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Ullah I, Wang X, Li H. Novel and experimental therapeutics for the management of motor and non-motor Parkinsonian symptoms. Neurol Sci 2024; 45:2979-2995. [PMID: 38388896 DOI: 10.1007/s10072-023-07278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/14/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND : Both motor and non-motor symptoms of Parkinson's disease (PD) have a substantial detrimental influence on the patient's quality of life. The most effective treatment remains oral levodopa. All currently known treatments just address the symptoms; they do not completely reverse the condition. METHODOLOGY In order to find literature on the creation of novel treatment agents and their efficacy for PD patients, we searched PubMed, Google Scholar, and other online libraries. RESULTS According to the most recent study on Parkinson's disease (PD), a great deal of work has been done in both the clinical and laboratory domains, and some current scientists have even been successful in developing novel therapies for PD patients. CONCLUSION The quality of life for PD patients has increased as a result of recent research, and numerous innovative medications are being developed for PD therapy. In the near future, we will see positive outcomes regarding PD treatment.
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Affiliation(s)
- Inam Ullah
- School of Life Sciences, Lanzhou University, Lanzhou, China
| | - Xin Wang
- School of Pharmacy, Lanzhou University, Lanzhou, China.
| | - Hongyu Li
- School of Life Sciences, Lanzhou University, Lanzhou, China.
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2
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Sun D, Wang B, Jiang Y, Kong Z, Mu M, Yang C, Tan J, Hu Y. Benzodioxane Carboxamide Derivatives As Novel Monoamine Oxidase B Inhibitors with Antineuroinflammatory Activity. ACS Med Chem Lett 2024; 15:798-805. [PMID: 38894921 PMCID: PMC11181489 DOI: 10.1021/acsmedchemlett.3c00532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/17/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
In this study, a series of N-phenyl-2,3-dihydrobenzo[b][1,4]dioxine-6-carboxamide derivatives were designed, synthesized, and evaluated for their inhibitory activities against human MAO-B (hMAO-B). The structure-activity relationship (SAR) was investigated and summarized. Compound 1l (N-(3,4-dichlorophenyl)-2,3-dihydrobenzo[b][1,4]dioxine-6-carboxamide) showed the most potent inhibitory activity with an IC50 value of 0.0083 μM and the selectivity index (IC50 (hMAO-A)/IC50 (hMAO-B)) was >4819. Kinetics and reversibility studies confirmed that compound 1l acted as a competitive and reversible inhibitor of hMAO-B. Molecular docking studies revealed the enzyme-inhibitor interactions, and the rationale was provided. Additionally, compound 1l could effectively inhibit the release of NO, TNF-α, and IL-1β in both LPS- and Aβ1-42-stimulated BV2 cells and attenuate the cytotoxicity induced by Aβ1-42. Since compound 1l exhibited low neurotoxicity, we believe that the hit compound with dual activities of inhibiting MAO-B and antineuroinflammation could be further investigated as a novel potential lead for future studies in vivo.
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Affiliation(s)
| | | | - Yanmei Jiang
- School of Bioengineering, Zhuhai Campus, Zunyi Medical University, Zhuhai 519041, China
| | - Zuo Kong
- School of Bioengineering, Zhuhai Campus, Zunyi Medical University, Zhuhai 519041, China
| | - Mengxue Mu
- School of Bioengineering, Zhuhai Campus, Zunyi Medical University, Zhuhai 519041, China
| | - Changhuan Yang
- School of Bioengineering, Zhuhai Campus, Zunyi Medical University, Zhuhai 519041, China
| | - Jingbo Tan
- School of Bioengineering, Zhuhai Campus, Zunyi Medical University, Zhuhai 519041, China
| | - Yun Hu
- School of Bioengineering, Zhuhai Campus, Zunyi Medical University, Zhuhai 519041, China
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3
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Jost WH, Gluth I, Lück JC, Lopes OIFDC. Real world data of a German Parkinson's disease population: effectiveness and safety of safinamide in routine clinical practice. Curr Med Res Opin 2023; 39:1621-1628. [PMID: 37421634 DOI: 10.1080/03007995.2023.2234728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Parkinson's Disease (PD) is a common progressive neurodegenerative disorder that leads to an imbalance of various neurotransmitters and affects cognitive, motor and non-motor function. Safinamide inhibits monoamine oxidase B in a highly selective and reversible manner and beyond that has anti-glutamatergic properties, with positive effects on motor and non-motor symptoms. The aim of the study was to obtain data about the effectiveness and tolerability of safinamide under routine clinical practice conditions in unselected patients with Parkinson's disease (PD). METHODS A post-hoc analysis of the German cohort of the European SYNAPSES study (a non-interventional cohort study). Patients were treated with safinamide as an add-on to levodopa and followed-up for 12 months. Analyses were done in the total cohort and in clinically relevant subgroups (patients older than 75 years; with relevant comorbidities; with psychiatric conditions). RESULTS 181 PD patients were eligible for analysis. Motor symptoms included bradykinesia (76.8%), rigidity (77.3%), tremor (58.6%), and postural instability (27.1%). Non-motor symptoms were reported in 161 patients (89.0%), mainly psychiatric symptoms (43.1%), sleep disorders (35.9%), fatigue (30.9%), and pain (27.6%). 28.7% of patients were aged 75 years or older, 84.5% had relevant comorbidities, and 38.1% had psychiatric conditions. During treatment, the rate of motor complications decreased from 100.0% to 71.1%. UPDRS scores improved under safinamide, with a clinically important effect in 50% in the total score and 45% in the motor score. The positive effect on motor complications occurred already at the 4-month visit and was maintained over 12 months. At least one adverse event (AE)/adverse drug reaction (ADR) was reported by 62.4%/25.4% of patients, AEs were generally mild or moderate, and completely resolved. Only 5 (1.5%) AEs had a definite relationship to safinamide. CONCLUSIONS The benefit-risk profile of safinamide was favourable and consistent with the total cohort of the SYNAPSES study. In the subgroups, findings were congruent with the total population, which allows the clinical utilisation of safinamide also in more vulnerable patient groups.
