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Sosa S, Bringas G, Urrutia N, Peñalver AI, López D, González E, Fernández A, Hernández ZM, Viña A, Peña Y, Batista JF, Valenzuela C, León K, Crombet T, Rodríguez T, Pérez L. NeuroEPO plus (NeuralCIM ®) in mild-to-moderate Alzheimer's clinical syndrome: the ATHENEA randomized clinical trial. Alzheimers Res Ther 2023; 15:215. [PMID: 38093366 PMCID: PMC10716956 DOI: 10.1186/s13195-023-01356-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/19/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND NeuroEPO plus is a recombinant human erythropoietin without erythropoietic activity and shorter plasma half-life due to its low sialic acid content. NeuroEPO plus prevents oxidative damage, neuroinflammation, apoptosis and cognitive deficit in an Alzheimer's disease (AD) models. The aim of this study was to assess efficacy and safety of neuroEPO plus. METHODS This was a double-blind, randomized, placebo-controlled, phase 2-3 trial involving participants ≥ 50 years of age with mild-to-moderate AD clinical syndrome. Participants were randomized in a 1:1:1 ratio to receive 0.5 or 1.0 mg of neuroEPO plus or placebo intranasally 3 times/week for 48 weeks. The primary outcome was change in the 11-item cognitive subscale of the AD Assessment Scale (ADAS-Cog11) score from baseline to 48 weeks (range, 0 to 70; higher scores indicate greater impairment). Secondary outcomes included CIBIC+, GDS, MoCA, NPI, Activities of Daily Living Scales, cerebral perfusion, and hippocampal volume. RESULTS A total of 174 participants were enrolled and 170 were treated (57 in neuroEPO plus 0.5 mg, 56 in neuroEPO plus 1.0 mg and 57 in placebo group). Mean age, 74.0 years; 121 (71.2%) women and 85% completed the trial. The median change in ADAS-Cog11 score at 48 weeks was -3.0 (95% CI, -4.3 to -1.7) in the 0.5 mg neuroEPO plus group, -4.0 (95% CI, -5.9 to -2.1) in the 1.0 mg neuroEPO plus group and 4.0 (95% CI, 1.9 to 6.1) in the placebo group. The difference of neuroEPO plus 0.5 mg vs. placebo was 7.0 points (95% CI, 4.5-9.5) P = 0.000 and between the neuroEPO plus 1.0 mg vs. placebo was 8.0 points (95% CI, 5.2-10.8) P = 0.000. NeuroEPO plus treatment induced a statistically significant improvement in some of clinical secondary outcomes vs. placebo including CIBIC+, GDS, MoCA, NPI, and the brain perfusion. CONCLUSIONS Among participants with mild-moderate Alzheimer's disease clinical syndrome, neuroEPO plus improved the cognitive evaluation at 48 weeks, with a very good safety profile. Larger trials are warranted to determine the efficacy and safety of neuroEPO plus in Alzheimer's disease. TRIAL REGISTRATION https://rpcec.sld.cu Identifier: RPCEC00000232.
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Affiliation(s)
- Saily Sosa
- Hospital Iván Portuondo, Calle 78 e/ Ave. 33 y 37, San Antonio de los Baños, Artemisa, CP 32 500, Cuba
| | - Giosmany Bringas
- National Institute of Neurology (INN), Calle 29 esquina D, Vedado, Havana, CP 10 400, Cuba
| | - Nelky Urrutia
- Hospital Iván Portuondo, Calle 78 e/ Ave. 33 y 37, San Antonio de los Baños, Artemisa, CP 32 500, Cuba
| | - Ana Ivis Peñalver
- National Institute of Neurology (INN), Calle 29 esquina D, Vedado, Havana, CP 10 400, Cuba
| | - Danay López
- Hospital Iván Portuondo, Calle 78 e/ Ave. 33 y 37, San Antonio de los Baños, Artemisa, CP 32 500, Cuba
| | - Evelio González
- Cuban Neurosciences Center (CNEURO), Avenida 25, No. 15 007, Cubanacán, Havana, CP 11 600, Cuba
| | - Ana Fernández
- Cuban Neurosciences Center (CNEURO), Avenida 25, No. 15 007, Cubanacán, Havana, CP 11 600, Cuba
| | - Zenaida Milagros Hernández
- Center of Neurological Restoration (CIREN), Calle 216 esquina 13, Siboney, Playa, Havana, CP 11 600, Cuba
| | - Ariel Viña
- Cuban Neurosciences Center (CNEURO), Avenida 25, No. 15 007, Cubanacán, Havana, CP 11 600, Cuba
| | - Yamile Peña
- Center for Clinical Investigation, CENTIS, Calle 45 No. 4501, esquina a 34, Reparto Kolhy, Havana, CP 11 300, Cuba
| | - Juan Felipe Batista
- Center for Clinical Investigation, CENTIS, Calle 45 No. 4501, esquina a 34, Reparto Kolhy, Havana, CP 11 300, Cuba
| | - Carmen Valenzuela
- Institute of Cybernetics, Mathematics and Physics (ICIMAF), Calle 15 #551 entre C y D, Plaza de la Revolución, Vedado, Havana, CP 10 400, Cuba
| | - Kalet León
- Center of Molecular Immunology (CIM), Calle 216 esquina 15, Siboney, Playa , Havana, CP 11 600, Cuba
| | - Tania Crombet
- Center of Molecular Immunology (CIM), Calle 216 esquina 15, Siboney, Playa , Havana, CP 11 600, Cuba
| | - Teresita Rodríguez
- Center of Molecular Immunology (CIM), Calle 216 esquina 15, Siboney, Playa , Havana, CP 11 600, Cuba
| | - Leslie Pérez
- Center of Molecular Immunology (CIM), Calle 216 esquina 15, Siboney, Playa , Havana, CP 11 600, Cuba.
