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Kastberger B, Winter S, Brandstätter H, Biller J, Wagner W, Plesnila N. Treatment with Cerebrolysin Prolongs Lifespan in a Mouse Model of Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy. Adv Biol (Weinh) 2024; 8:e2300439. [PMID: 38062874 DOI: 10.1002/adbi.202300439] [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: 08/22/2023] [Indexed: 02/15/2024]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare familial neurological disorder caused by mutations in the NOTCH3 gene and characterized by migraine attacks, depressive episodes, lacunar strokes, dementia, and premature death. Since there is no therapy for CADASIL the authors investigate whether the multi-modal neuropeptide drug Cerebrolysin may improve outcome in a murine CADASIL model. Twelve-month-old NOTCH3R169C mutant mice (n=176) are treated for nine weeks with Cerebrolysin or Vehicle and histopathological and functional outcomes are evaluated within the subsequent ten months. Cerebrolysin treatment improves spatial memory and overall health, reduces epigenetic aging, and prolongs lifespan, however, CADASIL-specific white matter vacuolization is not affected. On the molecular level Cerebrolysin treatment increases expression of Calcitonin Gene-Related Peptide (CGRP) and Silent Information Regulator Two (Sir2)-like protein 6 (SIRT6), decreases expression of Insulin-like Growth Factor 1 (IGF-1), and normalizes the expression of neurovascular laminin. In summary, Cerebrolysin fosters longevity and healthy aging without specifically affecting CADASIL pathology. Hence, Cerebrolysin may serve a therapeutic option for CADASIL and other disorders characterized by accelerated aging.
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Affiliation(s)
| | - Stefan Winter
- Ever Pharma, Oberburgau 3, Unterach am Attersee, 4866, Austria
| | | | - Janina Biller
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Wolfgang Wagner
- Institute for Stem Cell Biology, RWTH Aachen University Medical School, 52074, Aachen, Germany
- Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074, Aachen, Germany
- Cygenia GmbH, 52078, Aachen, Germany
| | - Nikolaus Plesnila
- Cluster of Systems Neurology (Synergy), 81377, Munich, Germany
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377, Munich, Germany
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2
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Rejdak K, Sienkiewicz-Jarosz H, Bienkowski P, Alvarez A. Modulation of neurotrophic factors in the treatment of dementia, stroke and TBI: Effects of Cerebrolysin. Med Res Rev 2023; 43:1668-1700. [PMID: 37052231 DOI: 10.1002/med.21960] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023]
Abstract
Neurotrophic factors (NTFs) are involved in the pathophysiology of neurological disorders such as dementia, stroke and traumatic brain injury (TBI), and constitute molecular targets of high interest for the therapy of these pathologies. In this review we provide an overview of current knowledge of the definition, discovery and mode of action of five NTFs, nerve growth factor, insulin-like growth factor 1, brain derived NTF, vascular endothelial growth factor and tumor necrosis factor alpha; as well as on their contribution to brain pathology and potential therapeutic use in dementia, stroke and TBI. Within the concept of NTFs in the treatment of these pathologies, we also review the neuropeptide preparation Cerebrolysin, which has been shown to resemble the activities of NTFs and to modulate the expression level of endogenous NTFs. Cerebrolysin has demonstrated beneficial treatment capabilities in vitro and in clinical studies, which are discussed within the context of the biochemistry of NTFs. The review focuses on the interactions of different NTFs, rather than addressing a single NTF, by outlining their signaling network and by reviewing their effect on clinical outcome in prevalent brain pathologies. The effects of the interactions of these NTFs and Cerebrolysin on neuroplasticity, neurogenesis, angiogenesis and inflammation, and their relevance for the treatment of dementia, stroke and TBI are summarized.
