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Farinato A, Cavalluzzi MM, Altamura C, Campanale C, Laghetti P, Saltarella I, Delre P, Barbault A, Tarantino N, Milani G, Rotondo NP, Di Cesare Mannelli L, Ghelardini C, Pierno S, Mangiatordi GF, Lentini G, Desaphy JF. Development of Riluzole Analogs with Improved Use-Dependent Inhibition of Skeletal Muscle Sodium Channels. ACS Med Chem Lett 2023; 14:999-1008. [PMID: 37465302 PMCID: PMC10350938 DOI: 10.1021/acsmedchemlett.3c00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
Several commercially available and newly synthesized riluzole analogs were evaluated in vitro as voltage-gated skeletal muscle sodium-channel blockers. Data obtained from the patch-clamp technique demonstrated that potency is well correlated with lipophilicity and the introduction of a protonatable amino function in the benzothiazole 2-position enhances the use-dependent behavior. The most interesting compound, the 2-piperazine analog of riluzole (14), although slightly less potent than the parent compound in the patch-clamp assay as well as in an in vitro model of myotonia, showed greater use-dependent Nav1.4 blocking activity. Docking studies allowed the identification of the key interactions that 14 makes with the amino acids of the local anesthetic binding site within the pore of the channel. The reported results pave the way for the identification of novel compounds useful in the treatment of cell excitability disorders.
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Affiliation(s)
- Alessandro Farinato
- Section
of Pharmacology, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | - Maria Maddalena Cavalluzzi
- Section
of Medicinal Chemistry, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | - Concetta Altamura
- Section
of Pharmacology, Department of Precision and Regenerative Medicine,
School of Medicine, University of Bari Aldo
Moro, 70124 Bari, Italy
| | - Carmen Campanale
- Section
of Pharmacology, Department of Precision and Regenerative Medicine,
School of Medicine, University of Bari Aldo
Moro, 70124 Bari, Italy
| | - Paola Laghetti
- Section
of Pharmacology, Department of Precision and Regenerative Medicine,
School of Medicine, University of Bari Aldo
Moro, 70124 Bari, Italy
| | - Ilaria Saltarella
- Section
of Pharmacology, Department of Precision and Regenerative Medicine,
School of Medicine, University of Bari Aldo
Moro, 70124 Bari, Italy
| | - Pietro Delre
- CNR
− Institute of Crystallography, via Amendola 122/o, 70126 Bari, Italy
| | - Arthur Barbault
- CNR
− Institute of Crystallography, via Amendola 122/o, 70126 Bari, Italy
| | - Nancy Tarantino
- Section
of Pharmacology, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | - Gualtiero Milani
- Section
of Medicinal Chemistry, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | - Natalie Paola Rotondo
- Section
of Medicinal Chemistry, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | - Lorenzo Di Cesare Mannelli
- Department
NEUROFARBA - Pharmaceutical and Nutraceutical Section, University of Firenze, 50139 Florence, Italy
| | - Carla Ghelardini
- Department
NEUROFARBA - Pharmaceutical and Nutraceutical Section, University of Firenze, 50139 Florence, Italy
| | - Sabata Pierno
- Section
of Pharmacology, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | | | - Giovanni Lentini
- Section
of Medicinal Chemistry, Department of Pharmacy − Drug Sciences, University of Bari Aldo Moro, 70125 Bari, Italy
| | - Jean-François Desaphy
- Section
of Pharmacology, Department of Precision and Regenerative Medicine,
School of Medicine, University of Bari Aldo
Moro, 70124 Bari, Italy
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Altamura C, Saltarella I, Campanale C, Laghetti P, Desaphy JF. Drug repurposing in skeletal muscle ion channelopathies. Curr Opin Pharmacol 2023; 68:102329. [PMID: 36512979 DOI: 10.1016/j.coph.2022.102329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 12/14/2022]
Abstract
Skeletal muscle ion channelopathies are rare genetic diseases mainly characterized by myotonia (muscle stiffness) or periodic paralysis (muscle weakness). Here, we reviewed the available therapeutic options in non-dystrophic myotonias (NDM) and periodic paralyses (PP), which consists essentially in drug repositioning to address stiffness or weakness attacks. Empirical use followed by successful randomized clinical trials eventually led to the orphan drug designation and marketing authorization granting of mexiletine for NDM and dichlorphenamide for PP. Yet, these treatments neither consider the genetic cause of the diseases nor address the individual variability in drug response. Thus, ongoing research aims at the identification of repurposed drugs alternative to mexiletine and dichlorphenamide to allow personalization of treatment. This review highlights how drug repurposing may represent an efficient strategy in rare diseases, allowing reduction of drug development time and costs in a context in which the return on investment may be particularly challenging.
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Affiliation(s)
- Concetta Altamura
- Section of Pharmacology, Department of Precision and Regenerative Medicine, School of Medicine, University of Bari Aldo Moro, Piazza Giulo Cesare, 70124, Bari, Italy
| | - Ilaria Saltarella
- Section of Pharmacology, Department of Precision and Regenerative Medicine, School of Medicine, University of Bari Aldo Moro, Piazza Giulo Cesare, 70124, Bari, Italy
| | - Carmen Campanale
- Section of Pharmacology, Department of Precision and Regenerative Medicine, School of Medicine, University of Bari Aldo Moro, Piazza Giulo Cesare, 70124, Bari, Italy
| | - Paola Laghetti
- Section of Pharmacology, Department of Precision and Regenerative Medicine, School of Medicine, University of Bari Aldo Moro, Piazza Giulo Cesare, 70124, Bari, Italy
| | - Jean-François Desaphy
- Section of Pharmacology, Department of Precision and Regenerative Medicine, School of Medicine, University of Bari Aldo Moro, Piazza Giulo Cesare, 70124, Bari, Italy.
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3
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De Bellis M, Boccanegra B, Cerchiara AG, Imbrici P, De Luca A. Blockers of Skeletal Muscle Na v1.4 Channels: From Therapy of Myotonic Syndrome to Molecular Determinants of Pharmacological Action and Back. Int J Mol Sci 2023; 24:ijms24010857. [PMID: 36614292 PMCID: PMC9821513 DOI: 10.3390/ijms24010857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
The voltage-gated sodium channels represent an important target for drug discovery since a large number of physiological processes are regulated by these channels. In several excitability disorders, including epilepsy, cardiac arrhythmias, chronic pain, and non-dystrophic myotonia, blockers of voltage-gated sodium channels are clinically used. Myotonia is a skeletal muscle condition characterized by the over-excitability of the sarcolemma, resulting in delayed relaxation after contraction and muscle stiffness. The therapeutic management of this disorder relies on mexiletine and other sodium channel blockers, which are not selective for the Nav1.4 skeletal muscle sodium channel isoform. Hence, the importance of deepening the knowledge of molecular requirements for developing more potent and use-dependent drugs acting on Nav1.4. Here, we review the available treatment options for non-dystrophic myotonia and the structure-activity relationship studies performed in our laboratory with a focus on new compounds with potential antimyotonic activity.
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Ruijs TQ, Koopmans IW, de Kam ML, Tannemaat MR, Groeneveld GJ, Heuberger JAAC. Muscle velocity recovery cycles as pharmacodynamic biomarker: Effects of mexiletine in a randomized double-blind placebo-controlled cross-over study. Clin Transl Sci 2022; 15:2971-2981. [PMID: 36281627 PMCID: PMC9747120 DOI: 10.1111/cts.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 01/26/2023] Open
Abstract
Measuring muscle velocity recovery cycles (MVRCs) is a method to obtain information on muscle cell excitability, independent of neuromuscular transmission. The goal was to validate MVRC as a pharmacodynamic (PD) biomarker for drugs targeting muscle excitability. As proof-of-concept, sensitivity of MVRC to detect effects of mexiletine, a voltage-gated sodium channel (Nav ) blocker, was assessed. In a randomized, double-blind, two-way crossover study, effects of a single pharmacologically active oral dose of 333 mg mexiletine was compared to placebo in 15 healthy male subjects. MVRC was performed predose, and 3- and 5-h postdose using QTrac. Effects of mexiletine versus placebo were calculated using a mixed effects model with baseline as covariate. Mexiletine had significant effects on MVRC when compared to placebo. Early supernormality after five conditioning stimuli was decreased by mexiletine (estimated difference -2.78% [95% confidence interval: -4.16, -1.40]; p value = 0.0003). Moreover, mexiletine decreased the difference in late supernormality after five versus one conditioning stimuli (5XLSN; ED -1.46% [-2.26, -0.65]; p = 0.001). These results indicate that mexiletine decreases the percentage increase in velocity of the muscle fiber action potential after five conditioning stimuli, at long and short interstimulus intervals, which corresponds to a decrease in muscle membrane excitability. This is in line with the pharmacological activity of mexiletine, which leads to use-dependent NaV 1.4 blockade affecting muscle membrane potentials. This study shows that effects of mexiletine can be detected using MVRC in healthy subjects, thereby indicating that MVRC can be used as a tool to demonstrate PD effects of drugs targeting muscle excitability in early phase drug development.
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Affiliation(s)
- Titia Q. Ruijs
- Centre for Human Drug ResearchLeidenThe Netherlands,Leiden University Medical CentreLeidenThe Netherlands
| | - Ingrid W. Koopmans
- Centre for Human Drug ResearchLeidenThe Netherlands,Leiden University Medical CentreLeidenThe Netherlands
| | | | | | - Geert Jan Groeneveld
- Centre for Human Drug ResearchLeidenThe Netherlands,Leiden University Medical CentreLeidenThe Netherlands
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5
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Xu L, Wang G, Lv X, Zhang D, Yan C, Lin P. A novel mutation in HINT1 gene causes autosomal recessive axonal neuropathy with neuromyotonia, effective treatment with carbamazepine and review of the literature. Acta Neurol Belg 2022; 122:1305-1312. [PMID: 35767146 DOI: 10.1007/s13760-022-02006-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Autosomal recessive axonal neuropathy with neuromyotonia (ARAN-NM) is a rare disease entity linked to mutations in the histidine triad nucleotide binding protein 1 (HINT1) gene. The diagnosis and treatment of ARAN-NM are challenging. There have been few reports of ARAN-NM in East Asia. METHODS A 15-year-old Chinese ARAN-NM patient developed muscle weakness, cramps and atrophy in the lower limbs at the age of 12. Electromyography (EMG) showed motor axonal degeneration and neuromyotonic discharges. Whole exome sequencing was performed. Bioinformatic methods and computational 3D structure modeling were used to analyze the identified variant. According to literature review, carbamazepine was prescribed to the patient. RESULTS Genetic tests identified a homozygous mutation c.356G > T (p.R119L) in the HINT1 gene, which has never been reported before according to HGMD database. Several bioinformatic approaches predicted the variant was damaging. Computational 3D modeling indicated the variant changed the structure of HINT1 protein. Notably, we demonstrated the positive effects of carbamazepine in treating muscle stiffness and cramps of ARAN-NM. DISCUSSION 22 variants have been reported in the HINT1 gene, and we identified a novel c.356G > T (p.R119L) variant. Our study expands the genetic spectrum of ARAN-NM. Moreover, large clinical trials are required to further demonstrate the role of carbamazepine in ARAN-NM.
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Affiliation(s)
- Ling Xu
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Guangyu Wang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Xiaoqing Lv
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Dong Zhang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Chuanzhu Yan
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China
| | - Pengfei Lin
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
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6
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Lukacs P, Pesti K, Földi MC, Zboray K, Toth AV, Papp G, Mike A. An Advanced Automated Patch Clamp Protocol Design to Investigate Drug-Ion Channel Binding Dynamics. Front Pharmacol 2021; 12:738260. [PMID: 34658875 PMCID: PMC8513526 DOI: 10.3389/fphar.2021.738260] [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: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 11/14/2022] Open
Abstract
Standard high throughput screening projects using automated patch-clamp instruments often fail to grasp essential details of the mechanism of action, such as binding/unbinding dynamics and modulation of gating. In this study, we aim to demonstrate that depth of analysis can be combined with acceptable throughput on such instruments. Using the microfluidics-based automated patch clamp, IonFlux Mercury, we developed a method for a rapid assessment of the mechanism of action of sodium channel inhibitors, including their state-dependent association and dissociation kinetics. The method is based on a complex voltage protocol, which is repeated at 1 Hz. Using this time resolution we could monitor the onset and offset of both channel block and modulation of gating upon drug perfusion and washout. Our results show that the onset and the offset of drug effects are complex processes, involving several steps, which may occur on different time scales. We could identify distinct sub-processes on the millisecond time scale, as well as on the second time scale. Automated analysis of the results allows collection of detailed information regarding the mechanism of action of individual compounds, which may help the assessment of therapeutic potential for hyperexcitability-related disorders, such as epilepsies, pain syndromes, neuromuscular disorders, or neurodegenerative diseases.
