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Amanzade A, Khakpai F, Zarrindast MR. Synergistic antidepressant-like effect of citicoline and CB 1 agonist in male mice. Psychopharmacology (Berl) 2024; 241:753-766. [PMID: 38383902 DOI: 10.1007/s00213-023-06507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/14/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND The endocannabinoid system plays a key role in the control of many emotional-correlated reactions such as stress, depressed mood, and anxiety. Moreover, citicoline has neuroprotective properties and indicates beneficial effects in the treatment of depressive problems. Acute restraint stress (ARS) is an experimental model used for the induction of rodent models of depression. OBJECTIVE This research was designed to assess the effects of intracerebroventricular (i.c.v.) injection of cannabinoid CB1 receptor agents on citicoline-induced response to depression-like behaviors in the non-acute restraint stress (NARS) and ARS mice. METHODS For i.c.v. microinjection, a guide cannula was implanted in the left lateral ventricle of male mice. The ARS model was carried out by movement restraint for 4 h. Depression-related behaviors were assessed by forced swimming test (FST), tail suspension test (TST), and splash test. RESULTS The results exhibited that the ARS mice showed depressive-like responses. I.c.v. infusion of ACPA (1 μg/mouse) induced an antidepressant-like effect in the NARS and ARS mice by reduction of immobility time in the FST and TST as well as enhancement of grooming activity time in the splash test. On the other hand, i.c.v. microinjection of AM251 dose-dependently (0.5 and 1 μg/mouse) induced a depressant-like effect in the NARS mice. I.p. injection of citicoline (80 mg/kg) induced an antidepressant-like response in the NARS and ARS mice. Furthermore, ACPA (0.25 μg/mouse, i.c.v.) potentiated the antidepressant-like response induced by citicoline (20 mg/kg, i.p.) in the NARS and ARS mice. However, AM251 (0.25 μg/mouse, i.c.v.) reversed the antidepressant-like effect produced by the citicoline (80 mg/kg, i.p.) in the NARS and ARS mice. Interestingly, our results indicated a synergistic effect between citicoline and ACPA based on the induction of an antidepressant-like effect in the NARS and ARS mice. CONCLUSIONS These results suggested an interaction between citicoline and cannabinoid CB1 receptors on the modulation of depression-like behaviors in the NARS and ARS mice.
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Affiliation(s)
- Aysan Amanzade
- Department of Pharmacology and Toxicology, Faculty of Pharmacy and Pharmaceutical Sciences, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Fatemeh Khakpai
- Department of Physiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mohammad-Reza Zarrindast
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
- Institute for Cognitive Science Studies (ICSS), Tehran, Iran.
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Rokach M, Portioli C, Brahmachari S, Estevão BM, Decuzzi P, Barak B. Tackling myelin deficits in neurodevelopmental disorders using drug delivery systems. Adv Drug Deliv Rev 2024; 207:115218. [PMID: 38403255 DOI: 10.1016/j.addr.2024.115218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/27/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
Interest in myelin and its roles in almost all brain functions has been greatly increasing in recent years, leading to countless new studies on myelination, as a dominant process in the development of cognitive functions. Here, we explore the unique role myelin plays in the central nervous system and specifically discuss the results of altered myelination in neurodevelopmental disorders. We present parallel developmental trajectories involving myelination that correlate with the onset of cognitive impairment in neurodevelopmental disorders and discuss the key challenges in the treatment of these chronic disorders. Recent developments in drug repurposing and nano/micro particle-based therapies are reviewed as a possible pathway to circumvent some of the main hurdles associated with early intervention, including patient's adherence and compliance, side effects, relapse, and faster route to possible treatment of these disorders. The strategy of drug encapsulation overcomes drug solubility and metabolism, with the possibility of drug targeting to a specific compartment, reducing side effects upon systemic administration.
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Affiliation(s)
- May Rokach
- Sagol School of Neuroscience, Tel-Aviv University, Israel
| | - Corinne Portioli
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Sayanti Brahmachari
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Bianca Martins Estevão
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Paolo Decuzzi
- Laboratory of Nanotechnology for Precision Medicine, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Boaz Barak
- Sagol School of Neuroscience, Tel-Aviv University, Israel; Faculty of Social Sciences, The School of Psychological Sciences, Tel-Aviv University, Israel.
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Gareri P, Cotroneo AM, Montella R, Gaglianone M, Putignano S. Citicoline: A Cholinergic Precursor with a Pivotal Role in Dementia and Alzheimer's Disease. J Alzheimers Dis 2024; 100:725-733. [PMID: 38905051 PMCID: PMC11307077 DOI: 10.3233/jad-240497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/23/2024]
Abstract
Background Citicoline is a naturally occurring compound with pleiotropic effects on neuronal function and cognitive processes. Objective Based on previous studies, which shed light on the positive effects of citicoline 1 g when combined with acetylcholinesterase inhibitors (AChEIs) and/or memantine, we further investigated the benefits of citicoline in combination therapy in Alzheimer's disease and mixed dementia. Methods We integrated the datasets of CITIMEM and CITIDEMAGE, increasing the overall sample size to enhance statistical power. We analyzed data from these two investigator-initiated studies involving 295 patients. The primary outcome was the assessment over time of the effects of combined treatment versus memantine given alone or AChEI plus memantine on cognitive functions assessed by Mini-Mental State Examination (MMSE). The secondary outcomes were the influence of combined treatment on daily life functions, mood, and behavioral symptoms assessed by activities of daily life (ADL) and instrumental ADL, Geriatric Depression Scale, and Neuropsychiatric Inventory Scale. One-hundred-forty-three patients were treated with memantine and/or AChEI (control group), and 152 patients were treated with memantine and/or AChEI plus citicoline 1 g/day orally (Citicoline group). Results A significant difference in MMSE score was found in the average between the two groups of treatment at 6 and 12 months. Conclusions This study confirmed the effectiveness of combined citicoline treatment in patients with mixed dementia and Alzheimer's disease, with a significant effect on the increase of MMSE score over time. The treated group also showed a significant reduction in the Geriatric Depression Scale and a significant increase in the instrumental ADL scale.
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Affiliation(s)
- Pietro Gareri
- Unit of Frailty, Center of Cognitive Impairment and Dementia, Catanzaro Lido, ASP Catanzaro, Catanzaro Lido, Italy
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Goel D, Shangari S, Mittal M, Bhat A. Endogenous defense mechanism-based neuroprotection in large-vessel acute ischemic stroke: A hope for future. Brain Circ 2024; 10:51-59. [PMID: 38655439 PMCID: PMC11034449 DOI: 10.4103/bc.bc_56_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality worldwide and a leading cause of disability. None of the neuroprotective agents have been approved internationally except edaravone in Japanese guidelines in acute ischemic stroke. We here discuss that there are two types of endogenous defense mechanisms (EDMs) after acute stroke for neuromodulation and neuroregeneration, and if both can be activated simultaneously, then we can have better recovery in stroke. AIMS AND OBJECTIVES We aimed to study the effect of combination of neuroprotection therapies acting on the two wings of EDM in acute large-vessel middle cerebral artery (LMCA) ischemic stroke. METHODS Sixty patients of LMCA stroke were enrolled and randomized within 72 h into two groups of 30 patients each. The control group received standard medical care without any neuroprotective agents while the intervention group received standard medical care combined with oral citicoline with vinpocetine for 3 months with initial 1 week intravenous and edaravone and cerebrolysin injection, started within 72 h of onset of stroke. Patients were assessed on the basis of the National Institutes of Health Stroke Scale, Fugl-Meyer Assessment Score, Glasgow Coma Scale, and Mini-Mental Status Examination at admission, discharge, and after 90 days. RESULTS The intervention group showed significant and early improvements in motor as well as cognitive recovery. CONCLUSION Combination therapy for neuroprotection which is acting on two pathways of EDM can be useful in functional recovery after acute ischemic stroke.
