RESUMO
Epilepsy is a common neurological disorder which affects 50 million people worldwide. Patients with epilepsy may present cognitive deficits and psychological impairment. Currently, 30% of patients fail to respond to any available antiseizure drug, and a significant number of patients do not well tolerate the offered treatments. Then, it is necessary to find out alternatives for controlling epileptic seizures. Studies have shown that despite its neuroprotective effects, resveratrol shows poor anticonvulsant properties. Resveratrol analog, piceatannol, possesses higher biological activity than resveratrol and could be an alternative to control seizure. Thus, the present study investigated the effects of resveratrol and piceatannol in pentylenetetrazole-induced seizures in adult zebrafish (Danio rerio). Only the experimental positive control (diazepam) showed anticonvulsant effect in this study. In addition, no behavioral changes were observed 24 h after seizure occurrence. Finally, the expression of genes related to neuronal activity (c-fos), neurogenesis (p70S6Ka and p70S6Kb), inflammatory response (interleukin 1ß), and cell apoptosis (caspase-3) did not change by pentylenetetrazole-induced seizures. Therefore, we failed to observe any anticonvulsant and neuroprotective potential of resveratrol and piceatannol in adult zebrafish. However, resveratrol and piceatannol benefits in epilepsy are not discharged, and more studies are necessary.
Assuntos
Epilepsia , Fármacos Neuroprotetores , Animais , Anticonvulsivantes/efeitos adversos , Caspase 3 , Diazepam/uso terapêutico , Epilepsia/tratamento farmacológico , Interleucina-1beta , Fármacos Neuroprotetores/efeitos adversos , Pentilenotetrazol/toxicidade , Resveratrol/farmacologia , Resveratrol/uso terapêutico , Convulsões/induzido quimicamente , Convulsões/tratamento farmacológico , Estilbenos , Peixe-ZebraRESUMO
In a previous in vitro study, dihydropyrimidinone-derived selenoesteres demonstrated antioxidant properties, metal chelators and inhibitory acetylcholinesterase (AChE) activity, making these compounds promising candidates for Alzheimer's Disease (AD) treatment. However, these effects have yet to be demonstrated in an in vivo animal model; therefore, this study aimed to evaluate the safety and efficacy of eight selenoester compounds in a Caenorhabditis elegans model using transgenic strains for amyloid-beta peptide (Aß) aggregation. The L1 stage worms were acutely exposed (30 min) to the compounds at concentrations ranging from 5 to 200 µM and after 48 h the maintenance temperature was increased to 25 ° C for Aß expression and aggregation. After 48 h, several parameters related to phenotypic manifestations of Aß toxicity and mechanistic elucidation were analyzed. At the concentrations tested no significant toxicity of the compounds was found. The selenoester compound FA90 significantly reduced the rate of paralyzed worms and increased the number of swimming movements compared to the untreated worms. In addition, FA90 and FA130 improved egg-laying induced by levamisole and positively modulated HSP-6 and HSP-4 expression, thereby increasing reticular and mitochondrial protein folding response in C. elegans, which could attenuate Aß aggregation in early exposure. Therefore, our initial screening using an alternative model demonstrated that FA90, among the eight selenoesters evaluated, was the most promising compound for AD evaluation screening in more complex animals.