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Affiliation(s)
- Peter Lukacs
- Plant Protection Institute, Centre for Agricultural Research, Martonvásár, Hungary
| | - Krisztina Pesti
- Department of Biochemistry, ELTE Eötvös Loránd University, Budapest, Hungary.,School of Ph.D. Studies, Semmelweis University, Budapest, Hungary
| | - Mátyás C Földi
- Plant Protection Institute, Centre for Agricultural Research, Martonvásár, Hungary.,Department of Biochemistry, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Katalin Zboray
- Plant Protection Institute, Centre for Agricultural Research, Martonvásár, Hungary
| | - Adam V Toth
- Plant Protection Institute, Centre for Agricultural Research, Martonvásár, Hungary.,Department of Biochemistry, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Gábor Papp
- Institute for Physics, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Arpad Mike
- Plant Protection Institute, Centre for Agricultural Research, Martonvásár, Hungary.,Department of Biochemistry, ELTE Eötvös Loránd University, Budapest, Hungary
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7
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Montagnese F. Current Treatment Options for Patients with Myotonic Dystrophy Type 2. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-021-00686-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Purpose of the review
Myotonic dystrophy types 1 and 2 are frequent forms of muscular dystrophies in adulthood. Their clinical differences need to be taken into account for the most appropriate treatment of patients. The aim of this article is to provide an overview on the current and upcoming therapeutic options for patients with myotonic dystrophy type 2 (DM2).
Recent findings
At the moment, no disease-modifying therapies are available for DM2; next-generation therapies may however be available in the near future. In the meanwhile, the symptomatic management of patients has greatly improved, thank to the production of consensus-based standards of care and the growing evidence of efficacy of anti-myotonic drugs, promising employment of cannabinoids for symptom’s relief, regular monitoring, and early detection of treatable extra-muscular manifestations.
Summary
The treatment of DM2 is currently symptomatic and relies on the coordinated intervention of a multidisciplinary team. It remains to be determined whether upcoming causal therapies for myotonic dystrophy type 1 will be applicable also in DM2.
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Pesti K, Földi MC, Zboray K, Toth AV, Lukacs P, Mike A. Characterization of Compound-Specific, Concentration-Independent Biophysical Properties of Sodium Channel Inhibitor Mechanism of Action Using Automated Patch-Clamp Electrophysiology. Front Pharmacol 2021; 12:738460. [PMID: 34497526 PMCID: PMC8419314 DOI: 10.3389/fphar.2021.738460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/10/2021] [Indexed: 01/15/2023] Open
Abstract
We have developed an automated patch-clamp protocol that allows high information content screening of sodium channel inhibitor compounds. We have observed that individual compounds had their specific signature patterns of inhibition, which were manifested irrespective of the concentration. Our aim in this study was to quantify these properties. Primary biophysical data, such as onset rate, the shift of the half inactivation voltage, or the delay of recovery from inactivation, are concentration-dependent. We wanted to derive compound-specific properties, therefore, we had to neutralize the effect of concentration. This study describes how this is done, and shows how compound-specific properties reflect the mechanism of action, including binding dynamics, cooperativity, and interaction with the membrane phase. We illustrate the method using four well-known sodium channel inhibitor compounds, riluzole, lidocaine, benzocaine, and bupivacaine. Compound-specific biophysical properties may also serve as a basis for deriving parameters for kinetic modeling of drug action. We discuss how knowledge about the mechanism of action may help to predict the frequency-dependence of individual compounds, as well as their potential persistent current component selectivity. The analysis method described in this study, together with the experimental protocol described in the accompanying paper, allows screening for inhibitor compounds with specific kinetic properties, or with specific mechanisms of inhibition.
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Affiliation(s)
- Krisztina Pesti
- Department of Biochemistry, ELTE Eötvös Loránd University, Budapest, Hungary
- School of Ph.D. Studies, Semmelweis University, Budapest, Hungary
| | - Mátyás C. Földi
- Department of Biochemistry, ELTE Eötvös Loránd University, Budapest, Hungary
- Plant Protection Institute, Centre for Agricultural Research, Martonvásár, Hungary
| | - Katalin Zboray
- Plant Protection Institute, Centre for Agricultural Research, Martonvásár, Hungary
| | - Adam V. Toth
- Department of Biochemistry, ELTE Eötvös Loránd University, Budapest, Hungary
- Plant Protection Institute, Centre for Agricultural Research, Martonvásár, Hungary
| | - Peter Lukacs
- Department of Biochemistry, ELTE Eötvös Loránd University, Budapest, Hungary
- Plant Protection Institute, Centre for Agricultural Research, Martonvásár, Hungary
| | - Arpad Mike
- Department of Biochemistry, ELTE Eötvös Loránd University, Budapest, Hungary
- Plant Protection Institute, Centre for Agricultural Research, Martonvásár, Hungary
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9
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Maggi L, Bonanno S, Altamura C, Desaphy JF. Ion Channel Gene Mutations Causing Skeletal Muscle Disorders: Pathomechanisms and Opportunities for Therapy. Cells 2021; 10:cells10061521. [PMID: 34208776 PMCID: PMC8234207 DOI: 10.3390/cells10061521] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 02/06/2023] Open
Abstract
Skeletal muscle ion channelopathies (SMICs) are a large heterogeneous group of rare genetic disorders caused by mutations in genes encoding ion channel subunits in the skeletal muscle mainly characterized by myotonia or periodic paralysis, potentially resulting in long-term disabilities. However, with the development of new molecular technologies, new genes and new phenotypes, including progressive myopathies, have been recently discovered, markedly increasing the complexity in the field. In this regard, new advances in SMICs show a less conventional role of ion channels in muscle cell division, proliferation, differentiation, and survival. Hence, SMICs represent an expanding and exciting field. Here, we review current knowledge of SMICs, with a description of their clinical phenotypes, cellular and molecular pathomechanisms, and available treatments.
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Affiliation(s)
- Lorenzo Maggi
- Neuroimmunology and Neuromuscular Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
- Correspondence:
| | - Silvia Bonanno
- Neuroimmunology and Neuromuscular Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Concetta Altamura
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (C.A.); (J.-F.D.)
| | - Jean-François Desaphy
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; (C.A.); (J.-F.D.)
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10
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Myers JH, Denman K, DuPont C, Hawash AA, Novak KR, Koesters A, Grabner M, Dayal A, Voss AA, Rich MM. The mechanism underlying transient weakness in myotonia congenita. eLife 2021; 10:e65691. [PMID: 33904400 PMCID: PMC8079152 DOI: 10.7554/elife.65691] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/24/2021] [Indexed: 12/23/2022] Open
Abstract
In addition to the hallmark muscle stiffness, patients with recessive myotonia congenita (Becker disease) experience debilitating bouts of transient weakness that remain poorly understood despite years of study. We performed intracellular recordings from muscle of both genetic and pharmacologic mouse models of Becker disease to identify the mechanism underlying transient weakness. Our recordings reveal transient depolarizations (plateau potentials) of the membrane potential to -25 to -35 mV in the genetic and pharmacologic models of Becker disease. Both Na+ and Ca2+ currents contribute to plateau potentials. Na+ persistent inward current (NaPIC) through NaV1.4 channels is the key trigger of plateau potentials and current through CaV1.1 Ca2+ channels contributes to the duration of the plateau. Inhibiting NaPIC with ranolazine prevents the development of plateau potentials and eliminates transient weakness in vivo. These data suggest that targeting NaPIC may be an effective treatment to prevent transient weakness in myotonia congenita.
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Affiliation(s)
- Jessica H Myers
- Department of Neuroscience, Cell Biology and Physiology, Wright State UniversityDaytonUnited States
| | - Kirsten Denman
- Department of Neuroscience, Cell Biology and Physiology, Wright State UniversityDaytonUnited States
| | - Chris DuPont
- Department of Neuroscience, Cell Biology and Physiology, Wright State UniversityDaytonUnited States
| | - Ahmed A Hawash
- Department of Dermatology & Cutaneous Surgery, University of MiamiMiamiUnited States
| | | | - Andrew Koesters
- Naval Medical Research Unit, Wright Patterson Air Force BaseDaytonUnited States
| | - Manfred Grabner
- Department of Pharmacology, Medical University of InnsbruckInnsbruckAustria
| | - Anamika Dayal
- Department of Pharmacology, Medical University of InnsbruckInnsbruckAustria
| | - Andrew A Voss
- Department of Biology, Wright State UniversityDaytonUnited States
| | - Mark M Rich
- Department of Neuroscience, Cell Biology and Physiology, Wright State UniversityDaytonUnited States
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11
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Desaphy JF, Altamura C, Vicart S, Fontaine B. Targeted Therapies for Skeletal Muscle Ion Channelopathies: Systematic Review and Steps Towards Precision Medicine. J Neuromuscul Dis 2021; 8:357-381. [PMID: 33325393 PMCID: PMC8203248 DOI: 10.3233/jnd-200582] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Skeletal muscle ion channelopathies include non-dystrophic myotonias (NDM), periodic paralyses (PP), congenital myasthenic syndrome, and recently identified congenital myopathies. The treatment of these diseases is mainly symptomatic, aimed at reducing muscle excitability in NDM or modifying triggers of attacks in PP. OBJECTIVE This systematic review collected the evidences regarding effects of pharmacological treatment on muscle ion channelopathies, focusing on the possible link between treatments and genetic background. METHODS We searched databases for randomized clinical trials (RCT) and other human studies reporting pharmacological treatments. Preclinical studies were considered to gain further information regarding mutation-dependent drug effects. All steps were performed by two independent investigators, while two others critically reviewed the entire process. RESULTS For NMD, RCT showed therapeutic benefits of mexiletine and lamotrigine, while other human studies suggest some efficacy of various sodium channel blockers and of the carbonic anhydrase inhibitor (CAI) acetazolamide. Preclinical studies suggest that mutations may alter sensitivity of the channel to sodium channel blockers in vitro, which has been translated to humans in some cases. For hyperkalemic and hypokalemic PP, RCT showed efficacy of the CAI dichlorphenamide in preventing paralysis. However, hypokalemic PP patients carrying sodium channel mutations may have fewer benefits from CAI compared to those carrying calcium channel mutations. Few data are available for treatment of congenital myopathies. CONCLUSIONS These studies provided limited information about the response to treatments of individual mutations or groups of mutations. A major effort is needed to perform human studies for designing a mutation-driven precision medicine in muscle ion channelopathies.
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Affiliation(s)
- Jean-François Desaphy
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Concetta Altamura
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Savine Vicart
- Sorbonne Université, INSERM, Assistance Publique Hôpitaux de Paris, Centre de Recherche en Myologie-UMR 974, Reference center in neuro-muscular channelopathies, Institute of Myology, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Bertrand Fontaine
- Sorbonne Université, INSERM, Assistance Publique Hôpitaux de Paris, Centre de Recherche en Myologie-UMR 974, Reference center in neuro-muscular channelopathies, Institute of Myology, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
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12
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Carocci A, Roselli M, Budriesi R, Micucci M, Desaphy JF, Altamura C, Cavalluzzi MM, Toma M, Passeri GI, Milani G, Lovece A, Catalano A, Bruno C, De Palma A, Corbo F, Franchini C, Habtemariam S, Lentini G. Synthesis and Evaluation of Voltage-Gated Sodium Channel Blocking Pyrroline Derivatives Endowed with Both Antiarrhythmic and Antioxidant Activities. ChemMedChem 2020; 16:578-588. [PMID: 33015979 DOI: 10.1002/cmdc.202000692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Indexed: 01/17/2023]
Abstract
Under the hypothesis that cardioprotective agents might benefit from synergism between antiarrhythmic activity and antioxidant properties, a small series of mexiletine analogues were coupled with the 2,2,5,5-tetramethylpyrroline moiety, known for its antioxidant effect, in order to obtain dual-acting drugs potentially useful in the protection of the heart against post-ischemic reperfusion injury. The pyrroline derivatives reported herein were found to be more potent as antiarrhythmic agents than mexiletine and displayed antioxidant activity. The most interesting tetramethylpyrroline congener, a tert-butyl-substituted analogue, was at least 100 times more active as an antiarrhythmic than mexiletine.