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Affiliation(s)
| | - Ivonne Gluth
- Medical Department, Zambon GmbH, Berlin, Germany
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4
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Aboulatta L, Haidar L, Abou-Setta A, Askin N, Rabbani R, Lavu A, Peymani P, Zarychanski R, Eltonsy S. Efficacy and Safety of MAO-B Inhibitors Safinamide and Zonisamide in Parkinson's Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. CNS Drugs 2023; 37:941-956. [PMID: 37973769 DOI: 10.1007/s40263-023-01048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND OBJECTIVE In Parkinson's disease, safinamide and zonisamide are novel monoamine oxidase-B inhibitors with a dual mechanism of action involving the inhibition of sodium and calcium channels and the subsequent release of glutamate. The aim of this systematic review and meta-analysis was to examine the efficacy and safety of both drugs compared with placebo on motor symptoms, cognitive function, and quality of life in patients with Parkinson's disease. METHODS We searched MEDLINE, EMBASE, Cochrane Central, Scopus, PsycINFO, and trials registries up to March 2023 for randomized controlled trials of adults with Parkinson's disease administered either safinamide or zonisamide and published in English. We excluded single-arm trials or if neither the efficacy nor safety outcomes of interest were reported. Primary outcomes were the change from baseline in Unified Parkinson's Disease Rating Scale section III (UPDRS-III) and serious adverse events. Secondary outcomes included a change from baseline in OFF-time, Parkinson's Disease Questionnaire 39 to evaluate quality of life, and Mini-Mental State Examination for cognitive function assessment. The meta-analysis was conducted using Review Manager 5.4.1. Random-effect models were used to calculate the pooled mean differences (MDs) and risk ratios with 95% confidence intervals (CIs). Subgroup analyses by medication, doses, Parkinson's disease stage, and risk of bias were conducted. We assessed the risk of bias using the Cochrane's risk of bias tool. Sensitivity analysis was conducted, and publication bias were evaluated. This meta-analysis was not externally funded, and the protocol is available on the Open Science Framework Registration ( https://doi.org/10.17605/OSF.IO/AMNP5 ). RESULTS Of 3570 screened citations, 16 trials met inclusion criteria (4314 patients with Parkinson's disease). Ten safinamide trials were conducted in several countries. Six zonisamide trials were included, five of which were conducted in Japan and one in India. UPDRS Part III scores were significantly lower with both monoamine oxidase-B inhibitors than with placebo (MD = - 2.18; 95% CI - 2.88 to - 1.49; I 2 =63%; n = 14 studies). A subgroup analysis showed a significant improvement in UPDRS-III in safinamide (MD = - 2.10; 95% CI - 3.09 to - 1.11; I2 = 71%; n = 8 studies) and zonisamide (MD = - 2.31; 95% CI - 3.35 to - 1.27; I2 = 52%; n = 6 studies) compared with placebo. Monoamine oxidase-B inhibitors significantly decreased OFF-time compared with placebo. No significant differences in cognitive function (Mini-Mental State Examination), whereas an improvement in quality of life (Parkinson's Disease Questionnaire 39 scores) was observed. There was no significant difference in incidence rates of serious adverse events among all examined doses of zonisamide and safinamide compared with placebo. Two trials were reported as a high risk of bias and sensitivity analyses confirmed the primary analysis results. CONCLUSIONS Evidence suggests that novel monoamine oxidase-B inhibitors not only improve motor symptoms but also enhance patients' quality of life. The meta-analysis showed that both medications have a similar safety profile to placebo with regard to serious adverse events. The overall findings emphasize the effectiveness of safinamide and zonisamide in the treatment of Parkinson's disease as adjunct therapy. Further long-term studies examining the impact of these medications on motor and non-motor symptoms are necessary.
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Affiliation(s)
- Laila Aboulatta
- College of Pharmacy, University of Manitoba, Winnipeg, MB, R3E 0T5, Canada
| | - Lara Haidar
- College of Pharmacy, University of Manitoba, Winnipeg, MB, R3E 0T5, Canada
| | - Ahmed Abou-Setta
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Askin
- WRHA Virtual Library, University of Manitoba, Winnipeg, MB, Canada
| | - Rasheda Rabbani
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Alekhya Lavu
- College of Pharmacy, University of Manitoba, Winnipeg, MB, R3E 0T5, Canada
| | - Payam Peymani
- College of Pharmacy, University of Manitoba, Winnipeg, MB, R3E 0T5, Canada
| | - Ryan Zarychanski
- Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Cancer Care Manitoba, Winnipeg, MB, Canada
| | - Sherif Eltonsy
- College of Pharmacy, University of Manitoba, Winnipeg, MB, R3E 0T5, Canada.
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Jing S, Yuan Y, Leuratti C, Vaja V, Cattaneo C. Pharmacokinetic and Safety Study of Single and Multiple Oral Doses of Safinamide in Healthy Chinese Volunteers. Clin Pharmacol Drug Dev 2023; 12:1104-1113. [PMID: 37293981 DOI: 10.1002/cpdd.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023]
Abstract
This randomized, parallel-group study evaluated the plasma pharmacokinetic profile of safinamide in 24 healthy Chinese men and women, randomly assigned to receive 50 or 100 mg of safinamide as a single dose, followed, after a 7-day washout, by multiple doses once daily for 7 days. Plasma safinamide was determined up to 96 h after the first single dose (day 1) and the last multiple dose (day 14), and up to 24 h after the first multiple dose (day 8). Following single- and multiple-dose administration, peak concentrations were achieved at a median time of 1.5-2 h. Plasma exposure increased in a dose-proportional manner. After single dose, mean half-life was 23-24 h. Area under the concentration-time curve (AUC) from time zero extrapolated to infinity was only slightly higher than AUC from time zero to the last quantifiable concentration, corresponding for the 2 parameters, respectively, to 12,380 and 11,560 ng • h/mL for the 50 mg and to 22,030 and 20,790 ng • h/mL for the 100-mg dose. AUC in the dosing interval at steady state was 13,150 and 23,100 ng • h/mL for 50 and 100 mg of safinamide. Steady state was reached in 6 days, accumulation was approximately twofold, and the pharmacokinetics were time independent. The plasma safinamide pharmacokinetic profile observed in this study is in line with the published results in both Chinese and non-Asian populations.
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Affiliation(s)
- Sun Jing
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaozong Yuan
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Espinoza-Vinces C, Villino-Rodríguez R, Atorrasagasti-Villar A, Martí-Andrés G, Luquin MR. Impact of Safinamide on Patient-Reported Outcomes in Parkinson's Disease. Patient Relat Outcome Meas 2023; 14:285-295. [PMID: 37840836 PMCID: PMC10576461 DOI: 10.2147/prom.s369590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Parkinson's disease (PD) is a chronic and progressive neurodegenerative condition due to the degeneration of nigral dopaminergic cells. Both motor and non-motor symptoms (NMS) of PD produce a marked impairment in PD patients' quality of life (QoL), but contrary to motor features, NMS do not improve with dopamine replacement. Novel therapeutic interventions for PD have successfully controlled most motor manifestations of PD, but the management of NMS is still challenging. Since NMS have a negative impact on the QoL of PD patients, researchers are currently looking for drugs that can modulate the activity of neurotransmitter systems other than dopamine in the hope that can alleviate NMS in PD. Among the recently approved drugs for patients experiencing fluctuations in motor symptoms, safinamide stands out as an effective add-on therapy to levodopa. Safinamide is a monoamine oxidase type-B inhibitor (MAOB-I), with proven efficacy in reducing motor fluctuations. Its distinctive mechanism of action impacts dopaminergic pathways via MAOB inhibition and glutamatergic pathways by blocking sodium and calcium channels. Findings from Phase III clinical trials, meta-analysis, post-hoc analysis, and real-life experiences indicate that safinamide benefits motor symptoms such as tremor, bradykinesia, rigidity, and gait. Additionally, it shows promise for improving NMS like fatigue, pain, mood, and sleep disturbances in patients with PD. Areas Covered In this article, the authors explore the impact of safinamide on patient-reported outcomes in PD. A thorough search was conducted on PubMed focusing on studies published between 2018 and 2023 in English. The inclusion criteria encompassed clinical trials, randomized controlled trials, systematic reviews, meta-analyses, and reviews. The search strategy revolved around the implementation of MeSH terms related to safinamide and its impact on the quality of life in PD. Conclusion Our data strongly support the improving effect on QoL, reducing the disabling NMS reported in patients with PD.
