Deprenyl: protective vs. symptomatic effect

Deprenyl in Parkinson’s Disease: Mechanisms, Neuroprotective Effect, Indications and Adverse Effects

Deprenyl is a synthetic, selective inhibitor of the monoamine oxidase-B enzyme system. The mechanism of its beneficial effect in early and advanced Parkinson’s disease is not settled. Increased striatal dopamine accumulation, sensitization of surviving dopamine neurons with increased dopamine production and reduced nigro-striatal toxicity may all contribute. The standard daily dose of deprenyl is 10 mg. Selectivity may be lost at higher doses. Deprenyl is especially indicated in untreated patients, improving up to 50 percent of patients with mild motor fluctuations. Major symptomatic benefit also occurs in occasional levodopa treated patients. Adverse effects are common, however. Increase dyskinesias, confusion and hallucinations, nausea and postural hypotension may necessitate drug withdrawal or the use of low dose regimens. Caution should be exercised with older patients, those with ulcer disease, which may be worsened by deprenyl, and individuals with active ischemic heart disease where the safety of this drug is not yet clear.

The effects of L-deprenyl treatment, alone and combined with GM1 ganglioside, on striatal dopamine content and substantia nigra pars compacta neurons

The present study examined the effects of GM1 ganglioside and the monoamine oxidase B (MAO-B) inhibitor L-deprenyl, alone and in combination, on striatal dopamine (DA) and DOPAC levels, and the density of tyrosine hydroxylase (TH) positive neurons in the substantia nigra pars compacta (SNc) of C57bl/6J mice following MPTP administration (20 mg/kg, s.c., twice daily for 5 days). GM1 treatment (30 mg/kg, i.p., daily for 3 weeks, beginning 24 h after the last MPTP injection) partially restored striatal DA levels and rescued SNc neurons. A high dose of L-deprenyl, inhibiting MAO-B activity, (10 mg/kg, i.p. every other day for 3 weeks beginning 3 days after the last MPTP injection) increased striatal DA content, but did not rescue TH-positive SNc neurons. A low dose of L-deprenyl (0.01 mg/kg, i.p. every other day for 3 weeks beginning 3 days after the last MPTP injection) had no effect on either striatal neurochemistry or the rescue of SNc TH-positive neurons. Co-administration of GM1 and high dose L-deprenyl caused a synergistic increase in striatal DA levels, above that obtained with either GM1 or high dose L-deprenyl alone. Co-administration of GM1 and low dose L-deprenyl was not only not synergistic, but caused GM1s effects to be antagonized. The results do not confirm previous findings that low dose L-deprenyl administration in vivo after MPTP can rescue SNc neurons. Given GM1's potential as an adjunct to present anti-parkinsonian medications which include L-deprenyl, it will be important to further investigate the interactions between these two potential therapies.

Effects of monoamine oxidase and catechol-O-methyltransferase inhibition on dopamine turnover: a PET study with 6-[18F]L-DOPA

The consequences of monoamine oxidase and catechol-O-methyltransferase inhibition on the effective turnover of dopamine were investigated using 6-[18F]L-3-4-dihydroxyphenylalanine (6-[18F]L-DOPA) and positron emission tomography. The effective dopamine turnover was expressed as the ratio between the rate of reversibility of 6-[18F]L-DOPA trapping (k[loss]) and the rate of uptake of 6-[81F]L-DOPA (Ki) in the striatum of normal cynomolgus monkeys. The monkeys received 6-[18F]L-DOPA scans, untreated or after pretreatment with either the peripheral catechol-O-methyltransferase inhibitor nitecapone; the peripheral and central catechol-O-methyltransferase inhibitor tolcapone; the monoamine oxidase inhibitors deprenyl or pargyline; a combination of tolcapone and the monoamine oxidase inhibitors. Tolcapone alone or combined with the monoamine oxidase inhibitors produced a significant decrease in the dopamine turnover (55 to 65%). Neither nitecapone nor monoamine oxidase inhibition alone produced significant changes. These results may have implications for the use of central catechol-O-methyltransferase inhibitors added to routine levodopa therapy in parkinsonian patients.

