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Bromley LE, Weinstock-Guttman B. Effects of Physical Therapy and Dalfampridine on Function and Quality of Life in Nonambulatory Individuals With Multiple Sclerosis: A Randomized Controlled Trial. Int J MS Care 2024; 26:98-103. [PMID: 38765304 PMCID: PMC11096856 DOI: 10.7224/1537-2073.2023-063] [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: 05/22/2024]
Abstract
BACKGROUND Decreases in mobility, quality of life (QOL) and cognition are commonly seen in people with multiple sclerosis (MS). Physical therapy (PT) and exercise have been shown to improve many symptoms in ambulatory individuals with MS; however, evidence in nonambulatory people with MS is lacking. Dalfampridine is a US Food and Drug Administration-approved medication for MS that treats impaired ambulation by enhancing nerve conduction. To our knowledge, no study has examined the combined effect of PT and dalfampridine and very few studies have examined dalfampridine's effect on function in individuals with more progressive disease. The purpose of this study was to examine the effectiveness of PT combined with dalfampridine or a placebo on function, QOL, and cognition in nonambulatory individuals with MS. In addition, we explored the benefits of PT in all participants to increase the extremely limited research in this population. METHODS Adults with MS were randomly assigned to receive dalfampridine (n = 13) or placebo (n = 14) for 12 weeks in conjunction with PT treatment 2 times a week. Function, QOL, and cognition were assessed at baseline, 6 weeks, and 12 weeks. RESULTS There was a significant time × group interaction for the Multiple Sclerosis Quality of Life-54 favoring the placebo group. Both groups significantly improved on the 9-Hole Peg Test (left arm only), sitting lateral reach (right), transferring from wheelchair to mat, and repeated sit to stand. CONCLUSIONS The addition of dalfampridine to physical therapy did not improve function, QOL, or cognitive processing speed. Importantly, this study demonstrated an overall benefit in function and QOL with physical therapy 2 times a week for 12 weeks for nonambulatory individuals with MS.
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Affiliation(s)
- Lacey E. Bromley
- From the Department of Physical Therapy, D’Youville University, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- the Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Li J, Xie Y, Zou X, Li Z, Liu W, Liu G, Ma M, Zheng Y. Ultrasonic/electrical dual stimulation response nanocomposite bioelectret for controlled precision drug release. Mater Today Bio 2023; 20:100665. [PMID: 37229214 PMCID: PMC10205496 DOI: 10.1016/j.mtbio.2023.100665] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023] Open
Abstract
Electret materials have attracted extensive attention because of their permanent polarization and electrostatic effect. However, it is one of problem that needs to be solved in biological application to manipulate the change of surface charge of electret by external stimulation. In this work, a drug-loaded electret with flexibility and no cytotoxicity was prepared under relatively mild conditions. The electret can release the charge through stress change and ultrasonic stimulation, and the drug release can be accurately controlled with the help of ultrasonic and electric double stimulation response. Here, the dipoles like particles of carnauba wax nanoparticles (nCW) are fixed in the matrix based on the interpenetrating polymer network structure, and "frozen" oriented dipolar particles that are treated by thermal polarization and cooled at high field strength. Subsequently, the charge density of the prepared composite electret can reach 101.1 nC/m2 at the initial stage of polarization and 21.1 nC/m2 after 3 weeks. In addition, the stimulated change of electret surface charge flow under cyclic tensile stress and cyclic compressive stress can generate a current of 0.187 nA and 0.105 nA at most. The ultrasonic stimulation results show that when the ultrasonic emission power was 90% (Pmax = 1200 W), the current of 0.472 nA can be generated. Finally, the drug release characteristics and biocompatibility of the nCW composite electret containing curcumin were tested. The results showed that it not only had the ability to accurately control the release by ultrasound, but also triggered the electrical effect of the material. The prepared drug loaded composite bioelectret provides a new way for the construction, design and testing of the bioelectret. Its ultrasonic and electrical double stimulation response can be accurately controlled and released as required, and it has broad application prospects.
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Affiliation(s)
- Junfei Li
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Yajie Xie
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Xiaoran Zou
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Zhengze Li
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Wenbo Liu
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
- Center for Medical Device Evaluation, National Medical Products Administration, Intellectual Property Publishing House Mansion, Qixiang Road, Haidian District, Beijing, China
| | - Guodong Liu
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Mengjiao Ma
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Yudong Zheng
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China
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4-Aminopyridine Induces Nerve Growth Factor to Improve Skin Wound Healing and Tissue Regeneration. Biomedicines 2022; 10:biomedicines10071649. [PMID: 35884953 PMCID: PMC9313269 DOI: 10.3390/biomedicines10071649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/30/2022] Open
Abstract
The discovery of ways to enhance skin wound healing is of great importance due to the frequency of skin lesions. We discovered that 4-aminopyridine (4-AP), a potassium channel blocker approved by the FDA for improving walking ability in multiple sclerosis, greatly enhances skin wound healing. Benefits included faster wound closure, restoration of normal-appearing skin architecture, and reinnervation. Hair follicle neogenesis within the healed wounds was increased, both histologically and by analysis of K15 and K17 expression. 4-AP increased levels of vimentin (fibroblasts) and alpha-smooth muscle actin (α-SMA, collagen-producing myofibroblasts) in the healed dermis. 4-AP also increased neuronal regeneration with increased numbers of axons and S100+ Schwann cells (SCs), and increased expression of SRY-Box Transcription Factor 10 (SOX10). Treatment also increased levels of transforming growth factor-β (TGF-β), substance P, and nerve growth factor (NGF), important promoters of wound healing. In vitro studies demonstrated that 4-AP induced nerve growth factor and enhanced proliferation and migration of human keratinocytes. Thus, 4-AP enhanced many of the key attributes of successful wound healing and offers a promising new approach to enhance skin wound healing and tissue regeneration.
