklinik der Universität Ulm, Oberer Eselsberg 45, 89081, Ulm, Deutschland.,Fachklinik für Neurologie Dietenbronn, Dietenbronn 7, 88477, Schwendi, Deutschland
| | - C Warnke
- Klinik für Neurologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - M S Weber
- Institut für Neuropathologie, Universitätsmedizin Göttingen der Georg-August-Universität, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - T Ziemssen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus der TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - F Zipp
- Klinik für Neurologie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - H Wiendl
- Department für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland.
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16
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Kasarełło K, Cudnoch-Jędrzejewska A, Członkowski A, Mirowska-Guzel D. Mechanism of action of three newly registered drugs for multiple sclerosis treatment. Pharmacol Rep 2017; 69:702-708. [PMID: 28550802 DOI: 10.1016/j.pharep.2017.02.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/16/2017] [Accepted: 02/16/2017] [Indexed: 11/16/2022]
Abstract
Multiple sclerosis (MS) is a disease of suspected autoimmune origin leading to neurodegeneration. The disease pathomechanism is considered to be primarily based on neuroinflammation directed against myelin antigens caused by autoreactive T cells. MS etiology remains still unknown, which makes it difficult to create an efficient therapy, therefore, MS treatment targets mechanisms involved in disease pathology. In this review, we present the mechanism of action of three newly registered drugs for MS. Dimethyl fumarate (DMF) is an agent presenting a broad spectrum of action. Its main activity is based on activating the nuclear factor E2 dependent pathway leading to antioxidant enzyme synthesis. DMF in general suppresses the pro-inflammatory immune activity and exerts a neuroprotective action. Teriflunomide is a more focused drug, acting as an inhibitor of pyrimidines synthesis, important for rapidly dividing cells such as activated lymphocytes. Similarly, alemtuzumab, an anti-CD52 antibody, causes depletion of mainly lymphocytes. Since in MS pathology, T and B cells are involved, this mode of action is promising.
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Affiliation(s)
- Kaja Kasarełło
- Department of Experimental and Clinical Physiology, Medical University of Warsaw, Warszawa, Poland
| | | | - Andrzej Członkowski
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warszawa, Poland
| | - Dagmara Mirowska-Guzel
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warszawa, Poland; Second Department of Neurology, Institute of Psychiatry and Neurology, Warszawa, Poland.
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17
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Havla J, Warnke C, Derfuss T, Kappos L, Hartung HP, Hohlfeld R. Interdisciplinary Risk Management in the Treatment of Multiple Sclerosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:879-886. [PMID: 28130920 PMCID: PMC5282476 DOI: 10.3238/arztebl.2016.0879] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 06/20/2016] [Accepted: 10/05/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common autoimmune disease of the central nervous system. There are at least 150 000 persons with MS in Germany. Recent years have seen the approval of new drugs against. METHODS This article is based on pertinent literature retrieved by a selective search in PubMed as well as on documentation of relevant risks and adverse effects in "red hand letters" (information bulletins from pharmaceutical companies to physicians about adverse drug effects) and elsewhere, along with data provided by the German Multiple Sclerosis Competence Network. RESULTS In recent years, there have been major advances enabling better, more individualized treatment of patients with MS. Physicians must, however, give due consideration to potentially severe or even life-threatening adverse drug effects. These can include, for example, transaminase elevation (hepatotoxicity), cardio- and nephrotoxicity, or lympho- and leukopenia with a variable risk of infection. Among patients taking natalizumab, the cumulative risk of developing progressive multifocal leukencephalopathy (PML) may be 1:100 or higher, depending on the individual risk profile. Rare cases of PML have also been seen under treatment with fingolimod and dimethyl fumarate. Moreover, any type of immunosuppressive treatment can, at least theoretically, increase the risk of malignant disease. Secondary autoimmune diseases can arise as well: approximately 35% of patients treated with alemtuzumab develop autoimmune thyroid disease within two years, and 2% of patients who take daclizumab have severe autoimmune dermatological side effects. Teriflunomide, fingolimod, natalizumab, mitoxantrone, interferon β1-a/b, and daclizumab can all damage the liver. There are also psychiatric, reproductive, and vaccineassociated risks and side effects that must be considered. CONCLUSION Newer drugs for MS have enabled more effective treatment, but are also associated with a higher risk of side effects. Interdisciplinary risk management is needed.