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Affiliation(s)
- Alessia Carocci
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari Aldo Moro, via E. Orabona n. 4, 70126, Bari, Italy
| | - Mariagrazia Roselli
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari Aldo Moro, via E. Orabona n. 4, 70126, Bari, Italy
| | - Roberta Budriesi
- Department of Pharmacy and Biotechnologies, Alma Mater Studiorum-University of Bologna, Via Belmeloro 6, Bologna, 40126, Italy
| | - Matteo Micucci
- Department of Pharmacy and Biotechnologies, Alma Mater Studiorum-University of Bologna, Via Belmeloro 6, Bologna, 40126, Italy
| | - Jean-François Desaphy
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, piazza Giulio Cesare, 70126, Bari, Italy
| | - Concetta Altamura
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, piazza Giulio Cesare, 70126, Bari, Italy
| | - Maria Maddalena Cavalluzzi
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari Aldo Moro, via E. Orabona n. 4, 70126, Bari, Italy
| | - Maddalena Toma
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari Aldo Moro, via E. Orabona n. 4, 70126, Bari, Italy
| | - Giovanna Ilaria Passeri
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari Aldo Moro, via E. Orabona n. 4, 70126, Bari, Italy
| | - Gualtiero Milani
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari Aldo Moro, via E. Orabona n. 4, 70126, Bari, Italy
| | - Angelo Lovece
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari Aldo Moro, via E. Orabona n. 4, 70126, Bari, Italy
| | - Alessia Catalano
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari Aldo Moro, via E. Orabona n. 4, 70126, Bari, Italy
| | - Claudio Bruno
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari Aldo Moro, via E. Orabona n. 4, 70126, Bari, Italy
| | - Annalisa De Palma
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari Aldo Moro, via E. Orabona 4, 70126, Bari, Italy
| | - Filomena Corbo
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari Aldo Moro, via E. Orabona n. 4, 70126, Bari, Italy
| | - Carlo Franchini
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari Aldo Moro, via E. Orabona n. 4, 70126, Bari, Italy
| | - Solomon Habtemariam
- Pharmacognosy Research Laboratories & Herbal Analysis services UK, University of Greenwich, Chatham-Maritime, Kent, ME4 4TB, UK
| | - Giovanni Lentini
- Department of Pharmacy - Pharmaceutical Sciences, University of Bari Aldo Moro, via E. Orabona n. 4, 70126, Bari, Italy
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13
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Abstract
PURPOSE OF REVIEW This article aims to review the current and upcoming treatment options of primary muscle channelopathies including the non-dystrophic myotonias and periodic paralyses. RECENT FINDINGS The efficacy of mexiletine in the treatment of myotonia is now supported by two randomised placebo-controlled trials, one of which utilised a novel aggregated n-of-1 design. This has resulted in licencing of the drug via orphan drug status. There is also good evidence that mexiletine is well tolerated and safe in this patient group without the need for intensive monitoring. A range of alternative antimyotonic treatment options include lamotrigine, carbamazepine and ranolazine exist with variable evidence base. In vitro studies have shown insight into reasons for treatment failure of some medications with certain genotypes opening the era of mutation-specific therapy such as use of flecainide. In the periodic paralyses, the ability of MRI to distinguish between reversible oedema and irreversible fatty replacement makes it an increasingly useful tool to guide and assess pharmacological treatment. Unfortunately, the striking efficacy of bumetanide in hypokalaemic periodic paralysis animal models was not replicated in a recent pilot study in humans. SUMMARY The treatment of skeletal muscle channelopathies combines dietary and lifestyle advice together with pharmacological interventions. The rarity of these conditions remains a barrier for clinical studies but the example of the aggregated n-of-1 trial of mexiletine shows that innovative trial design can overcome these hurdles. Further research is required to test efficacy of drugs shown to have promising characteristics in preclinical experiments such as safinamide, riluzule and magnesium for myotonia or bumetanide for hypokalaemic periodic paralysis.
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Affiliation(s)
- Nantaporn Jitpimolmard
- Queen Square Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
- Rehabilitation Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Emma Matthews
- Queen Square Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
- Atkinson-Morley Neuromuscular Centre, St George’s University Hospitals Foundation Trust, London, UK
| | - Doreen Fialho
- Queen Square Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, UCL, London, UK
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14
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Hoppe K, Chaiklieng S, Lehmann-Horn F, Jurkat-Rott K, Wearing S, Klingler W. Preclinical pharmacological in vitro investigations on low chloride conductance myotonia: effects of potassium regulation. Pflugers Arch 2020; 472:1481-1494. [PMID: 32748018 DOI: 10.1007/s00424-020-02410-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 12/20/2022]
Abstract
In myotonia, reduced Cl- conductance of the mutated ClC-1 channels causes hindered muscle relaxation after forceful voluntary contraction due to muscle membrane hyperexcitability. Repetitive contraction temporarily decreases myotonia, a phenomena called "warm up." The underlying mechanism for the reduction of hyperexcitability in warm-up is currently unknown. Since potassium displacement is known to reduce excitability in, for example, muscle fatigue, we characterized the role of potassium in native myotonia congenita (MC) muscle. Muscle specimens of ADR mice (an animal model for low gCl- conductance myotonia) were exposed to increasing K+ concentrations. To characterize functional effects of potassium ion current, the muscle of ADR mice was exposed to agonists and antagonists of the big conductance Ca2+-activated K+ channel (BK) and the voltage-gated Kv7 channel. Effects were monitored by functional force and membrane potential measurements. By increasing [K+]0 to 5 mM, the warm-up phenomena started earlier and at [K+]0 7 mM only weak myotonia was detected. The increase of [K+]0 caused a sustained membrane depolarization accompanied with a reduction of myotonic bursts in ADR mice. Retigabine, a Kv7.2-Kv7.5 activator, dose-dependently reduced relaxation deficit of ADR myotonic muscle contraction and promoted the warm-up phenomena. In vitro results of this study suggest that increasing potassium conductivity via activation of voltage-gated potassium channels enhanced the warm-up phenomena, thereby offering a potential therapeutic treatment option for myotonia congenita.
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Affiliation(s)
- Kerstin Hoppe
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany.
| | - Sunisa Chaiklieng
- Division of Neurophysiology in the Center of Rare Diseases, Ulm University, Albert Einstein Allee 23, 89081, Ulm, Germany
- Faculty of Public Health, Khon Kaen University, Muang Khon Kaen, Thailand
| | - Frank Lehmann-Horn
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Karin Jurkat-Rott
- Universtiy Medical Center Ulm, Division of Experimental Anesthesiology, Albert-Einstein-Allee 23, 89081, Ullm, Germany
| | - Scott Wearing
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, 4059, Australia
- Department of Conservative and Rehabilitation Orthopedics, Faculty of Sport and Health Science, Technical University of Munich, Gerog-Brauchle-Ring 60/62, Munich, Germany
| | - Werner Klingler
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, 4059, Australia
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, SRH Clinincs, Hohenzollernstraße 40, 72488, Sigmaringen, Germany
- Department of Conservative and Rehabilitation Orthopedics, Faculty of Sport and Health Science, Technical University of Munich, Gerog-Brauchle-Ring 60/62, Munich, Germany
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15
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Mignani S, Majoral JP, Desaphy JF, Lentini G. From Riluzole to Dexpramipexole via Substituted-Benzothiazole Derivatives for Amyotrophic Lateral Sclerosis Disease Treatment: Case Studies. Molecules 2020; 25:E3320. [PMID: 32707914 PMCID: PMC7435757 DOI: 10.3390/molecules25153320] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022] Open
Abstract
The 1,3-benzothiazole (BTZ) ring may offer a valid option for scaffold-hopping from indole derivatives. Several BTZs have clinically relevant roles, mainly as CNS medicines and diagnostic agents, with riluzole being one of the most famous examples. Riluzole is currently the only approved drug to treat amyotrophic lateral sclerosis (ALS) but its efficacy is marginal. Several clinical studies have demonstrated only limited improvements in survival, without benefits to motor function in patients with ALS. Despite significant clinical trial efforts to understand the genetic, epigenetic, and molecular pathways linked to ALS pathophysiology, therapeutic translation has remained disappointingly slow, probably due to the complexity and the heterogeneity of this disease. Many other drugs to tackle ALS have been tested for 20 years without any success. Dexpramipexole is a BTZ structural analog of riluzole and was a great hope for the treatment of ALS. In this review, as an interesting case study in the development of a new medicine to treat ALS, we present the strategy of the development of dexpramipexole, which was one of the most promising drugs against ALS.
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Affiliation(s)
- Serge Mignani
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologique, Université Paris Descartes, PRES Sorbonne Paris Cité, CNRS UMR 860, 45, rue des Saints Peres, 75006 Paris, France
- CQM-Centro de Química da Madeira, MMRG, Universidade da Madeira, Campus da Penteada, 9020-105 Funchal, Portugal
| | - Jean-Pierre Majoral
- Laboratoire de Chimie de Coordination du CNRS, 205 route de Narbonne, 31077 Toulouse CEDEX 4, France;
- Université Toulouse, 118 route de Narbonne, 31077 Toulouse CEDEX 4, France
| | - Jean-François Desaphy
- Dipartimento di Scienze Biomediche e Oncologia Umana, Scuola di Medicina, Università degli Studi di Bari Aldo Moro, Piazza Giulio Cesare, 70124 Bari, Italy;
| | - Giovanni Lentini
- Dipartimento di Farmacia—Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, via Orabona 4, 70125 Bari, Italy
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16
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Munger MA, Olğar Y, Koleske ML, Struckman HL, Mandrioli J, Lou Q, Bonila I, Kim K, Ramos Mondragon R, Priori SG, Volpe P, Valdivia HH, Biskupiak J, Carnes CA, Veeraraghavan R, Györke S, Radwański PB. Tetrodotoxin-Sensitive Neuronal-Type Na + Channels: A Novel and Druggable Target for Prevention of Atrial Fibrillation. J Am Heart Assoc 2020; 9:e015119. [PMID: 32468902 PMCID: PMC7429002 DOI: 10.1161/jaha.119.015119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Atrial fibrillation (AF) is a comorbidity associated with heart failure and catecholaminergic polymorphic ventricular tachycardia. Despite the Ca2+‐dependent nature of both of these pathologies, AF often responds to Na+ channel blockers. We investigated how targeting interdependent Na+/Ca2+ dysregulation might prevent focal activity and control AF. Methods and Results We studied AF in 2 models of Ca2+‐dependent disorders, a murine model of catecholaminergic polymorphic ventricular tachycardia and a canine model of chronic tachypacing‐induced heart failure. Imaging studies revealed close association of neuronal‐type Na+ channels (nNav) with ryanodine receptors and Na+/Ca2+ exchanger. Catecholamine stimulation induced cellular and in vivo atrial arrhythmias in wild‐type mice only during pharmacological augmentation of nNav activity. In contrast, catecholamine stimulation alone was sufficient to elicit atrial arrhythmias in catecholaminergic polymorphic ventricular tachycardia mice and failing canine atria. Importantly, these were abolished by acute nNav inhibition (tetrodotoxin or riluzole) implicating Na+/Ca2+ dysregulation in AF. These findings were then tested in 2 nonrandomized retrospective cohorts: an amyotrophic lateral sclerosis clinic and an academic medical center. Riluzole‐treated patients adjusted for baseline characteristics evidenced significantly lower incidence of arrhythmias including new‐onset AF, supporting the preclinical results. Conclusions These data suggest that nNaVs mediate Na+‐Ca2+ crosstalk within nanodomains containing Ca2+ release machinery and, thereby, contribute to AF triggers. Disruption of this mechanism by nNav inhibition can effectively prevent AF arising from diverse causes.