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Huang Y, Qi L, Kogiso M, Du Y, Braun FK, Zhang H, Huang LF, Xiao S, Teo W, Lindsay H, Zhao S, Baxter P, Su JMF, Adesina A, Yang J, Brabetz S, Kool M, Pfister SM, Chintagumpala M, Perlaky L, Wang Z, Zhou Y, Man T, Li X. Spatial Dissection of Invasive Front from Tumor Mass Enables Discovery of Novel microRNA Drivers of Glioblastoma Invasion. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2101923. [PMID: 34719887 PMCID: PMC8655179 DOI: 10.1002/advs.202101923] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/15/2021] [Indexed: 06/13/2023]
Abstract
Diffuse invasion is the primary cause of treatment failure of glioblastoma (GBM). Previous studies on GBM invasion have long been forced to use the resected tumor mass cells. Here, a strategy to reliably isolate matching pairs of invasive (GBMINV ) and tumor core (GBMTC ) cells from the brains of 6 highly invasive patient-derived orthotopic models is described. Direct comparison of these GBMINV and GBMTC cells reveals a significantly elevated invasion capacity in GBMINV cells, detects 23/768 miRNAs over-expressed in the GBMINV cells (miRNAINV ) and 22/768 in the GBMTC cells (miRNATC ), respectively. Silencing the top 3 miRNAsINV (miR-126, miR-369-5p, miR-487b) successfully blocks invasion of GBMINV cells in vitro and in mouse brains. Integrated analysis with mRNA expression identifies miRNAINV target genes and discovers KCNA1 as the sole common computational target gene of which 3 inhibitors significantly suppress invasion in vitro. Furthermore, in vivo treatment with 4-aminopyridine (4-AP) effectively eliminates GBM invasion and significantly prolongs animal survival times (P = 0.035). The results highlight the power of spatial dissection of functionally accurate GBMINV and GBMTC cells in identifying novel drivers of GBM invasion and provide strong rationale to support the use of biologically accurate starting materials in understanding cancer invasion and metastasis.
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Affiliation(s)
- Yulun Huang
- Department of NeurosurgeryDushu Lake HospitalSoochow UniversitySuzhou205124China
- Department of Neurosurgery and Brain and Nerve Research Laboratorythe First Affiliated HospitalSoochow UniversitySuzhou215007China
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - Lin Qi
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
- Program of Precision Medicine PDOX Modeling of Pediatric TumorsAnn & Robert H. Lurie Children's Hospital of ChicagoDepartment of PediatricsNorthwestern University Feinberg School of MedicineChicagoIL60611USA
- Department of PharmacologySchool of MedicineSun Yat‐Sen UniversityShenzhen518107China
| | - Mari Kogiso
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - Yuchen Du
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
- Program of Precision Medicine PDOX Modeling of Pediatric TumorsAnn & Robert H. Lurie Children's Hospital of ChicagoDepartment of PediatricsNorthwestern University Feinberg School of MedicineChicagoIL60611USA
| | - Frank K. Braun
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - Huiyuan Zhang
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - L. Frank Huang
- Department of Systems Medicine and BioegineeringHouston Methodist Hospital Research Institute and Cancer CenterWeill Cornell MedicineHoustonTX77030USA
- Division of Experimental Hematology and Cancer BiologyBrain Tumor CenterCincinnati Children’s Hospital Medical CenterDepartment of PediatricsUniversity of Cincinnati College of MedicineCincinnatiUnited States45229United States
| | - Sophie Xiao
- Program of Precision Medicine PDOX Modeling of Pediatric TumorsAnn & Robert H. Lurie Children's Hospital of ChicagoDepartment of PediatricsNorthwestern University Feinberg School of MedicineChicagoIL60611USA
| | - Wan‐Yee Teo
- Humphrey Oei Institute of Cancer ResearchNational Cancer Center SingaporeSingapore169610Singapore
| | - Holly Lindsay
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - Sibo Zhao
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - Patricia Baxter
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - Jack M. F. Su
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - Adekunle Adesina
- Department of PathologyTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - Jianhua Yang
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - Sebastian Brabetz
- Hopp Children's Cancer Center (KiTZ)Heidelberg69120Germany
- Division of Pediatric Neuro‐oncologyGerman Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK)Heidelberg69120Germany
| | - Marcel Kool
- Hopp Children's Cancer Center (KiTZ)Heidelberg69120Germany
- Division of Pediatric Neuro‐oncologyGerman Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK)Heidelberg69120Germany
| | - Stefan M. Pfister
- Hopp Children's Cancer Center (KiTZ)Heidelberg69120Germany
- Division of Pediatric Neuro‐oncologyGerman Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK)Heidelberg69120Germany
