多奈哌齐治疗阿尔兹海默症患者的临床剂量使用探讨

目的:评价多奈哌齐治疗阿尔兹海默症(AD)的疗效及疗效与用药剂量的关系,探讨检测血清中胰岛素样生长因子-I(IGF-I)来指导治疗剂量的可行性。方法:87例轻中度的AD患者,患者使用5 mg/d多奈哌齐疗效不佳。在增加剂量之前,根据血清胰岛素样生长因子-I(IGF-I)水平和简易智力状态检查表(MMSE)得分之间的一致性,将患者分为3组。A组:n=27,IGF-I≤99ng/m L,MMSE≤37;B组:n=33,IGF-I≤99 ng/m L,MMSE18;C组:n=27,IGF-I99 ng/m L,MMSE18。A、B组中,血清IGF-I水平显著低于C组。试验开始后将多奈哌齐的剂量从5 mg/d增加到10 mg/d,服用12周后,观察血清IGF-I水平同MMSE和阿尔兹海默症评定量表(ADAS)得分的相关性及三组患者的临床改善情况。结果:血清IGF-I水平同认知功能有明显相关性。IGF-I同MMSE正相关(r=0.478,P=0.036),IGF-I同ADAS得分负相关(r=-0.464,P=0.029)。增加多奈哌齐(10 mg/d)剂量治疗后,只有A组患者MMSE得到显著改善。A组患者对治疗的敏感性显著高于B、C组患者。结论:血清中IGF-I水平和MMSE分值可以做为一种标志物,判断对低剂量多奈哌齐(5 mg/d)无效的轻中度AD患者,能否采用高剂量多奈哌齐(10 mg/d)进行治疗。     

盐酸多奈哌齐联合综合康复训练对老年痴呆患者认知功能、事件相关电位及血清BDNF、IGF-1的影响

目的:探讨盐酸多奈哌齐联合综合康复训练对老年痴呆患者认知功能、事件相关电位及血清脑源性神经营养因子(BDNF)、胰岛素样生长因子1(IGF-1)的影响。方法:选取2017年3月~2020年3月期间来我院接受治疗的120例老年痴呆患者,根据随机数字表法分为对照组(n=60,盐酸多奈哌齐治疗)和联合组(n=60,盐酸多奈哌齐联合综合康复训练治疗)。对比两组疗效,治疗前、治疗3个月后的认知功能评分、事件相关电位、血清BDNF和IGF-1水平变化,以及治疗期间不良反应发生情况。结果:联合组的临床总有效率为91.67%,高于对照组的70.00%(P<0.05)。两组治疗3个月后日常生活能力评估量表(ADL)、临床痴呆量表(CDR)评分降低,且联合组低于对照组(P<0.05);简易精神状态量表(MMSE)评分升高,且联合组高于对照组(P<0.05)。两组治疗3个月后N1潜伏期、P2潜伏期均缩短,P3波幅均升高,且联合组治疗3个月后P2潜伏期短于对照组,P3波幅高于对照组(P<0.05);两组治疗3个月后N1潜伏期比较未见统计学差异(P>0.05)。联合组治疗3个月后BDNF水平高于对照组(P<0.05);两组治疗3个月后IGF-1水平比较未见统计学差异(P>0.05)。对照组与联合组不良反应发生率对比无统计学差异(P>0.05)。结论:老年痴呆患者在盐酸多奈哌齐基础上联合综合康复训练,认知功能可得到明显改善,同时还可调节患者事件相关电位及血清BDNF、IGF-1水平。     

Donepezil-tacrine hybrid related derivatives as new dual binding site inhibitors of AChE

A new series of donepezil–tacrine hybrid related derivatives have been synthesised as dual acetylcholinesterase inhibitors that could bind simultaneously to the peripheral and catalytic sites of the enzyme. These new hybrids combined a tacrine, 6-chlorotacrine or acridine unit as catalytic binding site and indanone (the heterocycle present in donepezil) or phthalimide moiety as peripheral binding site of the enzyme, connected through a different linker tether length. One of the synthesised compounds emerged as a potent and selective AChE inhibitor, which is able to displace propidium in a competition assay. These results seem to confirm the ability of this inhibitor to bind simultaneously to both sites of the enzyme and make it a promising lead for developing disease-modifying drugs for the future treatment of Alzheimer’s disease. To gain insight into the molecular determinants that modulate the inhibitory activity of these compounds, a molecular modelling study was performed to explore their binding to the enzyme.     

A new pharmacological role for donepezil: attenuation of morphine-induced tolerance and apoptosis in rat central nervous system

Background

Tolerance to the analgesic effect of opioids is a pharmacological phenomenon that occurs after their prolonged administration. It has been shown that morphine-induced tolerance is associated with apoptosis in the central nervous system and neuroprotective agents which prevented apoptosis signaling could attenuate tolerance to the analgesic effects. On the other hand donepezil, an acetylcholinesterase inhibitor, has been reported to have neuroprotective effects. Therefore in this study, the effect of systemic administration of donepezil on morphine-induced tolerance and apoptosis in the rat cerebral cortex and lumbar spinal cord was evaluated. Various groups of rats received morphine (ip) and different doses of donepezil (0, 0.5, 1, 1.5 mg/kg/day). Nociception was assessed using tail flick apparatus. Tail flick latency was recorded when the rat shook its tail. For apoptosis assay other groups of rats received the above treatment and apoptosis was evaluated by in situ terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) method.