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Affiliation(s)
- Mark A Munger
- Departments of Pharmacotherapy and Internal Medicine University of Utah Health Sciences Center Salt Lake City UT
| | - Yusuf Olğar
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Division of Pharmacy Practice and Sciences College of Pharmacy The Ohio State University Columbus OH
| | - Megan L Koleske
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Division of Pharmacy Practice and Sciences College of Pharmacy The Ohio State University Columbus OH
| | - Heather L Struckman
- Department of Biomedical Engineering College of Engineering The Ohio State University Columbus OH
| | - Jessica Mandrioli
- Department of Neuroscience St. Agostino Estense Hospital Azienda Ospedaliero Universitaria di Modena Italy
| | - Qing Lou
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Department of Physiology and Cell Biology College of Medicine The Ohio State University Columbus OH
| | - Ingrid Bonila
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Department of Physiology and Cell Biology College of Medicine The Ohio State University Columbus OH
| | - Kibum Kim
- Department of Pharmacotherapy University of Utah Health Sciences Center Salt Lake City UT
| | - Roberto Ramos Mondragon
- Department of Internal Medicine and of Molecular & Integrative Physiology University of Michigan Ann Arbor MI
| | - Silvia G Priori
- Molecular Cardiology Istituti Clinici Scientifici Maugeri IRCCS University of Pavia Italy.,Department of Molecular Medicine University of Pavia Italy
| | - Pompeo Volpe
- Department of Biomedical Sciences University of Padova Italy
| | - Héctor H Valdivia
- Department of Internal Medicine and of Molecular & Integrative Physiology University of Michigan Ann Arbor MI
| | - Joseph Biskupiak
- Department of Pharmacotherapy University of Utah Health Sciences Center Salt Lake City UT
| | - Cynthia A Carnes
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Division of Pharmacy Practice and Sciences College of Pharmacy The Ohio State University Columbus OH
| | - Rengasayee Veeraraghavan
- Department of Biomedical Engineering College of Engineering The Ohio State University Columbus OH.,Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Sándor Györke
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Department of Physiology and Cell Biology College of Medicine The Ohio State University Columbus OH
| | - Przemysław B Radwański
- Dorothy M. Davis Heart and Lung Research Institute College of Medicine The Ohio State University Wexner Medical Center Columbus OH.,Division of Pharmacy Practice and Sciences College of Pharmacy The Ohio State University Columbus OH.,Department of Physiology and Cell Biology College of Medicine The Ohio State University Columbus OH
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17
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Altamura C, Desaphy JF, Conte D, De Luca A, Imbrici P. Skeletal muscle ClC-1 chloride channels in health and diseases. Pflugers Arch 2020; 472:961-975. [PMID: 32361781 DOI: 10.1007/s00424-020-02376-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/18/2020] [Accepted: 03/31/2020] [Indexed: 12/14/2022]
Abstract
In 1970, the study of the pathomechanisms underlying myotonia in muscle fibers isolated from myotonic goats highlighted the importance of chloride conductance for skeletal muscle function; 20 years later, the human ClC-1 chloride channel has been cloned; last year, the crystal structure of human protein has been solved. Over the years, the efforts of many researchers led to significant advances in acknowledging the role of ClC-1 in skeletal muscle physiology and the mechanisms through which ClC-1 dysfunctions lead to impaired muscle function. The wide spectrum of pathophysiological conditions associated with modification of ClC-1 activity, either as the primary cause, such as in myotonia congenita, or as a secondary adaptive mechanism in other neuromuscular diseases, supports the idea that ClC-1 is relevant to preserve not only for skeletal muscle excitability, but also for skeletal muscle adaptation to physiological or harmful events. Improving this understanding could open promising avenues toward the development of selective and safe drugs targeting ClC-1, with the aim to restore normal muscle function. This review summarizes the most relevant research on ClC-1 channel physiology, associated diseases, and pharmacology.
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Affiliation(s)
- Concetta Altamura
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Jean-Francois Desaphy
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Diana Conte
- Department of Pharmacy-Drug Sciences, University of Bari "Aldo Moro", Bari, Italy
| | - Annamaria De Luca
- Department of Pharmacy-Drug Sciences, University of Bari "Aldo Moro", Bari, Italy
| | - Paola Imbrici
- Department of Pharmacy-Drug Sciences, University of Bari "Aldo Moro", Bari, Italy.
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18
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Desaphy JF, Farinato A, Altamura C, De Bellis M, Imbrici P, Tarantino N, Caccia C, Melloni E, Padoani G, Vailati S, Keywood C, Carratù MR, De Luca A, Conte D, Pierno S. Safinamide's potential in treating nondystrophic myotonias: Inhibition of skeletal muscle voltage-gated sodium channels and skeletal muscle hyperexcitability in vitro and in vivo. Exp Neurol 2020; 328:113287. [PMID: 32205118 DOI: 10.1016/j.expneurol.2020.113287] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/14/2020] [Accepted: 03/19/2020] [Indexed: 12/26/2022]
Abstract
The antiarrhythmic sodium-channel blocker mexiletine is used to treat patients with myotonia. However, around 30% of patients do not benefit from mexiletine due to poor tolerability or suboptimal response. Safinamide is an add-on therapy to levodopa for Parkinson's disease. In addition to MAOB inhibition, safinamide inhibits neuronal sodium channels, conferring anticonvulsant activity in models of epilepsy. Here, we investigated the effects of safinamide on skeletal muscle hNav1.4 sodium channels and in models of myotonia, in-vitro and in-vivo. Using patch-clamp, we showed that safinamide reversibly inhibited sodium currents in HEK293T cells transfected with hNav1.4. At the holding potential (hp) of -120 mV, the half-maximum inhibitory concentrations (IC50) were 160 and 33 μM at stimulation frequencies of 0.1 and 10 Hz, respectively. The calculated affinity constants of safinamide were dependent on channel state: 420 μM for closed channels and 9 μM for fast-inactivated channels. The p.F1586C mutation in hNav1.4 greatly impaired safinamide inhibition, suggesting that the drug binds to the local anesthetic receptor site in the channel pore. In a condition mimicking myotonia, i.e. hp. of -90 mV and 50-Hz stimulation, safinamide inhibited INa with an IC50 of 6 μM, being two-fold more potent than mexiletine. Using the two-intracellular microelectrodes current-clamp method, action potential firing was recorded in vitro in rat skeletal muscle fibers in presence of the chloride channel blocker, 9-anthracene carboxylic acid (9-AC), to increase excitability. Safinamide counteracted muscle fiber hyperexcitability with an IC50 of 13 μM. In vivo, oral safinamide was tested in the rat model of myotonia. In this model, intraperitoneal injection of 9-AC greatly increased the time of righting reflex (TRR) due to development of muscle stiffness. Safinamide counteracted 9-AC induced TRR increase with an ED50 of 1.2 mg/kg, which is 7 times lower than that previously determined for mexiletine. In conclusion, safinamide is a potent voltage and frequency dependent blocker of skeletal muscle sodium channels. Accordingly, the drug was able to counteract abnormal muscle hyperexcitability induced by 9-AC, both in vitro and in vivo. Thus, this study suggests that safinamide may have potential in treating myotonia and warrants further preclinical and human studies to fully evaluate this possibility.
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Affiliation(s)
- Jean-François Desaphy
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy.
| | - Alessandro Farinato
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Concetta Altamura
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Michela De Bellis
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Paola Imbrici
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Nancy Tarantino
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Carla Caccia
- Open R&D Department, Zambon S.p.A., Bresso, MI, Italy
| | - Elsa Melloni
- Open R&D Department, Zambon S.p.A., Bresso, MI, Italy
| | | | | | | | - Maria Rosaria Carratù
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Annamaria De Luca
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Diana Conte
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Sabata Pierno
- Department of Pharmacy & Drug Sciences, University of Bari Aldo Moro, Bari, Italy
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19
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Metzger S, Dupont C, Voss AA, Rich MM. Central Role of Subthreshold Currents in Myotonia. Ann Neurol 2019; 87:175-183. [PMID: 31725924 DOI: 10.1002/ana.25646] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 01/11/2023]
Abstract
It is generally thought that muscle excitability is almost exclusively controlled by currents responsible for generation of action potentials. We propose that smaller ion channel currents that contribute to setting the resting potential and to subthreshold fluctuations in membrane potential can also modulate excitability in important ways. These channels open at voltages more negative than the action potential threshold and are thus termed subthreshold currents. As subthreshold currents are orders of magnitude smaller than the currents responsible for the action potential, they are hard to identify and easily overlooked. Discovery of their importance in regulation of excitability opens new avenues for improved therapy for muscle channelopathies and diseases of the neuromuscular junction. ANN NEUROL 2020;87:175-183.
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Affiliation(s)
- Sabrina Metzger
- Department of Neuroscience, Cell Biology, and Physiology, Wright State University, Dayton, OH
| | - Chris Dupont
- Department of Neuroscience, Cell Biology, and Physiology, Wright State University, Dayton, OH
| | - Andrew A Voss
- Department of Biology, Wright State University, Dayton, OH
| | - Mark M Rich
- Department of Neuroscience, Cell Biology, and Physiology, Wright State University, Dayton, OH
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20
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Affiliation(s)
- Michela De Bellis
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Diana Conte Camerino
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Jean-François Desaphy
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
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21
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van der Peet PL, Sandanayake S, Jarrott B, Williams SJ. Discovery of N-Aryloxypropylbenzylamines as Voltage-Gated Sodium Channel Na V 1.2-Subtype-Selective Inhibitors. ChemMedChem 2019; 14:570-582. [PMID: 30676691 DOI: 10.1002/cmdc.201800781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/22/2019] [Indexed: 11/07/2022]
Abstract
We previously reported that a lipophilic N-(4'-hydroxy-3',5'-di-tert-butylbenzyl) derivative (1) of the voltage-gated sodium channel blocker mexiletine, was a more potent sodium channel blocker in vitro and in vivo. We demonstrate that replacing the chiral methylethylene linker between the amine and di-tert-butylphenol with an achiral 1,3-propylene linker (to give (2)) maintains potency in vitro. We synthesized 25 analogues bearing the 1,3-propylene linker and found that minor structural changes resulted in pronounced changes in state dependence of blocking human NaV 1.2 and 1.6 channels by high-throughput patch-clamp analysis. Compared to mexiletine, compounds 1 and 2 are highly selective NaV 1.2 inhibitors and >500 times less potent in inhibiting NaV 1.6 channels. On the other hand, a derivative (compound 4) bearing 2,6-dimethoxy groups in place of the 2,6-dimethyl groups found in mexiletine was found to be the most potent inhibitor, but is nonselective against both channels in the tonic, frequency-dependent and inactivated states. In a kindled mouse model of refractory epilepsy, compound 2 inhibited seizures induced by 6 Hz 44 mA electrical stimulation with an IC50 value of 49.9±1.6 mg kg-1 . As established sodium channel blockers do not suppress seizures in this mouse model, this indicates that 2 could be a promising candidate for treating pharmaco-resistant epilepsy.