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Rodriguez-Labrada R, Ortega-Sanchez R, Hernández Casaña P, Santos Morales O, Padrón-Estupiñan MDC, Batista-Nuñez M, Jiménez Rodríguez D, Canales-Ochoa N, Peña Acosta A, Medrano Montero J, Labrada Aguilera PE, Estupiñán Rodriguez A, Vazquez-Mojena Y, Almaguer Gotay D, Aymed-García J, García-García I, Torres Vega R, Viada González C, Valenzuela Silva CM, Silva Ricardo Y, Columbié Ximelis J, Tribin Rivero K, Valle Cabrera R, García-Rodriguez JC, Crombet Ramos T, Amaro-González D, Rodriguez-Obaya T, Velázquez-Pérez L. Erythropoietin in Spinocerebellar Ataxia Type 2: Feasibility and Proof-of-Principle Issues from a Randomized Controlled Study. Mov Disord 2022; 37:1516-1525. [PMID: 35607776 DOI: 10.1002/mds.29045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Several pieces of evidence have shown the neurotrophic effect of erythropoietin (EPO) and its introduction in the therapeutic practice of neurological diseases. However, its usefulness in the treatment of spinocerebellar ataxia type 2 (SCA2) has not been proven despite the fact that it is endogenously reduced in these patients. OBJECTIVE The study aims to investigate the safety, tolerability, and clinical effects of a nasally administered recombinant EPO in SCA2 patients. METHODS Thirty-four patients were enrolled in this double-blind, randomized, placebo-controlled, phase I-II clinical trial of the nasally administered human-recombinant EPO (NeuroEPO) for 6 months. The primary outcome was the change in the spinocerebellar ataxia functional index (SCAFI), while other motor, neuropsychological, and oculomotor measures were assessed. RESULTS The 6-month changes in SCAFI score were slightly higher in the patients allocated to NeuroEPO treatment than placebo in spite of the important placebo effect observed for this parameter. However, saccade latency was significantly decreased in the NeuroEPO group but not in placebo. The frequency and severity of adverse events were similar between both groups, without evidences of hematopoietic activity of the drug. CONCLUSIONS This study demonstrated the safety and tolerability of NeuroEPO in SCA2 patients after 6 months of treatments and suggested a small clinical effect of this drug on motor and cognitive abnormalities, but confirmatory studies are warranted. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Roberto Rodriguez-Labrada
- Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH), Holguín, Cuba.,Cuban Centre for Neurosciences, Havana, Cuba
| | | | | | | | | | - Maricela Batista-Nuñez
- Otorhinolaryngology Department, "Octavio de la Concepción" Pediatric Hospital, Holguín, Cuba
| | | | - Nalia Canales-Ochoa
- Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH), Holguín, Cuba
| | - Arnoy Peña Acosta
- Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH), Holguín, Cuba
| | | | | | | | - Yaimee Vazquez-Mojena
- Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH), Holguín, Cuba.,Cuban Centre for Neurosciences, Havana, Cuba
| | | | | | | | - Reydenis Torres Vega
- Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH), Holguín, Cuba
| | | | | | | | | | | | | | | | | | | | | | - Luis Velázquez-Pérez
- Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH), Holguín, Cuba.,Cuban Academy of Sciences, Havana, Cuba
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Ma Y, Zhou Z, Yang GY, Ding J, Wang X. The Effect of Erythropoietin and Its Derivatives on Ischemic Stroke Therapy: A Comprehensive Review. Front Pharmacol 2022; 13:743926. [PMID: 35250554 PMCID: PMC8892214 DOI: 10.3389/fphar.2022.743926] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/19/2022] [Indexed: 12/17/2022] Open
Abstract
Numerous studies explored the therapeutic effects of erythropoietin (EPO) on neurodegenerative diseases. Few studies provided comprehensive and latest knowledge of EPO treatment for ischemic stroke. In the present review, we introduced the structure, expression, function of EPO, and its receptors in the central nervous system. Furthermore, we comprehensively discussed EPO treatment in pre-clinical studies, clinical trials, and its therapeutic mechanisms including suppressing inflammation. Finally, advanced studies of the therapy of EPO derivatives in ischemic stroke were also discussed. We wish to provide valuable information on EPO and EPO derivatives’ treatment for ischemic stroke for basic researchers and clinicians to accelerate the process of their clinical applications.
