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Mohamed Yusof NIS, Mohd Fauzi F. Nature's Toolbox for Alzheimer's Disease: A Review on the Potential of Natural Products as Alzheimer's Disease Drugs. Neurochem Int 2024; 176:105738. [PMID: 38616012 DOI: 10.1016/j.neuint.2024.105738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/18/2024] [Accepted: 04/06/2024] [Indexed: 04/16/2024]
Abstract
Numerous clinical trials involving natural products have been conducted to observe cognitive performances and biomarkers in Alzheimer's Disease (AD) patients. However, to date, no natural-based drugs have been approved by the FDA as treatments for AD. In this review, natural product-based compounds that were tested in clinical trials from 2011 to 2023, registered at www.clinicaltrials.gov were reviewed. Thirteen compounds, encompassing 7 different mechanisms of action were covered. Several observations were deduced, which are: i) several compounds showed cognitive improvement, but these improvements may not extend to AD, ii) compounds that are endogenous to the human body showed better outcomes, and iii) Docosahexaenoic acid (DHA) and cerebrolysin had the most potential as AD drugs among the 13 compounds. Based on the current findings, natural products may be more suitable as a supplement than AD drugs in most cases. However, the studies covered here were conducted in a relatively short amount of time, where compounds acting on AD pathways may take time to show any effect. Given the diverse pathways that these natural products are involved in, they may potentially produce synergistic effects that would be beneficial in treating AD. Additionally, natural products benefit from both physicochemical properties being in more favorable ranges and active transport playing a more significant role than it does for synthetic compounds.
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Affiliation(s)
| | - Fazlin Mohd Fauzi
- Faculty of Pharmacy, Universiti Teknologi MARA Selangor, Puncak Alam Campus, 42 300 Bandar Puncak Alam, Selangor, Malaysia; Center for Drug Discovery Research, Faculty of Pharmacy, Universiti Teknologi MARA Selangor, Puncak Alam Campus, 42 300 Bandar Puncak Alam, Selangor, Malaysia.
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Kastberger B, Winter S, Brandstätter H, Biller J, Wagner W, Plesnila N. Treatment with Cerebrolysin Prolongs Lifespan in a Mouse Model of Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy. Adv Biol (Weinh) 2024; 8:e2300439. [PMID: 38062874 DOI: 10.1002/adbi.202300439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Indexed: 02/15/2024]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare familial neurological disorder caused by mutations in the NOTCH3 gene and characterized by migraine attacks, depressive episodes, lacunar strokes, dementia, and premature death. Since there is no therapy for CADASIL the authors investigate whether the multi-modal neuropeptide drug Cerebrolysin may improve outcome in a murine CADASIL model. Twelve-month-old NOTCH3R169C mutant mice (n=176) are treated for nine weeks with Cerebrolysin or Vehicle and histopathological and functional outcomes are evaluated within the subsequent ten months. Cerebrolysin treatment improves spatial memory and overall health, reduces epigenetic aging, and prolongs lifespan, however, CADASIL-specific white matter vacuolization is not affected. On the molecular level Cerebrolysin treatment increases expression of Calcitonin Gene-Related Peptide (CGRP) and Silent Information Regulator Two (Sir2)-like protein 6 (SIRT6), decreases expression of Insulin-like Growth Factor 1 (IGF-1), and normalizes the expression of neurovascular laminin. In summary, Cerebrolysin fosters longevity and healthy aging without specifically affecting CADASIL pathology. Hence, Cerebrolysin may serve a therapeutic option for CADASIL and other disorders characterized by accelerated aging.
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Affiliation(s)
| | - Stefan Winter
- Ever Pharma, Oberburgau 3, Unterach am Attersee, 4866, Austria
| | | | - Janina Biller
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Wolfgang Wagner
- Institute for Stem Cell Biology, RWTH Aachen University Medical School, 52074, Aachen, Germany
- Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074, Aachen, Germany
- Cygenia GmbH, 52078, Aachen, Germany
| | - Nikolaus Plesnila
- Cluster of Systems Neurology (Synergy), 81377, Munich, Germany
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377, Munich, Germany
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Zueva MV, Neroeva NV, Zhuravleva AN, Bogolepova AN, Kotelin VV, Fadeev DV, Tsapenko IV. Fractal Phototherapy in Maximizing Retina and Brain Plasticity. ADVANCES IN NEUROBIOLOGY 2024; 36:585-637. [PMID: 38468055 DOI: 10.1007/978-3-031-47606-8_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
The neuroplasticity potential is reduced with aging and impairs during neurodegenerative diseases and brain and visual system injuries. This limits the brain's capacity to repair the structure and dynamics of its activity after lesions. Maximization of neuroplasticity is necessary to provide the maximal CNS response to therapeutic intervention and adaptive reorganization of neuronal networks in patients with degenerative pathology and traumatic injury to restore the functional activity of the brain and retina.Considering the fractal geometry and dynamics of the healthy brain and the loss of fractality in neurodegenerative pathology, we suggest that the application of self-similar visual signals with a fractal temporal structure in the stimulation therapy can reactivate the adaptive neuroplasticity and enhance the effectiveness of neurorehabilitation. This proposition was tested in the recent studies. Patients with glaucoma had a statistically significant positive effect of fractal photic therapy on light sensitivity and the perimetric MD index, which shows that methods of fractal stimulation can be a novel nonpharmacological approach to neuroprotective therapy and neurorehabilitation. In healthy rabbits, it was demonstrated that a long-term course of photostimulation with fractal signals does not harm the electroretinogram (ERG) and retina structure. Rabbits with modeled retinal atrophy showed better dynamics of the ERG restoration during daily stimulation therapy for a week in comparison with the controls. Positive changes in the retinal function can indirectly suggest the activation of its adaptive plasticity and the high potential of stimulation therapy with fractal visual stimuli in a nonpharmacological neurorehabilitation, which requires further study.
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Affiliation(s)
- Marina V Zueva
- Department of Clinical Physiology of Vision, Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - Natalia V Neroeva
- Department of Pathology of the Retina and Optic Nerve, Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - Anastasia N Zhuravleva
- Department of Glaucoma, Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - Anna N Bogolepova
- Department of neurology, neurosurgery and medical genetics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Vladislav V Kotelin
- Department of Clinical Physiology of Vision, Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - Denis V Fadeev
- Scientific Experimental Center Department, Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - Irina V Tsapenko
- Department of Clinical Physiology of Vision, Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
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4
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Rejdak K, Sienkiewicz-Jarosz H, Bienkowski P, Alvarez A. Modulation of neurotrophic factors in the treatment of dementia, stroke and TBI: Effects of Cerebrolysin. Med Res Rev 2023; 43:1668-1700. [PMID: 37052231 DOI: 10.1002/med.21960] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023]
Abstract
Neurotrophic factors (NTFs) are involved in the pathophysiology of neurological disorders such as dementia, stroke and traumatic brain injury (TBI), and constitute molecular targets of high interest for the therapy of these pathologies. In this review we provide an overview of current knowledge of the definition, discovery and mode of action of five NTFs, nerve growth factor, insulin-like growth factor 1, brain derived NTF, vascular endothelial growth factor and tumor necrosis factor alpha; as well as on their contribution to brain pathology and potential therapeutic use in dementia, stroke and TBI. Within the concept of NTFs in the treatment of these pathologies, we also review the neuropeptide preparation Cerebrolysin, which has been shown to resemble the activities of NTFs and to modulate the expression level of endogenous NTFs. Cerebrolysin has demonstrated beneficial treatment capabilities in vitro and in clinical studies, which are discussed within the context of the biochemistry of NTFs. The review focuses on the interactions of different NTFs, rather than addressing a single NTF, by outlining their signaling network and by reviewing their effect on clinical outcome in prevalent brain pathologies. The effects of the interactions of these NTFs and Cerebrolysin on neuroplasticity, neurogenesis, angiogenesis and inflammation, and their relevance for the treatment of dementia, stroke and TBI are summarized.
