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Yaghmaei E, Lu H, Ehwerhemuepha L, Zheng J, Danioko S, Rezaie A, Sajjadi SA, Rakovski C. Combined use of Donepezil and Memantine increases the probability of five-year survival of Alzheimer's disease patients. COMMUNICATIONS MEDICINE 2024; 4:99. [PMID: 38783011 PMCID: PMC11116549 DOI: 10.1038/s43856-024-00527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is the most common neurodegenerative disease. Studying the effects of drug treatments on multiple health outcomes related to AD could be beneficial in demonstrating which drugs reduce the disease burden and increase survival. METHODS We conducted a comprehensive causal inference study implementing doubly robust estimators and using one of the largest high-quality medical databases, the Oracle Electronic Health Records (EHR) Real-World Data. Our work was focused on the estimation of the effects of the two common Alzheimer's disease drugs, Donepezil and Memantine, and their combined use on the five-year survival since initial diagnosis of AD patients. Also, we formally tested for the presence of interaction between these drugs. RESULTS Here, we show that the combined use of Donepezil and Memantine significantly elevates the probability of five-year survival. In particular, their combined use increases the probability of five-year survival by 0.050 (0.021, 0.078) (6.4%), 0.049 (0.012, 0.085), (6.3%), 0.065 (0.035, 0.095) (8.3%) compared to no drug treatment, the Memantine monotherapy, and the Donepezil monotherapy respectively. We also identify a significant beneficial additive drug-drug interaction effect between Donepezil and Memantine of 0.064 (0.030, 0.098). CONCLUSIONS Based on our findings, adopting combined treatment of Memantine and Donepezil could extend the lives of approximately 303,000 people with AD living in the USA to be beyond five-years from diagnosis. If these patients instead have no drug treatment, Memantine monotherapy or Donepezil monotherapy they would be expected to die within five years.
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Affiliation(s)
- Ehsan Yaghmaei
- Schmid College of Science and Technology, Chapman University, Orange, CA, USA
| | - Hongxia Lu
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Jianwei Zheng
- Schmid College of Science and Technology, Chapman University, Orange, CA, USA
| | - Sidy Danioko
- Schmid College of Science and Technology, Chapman University, Orange, CA, USA
| | - Ahmad Rezaie
- Schmid College of Science and Technology, Chapman University, Orange, CA, USA
| | | | - Cyril Rakovski
- Schmid College of Science and Technology, Chapman University, Orange, CA, USA.
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Zhai Z, Kong F, Zhu Z, Dai J, Cai J, Xie D, Shen Y, Xu Y, Sun T. Effect and Potential Mechanism of Immunotherapy on Cognitive Deficits in Animal Models of Alzheimer's Disease: A Systematic Review and Meta-Analysis. Am J Geriatr Psychiatry 2024; 32:555-583. [PMID: 38158285 DOI: 10.1016/j.jagp.2023.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 11/17/2023] [Accepted: 11/25/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Immunotherapy has been reported to ameliorate Alzheimer's disease (AD) in the animal model; however, the immunologic approaches and mechanisms have not been specifically described. Thus, the systematic review and meta-analysis were conducted to explore the effect and potential mechanism of immunotherapy on AD animal experiments based on behavioral indicators. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration guidelines and the inclusion/exclusion criteria of immunotherapy in animal studies, 15 studies were systematically reviewed after extraction from a collected database of 3,742 publications. Finally, the effect and mechanism of immunotherapy on AD models were described by performing multiple subgroup analyses. RESULTS After immunotherapy, the escape latency was reduced by 18.15 seconds and the number of crossings over the platform location was increased by 1.60 times in the Morris Water Maze. Furthermore, compared to the control group, active and passive immunization could markedly ameliorate learning and memory impairment in 3 × Tg AD animal models, and active immunization could ameliorate the learning and memory ability of the APPswe/PS1ΔE9 AD animal model. Meanwhile, it could be speculated that cognitive dysfunction was improved by immunotherapy, perhaps mainly via reducing Aβ40, Aβ42, and Tau levels, as well as increasing IL-4 levels. CONCLUSION Immunotherapy significantly ameliorated the cognitive dysfunction of AD animal models by assessing behavioral indicators.
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Affiliation(s)
- Zhenwei Zhai
- School of Intelligent Medicine (ZZ, FK, ZZ, JD, JC, TS), Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Fanjing Kong
- School of Intelligent Medicine (ZZ, FK, ZZ, JD, JC, TS), Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Zhishan Zhu
- School of Intelligent Medicine (ZZ, FK, ZZ, JD, JC, TS), Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Jingyi Dai
- School of Intelligent Medicine (ZZ, FK, ZZ, JD, JC, TS), Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Jie Cai
- School of Intelligent Medicine (ZZ, FK, ZZ, JD, JC, TS), Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Danni Xie
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy (DX, YS, TS), Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuzhao Shen
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy (DX, YS, TS), Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ying Xu
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province (YX), Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Tao Sun
- School of Intelligent Medicine (ZZ, FK, ZZ, JD, JC, TS), Chengdu University of Traditional Chinese Medicine, Chengdu, China; State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy (DX, YS, TS), Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Padovani A, Falato S, Pegoraro V. Extemporaneous combination of donepezil and memantine to treat dementia in Alzheimer disease: evidence from Italian real-world data. Curr Med Res Opin 2023; 39:567-577. [PMID: 36803101 DOI: 10.1080/03007995.2023.2182530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Providing evidence on donepezil and memantine administration as extemporaneous combination (DM-EXT) to treat Alzheimer Disease (AD) in Italy, and describing demographic and clinical features of AD patients prescribed DM-EXT. METHODS Retrospective observational study using IQVIA Italian LifeLink Treatment Dynamics (LRx) and Longitudinal Patient Database (LPD). Prevalent users of DM-EXT were identified on the databases (cohorts DMpLRx and DMpLPD) including patients with donepezil and memantine overlapping prescriptions during the selection period (DMpLRx: "July 2018-June 2021"; DMpLPD: "July 2012-June 2021"). Demographic and clinical profiles of patients were provided. Starting from cohort DMpLPD, new users of DM-EXT were selected to calculate treatment adherence. Three additional cohorts of prevalent users of DM-EXT were identified on IQVIA LRx over subsequent 12-month periods, from July 2018 to June 2021, to get national-level yearly estimates accounting for database representativeness. RESULTS Cohorts DMpLRx and DMpLPD included 9862 and 708 patients, respectively. For both cohorts, two-third of patients were female, and more than half were aged 80+. Concomitant conditions and co-treatments prevalence was very high; most frequent comorbidities included psychiatric and cardiovascular diseases. An intermediate-to-high adherence was observed in 57% of DM-EXT new users. National-level yearly estimates showed an increasing trend (+4%) in DM-EXT prescription, which led to estimate about 10,000 patients being treated during the period "July 2020-June 2021". CONCLUSIONS Prescription of DM-EXT is a common practice in Italy. Because the administration of fixed-dose (FDCs) instead of extemporaneous combinations improves treatment adherence, the introduction of an FDC containing donepezil and memantine might enhance AD patients' management and reduce caregiver burden.
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Affiliation(s)
- Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Serena Falato
- RWS Department, IQVIA Solutions Italy S.r.l, Milan, Italy
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Nabirotchkin S, Bouaziz J, Glibert F, Mandel J, Foucquier J, Hajj R, Callizot N, Cholet N, Guedj M, Cohen D. Combinational Drug Repurposing from Genetic Networks Applied to Alzheimer’s Disease. J Alzheimers Dis 2022; 88:1585-1603. [DOI: 10.3233/jad-220120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Human diseases are multi-factorial biological phenomena resulting from perturbations of numerous functional networks. The complex nature of human diseases explains frequently observed marginal or transitory efficacy of mono-therapeutic interventions. For this reason, combination therapy is being increasingly evaluated as a biologically plausible strategy for reversing disease state, fostering the development of dedicated methodological and experimental approaches. In parallel, genome-wide association studies (GWAS) provide a prominent opportunity for disclosing human-specific therapeutic targets and rational drug repurposing. Objective: In this context, our objective was to elaborate an integrated computational platform to accelerate discovery and experimental validation of synergistic combinations of repurposed drugs for treatment of common human diseases. Methods: The proposed approach combines adapted statistical analysis of GWAS data, pathway-based functional annotation of genetic findings using gene set enrichment technique, computational reconstruction of signaling networks enriched in disease-associated genes, selection of candidate repurposed drugs and proof-of-concept combinational experimental screening. Results: It enables robust identification of signaling pathways enriched in disease susceptibility loci. Therapeutic targeting of the disease-associated signaling networks provides a reliable way for rational drug repurposing and rapid development of synergistic drug combinations for common human diseases. Conclusion: Here we demonstrate the feasibility and efficacy of the proposed approach with an experiment application to Alzheimer’s disease.
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Blood-brain barrier leakage in Alzheimer's disease: From discovery to clinical relevance. Pharmacol Ther 2022; 234:108119. [PMID: 35108575 PMCID: PMC9107516 DOI: 10.1016/j.pharmthera.2022.108119] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/16/2022]
Abstract
Alzheimer's disease (AD) is the most common form of dementia. AD brain pathology starts decades before the onset of clinical symptoms. One early pathological hallmark is blood-brain barrier dysfunction characterized by barrier leakage and associated with cognitive decline. In this review, we summarize the existing literature on the extent and clinical relevance of barrier leakage in AD. First, we focus on AD animal models and their susceptibility to barrier leakage based on age and genetic background. Second, we re-examine barrier dysfunction in clinical and postmortem studies, summarize changes that lead to barrier leakage in patients and highlight the clinical relevance of barrier leakage in AD. Third, we summarize signaling mechanisms that link barrier leakage to neurodegeneration and cognitive decline in AD. Finally, we discuss clinical relevance and potential therapeutic strategies and provide future perspectives on investigating barrier leakage in AD. Identifying mechanistic steps underlying barrier leakage has the potential to unravel new targets that can be used to develop novel therapeutic strategies to repair barrier leakage and slow cognitive decline in AD and AD-related dementias.