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Affiliation(s)
- Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | | | | | - Anton Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, Coruña, Spain
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3
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Tran L, Alvarez XA, Le HA, Nguyen DA, Le T, Nguyen N, Nguyen T, Nguyen T, Vo T, Tran T, Duong C, Nguyen H, Nguyen S, Nguyen H, Le T, Nguyen M, Nguyen T. Clinical Efficacy of Cerebrolysin and Cerebrolysin plus Nootropics in the Treatment of Patients with Acute Ischemic Stroke in Vietnam. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 21:621-630. [PMID: 34414874 DOI: 10.2174/1871527320666210820091655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/29/2021] [Accepted: 07/11/2021] [Indexed: 01/13/2023]
Abstract
AIMS To investigate the efficacy and safety of Cerebrolysin and Cerebrolysin plus nootropics in the routine treatment of patients with acute ischemic stroke (AIS). BACKGROUND Acute ischemic stroke (AIS) is a leading cause of disability with unmet treatment needs lacking effective drug therapy. Multimodal drugs modulating stroke pathophysiology as Cerebrolysin constitute a good therapeutic option. OBJECTIVE In this study, we assessed the effects of Cerebrolysin and Cerebrolysin plus nootropics, in comparison with other nootropic drugs alone, on functional, neurological and cognitive recovery of patients with AIS in Vietnam. METHODS This non-interventional, controlled, open-label, prospective and multicenter study included 398 AIS patients (234 males) treated with Cerebrolysin (n=190; 20 i.v. infusions of 10 ml), other nootropics (comparator group; n=86), or a combination of both (n=122). The study primary endpoint was the modified Ranking Scale (mRS) score on day 90. Secondary endpoints included study-period change in NIHSS score; percentage of well-recovered (mRS 0-2) patients, the proportion of good NIHSS response (≥6 points) cases, and MoCA scores at day 90; and safety indicators. RESULTS Compared with other nootropics, both Cerebrolysin and combined therapy induced significant improvements (p<0.001) in: Functional recovery (mRS scores); percentage of well-recovered patients (Cerebrolysin: 81.6%; combination: 93.4%; comparator: 43.0%); neurological recovery (study- period NIHSS change); proportion of good NIHSS responders (Cerebrolysin: 77.5%; combination: 92.5%; comparator: 47.6%); and MoCA scores (Cerebrolysin: 23.3±4.8; combination: 23.7±4.1; comparator: 15.9±7.7). Compared to Cerebrolysin, combined therapy improved (p<0.01) mRS outcomes and NIHSS change, but not MoCA scores, in moderate-severe stroke (NIHSS>11) cases only. No drug-related adverse events were reported. CONCLUSION Cerebrolysin alone or combined with other nootropics was effective and safe in routine AIS treatment, during both acute and recovery phases, which supports its use in daily clinical practice. Others: According to the results of this multicenter study, the importance of reducing differences in the treatment regimens of AIS in Vietnam should be further emphasized.
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Affiliation(s)
- Luc Tran
- Outpatient Department, National Geriatric Hospital, Hanoi, Vietnam
| | - X Anton Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain.,Clinical Research Department, QPS Holdings, A Coruña, Spain
| | | | | | - Thinh Le
- Neurology Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Ngoc Nguyen
- Stroke centre, 108 Military Hospital, Hanoi, Vietnam
| | - Thang Nguyen
- Department of Cerebrovascular Disease, 115 People's Hospital, Hochiminh City, Vietnam
| | - Tai Nguyen
- Neurology Department, Cho Ray Hospital, Hochiminh City, Vietnam
| | - Tan Vo
- Neurology Department, Gia Dinh People's Hospital, Hochiminh City, Vietnam
| | - Tuan Tran
- Neurology Department, Thai Nguyen Central General Hosp, Thainguyen, Vietnam
| | - Chinh Duong
- Neurology Department, Nghe An General Hospital, Nghean, Vietnam
| | - Huyen Nguyen
- Neurology Department, Viet Tiep General Hospital, Haiphong, Vietnam
| | - Sam Nguyen
- Neurology Department, Thanh Hoa General Hospital, Thanhhoa, Vietnam
| | - Hien Nguyen
- Stroke unit, 103 Military Hospital, Hanoi, Vietnam
| | - Thanh Le
- Neurology Department, Thong Nhat Hospital, Hochiminh City, Vietnam
| | - Minh Nguyen
- Neurology Department, Trung Vuong Hospital, Hochiminh City, Vietnam
| | - Thang Nguyen
- Neurology Department, Hochiminh City Medicine and Pharmacy University Hospital, Hochiminh City, Vietnam