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Affiliation(s)
- Deepak Goel
- Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Sushant Shangari
- Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Manish Mittal
- Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Ashwani Bhat
- Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Zhao N, Zhu X, Xie L, Guan X, Tang L, Jiang G, Pang T. The Combination of Citicoline and Nicotinamide Mononucleotide Induces Neurite Outgrowth and Mitigates Vascular Cognitive Impairment via SIRT1/CREB Pathway. Cell Mol Neurobiol 2023; 43:4261-4277. [PMID: 37812361 DOI: 10.1007/s10571-023-01416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/17/2023] [Indexed: 10/10/2023]
Abstract
Vascular dementia (VD) is characterized with vascular cognitive impairment (VCI), which currently has few effective therapies in clinic. Neuronal damage and white matter injury are involved in the pathogenesis of VCI. Citicoline has been demonstrated to exhibit neuroprotection and neurorepair to improve cognition in cerebrovascular diseases. Nicotinamide adenine dinucleotide (NAD+)-dependent sirtuin (SIRT) signaling pathway constitutes a strong intrinsic defense system against various stresses including neuroinflammation in VCI. Our hypothesis is that the combined use of citicoline and the precursor of NAD+, nicotinamide mononucleotide (NMN), could enhance action on cognitive function in VCI. We investigated the synergistic effect of these two drugs in the rat model of VCI by bilateral common carotid artery occlusion (BCCAO). Citicoline significantly enhanced neurite outgrowth in Neuro-2a cells, and the combination of citicoline and NMN remarkably induced neurite outgrowth in Neuro-2a cells and primary cortical neuronal cells with an optimal proportion of 4:1. In the rat model of BCCAO, when two drugs in combination of 160 mg/kg citicoline and 40 mg/kg NMN, this combination administrated at 7 days post-BCCAO significantly improved the cognitive impairment in BCCAO rats compared with vehicle group by the analysis of the Morris water maze and the novel object recognition test. This combination also decreased microglial activation and neuroinflammation, and protected white matter integrity indicated by the increased myelin basic protein (MBP) expression through activation of SIRT1/TORC1/CREB signaling pathway. Our results suggest that the combination of citicoline and NMN has a synergistic effect for the treatment of VD associated with VCI.
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Affiliation(s)
- Ning Zhao
- State Key Laboratory of Natural Medicines, New Drug Screening Center, Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, #24 Tong Jia Xiang Street, Nanjing, 210009, People's Republic of China
| | - Xiaofeng Zhu
- State Key Laboratory of Natural Medicines, New Drug Screening Center, Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, #24 Tong Jia Xiang Street, Nanjing, 210009, People's Republic of China
| | - Luyang Xie
- State Key Laboratory of Natural Medicines, New Drug Screening Center, Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, #24 Tong Jia Xiang Street, Nanjing, 210009, People's Republic of China
| | - Xin Guan
- State Key Laboratory of Natural Medicines, New Drug Screening Center, Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, #24 Tong Jia Xiang Street, Nanjing, 210009, People's Republic of China
| | - Leilei Tang
- Department of Pharmacy, Affiliated Xiaoshan Hospital, Hangzhou Normal University, 728 Yucai North Road, Hangzhou, 311200, People's Republic of China
| | - Guojun Jiang
- Department of Pharmacy, Affiliated Xiaoshan Hospital, Hangzhou Normal University, 728 Yucai North Road, Hangzhou, 311200, People's Republic of China.
| | - Tao Pang
- State Key Laboratory of Natural Medicines, New Drug Screening Center, Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, #24 Tong Jia Xiang Street, Nanjing, 210009, People's Republic of China.
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Saceleanu VM, Toader C, Ples H, Covache-Busuioc RA, Costin HP, Bratu BG, Dumitrascu DI, Bordeianu A, Corlatescu AD, Ciurea AV. Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations. Biomedicines 2023; 11:2617. [PMID: 37892991 PMCID: PMC10604797 DOI: 10.3390/biomedicines11102617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Among the high prevalence of cerebrovascular diseases nowadays, acute ischemic stroke stands out, representing a significant worldwide health issue with important socio-economic implications. Prompt diagnosis and intervention are important milestones for the management of this multifaceted pathology, making understanding the various stroke-onset symptoms crucial. A key role in acute ischemic stroke management is emphasizing the essential role of a multi-disciplinary team, therefore, increasing the efficiency of recognition and treatment. Neuroimaging and neuroradiology have evolved dramatically over the years, with multiple approaches that provide a higher understanding of the morphological aspects as well as timely recognition of cerebral artery occlusions for effective therapy planning. Regarding the treatment matter, the pharmacological approach, particularly fibrinolytic therapy, has its merits and challenges. Endovascular thrombectomy, a game-changer in stroke management, has witnessed significant advances, with technologies like stent retrievers and aspiration catheters playing pivotal roles. For select patients, combining pharmacological and endovascular strategies offers evidence-backed benefits. The aim of our comprehensive study on acute ischemic stroke is to efficiently compare the current therapies, recognize novel possibilities from the literature, and describe the state of the art in the interdisciplinary approach to acute ischemic stroke. As we aspire for holistic patient management, the emphasis is not just on medical intervention but also on physical therapy, mental health, and community engagement. The future holds promising innovations, with artificial intelligence poised to reshape stroke diagnostics and treatments. Bridging the gap between groundbreaking research and clinical practice remains a challenge, urging continuous collaboration and research.
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Affiliation(s)
- Vicentiu Mircea Saceleanu
- Neurosurgery Department, Sibiu County Emergency Hospital, 550245 Sibiu, Romania;
- Neurosurgery Department, “Lucian Blaga” University of Medicine, 550024 Sibiu, Romania
| | - Corneliu Toader
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 020022 Bucharest, Romania
| | - Horia Ples
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), “Victor Babes” University of Medicine and Pharmacy, 300736 Timisoara, Romania
- Department of Neurosurgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Horia Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Andrei Bordeianu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Antonio Daniel Corlatescu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
- Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania
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Almeria M, Alvarez I, Molina-Seguin J, Besora S, Buongiorno M, Romero S, Casas L, Cano C, Castejon J, Arribas S, Krupinski J. Citicoline May Prevent Cognitive Decline in Patients with Cerebrovascular Disease. Clin Interv Aging 2023; 18:1093-1102. [PMID: 37489128 PMCID: PMC10363355 DOI: 10.2147/cia.s409994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
Introduction Neuroprotective drugs such as citicoline could improve cognitive performance and quality of life. We studied the effect of citicoline treatment and its association with Vascular Risk Factors (VRF) and APOE on cognition in patients with Subjective Cognitive Complaints (SCC) and Mild Cognitive Impairment (MCI). Methods This is an observational and prospective study with citicoline during 12 months follow-up. Eighty-one subjects who met criteria for SCC/MCI, aged 50-75 years with VRF were included and prescribed citicoline 1g/day. Subjects with previous cognitive impairment and any other central nervous system affection were excluded. Wilcoxon Signed Ranks test and paired samples t-test were used to analyze the change in neuropsychological performance. Results Mean age of the sample was 68.2 (SD 6.8) years and 26 (32.09%) were females. Fifteen subjects (24.6%) were APOE-ε4 carriers, fifty-six (76.7%) had hypertension, fifty-eight (79.5%) had dyslipidemia, twenty-one (28.8%) had diabetes mellitus and twenty-six (35.6%) had cardiopathy. Thirty-two (43.8%) subjects were diagnosed as SCC and forty-one (56.16%) as MCI. During the follow-up, Tweny-six patients (81.25%) in the group of SCC remained stable, six subjects (18.8%) converted to MCI. Twelve patients (29.9%) with MCI reverted to SCC and twenty-nine patients (70.7%) remained stable. At follow-up, SCC subjects had an improvement in the global language domain (p=0.03), naming (p<0.001), attention (p=0.01) and visuospatial abilities (p<0.01). MCI group showed an improvement in the screening test (p=0.03), delayed memory (p<0.01), global cognition (p=0.04) and in cognitive flexibility (p=0.03). Presence of APOE-ε4 had no impact on the above findings. Discussion SCC subjects showed an improvement in language and attention domains, while those with MCI performed better after 12 months in total scores of MoCA and RBANS domains, some converting back to SCC. This supports the idea that citicoline may prevent cognitive decline in patients with cognitive deficits.
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Affiliation(s)
- Marta Almeria
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
- Fundació per a la Recerca Biomèdica i Social MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Ignacio Alvarez
- Fundació per a la Recerca Biomèdica i Social MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Jessica Molina-Seguin
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Sarah Besora
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Mariateresa Buongiorno
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
- Fundació per a la Recerca Biomèdica i Social MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Silvia Romero
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Laura Casas
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Cristina Cano
- Fundació per a la Recerca Biomèdica i Social MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Judith Castejon
- Fundació per a la Recerca Biomèdica i Social MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Sonia Arribas
- Fundació per a la Recerca Biomèdica i Social MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Jerzy Krupinski
- Departament de Neurologia, Fundació Assistencial Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
- Healthcare Sciences, Manchester Metropolitan University, Manchester, UK
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Gareri P, Veronese N, Cotroneo AM. An Overview of Combination Treatment with Citicoline in Dementia. Rev Recent Clin Trials 2021; 17:4-8. [PMID: 34939548 DOI: 10.2174/1574887117666211221170344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/01/2021] [Accepted: 11/15/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The present article reports an overview of the studies about combination treatment with citicoline of Alzheimer's (AD) and mixed dementia (MD). METHODS A Medline search was carried out by using the keywords Alzheimer's dementia, mixed dementia, older people, treatment with citicoline, memantine, and acetylcholinesterase inhibitors (AchEIs). RESULTS Six studies were found to match the combination treatment of citicoline with AcheIs and/or memantine. The CITIRIVAD and CITICHOLINAGE studies were the first to report the potential benefits of adding citicoline to acetylcholinesterase inhibitors (AchEIs). Then, we added citicoline to memantine in the CITIMEM study, and finally, we demonstrated benefits in terms of delay in cognitive worsening with the triple therapy (citicoline + AchEIs + memantine). Other authors also reinforced our hypothesis through two further studies. CONCLUSIONS Open, prospective studies are advised to confirm the utility of combination therapy with citicoline for the treatment of AD and MD.