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Affiliation(s)
- Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | | | | | - Anton Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, Coruña, Spain
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5
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Bogolepova AN. [Cerebrolysin in the treatment of cognitive impairment]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:20-25. [PMID: 36946392 DOI: 10.17116/jnevro202312303120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Cognitive impairment is one of the most important problems of modern health care. Currently, according to WHO, more than 55 million people worldwide are living with dementia. Dementia is one of the leading causes of disability and addiction among older people worldwide. Even more significant is the number of patients with mild cognitive impairment who have an increased risk of progression to dementia compared to people of the same age without cognitive impairment. The number of patients with cognitive impairment has also increased due to the consequences of COVID-19. It is necessary to use drugs that not only improve cognitive functions, but also slow down their progression. One of these drugs is cerebrolysin, the effectiveness of which has been confirmed in various types of cognitive impairment. Cerebrolysin, being a preparation from the brain of a pig, belongs to the group of biological drugs. In the production of Cerebrolysin very strict measures are taken to comply with the technology, which ensures the quality and identity of the product from batch to batch. The experience of many years of clinical use of Cerebrolysin testifies not only to its high efficiency, but also to its safety. It should be taken into account that similar substances can be developed in relation to biological products - biosimilars or biosimilars, which can be considered comparable only in case of equivalent pharmacokinetic parameters, efficacy and safety.
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Affiliation(s)
- A N Bogolepova
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain and Neurotechnologies, Moscow, Russia
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Levin OS, Voznyuk IA, Illarioshkin SN, Tkacheva ON, Bogolepova AN, Vasenina EE, Gavrilova SI, Dokukina TV, Emelin AY, Lobzin VY, Mkhitaryan EA, Khatkova SE, Yakushin MA, Yanishevskiy SN. [Cognitive impairment and tactics of using the drug Cerebrolysin. Resolution of the International Council of Experts (May 12, 2023)]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:121-130. [PMID: 37796079 DOI: 10.17116/jnevro2023123091121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
The aging of the population and the associated increase in the share of cognitive impairments in the structure of a wide range of diseases are a serious challenge for modern healthcare. Difficulties in the treatment of cognitive disorders are determined by many factors, including the age of patients, comorbidity, forced polypragmasia and the adequacy of the dosage of drugs that restore cognitive activity. The experts discussed information about the therapeutic potential of the drug Cerebrolysin in the treatment of cognitive disorders of various origins, stated significant experience of its effective and safe use in many clinical studies in mild and moderate forms of dementia. At the same time, there was a lack of consistent and systematic data on the dosage regimen, frequency, and duration of use of the drug in different forms of cognitive impairment and the degree of their severity. The aim of the international council of experts was to determine the optimal dosage regimens of the drug Cerebrolysin in patients with various etiologies and severity of cognitive impairment. The result of the work was the approval of a unified scheme for the use of the drug Cerebrolysin, considering the severity of the disease and its duration.
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Affiliation(s)
- O S Levin
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - I A Voznyuk
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
- Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | | | - O N Tkacheva
- Russian Gerontological Scientific and Clinical Center of Pirogov Russian National Research Medical University, Moscow, Russia
| | - A N Bogolepova
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - E E Vasenina
- Russian Gerontological Scientific and Clinical Center of Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - T V Dokukina
- Republican Scientific and Practical Center of Mental Health, Minsk, Republic of Belarus
| | - A Y Emelin
- Kirov Military Medical Academy, St. Petersburg, Russia
| | - V Y Lobzin
- Kirov Military Medical Academy, St. Petersburg, Russia
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | | | - S E Khatkova
- National Medical Research Center «Treatment and Rehabilitation Center», Moscow, Russia
| | - M A Yakushin
- Moscow Regional Research and Clinical Institute, Moscow, Russia
- Semashko National Research Institute of Public Health, Moscow, Russia
| | - S N Yanishevskiy
- Almazov National Medical Research Centre, St. Petersburg, Russia
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Sharma HS, Muresanu DF, Nozari A, Lafuente JV, Buzoianu AD, Tian ZR, Huang H, Feng L, Bryukhovetskiy I, Manzhulo I, Wiklund L, Sharma A. Neuroprotective Effects of Nanowired Delivery of Cerebrolysin with Mesenchymal Stem Cells and Monoclonal Antibodies to Neuronal Nitric Oxide Synthase in Brain Pathology Following Alzheimer's Disease Exacerbated by Concussive Head Injury. ADVANCES IN NEUROBIOLOGY 2023; 32:139-192. [PMID: 37480461 DOI: 10.1007/978-3-031-32997-5_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Concussive head injury (CHI) is one of the major risk factors in developing Alzheimer's disease (AD) in military personnel at later stages of life. Breakdown of the blood-brain barrier (BBB) in CHI leads to extravasation of plasma amyloid beta protein (ΑβP) into the brain fluid compartments precipitating AD brain pathology. Oxidative stress in CHI or AD is likely to enhance production of nitric oxide indicating a role of its synthesizing enzyme neuronal nitric oxide synthase (NOS) in brain pathology. Thus, exploration of the novel roles of nanomedicine in AD or CHI reducing NOS upregulation for neuroprotection are emerging. Recent research shows that stem cells and neurotrophic factors play key roles in CHI-induced aggravation of AD brain pathologies. Previous studies in our laboratory demonstrated that CHI exacerbates AD brain pathology in model experiments. Accordingly, it is quite likely that nanodelivery of NOS antibodies together with cerebrolysin and mesenchymal stem cells (MSCs) will induce superior neuroprotection in AD associated with CHI. In this review, co-administration of TiO2 nanowired cerebrolysin - a balanced composition of several neurotrophic factors and active peptide fragments, together with MSCs and monoclonal antibodies (mAb) to neuronal NOS is investigated for superior neuroprotection following exacerbation of brain pathology in AD exacerbated by CHI based on our own investigations. Our observations show that nanowired delivery of cerebrolysin, MSCs and neuronal NOS in combination induces superior neuroprotective in brain pathology in AD exacerbated by CHI, not reported earlier.