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Alexander TD, Nataraj C, Wu C. A machine learning approach to predict quality of life changes in patients with Parkinson's Disease. Ann Clin Transl Neurol 2023; 10:312-320. [PMID: 36751867 PMCID: PMC10014008 DOI: 10.1002/acn3.51577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE Parkinson disease (PD) is a progressive neurodegenerative disorder with an annual incidence of approximately 0.1%. While primarily considered a motor disorder, increasing emphasis is being placed on its non-motor features. Both manifestations of the disease affect quality of life (QoL), which is captured in part II of the Unified Parkinson's Disease Rating Scale (UPDRS-II). While useful in the management of patients, it remains challenging to predict how QoL will change over time in PD. The goal of this work is to explore the feasibility of a machine learning algorithm to predict QoL changes in PD patients. METHODS In this retrospective cohort study, patients with at least 12 months of follow-up were identified from the Parkinson's Progression Markers Initiative database (N = 630) and divided into two groups: those with and without clinically significant worsening in UPDRS-II (n = 404 and n = 226, respectively). We developed an artificial neural network using only UPDRS-II scores, to predict whether a patient would clinically worsen or not at 12 months from follow-up. RESULTS Using UPDRS-II at baseline, at 2 months, and at 4 months, the algorithm achieved 90% specificity and 56% sensitivity. INTERPRETATION A learning model has the potential to rule in patients who may exhibit clinically significant worsening in QoL at 12 months. These patients may require further testing and increased focus.
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Affiliation(s)
- Tyler D Alexander
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, 19107, USA
| | - Chandrasekhar Nataraj
- Villanova Center for Analytics of Dynamic Systems (VCADS), Villanova University, Villanova, Pennsylvania, 19085, USA
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, 19107, USA
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Jing XZ, Yuan XZ, Luo X, Zhang SY, Wang XP. An Update on Nondopaminergic Treatments for Motor and Non-motor Symptoms of Parkinson's Disease. Curr Neuropharmacol 2023; 21:1806-1826. [PMID: 35193486 PMCID: PMC10514518 DOI: 10.2174/1570159x20666220222150811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/19/2022] [Accepted: 02/19/2022] [Indexed: 11/22/2022] Open
Abstract
Nondopaminergic neurotransmitters such as adenosine, norepinephrine, serotonin, glutamate, and acetylcholine are all involved in Parkinson's disease (PD) and promote its symptoms. Therefore, nondopaminergic receptors are key targets for developing novel preparations for the management of motor and non-motor symptoms in PD, without the potential adverse events of dopamine replacement therapy. We reviewed English-written articles and ongoing clinical trials of nondopaminergic treatments for PD patients till 2014 to summarize the recent findings on nondopaminergic preparations for the treatment of PD patients. The most promising research area of nondopaminergic targets is to reduce motor complications caused by traditional dopamine replacement therapy, including motor fluctuations and levodopa-induced dyskinesia. Istradefylline, Safinamide, and Zonisamide were licensed for the management of motor fluctuations in PD patients, while novel serotonergic and glutamatergic agents to improve motor fluctuations are still under research. Sustained- release agents of Amantadine were approved for treating levodopa induced dyskinesia (LID), and serotonin 5HT1B receptor agonist also showed clinical benefits to LID. Nondopaminergic targets were also being explored for the treatment of non-motor symptoms of PD. Pimavanserin was approved globally for the management of hallucinations and delusions related to PD psychosis. Istradefylline revealed beneficial effect on daytime sleepiness, apathy, depression, and lower urinary tract symptoms in PD subjects. Droxidopa may benefit orthostatic hypotension in PD patients. Safinamide and Zonisamide also showed clinical efficacy on certain non-motor symptoms of PD patients. Nondopaminergic drugs are not expected to replace dopaminergic strategies, but further development of these drugs may lead to new approaches with positive clinical implications.
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Affiliation(s)
- Xiao-Zhong Jing
- Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang-Zhen Yuan
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Shu-Yun Zhang
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China
| | - Xiao-Ping Wang
- Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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9
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De Masi C, Liguori C, Spanetta M, Fernandes M, Cerroni R, Garasto E, Pierantozzi M, Mercuri NB, Stefani A. Non-motor symptoms burden in motor-fluctuating patients with Parkinson's disease may be alleviated by safinamide: the VALE-SAFI study. J Neural Transm (Vienna) 2022; 129:1331-1338. [PMID: 36070008 PMCID: PMC9550691 DOI: 10.1007/s00702-022-02538-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/06/2022] [Indexed: 11/29/2022]
Abstract
Parkinson’s disease (PD) is characterized by motor symptoms often experienced in concomitance with non-motor symptoms (NMS), such as depression, apathy, pain, sleep disorders, and urinary dysfunction. The present study aimed to explore the effect of safinamide treatment on NMS and quality of life in motor-fluctuating PD patients. VALE-SAFI is an observational single-centre study performed in fluctuating PD patients starting safinamide treatment and followed for 6 months. The effects of safinamide on NMS, sleep, fatigue, depression and pain were assessed through validated sales. Changes in the scales from baseline to the 6-month follow-up visit were analysed. 60 PD patients (66.67% males) were enrolled at baseline, and 45 patients completed the 6-month follow-up. PD patients improved motor symptoms at follow-up, with the significant reduction of motor fluctuations. The global score of the NMS Scale significantly decreased between baseline and the follow-up. Regarding pain domains, patients reported a significant improvement in discolouration and oedema/swelling. Further, a significant improvement was observed from baseline to follow-up in sleep quality measured through the Pittsburgh Sleep Quality Index, while no changes were documented in daytime sleepiness. No differences were found in depression and fatigue between baseline and follow-up. Finally, the patient’s perception of the impact of PD on functioning and well-being decreased from baseline to follow-up. The present findings confirmed the beneficial effect of safinamide on both motor and non-motor symptoms, also improving the quality of life of PD patients. Furthermore, these data support the positive effects of safinamide on pain and mood, as well as on sleep quality and continuity.