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Affiliation(s)
- Phillip L van der Peet
- School of Chemistry and Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Saman Sandanayake
- School of Chemistry and Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Bevyn Jarrott
- Florey Institute of Neuroscience & Mental Health, Parkville, Victoria, 3010, Australia
| | - Spencer J Williams
- School of Chemistry and Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Parkville, Victoria, 3010, Australia
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22
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Pharmacogenetics of myotonic hNav1.4 sodium channel variants situated near the fast inactivation gate. Pharmacol Res 2019; 141:224-235. [DOI: 10.1016/j.phrs.2019.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/13/2022]
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23
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Camerino GM, Fonzino A, Conte E, De Bellis M, Mele A, Liantonio A, Tricarico D, Tarantino N, Dobrowolny G, Musarò A, Desaphy JF, De Luca A, Pierno S. Elucidating the Contribution of Skeletal Muscle Ion Channels to Amyotrophic Lateral Sclerosis in search of new therapeutic options. Sci Rep 2019; 9:3185. [PMID: 30816241 PMCID: PMC6395744 DOI: 10.1038/s41598-019-39676-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/25/2019] [Indexed: 12/11/2022] Open
Abstract
The discovery of pathogenetic mechanisms is essential to identify new therapeutic approaches in Amyotrophic Lateral Sclerosis (ALS). Here we investigated the role of the most important ion channels in skeletal muscle of an ALS animal model (MLC/SOD1G93A) carrying a mutated SOD1 exclusively in this tissue, avoiding motor-neuron involvement. Ion channels are fundamental proteins for muscle function, and also to sustain neuromuscular junction and nerve integrity. By a multivariate statistical analysis, using machine learning algorithms, we identified the discriminant genes in MLC/SOD1G93A mice. Surprisingly, the expression of ClC-1 chloride channel, present only in skeletal muscle, was reduced. Also, the expression of Protein Kinase-C, known to control ClC-1 activity, was increased, causing its inhibition. The functional characterization confirmed the reduction of ClC-1 activity, leading to hyperexcitability and impaired relaxation. The increased expression of ion channel coupled AMPA-receptor may contribute to sustained depolarization and functional impairment. Also, the decreased expression of irisin, a muscle-secreted peptide protecting brain function, may disturb muscle-nerve connection. Interestingly, the in-vitro application of chelerythrine or acetazolamide, restored ClC-1 activity and sarcolemma hyperexcitability in these mice. These findings show that ion channel function impairment in skeletal muscle may lead to motor-neuron increased vulnerability, and opens the possibility to investigate on new compounds as promising therapy.
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Affiliation(s)
- Giulia Maria Camerino
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, 70125, Bari, Italy
| | - Adriano Fonzino
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, 70125, Bari, Italy
| | - Elena Conte
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, 70125, Bari, Italy
| | - Michela De Bellis
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, 70125, Bari, Italy
| | - Antonietta Mele
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, 70125, Bari, Italy
| | - Antonella Liantonio
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, 70125, Bari, Italy
| | - Domenico Tricarico
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, 70125, Bari, Italy
| | - Nancy Tarantino
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, 70125, Bari, Italy
| | - Gabriella Dobrowolny
- DAHFMO-Unit of Histology and Medical Embryology, Sapienza University of Rome, 00161 Laboratory affiliated to Istituto Pasteur Italia - Fondazione Cenci Bolognetti, Rome, Italy.,Center for Life Nano Science at Sapienza, Istituto Italiano di Tecnologia, 00161, Rome, Italy
| | - Antonio Musarò
- DAHFMO-Unit of Histology and Medical Embryology, Sapienza University of Rome, 00161 Laboratory affiliated to Istituto Pasteur Italia - Fondazione Cenci Bolognetti, Rome, Italy.,Center for Life Nano Science at Sapienza, Istituto Italiano di Tecnologia, 00161, Rome, Italy
| | - Jean-Francois Desaphy
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Polyclinic, 70124, Bari, Italy
| | - Annamaria De Luca
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, 70125, Bari, Italy
| | - Sabata Pierno
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, 70125, Bari, Italy.
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24
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Coote DJ, Davis MR, Cabrera M, Needham M, Laing NG, Nowak KJ. Clinical Utility Gene Card for: autosomal dominant myotonia congenita (Thomsen Disease). Eur J Hum Genet 2018; 26:1072-1077. [PMID: 29695755 DOI: 10.1038/s41431-017-0065-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 09/28/2017] [Accepted: 11/23/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- David J Coote
- Centre for Medical Research, Faculty of Health and Medical Sciences, The University of Western Australia; and Harry Perkins Institute of Medical Research, QQ Block, QEII Medical Centre, Nedlands, WA, 6009, Australia
| | - Mark R Davis
- Neurogenetics Laboratory, Department of Diagnostic Genomics, PP Block, QEII Medical Centre, Nedlands, WA, 6009, Australia
| | - Macarena Cabrera
- Department of Neurology and Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Seville, 41013, Spain
| | - Merrilee Needham
- Western Australian Neuroscience Institute, QEII Medical Centre, Nedlands, Western Australia 6009; Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA, 6150, Australia
| | - Nigel G Laing
- Centre for Medical Research, Faculty of Health and Medical Sciences, The University of Western Australia; and Harry Perkins Institute of Medical Research, QQ Block, QEII Medical Centre, Nedlands, WA, 6009, Australia.,Neurogenetics Laboratory, Department of Diagnostic Genomics, PP Block, QEII Medical Centre, Nedlands, WA, 6009, Australia
| | - Kristen J Nowak
- Centre for Medical Research, Faculty of Health and Medical Sciences, The University of Western Australia; and Harry Perkins Institute of Medical Research, QQ Block, QEII Medical Centre, Nedlands, WA, 6009, Australia. .,School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, WA, Australia. .,Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, East Perth, WA, 6004, Australia.
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25
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Altamura C, Mangiatordi GF, Nicolotti O, Sahbani D, Farinato A, Leonetti F, Carratù MR, Conte D, Desaphy JF, Imbrici P. Mapping ligand binding pockets in chloride ClC-1 channels through an integrated in silico and experimental approach using anthracene-9-carboxylic acid and niflumic acid. Br J Pharmacol 2018; 175:1770-1780. [PMID: 29500929 DOI: 10.1111/bph.14192] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/19/2018] [Accepted: 02/23/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Although chloride channels are involved in several physiological processes and acquired diseases, the availability of compounds selectively targeting CLC proteins is limited. ClC-1 channels are responsible for sarcolemma repolarization after an action potential in skeletal muscle and have been associated with myotonia congenita and myotonic dystrophy as well as with other muscular physiopathological conditions. To date only a few ClC-1 blockers have been discovered, such as anthracene-9-carboxylic acid (9-AC) and niflumic acid (NFA), whereas no activator exists. The absence of a ClC-1 structure and the limited information regarding the binding pockets in CLC channels hamper the identification of improved modulators. EXPERIMENTAL APPROACH Here we provide an in-depth characterization of drug binding pockets in ClC-1 through an integrated in silico and experimental approach. We first searched putative cavities in a homology model of ClC-1 built upon an eukaryotic CLC crystal structure, and then validated in silico data by measuring the blocking ability of 9-AC and NFA on mutant ClC-1 channels expressed in HEK 293 cells. KEY RESULTS We identified four putative binding cavities in ClC-1. 9-AC appears to interact with residues K231, R421 and F484 within the channel pore. We also identified one preferential binding cavity for NFA and propose R421 and F484 as critical residues. CONCLUSIONS AND IMPLICATIONS This study represents the first effort to delineate the binding sites of ClC-1. This information is fundamental to discover compounds useful in the treatment of ClC-1-associated dysfunctions and might represent a starting point for specifically targeting other CLC proteins.
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Affiliation(s)
- C Altamura
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
| | - G F Mangiatordi
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
| | - O Nicolotti
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
| | - D Sahbani
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
| | - A Farinato
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
| | - F Leonetti
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
| | - M R Carratù
- Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', Bari, Italy
| | - D Conte
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
| | - J-F Desaphy
- Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro', Bari, Italy
| | - P Imbrici
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
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26
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Farinato A, Altamura C, Desaphy JF. Effects of Benzothiazolamines on Voltage-Gated Sodium Channels. Handb Exp Pharmacol 2018; 246:233-250. [PMID: 28939972 DOI: 10.1007/164_2017_46] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Benzothiazole is a versatile fused heterocycle that aroused much interest in drug discovery as anticonvulsant, neuroprotective, analgesic, anti-inflammatory, antimicrobial, and anticancer. Two benzothiazolamines, riluzole and lubeluzole, are known blockers of voltage-gated sodium (Nav) channels. Riluzole is clinically used as a neuroprotectant in amyotrophic lateral sclerosis. Inhibition of Nav channels by riluzole is voltage-dependent due to preferential binding to inactivated sodium channels. Yet the drug exerts little use-dependent block, probably because it lacks protonable amine. One important property is riluzole ability to inhibit persistent Na+ currents, which likely contributes to its neuroprotective activity. Lubeluzole showed promising neuroprotective effects in animal stroke models, but failed to show benefits in acute ischemic stroke in humans. One important concern is its propensity to prolong the cardiac QT interval, due to hERG K+ channel block. Lubeluzole very potently inhibits Nav channels in a voltage- and use-dependent manner, due to its great preferential affinity for inactivated channels and the presence of a protonable amine group. Patch-clamp experiments suggest that the binding sites of both drugs overlap the local anesthetic receptor within the ion-conducting pathway. Riluzole and lubeluzole displayed very potent antimyotonic activity in a rat model of myotonia, a pathological skeletal muscle condition characterized by high-frequency runs of action potentials. Such results well support the repurposing of riluzole as an antimyotonic drug, allowing the launch of a pilot study in myotonic patients. Riluzole, lubeluzole, and new Nav channel blockers built on the benzothiazolamine scaffold will certainly continue to be investigated for possible clinical applications.
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Affiliation(s)
- Alessandro Farinato
- Section of Pharmacology, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Concetta Altamura
- Section of Pharmacology, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Jean-François Desaphy
- Section of Pharmacology, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Policlinico, Piazza G. Cesare 11, 70124, Bari, Italy.
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27
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Hawash AA, Voss AA, Rich MM. Inhibiting persistent inward sodium currents prevents myotonia. Ann Neurol 2017; 82:385-395. [PMID: 28833464 PMCID: PMC5639374 DOI: 10.1002/ana.25017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/28/2017] [Accepted: 08/13/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Patients with myotonia congenita have muscle hyperexcitability due to loss-of-function mutations in the ClC-1 chloride channel in skeletal muscle, which causes involuntary firing of muscle action potentials (myotonia), producing muscle stiffness. The excitatory events that trigger myotonic action potentials in the absence of stabilizing ClC-1 current are not fully understood. Our goal was to identify currents that trigger spontaneous firing of muscle in the setting of reduced ClC-1 current. METHODS In vitro intracellular current clamp and voltage clamp recordings were performed in muscle from a mouse model of myotonia congenita. RESULTS Intracellular recordings revealed a slow afterdepolarization (AfD) that triggers myotonic action potentials. The AfD is well explained by a tetrodotoxin-sensitive and voltage-dependent Na+ persistent inward current (NaPIC). Notably, this NaPIC undergoes slow inactivation over seconds, suggesting this may contribute to the end of myotonic runs. Highlighting the significance of this mechanism, we found that ranolazine and elevated serum divalent cations eliminate myotonia by inhibiting AfD and NaPIC. INTERPRETATION This work significantly changes our understanding of the mechanisms triggering myotonia. Our work suggests that the current focus of treating myotonia, blocking the transient Na+ current underlying action potentials, is an inefficient approach. We show that inhibiting NaPIC is paralleled by elimination of myotonia. We suggest the ideal myotonia therapy would selectively block NaPIC and spare the transient Na+ current. Ann Neurol 2017;82:385-395.
