The effect of a cerebral vasodilator, vinpocetine, on cerebral vascular resistance evaluated by the Doppler ultrasonic technique in patients with cerebrovascular diseases

Effect of vinpocetine (cognitol™) on cognitive performances of a nigerian population

BACKGROUND

Chronic medical disorders are often complicated by cognitive impairments, making medical intervention that can alleviate cognitive disturbances desirable. Vinpocetine enhances cerebral utilization of oxygen and glucose and consequently improves cerebral functions including memory.

AIM

This study assessed the efficacy of vinpocetine (Cognitol™) in improving memory and concentration in cognitively impaired patients.

SUBJECTS AND METHODS

A prospective analytical study of 56 cognitively impaired patients compared with age, sex and level of education matched 56 controls. Cognitive performance was assessed with the Short Blessed Test, which was pilot-tested. Baseline cognitive performances of the patients and controls were obtained and thereafter cognitive performances of the patients were assessed at 6 and 12 weeks after administration of vinpocetine at a dose of 5 mg twice-a-day. Comparative analysis of their performances at baseline was done using the Student t-test, while the improvement in patients' performances and effect of disease variables on cognitive performances were analyzed with one-way analysis of variance and likelihood ratio analysis respectively.

RESULTS

The mean (standard deviation) [SD] ages of the cognitively impaired patients (56/112) and controls (56/112) were 49.5 (18.9) and 53.8 (15.8) years respectively (P = 0.19; 95% confidence interval [CI]: 2.2-10.8). The pilot study yielded an optimal cut-off error score of 6 with a sensitivity of 71.4%, specificity of 96.4% and accuracy of 83.9%. Patients performed significantly worse than the controls (P < 0.001; 95% CI 6.7-11.4). There were significant improvements in memory and concentration with vinpocetine therapy (P < 0.05). The clinical variables of the patients had no effect on the trend of cognitive performances.

CONCLUSIONS

Vinpocetine was effective in improving memory and concentration of patients with epilepsy and dementia although the efficacy was minimal in demented patients.

Effects of vinpocetine on the redistribution of cerebral blood flow and glucose metabolism in chronic ischemic stroke patients: a PET study

The pharmacological effects of the neuroprotective drug vinpocetine, administered intravenously in a 14-day long treatment regime, on the cerebral blood flow and cerebral glucose metabolism in chronic ischemic stroke patients (n=13) were studied with positron emission tomography in a double-blind design. The regional and global cerebral metabolic rates of glucose (CMRglc) and cerebral blood flow (CBF) as well as vital physiological parameters, clinical performance scales, and transcranial Doppler parameters were measured before and after the treatment period in patient groups treated with daily intravenous infusion with or without vinpocetine. While the global CMRglc values did not change markedly as a result of the infusion treatment with (n=6) or without (n=7) vinpocetine, the global CBF increased and regional CMRglc and CBF values showed marked changes in several brain structures in both cases, with more accentuated changes when the infusion contained vinpocetine. In the latter case the highest rCBF changes were observed in those structures in which the highest regional uptake of labelled vinpocetine was measured in other PET studies (thalamus and caudate nucleus: increases amounting to 36% and 37%, respectively). The findings indicate that a 2-week long intravenous vinpocetine treatment can contribute effectively to the redistribution of rCBF in chronic ischemic stroke patients. The effects are most pronounced in those brain regions with the highest uptake of the drug.

Preparation, evaluation, and NMR characterization of vinpocetine microemulsion for transdermal delivery