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Affiliation(s)
- Joachim Havla
- Institute for Clinical Neuroimmunology, Biomedical Center and Hospital, Ludwig-Maximilians Universität München, Munich
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine, Heinrich Heine University Düsseldorf
| | | | | | - Hans-Peter Hartung
- Department of Neurology, Faculty of Medicine, Heinrich Heine University Düsseldorf
| | - Reinhard Hohlfeld
- Institute for Clinical Neuroimmunology, Biomedical Center and Hospital, Ludwig-Maximilians Universität München, Munich
- Munich Cluster for Systems Neurology (SyNergy)
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Ochoa-Repáraz J, Colpitts SL, Kircher C, Kasper EJ, Telesford KM, Begum-Haque S, Pant A, Kasper LH. Induction of gut regulatory CD39 + T cells by teriflunomide protects against EAE. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e291. [PMID: 27766282 PMCID: PMC5063394 DOI: 10.1212/nxi.0000000000000291] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022]
Abstract
Objective: To determine whether as an orally delivered treatment, teriflunomide, an inhibitor of the mitochondrial enzyme dihydroorotate dehydrogenase approved to treat relapsing forms of multiple sclerosis, could affect gut-associated lymphoid tissue (GALT) immune responses functionally. Methods: C57BL/6 mice were treated orally with teriflunomide and flow cytometric analysis of immune GALT cells performed ex vivo, and adoptive transfer experiments were used to test the protective effects of GALT regulatory T (Treg) cells. Results: Teriflunomide reduced the percentages of antigen-presenting cells of Peyer patches when compared to controls. Conversely, a significant increase of the relative frequency of CD39+ Treg cells was observed. In vivo, the protective effect of GALT-derived teriflunomide-induced CD39+ Treg cells was established by adoptive transfer into recipient experimental autoimmune encephalomyelitis mice. Conclusions: Our results identify specific GALT-derived CD39+ Treg cells as a mechanism of action that may contribute to the efficacy of teriflunomide during CNS inflammatory demyelination and as an oral therapeutic in relapsing multiple sclerosis.
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Affiliation(s)
- Javier Ochoa-Repáraz
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH. J.O.-R. is currently affiliated with the Department of Biology, College of Science, Technology, Engineering and Mathematics, Eastern Washington University, Cheney, WA
| | - Sara L Colpitts
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH. J.O.-R. is currently affiliated with the Department of Biology, College of Science, Technology, Engineering and Mathematics, Eastern Washington University, Cheney, WA
| | - Christopher Kircher
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH. J.O.-R. is currently affiliated with the Department of Biology, College of Science, Technology, Engineering and Mathematics, Eastern Washington University, Cheney, WA
| | - Eli J Kasper
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH. J.O.-R. is currently affiliated with the Department of Biology, College of Science, Technology, Engineering and Mathematics, Eastern Washington University, Cheney, WA
| | - Kiel M Telesford
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH. J.O.-R. is currently affiliated with the Department of Biology, College of Science, Technology, Engineering and Mathematics, Eastern Washington University, Cheney, WA
| | - Sakhina Begum-Haque
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH. J.O.-R. is currently affiliated with the Department of Biology, College of Science, Technology, Engineering and Mathematics, Eastern Washington University, Cheney, WA
| | - Anudeep Pant
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH. J.O.-R. is currently affiliated with the Department of Biology, College of Science, Technology, Engineering and Mathematics, Eastern Washington University, Cheney, WA
| | - Lloyd H Kasper
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH. J.O.-R. is currently affiliated with the Department of Biology, College of Science, Technology, Engineering and Mathematics, Eastern Washington University, Cheney, WA