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Affiliation(s)
- Claudia De Masi
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Claudio Liguori
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy. .,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy. .,UOSD Parkinson's Disease Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Matteo Spanetta
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Rocco Cerroni
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Elena Garasto
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Mariangela Pierantozzi
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy.,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,UOSD Parkinson's Disease Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Nicola Biagio Mercuri
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy.,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,IRCCS Santa Lucia Foundation, Rome, Italy
| | - Alessandro Stefani
- Neurology Unit, University Hospital of Rome "Tor Vergata", Rome, Italy.,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,UOSD Parkinson's Disease Centre, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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10
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Tsuboi T, Satake Y, Hiraga K, Yokoi K, Hattori M, Suzuki M, Hara K, Ramirez-Zamora A, Okun MS, Katsuno M. Effects of MAO-B inhibitors on non-motor symptoms and quality of life in Parkinson's disease: A systematic review. NPJ Parkinsons Dis 2022; 8:75. [PMID: 35697709 PMCID: PMC9192747 DOI: 10.1038/s41531-022-00339-2] [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: 01/05/2022] [Accepted: 05/24/2022] [Indexed: 11/09/2022] Open
Abstract
Non-motor symptoms (NMS) are common among patients with Parkinson's disease and reduce patients' quality of life (QOL). However, there remain considerable unmet needs for NMS management. Three monoamine oxidase B inhibitors (MAO-BIs), selegiline, rasagiline, and safinamide, have become commercially available in many countries. Although an increasing number of studies have reported potential beneficial effects of MAO-BIs on QOL and NMS, there has been no consensus. Thus, the primary objective of this study was to provide an up-to-date systematic review of the QOL and NMS outcomes from the available clinical studies of MAO-BIs. We conducted a literature search using the PubMed, Scopus, and Cochrane Library databases in November 2021. We identified 60 publications relevant to this topic. Overall, rasagiline and safinamide had more published evidence on QOL and NMS changes compared with selegiline. This was likely impacted by selegiline being introduced many years prior to the field embarking on the study of NMS. The impact of MAO-BIs on QOL was inconsistent across studies, and this was unlikely to be clinically meaningful. MAO-BIs may potentially improve depression, sleep disturbances, and pain. In contrast, cognitive and olfactory dysfunctions are likely unresponsive to MAO-BIs. Given the paucity of evidence and controlled, long-term studies, the effects of MAO-BIs on fatigue, autonomic dysfunctions, apathy, and ICD remain unclear. The effects of MAO-BIs on static and fluctuating NMS have never been investigated systematically. More high-quality studies will be needed and should enable clinicians to provide personalized medicine based on a non-motor symptom profile.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Yuki Satake
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Hiraga
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsunori Yokoi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Neurology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Makoto Hattori
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Suzuki
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Clinical laboratory, Nagoya University Hospital, Nagoya, Japan
| | - Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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11
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Striatal glutamatergic hyperactivity in Parkinson's disease. Neurobiol Dis 2022; 168:105697. [DOI: 10.1016/j.nbd.2022.105697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/21/2022] Open
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12
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Safinamide in the treatment pathway of Parkinson's Disease: a European Delphi Consensus. NPJ Parkinsons Dis 2022; 8:17. [PMID: 35190544 PMCID: PMC8861053 DOI: 10.1038/s41531-022-00277-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/22/2021] [Indexed: 12/22/2022] Open
Abstract
Safinamide is a highly selective, reversible MAO B-inhibitor recently marketed in European and North American countries. To better define clinical indications regarding motor and non-motor symptoms, targeted population and safety of this compound, ten movement disorders specialists, experts in their field, convened and developed a panel of statements on: the role of glutamate in Parkinson's disease, introduction to fluctuations, efficacy of safinamide on motor symptoms, motor complications and non-motor symptoms, quality of life, safety of safinamide and target population for use. Strong consensus was reached for all the statements on the efficacy of safinamide on motor symptoms, motor fluctuations, quality of life and safety. Among non-motor symptoms, a positive consensus was reached for the symptoms sleep/fatigue, mood, and pain while there was a lack of consensus for the statements regarding the efficacy of safinamide in improving cognition, urinary and sexual functions. The statement on orthostatic hypotension obtained a negative consensus. The consistent and large agreement reached in this Delphi panel perfectly reflects the perception of efficacy, safety and tolerability of safinamide as evident from pivotal trials and clinical practice and shows how these findings may guide movement disorders specialists in their clinical therapeutic approach. The impact of non-motor symptoms in PD is considerable, and management remains an unmet need. In this context, the ability of safinamide to impact some non-motor symptoms may represent the most promising and distinctive feature of this compound and deserves further investigations.
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13
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A critical appraisal of MAO-B inhibitors in the treatment of Parkinson's disease. J Neural Transm (Vienna) 2022; 129:723-736. [PMID: 35107654 PMCID: PMC9188534 DOI: 10.1007/s00702-022-02465-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/15/2022] [Indexed: 10/31/2022]
Abstract
Since the 1980s, the MAO-B inhibitors have gained considerable status in the therapy of the Parkinson's disease. In addition to the symptomatic effect in mono- and combination therapies, a neuroprotective effect has repeatedly been a matter of some discussion, which has unfortunately led to a good many misunderstandings. Due to potential interactions, selegiline has declined in significance in the field. For the MAO-B inhibitor safinamide, recently introduced to the market, an additional inhibition of pathological release of glutamate has been postulated. At present, rasagiline and selegiline are being administered in early therapy as well as in combination with levodopa. Safinamide has been approved only for combination therapy with levodopa when motor fluctuations have occurred. MAO-B inhibitors are a significant therapeutic option for Parkinson's disease, an option which is too often not appreciated properly.
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14
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Wei Q, Tan Y, Xu P, Tao E, Lu Z, Pan X, Wang B, Liu C, Dong X, Tian Y, Sun X, Cattaneo C, Chen S, Shang H, Shang H, Tao E, Liu C, Wu Y, Geng D, Lu Z, Xu P, Hu X, Luo Y, Zhou J, Huang W, Chen G, Tian Y, Tuo H, Wang B, Zhang M, Liu J, Sun X, Jiao L, Jin L, Feng T, Liu Y, Zhang B, Ye Q, Xu Y, Liu J, Gu S, Xu YM, Dong X, Liu D, Pan X. The XINDI Study: A Randomized Phase III Clinical Trial Evaluating the Efficacy and Safety of Safinamide as Add-On Therapy to Levodopa in Chinese Patients with Parkinson's Disease with Motor Fluctuations. CNS Drugs 2022; 36:1217-1227. [PMID: 36346534 PMCID: PMC9641300 DOI: 10.1007/s40263-022-00958-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Levodopa remains the gold standard for the treatment of Parkinson's disease, but its long-term use is associated with motor complications whose management is still a significant challenge. Safinamide is a multimodal drug with proven efficacy as an adjunct to levodopa. OBJECTIVE The objective of this study was to investigate the efficacy and safety of safinamide as an add-on to levodopa in Chinese patients with Parkinson's disease with motor fluctuations. METHODS The XINDI study was a phase III, randomized, double-blind, placebo-controlled, multicenter study, with a 2-week screening period and a 16-week treatment period. The starting dose of safinamide (or placebo) was 50 mg once daily, increased to 100 mg once daily at day 15. Patients aged ≥ 18 years, with idiopathic Parkinson's disease of >3 years duration, Hoehn and Yahr stage 1-4, and daily OFF time ≥ 1.5 h, were eligible. Patients should follow a stable oral levodopa regimen and may receive concomitant treatment with stable doses of other anti-Parkinson drugs, except monoamine oxidase-B inhibitors. Patients with severe disabling peak-dose or biphasic dyskinesia, unpredictable or widely swinging fluctuations, other forms of parkinsonism, a history of dementia or severe cognitive dysfunction, major psychiatric illnesses, and/or clinically significant medical illnesses were excluded. The primary efficacy endpoint was the change from baseline to week 16 in the mean daily OFF time. Secondary efficacy endpoints included the Unified Parkinson's Disease Rating Scale, the Numerical Rating Scale, the Clinical Global Impression scale, and the 39-Item Parkinson's Disease Questionnaire scale. The statistical analysis of the efficacy parameters was conducted using an analysis of co-variance, except for the Clinical Global Impression scale scores that were assessed using the Wilcoxon-Mann-Whitney test. Safety was evaluated through the frequency of adverse events and serious adverse events, physical examination, vital signs, 12-lead electrocardiograms, and laboratory exams. All safety endpoints were summarized using descriptive statistics. RESULTS The trial enrolled 307 patients. At week 16, the difference in the change of the mean total daily OFF time between safinamide and placebo groups was 1.10 h (p < 0.0001). This change was significantly greater in the safinamide group starting from week 2, suggesting a rapid onset of drug efficacy. ON time, Unified Parkinson's Disease Rating Scale, Clinical Global Impression scale, and the 39-Item Parkinson's Disease Questionnaire showed statistically significant improvements. There were no significant between-group differences for adverse events or serious adverse events. CONCLUSIONS Safinamide, as add-on therapy to levodopa, significantly reduced motor fluctuations and improved motor symptoms and quality of life of Chinese patients with idiopathic Parkinson's disease. The improvements observed in the Unified Parkinson's Disease Rating Scale total and motor scores were also clinically significant. No safety concerns were identified, confirming the good tolerability profile of the drug. CLINICAL TRIAL REGISTRATION NCT03881371, registered on 19 March, 2019, https://clinicaltrials.gov/NCT03881371 .