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Alvarez XA, Winston CN, Barlow JW, Sarsoza FM, Alvarez I, Aleixandre M, Linares C, García-Fantini M, Kastberger B, Winter S, Rissman RA. Modulation of Amyloid-β and Tau in Alzheimer's Disease Plasma Neuronal-Derived Extracellular Vesicles by Cerebrolysin® and Donepezil. J Alzheimers Dis 2022; 90:705-717. [PMID: 36155516 PMCID: PMC9697063 DOI: 10.3233/jad-220575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Plasma neuronal-derived extracellular vesicles (NDEV) contain proteins of pathological, diagnostic, and therapeutic relevance. OBJECTIVE We investigated the associations of six plasma NDEV markers with Alzheimer's disease (AD) severity, cognition and functioning, and changes in these biomarkers after Cerebrolysin®, donepezil, and a combination therapy in AD. METHODS Plasma NDEV levels of Aβ42, total tau, P-T181-tau, P-S393-tau, neurogranin, and REST were determined in: 1) 116 mild to advanced AD patients and in 20 control subjects; 2) 110 AD patients treated with Cerebrolysin®, donepezil, or combination therapy in a randomized clinical trial (RCT). Samples for NDEV determinations were obtained at baseline in the NDEV study and at baseline and study endpoint in the RCT. Cognition and functioning were assessed at the same time points. RESULTS NDEV levels of Aβ42, total tau, P-T181-tau, and P-S393-tau were higher and those of neurogranin and REST were lower in mild-to-moderate AD than in controls (p < 0.05 to p < 0.001). NDEV total tau, neurogranin, and REST increased with AD severity (p < 0.05 to p < 0.001). NDEV Aβ42 and P-T181-tau correlated negatively with serum BDNF (p < 0.05), and total-tau levels were associated to plasma TNF-α (p < 0.01) and cognitive impairment (p < 0.05). Combination therapy reduced NDEV Aβ42 with respect to monotherapies (p < 0.05); and NDEV total tau, P-T181-tau, and P-S396-tau were decreased in Cerebrolysin-treated patients compared to those on donepezil monotherapy (p < 0.05). CONCLUSION The present results demonstrate the utility of NDEV determinations of pathologic and synaptic proteins as effective AD biomarkers, as markers of AD severity, and as potential tools for monitoring the effects of anti-AD drugs.
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Affiliation(s)
- X. Anton Alvarez
- Medinova Institute of Neurosciences, Clinica Reha Salud, A Coruña, Spain
- Clinical Research Department, QPS Holdings, A Coruña, Spain
| | | | - James W. Barlow
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Floyd M. Sarsoza
- Department of Neurosciences, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Irene Alvarez
- Medinova Institute of Neurosciences, Clinica Reha Salud, A Coruña, Spain
| | | | | | | | | | | | - Robert A. Rissman
- Department of Neurosciences, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
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Xu LZ, Li FY, Li BQ, Cao SM, Li Y, Xu J, Jia JP. Decreased Levels of Insulin-Like Growth Factor-1 Are Associated with Alzheimer's Disease: A Meta-Analysis. J Alzheimers Dis 2021; 82:1357-1367. [PMID: 34151815 DOI: 10.3233/jad-210516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alterations in levels of peripheral insulin-like growth factor-1 (IGF-1) in Alzheimer's disease (AD) have been reported in several studies, and results are inconsistent. OBJECTIVE We conducted a meta-analysis to investigate the relationship between peripheral and cerebrospinal fluid IGF-1 levels and AD or mild cognitive impairment (MCI). METHODS A systematic search in PubMed, Medline, Web of Science, Embase, and Cochrane Library was conducted and 18 studies were included. RESULTS Results of random-effects meta-analysis showed that there was no significant difference between AD patients and healthy control (17 studies; standard mean difference [SMD], -0.01; 95%CI, -0.35 to 0.32) and between MCI patients and healthy control (6 studies; SMD, -0.20; 95%CI, -0.52 to 0.13) in peripheral IGF-1 levels. Meta-regression analyses identified age difference might explain the heterogeneity (p = 0.017). However, peripheral IGF-1 levels were significantly decreased in AD subjects (9 studies; SMD, -0.44; 95%CI, -0.81 to -0.07) and MCI subjects exhibited a decreasing trend (4 studies; SMD, -0.31; 95%CI, -0.72 to 0.11) in studies with sample size≥80. Cerebrospinal fluid IGF-1 levels also significantly decreased in AD subjects (3 studies; SMD, -2.40; 95%CI, -4.36 to -0.43). CONCLUSION These findings suggest that decreased peripheral and cerebrospinal fluid IGF-1 levels might be a potential marker for the cognitive decline and progression of AD.