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Affiliation(s)
- Pietro Gareri
- Center for Cognitive Disorders and Dementia - Catanzaro Lido, ASP Catanzaro; Catanzaro. Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo. Italy
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Johns B, Ficken M, Engberg M, Wecker L, Philpot R. Increasing dietary choline attenuates spatial memory deficits resulting from exposure to the chemotherapeutic agents cyclophosphamide and doxorubicin. J Psychopharmacol 2021; 35:1300-1309. [PMID: 34225528 PMCID: PMC9152698 DOI: 10.1177/02698811211029752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Choline supplementation (+Ch) improves cognitive function in impaired animals and humans. Chemotherapy-related cognitive deficits (CRCDs) occur in cancer patients, and these deficits persist following treatment, adversely impacting quality of life. To date, there are no approved treatments for this condition. AIM Because +Ch improves impaired memory, it was of interest to determine whether +Ch can attenuate spatial memory deficits induced by the chemotherapeutic agents doxorubicin (DOX) and cyclophosphamide (CYP). METHODS Female BALB/C mice, 64 days of age, were trained in the Morris water maze and baseline performance determined on day 15. Following baseline assessment, mice were placed on +Ch diet (2.0% Ch) or remained on standard diet (0.12% Ch). Mice received intravenous injections of DOX (2.5 mg/kg) and CYP (25 mg/kg), or equivalent volumes of saline (0.9% NaCl), on days 16, 23, 30, and 37, and spatial memory was assessed weekly from day 22 to 71. RESULTS DOX and CYP produced a prolonged impairment in spatial memory as indicated by an increased latency to the correct zone (p < 0.05), and a decrease in time in the correct zone (p < 0.05), % of total swim distance in the correct zone (p < 0.05) and % entries to the correct zone (p < 0.05). These effects were attenuated by +Ch. CONCLUSION Although it remains to be determined whether this effect extends to other cognitive domains and whether +Ch is prophylactic or therapeutic, these findings suggest that +Ch may be an effective intervention for CRCDs.
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Affiliation(s)
| | | | | | | | - R.M. Philpot
- Corresponding Author: Rex M. Philpot, Ph.D., Assistant Professor, Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, 3515 E Fletcher Ave., Tampa, FL 33612,
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Salamah A, Mehrez M, Faheem A, El Amrousy D. Efficacy of Citicoline as a Neuroprotector in children with post cardiac arrest: a randomized controlled clinical trial. Eur J Pediatr 2021; 180:1249-1255. [PMID: 33169240 DOI: 10.1007/s00431-020-03871-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 02/08/2023]
Abstract
Brain hypoxia after cardiac arrest leads to damage of the neuronal cell membrane. Citicoline is necessary for the synthesis of cell membrane. We planned to assess the neuroprotective effect of citicoline in children after cardiac arrest. This randomized controlled trial was carried out at pediatric intensive care units (PICU) and surgical ICU at Tanta university hospital on 80 consecutive children surviving in-hospital cardiac arrest who were subdivided into two groups. Group I (citicoline group) included 40 children with post-cardiac arrest who received citicoline 10 mg /kg /12 h IV for 6 weeks plus other supportive measures and group II (control group) included 40 children with post-cardiac arrest who were managed with only supportive measures. All patients were evaluated for Glasgow coma score (GCS), modified Rankin scale (mRS) for children, seizures frequency, type and duration, and serum neuron-specific enolase (NSE) before and 3 months after the treatment. GCS and mRS significantly improved in citicholine group compared to the control group. Seizure frequency and duration, mortality, PICU and hospital stay significantly decreased in citicholine group compared to the control group. Serum NSE levels significantly decreased in citicholine group only. No side effects were recorded.Conclusion: Citicoline is a promising neuroprotective drug in children with post-cardiac arrest.Trial Registration: The study was registered at Pan African Clinical Trials Registry (PACTR) www.pactr.samrc.ac.za with trial number PACTR201907742119058. What is known? • Post-resuscitation brain injury is one of the major complications that can lead to death or disability. • CDP-choline has been studied for acute ischemic stroke in several adult studies because of its reparative effect. What is new? • Our study was the first in pediatrics that assessed the neuroprotective effect of CDP-choline on the brain in children after cardiac arrest. • We found that Citicoline is a promising neuroprotective drug in children with post-cardiac arrest.
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Affiliation(s)
- Abeer Salamah
- Pediatric Department, Kafr Elsheikh University, Kafr Elsheikh, Egypt
| | | | - Amany Faheem
- Anesthesiology and Surgical ICU Department, Tanta University, Tanta, Egypt
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Que DLS, Jamora RDG. Citicoline as Adjuvant Therapy in Parkinson's Disease: A Systematic Review. Clin Ther 2020; 43:e19-e31. [PMID: 33279231 DOI: 10.1016/j.clinthera.2020.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Parkinson disease (PD) medications are not readily available in all countries. Citicoline increases dopamine synthesis and inhibits dopamine uptake. This systematic review aims to synthesize current existing evidence on the efficacy of citicoline adjunctive therapy in improving PD symptoms. METHODS An extensive literature search of Scopus, Embase, PubMed, Cochrane Library, and Google Scholar was conducted for articles published on or before December 31, 2019. The studies were screened and selected by 2 independent reviewers. We included all studies that explored the efficacy of citicoline as an adjunct therapy in PD. FINDINGS A total of 7 studies (2 crossover, 3 randomized controlled, and 2 open prospective studies) were included. Despite the varied outcome tools, this review found that patients with PD who were taking citicoline had significant improvement in rigidity, akinesia, tremor, handwriting, and speech. Citicoline allowed effective reduction of levodopa by up to 50%. Significant improvement in cognitive status evaluation was also noted with citicoline adjunctive therapy. IMPLICATIONS Citicoline adjuvant therapy has beneficial effects as an adjuvant therapy in patients with PD. However, due to the heterogeneity of the studies, there is a need for more high-quality studies.
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Affiliation(s)
- Diana-Lynn S Que
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Roland Dominic G Jamora
- Section of Neurology, Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines; Movement Disorders Service, Institute for Neurosciences, St. Luke's Medical Center, Quezon City and Global City, Philippines; Department of Neurosciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
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Gareri P, Cotroneo AM, Orsitto G, Putignano S. The Importance of Citicoline in Combined Treatment in Dementia: What did the Citimem Study Teach us? Rev Recent Clin Trials 2020; 16:126-130. [PMID: 33243132 DOI: 10.2174/1574887115999201126205538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/08/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Citicoline is a drug used both in degenerative and in vascular cognitive decline; memantine is a drug used for the treatment of mild to moderate Alzheimer's disease (AD). Our hypothesis is that their combined use could have enhanced action in patients having AD and mixed dementia (MD). We report the main tips from a recent study on the use of these drugs, the CITIMEM study. METHODS The study was retrospective and was performed on 126 patients aged 65 years old or older affected with AD or MD (mean age 80.7 ± 5.2 years old) who had been visited between 2015 and 2017 in four different centers for dementia all over Italy. Neuropsychological and functional tests were administered at baseline (T0), after 6 (T1), and 12 months (T2). The effects of combined treatment versus memantine alone on cognitive functions assessed by Mini-Mental State Examination (MMSE) and the possible onset of side effects or adverse events, as well as the influence on daily life functions and behavioral symptoms, were investigated. RESULTS Patients undergoing combined treatment showed a significant increase in MMSE vs. memantine alone, both at T1 (p=0.003) and T2 (p =0.000). CONCLUSION The CITIMEM study confirms our hypothesis that the combined administration of memantine plus citicoline is safe and more effective than memantine alone on cognition in patients suffering from AD or MD.