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Affiliation(s)
- Ahmed A Hawash
- Department of Neuroscience, Cell Biology, and Physiology, Wright State University, Dayton, OH
| | - Andrew A Voss
- Department of Biology, Wright State University, Dayton, OH
| | - Mark M Rich
- Department of Neuroscience, Cell Biology, and Physiology, Wright State University, Dayton, OH
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28
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Arnold WD, Kline D, Sanderson A, Hawash AA, Bartlett A, Novak KR, Rich MM, Kissel JT. Open-label trial of ranolazine for the treatment of myotonia congenita. Neurology 2017; 89:710-713. [PMID: 28710329 DOI: 10.1212/wnl.0000000000004229] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 05/18/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To determine open-label, pilot study whether ranolazine could improve signs and symptoms of myotonia and muscle stiffness in patients with myotonia congenita (MC). METHODS Thirteen participants were assessed at baseline and 2, 4, and 5 weeks. Ranolazine was started after baseline assessment (500 mg twice daily), increased as tolerated after week 2 (1,000 mg twice daily), and maintained until week 4. Outcomes included change from baseline to week 4 in self-reported severity of symptoms (stiffness, weakness, and pain), Timed Up and Go (TUG), hand grip and eyelid myotonia, and myotonia on EMG. RESULTS Self-reported severity of stiffness (p < 0.0001) and weakness (p < 0.01) was significantly improved compared with baseline. TUG and grip myotonia times were reduced (p = 0.03, p = 0.01). EMG of the abductor digiti minimi and tibialis anterior showed significantly reduced myotonia duration (p < 0.001, p < 0.01) at week 4. No participant discontinued ranolazine because of side effects. CONCLUSIONS Ranolazine appeared to be well tolerated over a period of 4 weeks in individuals with MC, and ranolazine resulted in improvement of signs and symptoms of muscle stiffness. The findings of this study suggest that ranolazine should be investigated in a larger controlled study. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that ranolazine improves myotonia in myotonia congenita.
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Affiliation(s)
- W David Arnold
- From the Department of Neurology (W.D.A., A.S., A.B., J.T.K.), The Ohio State University Wexner Medical Center; Center for Biostatistics (D.K.), Department of Biomedical Informatics, The Ohio State University, Columbus; and Neuroscience, Cell Biology, and Physiology and Neurology (A.A.H., K.R.N., M.M.R.), Wright State University, Dayton, OH.
| | - David Kline
- From the Department of Neurology (W.D.A., A.S., A.B., J.T.K.), The Ohio State University Wexner Medical Center; Center for Biostatistics (D.K.), Department of Biomedical Informatics, The Ohio State University, Columbus; and Neuroscience, Cell Biology, and Physiology and Neurology (A.A.H., K.R.N., M.M.R.), Wright State University, Dayton, OH
| | - Alan Sanderson
- From the Department of Neurology (W.D.A., A.S., A.B., J.T.K.), The Ohio State University Wexner Medical Center; Center for Biostatistics (D.K.), Department of Biomedical Informatics, The Ohio State University, Columbus; and Neuroscience, Cell Biology, and Physiology and Neurology (A.A.H., K.R.N., M.M.R.), Wright State University, Dayton, OH
| | - Ahmed A Hawash
- From the Department of Neurology (W.D.A., A.S., A.B., J.T.K.), The Ohio State University Wexner Medical Center; Center for Biostatistics (D.K.), Department of Biomedical Informatics, The Ohio State University, Columbus; and Neuroscience, Cell Biology, and Physiology and Neurology (A.A.H., K.R.N., M.M.R.), Wright State University, Dayton, OH
| | - Amy Bartlett
- From the Department of Neurology (W.D.A., A.S., A.B., J.T.K.), The Ohio State University Wexner Medical Center; Center for Biostatistics (D.K.), Department of Biomedical Informatics, The Ohio State University, Columbus; and Neuroscience, Cell Biology, and Physiology and Neurology (A.A.H., K.R.N., M.M.R.), Wright State University, Dayton, OH
| | - Kevin R Novak
- From the Department of Neurology (W.D.A., A.S., A.B., J.T.K.), The Ohio State University Wexner Medical Center; Center for Biostatistics (D.K.), Department of Biomedical Informatics, The Ohio State University, Columbus; and Neuroscience, Cell Biology, and Physiology and Neurology (A.A.H., K.R.N., M.M.R.), Wright State University, Dayton, OH
| | - Mark M Rich
- From the Department of Neurology (W.D.A., A.S., A.B., J.T.K.), The Ohio State University Wexner Medical Center; Center for Biostatistics (D.K.), Department of Biomedical Informatics, The Ohio State University, Columbus; and Neuroscience, Cell Biology, and Physiology and Neurology (A.A.H., K.R.N., M.M.R.), Wright State University, Dayton, OH
| | - John T Kissel
- From the Department of Neurology (W.D.A., A.S., A.B., J.T.K.), The Ohio State University Wexner Medical Center; Center for Biostatistics (D.K.), Department of Biomedical Informatics, The Ohio State University, Columbus; and Neuroscience, Cell Biology, and Physiology and Neurology (A.A.H., K.R.N., M.M.R.), Wright State University, Dayton, OH
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Increased sodium channel use-dependent inhibition by a new potent analogue of tocainide greatly enhances in vivo antimyotonic activity. Neuropharmacology 2016; 113:206-216. [PMID: 27743929 PMCID: PMC5154332 DOI: 10.1016/j.neuropharm.2016.10.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/08/2016] [Accepted: 10/11/2016] [Indexed: 01/19/2023]
Abstract
Although the sodium channel blocker, mexiletine, is the first choice drug in myotonia, some myotonic patients remain unsatisfied due to contraindications, lack of tolerability, or incomplete response. More therapeutic options are thus needed for myotonic patients, which require clinical trials based on solid preclinical data. In previous structure-activity relationship studies, we identified two newly-synthesized derivatives of tocainide, To040 and To042, with greatly enhanced potency and use-dependent behavior in inhibiting sodium currents in frog skeletal muscle fibers. The current study was performed to verify their potential as antimyotonic agents. Patch-clamp experiments show that both compounds, especially To042, are greatly more potent and use-dependent blockers of human skeletal muscle hNav1.4 channels compared to tocainide and mexiletine. Reduced effects on F1586C hNav1.4 mutant suggest that the compounds bind to the local anesthetic receptor, but that the increased hindrance and lipophilia of the N-substituent may further strengthen drug-receptor interaction and use-dependence. Compared to mexiletine, To042 was 120 times more potent to block hNav1.4 channels in a myotonia-like cellular condition and 100 times more potent to improve muscle stiffness in vivo in a previously-validated rat model of myotonia. To explore toxicological profile, To042 was tested on hERG potassium currents, motor coordination using rotarod, and C2C12 cell line for cytotoxicity. All these experiments suggest a satisfactory therapeutic index for To042. This study shows that, owing to a huge use-dependent block of sodium channels, To042 is a promising candidate drug for myotonia and possibly other membrane excitability disorders, warranting further preclinical and human studies. To040 and To042 are potent use-dependent hNav1.4 sodium channel blockers. The compounds strengthen the molecular interaction at the local anesthetic receptor. To042 is 120-fold more potent than mexiletine in vitro in myotonia-like conditions. To042 is 100-fold more potent than mexiletine in vivo in a rat model of myotonia. To042 is a promising antimyotonic drug deserving further investigation.
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30
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Roy P, Rau F, Ochala J, Messéant J, Fraysse B, Lainé J, Agbulut O, Butler-Browne G, Furling D, Ferry A. Dystrophin restoration therapy improves both the reduced excitability and the force drop induced by lengthening contractions in dystrophic mdx skeletal muscle. Skelet Muscle 2016; 6:23. [PMID: 27441081 PMCID: PMC4952281 DOI: 10.1186/s13395-016-0096-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/11/2016] [Indexed: 12/16/2022] Open
Abstract
Background The greater susceptibility to contraction-induced skeletal muscle injury (fragility) is an important dystrophic feature and tool for testing preclinic dystrophin-based therapies for Duchenne muscular dystrophy. However, how these therapies reduce the muscle fragility is not clear. Methods To address this question, we first determined the event(s) of the excitation-contraction cycle which is/are altered following lengthening (eccentric) contractions in the mdx muscle. Results We found that the immediate force drop following lengthening contractions, a widely used measure of muscle fragility, was associated with reduced muscle excitability. Moreover, the force drop can be mimicked by an experimental reduction in muscle excitation of uninjured muscle. Furthermore, the force drop was not related to major neuromuscular transmission failure, excitation-contraction uncoupling, and myofibrillar impairment. Secondly, and importantly, the re-expression of functional truncated dystrophin in the muscle of mdx mice using an exon skipping strategy partially prevented the reductions in both force drop and muscle excitability following lengthening contractions. Conclusion We demonstrated for the first time that (i) the increased susceptibility to contraction-induced muscle injury in mdx mice is mainly attributable to reduced muscle excitability; (ii) dystrophin-based therapy improves fragility of the dystrophic skeletal muscle by preventing reduction in muscle excitability.
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Affiliation(s)
- Pauline Roy
- Groupe Hospitalier Pitié Salpêtrière, Centre de Recherche en Myologie, CNRS, Inserm, UPMC Univ Paris 06, Sorbonne Universités, Paris, F-75013 France
| | - Fredérique Rau
- Groupe Hospitalier Pitié Salpêtrière, Centre de Recherche en Myologie, CNRS, Inserm, UPMC Univ Paris 06, Sorbonne Universités, Paris, F-75013 France
| | - Julien Ochala
- Centre of Human and Aerospace Physiological Sciences, King's College London, Guy's Campus, SE3 8TL London, UK
| | - Julien Messéant
- Groupe Hospitalier Pitié Salpêtrière, Centre de Recherche en Myologie, CNRS, Inserm, UPMC Univ Paris 06, Sorbonne Universités, Paris, F-75013 France
| | - Bodvael Fraysse
- Groupe Hospitalier Pitié Salpêtrière, Centre de Recherche en Myologie, CNRS, Inserm, UPMC Univ Paris 06, Sorbonne Universités, Paris, F-75013 France
| | - Jeanne Lainé
- Groupe Hospitalier Pitié Salpêtrière, Centre de Recherche en Myologie, CNRS, Inserm, UPMC Univ Paris 06, Sorbonne Universités, Paris, F-75013 France
| | - Onnik Agbulut
- Biological Adaptation and Ageing, UMR CNRS 8256, Institut de Biologie Paris-Seine (IBPS), UPMC Univ Paris 06, Sorbonne Universités, Paris, F-75005 France
| | - Gillian Butler-Browne
- Groupe Hospitalier Pitié Salpêtrière, Centre de Recherche en Myologie, CNRS, Inserm, UPMC Univ Paris 06, Sorbonne Universités, Paris, F-75013 France
| | - Denis Furling
- Groupe Hospitalier Pitié Salpêtrière, Centre de Recherche en Myologie, CNRS, Inserm, UPMC Univ Paris 06, Sorbonne Universités, Paris, F-75013 France
| | - Arnaud Ferry
- Groupe Hospitalier Pitié Salpêtrière, Centre de Recherche en Myologie, CNRS, Inserm, UPMC Univ Paris 06, Sorbonne Universités, Paris, F-75013 France ; Sorbonne Paris Cité, Université Paris Descartes, Paris, F-75006 France ; Groupe Hospitalier Pitié-Salpétrière, Institut de Myologie, F-75013 Paris, France
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31
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Camerino GM, De Bellis M, Conte E, Liantonio A, Musaraj K, Cannone M, Fonzino A, Giustino A, De Luca A, Romano R, Camerino C, Laghezza A, Loiodice F, Desaphy JF, Conte Camerino D, Pierno S. Statin-induced myotoxicity is exacerbated by aging: A biophysical and molecular biology study in rats treated with atorvastatin. Toxicol Appl Pharmacol 2016; 306:36-46. [PMID: 27377005 DOI: 10.1016/j.taap.2016.06.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 01/08/2023]
Abstract
Statin-induced skeletal muscle damage in rats is associated to the reduction of the resting sarcolemmal chloride conductance (gCl) and ClC-1 chloride channel expression. These drugs also affect the ClC-1 regulation by increasing protein kinase C (PKC) activity, which phosphorylate and close the channel. Also the intracellular resting calcium (restCa) level is increased. Similar alterations are observed in skeletal muscles of aged rats, suggesting a higher risk of statin myotoxicity. To verify this hypothesis, we performed a 4-5-weeks atorvastatin treatment of 24-months-old rats to evaluate the ClC-1 channel function by the two-intracellular microelectrodes technique as well as transcript and protein expression of different genes sensitive to statins by quantitative real-time-PCR and western blot analysis. The restCa was measured using FURA-2 imaging, and histological analysis of muscle sections was performed. The results show a marked reduction of resting gCl, in agreement with the reduced ClC-1 mRNA and protein expression in atorvastatin-treated aged rats, with respect to treated adult animals. The observed changes in myocyte-enhancer factor-2 (MEF2) expression may be involved in ClC-1 expression changes. The activity of PKC was also increased and further modulate the gCl in treated aged rats. In parallel, a marked reduction of the expression of glycolytic and mitochondrial enzymes demonstrates an impairment of muscle metabolism. No worsening of restCa or histological features was found in statin-treated aged animals. These findings suggest that a strong reduction of gCl and alteration of muscle metabolism coupled to muscle atrophy may contribute to the increased risk of statin-induced myopathy in the elderly.