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Affiliation(s)
- Ling-Zhi Xu
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, P.R. China.,Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, P.R. China.,Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, P.R. China.,Center of Alzheimer's Disease, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, P.R. China.,Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing P.R. China
| | - Fang-Yu Li
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, P.R. China.,Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, P.R. China.,Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, P.R. China.,Center of Alzheimer's Disease, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, P.R. China.,Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing P.R. China
| | - Bing-Qiu Li
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, P.R. China.,Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, P.R. China.,Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, P.R. China.,Center of Alzheimer's Disease, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, P.R. China.,Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing P.R. China
| | - Shu-Man Cao
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, P.R. China.,Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, P.R. China.,Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, P.R. China.,Center of Alzheimer's Disease, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, P.R. China.,Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing P.R. China
| | - Yan Li
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, P.R. China.,Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, P.R. China.,Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, P.R. China.,Center of Alzheimer's Disease, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, P.R. China.,Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing P.R. China
| | - Jin Xu
- Department of Library, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Jian-Ping Jia
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, P.R. China.,Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, P.R. China.,Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, P.R. China.,Center of Alzheimer's Disease, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, P.R. China.,Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing P.R. China
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6
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Putilina MV, Teplova NV, Poryadin GV. [Prospects for pharmacological adaptation of neurovascular unit in conditions of neurotropic viral infection]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:144-150. [PMID: 34184491 DOI: 10.17116/jnevro2021121051144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The article discusses the prospects for pharmacological conditioning as a method for adaptation of neurovascular unit in conditions of neurotropic viral infection. A step-by-step mechanism for development of preconditioning and postconditioning is presented with a detailed description of it's main stages (trigger, signal and effector). The role of neuroinflammation as the leading mechanism of damage and the possibility of influencing the brain neurotrophic factor are considered. It is shown that different medications including neurotrophic drugs (cerebrolysin) can serve as inducers of conditioning. Usage of neurotrophic drugs in different doses for preconditioning and postconditioning is pathogenetically justified.
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Affiliation(s)
- M V Putilina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - N V Teplova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - G V Poryadin
- Pirogov Russian National Research Medical University, Moscow, Russia
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7
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Gavrilova SI, Alvarez A. Cerebrolysin in the therapy of mild cognitive impairment and dementia due to Alzheimer's disease: 30 years of clinical use. Med Res Rev 2020; 41:2775-2803. [PMID: 32808294 DOI: 10.1002/med.21722] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022]
Abstract
Alzheimer's disease (AD) is the most common neurocognitive disorder and a global health problem. The prevalence of AD is growing dramatically, especially in low- and middle-income countries, and will reach 131.5 million cases worldwide by 2050. Therefore, developing a disease-modifying therapy capable of delaying or even preventing the onset and progression of AD has become a world priority, and is an unmet need. The pathogenesis of AD, considered as the result of an imbalance between resilience and risk factors, begins many years before the typical clinical picture develops and involves multiple pathophysiological mechanisms. Since the pathophysiology of AD is multifactorial, it is not surprising that all attempts done to modify the disease course with drugs directed towards a single therapeutic target have been unsuccessful. Thus, combined modality therapy, using multiple drugs with a single mechanism of action or multi-target drugs, appears as the most promising strategy for both effective AD therapy and prevention. Cerebrolysin, acting as a multitarget peptidergic drug with a neurotrophic mode of action, exerts long-lasting therapeutic effects on AD that could reflect its potential utility for disease modification. Clinical trials demonstrated that Cerebrolysin is safe and efficacious in the treatment of AD, and may enhance and prolong the efficacy of cholinergic drugs, particularly in moderate to advanced AD patients. In this review, we summarize advances of therapeutic relevance in the pathogenesis and the biomarkers of AD, paying special attention to neurotrophic factors, and present results of preclinical and clinical investigations with Cerebrolysin in AD.
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Affiliation(s)
- Svetlana I Gavrilova
- Department of Geriatric Psychiatry, Cognitive Disorders and Alzheimer's Disease Unit, Mental Health Research Center, Moscow, Russia
| | - Anton Alvarez
- Department of Neuropsychiatry, Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain.,Clinical Research Department, QPS Holdings, A Coruña, Spain
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8
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Alvarez XA, Alvarez I, Martinez A, Romero I, Benito C, Suarez I, Mourente S, Fantini M, Figueroa J, Aleixandre M, Linares C, Muresanu D, Winter S, Moessler H. Serum VEGF Predicts Clinical Improvement Induced by Cerebrolysin Plus Donepezil in Patients With Advanced Alzheimer's Disease. Int J Neuropsychopharmacol 2020; 23:581-586. [PMID: 32640027 PMCID: PMC7710915 DOI: 10.1093/ijnp/pyaa046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022] Open
Abstract
Serum vascular endothelial growth factor (VEGF) increases with Alzheimer's disease (AD) severity and may prevent cognitive decline. However, information on the influence of AD drug therapy on circulating VEGF is limited. This study assessed changes in serum VEGF levels and its association with clinical and functional responses in mild to moderate AD patients who were treated with Cerebrolysin, donepezil, or the combined therapy in a randomized, controlled trial. Treatment with Cerebrolysin plus donepezil reduced elevated serum VEGF levels and improved functioning and cognition significantly compared with donepezil alone in patients with advanced AD, and treatment differences were more pronounced in patients with higher VEGF levels. Our results indicate that the combined therapy reversed the increase of serum VEGF in advanced AD, which was associated with cognitive and functional responses, particularly in patients with high baseline VEGF.