Pharmacological and clinical implications of MAO-B inhibitors

Although the involvement of monoamine oxidase B (MAO-B) in physiological function is not yet well understood, its inhibitors have been shown to be quite useful in the treatment of various neuropsychiatric disorders. Platelet MAO-B activity has been found to be reduced in several psychiatric disorders, related to substance abuse and associated with different personalities. 1-Deprenyl (selegiline), an archetypical MAO-B inhibitor, alone does not seem to exert an antidepressive effect, however, it may become useful when administered in combination with amine neurotransmitter precursors. MAO-B inhibitors are useful adjunct drugs to 1-DOPA in the symptomatic treatment of Parkinson's disease. Interestingly, 1-deprenyl alone can slow down the progress of otherwise disabled syndromes of Parkinson's disease. It has been proposed that 1-deprenyl may play a role in neuroprotection and neurorescue. MAO-B inhibitors can selectively and dramatically increase the level of beta-phenylethylamine, which has been shown to potentiate dopamine and noradrenaline function in the central nervous system. Several new types of highly selective, reversible and irreversible MAO-B inhibitors have recently been developed. The mechanism(s) of neuroprotective and rescue actions of 1-deprenyl and other MAO-B inhibitors will help to shed some light on our understanding of the neurodegenerative process.

MAO-A and -B inhibitors selectively alter Xenopus mucus-induced behaviors of snakes

Skin mucus of the frog Xenopus laevis, contacted orally by snakes, induces dyskinetic oral movements and climbing behavior that promote escape. The mucus contains peptides and indoleamines known to produce drug-induced movement disorders in other species. We hypothesized that inhibition of monoamine oxidase-A (MAO-A) by N-methyl-N-propargyl-3-(2,4-dichlorophenoxy)-propylamine [clorgyline (CLG)] and MAO-B by R(-)-N, alpha-Dimethyl-N-2-propynyl-benzene-ethanamine [L-deprenyl (LDL)] would selectively modify mucus-induced behaviors by elevating norepinephrine and serotonin (with CLG), phenylethylamine (with LDL), or dopamine (with both drugs). In Experiment 1 (EXP1), adult snakes received mucus and/or 20 micrograms/g (IP) of both drugs. In EXP2, juveniles received mucus and/or 5, 10, and 20 micrograms CLG or LDL. CLG given alone had no effect on tongue flicking, activity, and climbing (EXP1,2). LDL alone decreased tongue flicking in EXP2 and increased climbing (EXP1,2). Given with mucus, both drugs further lowered the tongue flicking rates attenuated by mucus (EXP1,2); only LDL potentiated mucus-induced climbing. Yawning was the only mucus-induced dyskinesia attenuated (20 micrograms CLG, adults; 20 micrograms LDL, juveniles). We suggest that dopamine and/or phenylethylamine, the substrates for MAO-B, may promote mucus-induced climbing and tongue flicking but may have some protective role against mucus-induced yawning in water snakes.

Nigral degeneration in Parkinson's disease

Neuronal loss in the substantia nigra of patients with Parkinson's disease (PD) does not occur evenly throughout the nucleus: the ventrolateral part of the substantia nigra degenerates more severely, whereas the medial part is relatively preserved. This pattern of nigral neuronal loss is compatible with the uneven loss of dopamine in the striatum (the putamen more affected than the caudate nucleus). The predominant loss of ventrolateral nigrostriatal projections in PD, leading to substantial loss of dopamine especially in the putamen, is thought to contribute to the motor symptoms of the patients. On the other hand, the more medial nigral projections may be involved in the cognitive symptoms of patients. Selegiline (L-deprenyl) has been shown to delay the need to initiate levodopa therapy in early PD, and selegiline has also been suggested to increase the survival of PD patients. These observations have led to the proposal of selegiline's neuron-saving effect in PD. There is some pathological evidence supporting the better survival of nigral neurons in PD patients treated with selegiline as compared with those without such treatment. Further studies are, however, needed to elucidate this question more clearly.

The free radical hypothesis in idiopathic parkinsonism: evidence against it

The free radical hypothesis for the pathogenesis of idiopathic parkinsonism (Parkinson's disease) has many similarities to the argument invoking an autoimmune mechanism. In both cases, cellular and molecular machinery that might be involved in neuronal destruction have been demonstrated. In recent years, the free radical hypothesis has become particularly fashionable; several workers have reported observations which, they infer, support the notion that damage by free radicals is a major factor in the underlying disease process. There is, however, no conclusive evidence that free radicals play a prominent role in the causal chain of events that leads to idiopathic parkinsonism; several findings may be construed as evidence against such a contention.