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Poulos C, Kinter E, Yang JC, Bridges JFP, Posner J, Gleißner E, Mühlbacher A, Kieseier B. A discrete-choice experiment to determine patient preferences for injectable multiple sclerosis treatments in Germany. Ther Adv Neurol Disord 2016; 9:95-104. [PMID: 27006697 DOI: 10.1177/1756285615622736] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the relative importance of features of a hypothetical injectable disease-modifying treatment for patients with multiple sclerosis using a discrete-choice experiment. METHODS German residents at least 18 years of age with a self-reported physician diagnosis of multiple sclerosis completed a 25-30 minute online discrete-choice experiment. Patients were asked to choose one of two hypothetical injectable treatments for multiple sclerosis, defined by different levels of six attributes (disability progression, the number of relapses in the next 4 years, injection time, frequency of injections, presence of flu-like symptoms, and presence of injection-site reactions). The data were analyzed using a random-parameters logit model. RESULTS Of 202 adults who completed the survey, results from 189 were used in the analysis. Approximately 50% of all patients reported a diagnosis of relapsing-remitting multiple sclerosis, and 31% reported secondary progressive multiple sclerosis. Approximately 71% of patients had current or prior experience with injectable multiple sclerosis medication. Approximately 53% had experienced flu-like symptoms caused by their medication, and 47% had experienced mild injection-site reactions. At least one significant difference was seen between levels in all attributes, except injection time. The greatest change in relative importance between levels of an attribute was years until symptoms get worse from 1 to 4 years. The magnitude of this difference was about twice that of relapses in the next 4 years, frequency of injections, and flu-like symptoms. CONCLUSIONS Most attributes examined in this experiment had an influence on patient preference. Patients placed a significant value on improvements in the frequency of dosing and disability progression. Results suggest that changes in injection frequency can be as important as changes in efficacy and safety attributes. Understanding which attributes of injectable therapies influence patient preference could potentially improve outcomes and adherence in patients with multiple sclerosis.
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Affiliation(s)
- Christine Poulos
- RTI Health Solutions, 200 Park Offices Drive, PO Box 12194, Research Triangle Park, NC 27709, USA
| | | | - Jui-Chen Yang
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | - Joshua Posner
- RTI Health Solutions, Research Triangle Park, NC, USA
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Leroy C, Rigot JM, Leroy M, Decanter C, Le Mapihan K, Parent AS, Le Guillou AC, Yakoub-Agha I, Dharancy S, Noel C, Vantyghem MC. Immunosuppressive drugs and fertility. Orphanet J Rare Dis 2015; 10:136. [PMID: 26490561 PMCID: PMC4618138 DOI: 10.1186/s13023-015-0332-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 08/30/2015] [Indexed: 12/16/2022] Open
Abstract
Immunosuppressive drugs are used in the treatment of inflammatory and autoimmune diseases, as well as in transplantation. Frequently prescribed in young people, these treatments may have deleterious effects on fertility, pregnancy outcomes and the unborn child. This review aims to summarize the main gonadal side effects of immunosuppressants, to detail the effects on fertility and pregnancy of each class of drug, and to provide recommendations on the management of patients who are seen prior to starting or who are already receiving immunosuppressive treatment, allowing them in due course to bear children. The recommendations for use are established with a rather low level of proof, which needs to be taken into account in the patient management. Methotrexate, mycophenolate, and le- and teri-flunomide, cyclophosphamide, mitoxanthrone are contraindicated if pregnancy is desired due to their teratogenic effects, as well as gonadotoxic effects in the case of cyclophosphamide. Anti-TNF-alpha and mTOR-inhibitors are to be used cautiously if pregnancy is desired, since experience using these drugs is still relatively scarce. Azathioprine, glucocorticoids, mesalazine, anticalcineurins such as cyclosporine and tacrolimus, ß-interferon, glatiramer-acetate and chloroquine can be used during pregnancy, bearing in mind however that side effects may still occur. Experience is limited concerning natalizumab, fingolimod, dimethyl-fumarate and induction treatments. Conclusion: At the time of prescription, patients must be informed of the possible consequences of immunosuppressants on fertility and of the need for contraception. Pregnancy must be planned and the treatment modified if necessary in a pre-conception time period adapted to the half-life of the drug, imperatively in relation with the prescriber of the immunosuppressive drugs.