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Affiliation(s)
- Pietro Gareri
- Center for Cognitive Disorders and Dementia, Catanzaro Lido, ASP Catanzaro, Catanzaro, Italy
| | - Antonino Maria Cotroneo
- Department of Elderly Health Care, Birago di Vische Hospital and Botticelli Territorial Geriatrics - ASL TO 2, Turin, Italy
| | - Giuseppe Orsitto
- U.O.C. Internal Medicine Ward, P.O. Bari Sud "Di Venere", Bari - Azienda Sanitaria Locale di Bari, Italy
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Gareri P, Cotroneo AM, Orsitto G, Putignano S. The CITIMEM study: A pilot study. Optimizing pharmacological treatment in dementia. Arch Gerontol Geriatr 2020; 89:104073. [PMID: 32447126 DOI: 10.1016/j.archger.2020.104073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/15/2020] [Accepted: 04/06/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Citicoline can have beneficial effects both in degenerative and in vascular cognitive decline; it works through an increase in acetylcholine intrasynaptic levels and promoting phospholipid synthesis, (chiefly phosphatidylcholine), cellular function, and neuronal repair. Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist used for the treatment of mild to moderate Alzheimer's disease (AD). When co-administered they could have a synergistic action in patients affected with AD and mixed dementia (MD) too. SCOPE The aim of the present study was to show the effectiveness of oral citicoline plus memantine in patients affected with AD and MD. PATIENTS AND METHODS This was a retrospective study between 2015 and 2017 on 126 patients aged 65 years old or older affected with AD or MD (mean age 80.7 ± 5.2 years old). The study involved four different centers for dementia all over Italy. Diagnosis of AD was made according to clinical symptoms, neuropsychological tests and brain imaging. Diagnosis of MD was made when symptoms typical of AD such as memory loss were associated to symptoms due to cerebrovascular deficits, i.e., impaired judgement, ability to make decisions, plan or organize, and brain imaging. 58 patients were treated with memantine (group A), 68 patients with memantine plus citicoline 1 g/day given orally (group B). In both groups memantine dosage was 10-20 mg/day according to its tolerability. 24 patients of group A and 29 patients of group B were affected with MD. Cognitive functions were assessed by MMSE, daily life functions by ADL and IADL, behavioral symptoms by NPI, comorbidities by CIRS, and mood by GDS-short form. Tests were administered at baseline (T0), after 6 (T1), and 12 months (T2). The primary outcomes were the effects of combined treatment versus memantine alone on cognitive functions assessed by MMSE. The secondary outcomes were the possible side effects or adverse events of combination therapy versus memantine alone, influence on daily life functions and behavioral symptoms. RESULTS AND CONCLUSIONS Patients treated with citicoline plus memantine showed an increase in MMSE between T0 and T1 (16.6 ± 2.9 vs 17.4 ± 2.7) and between T1 and T2 (17.4 ± 2.7 vs 17.7 ± 2.8). The difference in MMSE score was significant when comparing the two groups, both at T1 (p = 0.003) and T2 (p = 0.000). Since it is important to maximize the pharmacological means in AD and MD, the present study encourages the role of combined administration of memantine plus citicoline in disease management and in slowing down the progression of disease.
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Affiliation(s)
- Pietro Gareri
- Center for Cognitive Disorders and Dementia - Catanzaro Lido, ASP Catanzaro, Catanzaro, Italy.
| | - Antonino Maria Cotroneo
- Department of Elderly Health Care - Birago di Vische Hospital and Botticelli Territorial Geriatrics - ASL TO 2, Turin, Italy.
| | - Giuseppe Orsitto
- U.O.C. Internal Medicine Ward, P.O. Bari Sud "Di Venere", Bari, Azienda Sanitaria Locale di Bari, Italy.
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Putilina MV. [Combined therapy of cerebrovascular disorders with neuroprotectors]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 116:58-63. [PMID: 28091502 DOI: 10.17116/jnevro201611611158-63] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Safety of drugs is one of the priorities of modern medicine. The goal of pharmacological treatment is a search for effective and safety drugs as well as a study of possibilities of combined using of the drugs with opposite effects. Basing on the possible therapeutic interactions, 2-ethyl-6-methyl-3-hydroxypyridine succinate can be recommended as a basic medication for patients with cerebrovascular diseases to normalize the energy metabolism of brain cells. The complex use of cholinergic drugs with different neuroprotective effects is effective from the first hours after admission. Cholinergic drugs (citicoline or choline alfoscerate) as the drugs of the first choice should be justified taking into consideration dysfunction of the brain system activation. Patient's age, the level of consciousness, somatic pathology, previous strokes, cognitive impairment are predictors of treatment efficacy.
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Affiliation(s)
- M V Putilina
- Pirogiv Russian National Research Medical University, Moscow, Russia
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Farzaei MH, Bahramsoltani R, Abbasabadi Z, Braidy N, Nabavi SM. Role of green tea catechins in prevention of age-related cognitive decline: Pharmacological targets and clinical perspective. J Cell Physiol 2018; 234:2447-2459. [PMID: 30187490 DOI: 10.1002/jcp.27289] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 08/30/2018] [Indexed: 12/19/2022]
Abstract
Over the past decade, a wide range of scientific investigations have been performed to reveal neuropathological aspects of cognitive disorders; however, only limited therapeutic approaches currently exist. The failures of conventional therapeutic options as well as the predicted dramatic rise in the prevalence of cognitive decline in the coming future show the necessity for novel therapeutic agents. Recently, a wide range of research has focused on pharmacological activities of green tea catechins worldwide. Current investigations have clarified mechanistic effects of the catechins in inflammatory cascades, oxidative damages, different cellular transcription as well as transduction pathway in various body systems. It has been demonstrated that green tea polyphenols prevent age-related neurodegeneration through improvement of endogenous antioxidant defense mechanisms, modulation of neural growth factors, attenuation of neuroinflammatory pathway, and regulation of apoptosis. The catechins exhibited beneficial effects in cellular and animal models of neurodegenerative diseases including Alzheimer's disease, MS, and Parkinson's disease. The present review discusses the current pharmacological targets, which can be involved in the treatment of cognitive decline and addresses the action of catechin derivatives elicited from green tea on the multiple neural targets.
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Affiliation(s)
- Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roodabeh Bahramsoltani
- Department of Pharmacy in Persian Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Abbasabadi
- Phyto Pharmacology Interest Group (PPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nady Braidy
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Seyed Mohammad Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Aidelbaum R, Labelle A, Baddeley A, Knott V. Assessing the acute effects of CDP-choline on sensory gating in schizophrenia: A pilot study. J Psychopharmacol 2018; 32:541-551. [PMID: 29338621 DOI: 10.1177/0269881117746903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Deficient sensory gating (SG) in schizophrenia is associated with functional outcome and offers a therapeutic target as it is linked to the altered function/expression of the α7 nicotinic acetylcholine receptors (nAChRs). This study analyzed the effects of citicoline (CDP-choline), a supplement with α7 nAChRs agonist properties, on SG in a sample of schizophrenia (SZ) patients. Using a randomized, placebo-controlled, double-blind design the dose-dependent (500 mg, 1000 mg, 2000 mg) and baseline-dependent (deficient versus normal suppressors) effects of CDP-choline on SG were examined using the P50 event-related potential (ERP) index of SG. Overall analysis failed to demonstrate treatment effects but CDP-choline improved SG (500 mg) in the deficient SZ subgroup by increasing suppression of the S2 P50 amplitude. These findings tentatively support α7 nAChR dysfunction in the expression of SG deficits and suggest further trials to assess the effects of sustained α7 nAChR activation on SG with low doses of CDP-choline.
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Affiliation(s)
- Robert Aidelbaum
- 1 Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, ON, Canada.,2 Department of Psychology, Carleton University, ON, Canada
| | - Alain Labelle
- 3 Schizophrenia Program, Royal Ottawa Mental Health Centre, ON, Canada
| | - Ashley Baddeley
- 1 Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, ON, Canada
| | - Verner Knott
- 1 Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, ON, Canada
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Putilina MV, Ermoshkina NY, Sigitov IS, Sidelnikova LV. [Progressive multifocal encephalopathy in neurological practice]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 117:95-105. [PMID: 29376991 DOI: 10.17116/jnevro201711712195-105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Progressive multifocal leukoencephalopathy (PML) is considered so far as a rare rapidly progressive demyelinating CNS disease caused by the JC virus activation. Current data suggest that PML developed in people with impaired immunity. However, in some cases PML developed in the absence of severe immunological deficit. In clinical practice, the early diagnosis of PML is difficult because symptoms are mild and, therefore, the physician should be familiar with diagnostic criteria of this disease to make the correct diagnosis and start the symptomatic therapy as soon as possible. This will help to improve patient's state though there is no effective treatment of PML so far. Up to the present moment, antiviral medications, cytostatic drugs, serotonin receptor antagonists, plasmapheresis are widely used. These methods can be used only if the causes of PML have been identified while the patient needs urgent help. Thus, the schemes of pathogenetic treatment with the drugs with pleiotropic effects should be used.