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Gąsiorowski K, Brokos JB, Sochocka M, Ochnik M, Chojdak-Łukasiewicz J, Zajączkowska K, Fułek M, Leszek J. Current and Near-Future Treatment of Alzheimer's Disease. Curr Neuropharmacol 2022; 20:1144-1157. [PMID: 34856906 PMCID: PMC9886829 DOI: 10.2174/1570159x19666211202124239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 10/19/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022] Open
Abstract
Recent findings have improved our understanding of the multifactorial nature of AD. While in early asymptomatic stages of AD, increased amyloid-β synthesis and tau hyperphosphorylation play a key role, while in the latter stages of the disease, numerous dysfunctions of homeostatic mechanisms in neurons, glial cells, and cerebrovascular endothelium determine the rate of progression of clinical symptoms. The main driving forces of advanced neurodegeneration include increased inflammatory reactions in neurons and glial cells, oxidative stress, deficiencies in neurotrophic growth and regenerative capacity of neurons, brain insulin resistance with disturbed metabolism in neurons, or reduction of the activity of the Wnt-β catenin pathway, which should integrate the homeostatic mechanisms of brain tissue. In order to more effectively inhibit the progress of neurodegeneration, combination therapies consisting of drugs that rectify several above-mentioned dysfunctions should be used. It should be noted that many widely-used drugs from various pharmacological groups, "in addition" to the main therapeutic indications, have a beneficial effect on neurodegeneration and may be introduced into clinical practice in combination therapy of AD. There is hope that complex treatment will effectively inhibit the progression of AD and turn it into a slowly progressing chronic disease. Moreover, as the mechanisms of bidirectional communication between the brain and microbiota are better understood, it is expected that these pathways will be harnessed to provide novel methods to enhance health and treat AD.
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Affiliation(s)
| | | | - Marta Sochocka
- Laboratory of Virology, Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
| | - Michał Ochnik
- Laboratory of Virology, Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
| | | | | | - Michał Fułek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wrocław Medical University, Wrocław, Poland
| | - Jerzy Leszek
- Department of Psychiatry, Wrocław Medical University, Wrocław, Poland,Address correspondence to this author at the Department of Psychiatry, Wrocław Medical University, 10 Ludwika Pasteura Str., 50-367 Wrocław, Poland; Tel:+48603880572; E-mail:
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Association between long-term usage of acetylcholinesterase inhibitors and lung cancer in the elderly: a nationwide cohort study. Sci Rep 2022; 12:3531. [PMID: 35241672 PMCID: PMC8894396 DOI: 10.1038/s41598-022-06377-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
This retrospective cohort study aimed to evaluate the association between acetylcholinesterase inhibitors (AChEI) usage and the risk of lung cancer. Data from 116,106 new users of AChEI and 348,318, at a ratio of 1:3, matched by age, sex, and index-year, between 2000 and 2015 controls were obtained from the Taiwan Longitudinal Health Insurance Database in this cohort study. The Cox regression model was used to compare the risk of lung cancer. The adjusted hazard ratio (aHR) of lung cancer for AChEI users was 1.198 (95% confidence interval [CI] = 0.765–1.774, p = 0.167). However, the adjusted HR for patients aged ≥ 65 was adjusted to HR: 1.498 (95% CI = 1.124–1.798, p < 0.001), in contrast to the comparison groups. In addition, patients with comorbidities such as pneumonia, bronchiectasis, pneumoconiosis, pulmonary alveolar pneumonopathy, hypertension, stroke, coronary artery disease, diabetes mellitus, chronic kidney disease, depression, anxiety, smoking-related diseases, dementia, and seeking medical help from medical centers and regional hospitals, were associated with a higher risk in lung cancer. Furthermore, longer-term usage of rivastigmine (366–730 days, ≥ 731 days) and galantamine (≥ 731 days) was associated with the risk of lung cancer. AChEI increased the risk of lung cancer in the older aged patients, several comorbidities, and a longer-term usage of rivastigmine and galantamine. Therefore, physicians should estimate the risks and benefits of AChEI usage and avoid prescribing antidepressants concurrently.
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Kirsch M, von Arnim C. [Pharmacological treatment of dementia]. Dtsch Med Wochenschr 2022; 147:157-164. [PMID: 35158378 DOI: 10.1055/a-1593-8205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
It is part of the natural aging process that cognitive performance declines and the speed of information processing slows down. However, if brain function deteriorates significantly, spatial and temporal disorientation, speech and recognition disorders, as well as behavioral and psychological symptoms of dementia (BPSD) such as apathy, anxiety, depression, social withdrawal or even strong emotional fluctuations with agitation and apathy may occur. Occurring behavioral changes and the associated limitations in coping with everyday activities should be observed, because they may be the first signs of dementia.The current article focuses on the pharmacotherapeutic treatment of the most common dementia syndromes, such as Alzheimer's dementia, vascular dementia, Lewy body dementia, Parkinson dementia, and frontotemporal dementia. Furthermore, pharmacological treatment of accompanying psychopathological symptoms are highlighted.
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Callegari E, Šaltytė Benth J, Selbæk G, Grønnerød C, Bergh S. Do prescription rates of psychotropic drugs change over three years from nursing home admission? BMC Geriatr 2021; 21:496. [PMID: 34530728 PMCID: PMC8447606 DOI: 10.1186/s12877-021-02437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In this longitudinal study, we describe how psychotropic drugs (PTDs) are prescribed in nursing home (NH) patients from admission and over a 3-year period, to understand which clinical and environmental factors are associated with PTD prescription. METHODS We used data from the Resource Use and Disease Course in Dementia - Nursing Home (REDIC-NH) study, examining physical and mental health, dementia, and PTD prescription during a 3-year period from admission to a NH. Data were collected every six months. At baseline, we included 696 participants from 47 Norwegian NHs. We presented prevalence, incidence, and deprescribing rates of PTD prescriptions for each assessment point. We calculated the odds of receiving PTDs and used a generalized linear mixed model to analyze the variables associated with a change in odds throughout the 3-year period. RESULTS PTD prescriptions were frequent throughout the 3-year period. Antidepressants had the highest prescription rates (28.4%-42.2%). Every PTD category had the highest incidence rate between admission and six months, and antipsychotics had the highest values (49.4%). Deprescribing rates were comparable between assessment points. The odds of antipsychotic prescriptions were lower for older people (OR = 0.96, 95%CI:0.92-0.99, p = 0.023). People with more severe dementia had lower odds of being prescribed sedatives/hypnotics (OR = 0.89, 95%CI:0.85-0.94, p < 0.001). CONCLUSIONS PTDs, particularly antidepressants, are widely prescribed over time to NH patients. Older patients are less likely to receive antipsychotics. A higher severity of dementia decreases the odds of being prescribed sedatives/hypnotics. Close attention should be paid to PTD prescriptions during long-term NH stay to avoid prolonged and excessive treatment with these types of drugs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01920100 .
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Affiliation(s)
- Enrico Callegari
- grid.412938.50000 0004 0627 3923Østfold Hospital Trust, Sykehuset Østfold HF, postboks 300, 1714 Grålum, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway ,grid.412929.50000 0004 0627 386XResearch Centre for Age-related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway ,grid.411279.80000 0000 9637 455XHealth Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Geir Selbæk
- grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway ,grid.417292.b0000 0004 0627 3659Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway ,grid.55325.340000 0004 0389 8485Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Cato Grønnerød
- grid.412938.50000 0004 0627 3923Østfold Hospital Trust, Sykehuset Østfold HF, postboks 300, 1714 Grålum, Norway ,grid.5510.10000 0004 1936 8921Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
| | - Sverre Bergh
- grid.412929.50000 0004 0627 386XResearch Centre for Age-related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad, Norway ,grid.417292.b0000 0004 0627 3659Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Remya C, Dileep KV, Koti Reddy E, Mantosh K, Lakshmi K, Sarah Jacob R, Sajith AM, Jayadevi Variyar E, Anwar S, Zhang KYJ, Sadasivan C, Omkumar RV. Neuroprotective derivatives of tacrine that target NMDA receptor and acetyl cholinesterase - Design, synthesis and biological evaluation. Comput Struct Biotechnol J 2021; 19:4517-4537. [PMID: 34471497 PMCID: PMC8379669 DOI: 10.1016/j.csbj.2021.07.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/24/2022] Open
Abstract
The complex and multifactorial nature of neuropsychiatric diseases demands multi-target drugs that can intervene with various sub-pathologies underlying disease progression. Targeting the impairments in cholinergic and glutamatergic neurotransmissions with small molecules has been suggested as one of the potential disease-modifying approaches for Alzheimer’s disease (AD). Tacrine, a potent inhibitor of acetylcholinesterase (AChE) is the first FDA approved drug for the treatment of AD. Tacrine is also a low affinity antagonist of N-methyl-D-aspartate receptor (NMDAR). However, tacrine was withdrawn from its clinical use later due to its hepatotoxicity. With an aim to develop novel high affinity multi-target directed ligands (MTDLs) against AChE and NMDAR, with reduced hepatotoxicity, we performed in silico structure-based modifications on tacrine, chemical synthesis of the derivatives and in vitro validation of their activities. Nineteen such derivatives showed inhibition with IC50 values in the range of 18.53 ± 2.09 – 184.09 ± 19.23 nM against AChE and 0.27 ± 0.05 – 38.84 ± 9.64 μM against NMDAR. Some of the selected compounds also protected rat primary cortical neurons from glutamate induced excitotoxicity. Two of the tacrine derived MTDLs, 201 and 208 exhibited in vivo efficacy in rats by protecting against behavioral impairment induced by administration of the excitotoxic agent, monosodium glutamate. Additionally, several of these synthesized compounds also exhibited promising inhibitory activitiy against butyrylcholinesterase. MTDL-201 was also devoid of hepatotoxicity in vivo. Given the therapeutic potential of MTDLs in disease-modifying therapy, our studies revealed several promising MTDLs among which 201 appears to be a potential candidate for immediate preclinical evaluations.