- Department of Pediatric Hematology and OncologyHeidelberg University HospitalHeidelberg69120Germany
| | - Murali Chintagumpala
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - Laszlo Perlaky
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - Zhong Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratorythe First Affiliated HospitalSoochow UniversitySuzhou215007China
| | - Youxin Zhou
- Department of Neurosurgery and Brain and Nerve Research Laboratorythe First Affiliated HospitalSoochow UniversitySuzhou215007China
| | - Tsz‐Kwong Man
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
| | - Xiao‐Nan Li
- Texas Children's Cancer CenterTexas Children's HospitalBaylor College of MedicineHoustonTX77030USA
- Program of Precision Medicine PDOX Modeling of Pediatric TumorsAnn & Robert H. Lurie Children's Hospital of ChicagoDepartment of PediatricsNorthwestern University Feinberg School of MedicineChicagoIL60611USA
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Hegvik TA, Waløen K, Pandey SK, Faraone SV, Haavik J, Zayats T. Druggable genome in attention deficit/hyperactivity disorder and its co-morbid conditions. New avenues for treatment. Mol Psychiatry 2021; 26:4004-4015. [PMID: 31628418 PMCID: PMC7165040 DOI: 10.1038/s41380-019-0540-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 05/26/2019] [Accepted: 06/10/2019] [Indexed: 01/22/2023]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder with only symptomatic care available. Genome-wide association (GWA) studies can provide a starting point in the search for novel drug targets and possibilities of drug repurposing. Here, we explored the druggable genome in ADHD by utilising GWA studies on ADHD and its co-morbid conditions. First, we explored whether the genes targeted by current ADHD drugs show association with the disorder and/or its co-morbidities. Second, we aimed to identify genes and pathways involved in the biological processes underlying ADHD that can be targeted by pharmacological agents. These ADHD-associated druggable genes and pathways were also examined in co-morbidities of ADHD, as commonalities in their aetiology and management may lead to novel pharmacological insights. Strikingly, none of the genes encoding targets of first-line pharmacotherapeutics for ADHD were significantly associated with the disorder, suggesting that FDA-approved ADHD drugs may act through different mechanisms than those underlying ADHD. In the examined druggable genome, three loci on chromosomes 1, 4 and 12 revealed significant association with ADHD and contained nine druggable genes, five of which encode established drug targets for malignancies, autoimmune and neurodevelopmental disorders. To conclude, we present a framework to assess the druggable genome in a disorder, exemplified by ADHD. We highlight signal transduction and cell adhesion as potential novel avenues for ADHD treatment. Our findings add to knowledge on known ADHD drugs and present the exploration of druggable genome associated with ADHD, which may offer interventions at the aetiological level of the disorder.
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Affiliation(s)
- Tor-Arne Hegvik
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Kai Waløen
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Sunil K Pandey
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Stephen V Faraone
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jan Haavik
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tetyana Zayats
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway.
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
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Mark VW. Retention of Physical Gains in the Community Following Physical Training for Multiple Sclerosis: A Systematic Review and Implications. Semin Neurol 2021; 41:177-188. [PMID: 33690875 DOI: 10.1055/s-0041-1725139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple sclerosis (MS) is a progressive neurological illness whose typically young adult onset results in a nearly entire lifetime of worsening disability. But despite being an unrelenting neurodegenerative disease, numerous clinical trials over the past 40 years for MS have vigorously attempted to improve or at least stabilize declining physical function. Although the vast majority of the studies assessed training effects only within controlled laboratory or clinic settings, in recent years a growing interest has emerged to test whether newer therapies can instead benefit real-life activities in the community. Nonetheless, comparatively little attention has been paid to whether the training gains can be retained for meaningful periods. This review discusses the comparative success of various physical training methods to benefit within-community activities in MS, and whether the gains can be retained long afterward. This review will suggest future research directions toward establishing efficacious treatments that can allow persons with MS to reclaim their physical abilities and maximize functionality for meaningful periods.