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Affiliation(s)
- Qianqian Wei
- grid.412901.f0000 0004 1770 1022Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Yuyan Tan
- grid.16821.3c0000 0004 0368 8293Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pingyi Xu
- grid.470124.4Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Enxiang Tao
- grid.412536.70000 0004 1791 7851Department of Neurology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Zuneng Lu
- grid.412632.00000 0004 1758 2270Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoping Pan
- grid.413432.30000 0004 1798 5993Department of Neurology, Guangzhou First People’s Hospital, Guangzhou, China
| | - Baojun Wang
- Department of Neurology, Baotou City Central Hospital, Baotou, China
| | - Chunfeng Liu
- grid.452666.50000 0004 1762 8363Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xueshuang Dong
- grid.452354.10000 0004 1757 9055Department of Neurology, Daqing Oilfield General Hospital, Daqing, China
| | - Yuling Tian
- grid.452461.00000 0004 1762 8478Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xin Sun
- grid.64924.3d0000 0004 1760 5735Department of Neurology, The First Bethune Hospital of Jilin University, Jilin, China
| | - Carlo Cattaneo
- grid.476824.bMedical Department, Zambon SpA, Bresso, Italy
| | - Shengdi Chen
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 2000001, China.
| | - Huifang Shang
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Wuhou, Sichuan, 610041, Chengdu, China.
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15
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Characteristics of wearing-off and motor symptoms improved by safinamide adjunct therapy in patients with Parkinson's disease: A post hoc analysis of a Japanese phase 2/3 study. J Neurol Sci 2021; 434:120083. [PMID: 35007919 DOI: 10.1016/j.jns.2021.120083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) experience various motor and non-motor symptoms. We conducted a post hoc analysis of a Japanese phase 2/3 study of safinamide (50 or 100 mg/day) in patients with Parkinson's disease and wearing-off to evaluate response according to background factors. Safinamide efficacy against major motor symptoms was also assessed. METHODS Multiple regression analyses in safinamide-treated patients (50 or 100 mg/day) assessed changes in daily ON-time without troublesome dyskinesia (hereafter referred to as ON-time) according to baseline clinical variables. Subgroup analyses by baseline Unified Parkinson's Disease Rating Scale (UPDRS) part III score were also conducted. We evaluated cardinal motor symptoms using the UPDRS. RESULTS In the multiple regression analysis, changes in ON-time were related to baseline non-motor symptoms (UPDRS part I score) and ON-time in the 50-mg group, but no relationships with non-motor symptoms were observed in the 100-mg group. Additionally, in the subgroup analysis of patients with more severe motor symptoms (UPDRS part III score > 20), a significant improvement in ON-time was observed only with 100 mg/day (p = 0.01). At both doses, safinamide significantly improved cardinal motor symptom scores (bradykinesia, rigidity, tremor, axial symptoms, and gait disturbances). CONCLUSIONS The observed response profile to the 50-mg/day dose may be related to baseline non-motor symptoms, but this was not true for the 100-mg/day dose. Both safinamide doses improved major motor symptoms in levodopa-treated patients with PD.
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16
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Hutny M, Hofman J, Klimkowicz-Mrowiec A, Gorzkowska A. Current Knowledge on the Background, Pathophysiology and Treatment of Levodopa-Induced Dyskinesia-Literature Review. J Clin Med 2021; 10:jcm10194377. [PMID: 34640395 PMCID: PMC8509231 DOI: 10.3390/jcm10194377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/02/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023] Open
Abstract
Levodopa remains the primary drug for controlling motor symptoms in Parkinson’s disease through the whole course, but over time, complications develop in the form of dyskinesias, which gradually become more frequent and severe. These abnormal, involuntary, hyperkinetic movements are mainly characteristic of the ON phase and are triggered by excess exogenous levodopa. They may also occur during the OFF phase, or in both phases. Over the past 10 years, the issue of levodopa-induced dyskinesia has been the subject of research into both the substrate of this pathology and potential remedial strategies. The purpose of the present study was to review the results of recent research on the background and treatment of dyskinesia. To this end, databases were reviewed using a search strategy that included both relevant keywords related to the topic and appropriate filters to limit results to English language literature published since 2010. Based on the selected papers, the current state of knowledge on the morphological, functional, genetic and clinical features of levodopa-induced dyskinesia, as well as pharmacological, genetic treatment and other therapies such as deep brain stimulation, are described.