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Key Words
- AChE, acetylcholinesterase
- AChEIs, acetylcholinesterase inhibitors
- AChT, acetylthiocholine
- AD, Alzheimer’s disease
- ADME, absorption, distribution, metabolism and excretion
- Acetylcholinesterase
- Alzheimer’s disease
- BBB, blood brain barrier
- Ca2+, calcium
- ChE, Cholinesterases
- DMEM, Dulbecco’s modified Eagle’s medium
- DTNB, 5,5-dithiobis-(2-nitrobenzoic acid)
- ENM, elastic network modeling
- ER, endoplasmic reticulum
- FRET, fluorescence resonance energy transfer
- G6PD, glucose-6-phosphate dehydrogenase
- HBSS, Hank's balanced salt solution
- IP, intraperitoneal
- LBD, Ligand binding domain
- LC-MS, Liquid chromatography-mass spectrometry
- LiCABEDS, Ligand Classifier of Adaptively Boosting Ensemble Decision Stumps
- MAP2, microtubule associated protein 2
- MD, Molecular dynamics
- MTDLs
- MTDLs, multi-target directed ligands
- MWM, Morris water maze
- NBM, neurobasal medium
- NMA, normal mode analysis
- NMDA receptor
- NMDAR, N-methyl-D-aspartate receptor
- Neuroprotection
- OPLS, Optimized potential for liquid simulations
- PBS, phosphate-buffered saline
- PFA, paraformaldehyde
- Polypharmacology
- RMSD, root mean square deviation
- SAR, structure-activity relationships
- SD, standard deviation
- SVM, support vector machine
- Structure-based drug design
- TBI, traumatic brain injury
- TMD, transmembrane domain
- Tacrine
- h-NMDAR, human NMDAR
- hAChE, human AChE
- ppm, parts per million
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Affiliation(s)
- Chandran Remya
- Department of Biotechnology and Microbiology, Kannur University, Dr. Janaki Ammal Campus, Thalassery, Kerala 670661, India
| | - K V Dileep
- Laboratory for Structural Bioinformatics, Center for Biosystems Dynamics Research, RIKEN, 1-7-22 Suehiro, Tsurumi, Yokohama, Kanagawa 230-0045, Japan.,Laboratory for Computational and Structural Biology, Jubilee Center for Medical Research, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala 680005, India
| | - Eeda Koti Reddy
- Division of Chemistry, Department of Sciences and Humanities, Vignan's Foundation for Sciences, Technology and Research -VFSTR (Deemed to be University), Vadlamudi, Guntur, Andhra Pradesh 522 213, India
| | - Kumar Mantosh
- Molecular Neurobiology Division, Rajiv Gandhi Centre for Biotechnology, Thycaud PO, Thiruvananthapuram, Kerala 695014, India
| | - Kesavan Lakshmi
- Molecular Neurobiology Division, Rajiv Gandhi Centre for Biotechnology, Thycaud PO, Thiruvananthapuram, Kerala 695014, India
| | - Reena Sarah Jacob
- Molecular Neurobiology Division, Rajiv Gandhi Centre for Biotechnology, Thycaud PO, Thiruvananthapuram, Kerala 695014, India
| | - Ayyiliyath M Sajith
- Post Graduate and Research Department of Chemistry, Kasargod Govt. College, Kannur University, Kasaragod, India
| | - E Jayadevi Variyar
- Department of Biotechnology and Microbiology, Kannur University, Dr. Janaki Ammal Campus, Thalassery, Kerala 670661, India
| | - Shaik Anwar
- Division of Chemistry, Department of Sciences and Humanities, Vignan's Foundation for Sciences, Technology and Research -VFSTR (Deemed to be University), Vadlamudi, Guntur, Andhra Pradesh 522 213, India
| | - Kam Y J Zhang
- Laboratory for Structural Bioinformatics, Center for Biosystems Dynamics Research, RIKEN, 1-7-22 Suehiro, Tsurumi, Yokohama, Kanagawa 230-0045, Japan
| | - C Sadasivan
- Department of Biotechnology and Microbiology, Kannur University, Dr. Janaki Ammal Campus, Thalassery, Kerala 670661, India
| | - R V Omkumar
- Molecular Neurobiology Division, Rajiv Gandhi Centre for Biotechnology, Thycaud PO, Thiruvananthapuram, Kerala 695014, India
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Li Q, Chen Y, Xing S, Liao Q, Xiong B, Wang Y, Lu W, He S, Feng F, Liu W, Chen Y, Sun H. Highly Potent and Selective Butyrylcholinesterase Inhibitors for Cognitive Improvement and Neuroprotection. J Med Chem 2021; 64:6856-6876. [PMID: 33973470 DOI: 10.1021/acs.jmedchem.1c00167] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Butyrylcholinesterase (BChE) has been considered as a potential therapeutic target for Alzheimer's disease (AD) because of its compensation capacity to hydrolyze acetylcholine (ACh) and its close association with Aβ deposit. Here, we identified S06-1011 (hBChE IC50 = 16 nM) and S06-1031 (hBChE IC50 = 25 nM) as highly effective and selective BChE inhibitors, which were proved to be safe and long-acting. Candidate compounds exhibited neuroprotective effects and the ability to improve cognition in scopolamine- and Aβ1-42 peptide-induced cognitive deficit models. The best candidate S06-1011 increased the level of ghrelin, a substrate of BChE, which can function as improving the mental mood appetite. The weight gain of the S06-1011-treated group remarkably increased. Hence, BChE inhibition not only plays a protective role against dementia but also exerts a great effect on treating and nursing care.
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Affiliation(s)
- Qi Li
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
- School of Basic Medicine, Qingdao University, Qingdao 266071, People's Republic of China
| | - Ying Chen
- Department of Natural Medicinal Chemistry, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Shuaishuai Xing
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Qinghong Liao
- Department of Natural Medicinal Chemistry, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Baichen Xiong
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Yuanyuan Wang
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Weixuan Lu
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Siyu He
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Carcinogenesis and Intervention, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, People's Republic of China
| | - Feng Feng
- Department of Natural Medicinal Chemistry, China Pharmaceutical University, Nanjing 211198, People's Republic of China
- Jiangsu Food and Pharmaceutical Science College, No. 4 Meicheng Road, Huai'an 223003, People's Republic of China
| | - Wenyuan Liu
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
| | - Yao Chen
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, People's Republic of China
| | - Haopeng Sun
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, People's Republic of China
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12
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Pirolla NFF, Batista VS, Dias Viegas FP, Gontijo VS, McCarthy CR, Viegas C, Nascimento-Júnior NM. Alzheimer's Disease: Related Targets, Synthesis of Available Drugs, Bioactive Compounds Under Development and Promising Results Obtained from Multi-target Approaches. Curr Drug Targets 2021; 22:505-538. [PMID: 32814524 DOI: 10.2174/1389450121999200819144544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 11/22/2022]
Abstract
We describe herein the therapeutic targets involved in Alzheimer's disease as well as the available drugs and their synthetic routes. Bioactive compounds under development are also exploited to illustrate some recent research advances on the medicinal chemistry of Alzheimer's disease, including structure-activity relationships for some targets. The importance of multi-target approaches, including some examples from our research projects, guides new perspectives in search of more effective drug candidates. This review comprises the period between 2001 and early 2020.