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Affiliation(s)
- Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania
- "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Ala Nozari
- Anesthesiology & Intensive Care, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, USA
| | - Hongyun Huang
- Beijing Hongtianji Neuroscience Academy, Beijing, China
| | - Lianyuan Feng
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, China
| | - Igor Bryukhovetskiy
- Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia
| | - Igor Manzhulo
- Laboratory of Pharmacology, National Scientific Center of Marine Biology, Far East Branch of the Russian Academy of Sciences, Vladivostok, Russia
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
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Chen L, Jiao J, Zhang Y. Therapeutic approaches for improving cognitive function in the aging brain. Front Neurosci 2022; 16:1060556. [PMID: 36570840 PMCID: PMC9773601 DOI: 10.3389/fnins.2022.1060556] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
The rapid aging of populations around the world has become an unprecedented challenge. Aging is associated with cognitive impairment, including dementia and mild cognitive impairment. Successful drug development for improving or maintaining cognition in the elderly is critically important. Although 4 drugs for improving cognition in Alzheimer's disease have been approved, a variety of potential drugs targeting age-related cognitive impairment are still in development. In addition, non-pharmacological interventions, including cognition-oriented treatments, non-invasive brain stimulation physical exercise, and lifestyle-related interventions, have also been suggested as cognitive enhancers in the last decade. In this paper, we reviewed the recent evidence of pharmacological and non-pharmacological interventions aimed at improving or maintaining cognition in the elderly.
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Affiliation(s)
- Lingmin Chen
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Jiao Jiao
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Yonggang Zhang
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Yonggang Zhang,
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The Effects of Spirulina maxima Extract on Memory Improvement in Those with Mild Cognitive Impairment: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Nutrients 2022; 14:nu14183714. [PMID: 36145090 PMCID: PMC9505028 DOI: 10.3390/nu14183714] [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: 08/12/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022] Open
Abstract
Spirulina maxima is a marine microalga that has been promoted worldwide as a super food. This study was conducted to evaluate its ability to improve memory in the older adults using Spirulina maxima 70% ethanol extract (SM70EE). This randomized, double-blind, placebo-controlled clinical trial comprised 80 volunteers recruited from Jeonbuk National University Hospital in Jeonju, Republic of Korea, who were randomly assigned to two groups. The participants received either 1 g/day of SM70EE or a placebo without otherwise changing their diet or physical activity. The participants were examined at baseline and after a 12-week interval to determine whether there were changes in their results for visual learning, visual working memory, and verbal learning tests from the Korean version of the Montreal Cognitive Assessment, brain-derived neurotrophic factor and beta-amyloid levels, and total antioxidant capacity. Compared to the placebo group, the treatment group showed a significant improvement in visual learning and visual working memory test results and enhanced vocabulary. SM70EE use was shown to improve memory, with no adverse effects. Its efficacy in alleviating Alzheimer’s disease symptoms was verified for the first time through this clinical trial. SM70EE could play a role in the management of patients with dementia. This trial is registered with registration number of clinical research information service (CRIS: KCT0006161).
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Pharmacotherapy of Alzheimer's disease: an overview of systematic reviews. Eur J Clin Pharmacol 2022; 78:1567-1587. [PMID: 35881170 DOI: 10.1007/s00228-022-03363-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/02/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is a neurodegenerative disease and the most common cause of dementia. In this umbrella systematic review (SR), we summarized the efficacy of different pharmacological interventions in improving cognitive function in patients with AD. METHODS A systematic search was performed through the PubMed, Scopus, Embase, and Cochrane databases for SRs of studies assessing the efficacy of pharmacological interventions versus placebo in improving cognitive function in AD or mild cognitive impairment due to AD. The risk of bias (RoB) was assessed using the Risk of Bias in SRs (ROBIS) tool. RESULTS Out of 1748 articles found through the database survey, 33 SR articles were included. These studies assessed effects of immunotherapy, cholinesterase inhibitors (ChEIs), memantine, statins, lithium, nonsteroidal anti-inflammatory drugs (NSAIDs), antidiabetic agents, Cerebrolysin, RAS-targeting antihypertensive drugs (ARBs and ACEIs), psychostimulants, glycogen synthase kinase 3 (GSK-3) inhibitors, melatonin, and herbal medications on cognitive function in AD patients. There was no notable overall RoB in 18 studies (54.5%), the RoB in 14 studies (42.4%) was high, and in one study (3.0%) it was unclear. CONCLUSIONS The use of ChEIs, including rivastigmine, galantamine, and donepezil, as well as memantine has demonstrated a positive impact on improving cognitive outcomes of AD patients, but no considerable effects were found for immunotherapies. Melatonin, statins, antihypertensive drugs, antidiabetic agents, Cerebrolysin, psychostimulants, and some herbal drugs such as Danggui-Shaoyao-San and Ginkgo biloba seem to be effective in improving cognitive function of AD patients, but the evidence in this regard is limited.
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The Effect of Cerebrolysin on Anxiety, Depression, and Cognition in Moderate and Severe Traumatic Brain Injury Patients: A CAPTAIN II Retrospective Trial Analysis. Medicina (B Aires) 2022; 58:medicina58050648. [PMID: 35630065 PMCID: PMC9147297 DOI: 10.3390/medicina58050648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/03/2022] [Accepted: 05/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Traumatic brain injuries represent an important source of disease burden requiring emergency inpatient care and continuous outpatient tailored rehabilitation. Although most TBIs are mild, patients are still developing post-TBI depression, anxiety, and cognitive impairments. Our secondary retrospective trial analysis aimed to (1) analyze correlations between HADS-Anxiety/HADS-Depression and scales that measure cognitive and motor processes in patients treated with Cerebrolysin compared to the placebo group and (2) compare anxiety and depression scores among the two treatment groups. Materials and Methods: Our secondary retrospective analysis focused on TBI patients with moderate and severe disability divided into two groups: Cerebrolysin (treatment) and saline solution (procedural placebo). We analyzed data from 125 patients. We computed descriptive statistics for nominal and continuous variables. We used Spearman’s correlation to find associations between HADS and other neuropsychological scales and the Mann–Whitney U test to compare HADS-Anxiety and HADS-Depression scores among the two study arms. Results: Our sample consisted of patients with a mean age of 45.3, primarily men, and with a 24 h GCS (Glasgow Coma Scale) mean of 12.67. We obtained statistically significant differences for HADS-Anxiety during the second and third visits for patients treated with Cerebrolysin. Our results show that Cerebrolysin has a large effect size (0.73) on anxiety levels. In addition, there are positive and negative correlations between HADS-Anxiety and Depression subscales and other neuropsychological scales. Conclusions: Our secondary database analysis supports the existing body of evidence on the positive effect of Cerebrolysin on post-TBI mental health status. Future confirmatory trials are necessary to clarify the link between the intervention and measured outcomes.