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Affiliation(s)
- Victor W Mark
- Departments of Physical Medicine and Rehabilitation, Neurology, and Psychology, University of Alabama at Birmingham, Birmingham, Alabama
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Kostadinova I, Danchev N. 4-aminopyridine – the new old drug for the treatment of neurodegenerative diseases. PHARMACIA 2019. [DOI: 10.3897/pharmacia.66.e35976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this review are described the preclinical and clinical pharmacological data as well as new therapeutic indications for the use of 4-aminopyridine. 4-aminopyridine is a potassium (K+) channel blocker that has a long history and various application areas. It is a chemical agent developed in 1963 as a bird poison. The first approval for clinical application of 4-aminopyridine was in 70’s in Bulgaria, since anesthetists in that country have confirmed its effect as reversal agent for nondepolarizing myorelaxants. The Bulgarian pharmaceutical company Sopharma commersialized 4-aminopyridine under the trade name Pymadin. Since then 4-aminopyridine was extensively studied and in 2010 is approved in the USA for the treatment of walking disabilities in patients with multiple sclerosis. In recent years, data from clinical trials indicated that K-channel blockade may prove to be an appropriate strategy to overcome disturbances in nerve impulses conduction associated with demyelination of the central nervous system.
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Mark VW, Taub E, Uswatte G, Morris DM, Cutter GR, Adams TL, Bowman MH, McKay S. Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 1: Effects on Real-World Function. Neurorehabil Neural Repair 2019; 32:223-232. [PMID: 29668399 DOI: 10.1177/1545968318761050] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Constraint-Induced Movement therapy (CIMT) has controlled evidence of efficacy for improving real-world paretic limb use in non-progressive physically disabling disorders (stroke, cerebral palsy). OBJECTIVE This study sought to determine whether this therapy can produce comparable results with a progressive disorder such as multiple sclerosis (MS). We conducted a preliminary phase II randomized controlled trial of CIMT versus a program of complementary and alternative medicine (CAM) treatments for persons with MS, to evaluate their effect on real-world disability. METHODS Twenty adults with hemiparetic MS underwent 35 hours of either CIMT or CAM over 10 consecutive weekdays. The primary clinical outcome was change from pretreatment on the Motor Activity Log (MAL). RESULTS The CIMT group improved more on the MAL (2.7 points, 95% confidence interval 2.2-3.2) than did the CAM group (0.5 points, 95% confidence interval -0.1 to 1.1; P < .001). These results did not change at 1-year follow-up, indicating long-term retention of functional benefit for CIMT. The treatments were well tolerated and without adverse events. CONCLUSION These results suggest that CIMT can increase real-world use of the more-affected arm in patients with MS for at least 1 year. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01081275.
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Affiliation(s)
- Victor W Mark
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Taub
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - David M Morris
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gary R Cutter
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Terrie L Adams
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary H Bowman
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Staci McKay
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
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Ghalehshahi HG, Balalaie S, Sohbati HR, Azizian H, Alavijeh MS. Synthesis, CYP 450 evaluation, and docking simulation of novel 4-aminopyridine and coumarin derivatives. Arch Pharm (Weinheim) 2019; 352:e1800247. [DOI: 10.1002/ardp.201800247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/01/2018] [Accepted: 12/05/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Hajar G. Ghalehshahi
- Peptide Chemistry Research Center; K. N. Toosi University of Technology; Tehran Iran
| | - Saeed Balalaie
- Peptide Chemistry Research Center; K. N. Toosi University of Technology; Tehran Iran
- Medical Biology Research Center; Kermanshah University of Medical Sciences; Kermanshah Iran
| | - Hamid R. Sohbati
- Faculty of Pharmacy, Department of Medicinal Chemistry; Tehran University of Medical Science; Tehran Iran
| | - Homa Azizian
- Department of Medicinal Chemistry, School of Pharmacy international Campus; Iran University of Medical Sciences; Tehran Iran
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10
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Dalfampridine: Review on its recent development for symptomatic improvement in patients with multiple sclerosis. ARAB J CHEM 2016. [DOI: 10.1016/j.arabjc.2012.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Zörner B, Filli L, Reuter K, Kapitza S, Lörincz L, Sutter T, Weller D, Farkas M, Easthope CS, Czaplinski A, Weller M, Linnebank M. Prolonged-release fampridine in multiple sclerosis: Improved ambulation effected by changes in walking pattern. Mult Scler 2016; 22:1463-1475. [DOI: 10.1177/1352458515622695] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/22/2015] [Indexed: 11/16/2022]
Abstract
Background: Prolonged-release fampridine (PR-fampridine, 4-aminopyridine) increases walking speed in the timed 25-foot walk test (T25FW) in some patients (timed-walk responders) with multiple sclerosis (MS). Objective: To explore the effects of PR-fampridine on different aspects of walking function and to identify associated gait modifications in subjects with MS. Methods: In this prospective, randomized, placebo-controlled, double-blind, phase II study (FAMPKIN; clinicaltrials.gov , NCT01576354), subjects received a 6-week course of oral placebo or PR-fampridine treatment (10 mg, twice daily) before crossing over. Using 3D-motion-analysis, kinematic and kinetic parameters were assessed during treadmill walking (primary endpoint). Clinical outcome measures included T25FW, 6-minute walk test (6MWT), and balance scales. Physical activity in everyday life was measured with an accelerometer device. Results: Data from 55 patients were suitable for analysis. Seventeen subjects were timed-walk responders under PR-fampridine. For the total study population and for responders, a significant increase in walking speed (T25FW) and distance (6MWT) was observed. Gait pattern changes were found at the single-subject level and correlated with improvements in the T25FW and 6MWT. Physical activity was increased in responders. Conclusion: PR-fampridine improves walking speed, endurance, and everyday physical activity in a subset of subjects with MS and leads to individual modifications of the gait pattern.