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Affiliation(s)
- Natália F F Pirolla
- Laboratory of Medicinal Chemistry, Organic Synthesis, and Molecular Modelling (LaQMedSOMM), Institute of Chemistry, Department of Biochemistry and Organic Chemistry, Sao Paulo State University - UNESP, Rua Professor Francisco Degni, 55, Jardim Quitandinha, 14800-060, Araraquara-SP, Brazil
| | - Victor S Batista
- Laboratory of Medicinal Chemistry, Organic Synthesis, and Molecular Modelling (LaQMedSOMM), Institute of Chemistry, Department of Biochemistry and Organic Chemistry, Sao Paulo State University - UNESP, Rua Professor Francisco Degni, 55, Jardim Quitandinha, 14800-060, Araraquara-SP, Brazil
| | - Flávia Pereira Dias Viegas
- Laboratory of Research on Medicinal Chemistry (PeQuiM), Institute of Chemistry, Federal University of Alfenas, Alfenas-MG, 37133-840, Brazil
| | - Vanessa Silva Gontijo
- Laboratory of Research on Medicinal Chemistry (PeQuiM), Institute of Chemistry, Federal University of Alfenas, Alfenas-MG, 37133-840, Brazil
| | - Caitlin R McCarthy
- Laboratory of Medicinal Chemistry, Organic Synthesis, and Molecular Modelling (LaQMedSOMM), Institute of Chemistry, Department of Biochemistry and Organic Chemistry, Sao Paulo State University - UNESP, Rua Professor Francisco Degni, 55, Jardim Quitandinha, 14800-060, Araraquara-SP, Brazil
| | - Claudio Viegas
- Laboratory of Research on Medicinal Chemistry (PeQuiM), Institute of Chemistry, Federal University of Alfenas, Alfenas-MG, 37133-840, Brazil
| | - Nailton M Nascimento-Júnior
- Laboratory of Medicinal Chemistry, Organic Synthesis, and Molecular Modelling (LaQMedSOMM), Institute of Chemistry, Department of Biochemistry and Organic Chemistry, Sao Paulo State University - UNESP, Rua Professor Francisco Degni, 55, Jardim Quitandinha, 14800-060, Araraquara-SP, Brazil
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13
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Bruszt N, Bali ZK, Tadepalli SA, Nagy LV, Hernádi I. Potentiation of cognitive enhancer effects of Alzheimer's disease medication memantine by alpha7 nicotinic acetylcholine receptor agonist PHA-543613 in the Morris water maze task. Psychopharmacology (Berl) 2021; 238:3273-3281. [PMID: 34387707 PMCID: PMC8605977 DOI: 10.1007/s00213-021-05942-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/20/2021] [Indexed: 01/17/2023]
Abstract
RATIONALE There are controversial pieces of evidence whether combination therapies using memantine and cholinesterase inhibitors are beneficial over their monotreatments. However, results of preclinical studies are promising when memantine is combined with agonists and allosteric modulators of the alpha7 nicotinic acetylcholine receptor (nAChR). OBJECTIVES Here, we tested the hypothesis that cognitive enhancer effects of memantine can be potentiated through modulating alpha7 nAChRs in a scopolamine-induced amnesia model. METHODS Monotreatments, as well as co-administrations of selective alpha7 nicotinic acetylcholine receptor agonist PHA-543613 and memantine were tested in the Morris water maze task in rats. The efficacy of the co-administration treatment was observed on different domains of spatial episodic memory. RESULTS Low dose of memantine (0.1 mg/kg) and PHA-543613 (0.3 mg/kg) successfully reversed scopolamine-induced short-term memory deficits both in monotreatments and in co-administration. When recall of information from long-term memory was tested, pharmacological effects caused by co-administration of subeffective doses of memantine and PHA-543613 exceeded that of their monotreatments. CONCLUSION Our results further support the evidence of beneficial interactions between memantine and alpha7 nAChR ligands and suggest a prominent role of alpha7 nAChRs in the procognitive effects of memantine.
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Affiliation(s)
- Nóra Bruszt
- János Szentágothai Research Center, Center for Neuroscience, University of Pécs, 20 Ifjúság str, 7624 Pécs, Hungary ,Institute of Physiology, Medical School, University of Pécs, 12 Szigeti str, 7624 Pécs, Hungary
| | - Zsolt Kristóf Bali
- János Szentágothai Research Center, Center for Neuroscience, University of Pécs, 20 Ifjúság str, 7624, Pécs, Hungary. .,Institute of Physiology, Medical School, University of Pécs, 12 Szigeti str, 7624, Pécs, Hungary. .,Grastyán Endre Translational Research Center, University of Pécs, 6 Ifjúság str, 7624, Pécs, Hungary.
| | - Sai Ambika Tadepalli
- János Szentágothai Research Center, Center for Neuroscience, University of Pécs, 20 Ifjúság str, 7624 Pécs, Hungary ,Department of Experimental Zoology and Neurobiology, Faculty of Sciences, University of Pécs, 6 Ifjúság str, 7624 Pécs, Hungary
| | - Lili Veronika Nagy
- János Szentágothai Research Center, Center for Neuroscience, University of Pécs, 20 Ifjúság str, 7624 Pécs, Hungary ,Department of Experimental Zoology and Neurobiology, Faculty of Sciences, University of Pécs, 6 Ifjúság str, 7624 Pécs, Hungary
| | - István Hernádi
- János Szentágothai Research Center, Center for Neuroscience, University of Pécs, 20 Ifjúság str, 7624 Pécs, Hungary ,Institute of Physiology, Medical School, University of Pécs, 12 Szigeti str, 7624 Pécs, Hungary ,Grastyán Endre Translational Research Center, University of Pécs, 6 Ifjúság str, 7624 Pécs, Hungary ,Department of Experimental Zoology and Neurobiology, Faculty of Sciences, University of Pécs, 6 Ifjúság str, 7624 Pécs, Hungary
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14
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Kabir MT, Sufian MA, Uddin MS, Begum MM, Akhter S, Islam A, Mathew B, Islam MS, Amran MS, Md Ashraf G. NMDA Receptor Antagonists: Repositioning of Memantine as a Multitargeting Agent for Alzheimer's Therapy. Curr Pharm Des 2020; 25:3506-3518. [PMID: 31604413 DOI: 10.2174/1381612825666191011102444] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/08/2019] [Indexed: 12/28/2022]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease that causes problems with memory, thinking, and behavior. Currently, there is no drug that can reduce the pathological events of this degenerative disease but symptomatic relief is possible that can abate the disease condition. N-methyl-D-aspartate (NMDA) receptors exert a critical role for synaptic plasticity as well as transmission. Overstimulation of glutamate receptors, predominantly NMDA type, may cause excitotoxic effects on neurons and is recommended as a mechanism for neurodegeneration. Atypical activation of the NMDA receptor has been suggested for AD by synaptic dysfunction. NMDA receptor antagonists especially memantine block the NMDA receptor and can reduce the influx of calcium (Ca2+) ions into neuron, thus, toxic intracellular events are not activated. This review represents the role of NMDA receptors antagonists as potential therapeutic agents to reduce AD. Moreover, this review highlights the repositioning of memantine as a potential novel therapeutic multitargeting agent for AD.
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Affiliation(s)
| | | | - Md Sahab Uddin
- Department of Pharmacy, Southeast University, Dhaka, Bangladesh.,Pharmakon Neuroscience Research Network, Dhaka, Bangladesh
| | | | - Shammi Akhter
- Department of Pharmacy, Southeast University, Dhaka, Bangladesh
| | - Ariful Islam
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, United States
| | - Bijo Mathew
- Division of Drug Design and Medicinal Chemistry Research Lab, Department of Pharmaceutical Chemistry, Ahalia School of Pharmacy, Palakkad, India
| | | | - Md Shah Amran
- Department of Pharmaceutical Chemistry, University of Dhaka, Dhaka, Bangladesh
| | - Ghulam Md Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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15
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Salmerón S, Lozoya S, Plaza L, Soler-Moratalla I, Solís J, Abizanda P. Validation Prognostic of the Baylor Profound Mental Status Examination. Dement Geriatr Cogn Disord 2020; 48:113-122. [PMID: 31739306 DOI: 10.1159/000504168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are no validated prognostic instruments to evaluate severe Alzheimer's disease (AD) patients. OBJECTIVE To validate the prognostic value of the Baylor Profound Mental Status Examination (BPMSE). METHODS We selected 200 patients with severe AD. The following prognostic variables were collected: hospitalization, use of the emergency room, death, and prescription of drugs. ROC curve analysis was performed to see the overall behavior of the test when predicting the adverse event. We analyzed the AUC ROC and the best cut point was determined, and by using contingency tables, the risk was calculated. RESULTS For a BPMSE ≥16 points, there was a risk of 1.8 (95% CI 0.9-3.4) of prescription of psychotropic drugs in 12 months. For memantine in 12 months, for a BPMSE ≥16 points, there was a risk of 2.9 (95% CI 1.1-7.2). Emergency room visits, for a BMPSE ≤15 points, showed a risk of 1.7 (95% CI 1-3.2). The risk of hospitalization at 12 months, for a BPMSE ≤15, was 1.4 (95% CI 0.8-2.6). When comparing medians, patients with a higher BPMSE were prescribed more drugs at 12 months. CONCLUSIONS BPMSE has a limited predictive value for the variables studied.
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Affiliation(s)
- Sergio Salmerón
- Geriatrics Department, Hospital General de Villarrobledo, Villarrobledo, Spain,
| | - Silvia Lozoya
- Geriatrics Department, Hospital General de Villarrobledo, Villarrobledo, Spain
| | - Laura Plaza
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Julián Solís
- Internal Medicine Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Pedro Abizanda
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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16
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Verum- versus Sham-Acupuncture on Alzheimer's Disease (AD) in Animal Models: A Preclinical Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5901573. [PMID: 32337259 PMCID: PMC7150729 DOI: 10.1155/2020/5901573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/23/2019] [Accepted: 11/29/2019] [Indexed: 12/14/2022]
Abstract
Background Alzheimer's disease (AD) is a common health condition affecting senile people and leads to severe cognitive dysfunctions. Acupuncture has been shown to be a possible alternative natural remedy for AD in some animal studies. Objective To perform a systematic review to identify the effect of verum-acupuncture compared with sham-acupuncture on learning and memory performance among animal models of AD. Methods Experimental animal studies of treating AD via verum- and sham- acupuncture were searched in nine electronic databases, including Sciverse ScienceDirect, PubMed, Springer, Ebsco Medline, AMED, EMBASE (Elsevier), Scopus (Elsevier), PsycINFO (ProQuest), and OVID from the dates of the databases' inception to June 2019. The Morris water maze test was considered as an outcome measure. The software Revman 5.3 and Stata 16.0 were used to conduct the meta-analysis. Heterogeneity was examined by using I2 statistics. The publication bias was assessed via Begg's test by Stata 16.0. Results Twelve studies involving 229 animals met the inclusion criteria. Most of the studies had a moderate quality according to SYRCLE's risk of bias tool for animal studies. The results of the meta-analysis indicated that verum-acupuncture could reduce the escape latency (MD = −12.90, 95% CI (−17.08, −8.71), p < 0.001) and increase the time spent in the original platform quadrant (MD = 7.28, 95% CI (4.23, 10.33), p < 0.001) and frequency of the crossing former platform (MD = 2.01, 95% CI (1.53, 2.50), p < 0.001) compared with the sham-acupuncture. Conclusions Acupuncture is effective in improving cognitive functions in AD animal models, and this benefit is more than just a placebo effect. Further clinical trials are needed to confirm the findings.
