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Current Therapeutic Strategies for Alzheimer's Disease: A Lost Direction or a Hope Remains?


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1 Dept. of Pharmacology, Govt. College of Pharmacy, Rohru (Distt. Shimla) Himachal Pradesh-171207, India
     

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At present a handful of FDA approved drugs are commercially available to treat Alzheimer's disease (AD). Among these are either Acetyl cholinesterase inhibitors or N-methyl-D-aspartate antagonists. These are only temporary and palliative solutions as these drugs do not stop progression of the disease but also are associated with severe side effects. Clearly, the search for more potent and efficacious drugs for the treatment of AD is one of the most pressing pharmacological goals, and many more drugs are either in clinical trials or are being tested in laboratories around the world, both in academia and industry. In this text, we will review and compare aforementioned five drugs with several other molecules that are currently in use or being developed and are ready to go into clinical trials. These will include antioxidants, metal chelators, monoamine oxidase inhibitors, anti-inflammatory drugs, as well as other AChE and NMDA inhibitors. In addition, failure of these drugs and side effect will also be discussed.

Keywords

Alzheimer's Disease, Amyloid, Acetylcholine, MAO.
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  • Ikezu T. Alzheimer's Disease, Textbook of Neuroimmunpharmacology. Editors. Howard Gendelman and Tsuneya Ikezu. Springer. 2008. P. 343-362.
  • Prince M. Dementia in developing countries. A consensus statement from the 10/66 dementia research group. Int J Geriatr Psychiatry. 2000;15(1):14-20.
  • Alzheimer A. Uber eine eigenartige Erkrankung der Hirnrinde (Translation: A characteristic disease of the cerebral cortex). Allgemeine Zeitschrift fur Psychiatrie und Psychischgerichtliche Medizin.1907; 64: 146-148.
  • Sharma VK. Homocysteine induced dementia: Collecting Evidences for Alzheimer's disease. International Journal of Pharma and BioSciences.2010;1(1):1-6.
  • Geldmacher DS, Provenzano G, McRae T, et al. Donepezil is associated with delayed nursing home placement in patients with Alzheimer's disease. J Am Geriatr Soc. 2003;51(7):937-44.
  • Kalpana PP, Jane F, and Tsuneya I. HMGCoA-Reductase Inhibitors in Dementia: Benefit or Harm. Clinical Medicine: Geriatrics. 2009;3: 13-22.
  • Selkoe D J. Cell biology of protein misfolding: The examples of Alzheimer's and Parkinson's diseases. Nat. Cell Biol.2004; 6: 1054-1061.
  • Suh YH, Checler F. Amyloid precursor protein, presenilins, and alpha-synuclein: molecular pathogenesis and pharmacological applications in Alzheimer's disease.Pharmacol Rev. 2002;54(3):469-525.
  • Won H S, Kenneth S, Suslick and Yoo H S. Therapeutic Agents for Alzheimer's Disease. Curr Med Chem.2005; 5: 259-269.
  • Soreq H S, Acetylcholinesterase-new roles for an old actor. S. Nat. Rev. Neurosci. 2001; 2: 294-302.
  • Doody R S, Stevens J C, Beck C, Dubinsky R M, Kaye J A, Gwyther L et al. Practice parameter: Management of dementia. Neurology.2001; 56:1154-1166.
  • Knapp M J, Knopman D S, Solomon P R, Pendlebury W W, Davis C S, & Gracon S I. A 30-week randomized controlled trial of high-dose tacrine in patients with Alzheimer's disease. Journal of the American Medical Association.1994; 271:985-991.
  • Rogers S L, & Friedhoff L T. The efficacy and safety of donepezil in patients with Alzheimer's disease: Results of a U.S. multicenter, randomized, double-blind, placebo-controlled trial. The Donepezil Study Group. Dementia.1996;7:293-303.
  • Burns A, Rossor M, Hecker J,Gauthier S, J. Möller et al. The Effects of Donepezil in Alzheimer's Disease - Results from a Multinational Trial. Clinical review.1999;l10(3)1999.
  • Finkel SI. Effects of rivastigmine on behavioural and psychological symptoms of dementia in Alzheimer's disease. Clin Ther. 2004; 26:980-90.
  • Tabet N. Acetylcholinesterase inhibitors for Alzheimer's disease: anti-inflammatories in acetylcholine clothing!; Age and Ageing. 2006; 35:336-338.
  • Reisberg B, Doody R, Stoffler A, Schmitt F, Ferris S, Mobius HJ, Memantine Study Group. Memantine in moderate-tosevere Alzheimer's disease. N Engl J Med.2003: 348(14):1333-1341.