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Affiliation(s)
- Michał Hutny
- Students’ Scientific Society, Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
- Correspondence:
| | - Jagoda Hofman
- Students’ Scientific Society, Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Aleksandra Klimkowicz-Mrowiec
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Medical College, Jagiellonian University, 30-688 Kraków, Poland;
| | - Agnieszka Gorzkowska
- Department of Neurorehabilitation, Faculty of Medical Sciences, School of Medicine, Medical University of Silesia, 40-752 Katowice, Poland;
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Santos García D, Blázquez-Estrada M, Calopa M, Escamilla-Sevilla F, Freire E, García Ruiz PJ, Grandas F, Kulisevsky J, López-Manzanares L, Martínez Castrillo JC, Mir P, Pagonabarraga J, Pérez-Errazquin F, Salom JM, Tijero B, Valldeoriola F, Yáñez R, Avilés A, Luquín MR. Present and Future of Parkinson's Disease in Spain: PARKINSON-2030 Delphi Project. Brain Sci 2021; 11:1027. [PMID: 34439646 PMCID: PMC8393421 DOI: 10.3390/brainsci11081027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/16/2022] Open
Abstract
Parkinson's disease (PD) is a chronic progressive and irreversible disease and the second most common neurodegenerative disease worldwide. In Spain, it affects around 120.000-150.000 individuals, and its prevalence is estimated to increase in the future. PD has a great impact on patients' and caregivers' lives and also entails a substantial socioeconomic burden. The aim of the present study was to examine the current situation and the 10-year PD forecast for Spain in order to optimize and design future management strategies. This study was performed using the modified Delphi method to try to obtain a consensus among a panel of movement disorders experts. According to the panel, future PD management will improve diagnostic capacity and follow-up, it will include multidisciplinary teams, and innovative treatments will be developed. The expansion of new technologies and studies on biomarkers will have an impact on future PD management, leading to more accurate diagnoses, prognoses, and individualized therapies. However, the socio-economic impact of the disease will continue to be significant by 2030, especially for patients in advanced stages. This study highlighted the unmet needs in diagnosis and treatment and how crucial it is to establish recommendations for future diagnostic and therapeutic management of PD.
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Affiliation(s)
- Diego Santos García
- Department of Neurology, Complexo Universitario de A Coruña (CHUAC), C/As Xubias 84, 15006 A Coruña, Spain
| | - Marta Blázquez-Estrada
- Department of Neurology, Hospital Universitario Central de Asturias, Avenida de Roma s/n, 33011 Oviedo, Spain;
| | - Matilde Calopa
- Neurology Service, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain;
| | - Francisco Escamilla-Sevilla
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs. Granada, 18013 Granada, Spain;
| | - Eric Freire
- Departamento de Neurología, Hospital IMED Elche, Calle Max Planck 3, 03203 Elche, Spain;
| | - Pedro J. García Ruiz
- Servicio de Neurología, Fundación Jiménez Díaz, Avda Reyes Católicos 2, 28040 Madrid, Spain;
| | - Francisco Grandas
- Servicio de Neurología, Hospital Gregorio Marañón, Calle del Dr. Esquerdo 46, 28007 Madrid, Spain;
| | - Jaime Kulisevsky
- Servicio de Neurología, Unidad de Trastornos del Movimiento, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERNED, C/Mas Casanovas 90, 08041 Barcelona, Spain; (J.K.); (P.M.); (J.P.)
| | - Lydia López-Manzanares
- Servicio de Neurología, Hospital de la Princesa, Calle de Diego de León 62, 28006 Madrid, Spain;
| | | | - Pablo Mir
- Servicio de Neurología, Unidad de Trastornos del Movimiento, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERNED, C/Mas Casanovas 90, 08041 Barcelona, Spain; (J.K.); (P.M.); (J.P.)
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, S/n, 41013 Sevilla, Spain
| | - Javier Pagonabarraga
- Servicio de Neurología, Unidad de Trastornos del Movimiento, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBERNED, C/Mas Casanovas 90, 08041 Barcelona, Spain; (J.K.); (P.M.); (J.P.)
| | - Francisco Pérez-Errazquin
- Servicio de Neurología, Hospital Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain;
| | - José María Salom
- Servicio de Neurología, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez No. 17, 46010 Valencia, Spain;
| | - Beatriz Tijero
- Servicio de Neurología, Hospital Cruces, Cruces Plaza, S/N, 48903 Barakaldo, Bilbao, Spain;
| | - Francesc Valldeoriola
- Parkinson’s Disease and Movement Disorders Unit—Neurology Service, Hospital Clinic Barcelona, Universitat de Barcelona & Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/Casanova 170, 08036 Barcelona, Spain;
- CIBERNED, C/Mas Casanova 170, 08041 Barcelona, Spain
| | - Rosa Yáñez
- Servicio de Neurología, Complejo Hospitalario Universitario de Ourense, Ramon Puga Noguerol 54, 32005 Ourense, Spain;
| | - Arantxa Avilés
- Departamento Médico, Zambon S.A.U. C/Maresme, 5 Pol. Ind. Can Bernades-Subirà, 08130 Barcelona, Spain;
| | - María-Rosario Luquín
- Departamento de Neurología, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, Avenida de Pio XII 36, 31008 Pamplona, Spain;
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18
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Meira B, Degos B, Corsetti E, Doulazmi M, Berthelot E, Virbel-Fleischman C, Dodet P, Méneret A, Mariani LL, Delorme C, Cormier-Dequaire F, Bendetowicz D, Villain N, Tarrano C, Mantisi L, Letrillart H, Louapre C, McGovern E, Worbe Y, Grabli D, Vidailhet M, Hainque E, Roze E. Long-term effect of apomorphine infusion in advanced Parkinson's disease: a real-life study. NPJ PARKINSONS DISEASE 2021; 7:50. [PMID: 34117268 PMCID: PMC8196159 DOI: 10.1038/s41531-021-00194-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/09/2021] [Indexed: 02/06/2023]
Abstract
Long-term effects of continuous subcutaneous apomorphine infusion (CSAI) on health-related quality of life (HRQoL) and predictors of CSAI discontinuation are poorly known. Data from consecutive advanced Parkinson’s disease patients treated in routine care were retrospectively collected over 24 months after CSAI initiation, with a focus on the 39-item Parkinson’s disease questionnaire (PDQ-39). We determined predictors of CSAI discontinuation and HRQoL improvement using multiple regression analysis. Of the 110 subjects evaluated over a 2-year period, 35% discontinued CSAI. Of those who continued treatment, HRQoL remained stable with a sustained reduction in motor fluctuations. The observed effect on dyskinesias was mild and transient. Of note, patients with preexisting impulse control disorders showed an overall good tolerability. PDQ-39 was the only baseline predictor of HRQoL improvement after 2 years of treatment. The presence of dyskinesias, poorer psychological status, shorter disease duration, male sex, and worse OFF state were predictors of discontinuation. Best candidates for CSAI are patients with: (i) poor baseline HRQoL and (ii) marked motor fluctuations.
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Affiliation(s)
- Bruna Meira
- Neurology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Bertrand Degos
- Neurology Department, Avicenne Hospital, AP-HP, Sorbonne Paris Nord University, Bobigny, France
| | - Elise Corsetti
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Mohamed Doulazmi
- Adaptation Biologique et Vieillissement, Institut de Biologie Paris Seine, Sorbonne University, CNRS, Paris, France
| | - Emeline Berthelot
- Neurology Department, Hôpital Zobda Quitman, Fort-de-France, French West Indies, France
| | - Clara Virbel-Fleischman
- Air Liquide SA, Explor Center (Healthcare), Fort-de-France, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Pauline Dodet
- Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France.,Sleep Disorders (Department "R3S"), Pitié-Salpêtrière Hospital, Paris, France
| | - Aurélie Méneret
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Louise-Laure Mariani
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Cécile Delorme
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Florence Cormier-Dequaire
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - David Bendetowicz
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Nicolas Villain
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France.,Sorbonne Université, GRC no 21, Alzheimer Precision Medicine, Paris, France
| | - Clément Tarrano
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Lise Mantisi
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Hélène Letrillart
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Céline Louapre
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Eavan McGovern
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Yulia Worbe
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Neurophysiology Department, Saint Antoine Hospital, AP-HP, Paris, France
| | - David Grabli
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Marie Vidailhet
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Elodie Hainque
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France
| | - Emmanuel Roze
- Neurology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France. .,Paris Brain Institute, Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris, France.