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17
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Singh H, Sodhi RK, Chahal SK, Madan J. Meclizine ameliorates memory deficits in streptozotocin-induced experimental dementia in mice: role of nuclear pregnane X receptors. Can J Physiol Pharmacol 2020; 98:383-390. [PMID: 31935134 DOI: 10.1139/cjpp-2019-0421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pregnane X receptors (PXRs) regulate the expression of ATP-binding cassette proteins transporters and organic anion transporting polypeptides responsible for influx/efflux of xenobiotics across the brain. Ligand activation of PXR augments the expression of P-gp and promotes amyloid-β clearance across the blood-brain barrier. Dementia was induced in mice by intacerebroventricular administration of streptozotocin (STZ) followed by treatment with meclizine, a PXR agonist, and subsequently exposed to the Morris water maze test and biochemical and histopathological analysis to evaluate the effect on cognition. STZ-treated mice exhibited significant enhancement in brain thiobarbituric acid reactive species, interleukin-1β, tumour necrosis factor-α, myeloperoxidase, and acetylcholinestrase activity in addition to diminution in glutathione levels and superoxide dismutase activity in comparison to untreated mice. Administration of meclizine to STZ mice recuperated cognition and biochemical alterations. Concomitant administration of ketoconazole, a PXR antagonist, with meclizine prevented the protective effects. The upshots of our study proclaim that meclizine protects cognitive deficits by virtue of its antioxidant, anticholinesterase, and antiinflammatory properties. Results also signify the potential of PXR in neuroprotective actions of meclizine in dementia.
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Affiliation(s)
- Harmandeep Singh
- Department of Pharmacology, Chandigarh College of Pharmacy, Mohali (Punjab), India.,Department of Pharmacology, Chandigarh College of Pharmacy, Mohali (Punjab), India
| | - Rupinder Kaur Sodhi
- Department of Pharmacology, Chandigarh College of Pharmacy, Mohali (Punjab), India.,Department of Pharmacology, Chandigarh College of Pharmacy, Mohali (Punjab), India
| | - Simerjeet Kaur Chahal
- Department of Pharmacology, Chandigarh College of Pharmacy, Mohali (Punjab), India.,Department of Pharmacology, Chandigarh College of Pharmacy, Mohali (Punjab), India
| | - Jitender Madan
- Department of Pharmacology, Chandigarh College of Pharmacy, Mohali (Punjab), India.,Department of Pharmacology, Chandigarh College of Pharmacy, Mohali (Punjab), India
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18
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Rajpoot K. Nanotechnology-based Targeting of Neurodegenerative Disorders: A Promising Tool for Efficient Delivery of Neuromedicines. Curr Drug Targets 2020; 21:819-836. [PMID: 31906836 DOI: 10.2174/1389450121666200106105633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 12/13/2022]
Abstract
Traditional drug delivery approaches remained ineffective in offering better treatment to various neurodegenerative disorders (NDs). In this context, diverse types of nanocarriers have shown their great potential to cross the blood-brain barrier (BBB) and have emerged as a prominent carrier system in drug delivery. Moreover, nanotechnology-based methods usually involve numerous nanosized carrier platforms, which potentiate the effect of the therapeutic agents in the therapy of NDs especially in diagnosis and drug delivery with negligible side effects. In addition, nanotechnology-based techniques have offered several strategies to cross BBB to intensify the bioavailability of drug moieties in the brain. In the last few years, diverse kinds of nanoparticles (NPs) have been developed by incorporating various biocompatible components (e.g., polysaccharide-based NPs, polymeric NPs, selenium NPs, AuNPs, protein-based NPs, gadolinium NPs, etc.), that showed great therapeutic benefits against NDs. Eventually, this review provides deep insights to explore recent applications of some innovative nanocarriers enclosing active molecules for the efficient treatment of NDs.
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Affiliation(s)
- Kuldeep Rajpoot
- Institute of Pharmaceutical Sciences, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur, 495 009, Chhattisgarh, India
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19
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Li Q, Xing S, Chen Y, Liao Q, Li Q, Liu Y, He S, Feng F, Chen Y, Zhang J, Liu W, Guo Q, Sun Y, Sun H. Reasonably activating Nrf2: A long-term, effective and controllable strategy for neurodegenerative diseases. Eur J Med Chem 2019; 185:111862. [PMID: 31735576 DOI: 10.1016/j.ejmech.2019.111862] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 02/06/2023]
Abstract
Neurodegenerative diseases are a variety of debilitating and fatal disorder in central nervous system (CNS). Besides targeting neuronal activity by influencing neurotransmitters or their corresponding receptors, modulating the underlying processes that lead to cell death, such as oxidative stress and mitochondrial dysfunction, should also be emphasized as an assistant strategy for neurodegeneration therapy. Nuclear factor (erythroid-derived 2)-like 2 (Nrf2) has been closely verified to be related to anti-inflammation and oxidative stress, rationally regulating its belonging pathway and activating Nrf2 is emphasized to be a potential treatment approach. There have existed multiple Nrf2 activators with different mechanisms and diverse structures, but those applied for neuro-disorders are still limited. On the basis of research arrangement and compound summary, we put forward the limitations of existing Nrf2 activators for neurodegenerative diseases and their future developing directions in enhancing the blood-brain barrier permeability to make Nrf2 activators function in CNS and designing Nrf2-based multi-target-directed ligands to affect multiple nodes in pathology of neurodegenerative diseases.
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Affiliation(s)
- Qi Li
- Department of Medicinal Chemistry, School of Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Shuaishuai Xing
- Department of Medicinal Chemistry, School of Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Ying Chen
- Department of Natural Medicinal Chemistry, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Qinghong Liao
- Department of Natural Medicinal Chemistry, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Qihang Li
- Department of Medicinal Chemistry, School of Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Yang Liu
- Department of Medicinal Chemistry, School of Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Siyu He
- Department of Medicinal Chemistry, School of Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Feng Feng
- Jiangsu Food and Pharmaceutical Science College, No.4 Meicheng Road, Huai'an, 223003, PR China
| | - Yao Chen
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, 210023, PR China
| | - Jie Zhang
- Department of Natural Medicinal Chemistry, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Wenyuan Liu
- Department of Analytical Chemistry, School of Pharmacy, Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Qinglong Guo
- State Key Laboratory of Natural Medicines, Jiangsu Key Laboratory of Carcinogenesis and Intervention, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, PR China
| | - Yuan Sun
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, 95817, USA
| | - Haopeng Sun
- Department of Medicinal Chemistry, School of Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China; Jiangsu Food and Pharmaceutical Science College, No.4 Meicheng Road, Huai'an, 223003, PR China.
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20
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Hu YR, Xing SL, Chen C, Shen DZ, Chen JL. Tiaoxin Recipe, a Chinese herbal formula, inhibits microRNA-34a expression in the APPswe/PS1ΔE9 mouse model of Alzheimer's disease. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2019; 17:404-409. [PMID: 31548147 DOI: 10.1016/j.joim.2019.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/28/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the effect and underlying mechanisms of Tiaoxin Recipe (a Chinese herbal formula) treatment on Alzheimer's disease (AD). METHODS Twelve-week-old APPswe/PS1ΔE9 (APP/PS1) double transgenic mice were used as a model of AD-afflicted mice. One group of mice was treated with Tiaoxin Recipe by gastrogavage for 12 weeks, while two other groups were given intraperitoneal injections of nicotinamide adenine dinucleotide or FK866 for 4 weeks. Morris water maze and thioflavin S staining tests were performed to evaluate cognitive impairment and amyloid plaque deposition, respectively. Serum amyloid-β1-42 (Aβ1-42) content was detected using an enzyme-linked immunosorbent assay, and quantitative reverse transcription-polymerase chain reaction was performed to examine the expression levels of microRNA-34a (miR-34a) in cortex and hippocampus samples of the study mice. RESULTS Compared with the normal control group, the memory and learning abilities of the APP/PS1 model group were found to be impaired (P < 0.01), as shown by the increased levels of senile plaque deposition in cortex and hippocampus (P < 0.01), miR-34a expression (P < 0.01) and serum Aβ1-42 content (P < 0.01). Treatment with Tiaoxin Recipe significantly reduced memory impairment (P < 0.01) by reducing amyloid plaque accumulation in cortex and hippocampus (P < 0.01), miR-34a expression (P < 0.01) and serum Aβ1-42 content (P < 0.01) in APP/PS1 mice. CONCLUSION Tiaoxin Recipe is a viable complementary or alternative therapeutic treatment that is capable of delaying the development of early-stage AD by inhibiting the expression of miR-34a.
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Affiliation(s)
- Yi-Ran Hu
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200031, China
| | - San-Li Xing
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200031, China.
| | - Chuan Chen
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200031, China
| | - Ding-Zhu Shen
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200031, China
| | - Jiu-Lin Chen
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200031, China
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21
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Wang H, Zhang H. Reconsideration of Anticholinesterase Therapeutic Strategies against Alzheimer's Disease. ACS Chem Neurosci 2019; 10:852-862. [PMID: 30521323 DOI: 10.1021/acschemneuro.8b00391] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Alzheimer's disease (AD) is well-known as a severe neurodegeneration disease involving complicated etiologies, and cholinesterase inhibition remain the prevailing mode of clinical intervention in AD management. Although most clinically applied cholinesterase inhibitors (ChEIs) achieve limited clinical outcomes, research on the central cholinergic system is still thriving. Recently, an impressive amount of knowledge regarding novel acetylcholinesterase functions, as well as the close association between the central cholinergic system and other key elements for AD pathogenesis, has accumulated, highlighting that this field still has great potential for future drug development. In contrast to the overwhelmingly disappointing clinical therapeutic effects of various disease-modifying drug candidates, interesting evidence has continued to emerge over the past 20 years from the wealth of preclinical and clinical data on the usage of ChEIs, indicating underestimated clinical benefits due to physician ambivalence, a lack of persistent treatment, and inappropriate medication times or doses. Here we pinpoint several topics fit for future attention, focusing on the updated cholinergic hypothesis, especially the pleiotropic relationships with key pathogenetic signaling pathways and functions in AD, as well as possible novel therapeutic strategies, including novel ChEIs and cholinesterase inhibition-based innovative multifunctional therapeutic candidates. We intend to strengthen the future value of the precise application of cholinergic drugs, especially novel ChEIs, as a cornerstone pharmacological approach to AD treatment, either alone or in combination with other targets, to relieve symptoms and to modify disease progression.