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Affiliation(s)
- Giulia Maria Camerino
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy
| | - Michela De Bellis
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy
| | - Elena Conte
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy
| | - Antonella Liantonio
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy
| | - Kejla Musaraj
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy
| | - Maria Cannone
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy
| | - Adriano Fonzino
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy
| | - Arcangela Giustino
- Department of Biomedical Sciences and Human Oncology, University of Bari - Aldo Moro, Medical School, Bari, Italy
| | - Annamaria De Luca
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy
| | - Rossella Romano
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy
| | - Claudia Camerino
- Department of Medical Sciences, Neurosciences and Sense Organs, University of Bari - Aldo Moro, Bari, Italy
| | - Antonio Laghezza
- Section of Medicinal Chemistry, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy
| | - Fulvio Loiodice
- Section of Medicinal Chemistry, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy
| | - Jean-Francois Desaphy
- Department of Biomedical Sciences and Human Oncology, University of Bari - Aldo Moro, Medical School, Bari, Italy
| | - Diana Conte Camerino
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy
| | - Sabata Pierno
- Section of Pharmacology, Department of Pharmacy & Drug Sciences, University of Bari - Aldo Moro, Bari, Italy.
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Abstract
PURPOSE OF REVIEW This is an update on skeletal muscle sodium channelopathies since knowledge in the field have dramatically increased in the past years. RECENT FINDING The relationship between two phenotypes and SCN4A has been confirmed with additional cases that remain extremely rare: severe neonatal episodic laryngospasm mimicking encephalopathy, which should be actively searched for since patients respond well to sodium channel blockers; congenital myasthenic syndromes, which have the particularity to be the first recessive Nav1.4 channelopathy. Deep DNA sequencing suggests the contribution of other ion channels in the clinical expressivity of sodium channelopathies, which may be one of the factors modulating the latter. The increased knowledge of channel molecular structure, the quantity of sodium channel blockers, and the availability of preclinical models would permit a most personalized choice of medication for patients suffering from these debilitating neuromuscular diseases. SUMMARY Advances in the understanding of the molecular structure of voltage-gated sodium channels, as well as availability of preclinical models, would lead to improved medical care of patients suffering from skeletal muscle, as well as other sodium channelopathies.
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Synthesis, antiarrhythmic activity, and toxicological evaluation of mexiletine analogues. Eur J Med Chem 2016; 121:300-307. [PMID: 27267000 DOI: 10.1016/j.ejmech.2016.05.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/20/2016] [Accepted: 05/21/2016] [Indexed: 11/24/2022]
Abstract
Four mexiletine analogues have been tested for their antiarrhythmic, inotropic, and chronotropic effects on isolated guinea pig heart tissues and to assess calcium antagonist activity, in comparison with the parent compound mexiletine. All analogues showed from moderate to high antiarrhythmic activity. In particular, three of them (1b,c,e) were more active and potent than the reference drug, while exhibiting only modest or no negative inotropic and chronotropic effects and vasorelaxant activity, thus showing high selectivity of action. All compounds showed no cytotoxicity and 1b,c,d did not impair motor coordination. All in, these new analogues exhibit an interesting cardiovascular profile and deserve further investigation.
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Imbrici P, Liantonio A, Camerino GM, De Bellis M, Camerino C, Mele A, Giustino A, Pierno S, De Luca A, Tricarico D, Desaphy JF, Conte D. Therapeutic Approaches to Genetic Ion Channelopathies and Perspectives in Drug Discovery. Front Pharmacol 2016; 7:121. [PMID: 27242528 PMCID: PMC4861771 DOI: 10.3389/fphar.2016.00121] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/25/2016] [Indexed: 12/21/2022] Open
Abstract
In the human genome more than 400 genes encode ion channels, which are transmembrane proteins mediating ion fluxes across membranes. Being expressed in all cell types, they are involved in almost all physiological processes, including sense perception, neurotransmission, muscle contraction, secretion, immune response, cell proliferation, and differentiation. Due to the widespread tissue distribution of ion channels and their physiological functions, mutations in genes encoding ion channel subunits, or their interacting proteins, are responsible for inherited ion channelopathies. These diseases can range from common to very rare disorders and their severity can be mild, disabling, or life-threatening. In spite of this, ion channels are the primary target of only about 5% of the marketed drugs suggesting their potential in drug discovery. The current review summarizes the therapeutic management of the principal ion channelopathies of central and peripheral nervous system, heart, kidney, bone, skeletal muscle and pancreas, resulting from mutations in calcium, sodium, potassium, and chloride ion channels. For most channelopathies the therapy is mainly empirical and symptomatic, often limited by lack of efficacy and tolerability for a significant number of patients. Other channelopathies can exploit ion channel targeted drugs, such as marketed sodium channel blockers. Developing new and more specific therapeutic approaches is therefore required. To this aim, a major advancement in the pharmacotherapy of channelopathies has been the discovery that ion channel mutations lead to change in biophysics that can in turn specifically modify the sensitivity to drugs: this opens the way to a pharmacogenetics strategy, allowing the development of a personalized therapy with increased efficacy and reduced side effects. In addition, the identification of disease modifiers in ion channelopathies appears an alternative strategy to discover novel druggable targets.
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Affiliation(s)
- Paola Imbrici
- Department of Pharmacy - Drug Sciences, University of Bari "Aldo Moro" Bari, Italy
| | - Antonella Liantonio
- Department of Pharmacy - Drug Sciences, University of Bari "Aldo Moro" Bari, Italy
| | - Giulia M Camerino
- Department of Pharmacy - Drug Sciences, University of Bari "Aldo Moro" Bari, Italy
| | - Michela De Bellis
- Department of Pharmacy - Drug Sciences, University of Bari "Aldo Moro" Bari, Italy
| | - Claudia Camerino
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro" Bari, Italy
| | - Antonietta Mele
- Department of Pharmacy - Drug Sciences, University of Bari "Aldo Moro" Bari, Italy
| | - Arcangela Giustino
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Bari, Italy
| | - Sabata Pierno
- Department of Pharmacy - Drug Sciences, University of Bari "Aldo Moro" Bari, Italy
| | - Annamaria De Luca
- Department of Pharmacy - Drug Sciences, University of Bari "Aldo Moro" Bari, Italy
| | - Domenico Tricarico
- Department of Pharmacy - Drug Sciences, University of Bari "Aldo Moro" Bari, Italy
| | - Jean-Francois Desaphy
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Bari, Italy
| | - Diana Conte
- Department of Pharmacy - Drug Sciences, University of Bari "Aldo Moro" Bari, Italy
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Desaphy JF, Carbonara R, D'Amico A, Modoni A, Roussel J, Imbrici P, Pagliarani S, Lucchiari S, Lo Monaco M, Conte Camerino D. Translational approach to address therapy in myotonia permanens due to a new SCN4A mutation. Neurology 2016; 86:2100-8. [PMID: 27164696 PMCID: PMC4891212 DOI: 10.1212/wnl.0000000000002721] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/19/2016] [Indexed: 01/26/2023] Open
Abstract
Objective: We performed a clinical, functional, and pharmacologic characterization of the novel p.P1158L Nav1.4 mutation identified in a young girl presenting a severe myotonic phenotype. Methods: Wild-type hNav1.4 channel and P1158L mutant were expressed in tsA201 cells for functional and pharmacologic studies using patch-clamp. Results: The patient shows pronounced myotonia, slowness of movements, and generalized muscle hypertrophy. Because of general discomfort with mexiletine, she was given flecainide with satisfactory response. In vitro, mutant channels show a slower current decay and a rightward shift of the voltage dependence of fast inactivation. The voltage dependence of activation and slow inactivation were not altered. Mutant channels were less sensitive to mexiletine, whereas sensitivity to flecainide was not altered. The reduced inhibition of mutant channels by mexiletine was also observed using clinically relevant drug concentrations in a myotonic-like condition. Conclusions: Clinical phenotype and functional alterations of P1158L support the diagnosis of myotonia permanens. Impairment of fast inactivation is consistent with the possible role of the channel domain III S4-S5 loop in the inactivation gate docking site. The reduced sensitivity of P1158L to mexiletine may have contributed to the unsatisfactory response of the patient. The success of flecainide therapy underscores the usefulness of in vitro functional studies to help in the choice of the best drug for each individual.
