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Lawlor B, Segurado R, Kennelly S, Olde Rikkert MGM, Howard R, Pasquier F, Börjesson-Hanson A, Tsolaki M, Lucca U, Molloy DW, Coen R, Riepe MW, Kálmán J, Kenny RA, Cregg F, O'Dwyer S, Walsh C, Adams J, Banzi R, Breuilh L, Daly L, Hendrix S, Aisen P, Gaynor S, Sheikhi A, Taekema DG, Verhey FR, Nemni R, Nobili F, Franceschi M, Frisoni G, Zanetti O, Konsta A, Anastasios O, Nenopoulou S, Tsolaki-Tagaraki F, Pakaski M, Dereeper O, de la Sayette V, Sénéchal O, Lavenu I, Devendeville A, Calais G, Crawford F, Mullan M. Nilvadipine in mild to moderate Alzheimer disease: A randomised controlled trial. PLoS Med 2018; 15:e1002660. [PMID: 30248105 PMCID: PMC6152871 DOI: 10.1371/journal.pmed.1002660] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/24/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study reports the findings of the first large-scale Phase III investigator-driven clinical trial to slow the rate of cognitive decline in Alzheimer disease with a dihydropyridine (DHP) calcium channel blocker, nilvadipine. Nilvadipine, licensed to treat hypertension, reduces amyloid production, increases regional cerebral blood flow, and has demonstrated anti-inflammatory and anti-tau activity in preclinical studies, properties that could have disease-modifying effects for Alzheimer disease. We aimed to determine if nilvadipine was effective in slowing cognitive decline in subjects with mild to moderate Alzheimer disease. METHODS AND FINDINGS NILVAD was an 18-month, randomised, placebo-controlled, double-blind trial that randomised participants between 15 May 2013 and 13 April 2015. The study was conducted at 23 academic centres in nine European countries. Of 577 participants screened, 511 were eligible and were randomised (258 to placebo, 253 to nilvadipine). Participants took a trial treatment capsule once a day after breakfast for 78 weeks. Participants were aged >50 years, meeting National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's disease Criteria (NINCDS-ADRDA) for diagnosis of probable Alzheimer disease, with a Standardised Mini-Mental State Examination (SMMSE) score of ≥12 and <27. Participants were randomly assigned to 8 mg sustained-release nilvadipine or matched placebo. The a priori defined primary outcome was progression on the Alzheimer's Disease Assessment Scale Cognitive Subscale-12 (ADAS-Cog 12) in the modified intention-to-treat (mITT) population (n = 498), with the Clinical Dementia Rating Scale sum of boxes (CDR-sb) as a gated co-primary outcome, eligible to be promoted to primary end point conditional on a significant effect on the ADAS-Cog 12. The analysis set had a mean age of 73 years and was 62% female. Baseline demographic and Alzheimer disease-specific characteristics were similar between treatment groups, with reported mean of 1.7 years since diagnosis and mean SMMSE of 20.4. The prespecified primary analyses failed to show any treatment benefit for nilvadipine on the co-primary outcome (p = 0.465). Decline from baseline in ADAS-Cog 12 on placebo was 0.79 (95% CI, -0.07-1.64) at 13 weeks, 6.41 (5.33-7.49) at 52 weeks, and 9.63 (8.33-10.93) at 78 weeks and on nilvadipine was 0.88 (0.02-1.74) at 13 weeks, 5.75 (4.66-6.85) at 52 weeks, and 9.41 (8.09-10.73) at 78 weeks. Exploratory analyses of the planned secondary outcomes showed no substantial effects, including on the CDR-sb or the Disability Assessment for Dementia. Nilvadipine appeared to be safe and well tolerated. Mortality was similar between groups (3 on nilvadipine, 4 on placebo); higher counts of adverse events (AEs) on nilvadipine (1,129 versus 1,030), and serious adverse events (SAEs; 146 versus 101), were observed. There were 14 withdrawals because of AEs. Major limitations of this study were that subjects had established dementia and the likelihood that non-Alzheimer subjects were included because of the lack of biomarker confirmation of the presence of brain amyloid. CONCLUSIONS The results do not suggest benefit of nilvadipine as a treatment in a population spanning mild to moderate Alzheimer disease. TRIAL REGISTRATION Clinicaltrials.gov NCT02017340, EudraCT number 2012-002764-27.