  • Winblad B, Poritis N. Memantine in severe dementia: results of the 9M-Best Study (Benefit and efficacy in severely demented patients during treatment with memantine). Int J Geriatr Psychiatry.1999;14(2):135-146.
  • Kemp JA and McKernan, RM. NMDA receptor pathways as drug targets., Nat. Neurosci.2002;5:1039-1042.
  • Tover KR and Westbrook GL. Mobile NMDA receptors at hippocampal synapses. Neuron.2002; 34: 255-264.
  • Danysz W, Parsons CG, Mobius HJ, Stoffler A, Quack G. Neuroprotective and symptomalogical action of memantine relevant for Alzheimer's disease—a unified glutamatergic hypothesis on the mechanism of action. Neurotoxicity Res.2000;2:85-98.
  • www.alz.org(1.800.272.3900|Updated July 2007).
  • Einarson TR, Metge CJ, Iskedjian M, et al. An examination of the effect of cytochrome P450 drug interactions of hydroxymethylglutaryl-coenzyme A reductase inhibitors on health care utilization: A canadian population-based study. Clin Ther. 2002; 24(12):2126-36.
  • Jurevics H, Morell P. Cholesterol for synthesis of myelin is made locally, not imported into brain. J Neurochem. 1995;64(2):895-901.
  • Shobab LA, Hsiung GY, and Feldman HH. Cholesterol in Alzheimer's disease. Lancet Neurol.2005; 4:841-852.
  • Wolozin B, Kellman W, Ruosseau P, Celesia GG, and Siegel G. Decreased prevalence of Alzheimer disease associated with 3- hydroxy-3-methyglutaryl coenzyme A reductase inhibitors. Arch Neurol.2000;57:1439-1443.
  • Simone G S, Ursula M, Fernando B, Felix Bermejo, and Angeles M. HMG-CoA Reductase Inhibitor Simvastatin Inhibits Cell Cycle Progression at the G1/S Checkpoint in Immortalized Lymphocytes from Alzheimer's Disease Patients Independently of Cholesterol-Lowering Effects. JPET.2008; 324:352-359.
  • Takemoto M and Liao JK. Pleiotropic effects of 3-hydroxy-3- methylglutaryl coenzyme a reductase inhibitors. Arterioscler Thromb Vasc Biol.2001; 21:1712-1719.
  • Koyuturk M, Ersoz M, and Altiok N. Simvastatin induces proliferation inhibition and apoptosis in C6 glioma cells via cjun N-terminal kinase. Neurosci Lett.2004;370:212-217.
  • Nagy Z. The last neuronal division: a unifying hypothesis for the pathogenesis of Alzheimer's disease. J Cell Mol Med.2005; 9:531-541.
  • Herrup K, Neve R, Ackerman SL, and Copani A. Divide and die: cell cycle events as triggers of nerve cell death. J Neurosci.2004;24:9232-9239.
  • Hartman D. Free radical theory of aging: Alzheimer's disease pathogenesis. Age. 1995; 18:97-119.
  • Halliwell B, Gutteridge JMC. Free radicals in biology and medicine. Oxford, United Kingdom: Oxford University Press, 1989.
  • Ames B, Shingenaga M, Park EM. Oxidation damage and repair: chemical, biological and medical aspects. Elmsford, United Kingdom:Pergamon Press, 1991.
  • Cooper AJL. Glutathione in the brain: disorders of glutathione metabolism. In: Rosenberg RN, Prusiner SB, DiMauro S, Barchi RL, Klunk LM, eds. The molecular and genetic basis of neurological disease. Boston: Butterworth- Heinemann.1997:1242-5.
  • Hazel JR, Williams EE. The role of alterations in membrane lipid composition in enabling physiological adaptation of organisms to their physical environment. Prog Lipid Res. 1990;29:167-227.
  • Smith MA, Rudnicka-Nawrot M, Richey PL et al. Carbonylrelated posttranslational modification of neurofilament protein in the neurofibrillary pathology of Alzheimer's disease. J Neurochem. 1995;64:2660-6.
  • Oken BS, Storzbach DM, Kaye JA. The efficacy of Ginkgo biloba on cognitive function in Alzheimer disease. Arch Neurol. 1998;55:1409-15.
  • Yves C. Oxidative stress and Alzheimer disease; Am J Clin Nutr. 2000;71:621-629.
  • Pappolla M A, Chyan Y J, Poeggeler B, Frangione B, Wilson G, Ghiso J, Reiter R J J. Actions of Melatonin in the Reduction of Oxidative Stress Neural. Transm. 2000; 107:203-231.
  • Mishra LC, Singh BB. Scientific Basis for the Therapeutic Use of Withania somnifera (Ashwagandha): A Review; Alternative Medicine Review.2000;5(4).
  • David S.Vitamin E doesn't slow progression to Alzheimer's disease: BMJ. 2005;23: 330-33.
  • Zilka N, Ferencik M, Hulin I. Neuroinflamation in Alzheimer's disease; protector or promoter. Bratisl Lek Listy.2006. 107(9-10):374-381.
  • Akiyama H, Barger S, Barnum S, Bradt B, Bauer J, Cole G M. Inflammation and Alzheimer's disease. Neurobiol. Aging.2000; 21:383-421.