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Affiliation(s)
- M V Putilina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N Yu Ermoshkina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - I S Sigitov
- Pirogov Russian National Research Medical University, Moscow, Russia
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Castagna A, Cotroneo AM, Ruotolo G, Gareri P. The CITIRIVAD Study: CITIcoline plus RIVAstigmine in Elderly Patients Affected with Dementia Study. Clin Drug Investig 2017; 36:1059-1065. [PMID: 27587069 DOI: 10.1007/s40261-016-0454-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Acetylcholinesterase inhibitors (AchEIs), such as rivastigmine, coadministered with cholinergic precursors, such as citicoline, could be effective in Alzheimer's disease (AD) and in mixed dementia (MD), because they are able to increase the intrasynaptic levels of acetylcholine more than the single drugs given alone. OBJECTIVE The aim of the present study was to show the effectiveness of oral citicoline plus rivastigmine in patients with AD and MD. METHODS The CITIRIVAD study was a retrospective case-control study on 174 consecutive outpatients aged ≥65 years, affected with AD or MD, mean age 81.3 ± 4.5 years. Of the 174 patients, 92 had been treated with rivastigmine + citicoline 1000 mg/day given orally (group A); 82 patients had been treated with rivastigmine (group B). In both groups rivastigmine patch had been used for at least six months at the highest tolerated dosage. Group A comprised 62 patients affected with AD and 30 patients with MD. Group B comprised 53 patients affected with AD and 29 with MD. Cognitive functions had been assessed by Mini Mental State Examination (MMSE), daily life functions by activities of daily living (ADL) and instrumental activities (IADL), behavioral symptoms by neuropsychiatric inventory (NPI), comorbidities by the Cumulative Illness Rating Scale and mood by geriatric depression scale (GDS)-short form tests, which had been administered at baseline, 3 and 9 months. RESULTS AND CONCLUSIONS Data show the effectiveness of combined administration versus the AchEI alone, mainly in slowing disease progression and consequently in disease management, both in AD and in MD. No differences regarding the combined treatment were found between the two groups. Treatment with citicoline plus rivastigmine was safe and well tolerated.
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Affiliation(s)
- Alberto Castagna
- Center for Cognitive Disorders and Dementia, Catanzaro Lido and Soverato-Chiaravalle-ASP Catanzaro, 88100, Catanzaro, Italy
| | | | - Giovanni Ruotolo
- Geriatric Unit, Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy
| | - Pietro Gareri
- Center for Cognitive Disorders and Dementia, Catanzaro Lido and Soverato-Chiaravalle-ASP Catanzaro, 88100, Catanzaro, Italy.
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Gareri P, Castagna A, Cotroneo AM, Putignano D, Conforti R, Santamaria F, Marino S, Putignano S. The Citicholinage Study: Citicoline Plus Cholinesterase Inhibitors in Aged Patients Affected with Alzheimer's Disease Study. J Alzheimers Dis 2017; 56:557-565. [PMID: 28035929 DOI: 10.3233/jad-160808] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Citicoline can have beneficial effects both in degenerative and in vascular cognitive decline in a variety of ways (apoptosis inhibition, neuroplasticity potentiation, phospholipid, and acetylcholine (ACh) synthesis). Acetylcholinesterase inhibitors (AChEIs) have been used for treatment of Alzheimer's disease (AD). When co-administered with cholinergic precursors, they are able to increase the intrasynaptic levels of ACh more than when the single drugs given alone. OBJECTIVE The aim of the present study was to show the effectiveness of oral citicoline plus AChEIs in patients affected with AD. METHODS This was a retrospective multi-centric case-control study, involving seven Centers for Cognitive Impairment and Dementia in Italy, on 448 consecutive patients aged 65 years old or older affected with AD. 197 patients were treated with an AChEI while 251 were treated with an AchEI + citicoline 1000 mg/day given orally. Cognitive functions were assessed by MMSE, daily life functions by ADL and IADL, behavioral symptoms by NPI, comorbidities by CIRS, and mood by GDS-short form. Tests were administered at baseline (T0), after 3 (T1), and 9 months (T2). The primary outcomes were effects of combined administration versus AChEIs given alone on cognitive functions assessed by MMSE. The secondary outcomes were possible side effects or adverse events of combination therapy versus AChEIs alone. RESULTS Patients treated with citicoline plus an AChEI showed a statistically significant increase in MMSE between T0 and T1 (16.88±3.38 versus 17.62±3.64; p = 0.000) and between T1 and T2 (17.62±3.64 versus 17.89±3.54; p = 0.000). CONCLUSION The present study encourages the role of combined administration in disease management by slowing disease progression.
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Affiliation(s)
- Pietro Gareri
- Center for Cognitive Disorders and Dementia - Distretto Socio-Sanitario Catanzaro Lido - ASP Catanzaro, Catanzaro, Italy
| | - Alberto Castagna
- Center for Cognitive Disorders and Dementia - Distretto Socio-Sanitario Catanzaro Lido - ASP Catanzaro, Catanzaro, Italy
| | - Antonino Maria Cotroneo
- Director Department of Elderly Health Care - Birago di Vische Hospital and Botticelli Territorial Geriatrics - ASL TO 2, Turin, Italy
| | | | - Raffaele Conforti
- Scientific Responsible Nursing Home San Giuseppe - Monte Compatri, Rome, Italy
| | | | - Saverio Marino
- Operative Unit Elderly Care, District 53 Castellammare di Stabia ASL NA3 Sud, Italy
| | - Salvatore Putignano
- Operative Unit Elderly Care, District 30, ASL Napoli Centro - Associazione Geriatri Extraospedalieri (AGE) President, Naples, Italy
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Gareri P, Castagna A, Cotroneo AM, Putignano S, De Sarro G, Bruni AC. The role of citicoline in cognitive impairment: pharmacological characteristics, possible advantages, and doubts for an old drug with new perspectives. Clin Interv Aging 2015; 10:1421-9. [PMID: 26366063 PMCID: PMC4562749 DOI: 10.2147/cia.s87886] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Citicoline is able to potentiate neuroplasticity and is a natural precursor of phospholipid synthesis, or rather serves as a choline source in the metabolic pathways for biosynthesis of acetylcholine. Several studies have shown that it can have beneficial effects both in degenerative and in vascular cognitive decline. The aim of the present study was to review the pharmacokinetics and pharmacodynamics of this drug and its role in cognitive impairment according to the present medical literature. METHODS A MEDLINE(®) search was made using the following key words: citicoline, pharmacokinetics, pharmacodynamics, elderly, cognitive impairment, vascular dementia, and Alzheimer's disease. Recent studies on the possible role of citicoline in increasing sirtuin 1 (SIRT1) expression were assessed. Some personal studies were also considered, such as the VITA study and the IDEALE study. RESULTS Administered by both oral and intravenous routes, citicoline is converted into two major circulating metabolites, cytidine and choline. It is metabolized in the gut wall and liver. Pharmacokinetic studies suggested that it is well absorbed and highly bioavailable with oral dosing. A number of studies have clearly shown the possible role of citicoline in cognitive impairment of diverse etiology. It can also modulate the activity/expression of some protein kinases involved in neuronal death and increases SIRT1 expression in the central nervous system. The VITA study and the IDEALE study suggested that both parenteral and oral citicoline are effective and safe. Other studies have clearly demonstrated citicoline's effects on several cognitive domains. Conversely, some studies did not point out any evidence of efficacy of this drug. CONCLUSION Citicoline appears to be a promising agent to improve cognitive impairment, especially of vascular origin. In fact, so far it appears as a drug with the ability to promote "safe" neuroprotection, capable of enhancing endogenous protective. Large clinical trials are needed to confirm its benefits.