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Affiliation(s)
- Huan Wang
- CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, China
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, China
| | - Haiyan Zhang
- CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, China
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai 201203, China
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22
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Kumar A, Mehta V, Raj U, Varadwaj PK, Udayabanu M, Yennamalli RM, Singh TR. Computational and In-Vitro Validation of Natural Molecules as Potential Acetylcholinesterase Inhibitors and Neuroprotective Agents. Curr Alzheimer Res 2019; 16:116-127. [DOI: 10.2174/1567205016666181212155147] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/04/2018] [Accepted: 12/11/2018] [Indexed: 01/07/2023]
Abstract
Background:
Cholinesterase inhibitors are the first line of therapy for the management of
Alzheimer’s disease (AD), however, it is now established that they provide only temporary and symptomatic
relief, besides, having several inherited side-effects. Therefore, an alternative drug discovery
method is used to identify new and safer ‘disease-modifying drugs’.
Methods:
Herein, we screened 646 small molecules of natural origin having reported pharmacological
and functional values through in-silico docking studies to predict safer neuromodulatory molecules with
potential to modulate acetylcholine metabolism. Further, the potential of the predicted molecules to inhibit
acetylcholinesterase (AChE) activity and their ability to protect neurons from degeneration was
determined through in-vitro assays.
Results:
Based on in-silico AChE interaction studies, we predicted quercetin, caffeine, ascorbic acid and
gallic acid to be potential AChE inhibitors. We confirmed the AChE inhibitory potential of these molecules
through in-vitro AChE inhibition assay and compared results with donepezil and begacestat. Herbal
molecules significantly inhibited enzyme activity and inhibition for quercetin and caffeine did not show
any significant difference from donepezil. Further, the tested molecules did not show any neurotoxicity
against primary (E18) hippocampal neurons. We observed that quercetin and caffeine significantly improved
neuronal survival and efficiently protected hippocampal neurons from HgCl2 induced neurodegeneration,
which other molecules, including donepezil and begacestat, failed to do.
Conclusion:
Quercetin and caffeine have the potential as “disease-modifying drugs” and may find application
in the management of neurological disorders such as AD.
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Affiliation(s)
- Ashwani Kumar
- Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology, Waknaghat, Solan, Himachal Pradesh, 173234, India
| | - Vineet Mehta
- Department of Pharmacy, Jaypee University of Information Technology, Waknaghat, Solan, Himachal Pradesh, 173234, India
| | - Utkarsh Raj
- Indian Institute of Information Technology-Allahabad, Allahabad, Uttar Pradesh - 211012, India
| | - Pritish Kumar Varadwaj
- Indian Institute of Information Technology-Allahabad, Allahabad, Uttar Pradesh - 211012, India
| | - Malairaman Udayabanu
- Department of Pharmacy, Jaypee University of Information Technology, Waknaghat, Solan, Himachal Pradesh, 173234, India
| | - Ragothaman M. Yennamalli
- Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology, Waknaghat, Solan, Himachal Pradesh, 173234, India
| | - Tiratha Raj Singh
- Department of Biotechnology and Bioinformatics, Jaypee University of Information Technology, Waknaghat, Solan, Himachal Pradesh, 173234, India
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Dwivedi N, Shah J, Mishra V, Tambuwala M, Kesharwani P. Nanoneuromedicine for management of neurodegenerative disorder. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2018.12.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Donepezil-based multi-functional cholinesterase inhibitors for treatment of Alzheimer's disease. Eur J Med Chem 2018; 158:463-477. [PMID: 30243151 DOI: 10.1016/j.ejmech.2018.09.031] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/03/2018] [Accepted: 09/10/2018] [Indexed: 12/19/2022]
Abstract
Alzheimer's disease (AD) is one of the most common neurodegenerative disorders in elderly people. Considering the multifactorial nature of AD, the concept of multi-target-directed ligands (MTDLs) has recently emerged as a new strategy for designing therapeutic agents on AD. MTDLs are confirmed to simultaneously affect diverse targets which contribute to etiology of AD. As the most potent approved drug, donepezil affects various events of AD, like inhibiting cholinesterases activities, anti-Aβ aggregation, anti-oxidative stress et al. Modifications of donepezil or hybrids with pharmacophores of donepezil in recent five years are summarized in this article. On the basis of case studies, our concerns and opinions about development of donepezil derivatives, designing of MTDLs, and perspectives for AD treatments are discussed in final part.
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Ayikobua ET, Semuyaba I, Eze DE, Kalange M, Nansunga M, Okpanachi AO, Safiriyu AA. Combined Donepezil and Ethanolic Extract of Propolis Improved Memory Better Than Donepezil and Propolis Monotherapy in Wild Type Drosophila melanogaster. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:3717328. [PMID: 30158994 PMCID: PMC6109536 DOI: 10.1155/2018/3717328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/07/2018] [Accepted: 07/18/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Donepezil is the most common drug used in the treatment of disorders associated with memory loss, especially that in Alzheimer's disease. Healthy individuals however have continued to use it as a memory enhancer. This study was aimed at evaluating the combined therapy of donepezil and propolis on cognition in Drosophila melanogaster. Method. Drosophila melanogaster flies were divided into five groups and fed with the different treatment doses of ethanolic extract of propolis and donepezil as follows: normal food, propolis 250 mg/mL, propolis 50 mg/mL, donepezil 0.001M, and donepezil 0.001M/propolis 50 mg/mL added to their food. The flies were fed from larval stage for 30 days. The memory and learning tests were conducted after every 10 days to assess improvement with time. RESULTS The results obtained showed that the combination of propolis with donepezil caused a remarkable improvement in both the short- and long-term memory. In addition, there was a dose dependent improvement with the administration of propolis. CONCLUSION Propolis extract obtained from different parts of Uganda expressed cognitive improvement when coadministered with donepezil in wild type Drosophila melanogaster.
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Affiliation(s)
- Emmanuel Tiyo Ayikobua
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O. Box 71, Bushenyi, Uganda
- Institute of Biomedical Research Laboratory, Kampala International University, Western Campus, P.O. Box 71, Bushenyi, Uganda
| | - Ibrahim Semuyaba
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O. Box 71, Bushenyi, Uganda
| | - Daniel Ejike Eze
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O. Box 71, Bushenyi, Uganda
| | - Muhamudu Kalange
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O. Box 71, Bushenyi, Uganda
| | - Mariam Nansunga
- Department of Physiology, Faculty of Biomedical Sciences, St. Augustine International University, P.O. Box 88, Kampala, Uganda
| | - Alfred Omachonu Okpanachi
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O. Box 71, Bushenyi, Uganda
- Institute of Biomedical Research Laboratory, Kampala International University, Western Campus, P.O. Box 71, Bushenyi, Uganda
| | - Abass Alao Safiriyu
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University, Western Campus, P.O. Box 71, Bushenyi, Uganda
- Institute of Biomedical Research Laboratory, Kampala International University, Western Campus, P.O. Box 71, Bushenyi, Uganda
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Guo H, Grajauskas L, Habash B, D'Arcy RCN, Song X. Functional MRI technologies in the study of medication treatment effect on Alzheimer's disease. Aging Med (Milton) 2018; 1:75-95. [PMID: 31942484 PMCID: PMC6880690 DOI: 10.1002/agm2.12017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 12/14/2022] Open
Abstract
Alzheimer's disease (AD) is the most common cause of late-life dementia. Characterized by progressive neurodegeneration, the disease is expressed as gradual memory loss together with decline in cognitive abilities and other brain functions. Despite extensive research over the past decade, the cause and cure of AD both remain largely unknown. Several AD-associated deficits have been targeted for interventions, including those based on amyloid-beta, tau, and inflammation hypotheses. Only 2 types of medications-cholinesterase inhibitors and memantine-have been approved, to control the cognitive symptoms of AD such as the loss of memory, language, and executive function. Noninvasive in vivo functional magnetic resonance imaging (MRI) technologies, including the blood oxygen level-dependent functional MRI, arterial spin labeling-based perfusion MRI, and the proton magnetic resonance spectroscopy have been used to study the effect of ChEIs and memantine in the brain. Most of these studies have demonstrated increased functional activation and connectivity, increased regional brain blood flow and volume post-treatment, and positive responses of critical brain metabolites reflecting neuronal status and functionality in patients with AD and mild cognitive impairment. The findings have contributed to the understanding of the mechanisms underlying the medication treatments and support the crucial role of functional MRI technologies in the development and refinement of AD medication therapies.