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Affiliation(s)
- Björn Zörner
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Linard Filli
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Katja Reuter
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Sandra Kapitza
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Lilla Lörincz
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Tabea Sutter
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - David Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Melinda Farkas
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland/Europe and Canada Regional Medical, Biogen International GmbH, Zug, Switzerland
| | | | | | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Linnebank
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland/ Department of Neurology, HELIOS-Klinik Hagen-Ambrock, Hagen, Germany
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12
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Huisinga JM, St George RJ, Spain R, Overs S, Horak FB. Postural response latencies are related to balance control during standing and walking in patients with multiple sclerosis. Arch Phys Med Rehabil 2014; 95:1390-7. [PMID: 24445088 PMCID: PMC4331055 DOI: 10.1016/j.apmr.2014.01.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To understand and examine the relation between postural response latencies obtained during postural perturbations and representative measures of balance during standing (sway variables) and walking (trunk motion). DESIGN Cross-sectional. SETTING University medical center. PARTICIPANTS Persons with multiple sclerosis (MS) (n=40) were compared with similar aged control subjects (n=20). There were 20 subjects with MS in the normal walking velocity group and 20 subjects with MS who had slow walking velocity based on a timed 25-foot walk (T25FW) of <5 seconds. INTERVENTIONS None. MAIN OUTCOME MEASURES Postural response latency, sway variables, trunk motion variables. RESULTS We found that subjects with MS with both slow or normal walking velocities had significantly longer postural response latencies than the healthy control group. Postural response latency was not correlated with the T25FW. Postural response latency was significantly correlated with center of pressure sway variables during quiet standing (root mean square: ρ=.334, P=.04; range: ρ=.385, P=.017; mean velocity: ρ=.337, P=.038; total sway area: ρ=.393, P=.015). Postural response latency was also significantly correlated with motion of the trunk during walking (sagittal plane range of motion: ρ=.316, P=.05; SD of transverse plane range of motion: ρ=-.43, P=.006). CONCLUSIONS These findings clearly indicate that slow postural responses to external perturbations in patients with MS contribute to disturbances in balance control during both standing and walking.
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Affiliation(s)
- Jessie M Huisinga
- Landon Center on Aging, University of Kansas Medical Center, Kansas City, KS.
| | | | - Rebecca Spain
- Department of Neurology, Oregon Health and Science University, Portland, OR; Neurology Department, Portland Veterans Affairs Medical Center, Portland, OR
| | - Shannon Overs
- Department of Neurology, Oregon Health and Science University, Portland, OR
| | - Fay B Horak
- Department of Neurology, Oregon Health and Science University, Portland, OR
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Frejo MT, del Pino J, Lobo M, García J, Capo MA, Díaz MJ. Liver and kidney damage induced by 4-aminopyridine in a repeated dose (28 days) oral toxicity study in rats: Gene expression profile of hybrid cell death. Toxicol Lett 2014; 225:252-63. [DOI: 10.1016/j.toxlet.2013.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
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14
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Jensen HB, Ravnborg M, Dalgas U, Stenager E. 4-Aminopyridine for symptomatic treatment of multiple sclerosis: a systematic review. Ther Adv Neurol Disord 2014; 7:97-113. [PMID: 24587826 PMCID: PMC3932769 DOI: 10.1177/1756285613512712] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This systematic review summarizes the existing evidence on the effect of 4-aminopyridine (4-AP) as a symptomatic treatment of decreased walking capacity in patients with multiple sclerosis (MS) when administered as an immediate release compound and a slow release compound. It summarizes existing evidence on the basic mechanisms of 4-AP from experimental studies and evidence on the clinical use of the compound. A systematic literature search was conducted of the following databases: PubMed and EMBASE. Thirty-five studies were included in the review divided into 16 experimental studies, two clinical studies with paraclinical endpoints and 17 clinical studies with clinical endpoints. Animal studies show that 4-AP can improve impulse conduction through demyelinated lesions. In patients with MS this translates into improved walking speed and muscle strength of the lower extremities in a subset of patients at a level that is often of clinical relevance. Phase III trials demonstrate approximately 25% increase in walking speed in roughly 40% and improved muscle strength in the lower extremities. Furthermore, 4-AP might have an effect on other domains such as cognition, upper extremity function and bowel and bladder, but this warrants further investigation. Side effects are mainly mild to moderate, consisting primarily of paraesthesia, dizziness, nausea/vomiting, falls/balance disorders, insomnia, urinary tract infections and asthenia. Side effects are worse when administered intravenously and when administered as an immediate release compound. Serious adverse events are rarely seen in the marketed clinical dosages. In conclusion, 4-AP is easy and safe to use. Slow release 4-AP shows more robust clinical effects and a more beneficial side-effect profile than immediate release 4-AP.