Assuntos
Peptídeos beta-Amiloides/antagonistas & inibidores , Fármacos Neuroprotetores/farmacologia , Compostos Organosselênicos/farmacologia , Pirimidinonas/farmacologia , Acetilcolinesterase/metabolismo , Peptídeos beta-Amiloides/metabolismo , Animais , Caenorhabditis elegans , Modelos Animais de Doenças , Levamisol/farmacologia , Fármacos Neuroprotetores/efeitos adversos , Organismos Geneticamente Modificados , Compostos Organosselênicos/efeitos adversos , Oviposição/efeitos dos fármacos , Pirimidinonas/efeitos adversosRESUMO
INTRODUCTION: No neuroprotective treatment has been able to successfully halt the progression of Parkinson disease or prevent development of associated complications. Recombinant erythropoetin (EPO), an erythropoiesis-stimulating agent originally indicated in anemia, produced and manufactured in Cuba (iorEPOCIM, CIMAB S.A, Havana, Cuba) has neuroprotective properties. NeuroEPO is a new nasal formulation of recombinant EPO with a low content of sialic acid and without hematopoietic effects. It has neuroprotective effects in animal models. OBJECTIVE: Evaluate short-term tolerance of intranasal NeuroEPO in patients with Parkinson disease. METHODS: As part of a monocentric randomized placebo-controlled double-blind study (registered at www.clinicaltrials.gov number NCT04110678), 26 patients with Parkinson disease (stages 1 and 2 on Hoehn & Yahr Scale), were randomly divided into two groups: NeuroEPO (n = 15) and placebo (n = 11), both treated intranasally either with the drug (1 mL, at a concentration of 1 mg/mL of NeuroEPO) or placebo once a week for 5 weeks. At each application, we recorded any adverse events and blood pressure. To assess potential hematopoietic effects of the drug, hematological and biochemical variables were evaluated one week before and one week after the intervention. RESULTS: There were no significant differences (p = 0.22) between the two groups in terms of frequency of adverse events (20.0% in NeuroEPO and 9.1% in placebo groups). Three patients in NeuroEPO presented nausea, and one vomited (possibly due to the patient's positioning during drug application). One patient in placebo group reported polyuria and nasal irritation. In both groups, the adverse events were mild, brief, required no treatment and did not present sequelae. CONCLUSIONS: Nasally administered NeuroEPO for five weeks in patients with Parkinson disease stages 1 and 2 on Hoehn & Yahr Scale is well tolerated.
Assuntos
Eritropoetina/administração & dosagem , Eritropoetina/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Administração Intranasal , Adulto , Idoso , Cuba , Método Duplo-Cego , Eritropoetina/efeitos adversos , Humanos , Pessoa de Meia-Idade , Fármacos Neuroprotetores/administração & dosagem , Fármacos Neuroprotetores/efeitos adversos , Fármacos Neuroprotetores/uso terapêutico , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêuticoRESUMO
BACKGROUND: Recent findings on the benefits of glibenclamide as a neuroprotective drug have started a new era for prospective studies on sulfonylureas. The effect of glibenclamide blocking the Sur1-Trpm4 channel was examined in models of subarachnoid hemorrhage and stroke, with findings of significantly reduced tight-junction abnormalities, resulting in less edema formation and considerably reduced transsynaptic apoptosis of hippocampal neurons and significantly ameliorated impairments in spatial learning. Based on these data, we plan a clinical trial to establish evidence of glibenclamide as an adjunct treatment in aneurysmal subarachnoid hemorrhage. METHODS: An estimated 80 patients meeting the inclusion criteria of radiological confirmatory evidence of an aneurysmal subarachnoid hemorrhage, age 18-70 years, and presentation of less than 96 h from the ictus will be allocated randomly into two groups, one receiving 5 mg daily oral intake of glibenclamide for 21 days and another control group receiving a placebo. The study's primary outcome is the modified Rankin scale (mRS) after 6 months, as favorable (mRS 0-2) or unfavorable (mRS 3-6). The secondary outcomes will be late cognitive status, assessed after 6 months by psychological tests (the Short Form Health Survey Questionnaire and the Montreal Cognitive Assessment), as well as death at 6 months, delayed cerebral ischemia and occurrence of serious adverse events due to study medication. DISCUSSION: There is a growing interest in the scientific community regarding glibenclamide in brain edema and traumatic brain injury, but with very little of this interest targeting spontaneous brain hemorrhage, especially aneurism rupture. Positive outcomes are expected for the treatment patients, especially in language and memory preservation, as has been shown in experimental models. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03569540 . Retrospectively registered on 26 June 2018.