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Affiliation(s)
- Pietro Gareri
- Centro Regionale di Neurogenetica, ASP Catanzaro, Lamezia Terme, Catanzaro, Italy
| | - Alberto Castagna
- Centro Regionale di Neurogenetica, ASP Catanzaro, Lamezia Terme, Catanzaro, Italy
| | | | | | - Giovambattista De Sarro
- Department of Health Sciences, School of Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Amalia Cecilia Bruni
- Centro Regionale di Neurogenetica, ASP Catanzaro, Lamezia Terme, Catanzaro, Italy
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Knott V, Impey D, Choueiry J, Smith D, de la Salle S, Saghir S, Smith M, Beaudry E, Ilivitsky V, Labelle A. An acute dose, randomized trial of the effects of CDP-Choline on Mismatch Negativity (MMN) in healthy volunteers stratified by deviance detection level. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/s40810-014-0002-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Neurocognitive effects of acute choline supplementation in low, medium and high performer healthy volunteers. Pharmacol Biochem Behav 2015; 131:119-29. [PMID: 25681529 DOI: 10.1016/j.pbb.2015.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/20/2015] [Accepted: 02/04/2015] [Indexed: 12/28/2022]
Abstract
Novel pharmacological treatments targeting alpha 7 nicotinic acetylcholine receptor (α7 nAChR) hypofunction in schizophrenia have shown mixed success in ameliorating cognitive impairments associated with this disorder. Choline, a selective agonist at α7 receptors is increased with oral administration of cytidine 5'-diphosphocholine (CDP-choline), the cognitive effects of which were assessed in healthy volunteers. Using the CogState test battery, behavioral performance in schizophrenia-relevant cognitive domains was assessed in 24 male participants following a single low (500mg) and moderate (1000mg) dose of CDP-choline. Relative to placebo, CDP-choline improved processing speed, working memory, verbal learning, verbal memory, and executive function in low baseline performers, while exerting no effects in medium baseline performers, and diminishing cognition in high baseline performers. Dose effects varied with cognitive domain but were evident with both the 500mg and 1000mg doses. These preliminary findings of cognitive enhancement in relatively impaired performers are consistent with the α7 receptor mechanism and support further trials with CDP-choline as a potential pro-cognitive strategy for cognitive impairment in schizophrenia.
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Skripuletz T, Manzel A, Gropengießer K, Schäfer N, Gudi V, Singh V, Salinas Tejedor L, Jörg S, Hammer A, Voss E, Vulinovic F, Degen D, Wolf R, Lee DH, Pul R, Moharregh-Khiabani D, Baumgärtner W, Gold R, Linker RA, Stangel M. Pivotal role of choline metabolites in remyelination. ACTA ACUST UNITED AC 2014; 138:398-413. [PMID: 25524711 DOI: 10.1093/brain/awu358] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Neuroprotective approaches for central nervous system regeneration have not been successful in clinical practice so far and compounds that enhance remyelination are still not available for patients with multiple sclerosis. The objective of this study was to determine potential regenerative effects of the substance cytidine-5'-diphospho (CDP)-choline in two different murine animal models of multiple sclerosis. The effects of exogenously applied CDP-choline were tested in murine myelin oligodendrocyte glycoprotein-induced experimental autoimmune encephalomyelitis. In addition, the cuprizone-induced mouse model of de- and remyelination was used to specifically test the hypothesis that CDP-choline directly increases remyelination. We found that CDP-choline ameliorated the disease course of experimental autoimmune encephalomyelitis and exerted beneficial effects on myelin, oligodendrocytes and axons. After cuprizone-induced demyelination, CDP-choline effectively enhanced myelin regeneration and reversed motor coordination deficits. The increased remyelination arose from an increase in the numbers of proliferating oligodendrocyte precursor cells and oligodendrocytes. Further in vitro studies suggest that this process is regulated by protein kinase C. We thus identified a new mechanism to enhance central nervous system remyelination via the choline pathway. Due to its regenerative action combined with an excellent safety profile, CDP-choline could become a promising substance for patients with multiple sclerosis as an add-on therapy.
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Affiliation(s)
- Thomas Skripuletz
- 1 Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Arndt Manzel
- 2 Ruhr-University Bochum, International Graduate School of Neuroscience, 44801 Bochum, Germany 3 Department of Neurology, University Hospital Erlangen, 91054 Erlangen, Germany
| | | | - Nora Schäfer
- 1 Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Viktoria Gudi
- 1 Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Vikramjeet Singh
- 1 Department of Neurology, Hannover Medical School, 30625 Hannover, Germany 4 Centre for Systems Neuroscience, 30559 Hannover, Germany
| | - Laura Salinas Tejedor
- 1 Department of Neurology, Hannover Medical School, 30625 Hannover, Germany 4 Centre for Systems Neuroscience, 30559 Hannover, Germany
| | - Stefanie Jörg
- 3 Department of Neurology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Anna Hammer
- 3 Department of Neurology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Elke Voss
- 1 Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Franca Vulinovic
- 1 Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Diane Degen
- 1 Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Rebecca Wolf
- 3 Department of Neurology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - De-Hyung Lee
- 3 Department of Neurology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Refik Pul
- 1 Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | | | - Wolfgang Baumgärtner
- 4 Centre for Systems Neuroscience, 30559 Hannover, Germany 5 Department of Pathology, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Ralf Gold
- 6 Department of Neurology, St Josef Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Ralf A Linker
- 3 Department of Neurology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Martin Stangel
- 1 Department of Neurology, Hannover Medical School, 30625 Hannover, Germany 4 Centre for Systems Neuroscience, 30559 Hannover, Germany
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Knott V, Smith D, de la Salle S, Impey D, Choueiry J, Beaudry E, Smith M, Saghir S, Ilivitsky V, Labelle A. CDP-choline: effects of the procholine supplement on sensory gating and executive function in healthy volunteers stratified for low, medium and high P50 suppression. J Psychopharmacol 2014; 28:1095-108. [PMID: 25315828 DOI: 10.1177/0269881114553254] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diminished auditory sensory gating and associated neurocognitive deficits in schizophrenia have been linked to altered expression and function of the alpha-7 nicotinic acetycholinergic receptor (α7 nAChR), the targeting of which may have treatment potential. Choline is a selective α7 nAChR agonist and the aim of this study was to determine whether cytidine 5'-diphosphocholine (CDP-choline), or citicoline, a dietary source of choline, increases sensory gating and cognition in healthy volunteers stratified for gating level. In a randomized, placebo-controlled, double-blind design involving acute administration of low, moderate doses (500 mg, 1000 mg) of CDP-choline, 24 healthy volunteers were assessed for auditory gating as indexed by suppression of the P50 event-related potential (ERP) in a paired-stimulus (S1, S2) paradigm, and for executive function as measured by the Groton Maze Learning Task (GMLT) of the CogState Schizophrenia Battery. CDP-choline improved gating (1000 mg) and suppression of the S2 P50 response (500 mg, 1000 mg), with the effects being selective for individuals with low gating (suppression) levels. Tentative support was also shown for increased GMLT performance (500 mg) in low suppressors. These preliminary findings with CDP-choline in a healthy, schizophrenia-like surrogate sample are consistent with a α7 nAChR mechanism and support further trials with choline as a pro-cognitive strategy.
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Affiliation(s)
- Verner Knott
- Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada School of Psychology, University of Ottawa, Ottawa, ON, Canada Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Dylan Smith
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Danielle Impey
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Joelle Choueiry
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Elise Beaudry
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Meaghan Smith
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Salman Saghir
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Vadim Ilivitsky
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Alain Labelle
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
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25
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Qian Y, Ding Q, Li Y, Zou Z, Yan B, Ou L. Phosphorylation of uridine and cytidine by uridine–cytidine kinase. J Biotechnol 2014; 188:81-7. [DOI: 10.1016/j.jbiotec.2014.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 08/10/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
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Padilla Luz A, Reyes Rodríguez JF, Gómez Rodríguez de Acuña A, González Gómez CM, Álvarez Dorta I, Pérez Cánovas ME. [Prescription appropriateness: Indication of citicoline in Primary Care]. Semergen 2014; 41:199-205. [PMID: 25016945 DOI: 10.1016/j.semerg.2013.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/24/2013] [Accepted: 09/29/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The economic situation has made it necessary to optimize resources by adjusting the pharmaceutical expenditure. Citicoline was (2011) the 10th drug by rank of billed amount. Its approved indications are stroke (acute and sub-acute) and head injury, but not cognitive decline associated with age, the presumed indication for most of its use. OBJECTIVES To assess the conditions of use of citicoline in the Health Area of Tenerife, in order to detect deviations from the indications of use as stipulated in the prescribing information sheet and the pattern of prescription, with emphasis on the analysis of its use in dementia where currently it has no indication or evidence to support it. METHOD Cross-sectional study of prescription-indication. A 680 patient sample, segmented by reference hospital (error±5%; CI: 0.95%; P=0.5) was taken from the 4036 patients with a prescription of citicoline billed during august-october 2011 (obtained from the prescription database program, Farmacanarias). RESULTS We found that 123 patients (18.1%) had an appropriate indication. By including the prescription regimen, 28 patients (4.1%) had adequate indication and dose levels, and in only 2 patients (0.2%) an appropriate indication, dosage and duration were found. CONCLUSIONS "The correct prescription-indication" of citicoline is inappropiate in almost all patients studied. Impact actions are needed in order to optimize prescription, improve patient safety by reducing potential interactions, and the occurrence of adverse effects, and improve efficiency by promoting savings.