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Affiliation(s)
- X Anton Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain ,Clinical Research Department, QPS Holdings, A Coruña, Spain,Correspondence: Dr X. Antón Alvarez, MD, PhD, Medinova Institute of Neurosciences, Clinica RehaSalud, 15006-A Coruña, Spain ()
| | - Irene Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain
| | - Antia Martinez
- Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Iria Romero
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain ,Clinical Research Department, QPS Holdings, A Coruña, Spain
| | - Concha Benito
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain
| | - Irene Suarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain
| | | | | | - Jesús Figueroa
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain ,Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | | | - Dafin Muresanu
- Department of Clinical Neurosciences, University of Medicine and Pharmacy “Iuliu Hațieganu,” Cluj-Napoca, Romania
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Nanowired delivery of cerebrolysin with neprilysin and p-Tau antibodies induces superior neuroprotection in Alzheimer's disease. PROGRESS IN BRAIN RESEARCH 2019; 245:145-200. [DOI: 10.1016/bs.pbr.2019.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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10
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Mahmoudi J, Mohaddes G, Erfani M, Sadigh-Eteghad S, Karimi P, Rajabi M, Reyhani-Rad S, Farajdokht F. Cerebrolysin attenuates hyperalgesia, photophobia, and neuroinflammation in a nitroglycerin-induced migraine model in rats. Brain Res Bull 2018; 140:197-204. [DOI: 10.1016/j.brainresbull.2018.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 02/07/2023]
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11
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Barakat W, Fahmy A, Askar M, El-Kannishy S. Effectiveness of arginase inhibitors against experimentally induced stroke. Naunyn Schmiedebergs Arch Pharmacol 2018; 391:603-612. [PMID: 29600431 DOI: 10.1007/s00210-018-1489-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/22/2018] [Indexed: 01/28/2023]
Abstract
Stroke is a lethal disease, but it disables more than it kills. Stroke is the second leading cause of death and the most frequent cause of permanent disability in adults worldwide, with 90% of survivors having residual deficits. The pathophysiology of stroke is complex and involves a strong inflammatory response associated with oxidative stress and activation of several proteolytic enzymes. The current study was designed to investigate the effect of arginase inhibitors (L-citruline and L-ornithine) against ischemic stroke induced in rats by middle cerebral artery occlusion (MCAO). MCAO resulted in alteration in rat behavior, brain infarct, and edema associated with disruption of the blood-brain barrier (BBB). This was mediated through overexpression of arginase I and II, inducible NOS (iNOS), malondialdehyde (MDA), advanced glycation end products (AGEs), TNF-α, and IL-1β and downregulation of endothelial nitric oxide synthase (eNOS). Treatment with L-citruline and L-ornithine and the standard neuroprotective drug cerebrolysin ameliorated all the deleterious effects of stroke. These results indicate the possible use of arginase inhibitors in the treatment of stroke after suitable clinical trials are done.
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Affiliation(s)
- Waleed Barakat
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tabuk University, Tabuk, Kingdom of Saudi Arabia.
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt.
| | - Ahmad Fahmy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Mohamed Askar
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Sherif El-Kannishy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tabuk University, Tabuk, Kingdom of Saudi Arabia
- Analytical Toxicology - Emergency Hospital, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
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12
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Hu X, Yang Y, Gong D. Circulating insulin-like growth factor 1 and insulin-like growth factor binding protein-3 level in Alzheimer's disease: a meta-analysis. Neurol Sci 2016; 37:1671-7. [PMID: 27379655 DOI: 10.1007/s10072-016-2655-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Abstract
It has been reported that the associations between circulating insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) and Alzheimer's disease (AD) are controversial. Thus, present meta-analysis was carried out to confirm the probable associations. We searched "PubMed", "Springer" and "Medline" databases using the term ("insulin-like growth factor-1" or "IGF-1" or "insulin-like growth factor binding protein-3" or "IGFBP-3") and ("Alzheimer's disease") until April 2016. Furthermore, standard mean differences (SMDs) were calculated. A total of seven reports involving 1342 percipients were pooled. SMDs were -0.25 (P = 0.22) and -0.33 (P = 0.08) for IGF-1 and IGFBP-3, respectively. Furthermore, the circulating IGF-1 levels in AD patients were lower than controls when studies with the difference of mean age ≤1 year (SMD -0.57, P = 0.007) or 2 years (SMD -0.58, P = 0.02) or difference of mean MMSE scores ≤10 scores (SMD -0.94, P < 0.00001), or studies from Europe (SMD -0.89, P < 0.00001) were excluded. In addition, the circulating IGFBP-3 levels in AD patients were lower than controls when studies with the difference of mean age ≤2 years (SMD -0.62, P = 0.006) or difference of mean MMSE scores ≤6 scores (SMD -0.48, P = 0.0004), 7 scores (SMD -0.58, P = 0.02), or 8 scores (SMD -0.80, P = 0.03) were excluded. Even though no significant difference of circulating IGF-1 and IGFBP-3 levels in AD patients comparing with controls was found in present meta-analysis, the current study provided the evidence that the circulating IGF-1 and IGFBP-3 level in AD patients were influenced by the difference of mean age as well as MMSE scores. Furthermore, circulating IGFBP-3 levels in AD patients may be decreased earlier than IGF-1.