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Affiliation(s)
- Clara Leroy
- Endocrinology and Metabolism, Hôpital Huriez, Lille University Hospital, 59037, Lille Cedex, France.
- Andrology, Hôpital Calmette, Lille University Hospital, 59037, Lille Cedex, France.
| | - Jean-Marc Rigot
- Andrology, Hôpital Calmette, Lille University Hospital, 59037, Lille Cedex, France.
| | - Maryse Leroy
- Gynaecology -Obstetrics, Hôpital Jeanne de Flandres, Lille University Hospital, 59037, Lille Cedex, France.
| | - Christine Decanter
- Endocrine Gynaecology, Hôpital Jeanne de Flandres, Lille University Hospital, 59037, Lille Cedex, France.
| | - Kristell Le Mapihan
- Endocrinology and Metabolism, Hôpital Huriez, Lille University Hospital, 59037, Lille Cedex, France.
| | - Anne-Sophie Parent
- Endocrinology and Metabolism, Hôpital Huriez, Lille University Hospital, 59037, Lille Cedex, France.
| | - Anne-Claire Le Guillou
- Endocrinology and Metabolism, Hôpital Huriez, Lille University Hospital, 59037, Lille Cedex, France.
| | - Ibrahim Yakoub-Agha
- Hematology, Hôpital Huriez, Lille University Hospital, 59037, Lille Cedex, France.
| | - Sébastien Dharancy
- Liver Diseases and Gastroenterology, Hôpital Huriez, Lille University Hospital, 59037, Lille Cedex, France.
| | - Christian Noel
- Nephrology Hôpital Huriez, Lille University Hospital, 59037, Lille Cedex, France.
| | - Marie-Christine Vantyghem
- Endocrinology and Metabolism, Hôpital Huriez, Lille University Hospital, 59037, Lille Cedex, France.
- InsermU859 Biotherapies of Diabetes, Lille University Hospital, 59037, Lille Cedex, France.
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Update on treatments in multiple sclerosis. Presse Med 2015; 44:e137-51. [DOI: 10.1016/j.lpm.2015.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/01/2015] [Accepted: 02/09/2015] [Indexed: 02/04/2023] Open
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Fragoso YD, Brooks JBB. Leflunomide and teriflunomide: altering the metabolism of pyrimidines for the treatment of autoimmune diseases. Expert Rev Clin Pharmacol 2015; 8:315-20. [PMID: 25712857 DOI: 10.1586/17512433.2015.1019343] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Leflunomide modulates T-cell responses and induces a shift from the Th1 to Th2 subpopulation. This process results in a beneficial effect in diseases in which there is good evidence that T cells play a major role in both initiation and perpetuation of the inflammatory condition. Leflunomide has been successfully used for treating rheumatoid arthritis and psoriatic arthritis for many years. The active metabolite of leflunomide is teriflunomide, which has been approved for treating multiple sclerosis. Teriflunomide, just like the mother drug, inhibits dihydro-orotate dehydrogenase and synthesis of pyrimidine. The present review presents and discusses the safety profiles of leflunomide and teriflunomide, two drugs that are indeed the same, considering that much can be learned from the reported side effects of both.
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Affiliation(s)
- Yara Dadalti Fragoso
- Department of Neurology, Medical School, Universidade Metropolitana de Santos, Rua da Constituicao 374, CEP 11015-470, Santos SP, Brazil
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Teriflunomide (Aubagio®) for the treatment of multiple sclerosis. Exp Neurol 2014; 262 Pt A:57-65. [DOI: 10.1016/j.expneurol.2014.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/31/2014] [Accepted: 06/03/2014] [Indexed: 01/19/2023]
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