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Affiliation(s)
- Brian Lawlor
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin (TCD), Dublin, Ireland
- * E-mail:
| | - Ricardo Segurado
- Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin (UCD), Dublin, Ireland
- School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland
| | - Sean Kennelly
- Department of Age Related Healthcare, Tallaght Hospital, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric Medicine, Radboudumc Alzheimer Center, Donders Institute of Medical Neurosciences, Radboudumc, Nijmegen, the Netherlands
| | - Robert Howard
- Division of Psychiatry, University College London and King’s College London, London, United Kingdom
| | - Florence Pasquier
- CHU Lille, Univ. Lille, DISTALZ Laboratory of Excellence, F-59000 Lille, France
| | - Anne Börjesson-Hanson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magda Tsolaki
- Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Ugo Lucca
- Laboratory of Geriatric Neuropsychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - D. William Molloy
- University College Cork Centre for Gerontology and Rehabilitation, Cork, Ireland
| | - Robert Coen
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Matthias W. Riepe
- Department of Geriatrics and Old Age Psychiatry, Psychiatry II, Ulm University at BKH Günzburg, Günzburg, Germany
| | - János Kálmán
- Department of Psychiatry, University of Szeged, Szeged, Hungary
| | - Rose Anne Kenny
- Department of Medical Gerontology, Trinity College Dublin (TCD), Dublin, Ireland
| | - Fiona Cregg
- Department of Medical Gerontology, Trinity College Dublin (TCD), Dublin, Ireland
| | - Sarah O'Dwyer
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Cathal Walsh
- Health Research Institute, University of Limerick, Limerick, Ireland
- Mathematics Applications Consortium for Science and Industry (MACSI), Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Jessica Adams
- Department of Old Age Psychiatry, King's College London, London, United Kingdom
| | - Rita Banzi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - Laetitia Breuilh
- CHU Lille, Univ. Lille, DISTALZ Laboratory of Excellence, F-59000 Lille, France
| | - Leslie Daly
- Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin (UCD), Dublin, Ireland
- School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland
| | - Suzanne Hendrix
- Pentara Corporation, Salt Lake City, Utah, United States of America
| | - Paul Aisen
- Department of Neurology, University of Southern California, Los Angeles, California, United States of America
| | | | - Ali Sheikhi
- Health Research Institute, University of Limerick, Limerick, Ireland
- Mathematics Applications Consortium for Science and Industry (MACSI), Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Diana G. Taekema
- Department of Geriatric Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Frans R. Verhey
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Raffaello Nemni
- IRCCS Don Gnocchi Foundation-University of Milan, Milan, Italy
| | - Flavio Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS AOU Polyclinic, Hospital San Martino, Genoa, Italy
| | | | - Giovanni Frisoni
- Centro San Giovanni di Dio—IRCCS Fatebenefratelli, Brescia, Italy
| | - Orazio Zanetti
- Centro San Giovanni di Dio—IRCCS Fatebenefratelli, Brescia, Italy
| | - Anastasia Konsta
- Aristotle University of Thessaloniki (AUTH), First Psychiatric Department, Papageorgiou General Hospital, Thessaloniki, Greece
| | | | | | | | | | | | | | | | | | | | - Gauthier Calais
- Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Lille, France
| | - Fiona Crawford
- Archer Pharmaceuticals, Sarasota, Florida, United States of America
- Roskamp Institute, Sarasota, Florida, United States of America
| | - Michael Mullan
- Archer Pharmaceuticals, Sarasota, Florida, United States of America
- Roskamp Institute, Sarasota, Florida, United States of America