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Affiliation(s)
- A Padilla Luz
- Departamento de Farmacia, Gerencia de Atención Primaria, Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España.
| | - J F Reyes Rodríguez
- Área Técnica de Salud Pública, Gerencia de Atención Primaria, Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - A Gómez Rodríguez de Acuña
- Departamento de Farmacia, Gerencia de Atención Primaria, Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - C M González Gómez
- Departamento de Farmacia, Gerencia de Atención Primaria, Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - I Álvarez Dorta
- Departamento de Farmacia, Gerencia de Atención Primaria, Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - M E Pérez Cánovas
- Dirección Médica, Gerencia de Atención Primaria, Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
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Wignall ND, Brown ES. Citicoline in addictive disorders: a review of the literature. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 40:262-8. [PMID: 24950234 PMCID: PMC4139283 DOI: 10.3109/00952990.2014.925467] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 05/07/2014] [Accepted: 05/12/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Citicoline is a dietary supplement that has been used as a neuroprotective agent for neurological disorders such as stroke and dementia. Citicoline influences acetylcholine, dopamine, and glutamate neurotransmitter systems; serves as an intermediate in phospholipid metabolism; and enhances the integrity of neuronal membranes. Interest has grown in citicoline as a treatment for addiction since it may have beneficial effects on craving, withdrawal symptoms, and cognitive functioning, as well as the ability to attenuate the neurotoxic effects of drugs of abuse. OBJECTIVES To review the literature on citicoline's use in addictive disorders. METHODS Using PubMed we conducted a narrative review of the clinical literature on citicoline related to addictive disorders from the years 1900-2013 using the following keywords: citicoline, CDP-choline, addiction, cocaine, alcohol, substance abuse, and substance dependence. Out of approximately 900 first hits, nine clinical studies have been included in this review. RESULTS Most addiction research investigated citicoline for cocaine use. The findings suggest that it is safe and well tolerated. Furthermore, citicoline appears to decrease craving and is associated with a reduction in cocaine use, at least at high doses in patients with both bipolar disorder and cocaine dependence. Limited data suggest citicoline may also hold promise for alcohol and cannabis dependence and in reducing food consumption. CONCLUSIONS Currently, there is limited research on the efficacy of citicoline for addictive disorders, but the available literature suggests promising results. Future research should employ larger sample sizes, increased dosing, and more complex study designs.
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Affiliation(s)
- Nicholas D. Wignall
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX
| | - E. Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX
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Abstract
Citicoline is the generic name of the pharmaceutical substance that chemically is cytidine-5'-diphosphocholine (CDP-choline), which is identical to the natural intracellular precursor of phospholipid phosphatidylcholine. Following injection or ingestion, citicoline is believed to undergo quick hydrolysis and dephosphorylation to yield cytidine and choline, which then enter the brain separately and are used to resynthesize CDP-choline inside brain cells. Neuroprotective activity of citicoline has been repeatedly shown in preclinical models of brain ischaemia and trauma, but two recent, large, pivotal clinical trials have revealed no benefits in ischaemic stroke and traumatic brain injury. However, the substance seems to be beneficial in some slowly advancing neurodegenerative disorders such as glaucoma and mild vascular cognitive impairment. This paper critically discusses issues related to the clinical pharmacology of citicoline, including its pharmacokinetics/biotransformation and pharmacodynamics/mode of action. It is concluded that at present, there is no adequate description of the mechanism(s) of the pharmacological actions of this substance. The possibility should be considered and tested that, in spite of apparently fast catabolism, the intact citicoline molecule or the phosphorylated intermediate products of its hydrolysis, cytidine monophosphate and phosphocholine, are pharmacologically active.
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Affiliation(s)
- Pawel Grieb
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 5 Pawinskiego str., 02-106, Warsaw, Poland,
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29
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Potential efficacy of citicoline as adjunct therapy in treatment of cerebral malaria. Antimicrob Agents Chemother 2013; 58:602-5. [PMID: 24165175 DOI: 10.1128/aac.02591-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Cerebral malaria (CM) is characterized by a dysregulated immune response that results in endothelial membrane destabilization and increased microparticle (MP) production. Citicoline (CTC) is a membrane stabilizer used for the treatment of neurological disorders. We evaluated the efficacy of CTC as adjunct therapy to aid recovery from experimental CM. We show that CTC reduces MP production in vitro; in combination with artesunate in vivo, confers partial protection against CM; and prolongs survival.
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Alvarez-Sabín J, Román GC. The role of citicoline in neuroprotection and neurorepair in ischemic stroke. Brain Sci 2013; 3:1395-414. [PMID: 24961534 PMCID: PMC4061873 DOI: 10.3390/brainsci3031395] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/10/2013] [Accepted: 08/14/2013] [Indexed: 12/12/2022] Open
Abstract
Advances in acute stroke therapy resulting from thrombolytic treatment, endovascular procedures, and stroke units have improved significantly stroke survival and prognosis; however, for the large majority of patients lacking access to advanced therapies stroke mortality and residual morbidity remain high and many patients become incapacitated by motor and cognitive deficits, with loss of independence in activities of daily living. Therefore, over the past several years, research has been directed to limit the brain lesions produced by acute ischemia (neuroprotection) and to increase the recovery, plasticity and neuroregenerative processes that complement rehabilitation and enhance the possibility of recovery and return to normal functions (neurorepair). Citicoline has therapeutic effects at several stages of the ischemic cascade in acute ischemic stroke and has demonstrated efficiency in a multiplicity of animal models of acute stroke. Long-term treatment with citicoline is safe and effective, improving post-stroke cognitive decline and enhancing patients' functional recovery. Prolonged citicoline administration at optimal doses has been demonstrated to be remarkably well tolerated and to enhance endogenous mechanisms of neurogenesis and neurorepair contributing to physical therapy and rehabilitation.
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Affiliation(s)
- José Alvarez-Sabín
- Neurovascular Unit, Department of Neurology, Universitat Autónoma de Barcelona, 119-129 Passeig de la Vall d'Hebron, Barcelona 08035, Spain.
| | - Gustavo C Román
- Department of Neurology, Nantz National Alzheimer Center, Methodist Neurological Institute, Houston, TX 77030, USA.
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Alonso de Leciñana M, Gutiérrez-Fernández M, Romano M, Cantú-Brito C, Arauz A, Olmos LE, Ameriso SF, Díez-Tejedor E. Strategies to improve recovery in acute ischemic stroke patients: Iberoamerican Stroke Group Consensus. Int J Stroke 2013; 9:503-13. [PMID: 23802573 DOI: 10.1111/ijs.12070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/31/2012] [Indexed: 12/20/2022]
Abstract
Stroke is not only a leading cause of death worldwide but also a main cause of disability. In developing countries, its burden is increasing as a consequence of a higher life expectancy. Whereas stroke mortality has decreased in developed countries, in Latin America, stroke mortality rates continue to rise as well as its socioeconomic dramatic consequences. Therefore, it is necessary to implement stroke care and surveillance programs to better describe the epidemiology of stroke in these countries in order to improve therapeutic strategies. Advances in the understanding of the pathogenic processes of brain ischemia have resulted in development of effective therapies during the acute phase. These include reperfusion therapies (both intravenous thrombolysis and interventional endovascular approaches) and treatment in stroke units that, through application of management protocols directed to maintain homeostasis and avoid complications, helps to exert effective brain protection that decreases further cerebral damage. Some drugs may enhance protection, and besides, there is increasing knowledge about brain plasticity and repair mechanisms that take place for longer periods beyond the acute phase. These mechanisms are responsible for recovery in certain patients and are the focus of basic and clinical research at present. This paper discusses recovery strategies that have demonstrated clinical effect, or that are promising and need further study. This rapidly evolving field needs to be carefully and critically evaluated so that investment in patient care is grounded on well-proven strategies.