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19
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Abbruzzese G, Barone P, Lopiano L, Stocchi F. The Current Evidence for the Use of Safinamide for the Treatment of Parkinson's Disease. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:2507-2517. [PMID: 34140766 PMCID: PMC8203199 DOI: 10.2147/dddt.s302673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/25/2021] [Indexed: 12/17/2022]
Abstract
Introduction Parkinson’s therapeutic interventions are only symptomatic. An optimal treatment should therefore address the largest number of motor and non-motor symptoms, to manage patients at best. Safinamide is one of the most recent approved drugs for fluctuating patients, in add-on to levodopa, that remains the gold standard treatment. It has a unique mechanism of action, both dopaminergic (as MAO-B inhibitor) and glutamatergic (through Na+ channel blockade). Results from Phase III trials, post-hoc analyses and real-life experiences suggest a beneficial effect on motor (such as tremor, bradykinesia, rigidity and gait) and non-motor (pain, mood, sleep) symptoms. Areas Covered Here, the authors discuss clinical efficacy and safety of safinamide, identifying the patients’ profiles that could benefit most. A search in PubMed was performed in September 2020, with no time limits. Publications’ abstracts were reviewed. Conclusion Safinamide is peculiar due to its double mechanism of action. Its benefits in improving motor functions and fluctuations, and some non-motor symptoms, could have a valuable impact on patients’ quality of life (QoL), together with its safety profile.
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Affiliation(s)
| | - Paolo Barone
- School of Medicine, University of Salerno, Salerno, Italy
| | - Leonardo Lopiano
- Department of Neuroscience, University of Turin, AOU Città della Salute e della Scienza, Torino, Italy
| | - Fabrizio Stocchi
- Department of Neurology, University and Institute for Research and Medical Care, San Raffaele Roma, Rome, Italy
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20
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Santos García D, Labandeira Guerra C, Yáñez Baña R, Cimas Hernando MI, Cabo López I, Paz Gonález JM, Alonso Losada MG, González Palmás MJ, Martínez Miró C. Safinamide Improves Non-Motor Symptoms Burden in Parkinson's Disease: An Open-Label Prospective Study. Brain Sci 2021; 11:316. [PMID: 33801565 PMCID: PMC7999475 DOI: 10.3390/brainsci11030316] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022] Open
Abstract
Some studies observed a benefit of Parkinson's disease (PD) patients after treatment with safinamide in some non-motor symptoms (NMSs). The aim of this study was to analyze the effectiveness of safinamide on NMS burden in PD. SAFINONMOTOR (an open-label study of the effectiveness of safinamide on non-motor symptoms in Parkinson's disease patients) is a prospective open-label single-arm study conducted in five centers from Spain. The primary efficacy outcome was the change from baseline (V1) to the end of the observational period (6 months) (V4) in the non-motor symptoms scale (NMSS) total score. Between May/2019 and February/2020 50 patients were included (age 68.5 ± 9.12 years; 58% females; 6.4 ± 5.1 years from diagnosis). At 6 months, 44 patients completed the follow-up (88%). The NMSS total score was reduced by 38.5% (from 97.5 ± 43.7 in V1 to 59.9 ± 35.5 in V4; p < 0.0001). By domains, improvement was observed in sleep/fatigue (-35.8%; p = 0.002), mood/apathy (-57.9%; p < 0.0001), attention/memory (-23.9%; p = 0.026), gastrointestinal symptoms (-33%; p = 0.010), urinary symptoms (-28.3%; p = 0.003), and pain/miscellaneous (-43%; p < 0.0001). Quality of life (QoL) also improved with a 29.4% reduction in the PDQ-39SI (from 30.1 ± 17.6 in V1 to 21.2 ± 13.5 in V4; p < 0.0001). A total of 21 adverse events in 16 patients (32%) were reported, 5 of which were severe (not related to safinamide). Dyskinesias and nausea were the most frequent (6%). Safinamide is well tolerated and improves NMS burden and QoL in PD patients with severe or very severe NMS burden at 6 months.
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Affiliation(s)
- Diego Santos García
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.M.M.)
| | - Carmen Labandeira Guerra
- Department of Neurology, CHUVI, Complejo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (C.L.G.); (M.G.A.L.)
| | - Rosa Yáñez Baña
- Department of Neurology, CHUO, Complejo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | | | - Iria Cabo López
- Department of Neurology, CHOP, Complejo Hospitalario Universitario de Pontevedra, 36002 Pontevedra, Spain; (I.C.L.); (M.J.G.P.)
| | - Jose Manuel Paz Gonález
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.M.M.)
| | - Maria Gemma Alonso Losada
- Department of Neurology, CHUVI, Complejo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (C.L.G.); (M.G.A.L.)
| | - María José González Palmás
- Department of Neurology, CHOP, Complejo Hospitalario Universitario de Pontevedra, 36002 Pontevedra, Spain; (I.C.L.); (M.J.G.P.)
| | - Cristina Martínez Miró
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (J.M.P.G.); (C.M.M.)
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21
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Impact of SAfinamide on Depressive Symptoms in Parkinson's Disease Patients (SADness-PD Study): A Multicenter Retrospective Study. Brain Sci 2021; 11:brainsci11020232. [PMID: 33668408 PMCID: PMC7918129 DOI: 10.3390/brainsci11020232] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/24/2021] [Accepted: 02/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We aimed to assess the effects of safinamide on depression, motor symptoms, and the serotonin syndrome related to its co-administration with antidepressants in patients with Parkinson's disease (PD). METHODS We retrospectively analyzed the data of patients at 1 and 3 months of follow-up compared to baseline. RESULTS n = 82 (safinamide 50 mg = 22, 100 mg = 60, with antidepressants = 44). First, we found improvement in depression (Hamilton Depression Rating Scale: -6 ± 5.10 at 1 month and -7.27 ± 5.10 at 3 months, p < 0.0001; Patient Global Impression of Improvement Scale: 60.3% and 69.5% of patients at 1 and 3 months reported some improvement). Second, safinamide improved the daily life activities and motor symptoms/motor complications (Unified Parkinson's Disease Rating Scale (UPDRS-II): -2.51 ± 6.30 and -2.47 ± 6.11 at 1 and 3 months, p < 0.0001; III: -3.58 ± 8.68 and -4.03 ± 8.95 at 1 and 3 months, p < 0.0001; IV: -0.61 ± 2.61 and -0.8 ± 2.53 at 1 and 3 months, p < 0.0001). Third, 7.31% and 8.53% of patients developed non-severe adverse events related to safinamide at 1 and 3 months. Serotonin syndrome was not observed in the patients treated with antidepressants; some isolated serotonin syndrome symptoms were reported. CONCLUSIONS Safinamide could be useful for treating depression in PD; it was effective for motor symptoms and motor complications and safe even when co-administered with antidepressants.