Assuntos
Encéfalo/efeitos dos fármacos , Cognição/efeitos dos fármacos , Glibureto/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Hemorragia Subaracnóidea/tratamento farmacológico , Adolescente , Adulto , Idoso , Encéfalo/fisiopatologia , Brasil , Método Duplo-Cego , Feminino , Glibureto/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuroprotetores/efeitos adversos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/fisiopatologia , Hemorragia Subaracnóidea/psicologia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Currently, available therapies for Parkinson's disease (PD) are symptomatic. Therefore, the search for neuroprotective drugs remains a top priority. Areas covered: In this review, the potential symptomatic or disease-modifying effect of drugs targeting the Renin-Angiotensin System (RAS) in PD will be explored. Expert opinion: The importance of nigrostriatal local RAS has only begun to be unraveled in the last decades. On one hand, there is a complex feedback cycle between RAS and dopamine (DA). On the other hand, RAS affects dopaminergic neurons vulnerability. Neuroprotective effects in animal PD models have been shown for the angiotensin-converting enzyme (ACE) inhibitors captopril and perindopril, and the AT1 receptor antagonists losartan, candesartan and telmisartan. These effects appear to be mediated by a reduction in the overproduction of reactive oxygen species. In a proof-of-concept, randomized, double-blind, crossover study in PD patients, perindopril enhanced the effect of levodopa without inducing dyskinesias. There has not been any clinical trial exploring the neuroprotective effect of RAS drugs, but one cohort study in hypertensive patients suggested a protective effect of ACE inhibitors on PD risk. RAS is a promising target for symptomatic and neuroprotective therapies in PD. Further studies in PD animal models and patients are warranted.
Assuntos
Antiparkinsonianos/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Animais , Antiparkinsonianos/efeitos adversos , Antiparkinsonianos/farmacologia , Dopamina/metabolismo , Desenho de Fármacos , Humanos , Terapia de Alvo Molecular , Fármacos Neuroprotetores/efeitos adversos , Fármacos Neuroprotetores/farmacologia , Doença de Parkinson/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Espécies Reativas de Oxigênio/metabolismo , Sistema Renina-Angiotensina/efeitos dos fármacosRESUMO
BACKGROUND: Delivery of therapeutic agents as erythropoietin (EPO) into Central Nervous System through intranasal route could benefit patients with neurological disorders. A new nasal formulation containing a non-hematopoietic recombinant EPO (NeuroEPO) has shown neuroprotective actions in preclinical models. In the current study, the safety of NeuroEPO was evaluated for the first time in humans. METHODS: A phase I, randomized, parallel, open-label study was carried out in healthy volunteers. They received, intranasally, 1 mg of NeuroEPO every 8 h during 4 days (Group A) or 0.5 mg of NeuroEPO (Group B) with the same schedule. The working hypothesis was that intranasal NeuroEPO produce <10% of severe adverse reactions in the evaluated groups. Therefore, a rigorous assessment of possible adverse events was carried out, which included tolerance of the nasal mucosa and the effect on hematopoietic activity. Clinical safety evaluation was daily during treatment and laboratory tests were done before and on days 5 and 14 after starting treatment. RESULTS: Twenty-five volunteers, 56% women, with a mean age of 27 yrs. were included. Twelve of them received the highest NeuroEPO dose. Twenty types of adverse events occurred, with headache (20%) and increase of hepatic enzymes (20%) as the most reported ones. Nasopharyngeal itching was the most common local event but only observed in four patients (16%), all of them from the lowest dose group. About half of the events were very probably or probably caused by the studied product. Most of the events were mild (95.5%), did not require treatment (88.6%) and were completely resolved (81.8%). No severe adverse events were reported. During the study the hematopoietic variables were kept within reference values. CONCLUSIONS: NeuroEPO was a safe product, well tolerated at the nasal mucosa level and did not stimulate erythropoiesis in healthy volunteers. TRIAL REGISTRATION: Cuban Public Registry of Clinical Trials RPCEC00000157 , June 10, 2013.