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Alvarez XA, Winston CN, Barlow JW, Sarsoza FM, Alvarez I, Aleixandre M, Linares C, García-Fantini M, Kastberger B, Winter S, Rissman RA. Modulation of Amyloid-β and Tau in Alzheimer's Disease Plasma Neuronal-Derived Extracellular Vesicles by Cerebrolysin® and Donepezil. J Alzheimers Dis 2022; 90:705-717. [PMID: 36155516 PMCID: PMC9697063 DOI: 10.3233/jad-220575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Plasma neuronal-derived extracellular vesicles (NDEV) contain proteins of pathological, diagnostic, and therapeutic relevance. OBJECTIVE We investigated the associations of six plasma NDEV markers with Alzheimer's disease (AD) severity, cognition and functioning, and changes in these biomarkers after Cerebrolysin®, donepezil, and a combination therapy in AD. METHODS Plasma NDEV levels of Aβ42, total tau, P-T181-tau, P-S393-tau, neurogranin, and REST were determined in: 1) 116 mild to advanced AD patients and in 20 control subjects; 2) 110 AD patients treated with Cerebrolysin®, donepezil, or combination therapy in a randomized clinical trial (RCT). Samples for NDEV determinations were obtained at baseline in the NDEV study and at baseline and study endpoint in the RCT. Cognition and functioning were assessed at the same time points. RESULTS NDEV levels of Aβ42, total tau, P-T181-tau, and P-S393-tau were higher and those of neurogranin and REST were lower in mild-to-moderate AD than in controls (p < 0.05 to p < 0.001). NDEV total tau, neurogranin, and REST increased with AD severity (p < 0.05 to p < 0.001). NDEV Aβ42 and P-T181-tau correlated negatively with serum BDNF (p < 0.05), and total-tau levels were associated to plasma TNF-α (p < 0.01) and cognitive impairment (p < 0.05). Combination therapy reduced NDEV Aβ42 with respect to monotherapies (p < 0.05); and NDEV total tau, P-T181-tau, and P-S396-tau were decreased in Cerebrolysin-treated patients compared to those on donepezil monotherapy (p < 0.05). CONCLUSION The present results demonstrate the utility of NDEV determinations of pathologic and synaptic proteins as effective AD biomarkers, as markers of AD severity, and as potential tools for monitoring the effects of anti-AD drugs.
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Affiliation(s)
- X. Anton Alvarez
- Medinova Institute of Neurosciences, Clinica Reha Salud, A Coruña, Spain
- Clinical Research Department, QPS Holdings, A Coruña, Spain
| | | | - James W. Barlow
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Floyd M. Sarsoza
- Department of Neurosciences, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Irene Alvarez
- Medinova Institute of Neurosciences, Clinica Reha Salud, A Coruña, Spain
| | | | | | | | | | | | - Robert A. Rissman
- Department of Neurosciences, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
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Levin O, Bogolepova A, Lobzin V. General mechanisms of the pathogenesis of neurodenerative and cerebrovascular diseases and the possibilities of their correction. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:11-16. [DOI: 10.17116/jnevro202212205111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Fan F, Liu H, Shi X, Ai Y, Liu Q, Cheng Y. The Efficacy and Safety of Alzheimer's Disease Therapies: An Updated Umbrella Review. J Alzheimers Dis 2021; 85:1195-1204. [PMID: 34924395 DOI: 10.3233/jad-215423] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Evidence summaries for efficacy and safety of frequently employed treatments of Alzheimer's disease (AD) are sparse. OBJECTIVE We aimed to perform an updated umbrella review to identify an efficacious and safe treatment for AD patients. METHODS We conducted a search for meta-analyses and systematic reviews on the Embase, PubMed, The Cochrane Library, and Web of Science to address this knowledge gap. We examined the cognitive functions, behavioral symptoms, global clinical assessment, and Activities of Daily Living as efficacy endpoints, and the incidence of adverse events as safety profiles. RESULTS Sixteen eligible papers including 149 studies were included in the umbrella review. The results showed that AChE inhibitors (donepezil, galantamine, rivastigmine, Huperzine A), Ginkgo biloba, and cerebrolysin appear to be beneficial for cognitive, global performances, and activities of daily living in patients with AD. Furthermore, anti-Aβ agents are unlikely to have an important effect on slowing cognitive or functional impairment in mild to moderate AD. CONCLUSION Our study demonstrated that AChE inhibitors, Ginkgo biloba, and cerebrolysin are the optimum cognitive and activities of daily living medication for patients with AD.
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Affiliation(s)
- Fangcheng Fan
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Hua Liu
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Xiaojie Shi
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Yangwen Ai
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Qingshan Liu
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Yong Cheng
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China.,College of Life and Environmental Sciences, Minzu University of China, Beijing, China
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Liu X, Zhang Y, Wang Y, Qian T. Inflammatory Response to Spinal Cord Injury and Its Treatment. World Neurosurg 2021; 155:19-31. [PMID: 34375779 DOI: 10.1016/j.wneu.2021.07.148] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 01/14/2023]
Abstract
Spinal cord injury (SCI), as one of the intractable diseases in clinical medicine, affects thousands of human beings, and the pathologic changes after injury have been a hot spot for exploration in clinical medicine. With the development of new treatments, the survival of patients has shown an increasing trend; however, the inflammatory response after injury has not yet been effectively controlled. SCI is divided into primary injury and secondary injury according to the time of injury and pathophysiologic changes. Primary injury occurs immediately and the damage to the injury site is irreversible; however, secondary injury occurs after primary injury and involves pathologic changes at the cellular and molecular levels, which are reversible. Thus, the inflammatory response from secondary injuries has become the main direction of research. In recent years, a complex pathophysiologic mechanism has gradually been unveiled, which has been followed by an upgrade of treatment methods. This article describes the mechanisms of the inflammatory response after SCI and the mainstream treatment modalities. Also, neuroprotective agents and nerve regeneration agent agents are commonly used in the treatment of SCI; the therapeutic mechanism and classification of these agents are reviewed.
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Affiliation(s)
- Xiangyu Liu
- Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China
| | - Yiwen Zhang
- Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China
| | - Yitong Wang
- Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China
| | - Taibao Qian
- Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China.
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Bogolepova A, Vasenina E, Gomzyakova N, Gusev E, Dudchenko N, Emelin A, Zalutskaya N, Isaev R, Kotovskaya Y, Levin O, Litvinenko I, Lobzin V, Martynov M, Mkhitaryan E, Nikolay G, Palchikova E, Tkacheva O, Cherdak M, Chimagomedova A, Yakhno N. Clinical Guidelines for Cognitive Disorders in Elderly and Older Patients. Zh Nevrol Psikhiatr Im S S Korsakova 2021. [DOI: 10.17116/jnevro20211211036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Woo PYM, Ho JWK, Ko NMW, Li RPT, Jian L, Chu ACH, Kwan MCL, Chan Y, Wong AKS, Wong HT, Chan KY, Kwok JCK. Randomized, placebo-controlled, double-blind, pilot trial to investigate safety and efficacy of Cerebrolysin in patients with aneurysmal subarachnoid hemorrhage. BMC Neurol 2020; 20:401. [PMID: 33143640 PMCID: PMC7607674 DOI: 10.1186/s12883-020-01908-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background There are limited neuroprotective treatment options for patients with aneurysmal subarachnoid hemorrhage (SAH). Cerebrolysin, a brain-specific proposed pleiotropic neuroprotective agent, has been suggested to improve global functional outcomes in ischemic stroke. We investigated the efficacy, safety and feasibility of administering Cerebrolysin for SAH patients. Methods This was a prospective, randomized, double-blind, placebo-controlled, single-center, parallel-group pilot study. Fifty patients received either daily Cerebrolysin (30 ml/day) or a placebo (saline) for 14 days (25 patients per study group). The primary endpoint was a favorable Extended Glasgow Outcome Scale (GOSE) of 5 to 8 (moderate disability to good recovery) at six-months. Secondary endpoints included the modified Ranking Scale (mRS), the Montreal Cognitive Assessment (MOCA) score, occurrence of adverse effects and the occurrence of delayed cerebral ischemia (DCI). Results No severe adverse effects or mortality attributable to Cerebrolysin were observed. No significant difference was detected in the proportion of patients with favorable six-month GOSE in either study group (odds ratio (OR): 1.49; 95% confidence interval (CI): 0.43–5.17). Secondary functional outcome measures for favorable six-month recovery i.e. a mRS of 0 to 3 (OR: 3.45; 95% CI 0.79–15.01) were comparable for both groups. Similarly, there was no difference in MOCA neurocognitive performance (p-value: 0.75) and in the incidence of DCI (OR: 0.85 95% CI: 0.28–2.59). Conclusions Use of Cerebrolysin in addition to standard-of-care management of aneurysmal SAH is safe, well tolerated and feasible. However, the neutral results of this trial suggest that it does not improve the six-month global functional performance of patients. Clinical trial registration Name of Registry: ClinicalTrials.gov Trial Registration Number: NCT01787123. Date of Registration: 8th February 2013.