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McMurtrey JJ, Tso MOM. A review of the immunologic findings observed in retinitis pigmentosa. Surv Ophthalmol 2018; 63:769-781. [PMID: 29551596 DOI: 10.1016/j.survophthal.2018.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 12/20/2022]
Abstract
Most patients suffering from retinitis pigmentosa (RP) inherit the disorder; however, the immune-pathologic features associated with this disease have yet to be extensively studied. Six reports correlate antiretinal immune activity with vision deterioration in RP patients. Some of these patients have sporadic RP that occurs in excess of expected gene segregation during inheritance. The hypothesis that a primary immune-mediated disease process occurs in this sporadic group is supported by significant associations of RP with autoimmune endocrinopathies and other immune-related conditions or factors; however, no immunologic difference regarding RP family history is reported in the peripheral blood studies of RP patients. Twenty-one percent to 51% of RP patients display antiretinal antibodies, whereas 19-58% have antiretinal lymphocyte reactivity to retinal extract, and 60-85% have activated T cells. Mutations in animal models of RP have been shown to cause endoplasmic reticulum stress that may initiate immunopathology for genetic RP, but oxidative stress also encourages immune cytotoxicity. In addition, necrotic cell death is evident, which promotes inflammatory conditions. We review mechanisms and evidence for an occult inflammation in genetic RP and examine reports of efficacy in retarding RP progression with anti-inflammatory agents in clinical trials.
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Affiliation(s)
- John J McMurtrey
- The Wilmer Ophthalmological Institute, The Johns Hopkins University and Hospital, Baltimore, Maryland, USA.
| | - Mark O M Tso
- The Wilmer Ophthalmological Institute, The Johns Hopkins University and Hospital, Baltimore, Maryland, USA
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Attakpa ES, Bertin GA, Chabi NW, Ategbo JM, Seri B, Khan NA. Moringa oleifera-rich diet and T cell calcium signaling in spontaneously hypertensive rats. Physiol Res 2017; 66:753-767. [PMID: 28406707 DOI: 10.33549/physiolres.933397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Moringa oleifera is a plant whose fruits, roots and leaves have been advocated for traditional medicinal uses. The physicochemical analysis shows that Moringa oleifera contains more dietary polyunsaturated fatty acids (PUFA) than saturated fatty acids (SFA). The consumption of an experimental diet enriched with Moringa oleifera extracts lowered blood pressure in spontaneously hypertensive rats (SHR), but not in normotensive Wistar-Kyoto (WKY) rats as compared to rats fed an unsupplemented control diet. Anti-CD3-stimulated T cell proliferation was diminished in both strains of rats fed the Moringa oleifera. The experimental diet lowered secretion of interleukin-2 in SHR, but not in WKY rats compared with rats fed the control diet. Studies of platelets from patients with primary hypertension and from SHR support the notion that the concentration of intracellular free calcium [Ca(2+)](i) is modified in both clinical and experimental hypertension. We observed that the basal, [Ca(2+)](i) was lower in T cells of SHR than in those of WKY rats fed the control diet. Feeding the diet with Moringa oleifera extracts to WKY rats did not alter basal [Ca(2+)](i) in T cells but increased basal [Ca(2+)](i) in SHR. Our study clearly demonstrated that Moringa oleifera exerts antihypertensive effects by inhibiting the secretion of IL-2 and modulates T cell calcium signaling in hypertensive rats.
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Affiliation(s)
- E S Attakpa
- Laboratoire de Physiopathologie Moléculaire et Toxicologie, Département de Physiologie Animale, Faculté des Sciences et Techniques, Université d'Abomey Calavi, Cotonou, Republic of Benin.