A novel microemulsion was prepared to increase the solubility and the in vitro transdermal delivery of poorly water-soluble vinpocetine. The correlation between the transdermal permeation rate and structural characteristics of vinpocetine microemulsion was investigated by pulsed field gradient nuclear magnetic resonance (PFG-NMR). For the microemulsions, oleic acid was chosen as oil phase, PEG-8 glyceryl caprylate/caprate (Labrasol) as surfactant (S), purified diethylene glycol monoethyl ether (Transcutol P) as cosurfactant (CoS), and the double-distilled water as water phase. Pseudo-ternary phase diagrams were constructed to obtain the concentration range of each component for the microemulsion formation. The effects of various oils and different weight ratios of surfactant to cosurfactant (S/CoS) on the solubility and permeation rate of vinpocetine were investigated. Self-diffusion coefficients were determined by PFG-NMR in order to investigate the influence of microemulsion composition with the equal drug concentration on their transdermal delivery. Finally, the microemulsion containing 1% vinpocetine was optimized with 4% oleic acid, 20.5% Labrasol, 20.5% Transcutol P, and 55% double-distilled water (w/w), in which drug solubility was about 3160-fold higher compared to that in water and the apparent permeation rate across the excised rat skin was 36.4 +/- 2.1 microg/cm2/h. The physicochemical properties of the optimized microemulsion were examined for the pH, viscosity, refractive index, conductivity, and particle size distribution. The microemulsion was stable after storing more than 12 months at 25 degrees C. The irritation study showed that the optimized microemulsion was a nonirritant transdermal delivery system.

Autoradiographic evaluation of [11C]vinpocetine binding in the human postmortem brain

The main objective ofthe study was to evaluate with autoradiographic technique whether or not [11C]vinpocetine, a compound widely used in the prevention and treatment of cerebrovascular diseases (Cavinton, Gedeon Richter Ltd., Budapest), binds to specific sites in the human brain in post mortem human brain sections. Binding was assessed under four conditions: the incubation was performed using Tris-HCl buffer with or without the addition of salts (0.1% (weight/vol) ascorbic acid, 120 mM NaCl, 5 mM KCl, 2 mM CaCl2 and 1 mM MgCl2), with or without the addition of excess (10 microM) unlabelled vinpocetine. Measurements on digitized autoradiograms indicated that [11C]vinpocetine labelled all grey matter areas in the human brain to a similar extent and no significantly heterogeneous binding could be demonstrated among cortical or subcortical regions. The addition of excess unlabelled vinpocetine lowered the binding slightly in all regions. Although these results indicate that [11C]vinpocetine does not bind to human brain transmitter receptors or transporters with a high affinity (Ki < 10 nM), it cannot be ruled out that the compound binds to receptors and/or transporters with lower affinity.

In vitro antioxidant properties of pentoxifylline, piracetam, and vinpocetine

Oxygen-free radicals play an important role in several physiologic and pathophysiologic processes. In pathologic circumstances, they can modify and damage biologic systems. Because oxygen-free radicals are involved in a wide range of diseases (cerebrovascular, cardiovascular, etc.), scavenging these radicals should be considered as an important therapeutic approach. In our in vitro study, we investigated the antioxidant capacity of three drugs: pentoxiphylline (Sigma Aldrich, St. Louis, MO, USA) piracetam (Sigma Aldrich), and vinpocetine (Richter Gedeon RT, Budapest, Hungary). Phenazine methosulphate was applied to generate free radicals, increasing red blood cell rigidity. Filtration technique and potassium leaking were used to detect the cellular damage and the scavenging effect of the examined drugs. According to our results, at human therapeutic serum concentration, only vinpocetine (Richter Gedeon RT) had significant (p < 0.01) scavenging activity with a protective effect that increased further at higher concentrations. Pentoxiphylline (Sigma Aldrich) and piracetam (Sigma Aldrich) did not have significant antioxidant capacity at therapeutic concentrations, but increasing their concentrations (pentoxiphylline at 100-times, and piracetam at 10-times higher concentrations) led to a significant (p < 0.01) scavenger effect. Our findings suggest that this pronounced antioxidant effect of vinpocetine and even the milder scavenging capacity of pentoxiphylline and piracetam may be of value in the treatment of patients with cerebrovascular disorders, but merits further investigations.