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Affiliation(s)
- Xiaohui Hu
- Department of Neurology, Jingzhou Hospital, Tongji Medical College, Huazhong University of Science Technology, Renming Road No.1, Jingzhou, 434020, Hubei, China
| | - Yan Yang
- Hubei College of Chinese Medicines, Jingzhou, China
| | - Daokai Gong
- Department of Neurology, Jingzhou Hospital, Tongji Medical College, Huazhong University of Science Technology, Renming Road No.1, Jingzhou, 434020, Hubei, China.
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Alvarez XA, Alvarez I, Iglesias O, Crespo I, Figueroa J, Aleixandre M, Linares C, Granizo E, Garcia-Fantini M, Marey J, Masliah E, Winter S, Muresanu D, Moessler H. Synergistic Increase of Serum BDNF in Alzheimer Patients Treated with Cerebrolysin and Donepezil: Association with Cognitive Improvement in ApoE4 Cases. Int J Neuropsychopharmacol 2016; 19:pyw024. [PMID: 27207906 PMCID: PMC4926802 DOI: 10.1093/ijnp/pyw024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/11/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Low circulating brain derived neurotrophic factor may promote cognitive deterioration, but the effects of neurotrophic and combination drug therapies on serum brain derived neurotrophic factor were not previously investigated in Alzheimer's disease. METHODS We evaluated the effects of Cerebrolysin, donepezil, and the combined therapy on brain derived neurotrophic factor serum levels at week 16 (end of Cerebrolysin treatment) and week 28 (endpoint) in mild-to-moderate Alzheimer's disease patients. RESULTS Cerebrolysin, but not donepezil, increased serum brain derived neurotrophic factor at week 16, while the combination therapy enhanced it at both week 16 and study endpoint. Brain derived neurotrophic factor responses were significantly higher in the combination therapy group than in donepezil and Cerebrolysin groups at week 16 and week 28, respectively. Brain derived neurotrophic factor increases were greater in apolipoprotein E epsilon-4 allele carriers, and higher brain derived neurotrophic factor levels were associated with better cognitive improvements in apolipoprotein E epsilon-4 allele patients treated with Cerebrolysin and the combined therapy. CONCLUSION Our results indicate a synergistic action of Cerebrolysin and donepezil to increase serum brain derived neurotrophic factor and delaying cognitive decline, particularly in Alzheimer's disease cases with apolipoprotein E epsilon-4 allele.
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Affiliation(s)
- X Anton Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu).