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Affiliation(s)
- Henrik Boye Jensen
- Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense C, Denmark
| | - Mads Ravnborg
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Ulrik Dalgas
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus, Denmark
| | - Egon Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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15
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Fernandez O, Berger T, Hartung HP, Putzki N. Historical overview of the rationale for the pharmacological use of prolonged-release fampridine in multiple sclerosis. Expert Rev Clin Pharmacol 2014; 5:649-65. [DOI: 10.1586/ecp.12.59] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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16
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17
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Tomassini V, Matthews PM, Thompson AJ, Fuglø D, Geurts JJ, Johansen-Berg H, Jones DK, Rocca MA, Wise RG, Barkhof F, Palace J. Neuroplasticity and functional recovery in multiple sclerosis. Nat Rev Neurol 2012; 8:635-46. [PMID: 22986429 PMCID: PMC3770511 DOI: 10.1038/nrneurol.2012.179] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The development of therapeutic strategies that promote functional recovery is a major goal of multiple sclerosis (MS) research. Neuroscientific and methodological advances have improved our understanding of the brain's recovery from damage, generating novel hypotheses about potential targets and modes of intervention, and laying the foundation for development of scientifically informed recovery-promoting strategies in interventional studies. This Review aims to encourage the transition from characterization of recovery mechanisms to development of strategies that promote recovery in MS. We discuss current evidence for functional reorganization that underlies recovery and its implications for development of new recovery-oriented strategies in MS. Promotion of functional recovery requires an improved understanding of recovery mechanisms that can be modulated by interventions and the development of robust measurements of therapeutic effects. As imaging methods can be used to measure functional and structural alterations associated with recovery, this Review discusses their use to obtain reliable markers of the effects of interventions.
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18
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Hersh C, Rae-Grant A. Extended-release dalfampridine in the management of multiple-sclerosis-related walking impairment. Ther Adv Neurol Disord 2012; 5:199-204. [PMID: 22783369 DOI: 10.1177/1756285612447091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system that causes neurological impairment in young adults. As part of the disease, ambulation remains one of the most disabling features of multiple sclerosis. Extended-release dalfampridine is a long-acting form of 4-aminopyridine that has been shown in two phase III trials to increase ambulation speed in a subset of patients with multiple sclerosis (timed walk responders). The primary endpoint of these studies was 'responder status', analyzing difference in the proportion of timed walk responders between extended-release dalfampridine and placebo groups. Extended-release dalfampridine exerts its effects by inhibiting voltage-activated K(+) channels and has been previously demonstrated to improve action potential propagation in demyelinated nerve fibers in vitro. Side effects of extended-release dalfampridine include increased urinary tract infections, insomnia, headache, asthenia, dizziness, back pain, and paresthesias. Rare seizure events are also reported on the approved dose of 10 mg every 12 h. In this review we will summarize the results of key phase II and phase III trials of extended-release dalfampridine, its safety, and potential use in patients with multiple sclerosis.
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Affiliation(s)
- Carrie Hersh
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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19
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Chitnis T, Krupp L, Yeh A, Rubin J, Kuntz N, Strober JB, Chabas D, Weinstock-Guttmann B, Ness J, Rodriguez M, Waubant E. Pediatric multiple sclerosis. Neurol Clin 2011; 29:481-505. [PMID: 21439455 DOI: 10.1016/j.ncl.2011.01.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the past 5 years, there has been an exponential growth in the knowledge about multiple sclerosis (MS) in children and adolescents. Recent publications have shed light on its diagnosis, pathogenesis, clinical course, and treatment. However, there remain several key areas that require further exploration. This article summarizes the current state of knowledge on pediatric MS and discusses future avenues of investigation.
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Affiliation(s)
- Tanuja Chitnis
- Harvard Medical School, Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA 02114, USA
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20
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Blight AR. Treatment of walking impairment in multiple sclerosis with dalfampridine. Ther Adv Neurol Disord 2011; 4:99-109. [PMID: 21694807 DOI: 10.1177/1756285611403960] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Potassium channel blockade has long been considered a potential therapeutic strategy for treatment of multiple sclerosis (MS) based on the pathophysiology of demyelinated axons. Dalfampridine, which is also known as fampridine or 4-aminopyridine (4-AP), is the potassium channel blocker that has been studied most extensively in MS and other demyelinating neurologic disorders. An extended-release formulation of dalfampridine was recently approved by the US Food and Drug Administration to improve walking in patients with MS. In randomized, double-blind, placebo-controlled trials, with dalfampridine extended release tablets 10 mg taken twice daily, about 12 h apart, walking speed was improved in approximately one-third of treated patients; in these patients, average walking speed on therapy was about 25% above baseline. This improvement was clinically meaningful as assessed by concurrent measurement of patient-reported severity of walking-related disability. Dalfampridine extended release tablets were generally well tolerated, with a range of adverse effects that appear to be related to increases in central nervous system excitation. There is a dose-dependent increase in the occurrence of seizures at doses higher than the recommended 10 mg twice daily.