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Affiliation(s)
- Peter Y M Woo
- Department of Neurosurgery, Kwong Wah Hospital, Room CS11-01, 11th Floor, 25 Waterloo Road, Yaumatei, Hong Kong, China.
| | - Joanna W K Ho
- Department of Neurosurgery, Kwong Wah Hospital, Room CS11-01, 11th Floor, 25 Waterloo Road, Yaumatei, Hong Kong, China
| | - Natalie M W Ko
- Department of Neurosurgery, Kwong Wah Hospital, Room CS11-01, 11th Floor, 25 Waterloo Road, Yaumatei, Hong Kong, China
| | - Ronald P T Li
- Department of Neurosurgery, Kwong Wah Hospital, Room CS11-01, 11th Floor, 25 Waterloo Road, Yaumatei, Hong Kong, China
| | - Leo Jian
- Department of Neurosurgery, Kwong Wah Hospital, Room CS11-01, 11th Floor, 25 Waterloo Road, Yaumatei, Hong Kong, China
| | - Alberto C H Chu
- Department of Neurosurgery, Kwong Wah Hospital, Room CS11-01, 11th Floor, 25 Waterloo Road, Yaumatei, Hong Kong, China
| | - Marco C L Kwan
- Department of Neurosurgery, Kwong Wah Hospital, Room CS11-01, 11th Floor, 25 Waterloo Road, Yaumatei, Hong Kong, China
| | - Yung Chan
- Department of Neurosurgery, Kwong Wah Hospital, Room CS11-01, 11th Floor, 25 Waterloo Road, Yaumatei, Hong Kong, China
| | - Alain K S Wong
- Department of Neurosurgery, Kwong Wah Hospital, Room CS11-01, 11th Floor, 25 Waterloo Road, Yaumatei, Hong Kong, China
| | - Hoi-Tung Wong
- Department of Neurosurgery, Kwong Wah Hospital, Room CS11-01, 11th Floor, 25 Waterloo Road, Yaumatei, Hong Kong, China
| | - Kwong-Yau Chan
- Department of Neurosurgery, Kwong Wah Hospital, Room CS11-01, 11th Floor, 25 Waterloo Road, Yaumatei, Hong Kong, China
| | - John C K Kwok
- Department of Neurosurgery, Kwong Wah Hospital, Room CS11-01, 11th Floor, 25 Waterloo Road, Yaumatei, Hong Kong, China
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Gavrilova SI, Alvarez A. Cerebrolysin in the therapy of mild cognitive impairment and dementia due to Alzheimer's disease: 30 years of clinical use. Med Res Rev 2020; 41:2775-2803. [PMID: 32808294 DOI: 10.1002/med.21722] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022]
Abstract
Alzheimer's disease (AD) is the most common neurocognitive disorder and a global health problem. The prevalence of AD is growing dramatically, especially in low- and middle-income countries, and will reach 131.5 million cases worldwide by 2050. Therefore, developing a disease-modifying therapy capable of delaying or even preventing the onset and progression of AD has become a world priority, and is an unmet need. The pathogenesis of AD, considered as the result of an imbalance between resilience and risk factors, begins many years before the typical clinical picture develops and involves multiple pathophysiological mechanisms. Since the pathophysiology of AD is multifactorial, it is not surprising that all attempts done to modify the disease course with drugs directed towards a single therapeutic target have been unsuccessful. Thus, combined modality therapy, using multiple drugs with a single mechanism of action or multi-target drugs, appears as the most promising strategy for both effective AD therapy and prevention. Cerebrolysin, acting as a multitarget peptidergic drug with a neurotrophic mode of action, exerts long-lasting therapeutic effects on AD that could reflect its potential utility for disease modification. Clinical trials demonstrated that Cerebrolysin is safe and efficacious in the treatment of AD, and may enhance and prolong the efficacy of cholinergic drugs, particularly in moderate to advanced AD patients. In this review, we summarize advances of therapeutic relevance in the pathogenesis and the biomarkers of AD, paying special attention to neurotrophic factors, and present results of preclinical and clinical investigations with Cerebrolysin in AD.
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Affiliation(s)
- Svetlana I Gavrilova
- Department of Geriatric Psychiatry, Cognitive Disorders and Alzheimer's Disease Unit, Mental Health Research Center, Moscow, Russia
| | - Anton Alvarez
- Department of Neuropsychiatry, Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain.,Clinical Research Department, QPS Holdings, A Coruña, Spain
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Alvarez XA, Alvarez I, Martinez A, Romero I, Benito C, Suarez I, Mourente S, Fantini M, Figueroa J, Aleixandre M, Linares C, Muresanu D, Winter S, Moessler H. Serum VEGF Predicts Clinical Improvement Induced by Cerebrolysin Plus Donepezil in Patients With Advanced Alzheimer's Disease. Int J Neuropsychopharmacol 2020; 23:581-586. [PMID: 32640027 PMCID: PMC7710915 DOI: 10.1093/ijnp/pyaa046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 12/12/2022] Open
Abstract
Serum vascular endothelial growth factor (VEGF) increases with Alzheimer's disease (AD) severity and may prevent cognitive decline. However, information on the influence of AD drug therapy on circulating VEGF is limited. This study assessed changes in serum VEGF levels and its association with clinical and functional responses in mild to moderate AD patients who were treated with Cerebrolysin, donepezil, or the combined therapy in a randomized, controlled trial. Treatment with Cerebrolysin plus donepezil reduced elevated serum VEGF levels and improved functioning and cognition significantly compared with donepezil alone in patients with advanced AD, and treatment differences were more pronounced in patients with higher VEGF levels. Our results indicate that the combined therapy reversed the increase of serum VEGF in advanced AD, which was associated with cognitive and functional responses, particularly in patients with high baseline VEGF.