| | - Irene Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Olalla Iglesias
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Ignacio Crespo
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Jesus Figueroa
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Manuel Aleixandre
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Carlos Linares
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Elias Granizo
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Manuel Garcia-Fantini
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Jose Marey
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Eliezer Masliah
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Stefan Winter
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Dafin Muresanu
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Herbert Moessler
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
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Georgy GS, Nassar NN, Mansour HA, Abdallah DM. Cerebrolysin Ameloriates Cognitive Deficits in Type III Diabetic Rats. PLoS One 2013; 8:e64847. [PMID: 23840309 PMCID: PMC3686810 DOI: 10.1371/journal.pone.0064847] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/19/2013] [Indexed: 12/22/2022] Open
Abstract
Cerebrolysin (CBL), a mixture of several active peptide fragments and neurotrophic factors including brain-derived neurotrophic factor (BDNF), is currently used in the management of cognitive alterations in patients with dementia. Since Cognitive decline as well as increased dementia are strongly associated with diabetes and previous studies addressed the protective effect of BDNF in metabolic syndrome and type 2 diabetes; hence this work aimed to evaluate the potential neuroprotective effect of CBL in modulating the complications of hyperglycaemia experimentally induced by streptozotocin (STZ) on the rat brain hippocampus. To this end, male adult Sprague Dawley rats were divided into (i) vehicle- (ii) CBL- and (iii) STZ diabetic-control as well as (iv) STZ+CBL groups. Diabetes was confirmed by hyperglycemia and elevated glycated haemoglobin (HbA1c%), which were associated by weight loss, elevated tumor necrosis factor (TNF)-α and decreased insulin growth factor (IGF)-1β in the serum. Uncontrolled hyperglycemia caused learning and memory impairments that corroborated degenerative changes, neuronal loss and expression of caspase (Casp)-3 in the hippocampal area of STZ-diabetic rats. Behavioral deficits were associated by decreased hippocampal glutamate (GLU), glycine, serotonin (5-HT) and dopamine. Moreover, diabetic rats showed an increase in hippocampal nitric oxide and thiobarbituric acid reactive substances versus decreased non-protein sulfhydryls. Though CBL did not affect STZ-induced hyperglycemia, it partly improved body weight as well as HbA1c%. Such effects were associated by enhancement in both learning and memory as well as apparent normal cellularity in CA1and CA3 areas and reduced Casp-3 expression. CBL improved serum TNF-α and IGF-1β, GLU and 5-HT as well as hampering oxidative biomarkers. In conclusion, CBL possesses neuroprotection against diabetes-associated cerebral neurodegeneration and cognitive decline via anti-inflammatory, antioxidant and antiapototic effects.
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Affiliation(s)
- Gehan S. Georgy
- Department of Pharmacology, National Organization of Drug Control and Research (NODCAR), Giza, Egypt
| | - Noha N. Nassar
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Hanaa A. Mansour
- Department of Pharmacology, National Organization of Drug Control and Research (NODCAR), Giza, Egypt
| | - Dalaal M. Abdallah
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Álvarez XA, Figueroa J, Muresanu D. Peptidergic drugs for the treatment of traumatic brain injury. FUTURE NEUROLOGY 2013. [DOI: 10.2217/fnl.12.95] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Traumatic brain injury (TBI) is a devastating medical condition that has an enormous socioeconomic impact because it affects more than 10 million people annually worldwide and is associated with high rates of hospitalization, mortality and disability. Although TBI survival has improved continuously for decades, particularly in developing countries, implementation of an effective drug therapy for TBI represents an unmet clinical need. All confirmatory trials conducted to date with drugs targeting a single TBI pathological pathway failed to show clinical efficacy, probably because TBI pathophysiology involves multiple cellular and molecular mechanisms of secondary brain damage. According to current scientific evidence of the participation of peptide-mediated mechanisms in the processes of brain injury and repair after TBI, peptidergic drugs represent a multimodal therapy alternative to improve acute outcome and long-term recovery in TBI patients. Preliminary randomized-controlled clinical trials and open-label studies conducted to date with the peptidergic drug Cerebrolysin® (Ever Neuro Pharma GmbH, Unterach, Austria) and with the endogenous neuropeptides progesterone and erythropoietin, showed positive clinical results. Cerebrolysin-treated patients had a faster clinical recovery, a shorter hospitalization time and a better long-term outcome. Treatment with progesterone showed advantages over placebo regarding TBI mortality and clinical outcome, whereas erythropoietin only reduced mortality. Further validation of these promising findings in confirmatory randomized-controlled clinical trials is warranted. This article reviews the scientific basis and clinical evidence on the development of multimodal peptidergic drugs as a therapeutic option for the effective treatment of TBI patients.
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Affiliation(s)
| | - Jesús Figueroa
- Rehabilitation Department, Santiago University Hospital, Santiago de Compostela, Spain
| | - Dafin Muresanu
- Department of Neurology, University of Medicine & Pharmacy ‘Iuliu Hatieganu’, Cluj-Napoca, Romania
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Psychotropic drug effects on gene transcriptomics relevant to Alzheimer disease. Alzheimer Dis Assoc Disord 2012; 26:1-7. [PMID: 21399480 DOI: 10.1097/wad.0b013e318214b7d0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psychotropics are widely prescribed in Alzheimer disease (AD) without regard to their pathobiological effects. Results summarize a comprehensive survey of psychotropic effects on messenger ribonucleic acid (mRNA) expression for 52 genes linked to AD. Pending future investigations, current data indicate that atypical antipsychotics, lithium, and fluoxetine reduce AD risk, whereas other drug classes promote risk. Risk may be attenuated by antipsychotics and lithium (down-regulate TNF), atypical antipsychotics (down-regulate TF), risperidone (down-regulates IL1B), olanzapine (up-regulates TFAM, down-regulates PRNP), fluoxetine (up-regulates CLU, SORCS1, NEDD9, GRN, and ECE1), and lithium coadministered with antipsychotics (down-regulates IL1B). Risk may be enhanced by neuroleptics (up-regulate TF), haloperidol (up-regulates IL1B and PION), olanzapine (down-regulates THRA and PRNP, up-regulates IL1A), and chlorpromazine, imipramine, maprotiline, fluvoxamine, and diazepam (up-regulate IL1B). There were no results for dextromethorphan-plus-quinidine. Fluoxetine effects on CLU, NEDD9, and GRN were statistically robust. Drug effects on specific variants, polymorphisms, genotypes, and other genes (CCR2, TF, and PRNP) are detailed. Translational AD risk applications and their limitations related to specific genes, mutations, variants, polymorphisms, genotypes, brain site, sex, clinical population, AD stage, and other factors are discussed. This report provides an initial summary and framework to understand the potential impact of psychotropic drugs on AD-relevant genes.