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Affiliation(s)
- Hui Guo
- SFU ImageTech LaboratorySurrey Memorial HospitalSurreyBCCanada
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBCCanada
- Department of Diagnostic ImagingTianjin Medical University General HospitalTianjinChina
| | - Lukas Grajauskas
- SFU ImageTech LaboratorySurrey Memorial HospitalSurreyBCCanada
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBCCanada
| | - Baraa Habash
- SFU ImageTech LaboratorySurrey Memorial HospitalSurreyBCCanada
- Department of Engineering ScienceSimon Fraser UniversityBurnabyBCCanada
| | - Ryan CN D'Arcy
- SFU ImageTech LaboratorySurrey Memorial HospitalSurreyBCCanada
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBCCanada
- Department of Engineering ScienceSimon Fraser UniversityBurnabyBCCanada
- Department of Computing ScienceSimon Fraser UniversityBurnabyBCCanada
| | - Xiaowei Song
- SFU ImageTech LaboratorySurrey Memorial HospitalSurreyBCCanada
- Health Sciences and InnovationSurrey Memorial HospitalFraser HealthSurreyBCCanada
- Department of Engineering ScienceSimon Fraser UniversityBurnabyBCCanada
- Department of Computing ScienceSimon Fraser UniversityBurnabyBCCanada
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Kaur J, Sodhi RK, Madan J, Chahal SK, Kumar R. Forskolin convalesces memory in high fat diet-induced dementia in wistar rats—Plausible role of pregnane x receptors. Pharmacol Rep 2018; 70:161-171. [DOI: 10.1016/j.pharep.2017.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/14/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
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Chen R, Chan PT, Chu H, Lin YC, Chang PC, Chen CY, Chou KR. Treatment effects between monotherapy of donepezil versus combination with memantine for Alzheimer disease: A meta-analysis. PLoS One 2017; 12:e0183586. [PMID: 28827830 PMCID: PMC5565113 DOI: 10.1371/journal.pone.0183586] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/07/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This is the first meta-analysis to compare the treatment effects and safety of administering donepezil alone versus a combination of memantine and donepezil to treat patients with moderate to severe Alzheimer Disease, particularly regarding cognitive functions, behavioral and psychological symptoms in dementia (BPSD), and global functions. METHODS PubMed, Medline, Embase, PsycINFO, and Cochrane databases were used to search for English and non-English articles for inclusion in the meta-analysis to evaluate the effect size and incidence of adverse drug reactions of different treatments. RESULTS Compared with patients who received donepezil alone, those who received donepezil in combination with memantine exhibited limited improvements in cognitive functions (g = 0.378, p < .001), BPSD (g = -0.878, p < .001) and global functions (g = -0.585, p = .004). Gradual titration of memantine plus a fixed dose and gradual titration of donepezil as well as a fixed dose and gradual titration of memantine resulted in limited improvements in cognitive functions(g = 0.371, p = .005), BPSD(g = -0.913, p = .001), and global functions(g = -0.371, p = .001). CONCLUSION Both in the 24th week and at the final evaluation point, the combination of donepezil and memantine led to greater improvement in cognitive functions, BPSD, and global functions than did donepezil alone in patients with moderate to severe Alzheimer Disease.
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Affiliation(s)
- Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pi-Tuan Chan
- Department of Nursing, En Chu Kong Hospital, Taipei, Taiwan
| | - Hsin Chu
- Aviation Physiology Research Laboratory, Kaohsiung Armed Forces General Hospital Gangshan Branch, Kaohsiung, Taiwan
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Cih Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pi-Chen Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease, characterized by the loss of memory, multiple cognitive impairments and changes in the personality and behavior. Several decades of intense research have revealed that multiple cellular changes are involved in disease process, including synaptic damage, mitochondrial abnormalities and inflammatory responses, in addition to formation and accumulation of amyloid-β (Aβ) and phosphorylated tau. Although tremendous progress has been made in understanding the impact of neurotransmitters in the progression and pathogenesis of AD, we still do not have a drug molecule associated with neurotransmitter(s) that can delay disease process in elderly individuals and/or restore cognitive functions in AD patients. The purpose of our article is to assess the latest developments in neurotransmitters research using cell and mouse models of AD. We also updated the current status of clinical trials using neurotransmitters' agonists/antagonists in AD.
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Affiliation(s)
- Ramesh Kandimalla
- Garrison Institute on Aging Department, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Pharmacology & Neuroscience Department, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - P. Hemachandra Reddy
- Garrison Institute on Aging Department, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Pharmacology & Neuroscience Department, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Cell Biology & Biochemistry Department, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Neurology Department, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Garrison Institute on Aging, South West Campus, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Liu W, Lang M, Youdim MBH, Amit T, Sun Y, Zhang Z, Wang Y, Weinreb O. Design, synthesis and evaluation of novel dual monoamine-cholinesterase inhibitors as potential treatment for Alzheimer's disease. Neuropharmacology 2016; 109:376-385. [PMID: 27318273 DOI: 10.1016/j.neuropharm.2016.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 11/18/2022]
Abstract
Current novel therapeutic approach suggests that multifunctional compounds with diverse biological properties and a single bioavailability and pharmacokinetic metabolism, will produce higher significant advantages in treatment of neurodegenerative diseases, such as Alzheimer's disease (AD). Based on this rational, a new class of cholinesterase (ChE)-monoamine oxidase (MAO) inhibitors were designed and synthesized by amalgamating the propargyl moiety of the irreversible selective MAO-B inhibitor, neuroprotective/neurorestorative anti-Parkinsonian drug, rasagiline, into the "N-methyl" position of the ChE inhibitor, anti-AD drug rivastigmine. Initially, we examined the MAO and ChE inhibitory effect of these novel compounds, MT series in vitro and in vivo. Among MT series, MT-031 exhibited higher potency as a dual MAO-A and ChE inhibitor compared to other compounds in acute-treated mice. Additionally, MT-031 was found to increase the striatal levels of dopamine (DA), serotonin (5-HT) and norepinephrine (NE), and prevent the metabolism of DA and 5-HT. Finally, we have demonstrated that MT-031 exerted neuroprotective effect against H2O2-induced neurotoxicity and reactive oxygen species generation in human neuroblastoma SH-SY5Y cells. These findings provide evidence that MT-031 is a potent brain permeable novel multifunctional, neuroprotective and MAO-A/ChE inhibitor, preserves in one molecule entity some of the beneficial properties of its parent drugs, rasagiline and rivastigmine, and thus may be indicated as novel therapeutic approach for AD.
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Affiliation(s)
- Wei Liu
- Eve Topf Centers of Excellence for Neurodegenerative Diseases Research, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ming Lang
- Institute of New Drug Research, Jinan University College of Pharmacy, Guangzhou, China
| | - Moussa B H Youdim
- Eve Topf Centers of Excellence for Neurodegenerative Diseases Research, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tamar Amit
- Eve Topf Centers of Excellence for Neurodegenerative Diseases Research, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yewei Sun
- Institute of New Drug Research, Jinan University College of Pharmacy, Guangzhou, China
| | - Zaijun Zhang
- Institute of New Drug Research, Jinan University College of Pharmacy, Guangzhou, China
| | - Yuqiang Wang
- Institute of New Drug Research, Jinan University College of Pharmacy, Guangzhou, China
| | - Orly Weinreb
- Eve Topf Centers of Excellence for Neurodegenerative Diseases Research, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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The effect of memantine on sleep architecture and psychiatric symptoms in patients with Alzheimer's disease. Acta Neuropsychiatr 2016; 28:157-64. [PMID: 26572055 DOI: 10.1017/neu.2015.61] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Behavioural and psychological symptoms of dementia (BPSD) are commonly present in patients with Alzheimer's disease (AD). Disturbed sleep quality is also observed in AD patients. However, the effects of memantine on sleep architecture have not been investigated. The purpose of this study was to investigate the effects of memantine on polysomnography (PSG) variables and BPSD. METHODS In total, 12 patients with AD (mean age: 79.0±4.1 years old) were enrolled in this study. The following tests were performed: the Neuropsychiatric Inventory for the assessment of BPSD, the Mini-Mental State Examination (MMSE) for cognitive function, and PSG for evaluation of sleep architecture. After baseline examinations, patients were treated with memantine according to a standard prescription protocol. After being treated with 20 mg/day of memantine for 4 weeks, examinations were carried out again. RESULTS All subjects completed the trial. The mean MMSE and NPI scores were 22.6±3.4 and 13.8±12.9, respectively. Treatment with memantine significantly decreased the NPI score (5.8±4.3, p<0.01). There were significant decreases in the scores of subscales for anxiety (p=0.04) and irritability/lability (p=0.04). PSG demonstrated a longer total sleep time (TST) (p<0.01), increases in sleep efficiency (p<0.01) and time spent in stage II (% TST, p=0.02), and decreases in nocturnal awakening (p<0.01), the periodic limb movement index (p<0.01), and time spent in stage I (% TST, p=0.02). CONCLUSION Memantine was effective for reducing fragmented sleep and improving BPSD, and was well tolerated.
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Neuroprotection of medial septal cholinergic neurons by memantine after intralateral septal injection of Aβ1-40. Neuroreport 2016; 26:450-4. [PMID: 25919992 DOI: 10.1097/wnr.0000000000000364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Alzheimer's disease (AD) is a progressive disorder of the brain that leads to memory loss, dementia, and death. Several lines of evidence suggest that the accumulation of amyloid-β (Aβ) peptides may trigger the dysfunction and degeneration observed in the AD brain. The basal forebrain, including the septal region, which regulates the excitability of the hippocampus and neocortex, is affected early in AD because its neurons are vulnerable to Aβ peptides. In addition, connections between lateral and medial septal regions (medial septum and diagonal band of Broca) have been demonstrated in previous studies. To demonstrate the involvement of excitotoxicity in Aβ-induced septal damage, we compared rats injected with Aβ1-40 into the lateral septal region structure with rats treated with memantine (a noncompetitive NMDA receptor antagonist), before, during, and after Aβ1-40 injection. Medial septal cholinergic neurons were immunochemically identified and their numbers were estimated using Image J cell count. Our results show that Aβ1-40-treated animals have a significantly low number of medial septum and diagonal band of Broca cholinergic neurons compared with the Aβ/memantine-treated group.