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Affiliation(s)
- Yuanyuan Ma
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiyuan Zhou
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Yuan Yang
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Guo-Yuan Yang, ; Jing Ding,
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Guo-Yuan Yang, ; Jing Ding,
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of The State Key Laboratory of Medical Neurobiology, The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
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Santos-Morales O, Díaz-Machado A, Jiménez-Rodríguez D, Pomares-Iturralde Y, Festary-Casanovas T, González-Delgado CA, Pérez-Rodríguez S, Alfonso-Muñoz E, Viada-González C, Piedra-Sierra P, García-García I, Amaro-González D, García-Rodríguez JC, Sosa-Testé I, Lagarto-Parra A, Barrero-Viera L, David-Baldo M, Tamayo-Rodríguez M, Rivero-Vázquez I, González-Gamiz G, Martín-Trujillo A, Rodríguez-Fernández Y, Ledo-de la Luz AA, Álvarez-Delgado M, Howland-Álvarez I, Cruz-Gómez Y. Nasal administration of the neuroprotective candidate NeuroEPO to healthy volunteers: a randomized, parallel, open-label safety study. BMC Neurol 2017; 17:129. [PMID: 28676085 PMCID: PMC5496637 DOI: 10.1186/s12883-017-0908-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delivery of therapeutic agents as erythropoietin (EPO) into Central Nervous System through intranasal route could benefit patients with neurological disorders. A new nasal formulation containing a non-hematopoietic recombinant EPO (NeuroEPO) has shown neuroprotective actions in preclinical models. In the current study, the safety of NeuroEPO was evaluated for the first time in humans. METHODS A phase I, randomized, parallel, open-label study was carried out in healthy volunteers. They received, intranasally, 1 mg of NeuroEPO every 8 h during 4 days (Group A) or 0.5 mg of NeuroEPO (Group B) with the same schedule. The working hypothesis was that intranasal NeuroEPO produce <10% of severe adverse reactions in the evaluated groups. Therefore, a rigorous assessment of possible adverse events was carried out, which included tolerance of the nasal mucosa and the effect on hematopoietic activity. Clinical safety evaluation was daily during treatment and laboratory tests were done before and on days 5 and 14 after starting treatment. RESULTS Twenty-five volunteers, 56% women, with a mean age of 27 yrs. were included. Twelve of them received the highest NeuroEPO dose. Twenty types of adverse events occurred, with headache (20%) and increase of hepatic enzymes (20%) as the most reported ones. Nasopharyngeal itching was the most common local event but only observed in four patients (16%), all of them from the lowest dose group. About half of the events were very probably or probably caused by the studied product. Most of the events were mild (95.5%), did not require treatment (88.6%) and were completely resolved (81.8%). No severe adverse events were reported. During the study the hematopoietic variables were kept within reference values. CONCLUSIONS NeuroEPO was a safe product, well tolerated at the nasal mucosa level and did not stimulate erythropoiesis in healthy volunteers. TRIAL REGISTRATION Cuban Public Registry of Clinical Trials RPCEC00000157 , June 10, 2013.
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Affiliation(s)
| | - Alina Díaz-Machado
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
| | - Daise Jiménez-Rodríguez
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | | | - Tatiana Festary-Casanovas
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | | | - Sonia Pérez-Rodríguez
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
| | - Eulalia Alfonso-Muñoz
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
| | - Carmen Viada-González
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
| | | | - Idrian García-García
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Daniel Amaro-González
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
| | - for the NeuroEPO Study Group
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Julio César García-Rodríguez
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Iliana Sosa-Testé
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Alicia Lagarto-Parra
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Laura Barrero-Viera
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Marlene David-Baldo
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Maura Tamayo-Rodríguez
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Ivonne Rivero-Vázquez
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Gricel González-Gamiz
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Alis Martín-Trujillo
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Yasmila Rodríguez-Fernández
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Ana Alfa Ledo-de la Luz
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Maylén Álvarez-Delgado
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Ivón Howland-Álvarez
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
| | - Yolanda Cruz-Gómez
- NeuroEPO Research and Development Group, Center of Molecular Immunology, Havana, Cuba
- National Center for Toxicology, “Carlos J. Finlay” University Hospital, Havana, Cuba
- Clinical Trials Group, Research Direction, Center for Drug Research and Development (CIDEM), Ave. 26 and Puentes Grandes, No. 1605, Nuevo Vedado, Havana, Cuba
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