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Affiliation(s)
- Andrew R Blight
- Chief Scientific Officer, Acorda Therapeutics, Inc., 15 Skyline Drive, Hawthorne, NY 10532, USA
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21
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Sahraian MA, Maghzi AH, Etemadifar M, Minagar A. Dalfampridine: review of its efficacy in improving gait in patients with multiple sclerosis. J Cent Nerv Syst Dis 2011; 3:87-93. [PMID: 23861641 PMCID: PMC3663610 DOI: 10.4137/jcnsd.s4868] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Multiple sclerosis (MS) is a progressive immune-mediated neurodegenerative disease of human central nervous system (CNS), which causes irreversible disability in young adults. The cause and cure for MS remain unknown. Pathophysiology of MS includes two arms: inflammatory demyelination and neurodegeneration. The inflammatory demyelination of MS which is mainly promoted by a massive activation of the immune system against putative CNS antigen(s) leads to loss of oligodendrocyte/myelin complex which slows down or halts impulse conduction in denuded axons. Practically, loss of myelin significantly reduces signal conduction along the demyelinated axons through alterations in the distribution of axonal ion channels. Dalfampridine (4-aminopyridine or 4-AP) is an oral potassium channel blocker, which was recently approved by FDA for symptomatic treatment of MS. Dalfampridine, which acts at the central and peripheral nervous systems, enhances conduction in demyelinated axons and improves walking ability of MS patients. A number of clinical trials have evaluated the safety and efficacy of fampridine in MS patients with the degree of gait improvement as the main outcome. The objective of this manuscript is to provide an overview of the pharmacology, pharmacokinetics, clinical trials, side effects and interactions of dalfampridine used in treatment of MS patients.
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Affiliation(s)
- M A Sahraian
- Sina MS Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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22
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Rabchevsky AG, Patel SP, Springer JE. Pharmacological interventions for spinal cord injury: where do we stand? How might we step forward? Pharmacol Ther 2011; 132:15-29. [PMID: 21605594 DOI: 10.1016/j.pharmthera.2011.05.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 04/28/2011] [Indexed: 12/15/2022]
Abstract
Despite numerous studies reporting some measures of efficacy in the animal literature, there are currently no effective therapies for the treatment of traumatic spinal cord injuries (SCI) in humans. The purpose of this review is to delineate key pathophysiological processes that contribute to neurological deficits after SCI, as well as to describe examples of pharmacological approaches that are currently being tested in clinical trials, or nearing clinical translation, for the therapeutic management of SCI. In particular, we will describe the mechanistic rationale to promote neuroprotection and/or functional recovery based on theoretical, yet targeted pathological events. Finally, we will consider the clinical relevancy for emerging evidence that pharmacologically targeting mitochondrial dysfunction following injury may hold the greatest potential for increasing tissue sparing and, consequently, the extent of functional recovery following traumatic SCI.
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Affiliation(s)
- Alexander G Rabchevsky
- Spinal Cord & Brain injury Research Center, Lexington, University of Kentucky, KY 40536-0509, USA.
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23
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Hayes KC. Impact of extended-release dalfampridine on walking ability in patients with multiple sclerosis. Neuropsychiatr Dis Treat 2011; 7:229-39. [PMID: 21573085 PMCID: PMC3090287 DOI: 10.2147/ndt.s10469] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Indexed: 11/23/2022] Open
Abstract
Dalfampridine extended release (ER) 10 mg is an oral tablet form of the potassium (K(+)) channel-blocking compounded dalfampridine, also known as fampridine, and chemically 4-aminopyridine or 4-AP, which received regulatory approval in the United States for the treatment of walking in patients with multiple sclerosis (MS) in January 2010. Two pivotal Phase 3 clinical trials demonstrated significant improvements in walking in patients with the four primary forms of MS following administration of dalfampridine ER tablets 10 mg twice daily. The drug is thought to act by restoring conduction in focally demyelinated axons and by enhancing neurotransmission, thereby leading to improved neurological function. This review describes how dalfampridine represents a new pharmacotherapeutic approach to the clinical management of mobility impairment. It describes the mechanism of action and chemistry of dalfampridine ER, its pharmacokinetics, tolerability, and side effects, and the outcomes of multicenter trials showing its efficacy in improving walking speed. Clinician and patient global assessments, as well as patient self-assessment of the impact of MS on their gait disability, confirm clinically relevant benefit from the therapy. Patients tolerate the drug well and their improvement in terms of household and community ambulation, inferred from analysis of pooled data from several studies, is likely to translate into benefits in the performance of instrumental activities of daily living and a reduction in the neuropsychiatric burden of disease.