  • Tuppoa E and Ariasb H R. The role of inflammation in Alzheimer's disease. Intern. J. Biochem. Cell Biol.2005; 37:289-305.
  • Dhikav V, Singh S, Anand KS. Newer Non-steroidal Antiinflammatory Drugs - A Review of their Therapeutic Potential and Adverse Drug Reactions. JIACM. 2002; 3(4):332-8.
  • Zandi PP, Anthony JC, Hayden KM, Mehta K, Mayer L, Brietner JC, et al. Reduced incidence of AD with NSAID but not H2 receptor antagonists: the Cache County study. Neurology. 2002.59:880-6.
  • Infoscan Services International analgesics category, Total food, drug and mass. Plymouth and Pennsylvania: Information Resources.2000.
  • Woodfork KA, Dyke KV. Anti-inflammatory and antirheumatic drugs. In. Craig CR, Stitzel RE,eds. Modern Pharmacology with clinical applications, 6th edition, Lippincott Williams and Wilkins-Philadelphia.2004:423-39.
  • Chandrasekharan NV, Dai H, Roos KL, Evanson NK, Tomsik J, Elton TS, Simmons DL.COX-3, a cyclooxygenase-1 variant inhibited by acetaminophen and other analgesic/antipyretic drugs: cloning, structure, and expression. Proc Natl Acad Sci U S A .2002;99:13926-31.
  • Ricole M, Li A C, Willson T M, Kelly C J, Glass C K. The Peroxisome proliferator-activated receptor - gamma is a negative regulator of macrophage activations. Nature 1998;391:79-82.
  • Lehmann JM, Lenhard JM, Oliver BB, Ringold GM, Kliewer S A. Peroxisome proliferators-activated receptors alpha and gamma are activated by indomethacin and other nonsteroidal anti-inflammatory drugs. J Biol Chem 1997;272:3406-10.
  • Vfid BA, Ruitfnrfrg A, Hofman A, et al. Nonsteroidal anti inflammatory drugs and the risk of Alzheimer's disease. N Eng J Med 2001;345:1615-21.
  • Rovner S L. Chem. Eng. News 2005; 83: 38-45.
  • Geha RM. Chen K, Wouters J, Ooms F, Shih JC, Analysis of conserved active site residues in monoamine oxidase A and B and their three-dimensional molecular modeling. J.Biol Chem. 2002; 277:17209-17216.
  • Moussa BH, Youdima M, Fridkinb H, Zheng B. Bifunctional drug derivatives of MAO-B inhibitor rasagiline and iron chelator VK-28 as a more effective approach to treatment of brain ageing and ageing neurodegenerative diseases. Mechanisms of Ageing and Development.2005;126:317-326.
  • Roth AD, Gigliola R, Rodrgio A and Rommy VB, Oligodendrocytes damage in Alzheimer's disease: Beta amyloid toxicity and inflammation. Biol Res.2005;38: 381-387.
  • Koudinov AR, Koudinova NV. Soluble amyloid beta protein is secreted by HepG2 cells as an apolipoprotein. Cell Biol Inter.1997; 25: 265-271.
  • Hardy J, Selkoe DJ. The amyloid hypothesis of Alzheimer's disease: progress and problems on the road to therapeutics. Science. 2002; 297:353-356.
  • Paul SA. Alzheimer's disease therapeutic research: the path forward; Alzheimer's Research & Therapy. 2009;1:2 (doi:10.1186/alzrt2).
  • Relkin NR. Current state of immunotherapy for Alzheimer's disease. CNS Spectr 2008, 13:39-41.

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  • Current Therapeutic Strategies for Alzheimer's Disease: A Lost Direction or a Hope Remains?

Abstract Views: 315  |  PDF Views: 2

Authors

Vivek Kumar Sharma
Dept. of Pharmacology, Govt. College of Pharmacy, Rohru (Distt. Shimla) Himachal Pradesh-171207, India

Abstract


At present a handful of FDA approved drugs are commercially available to treat Alzheimer's disease (AD). Among these are either Acetyl cholinesterase inhibitors or N-methyl-D-aspartate antagonists. These are only temporary and palliative solutions as these drugs do not stop progression of the disease but also are associated with severe side effects. Clearly, the search for more potent and efficacious drugs for the treatment of AD is one of the most pressing pharmacological goals, and many more drugs are either in clinical trials or are being tested in laboratories around the world, both in academia and industry. In this text, we will review and compare aforementioned five drugs with several other molecules that are currently in use or being developed and are ready to go into clinical trials. These will include antioxidants, metal chelators, monoamine oxidase inhibitors, anti-inflammatory drugs, as well as other AChE and NMDA inhibitors. In addition, failure of these drugs and side effect will also be discussed.

Keywords


Alzheimer's Disease, Amyloid, Acetylcholine, MAO.

References