[Cerebrolysin Treatment Reduces the Risk of Mild Cognitive Decline to Dementia in 1st-Degree Relatives of Alzheimer's Patients: A Prospective Comparative Study]

OBJECTIVE

To evaluate the long-term effects of annual course therapy with Cerebrolysin on cognitive functioning and the risk of transition to dementia in relatives of patients with Alzheimer's disease (AD) with amnestic-type mild cognitive decline syndrome (aMCI) in comparison with the same group untreated relatives.

MATERIAL AND METHODS

The cohort included 88 first-degree relatives of BA patients with aMCI syndrome aged 50 to 82 years (mean age 65.0±9.9 years) of which 46 people received course therapy with Cerebrolysin and 42 people were not treated. Clinical, neuropsychological, statistical methods were used. Conducted annual course therapy with Cerebrolysin (a total of 3 courses of infusion therapy: for a course of 20 intravenous infusions of 20 ml of Cerebrolysin in 100 ml of isotonic saline) followed by a follow-up study after 3 months after the end of the therapeutic period. The dynamics of cognitive functioning in the therapeutic group was compared with the corresponding dynamics in the comparison group over the same period. The assessment was carried out on day 0, by the end of 1, 14, 27 and 30 months research.

RESULTS

In the therapeutic group, according to the CGI-I scale, by the end of the 3rd course of therapy, in 95.7% of cases, a pronounced or moderate improvement was achieved after each of the courses on all scales and tests. In this group, by the end of the therapeutic period, a significant improvement in the initial mean group scores was established. According to the all scales and tests, a significant improvement of the initial average group scores was found after each course of therapy (p<0.05). In the comparison group there was a significant deterioration (p<0.05) of the average group scores of most of the cognitive scales and test by the end of the observation. The annual conversion from aMCI to dementia due to probable AD was 9.5% only in the comparison group. The average group indicators of all scales and tests significantly worsened starting from the 14th month of observation in the comparison group.

CONCLUSION

The absence of cases of aMCI conversion to dementia in the treated patients for 2.5 years of observation can serve as confirmation of a disease-modifying effect in Cerebrolysin. These results indicate the need for more extensive clinical studies of the preventive effects of Cerebrolysin and to explore the possibility of including such therapy in drug prevention programs for AD in people at high risk for this disease.

[Delayed effects of cerebrolysin in the prevention of cognitive impairment progression in the first degree relatives of patients with Alzheimer's disease: the role of the ApoE genotype]

OBJECTIVE

To assess the delayed effect of course therapy with cerebrolysin on the cognitive functioning of the first degree relatives of patients with Alzheimer's disease (AD), including, depending on the ApoE4 genotype.

MATERIAL AND METHODS

A cohort of 72 blood relatives of patients with AD, including 46 with objectively confirmed clinical and neuropsychological examination signs of mild cognitive dysfunction (group 1) and 26 (group 2) with cognitive impairment that meets the diagnostic criteria of mild cognitive impairment (ICD-10 F06.7), was studied. The dynamics of the initial (0 day) indicators of cognitive functioning was compared immediately after a four-week course of treatment with cerebrolysin infusions, as well as 1 and 2 months after its completion, depending on the presence of ApoE4(+) or ApoE4(-) genotype. Clinical, psychopathological, psychometric, follow-up, molecular-genetic and statistical methods were used.

RESULTS

A positive prolonged effect of course therapy with cerebrolysin on cognitive functioning of the first degree relatives of patients with AD was established in both groups. A significant negative effect of the ApoE4(+) genotype on the immediate and delayed effects of cerebrolysin treatment has been proven.

CONCLUSION

The results can form the basis for the development of therapeutic measures aimed at preventing the progression of cognitive impairment and the development of dementia in the first degree relatives of patients with AD as those with the highest risk of dementia.

[An analysis of the peptide composition of a 'light' peptide fraction of cerebrolysin]

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.