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Affiliation(s)
- Keith C Hayes
- Department of Physical Medicine and Rehabilitation, The University of Western Ontario, London, ON, Canada
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24
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Tegla CA, Cudrici C, Rozycka M, Soloviova K, Ito T, Singh AK, Khan A, Azimzadeh P, Andrian-Albescu M, Khan A, Niculescu F, Rus V, Judge SIV, Rus H. C5b-9-activated, K(v)1.3 channels mediate oligodendrocyte cell cycle activation and dedifferentiation. Exp Mol Pathol 2011; 91:335-45. [PMID: 21540025 DOI: 10.1016/j.yexmp.2011.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 04/13/2011] [Indexed: 12/11/2022]
Abstract
Voltage-gated potassium (K(v)) channels play an important role in the regulation of growth factor-induced cell proliferation. We have previously shown that cell cycle activation is induced in oligodendrocytes (OLGs) by complement C5b-9, but the role of K(v) channels in these cells had not been investigated. Differentiated OLGs were found to express K(v)1.4 channels, but little K(v)1.3. Exposure of OLGs to C5b-9 modulated K(v)1.3 functional channels and increased protein expression, whereas C5b6 had no effect. Pretreatment with the recombinant scorpion toxin rOsK-1, a highly selective K(v)1.3 inhibitor, blocked the expression of K(v)1.3 induced by C5b-9. rOsK-1 inhibited Akt phosphorylation and activation by C5b-9 but had no effect on ERK1 activation. These data strongly suggest a role for K(v)1.3 in controlling the Akt activation induced by C5b-9. Since Akt plays a major role in C5b-9-induced cell cycle activation, we also investigated the effect of inhibiting K(v)1.3 channels on DNA synthesis. rOsK-1 significantly inhibited the DNA synthesis induced by C5b-9 in OLG, indicating that K(v)1.3 plays an important role in the C5b-9-induced cell cycle. In addition, C5b-9-mediated myelin basic protein and proteolipid protein mRNA decay was completely abrogated by inhibition of K(v)1.3 expression. In the brains of multiple sclerosis patients, C5b-9 co-localized with NG2(+) OLG progenitor cells that expressed K(v)1.3 channels. Taken together, these data suggest that K(v)1.3 channels play an important role in controlling C5b-9-induced cell cycle activation and OLG dedifferentiation, both in vitro and in vivo.
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Affiliation(s)
- Cosmin A Tegla
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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25
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Wipfler P, Harrer A, Pilz G, Oppermann K, Trinka E, Kraus J. Recent developments in approved and oral multiple sclerosis treatment and an update on future treatment options. Drug Discov Today 2011; 16:8-21. [DOI: 10.1016/j.drudis.2010.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/12/2010] [Accepted: 10/25/2010] [Indexed: 12/23/2022]
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26
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Piaton G, Gould RM, Lubetzki C. Axon-oligodendrocyte interactions during developmental myelination, demyelination and repair. J Neurochem 2010; 114:1243-60. [PMID: 20524961 DOI: 10.1111/j.1471-4159.2010.06831.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In multiple sclerosis, CNS demyelination is often followed by spontaneous repair, mostly achieved by adult oligodendrocyte precursor cells. Extent of this myelin repair differs, ranging from very low, limited to the plaque border, to extensive, with remyelination throughout the 'shadow plaques.' In addition to restoring neuronal connectivity, new myelin is neuroprotective. It reduces axonal loss and thus disability progression. Reciprocal communication between neurons and oligodendrocytes is essential for both myelin biogenesis and myelin repair. Hence, deciphering neuron-oligodendrocyte communication is not only important for understanding myelination per se, but also the pathophysiology that underlies demyelinating diseases and the development of innovative therapeutic strategies.
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27
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Kuntz NL, Chabas D, Weinstock-Guttman B, Chitnis T, Yeh EA, Krupp L, Ness J, Rodriguez M, Waubant E. Treatment of multiple sclerosis in children and adolescents. Expert Opin Pharmacother 2010; 11:505-20. [DOI: 10.1517/14656560903527218] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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28
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Husseini L, Leussink VI, Kieseier BC, Hartung HP. [4-Aminopyridine (Fampridine). A new attempt for the symptomatic treatment of multiple sclerosis]. DER NERVENARZT 2010; 81:203-211. [PMID: 20112006 DOI: 10.1007/s00115-009-2902-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Mobility limitation is a frequent clinical symptom of multiple sclerosis (MS) that poses a therapeutic challenge. For years results of animal experiments and clinical experience have indicated that the potassium channel blocker 4-aminopyridine improves axonal excitatory circuits and thus muscular strength in demyelinating diseases. A recently conducted randomized, placebo-controlled, multicenter phase 3 clinical trial in MS patients was able to show that an oral sustained-release formulation of 4-aminopyridine (Fampridine-SR) represents a suitable agent for treatment of walking disability in MS patients.This overview presents the study data and discusses the value of 4-aminopyridine for the symptomatic treatment of MS as a neurofunctional modifier of this disabling disease.
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Affiliation(s)
- L Husseini
- Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, Düsseldorf, Germany
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