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Affiliation(s)
- Jean-François Desaphy
- From the Departments of Biomedical Sciences and Human Oncology (J.-F.D.) and Pharmacy & Drug Sciences (R.C., J.R., P.I., D.C.C.), University of Bari Aldo Moro, Bari; Unit of Neuromuscular and Neurodegenerative Disorders (A.D.), Bambino Gesù Children's Hospital, Rome; Departments of Geriatrics, Neurosciences, and Orthopedics (A.M., M.L.M.), Institute of Neurology, Catholic University of the Sacred Heart, Rome; Dino Ferrari Centre (S.P., S.L.), Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan; and Neurology Unit (S.P., S.L.), IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Roberta Carbonara
- From the Departments of Biomedical Sciences and Human Oncology (J.-F.D.) and Pharmacy & Drug Sciences (R.C., J.R., P.I., D.C.C.), University of Bari Aldo Moro, Bari; Unit of Neuromuscular and Neurodegenerative Disorders (A.D.), Bambino Gesù Children's Hospital, Rome; Departments of Geriatrics, Neurosciences, and Orthopedics (A.M., M.L.M.), Institute of Neurology, Catholic University of the Sacred Heart, Rome; Dino Ferrari Centre (S.P., S.L.), Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan; and Neurology Unit (S.P., S.L.), IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Adele D'Amico
- From the Departments of Biomedical Sciences and Human Oncology (J.-F.D.) and Pharmacy & Drug Sciences (R.C., J.R., P.I., D.C.C.), University of Bari Aldo Moro, Bari; Unit of Neuromuscular and Neurodegenerative Disorders (A.D.), Bambino Gesù Children's Hospital, Rome; Departments of Geriatrics, Neurosciences, and Orthopedics (A.M., M.L.M.), Institute of Neurology, Catholic University of the Sacred Heart, Rome; Dino Ferrari Centre (S.P., S.L.), Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan; and Neurology Unit (S.P., S.L.), IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Modoni
- From the Departments of Biomedical Sciences and Human Oncology (J.-F.D.) and Pharmacy & Drug Sciences (R.C., J.R., P.I., D.C.C.), University of Bari Aldo Moro, Bari; Unit of Neuromuscular and Neurodegenerative Disorders (A.D.), Bambino Gesù Children's Hospital, Rome; Departments of Geriatrics, Neurosciences, and Orthopedics (A.M., M.L.M.), Institute of Neurology, Catholic University of the Sacred Heart, Rome; Dino Ferrari Centre (S.P., S.L.), Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan; and Neurology Unit (S.P., S.L.), IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Julien Roussel
- From the Departments of Biomedical Sciences and Human Oncology (J.-F.D.) and Pharmacy & Drug Sciences (R.C., J.R., P.I., D.C.C.), University of Bari Aldo Moro, Bari; Unit of Neuromuscular and Neurodegenerative Disorders (A.D.), Bambino Gesù Children's Hospital, Rome; Departments of Geriatrics, Neurosciences, and Orthopedics (A.M., M.L.M.), Institute of Neurology, Catholic University of the Sacred Heart, Rome; Dino Ferrari Centre (S.P., S.L.), Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan; and Neurology Unit (S.P., S.L.), IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Imbrici
- From the Departments of Biomedical Sciences and Human Oncology (J.-F.D.) and Pharmacy & Drug Sciences (R.C., J.R., P.I., D.C.C.), University of Bari Aldo Moro, Bari; Unit of Neuromuscular and Neurodegenerative Disorders (A.D.), Bambino Gesù Children's Hospital, Rome; Departments of Geriatrics, Neurosciences, and Orthopedics (A.M., M.L.M.), Institute of Neurology, Catholic University of the Sacred Heart, Rome; Dino Ferrari Centre (S.P., S.L.), Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan; and Neurology Unit (S.P., S.L.), IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Serena Pagliarani
- From the Departments of Biomedical Sciences and Human Oncology (J.-F.D.) and Pharmacy & Drug Sciences (R.C., J.R., P.I., D.C.C.), University of Bari Aldo Moro, Bari; Unit of Neuromuscular and Neurodegenerative Disorders (A.D.), Bambino Gesù Children's Hospital, Rome; Departments of Geriatrics, Neurosciences, and Orthopedics (A.M., M.L.M.), Institute of Neurology, Catholic University of the Sacred Heart, Rome; Dino Ferrari Centre (S.P., S.L.), Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan; and Neurology Unit (S.P., S.L.), IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Sabrina Lucchiari
- From the Departments of Biomedical Sciences and Human Oncology (J.-F.D.) and Pharmacy & Drug Sciences (R.C., J.R., P.I., D.C.C.), University of Bari Aldo Moro, Bari; Unit of Neuromuscular and Neurodegenerative Disorders (A.D.), Bambino Gesù Children's Hospital, Rome; Departments of Geriatrics, Neurosciences, and Orthopedics (A.M., M.L.M.), Institute of Neurology, Catholic University of the Sacred Heart, Rome; Dino Ferrari Centre (S.P., S.L.), Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan; and Neurology Unit (S.P., S.L.), IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Lo Monaco
- From the Departments of Biomedical Sciences and Human Oncology (J.-F.D.) and Pharmacy & Drug Sciences (R.C., J.R., P.I., D.C.C.), University of Bari Aldo Moro, Bari; Unit of Neuromuscular and Neurodegenerative Disorders (A.D.), Bambino Gesù Children's Hospital, Rome; Departments of Geriatrics, Neurosciences, and Orthopedics (A.M., M.L.M.), Institute of Neurology, Catholic University of the Sacred Heart, Rome; Dino Ferrari Centre (S.P., S.L.), Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan; and Neurology Unit (S.P., S.L.), IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Diana Conte Camerino
- From the Departments of Biomedical Sciences and Human Oncology (J.-F.D.) and Pharmacy & Drug Sciences (R.C., J.R., P.I., D.C.C.), University of Bari Aldo Moro, Bari; Unit of Neuromuscular and Neurodegenerative Disorders (A.D.), Bambino Gesù Children's Hospital, Rome; Departments of Geriatrics, Neurosciences, and Orthopedics (A.M., M.L.M.), Institute of Neurology, Catholic University of the Sacred Heart, Rome; Dino Ferrari Centre (S.P., S.L.), Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan; and Neurology Unit (S.P., S.L.), IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Liu XL, Huang XJ, Luan XH, Zhou HY, Wang T, Wang JY, Chen SD, Tang HD, Cao L. Mutations of SCN4A gene cause different diseases: 2 case reports and literature review. Channels (Austin) 2016; 9:82-7. [PMID: 25839108 DOI: 10.1080/19336950.2015.1012945] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
SCN4A encodes the Nav1.4 channel and mutations in SCN4A lead to different ionic channelopathies. In this study, one sporadic individual of periodic paralysis, one paramyotonia family and 200 normal healthy controls are enrolled. Genomic DNA was extracted from peripheral blood leukocytes, followed by polymerase chain reaction and DNA sequencing of candidate genes, including SCN4A and CACNA1S. As a result, heterozygous mutations c.2024G>A (R675Q) and c.1333G>A (V445M) of gene SCN4A were identified in the hypokalemic periodic paralysis patient and the paramyotonia congenita family respectively. Both mutations were not detected in healthy controls. Compared with reported cases, patients with mutation R675Q usually do not present hypokalemic periodic paralysis but hyperkalemic or normokalemic periodic paralysis. The mutation V445M was first reported in Chinese patients with nondystrophic myotonias. In addition, we carried out literature review by summarizing clinical features of the 2 mutations and establish the genotype-phenotype correlations to provide guidance for diagnosis.
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Affiliation(s)
- Xiao-li Liu
- a Department of Neurology ; Rui Jin Hospital & Rui Jin Hospital North ; Shanghai Jiao Tong University School of Medicine ; Shanghai , China
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Hahn C, Salajegheh MK. Myotonic disorders: A review article. IRANIAN JOURNAL OF NEUROLOGY 2016; 15:46-53. [PMID: 27141276 PMCID: PMC4852070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The myotonic disorders are a heterogeneous group of genetically determined diseases that are unified by the presence of myotonia, which is defined as failure of muscle relaxation after activation. The presentation of these disorders can range from asymptomatic electrical myotonia, as seen in some forms of myotonia congenita (MC), to severe disability with muscle weakness, cardiac conduction defects, and other systemic features as in myotonic dystrophy type I (DM1). In this review, we describe the clinical features and pathophysiology of the different myotonic disorders, their laboratory and electrophysiologic findings and briefly review the currently available treatments.
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Affiliation(s)
- Chris Hahn
- 1 Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
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Imbrici P, Altamura C, Pessia M, Mantegazza R, Desaphy JF, Camerino DC. ClC-1 chloride channels: state-of-the-art research and future challenges. Front Cell Neurosci 2015; 9:156. [PMID: 25964741 PMCID: PMC4410605 DOI: 10.3389/fncel.2015.00156] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/08/2015] [Indexed: 01/06/2023] Open
Abstract
The voltage-dependent ClC-1 chloride channel belongs to the CLC channel/transporter family. It is a homodimer comprising two individual pores which can operate independently or simultaneously according to two gating modes, the fast and the slow gate of the channel. ClC-1 is preferentially expressed in the skeletal muscle fibers where the presence of an efficient Cl(-) homeostasis is crucial for the correct membrane repolarization and propagation of action potential. As a consequence, mutations in the CLCN1 gene cause dominant and recessive forms of myotonia congenita (MC), a rare skeletal muscle channelopathy caused by abnormal membrane excitation, and clinically characterized by muscle stiffness and various degrees of transitory weakness. Elucidation of the mechanistic link between the genetic defects and the disease pathogenesis is still incomplete and, at this time, there is no specific treatment for MC. Still controversial is the subcellular localization pattern of ClC-1 channels in skeletal muscle as well as its modulation by some intracellular factors. The expression of ClC-1 in other tissues such as in brain and heart and the possible assembly of ClC-1/ClC-2 heterodimers further expand the physiological properties of ClC-1 and its involvement in diseases. A recent de novo CLCN1 truncation mutation in a patient with generalized epilepsy indeed postulates an unexpected role of this channel in the control of neuronal network excitability. This review summarizes the most relevant and state-of-the-art research on ClC-1 chloride channels physiology and associated diseases.
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Affiliation(s)
- Paola Imbrici
- Department of Pharmacy - Drug Sciences, University of Bari “Aldo Moro”,Bari, Italy
| | - Concetta Altamura
- Department of Pharmacy - Drug Sciences, University of Bari “Aldo Moro”,Bari, Italy
| | - Mauro Pessia
- Department of Pharmacy - Drug Sciences, University of Bari “Aldo Moro”,Bari, Italy
| | - Renato Mantegazza
- Department of Pharmacy - Drug Sciences, University of Bari “Aldo Moro”,Bari, Italy
| | | | - Diana Conte Camerino
- Department of Pharmacy - Drug Sciences, University of Bari “Aldo Moro”,Bari, Italy
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Novak KR, Norman J, Mitchell JR, Pinter MJ, Rich MM. Sodium channel slow inactivation as a therapeutic target for myotonia congenita. Ann Neurol 2015; 77:320-32. [PMID: 25515836 DOI: 10.1002/ana.24331] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 12/01/2014] [Accepted: 12/07/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Patients with myotonia congenita have muscle hyperexcitability due to loss-of-function mutations in the chloride channel in skeletal muscle, which causes spontaneous firing of muscle action potentials (myotonia), producing muscle stiffness. In patients, muscle stiffness lessens with exercise, a change known as the warmup phenomenon. Our goal was to identify the mechanism underlying warmup and to use this information to guide development of novel therapy. METHODS To determine the mechanism underlying warmup, we used a recently discovered drug to eliminate muscle contraction, thus allowing prolonged intracellular recording from individual muscle fibers during induction of warmup in a mouse model of myotonia congenita. RESULTS Changes in action potentials suggested slow inactivation of sodium channels as an important contributor to warmup. These data suggested that enhancing slow inactivation of sodium channels might offer effective therapy for myotonia. Lacosamide and ranolazine enhance slow inactivation of sodium channels and are approved by the US Food and Drug Administration for other uses in patients. We compared the efficacy of both drugs to mexiletine, a sodium channel blocker currently used to treat myotonia. In vitro studies suggested that both lacosamide and ranolazine were superior to mexiletine. However, in vivo studies in a mouse model of myotonia congenita suggested that side effects could limit the efficacy of lacosamide. Ranolazine produced fewer side effects and was as effective as mexiletine at a dose that produced none of mexiletine's hypoexcitability side effects. INTERPRETATION We conclude that ranolazine has excellent therapeutic potential for treatment of patients with myotonia congenita.
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Affiliation(s)
- Kevin R Novak
- Department of Neuroscience, Cell Biology, and Physiology, Wright State University, Dayton, OH
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Matthews E, Hanna MG. Repurposing of sodium channel antagonists as potential new anti-myotonic drugs. Exp Neurol 2014; 261:812-5. [PMID: 25218042 DOI: 10.1016/j.expneurol.2014.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/22/2014] [Accepted: 09/02/2014] [Indexed: 01/08/2023]
Abstract
Myotonia is often a painful and disabling symptom which can interfere with daily motor function resulting in significant morbidity. Since myotonic disorders are rare it has generally proved difficult to obtain class I level evidence for anti-myotonic drug efficacy by performing randomized placebo controlled trials. Current treatment guidance is therefore largely based on anecdotal reports and physician experience. Despite the genetic channel heterogeneity of the myotonic disorders the sodium channel antagonists have become the main focus of pharmacological interest. Mexiletine is currently regarded as the first choice sodium channel blocker based on a recent placebo controlled randomized trial. However, some patients do not respond to mexiletine or have significant side effects limiting its use. There is a clinical need to develop additional antimyotonic agents. The study of Desaphy et al. is therefore important and provides in vitro evidence that a number of existing drugs with sodium channel blocking capability could potentially be repurposed as anti-myotonic drugs. Translation of these potentially important in vitro findings into clinical practice requires carefully designed randomized controlled trials. Here we discuss Desaphy's findings in the wider context of attempts to develop additional therapies for patients with clinically significant myotonia.
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Affiliation(s)
- E Matthews
- MRC Centre for Neuromuscular Diseases, Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - M G Hanna
- MRC Centre for Neuromuscular Diseases, Department of Molecular Neuroscience, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
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Abstract
OPINION STATEMENT Neuromuscular channelopathies are heterogeneous disorders with marked phenotypic and genotypic variability. These include non-dystrophic myotonia (NDM), periodic paralysis (PP), and congenital myasthenic syndrome (CMS). Their diverse clinical manifestations remain a challenge in diagnosis and management to this date. These disorders impact quality of life and cause lifelong disabling symptoms. Treatment options are few and not FDA-approved. This is largely due to a paucity of large, randomized clinical trials in these rare diseases. Challenges of conducting such trials include the rarity of these disorders and the genetic heterogeneity. Physicians rely on off-label use of drugs to treat muscle channelopathies to reduce morbidity and improve quality of life. Besides pharmacological treatment, dietary modifications, lifestyle changes, awareness of triggers, and genetic counseling also play an important role in long-term disease management. This article reviews the current management strategies for neuromuscular channelopathies.
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