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Pharmacological benefits of selective modulation of cannabinoid receptor type 2 (CB2) in experimental Alzheimer's disease. Pharmacol Biochem Behav 2015; 140:39-50. [PMID: 26577751 DOI: 10.1016/j.pbb.2015.11.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 10/09/2015] [Accepted: 11/10/2015] [Indexed: 12/13/2022]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder that pervasively affects the population across the world. Currently, there is no effective treatment available for this and existing drugs merely slow the progression of cognitive function decline. Thus, massive effort is required to find an intended therapeutic target to overcome this condition. The present study has been framed to investigate the ameliorative role of selective modulator of cannabinoid receptor type 2 (CB2), 1-phenylisatin in experimental AD condition. We have induced experimental AD in mice by using two induction models viz., intracerebroventricular (i.c.v.) administration of streptozotocin (STZ) and aluminum trichloride (AlCl3)+d-galactose. Morris water maze (MWM) and attentional set shifting test (ASST) were used to assess learning and memory. Hematoxylin-eosin and Congo red staining were used to examine the structural variation in brain. Brain oxidative stress (thiobarbituric acid reactive substance and glutathione), nitric oxide levels (nitrites/nitrates), acetyl cholinesterase activity, myeloperoxidase and calcium levels were also estimated. i.c.v. STZ as well as AlCl3+d-galactose have impaired spatial and reversal learning with executive functioning, increased brain oxidative and nitrosative stress, cholinergic activity, inflammation and calcium levels. Furthermore, these agents have also enhanced the burden of Aβ plaque in the brain. Treatment with 1-phenylisatin and donepezil attenuated i.c.v. STZ as well as AlCl3+d-galactose induced impairment of learning-memory, brain biochemistry and brain damage. Hence, this study concludes that CB2 receptor modulation can be a potential therapeutic target for the management of AD.
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Kuronen M, Koponen H, Nykänen I, Karppi P, Hartikainen S. Use of anti-dementia drugs in home care and residential care and associations with neuropsychiatric symptoms: a cross-sectional study. BMC Geriatr 2015; 15:100. [PMID: 26268660 PMCID: PMC4535784 DOI: 10.1186/s12877-015-0102-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/04/2015] [Indexed: 01/19/2023] Open
Abstract
Background The number of people with dementia is increasing alongside the aging population, and most of these patients manifest with neuropsychiatric symptoms (NPS). The objective of this study was to investigate anti-dementia drug use and its associations with NPS. Methods Questionnaires on demographic information, current drug use, activities of daily living and NPS were sent to all municipal home care producers and to all institutions providing long-term residential care in the South Savo Hospital District, Finland. Results The study population comprised 2821 persons. Their mean age was 81 years and 68 % were female. Dementia had been diagnosed in 31 % (n = 410) in home care and in 56 % (n = 774) in residential care. Anti-dementia drugs were used by 69 % of patients with dementia. Hyperactivity symptoms were common in residential care patients (n = 456, 33 %), while problems with mood and apathy dominated in home care patients (n = 486, 54 %). In multivariate regression analysis, the mood symptoms and apathy subgroup was associated with use of an acetylcholinesterase inhibitor (AChEI) (OR 1.44; 95 % Cl 1.03–2.02), memantine (OR 1.77, 95 % Cl 1.15–2.72) or their combinations (OR 1.56, 95 % Cl 1.03-2.34). Hyperactivity symptoms were associated with combination therapy of this type (OR 2.03, 95 % Cl 1.36–2.34). Conclusions The use of anti-dementia drugs was common in both care settings. The use of any anti-dementia drug or combination was associated with the mood and apathy subgroup. The hyperactivity subgroup was associated with combination use of memantine and AChEI.
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Affiliation(s)
- Marja Kuronen
- Mikkeli Central Hospital, Porrassalmenkatu 35-37, FI-50100, Mikkeli, Finland.
| | - Hannu Koponen
- Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki and Helsinki University Hospital, P. O. BOX 590, FI-00029, HUS, Helsinki, Finland.
| | - Irma Nykänen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland. .,Faculty of Health Sciences, Kuopio Research Centre of Geriatric Care, P. O. BOX 1627, Kuopio, FI-70211, Finland.
| | - Pertti Karppi
- Mikkeli Central Hospital, Porrassalmenkatu 35-37, FI-50100, Mikkeli, Finland.
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland. .,Faculty of Health Sciences, Kuopio Research Centre of Geriatric Care, P. O. BOX 1627, Kuopio, FI-70211, Finland.
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Wu CY, Hu HY, Chow LH, Chou YJ, Huang N, Wang PN, Li CP. The Effects of Anti-Dementia and Nootropic Treatments on the Mortality of Patients with Dementia: A Population-Based Cohort Study in Taiwan. PLoS One 2015; 10:e0130993. [PMID: 26098910 PMCID: PMC4476616 DOI: 10.1371/journal.pone.0130993] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/27/2015] [Indexed: 11/25/2022] Open
Abstract
Background Few studies have examined the contribution of treatment on the mortality of dementia based on a population-based study. Objective To investigate the effects of anti-dementia and nootropic treatments on the mortality of dementia using a population-based cohort study. Methods 12,193 incident dementia patients were found from 2000 to 2010. Their data were compared with 12,193 age- and sex-matched non-dementia controls that were randomly selected from the same database. Dementia was classified into vascular (VaD) and degenerative dementia. Mortality incidence and hazard ratios (HRs) were calculated. Results The median survival time was 3.39 years (95% confidence interval [CI]: 2.88–3.79) for VaD without medication, 6.62 years (95% CI: 6.24–7.21) for VaD with nootropics, 3.01 years (95% CI: 2.85–3.21) for degenerative dementia without medication, 8.11 years (95% CI: 6.30–8.55) for degenerative dementia with anti-dementia medication, 6.00 years (95% CI: 5.73–6.17) for degenerative dementia with nootropics, and 9.03 years (95% CI: 8.02–9.87) for degenerative dementia with both anti-dementia and nootropic medications. Compared to the non-dementia group, the HRs among individuals with degenerative dementia were 2.69 (95% CI: 2.55–2.83) without medication, 1.46 (95% CI: 1.39–1.54) with nootropics, 1.05 (95% CI: 0.82–1.34) with anti-dementia medication, and 0.92 (95% CI: 0.80–1.05) with both nootropic and anti-dementia medications. VaD with nootropics had a lower mortality (HR: 1.25, 95% CI: 1.15–1.37) than VaD without medication (HR: 2.46, 95% CI: 2.22–2.72). Conclusion Pharmacological treatments have beneficial effects for patients with dementia in prolonging their survival.
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Affiliation(s)
- Chen-Yi Wu
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health & Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Institute of Public Health & Department of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Lok-Hi Chow
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health & Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Ning Wang
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- * E-mail: (CPL); (PNW)
| | - Chung-Pin Li
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- * E-mail: (CPL); (PNW)
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A Risk-Benefit Assessment of Dementia Medications: Systematic Review of the Evidence. Drugs Aging 2015; 32:453-67. [DOI: 10.1007/s40266-015-0266-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Nanoparticle-mediated growth factor delivery systems: A new way to treat Alzheimer's disease. J Control Release 2015; 206:187-205. [DOI: 10.1016/j.jconrel.2015.03.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/19/2015] [Accepted: 03/20/2015] [Indexed: 01/03/2023]
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Lauzon MA, Daviau A, Marcos B, Faucheux N. Growth factor treatment to overcome Alzheimer's dysfunctional signaling. Cell Signal 2015; 27:1025-38. [PMID: 25744541 DOI: 10.1016/j.cellsig.2015.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
Abstract
The number of people suffering from Alzheimer's disease (AD) will increase as the world population ages, creating a huge socio-economic burden. The three pathophysiological hallmarks of AD are the cholinergic system dysfunction, the β-amyloid peptide deposition and the Tau protein hyperphosphorylation. Current treatments have only transient effects and each tends to concentrate on a single pathophysiological aspect of AD. This review first provides an overall view of AD in terms of its pathophysiological symptoms and signaling dysfunction. We then examine the therapeutic potential of growth factors (GFs) by showing how they can overcome the dysfunctional cell signaling that occurs in AD. Finally, we discuss new alternatives to GFs that help overcome the problem of brain uptake, such as small peptides, with evidence from some of our unpublished data on human neuronal cell line.
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Affiliation(s)
- Marc-Antoine Lauzon
- Cell-Biomaterial Biohybrid Systems, Department of Chemical and Biotechnological Engineering, Université de Sherbrooke, 2500 boul. de l'Université, Sherbrooke, Québec J1K 2R1, Canada
| | - Alex Daviau
- Cell-Biomaterial Biohybrid Systems, Department of Chemical and Biotechnological Engineering, Université de Sherbrooke, 2500 boul. de l'Université, Sherbrooke, Québec J1K 2R1, Canada
| | - Bernard Marcos
- Department of Chemical and Biotechnological Engineering, Université de Sherbrooke, 2500 boul. de l'Université, Sherbrooke, Québec J1K 2R1, Canada
| | - Nathalie Faucheux
- Cell-Biomaterial Biohybrid Systems, Department of Chemical and Biotechnological Engineering, Université de Sherbrooke, 2500 boul. de l'Université, Sherbrooke, Québec J1K 2R1, Canada.
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Kwon KJ, Kim MK, Lee EJ, Kim JN, Choi BR, Kim SY, Cho KS, Han JS, Kim HY, Shin CY, Han SH. Effects of donepezil, an acetylcholinesterase inhibitor, on neurogenesis in a rat model of vascular dementia. J Neurol Sci 2014; 347:66-77. [DOI: 10.1016/j.jns.2014.09.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 09/01/2014] [Accepted: 09/15/2014] [Indexed: 12/20/2022]
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