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Affiliation(s)
- X Anton Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain ,Clinical Research Department, QPS Holdings, A Coruña, Spain,Correspondence: Dr X. Antón Alvarez, MD, PhD, Medinova Institute of Neurosciences, Clinica RehaSalud, 15006-A Coruña, Spain ()
| | - Irene Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain
| | - Antia Martinez
- Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Iria Romero
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain ,Clinical Research Department, QPS Holdings, A Coruña, Spain
| | - Concha Benito
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain
| | - Irene Suarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain
| | | | | | - Jesús Figueroa
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain ,Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | | | - Dafin Muresanu
- Department of Clinical Neurosciences, University of Medicine and Pharmacy “Iuliu Hațieganu,” Cluj-Napoca, Romania
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Gromova OA, Torshin IY, Zgoda VG, Tikhonova OV. [An analysis of the peptide composition of a 'light' peptide fraction of cerebrolysin]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:75-83. [PMID: 31626174 DOI: 10.17116/jnevro201911908175] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To analyze the peptide composition of a light peptide fraction of cerebrolysin. MATERIAL AND METHODS Mass spectrometry (MS) with orbital ion traps and modern de novo MS-sequencing algorithms was performed. RESULTS The amino acid sequences of 14 635 peptides corresponding to the 1643 porcine proteome neuronal proteins are identified. An analysis of the human proteome annotation shows that these peptides can mimic the corresponding human peptides. In particular, 405 peptide fragments correspond to 300 known biologically active peptides, including fragments of antibacterial peptides (defensins, histatins), immunomodulatory (granulin, manserin) and vasoactive (endothelin, VIP) peptides. At the same time, 8953 of 14 635 peptides can modulate the activity of 275 human signaling proteins, including kinases CDK1, CDK2, TGFBR2, GSK3, MTOR, pro-apoptotic caspases CASP1, CASP3 and CASP6 etc. The results confirm the presence of Leu- and Met-enkephalins, fragments of neuropeptide orexin, neuropeptide VF, galanin and nerve growth factor that have a neurotrophic effect. CONCLUSION The results of a proteomic study of the peptide composition of cerebrolysin indicate the widest range of molecular mechanisms responsible for the clinical efficacy of this drug.
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Affiliation(s)
- O A Gromova
- Federal Research Center 'Computer Science and Control' of the Russian Academy of Sciences, Moscow, Russia; Big Data Storage and Analysis Center, Lomonosov Moscow State University, Moscow, Russia
| | - I Yu Torshin
- Federal Research Center 'Computer Science and Control' of the Russian Academy of Sciences, Moscow, Russia; Big Data Storage and Analysis Center, Lomonosov Moscow State University, Moscow, Russia
| | - V G Zgoda
- Orekhovich Research Institute of Biomedical Chemistry, Moscow, Russia
| | - O V Tikhonova
- Orekhovich Research Institute of Biomedical Chemistry, Moscow, Russia
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Abstract
BACKGROUND Although vascular dementia is the second most common cause of dementia globally, evidence-based treatments are still lacking. Cerebrolysin is a porcine brain-derived preparation that is said to have neurotrophic and neuroprotective activity. In many parts of the world Cerebrolysin, given as a series of daily intravenous infusions, is used as a potential intervention for vascular dementia. A previous Cochrane Review on Cerebrolysin in vascular dementia yielded inconsistent results. We wished to update the review to add new studies from the international literature and employ contemporary methods for appraising the strength of the evidence. This is the first update of a review first published in 2013. OBJECTIVES Primary: to assess the effect of Cerebrolysin on cognitive function, global function, and all-cause mortality in people living with vascular dementia. Secondary: to assess the adverse effects of Cerebrolysin and to assess the effect of Cerebrolysin on quality of life and caregiver burden. SEARCH METHODS We searched ALOIS, MEDLINE, Embase, PsycINFO, CINAHL, ISI Web of Knowledge, LILACS, the Cochrane Library, ClinicalTrials.gov, and the WHO ICTRP on 16 June 2017, 9 May 2018, and 9 May 2019. We expanded the search by adding four Chinese databases, searched from 1 January 2012 to 19 May 2019. We checked bibliographies of relevant papers identified and contacted pharmaceutical companies, trial authors, and experts in the field to identify any additional published or unpublished data. SELECTION CRITERIA We included all randomised controlled trials of Cerebrolysin used in people living with vascular dementia. We applied no language restriction. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion and evaluated their methodological quality. Data were extracted and analysed using mean differences (MDs) or standardised mean differences (SMDs) with 95% confidence intervals (95% CI) for continuous outcomes. We reported dichotomous outcomes as risk ratio (RR) with 95% CI. We assessed the strength of the available evidence using the GRADE approach. MAIN RESULTS We identified six randomised controlled trials with a total of 597 participants that were eligible for inclusion in the 2013 review. No new studies were eligible for inclusion in this update. Participants in the included studies, where dementia severity was reported, had mild to moderate severity of vascular dementia (four trials). The included studies tested varying doses and duration of Cerebrolysin treatment. Follow-up ranged from 15 days to three years. Five of included studies were conducted in China (three studies), Russia (one study), and Romania (one study), while relevant information of other study was unclear. Where details of funding were available, all studies were supported by the pharmaceutical industry (three studies). Cognitive function was measured using the Mini-Mental State Examination (MMSE) or Alzheimer's Disease Assessment Scale Cognitive Subpart, extended version (ADAS-cog+). Combining the MMSE and ADAS-cog+ data (three studies, 420 people), there was a beneficial effect of Cerebrolysin (SMD 0.36, 95% CI 0.13 to 0.58; very low-quality evidence). Global function was measured by Clinician's Interview-Based Impression of Change plus Caregiver Input (CIBIC+) or Investigator's Clinical Global Impression (CGI). We assessed response rates on these measures (the proportion of participants with a CIBIC+ score of < 3; or at least moderate improvement of the CGI rating at the last visit). There was a beneficial effect of Cerebrolysin (two studies, 379 participants, RR 2.69, 95% CI 1.82 to 3.98; very low-quality evidence). Only one trial described mortality and reported no deaths. Four studies reported adverse events; data from two studies (379 people) were in a format that permitted meta-analysis, and there was no difference in rates of adverse effects (RR 0.91, 95% CI 0.29 to 2.85; very low-quality evidence). No studies reported on quality of life or caregiver burden. AUTHORS' CONCLUSIONS Courses of intravenous Cerebrolysin improved cognition and general function in people living with vascular dementia, with no suggestion of adverse effects. However, these data are not definitive. Our analyses were limited by heterogeneity, and the included papers had high risk of bias. If there are benefits of Cerebrolysin, the effects may be too small to be clinically meaningful. There have been no new studies of Cerebrolysin in vascular dementia since the last Cochrane Review. Cerebrolysin continues to be used and promoted as a treatment for vascular dementia, but the supporting evidence base is weak. Adequately powered, methodologically robust trials are needed to properly assess the effects of Cerebrolysin in vascular dementia.