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22
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Wasan H, Singh D, Kh R. Safinamide in neurological disorders and beyond: Evidence from preclinical and clinical studies. Brain Res Bull 2020; 168:165-177. [PMID: 33387637 DOI: 10.1016/j.brainresbull.2020.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/04/2020] [Accepted: 12/27/2020] [Indexed: 01/08/2023]
Abstract
The discovery and development of safinamide, an alpha-aminoamide, has been a valuable addition to the existing clinical management of Parkinson's disease (PD). The journey of safinamide dates back to the year 1983, when an alpha-aminoamide called milacemide showed a weak anticonvulsant activity. Milacemide was then structurally modified to give rise to safinamide, which in turn produced robust anticonvulsant activity. The underlying mechanism behind this action of safinamide is attributed to the inhibition of voltage gated calcium and sodium channels. Moreover, owing to the importance of ion channels in maintaining neuronal circuitry and neurotransmitter release, numerous studies explored the potential of safinamide in neurological diseases including PD, stroke, multiple sclerosis and neuromuscular disorders such as Duchenne muscular dystrophy and non-dystrophic myotonias. Nevertheless, evidence from multiple preclinical studies suggested a potent, selective and reversible inhibitory activity of safinamide against monoamine oxidase (MAO)-B enzyme which is responsible for degrading dopamine, a neurotransmitter primarily implicated in the pathophysiology of PD. Therefore, clinical studies were conducted to assess safety and efficacy of safinamide in PD. Indeed, results from various Phase 3 clinical trials suggested strong evidence of safinamide as an add-on therapy in controlling the exacerbation of PD. This review presents a thorough developmental history of safinamide in PD and provides comprehensive insight into plausible mechanisms via which safinamide can be explored in other neurological and muscular diseases.
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Affiliation(s)
- Himika Wasan
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
| | - Devendra Singh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
| | - Reeta Kh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
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23
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Domingues AV, Pereira IM, Vilaça-Faria H, Salgado AJ, Rodrigues AJ, Teixeira FG. Glial cells in Parkinson´s disease: protective or deleterious? Cell Mol Life Sci 2020; 77:5171-5188. [PMID: 32617639 PMCID: PMC11104819 DOI: 10.1007/s00018-020-03584-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/25/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Abstract
Glial cells have been identified more than 100 years ago, and are known to play a key role in the central nervous system (CNS) function. A recent piece of evidence is emerging showing that in addition to the capacity of CNS modulation and homeostasis, glial cells are also being looked like as a promising cell source not only to study CNS pathologies initiation and progression but also to the establishment and development of new therapeutic strategies. Thus, in the present review, we will discuss the current evidence regarding glial cells' contribution to neurodegenerative diseases as Parkinson's disease, providing cellular, molecular, functional, and behavioral data supporting its active role in disease initiation, progression, and treatment. As so, considering their functional relevance, glial cells may be important to the understanding of the underlying mechanisms regarding neuronal-glial networks in neurodegeneration/regeneration processes, which may open new research opportunities for their future use as a target or treatment in human clinical trials.
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Affiliation(s)
- Ana V Domingues
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal
- ICVS/3B's Associate Lab, PT Government Associated Laboratory, Braga/Guimarães, Portugal
| | - Inês M Pereira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal
- ICVS/3B's Associate Lab, PT Government Associated Laboratory, Braga/Guimarães, Portugal
| | - Helena Vilaça-Faria
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal
- ICVS/3B's Associate Lab, PT Government Associated Laboratory, Braga/Guimarães, Portugal
| | - António J Salgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal
- ICVS/3B's Associate Lab, PT Government Associated Laboratory, Braga/Guimarães, Portugal
| | - Ana J Rodrigues
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal.
- ICVS/3B's Associate Lab, PT Government Associated Laboratory, Braga/Guimarães, Portugal.
| | - Fábio G Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057, Braga, Portugal.
- ICVS/3B's Associate Lab, PT Government Associated Laboratory, Braga/Guimarães, Portugal.
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24
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Jismy B, El Qami A, Pišlar A, Frlan R, Kos J, Gobec S, Knez D, Abarbri M. Pyrimido[1,2-b]indazole derivatives: Selective inhibitors of human monoamine oxidase B with neuroprotective activity. Eur J Med Chem 2020; 209:112911. [PMID: 33071056 DOI: 10.1016/j.ejmech.2020.112911] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
Structurally diverse heterotricyclic compounds are recognized as monoamine oxidase (MAO) inhibitors and thus represent an appealing scaffold in development and optimization of novel MAO inhibitors. Herein we explored the chemical space of pyrimido[1,2-b]indazoles as MAO inhibitors by preparing a small library of (hetero)aryl derivatives. An efficient synthetic strategy was developed starting from commercially available 1H-indazol-3-amines, which were converted to various 3-bromoheterotricyclic derivatives and further functionalized via Suzuki-Miyaura coupling reaction. Derivatives 4a-t selectively inhibited human MAO-B isoform in a reversible and competitive manner as confirmed by kinetic experiments and docking studies. Selected derivatives were not cytotoxic to neuroblastoma SH-SY5Y cells. Moreover, analogue 4i protected human neuroblastoma SH-SY5Y cells against 6-hydroxydopamine-induced cell death, which confirms the applicability of the pyrimido[1,2-b]indazoles as potential antiparkinsonian agents.
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Affiliation(s)
- Badr Jismy
- Laboratoire de Physico-Chimie des Matériaux et des Electrolytes pour L'Energie (PCM2E), EA 6299. Avenue Monge Faculté des Sciences, Parc de Grandmont, 37200, Tours, France
| | - Abdelkarim El Qami
- Département de Chimie Université Hassan II de Casablanca, Laboratoire de Chimie Physique et de Chimie Bioorganique, URAC 22, BP 146, 28800, Mohammedia, Morocco
| | - Anja Pišlar
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, SI-1000, Ljubljana, Slovenia
| | - Rok Frlan
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, SI-1000, Ljubljana, Slovenia
| | - Janko Kos
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, SI-1000, Ljubljana, Slovenia; Department of Biotechnology, Jožef Stefan Institute, Jamova 39, SI-1000, Ljubljana, Slovenia
| | - Stanislav Gobec
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, SI-1000, Ljubljana, Slovenia
| | - Damijan Knez
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, SI-1000, Ljubljana, Slovenia.
| | - Mohamed Abarbri
- Laboratoire de Physico-Chimie des Matériaux et des Electrolytes pour L'Energie (PCM2E), EA 6299. Avenue Monge Faculté des Sciences, Parc de Grandmont, 37200, Tours, France.
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