Assuntos
Eritropoetina/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Administração Intranasal , Adulto , Eritropoetina/efeitos adversos , Feminino , Humanos , Masculino , Fármacos Neuroprotetores/efeitos adversos , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Adulto JovemRESUMO
Introducción: El empleo de sulfato de magnesio para neuroprotección fetal es un tratamiento cada vez más frecuente. Objetivo: Estudiar la asociación entre sulfato de magnesio administrado a la gestante y la necesidad de reanimación neonatal. Pacientes y método: Estudio prospectivo de un grupo de prematuros menores de 32 semanas expuestos al sulfato de magnesio como neuroprotector y otro grupo retrospectivo inmediatamente anterior al inicio de este tratamiento. En ambos grupos se descartaron los casos que no habían recibido maduración pulmonar con corticoides. Se analizaron y compararon el porcentaje de reanimación y diferentes comorbilidades. Resultados: Se incluyó a 107 prematuros, 56 expuestos al sulfato de magnesio. El porcentaje de reanimación avanzada fue similar en ambos grupos. No se encontraron diferencias en mortalidad, ventilación mecánica invasiva, tiempo de la primera deposición y otras comorbilidades. Conclusiones: El sulfato de magnesio para neuroprotección no aumenta de forma significativa la necesidad de reanimación de los prematuros menores de 32 semanas.
Introduction: Magnesium sulphate administration is recommended for foetal neuroprotection in pregnant women at imminent risk of early preterm birth. Objective: To evaluate the relationship between intrapartum magnesium sulphate for foetal neuroprotection and delivery room resuscitation of preterm infants less 32 weeks. Patients and method: A prospective observational study was conducted on preterm infants less 32 weeks exposed to magnesium sulphate for neuroprotection, and a comparison made with another historic group immediately before starting this treatment. Cases in both groups that had not reached lung maturity with corticosteroids were rejected. The rates of resuscitation, morbidity and mortality for each of the groups were analysed and compared. Results: There was a total of 107 preterm, with 56 exposed to magnesium sulphate. Rate of advanced resuscitation were similar between the two groups. There were no other differences in mortality, invasive mechanical ventilation, time to first stool, and other comorbidities. Conclusions: Intrapartum magnesium sulphate for foetal neuroprotection was not associated with an increased need for intensive delivery room resuscitation and other morbidities in these cohorts of less than 32 weeks preterm infants.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Adulto , Adulto Jovem , Cuidado Pré-Natal/métodos , Ressuscitação/estatística & dados numéricos , Fármacos Neuroprotetores/administração & dosagem , Sulfato de Magnésio/administração & dosagem , Recém-Nascido Prematuro , Estudos Prospectivos , Fármacos Neuroprotetores/efeitos adversos , Sulfato de Magnésio/efeitos adversosRESUMO
Recent studies have demonstrated that lithium (Li) exerts neuronal protective and regenerative effects both in vitro and in vivo. However, the effects of long-term Li treatment in the brain areas associated with memory impairment of elderly bipolar patients are still unknown. The aim of this study was to compare the hippocampal volumes of elderly bipolar patients using Li, elderly bipolar patients not using Li and healthy controls. Sociodemographic, clinical and magnetic resonance imaging data from 30 elderly euthymic bipolar patients who had been using Li for an average of >61 months; 27 elderly euthymic bipolar patients not taking Li for an average of 45 months; and 22 elderly healthy controls were analyzed. Volumetric differences in the hippocampus between groups were investigated with voxel-based morphometry (VBM) based on the Statistical Parametric Mapping technique. No statistical differences in sociodemographic and clinical characteristics and course of bipolar disorder between the two bipolar groups were observed. Using small volume correction in the VBM analysis (analysis of variance (ANOVA)), one voxel cluster of statistical significance was detected in the left hippocampus (P<0.05 corrected for multiple comparisons, extent threshold >10 voxels). Post hoc unpaired t-tests revealed increased left hippocampal volume in the Li-treated group compared with the non-Li-treated group, and decreased left hippocampal volume in the non-Li group relative to controls. Additional exploratory two-group comparisons indicated trends toward reduced right-hippocampal volumes in the non-Li-treated group relative to both the Li-treated group and controls. The findings suggested that the use of Li may influence the volume of the hippocampus, possibly due to its neuroprotective effects.