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Affiliation(s)
- Shuhui Cui
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37 Guo Xue XiangChengduSichuanChina610041
| | - Ning Chen
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37 Guo Xue XiangChengduSichuanChina610041
| | - Mi Yang
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37 Guo Xue XiangChengduSichuanChina610041
| | - Jian Guo
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37 Guo Xue XiangChengduSichuanChina610041
| | - Muke Zhou
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37 Guo Xue XiangChengduSichuanChina610041
| | - Cairong Zhu
- School of Public Health, Sichuan UniversityEpidemic Disease & Health Statistics DepartmentChengduChina
| | - Li He
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37 Guo Xue XiangChengduSichuanChina610041
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Mustapha M, Nassir CMNCM, Aminuddin N, Safri AA, Ghazali MM. Cerebral Small Vessel Disease (CSVD) - Lessons From the Animal Models. Front Physiol 2019; 10:1317. [PMID: 31708793 PMCID: PMC6822570 DOI: 10.3389/fphys.2019.01317] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 09/30/2019] [Indexed: 12/28/2022] Open
Abstract
Cerebral small vessel disease (CSVD) refers to a spectrum of clinical and imaging findings resulting from pathological processes of various etiologies affecting cerebral arterioles, perforating arteries, capillaries, and venules. Unlike large vessels, it is a challenge to visualize small vessels in vivo, hence the difficulty to directly monitor the natural progression of the disease. CSVD might progress for many years during the early stage of the disease as it remains asymptomatic. Prevalent among elderly individuals, CSVD has been alarmingly reported as an important precursor of full-blown stroke and vascular dementia. Growing evidence has also shown a significant association between CSVD's radiological manifestation with dementia and Alzheimer's disease (AD) pathology. Although it remains contentious as to whether CSVD is a cause or sequelae of AD, it is not far-fetched to posit that effective therapeutic measures of CSVD would mitigate the overall burden of dementia. Nevertheless, the unifying theory on the pathomechanism of the disease remains elusive, hence the lack of effective therapeutic approaches. Thus, this chapter consolidates the contemporary insights from numerous experimental animal models of CSVD, to date: from the available experimental animal models of CSVD and its translational research value; the pathomechanical aspects of the disease; relevant aspects on systems biology; opportunities for early disease biomarkers; and finally, converging approaches for future therapeutic directions of CSVD.
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Affiliation(s)
- Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | | | - Niferiti Aminuddin
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Department of Basic Medical Sciences, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia
| | - Amanina Ahmad Safri
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Mazira Mohamad Ghazali
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Nanowired delivery of cerebrolysin with neprilysin and p-Tau antibodies induces superior neuroprotection in Alzheimer's disease. PROGRESS IN BRAIN RESEARCH 2019; 245:145-200. [DOI: 10.1016/bs.pbr.2019.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Gromova OA, Torshin IY, Stakhovskaia LV, Maiorova LA, Ostrenko KS. Comparative studies of neurotrophic drugs based on brain hydrolysates. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:134-140. [DOI: 10.17116/jnevro2019119101134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ghaffarpasand F, Torabi S, Rasti A, Niakan MH, Aghabaklou S, Pakzad F, Beheshtian MS, Tabrizi R. Effects of cerebrolysin on functional outcome of patients with traumatic brain injury: a systematic review and meta-analysis. Neuropsychiatr Dis Treat 2018; 15:127-135. [PMID: 30643411 PMCID: PMC6311329 DOI: 10.2147/ndt.s186865] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) remains a main public health problem being associated with high mortality and morbidity. The functional outcome of TBI remains unfavorable despite several surgical and medical therapies. Cerebrolysin is a neuropeptide with potential neuroregenerative entities. OBJECTIVE The aim of the current systematic review and meta-analysis was to investigate the effects of cerebrolysin on functional outcome in patients with moderate and severe TBI. DATA SOURCES Online databases used included Medline, Scopus, EMBASE, Google Scholar, Web of Science, and Cochrane Library. STUDY ELIGIBILITY CRITERIA All the relevant studies with randomized clinical trial and cohort design evaluating the effects of intravenous cerebrolysin vs placebo on functional outcome of patients with TBI within the English literature up to October 2018 were included. STUDY APPRAISAL AND SYNTHESIS METHODS The articles were reviewed by two independent authors and the data were extracted to a data sheet. I 2 and Cochran's Q-statistics were used to assess heterogeneity. Based on the presence of significant heterogeneity across included studies, data were pooled using random-effects model with Dersimonian-Laird method and presented as standardized mean differences (SMDs) and corresponding 95% CI. RESULTS Five articles (5,685 participants) were included in the current meta-analysis. The overall pooled findings using random-effects models among patients with TBI indicated that intravenous administration of cerebrolysin significantly increased Glasgow Outcome Scale score (SMD =0.30; 95% CI: 0.18 to 0.42; P<0.001; I 2: 87.8%) and decreased modified Rankin Scale score (SMD =-0.29; 95% CI: -0.42 to 0.16; P=0.05; I 2: 89.6%). LIMITATIONS The results are mainly based on cohort studies and there is a lack of clinical trials in the literature. There is also heterogeneity among the studies regarding the dosage and duration of administration and the measurement of functional outcome. CONCLUSION The results of the current study revealed that intravenous administration of cerebrolysin is associated with improved functional outcome in patients with TBI measured by the Glasgow Outcome Scale and the modified Rankin Scale scores.
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Affiliation(s)
- Fariborz Ghaffarpasand
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Torabi
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Ali Rasti
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Niakan
- Trauma Research Center, Rajaei Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - Sara Aghabaklou
- Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Pakzad
- Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Tabrizi
- Health Policy Research Center, Institute of Health, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
Alzheimer's disease and vascular dementia are two most common causes of dementia in late life. The combination of Alzheimer's type dementia and vascular dementia is the third most common form of dementia, especially in the elderly. Most clinical forms of dementia are characterized by the presence of 'overlap' symptoms of both neurodegenerative and vascular pathology, which makes it expedient to consider mixed dementia as a separate entity characterized by clinical presentations, course and the rate of progression of cognitive decline. Despite the lack of clinical guidelines for management of patients with mixed dementia, it seems appropriate to use strategies that have shown their effectiveness in various types of cognitive impairment.
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Affiliation(s)
- G R Tabeeva
- Sechenov First Moscow State Medical University, Moscow, Russia
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27
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Stepanichev MY, Onufriev MV, Peregud DI, Lazareva NA, Moiseeva YV, Nesterenko AN, Novikova MR, Stefanova NA, Kolosova NG, Gulyaeva NV. The Effects of Cortexin on Free-Radical Oxidation and Inflammatory Processes in Rats with Normal and Accelerated Aging. NEUROCHEM J+ 2018. [DOI: 10.1134/s1819712418020113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Malashenkova IK, Krynskiy SA, Hailov NA, Ogurtsov DP, Selezneva ND, Fedorova YB, Ponomareva EV, Kolyhalov IV, Gavrilova SI, Didkovsky NA. Anti-inflammatory effects of neurotrophic therapy (a pilot study). Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:39-44. [DOI: 10.17116/jnevro20181185139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
In the last few years, exciting properties have emerged regarding the activation, signaling, mechanisms of action, and therapeutic targeting of the two types of neurotrophin receptors: the p75NTR with its intracellular and extracellular peptides, the Trks, their precursors and their complexes. This review summarizes these new developments, with particular focus on neurodegenerative diseases. Based on the evolving knowledge, innovative concepts have been formulated regarding the pathogenesis of these diseases, especially the Alzheimer's and two other, the Parkinson's and Huntington's diseases. The medical progresses include original procedures of diagnosis, started from studies in mice and now investigated for human application, based on innovative classes of receptor agonists and blockers. In parallel, comprehensive studies have been and are being carried out for the development of drugs. The relevance of these studies is based on the limitations of the therapies employed until recently, especially for the treatment of Alzheimer's patients. Starting from well known drugs, previously employed for non-neurodegenerative diseases, the ongoing progress has lead to the development of small molecules that cross rapidly the blood-brain barrier. Among these molecules the most promising are specific blockers of the p75NTR receptor. Additional drugs, that activate Trk receptors, were shown effective against synaptic loss and memory deficits. In the near future such approaches, coordinated with treatments with monoclonal antibodies and with developments in the microRNA field, are expected to improve the therapy of neurodegenerative diseases, and may be relevant also for other human disease conditions.