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Alvarez XA, Cacabelos R, Sampedro C, Aleixandre M, Linares C, Granizo E, Doppler E, Moessler H. Efficacy and safety of Cerebrolysin in moderate to moderately severe Alzheimer's disease: results of a randomized, double-blind, controlled trial investigating three dosages of Cerebrolysin. Eur J Neurol 2011; 18:59-68. [PMID: 20500802 DOI: 10.1111/j.1468-1331.2010.03092.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND cerebrolysin is a neuropeptide preparation mimicking the effects of neurotrophic factors. This subgroup analysis assessed safety and efficacy of Cerebrolysin in patients with moderate to moderately severe Alzheimer's disease (AD) (ITT data set: N = 133; MMSE: 14-20) included in a dose-finding study (ITT data set: N = 51; MMSE: 14-25). Results of the mild AD subgroup (ITT data set: N = 118; MMSE: 21-25) are also presented. METHODS patients with AD received 100 ml IV infusions of Cerebrolysin (10, 30 or 60 ml diluted in saline; N = 32, 34 and 35, respectively) or placebo (saline; N = 32) over twelve weeks (5 days per week for 4 weeks and 2 days per week for another 8 weeks). Primary efficacy criteria ADAS-cog+ (Alzheimer's Disease Assessment Scale Cognitive Subpart Modified) and CIBIC+ (Clinical Interview-based Impression of Change with Caregiver Input) were assessed 24 weeks after baseline. RESULTS at week 24, Cerebrolysin improved the global clinical function significantly with all three dosages and induced significant improvements in cognition, initiation of activities of daily living (ADL) and neuropsychiatric symptoms at 10-, 30- and 60-ml doses, respectively. Treatment effects on total ADL and other secondary parameters (MMSE, Trail-making test) were not significant. Cerebrolysin was safe and well tolerated. CONCLUSIONS these results demonstrate the efficacy of Cerebrolysin in moderate to moderately severe AD, showing dose-specific effects similar to those reported for patients with mild to moderate AD. The benefits of Cerebrolysin in advanced AD need to be confirmed in larger trials.
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Affiliation(s)
- X A Alvarez
- EuroEspes Biomedical Research Centre, Santa Maria de Babio, 15166 Bergondo, La Coruna, Spain.
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Muresanu DF, Alvarez XA, Moessler H, Novak PH, Stan A, Buzoianu A, Bajenaru O, Popescu BO. Persistence of the effects of Cerebrolysin on cognition and qEEG slowing in vascular dementia patients: Results of a 3-month extension study. J Neurol Sci 2010; 299:179-83. [DOI: 10.1016/j.jns.2010.08.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 08/22/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
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Abstract
Cerebrolysin is a parenterally administered, porcine brain-derived peptide preparation that has pharmacodynamic properties similar to those of endogenous neurotrophic factors. In several randomized, double-blind trials of up to 28 weeks' duration in patients with Alzheimer's disease, Cerebrolysin was superior to placebo in improving global outcome measures and cognitive ability. A large, randomized comparison of Cerebrolysin, donepezil or combination therapy showed beneficial effects on global measures and cognition for all three treatment groups compared with baseline. Although not as extensively studied in patients with vascular dementia, Cerebrolysin has also shown beneficial effects on global measures and cognition in this patient population. Cerebrolysin was generally well tolerated in clinical trials, with dizziness (or vertigo) being the most frequently reported adverse event. Although further studies with Cerebrolysin, including longer term trials and further exploration of its use in combination with cholinesterase inhibitors, are needed to more clearly determine its place in the management of Alzheimer's disease and vascular dementia, available data suggest that Cerebrolysin is a useful addition to the treatment options available for dementia.
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