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Affiliation(s)
- M Alonso de Leciñana
- Stroke Unit, Deparment of Neurology, University Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
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Cotroneo AM, Castagna A, Putignano S, Lacava R, Fantò F, Monteleone F, Rocca F, Malara A, Gareri P. Effectiveness and safety of citicoline in mild vascular cognitive impairment: the IDEALE study. Clin Interv Aging 2013; 8:131-7. [PMID: 23403474 PMCID: PMC3569046 DOI: 10.2147/cia.s38420] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The studio di intervento nel decadimento vascolare lieve (IDEALE study) was an open multicenter Italian study, the aim of which was to assess the effectiveness and safety of oral citicoline in elderly people with mild vascular cognitive impairment. METHODS The study was performed in 349 patients. The active or citicoline group was composed of 265 patients and included 122 men and 143 women of mean age 79.9 ± 7.8 years selected from six Italian regions. Inclusion criteria were age ≥ 65 years, Mini-Mental State Examination (MMSE) score ≥ 21, subjective memory complaints but no evidence of deficits on MMSE, and evidence of vascular lesions on neuroradiology. Those with probable Alzheimer's disease were excluded. The control group consisted of 84 patients, including 36 men and 48 women of mean age 78.9 ± 7.01 (range 67-90) years. Patients included in the study underwent brain computed tomography or magnetic resonance imaging, and plasma dosage of vitamin B12, folate, and thyroid hormones. Functional dependence was investigated by scores on the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales, mood was assessed by the Geriatric Depression Scale (GDS), and behavioral disorders using the Neuropsychiatric Inventory scale. Comorbidity was assessed using the Cumulative Illness Rating Scale. An assessment was made at baseline (T0), after 3 months (T1), and after 9 months (T2, ie, 6 months after T1). The main outcomes were an improvement in MMSE, ADL, and IADL scores in the study group compared with the control group. Side effects were also investigated. The study group was administered oral citicoline 500 mg twice a day throughout the study. RESULTS MMSE scores remained unchanged over time (22.4 ± 4 at T0; 22.7 ± 4 at T1; 22.9 ± 4 at T2), whereas a significant difference was found between the study and control groups, both in T1 and in T2. No differences were found in ADL and IADL scores between the two groups. A slight but not statistically significant difference was found in GDS score between the study and control groups (P = 0.06). No adverse events were recorded. CONCLUSION In this study, citicoline was effective and well tolerated in patients with mild vascular cognitive impairment. Citicoline activates biosynthesis of phospholipids in neuronal membranes, increases brain metabolism as well as norepinephrine and dopamine levels in the central nervous system, and has neuroprotective effects during hypoxia and ischemia. Therefore, citicoline may be recommended for patients with mild vascular cognitive impairment.
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Knippenberg S, Skripuletz T, Rath KJ, Thau N, Gudi V, Pul R, Körner S, Dengler R, Stangel M, Petri S. CDP-choline is not protective in the SOD1-G93A mouse model of ALS. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:284-90. [PMID: 23286744 DOI: 10.3109/21678421.2012.745569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Important pathogenic factors in ALS include excitotoxicity and oxidative stress. Cytidine 5-diphosphocholine (CDP-choline) has recently been reported to have neuroprotective effects in animal models for neurodegenerative diseases, attributable to its anti-glutamatergic, anti-excitotoxic, anti-apoptotic and membrane-preserving properties. In this study we administered either CDP-choline or vehicle to transgenic SOD1-G93A mice daily via intraperitoneal (i.p.) injection starting before disease onset (day 30). By monitoring of survival, motor function, weight and general condition we examined possible therapeutic effects. Additional animals were used for histological studies to determine the effect of CDP-choline on motor neuron survival, astrocytosis and myelination in the spinal cord. Results showed that CDP-choline treatment modified neither the deterioration of general condition nor the loss of body weight. Survival of CDP-choline treated animals was not prolonged compared to vehicle treated controls. None of the behavioural motor function tests revealed differences between groups and no differences in motor neuron survival, astrocytosis or myelination were detected by histological analyses. In conclusion, our data from the transgenic mouse model do not strongly support further clinical validation of CDP-choline for the treatment of ALS.
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Affiliation(s)
- Sarah Knippenberg
- Department of Neurology, Hannover Medical School, Hannover, Germany.
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Colucci L, Bosco M, Rosario Ziello A, Rea R, Amenta F, Fasanaro AM. Effectiveness of nootropic drugs with cholinergic activity in treatment of cognitive deficit: a review. J Exp Pharmacol 2012; 4:163-72. [PMID: 27186129 PMCID: PMC4863555 DOI: 10.2147/jep.s35326] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Nootropics represent probably the first “smart drugs” used for the treatment of cognitive deficits. The aim of this paper is to verify, by a systematic analysis of the literature, the effectiveness of nootropics in this indication. The analysis was limited to nootropics with cholinergic activity, in view of the role played by acetylcholine in learning and memory. Acetylcholine was the first neurotransmitter identified in the history of neuroscience and is the main neurotransmitter of the peripheral, autonomic, and enteric nervous systems. We conducted a systematic review of the literature for the 5-year period 2006–2011. From the data reported in the literature, it emerges that nootropics may be an effective alternative for strengthening and enhancing cognitive performance in patients with a range of pathologies. Although nootropics, and specifically the cholinergic precursors, already have a long history behind them, according to recent renewal of interest, they still seem to have a significant therapeutic role. Drugs with regulatory indications for symptomatic treatment of Alzheimer’s disease, such as cholinesterase inhibitors and memantine, often have transient effects in dementia disorders. Nootropics with a cholinergic profile and documented clinical effectiveness in combination with cognate drugs such as cholinesterase inhibitors or alone in patients who are not suitable for these inhibitors should be taken into account and evaluated further.
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Affiliation(s)
- Luisa Colucci
- Centro di Ricerche Cliniche, Telemedicina e Telefarmacia, Università di Camerino, Camerino, Italy; Unità Valutazione Alzheimer, Naples, Italy
| | | | - Antonio Rosario Ziello
- Centro di Ricerche Cliniche, Telemedicina e Telefarmacia, Università di Camerino, Camerino, Italy; Unità Valutazione Alzheimer, Naples, Italy
| | - Raffaele Rea
- Centro di Ricerche Cliniche, Telemedicina e Telefarmacia, Università di Camerino, Camerino, Italy; Unità Valutazione Alzheimer, Naples, Italy
| | - Francesco Amenta
- Centro di Ricerche Cliniche, Telemedicina e Telefarmacia, Università di Camerino, Camerino, Italy
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Putignano S, Gareri P, Castagna A, Cerqua G, Cervera P, Cotroneo AM, Fiorillo F, Grella R, Grella R, Lacava R, Maddonni A, Marino S, Pluderi A, Putignano D, Rocca F. Retrospective and observational study to assess the efficacy of citicoline in elderly patients suffering from stupor related to complex geriatric syndrome. Clin Interv Aging 2012; 7:113-8. [PMID: 22654511 PMCID: PMC3363302 DOI: 10.2147/cia.s29366] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A significant percentage of elderly subjects (50%-80%) suffering from sub-acute ischemic cerebrovascular disease, with or without moderate or severe cognitive memory decline and with or without associated behavioral and psychological symptoms, shows a complex syndrome. This syndrome is related to the progressive impairment of health conditions and/or stressing events (ie, hospitalization), characterized by confusion and/or stupor, which are consequently difficult to manage and require a great deal of care. Geriatric patients often suffer from multiple chronic illnesses, may take numerous medications daily, exhibit clinical instability, and may experience worsening of medical conditions following cerebral ischemic events and thus have an increased risk of disability and mortality. There are several studies in literature which demonstrate the efficacy of citicoline, thanks to its neuroprotective function, for the recovery and in postischemic cerebral rehabilitation. It has been shown that, even soon after an ischemic stroke, administration of oral citicoline (500-4000 mg/day) improves the general conditions evaluated with the Rankin scale and the National Institute of Health Stroke Scale 12. In particular, it has been shown that the CDP-choline improves the cognitive and mental performance in Alzheimer's dementia and vascular dementia. We have evaluated the administration of citicoline in geriatric patients following a protocol of intravenous study on improvement of individual performances.
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Affiliation(s)
- Salvatore Putignano
- Associazione Geriatri Extraospedalieri - Geriatria Italiana Territoriale, Tenore 17, Naples, Italy.
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Alvarez-Sabín J, Román GC. Citicoline in vascular cognitive impairment and vascular dementia after stroke. Stroke 2011; 42:S40-3. [PMID: 21164117 DOI: 10.1161/strokeaha.110.606509] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cognitive decline after stroke is more common than stroke recurrence. Stroke doubles the risk of dementia and is a major contributor to vascular cognitive impairment and vascular dementia. Neuropathological studies in most cases of dementia in the elderly reveal a large load of vascular ischemic brain lesions mixed with a lesser contribution of neurodegenerative lesions of Alzheimer disease. Nonetheless, few pharmacological studies have addressed vascular cognitive impairment and vascular dementia after stroke. Citicoline has demonstrated neuroprotective effects in acute stroke and has been shown to improve cognition in patients with chronic cerebrovascular disease and in some patients with Alzheimer disease. A recent trial lasting 6 months in patients with first-ever ischemic stroke showed that citicoline prevented cognitive decline after stroke with significant improvement of temporal orientation, attention, and executive function. Experimentally, citicoline exhibits neuroprotective effects and enhances neural repair. Citicoline appears to be a safe and promising alternative to improve stroke recovery and could be indicated in patients with vascular cognitive impairment, vascular dementia, and Alzheimer disease with significant cerebrovascular disease.
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Affiliation(s)
- Jose Alvarez-Sabín
- Neurovascular Unit, Department of Neurology, Universitat Autónoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain
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