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Affiliation(s)
- Jacopo Meldolesi
- Department of Neuroscience, Vita-Salute San Raffaele University and Scientific Institute San Raffaele, via Olgettina 58, 20132 Milan, Italy.
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Khalili H, Niakan A, Ghaffarpasand F. Effects of cerebrolysin on functional recovery in patients with severe disability after traumatic brain injury: A historical cohort study. Clin Neurol Neurosurg 2017; 152:34-38. [DOI: 10.1016/j.clineuro.2016.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/11/2016] [Accepted: 11/12/2016] [Indexed: 11/29/2022]
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Intranasal Cerebrolysin Attenuates Learning and Memory Impairments in D-galactose-Induced Senescence in Mice. Exp Gerontol 2016; 87:16-22. [PMID: 27894939 DOI: 10.1016/j.exger.2016.11.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/11/2016] [Accepted: 11/21/2016] [Indexed: 11/20/2022]
Abstract
Neurotrophic factors are currently being considered as pro-cognitive therapeutic approaches for management of cognitive deficits. This study aims to evaluate the effects of intranasal (i.n.) or intraperitoneal (i.p.) administration of Cerebrolysin (CBL) (as a mixture of neurotrophic factors) on the d-galactose-induced oxidative stress, apoptosis and memory as well as learning impairment in mice. For this purpose, CBL (1, 2.5, 5 ml/kg/i.p.) or (1 ml/kg/i.n.), were administrated daily in d-galactose-received (100 mg/kg/subcutaneous (s.c.)) mice model of aging for eight weeks. Spatial and recognition memories were assessed by the Morris water maze and novel object recognition tasks. Brain and blood of animals were analysed for oxidative stress biomarkers including malondialdehyde, total antioxidant capacity, glutathione peroxidase and superoxide dismutase. Apoptosis rate in the hippocampus was evaluated by TUNEL staining of brain tissue. 5 ml/kg/i.p. dose of CBL increased the locomotor activity but, 1 ml/kg/i.p. dose didn't show detectable behavioural or molecular effects on aged mice. Treatment with 2.5 ml/kg/i.p. and 1 ml/kg/i.n. doses attenuated d-galactose-impaired spatial and recognition memories. Results showed an obvious increase in the antioxidant biomarkers and decrease in the malondialdehyde levels both in the blood and brain of aged mice in 2.5 ml/kg/i.p. dose, and only in the brain in 1 ml/kg/i.n. dose of CBL. Anti-apoptotic effects also were seen in the same dose/rout of CBL administration in aged animals. This study proves the usefulness of i.n. CBL administration as a non-invasive and efficient method of drug delivery to the brain to improve aging-induced oxidative stress, apoptosis and learning as well as memory impairment.
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Alvarez XA, Alvarez I, Iglesias O, Crespo I, Figueroa J, Aleixandre M, Linares C, Granizo E, Garcia-Fantini M, Marey J, Masliah E, Winter S, Muresanu D, Moessler H. Synergistic Increase of Serum BDNF in Alzheimer Patients Treated with Cerebrolysin and Donepezil: Association with Cognitive Improvement in ApoE4 Cases. Int J Neuropsychopharmacol 2016; 19:pyw024. [PMID: 27207906 PMCID: PMC4926802 DOI: 10.1093/ijnp/pyw024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/11/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Low circulating brain derived neurotrophic factor may promote cognitive deterioration, but the effects of neurotrophic and combination drug therapies on serum brain derived neurotrophic factor were not previously investigated in Alzheimer's disease. METHODS We evaluated the effects of Cerebrolysin, donepezil, and the combined therapy on brain derived neurotrophic factor serum levels at week 16 (end of Cerebrolysin treatment) and week 28 (endpoint) in mild-to-moderate Alzheimer's disease patients. RESULTS Cerebrolysin, but not donepezil, increased serum brain derived neurotrophic factor at week 16, while the combination therapy enhanced it at both week 16 and study endpoint. Brain derived neurotrophic factor responses were significantly higher in the combination therapy group than in donepezil and Cerebrolysin groups at week 16 and week 28, respectively. Brain derived neurotrophic factor increases were greater in apolipoprotein E epsilon-4 allele carriers, and higher brain derived neurotrophic factor levels were associated with better cognitive improvements in apolipoprotein E epsilon-4 allele patients treated with Cerebrolysin and the combined therapy. CONCLUSION Our results indicate a synergistic action of Cerebrolysin and donepezil to increase serum brain derived neurotrophic factor and delaying cognitive decline, particularly in Alzheimer's disease cases with apolipoprotein E epsilon-4 allele.
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Affiliation(s)
- X Anton Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu).
| | - Irene Alvarez
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Olalla Iglesias
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Ignacio Crespo
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Jesus Figueroa
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Manuel Aleixandre
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Carlos Linares
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Elias Granizo
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Manuel Garcia-Fantini
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Jose Marey
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Eliezer Masliah
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Stefan Winter
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Dafin Muresanu
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
| | - Herbert Moessler
- Medinova Institute of Neurosciences, Clinica RehaSalud, A Coruña, Spain (Dr Alvarez, Ms Alvarez, Ms Iglesias, Mr Crespo, and Dr Figueroa); Clinical Research Department, QPS Holdings, A Coruña, Spain (Dr Alvarez); Rehabilitation Department, Hospital Clinico Universitario, Santiago de Compostela, Spain (Dr Figueroa); School of Psychology, Granada University, Granada, Spain (Dr Aleixandre); Complejo Asistencial HHSCJ, Málaga, Spain (Drs Linares and Granizo); Department of Neurosurgery, Hospital HM Modelo, A Coruña, Spain (Dr Garcia-Fantini); Department of Neurology, Hospital Clinico Universitario, A Coruña, Spain (Dr Marey); Departments of Neurosciences and Pathology, School of Medicine, University of California San Diego, La Jolla, CA (Dr Masliah); Ever NeuroPharma, Unterach, Austria (Drs Winter and Moessler); Department of Clinical Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania (Dr Muresanu); and ''RoNeuro'' Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania (Dr Muresanu)
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Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, Cedazo-Minguez A, Dubois B, Edvardsson D, Feldman H, Fratiglioni L, Frisoni GB, Gauthier S, Georges J, Graff C, Iqbal K, Jessen F, Johansson G, Jönsson L, Kivipelto M, Knapp M, Mangialasche F, Melis R, Nordberg A, Rikkert MO, Qiu C, Sakmar TP, Scheltens P, Schneider LS, Sperling R, Tjernberg LO, Waldemar G, Wimo A, Zetterberg H. Defeating Alzheimer's disease and other dementias: a priority for European science and society. Lancet Neurol 2016; 15:455-532. [DOI: 10.1016/s1474-4422(16)00062-4] [Citation(s) in RCA: 1001] [Impact Index Per Article: 125.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/06/2015] [Accepted: 02/09/2016] [Indexed: 12/15/2022]
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