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Meulenbroek O, O'Dwyer S, de Jong D, van Spijker G, Kennelly S, Cregg F, Olde Rikkert M, Abdullah L, Wallin A, Walsh C, Coen R, Kenny RA, Daly L, Segurado R, Borjesson-Hanson A, Crawford F, Mullan M, Lucca U, Banzi R, Pasquier F, Breuilh L, Riepe M, Kalman J, Molloy W, Tsolaki M, Howard R, Adams J, Gaynor S, Lawlor B. European multicentre double-blind placebo-controlled trial of Nilvadipine in mild-to-moderate Alzheimer's disease-the substudy protocols: NILVAD frailty; NILVAD blood and genetic biomarkers; NILVAD cerebrospinal fluid biomarkers; NILVAD cerebral blood flow. BMJ Open 2016; 6:e011584. [PMID: 27436668 PMCID: PMC4964180 DOI: 10.1136/bmjopen-2016-011584] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In conjunction with the NILVAD trial, a European Multicentre Double-Blind Placebo Controlled trial of Nilvadipine in Mild-to-Moderate Alzheimer's disease (AD), there are four NILVAD substudies in which eligible NILVAD patients are also invited to participate. The main NILVAD protocol was previously published in BMJ Open (2014). The objectives of the NILVAD substudies are to determine whether frailty, cerebrospinal fluid (CSF), blood biomarker profile and Apolipoprotein E (APOE) status predict response to Nilvadipine, and to investigate the effect of Nilvadipine on cerebral blood flow and blood biomarkers. METHODS AND ANALYSIS All participants who fulfil criteria for the main NILVAD study are eligible for participation in the NILVAD substudies. Participation is subject to informed consent and whether the substudy is available at a particular NILVAD study site. Each substudy entails extra measurements during the course of the main NILVAD study. For example, in the blood and genetic biomarkers substudy, extra blood (30 mL) will be collected at week 0, week 13, week 52 and week 78, while in the cerebral blood flow substudy, participants will receive an MRI and transcranial Doppler measurements at week 0, week 26 and week 78. In the CSF substudy, 10 mL CSF is collected at week 0 and week 78. ETHICS AND DISSEMINATION All NILVAD substudies and all subsequent amendments have received ethical approval within each participating country, according to national regulations. Each participant provides written consent to participate. All participants remain anonymised throughout and the results of each substudy will be published in an international peer reviewed journal. TRIAL REGISTRATION NUMBER EUDRACT 2012-002764-27; Pre-results.
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Affiliation(s)
- Olga Meulenbroek
- Radboud Alzheimer Centre; Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sarah O'Dwyer
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Daan de Jong
- Radboud Alzheimer Centre; Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gerrita van Spijker
- Radboud Alzheimer Centre; Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Fiona Cregg
- Trinity College Dublin (TCD), Dublin, Ireland
| | - Marcel Olde Rikkert
- Radboud Alzheimer Centre; Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | - Cathal Walsh
- University College Dublin (UCD), Dublin, Ireland
| | - Robert Coen
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Leslie Daly
- University College Dublin (UCD), Dublin, Ireland
| | | | | | | | | | - Ugo Lucca
- Department of Laboratory of Geriatric Neuropsychiatry, IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri” (IRFMN), Milan, Italy
| | - Rita Banzi
- Department of Laboratory of Geriatric Neuropsychiatry, IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri” (IRFMN), Milan, Italy
| | - Florence Pasquier
- Centre Hospitalier Regional et Universitaire de Lille (CHRU- LILLE), Lille, France
| | - Laetitia Breuilh
- Centre Hospitalier Regional et Universitaire de Lille (CHRU- LILLE), Lille, France
| | | | - Janos Kalman
- Szegedi Tudomanyegyetem (SZEGED), Szeged, Hungary
| | - William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork (UCC), Cork, Ireland
| | - Magda Tsolaki
- Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | | | | | | | - Brian Lawlor
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