Complementary and alternative medicine for glaucoma

Given the recent interest in complementary and alternative medicine (CAM), some patients may seek such treatments to supplement their traditional glaucoma management. The prevalence of CAM use for glaucoma is approximately 5%. We reviewed the literature to determine the potential benefit of various alternative treatments. Aside from a temporary osmotic effect from high dose intravenous ascorbic acid, there is no evidence that megavitamin supplementation has a beneficial effect on glaucoma. During exercise, autoregulation in healthy eyes seems to maintain a consistent blood flow rate to the optic nerve despite fluctuations in intraocular pressure (IOP). In a glaucomatous eye, the very modest IOP-lowering that follows exercise may be offset by the initial elevation in IOP that occurs when one first initiates exercise. At this time, there is no evidence to encourage or discourage the use of special diets, acupuncture, relaxation techniques, or therapeutic touch specifically for the treatment of glaucoma. Very little research has been done on the majority of herbal remedies with regard to their treatment of glaucoma. Marijuana can cause a profound lowering of IOP, but the high nonresponse rate, short half life, and significant toxicity are strong indicators that it is not an appropriate therapeutic agent. Ginkgo biloba and some other Chinese herbal remedies do not affect IOP, but may improve blood flow to the optic nerve and, as such, may have a beneficial effect on glaucoma. These agents have recognized toxicities. Although there are some well-designed studies of alternative treatments, many of the recommendations for using alternative treatments are currently unsupported by the data provided.

The nootropic drug vinpocetine modulates different types of potassium currents in molluscan neurons

Three types of high-threshold K+ currents were recorded in isolated neurons of the snail Helix pomatia using a two-microelectrode voltage clamp technique: transient K+ current (I(A)), delayed rectifier (I(KD)) and Ca2+-dependent K+ current (I(K(Ca))). Vinpocetine (1-100 microM) applied to the bath affected different types of K+ current in different ways: I(A) was increased (35+/-14%), I(KD) was moderately inhibited (20+/-9%) and I(K(Ca)) was strongly suppressed (45+/-15%). When I(A) and I(K(Ca)) were present in the same cell, vinpocetine exerted a dual effect on the total K+ current, depending on the amplitude of the test stimulus. In the presence of vinpocetine, the I-V curve crossed the control I-V curve. The inhibition of I(K(Ca)) by vinpocetine between 1 and 100 microM is unlikely to be a result of Ca2+ current (I(Ca)) suppression, as the latter was inhibited only at vinpocetine concentrations exceeding 300 microM. Dibutyryl cyclic GMP (dbcGMP) (but not dbcAMP) mimicked the effects of vinpocetine in the majority of cells tested (coefficient of correlation r=0.60, P<0.05, n=22). The data suggest that modulation of different types of K+ current in neuronal membrane can contribute, at least partially, to the nootropic effect of vinpocetine through the regulation of intracellular Ca2+ concentration.

Brain uptake and plasma metabolism of [11C]vinpocetine: a preliminary PET study in a cynomolgus monkey

Vinpocetine, a vinca alkaloid, is a widely used therapeutic agent in patients with acute and chronic stroke. To reveal the mechanisms of vinpocetine action in the brain, vinpocetine was labeled with 11C. Positron emission tomography (PET) was used to determine the uptake and distribution of [11C]vinpocetine in brain regions and the trunk of a cynomolgous monkey in two independent measurements. The concentration of vinpocetine and its labeled metabolites was determined in blood and plasma using high-performance liquid chromatography (HPLC). Almost identical measurements were obtained in the two independent studies. After intravenous administration, following an initial peak, the total concentration of radioactivity in blood was relatively stable with time, whereas the concentration of the unchanged compound decreased with time in an exponential manner. The uptake of [11C]vinpocetine in brain was rapid, and 5% of the radioactivity totally injected was present in the brain 2 minutes after drug administration, indicating that the compound entered the brain readily. The radioactivity uptake was heterogeneously distributed among brain regions and was highest in the thalamus, the basal ganglia, and certain neocortical regions. The high brain uptake and the heterogeneous regional distribution indicate that direct central nervous system (CNS) effects of vinpocetine must be considered as explanation for the therapeutic effects. The detailed exploration of this suggestion requires further studies.