Assuntos
Transtorno Bipolar/diagnóstico por imagem , Transtorno Bipolar/tratamento farmacológico , Hipocampo/efeitos dos fármacos , Hipocampo/diagnóstico por imagem , Carbonato de Lítio/efeitos adversos , Carbonato de Lítio/uso terapêutico , Imageamento por Ressonância Magnética , Fármacos Neuroprotetores/efeitos adversos , Fármacos Neuroprotetores/uso terapêutico , Tamanho do Órgão/efeitos dos fármacos , Fatores Etários , Idoso , Estudos de Casos e Controles , Dominância Cerebral/efeitos dos fármacos , Feminino , Humanos , Assistência de Longa Duração , Masculino , Memória/efeitos dos fármacos , Pessoa de Meia-Idade , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/efeitos dos fármacosRESUMO
INTRODUCTION: Magnesium sulphate administration is recommended for foetal neuroprotection in pregnant women at imminent risk of early preterm birth. OBJECTIVE: To evaluate the relationship between intrapartum magnesium sulphate for foetal neuroprotection and delivery room resuscitation of preterm infants less 32 weeks. PATIENTS AND METHOD: A prospective observational study was conducted on preterm infants less 32 weeks exposed to magnesium sulphate for neuroprotection, and a comparison made with another historic group immediately before starting this treatment. Cases in both groups that had not reached lung maturity with corticosteroids were rejected. The rates of resuscitation, morbidity and mortality for each of the groups were analysed and compared. RESULTS: There was a total of 107 preterm, with 56 exposed to magnesium sulphate. Rate of advanced resuscitation were similar between the two groups. There were no other differences in mortality, invasive mechanical ventilation, time to first stool, and other comorbidities. CONCLUSIONS: Intrapartum magnesium sulphate for foetal neuroprotection was not associated with an increased need for intensive delivery room resuscitation and other morbidities in these cohorts of less than 32 weeks preterm infants.
Assuntos
Sulfato de Magnésio/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Cuidado Pré-Natal/métodos , Ressuscitação/estatística & dados numéricos , Adulto , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Sulfato de Magnésio/efeitos adversos , Masculino , Fármacos Neuroprotetores/efeitos adversos , Gravidez , Estudos Prospectivos , Adulto JovemRESUMO
OBJECTIVE: To evaluate the clinical safety of antenatal and postnatal N-acetylcysteine (NAC) as a neuroprotective agent in maternal chorioamnionitis in a randomized, controlled, double-blinded trial. STUDY DESIGN: Twenty-two mothers >24 weeks gestation presenting within 4 hours of diagnosis of clinical chorioamnionitis were randomized with their 24 infants to NAC or saline treatment. Antenatal NAC (100 mg/kg/dose) or saline was given intravenously every 6 hours until delivery. Postnatally, NAC (12.5-25 mg/kg/dose, n = 12) or saline (n = 12) was given every 12 hours for 5 doses. Doppler studies of fetal umbilical and fetal and infant cerebral blood flow, cranial ultrasounds, echocardiograms, cerebral oxygenation, electroencephalograms, and serum cytokines were evaluated before and after treatment, and 12, 24, and 48 hours after birth. Magnetic resonance spectroscopy and diffusion imaging were performed at term age equivalent. Development was followed for cerebral palsy or autism to 4 years of age. RESULTS: Cardiovascular measures, cerebral blood flow velocity and vascular resistance, and cerebral oxygenation did not differ between treatment groups. Cerebrovascular coupling was disrupted in infants with chorioamnionitis treated with saline but preserved in infants treated with NAC, suggesting improved vascular regulation in the presence of neuroinflammation. Infants treated with NAC had higher serum anti-inflammatory interleukin-1 receptor antagonist and lower proinflammatory vascular endothelial growth factor over time vs controls. No adverse events related to NAC administration were noted. CONCLUSIONS: In this cohort of newborns exposed to chorioamnionitis, antenatal and postnatal NAC was safe, preserved cerebrovascular regulation, and increased an anti-inflammatory neuroprotective protein. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00724594.