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Lawlor B, Kennelly S, O'Dwyer S, Cregg F, Walsh C, Coen R, Kenny RA, Howard R, Murphy C, Adams J, Daly L, Segurado R, Gaynor S, Crawford F, Mullan M, Lucca U, Banzi R, Pasquier F, Breuilh L, Riepe M, Kalman J, Wallin A, Borjesson A, Molloy W, Tsolaki M, Olde Rikkert M. NILVAD protocol: a European multicentre double-blind placebo-controlled trial of nilvadipine in mild-to-moderate Alzheimer's disease. BMJ Open 2014; 4:e006364. [PMID: 25300460 PMCID: PMC4194801 DOI: 10.1136/bmjopen-2014-006364] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION This study is a European multicentre, randomised, double-blind, placebo-controlled trial investigating the efficacy and safety of nilvadipine as a disease course modifying treatment for mild-to-moderate Alzheimer's disease (AD) in a phase III study that will run for a period of 82 weeks with a treatment period of 78 weeks. METHODS AND ANALYSIS Adult patients, males and females over 50 years with mild-to-moderate AD as defined by the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's disease and Related Disorders Association (NINCDS-ADRDA) criteria, will be included in the study. It aims to recruit a total of 500 patients with AD; 250 in the nilvadipine group and 250 in the placebo group. Participants will be randomised to receive nilvadipine, an 8 mg overencapsulated, sustained release capsule, or a matching overencapsulated placebo (sugar pill) for a period of 78 weeks of treatment. The primary efficacy outcome measure in this study is the change in cognitive function as assessed by the Alzheimer's disease Assessment Scale (ADAS-Cog 12) from baseline to the end of treatment duration (78 weeks). There are two key secondary outcome measures, the Clinical Dementia Rating Scale Sum of Boxes (CDR-sb) and the Disability Assessment for Dementia (DAD). If a statistically significant effect is seen in the primary outcome, CDR-sb will be considered to be a coprimary end point and only the DAD will contribute to the secondary outcome analysis. ETHICS AND DISSEMINATION The study and all subsequent amendments have received ethical approval within each participating country according to national regulations. Each participant will provide written consent to participate in the study. All participants will remain anonymised throughout and the results of the study will be published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER EUDRACT Reference Number: 2012-002764-27.
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Affiliation(s)
- Brian Lawlor
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Sean Kennelly
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Sarah O'Dwyer
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Fiona Cregg
- Trinity College Dublin (TCD), Dublin, Ireland
| | | | - Robert Coen
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland
| | | | | | | | - Leslie Daly
- University College Dublin (UCD), Dublin, Ireland
| | | | | | - Fiona Crawford
- Archer Pharmaceuticals Inc, 2040 Whitefield Avenue, Sarasota, Florida, USA
| | - Michael Mullan
- Archer Pharmaceuticals Inc, 2040 Whitefield Avenue, Sarasota, Florida, USA
| | - Ugo Lucca
- IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri” (IRFMN), Milan, Italy
| | - Rita Banzi
- IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri” (IRFMN), Milan, Italy
| | - Florence Pasquier
- Centre Hospitalier Regional et Universitaire de Lille (CHRU- LILLE), Lille, France
| | - Laetitia Breuilh
- Centre Hospitalier Regional et Universitaire de Lille (CHRU- LILLE), Lille, France
| | | | - Janos Kalman
- Szegedi Tudomanyegyetem (SZEGED), Szeged, Hungary
| | | | | | | | | | - Marcel Olde Rikkert
- Radboud Alzheimer Centre; Radboud University Medical Centre, Nijmegen, The Netherlands
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Saravanaraman P, Chinnadurai RK, Boopathy R. Why calcium channel blockers could be an elite choice in the treatment of Alzheimer’s disease: a comprehensive review of evidences. Rev Neurosci 2014; 25:231-46. [DOI: 10.1515/revneuro-2013-0056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/26/2014] [Indexed: 11/15/2022]
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Paris D, Bachmeier C, Patel N, Quadros A, Volmar CH, Laporte V, Ganey J, Beaulieu-Abdelahad D, Ait-Ghezala G, Crawford F, Mullan MJ. Selective antihypertensive dihydropyridines lower Aβ accumulation by targeting both the production and the clearance of Aβ across the blood-brain barrier. Mol Med 2011; 17:149-62. [PMID: 21170472 PMCID: PMC3060987 DOI: 10.2119/molmed.2010.00180] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 12/16/2010] [Indexed: 11/06/2022] Open
Abstract
Several large population-based or clinical trial studies have suggested that certain dihydropyridine (DHP) L-type calcium channel blockers (CCBs) used for the treatment of hypertension may confer protection against the development of Alzheimer disease (AD). However, other studies with drugs of the same class have shown no beneficial clinical effects. To determine whether certain DHPs are able to impact underlying disease processes in AD (specifically the accumulation of the Alzheimer Aβ peptide), we investigated the effect of several antihypertensive DHPs and non-DHP CCBs on Aβ production. Among the antihypertensive DHPs tested, a few, including nilvadipine, nitrendipine and amlodipine inhibited Aβ production in vitro, whereas others had no effect or raised Aβ levels. In vivo, nilvadipine and nitrendipine acutely reduced brain Aβ levels in a transgenic mouse model of AD (Tg PS1/APPsw) and improved Aβ clearance across the blood-brain barrier (BBB), whereas amlodipine and nifedipine were ineffective showing that the Aβ-lowering activity of the DHPs is independent of their antihypertensive activity. Chronic oral treatment with nilvadipine decreased Aβ burden in the brains of Tg APPsw (Tg2576) and Tg PS1/APPsw mice, and also improved learning abilities and spatial memory. Our data suggest that the clinical benefit conferred by certain antihypertensive DHPs against AD is unrelated to their antihypertensive activity, but rely on their ability to lower brain Aβ accumulation by affecting both Aβ production and Aβ clearance across the BBB.
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Affiliation(s)
- Daniel Paris
- The Roskamp Institute, Sarasota, Florida 34243, United States of America.
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Triboulot C, Hichami A, Denys A, Khan NA. Dietary (n-3) polyunsaturated fatty acids exert antihypertensive effects by modulating calcium signaling in T cells of rats. J Nutr 2001; 131:2364-9. [PMID: 11533280 DOI: 10.1093/jn/131.9.2364] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
After 10 wk of feeding an experimental diet enriched with (n-3) polyunsaturated fatty acids (PUFA), i.e., eicosapentaenoic acid [EPA, 20:5(n-3)] and [DHA, 22:6(n-3)] (EPAX), blood pressure in spontaneously hypertensive rats (SHR), but not in normotensive Wistar-Kyoto (WKY) rats was reduced relative to rats fed an unsupplemented control diet. Concanavalin A-stimulated T-cell proliferation was diminished in both strains of rats fed the PUFA/EPAX diet. The experimental diet lowered secretion of interleukin-2 in SHR, but not in WKY rats compared with rats fed the control diet. To determine whether there was a defect in calcium homeostasis in T cells during hypertension, we employed the following agents: caffeine, which recruits calcium from the cytosolic Ca(2+)-induced Ca(2+)-release pool; ionomycin, which at low concentrations opens calcium channels; and thapsigargin (TG), which mobilizes [Ca(2+)]i from the endoplasmic reticulum (ER) pool. Caffeine-induced increases in [Ca(2+)]i were not modified by the PUFA/EPAX diet. The ionomycin-induced increases in [Ca(2+)]i in T cells from SHR were greater than in those from WKY rats; consumption of the PUFA/EPAX diet did not modify Ca(2+) influx in cells of either strain. The TG-induced increases in [Ca(2+)]i in T cells from SHR were greater than those in cells from WKY rats. Interestingly, consumption of the experimental diet reduced TG-evoked increases in [Ca(2+)]i in T cells from SHR and increased those in T cells from WKY rats, indicating that the PUFA/EPAX diet could reverse the calcium mobilization from the ER pool in T cells. These results suggest that (n-3) PUFA exert antihypertensive effects and modulate T-cell calcium signaling during hypertension in rats.
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Affiliation(s)
- C Triboulot
- UPRES Lipids & Nutrition, Faculty of Life Sciences, Université de Bourgogne, Dijon 21000, France
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