Results

The results showed that administration of donepezil (0.5, 1, 1.5 mg/kg, ip) delayed the morphine tolerance for 9, 12 and 17 days, respectively. Furthermore pretreatment injection of donepezil attenuated the number of apoptotic cells in the cerebral cortex and lumbar spinal cord compared to the control group.

Conclusion

In conclusion, we found that systemic administration of donepezil attenuated morphine-induced tolerance and apoptosis in the rat cerebral cortex and lumbar spinal cord.     

Synthesis and in silico evaluation of 1N-methyl-1S-methyl-2-nitroethylene (NMSM) derivatives against Alzheimer disease: to understand their interacting mechanism with acetylcholinesterase

Anomalous action of human acetylcholinesterase (hAChE) in Alzheimer’s disease (AD) was restrained by various AChE inhibitors, of which the specific and potent lead candidate Donepezil is used for treating the disease AD. Besides the specificity, the observed undesirable side effects caused by Donepezil invoked the quest for new lead molecules with the increased potency and specificity for AChE. The present study elucidates the potency of six 1N-methyl-1S-methyl-2-nitroethylene (NMSM) derivatives to form a specific interaction with the peripheral anionic site and catalytic anionic subsite residues of hAChE. The NMSMs were prepared in good yield from 1,1-di(methylsulfanyl)-2-nitroethylene and primary amine (or) amino acid esters. In silico interaction analysis reveals specific and potent interactions between hAChE and selected ligand molecules. The site-specific interactions formed between these molecules also results in a conformational change in the orientation of active site residues of hAChE, which prevents them from being accessed by beta-amyloid protein (Aβ), which is a causative agent for amyloid plaque formation and acetylcholine (ACh). In silico interaction analysis between the ligand-bounded hAChE with Aß and ACh confirms this observation. The variation in the conformation of hAChE associated with the decreased ability of Aβ and ACh to access the respective functional residues of hAChE induced by the novel NMSMs favors their selection for in vivo analysis to present themselves as new members of hAChE inhibitors.     

Structure-based design,synthesis, and evaluation of structurally rigid donepezil analogues as dual AChE and BACE-1 inhibitors

A new series of structurally rigid donepezil analogues was designed, synthesized and evaluated as potential multi-target-directed ligands (MTDLs) against neurodegenerative diseases. The investigated compounds 10–13 displayed dual AChE and BACE-1 inhibitory activities in comparison to donepezil, the FDA-approved drug. The hybrid compound 13 bearing 2-aminoquinoline scaffold exhibited potent AChE inhibition (IC₅₀ value of 14.7?nM) and BACE-1 inhibition (IC₅₀ value of 13.1?nM). Molecular modeling studies were employed to reveal potential dual binding mode of 13 to AChE and BACE-1. The effect of the investigated compounds on the viability of SH-SY5Y neuroblastoma cells and their ability to cross the blood-brain barrier (BBB) in PAMPA-BBB assay were further studied.     

Design,synthesis and biological evaluation of novel donepezil–coumarin hybrids as multi-target agents for the treatment of Alzheimer’s disease

Combining N-benzylpiperidine moiety of donepezil and coumarin into in a single molecule, novel hybrids with ChE and MAO-B inhibitory activity were designed and synthesized. The biological screening results indicated that most of compounds displayed potent inhibitory activity for AChE and BuChE, and clearly selective inhibition to MAO-B. Of these compounds, 5m was the most potent inhibitor for eeAChE and eqBuChE (0.87 μM and 0.93 μM, respectively), and it was also a good and balanced inhibitor to hChEs and hMAO-B (1.37 μM for hAChE; 1.98 μM for hBuChE; 2.62 μM for hMAO-B). Molecular modeling and kinetic studies revealed that 5m was a mixed-type inhibitor, which bond simultaneously to CAS, PAS and mid-gorge site of AChE, and it was also a competitive inhibitor, which occupied the active site of MAO-B. In addition, 5m showed good ability to cross the BBB and had no toxicity on SH-SY5Y neuroblastoma cells. Collectively, all these results suggested that 5m might be a promising multi-target lead candidate worthy of further pursuit.     

重酒石酸卡巴拉汀与盐酸多奈哌齐对阿尔兹海默症患者认知功能及血清 缓激肽水平的影响

目的:探讨重酒石酸卡巴拉汀联合盐酸多奈哌齐对阿尔兹海默症患者认知功能及血清缓激肽水平的影响。方法:收集我院就诊或住院治疗的96例阿尔兹海默症患者,随机分为实验组和对照组,每组48例。对照组患者给予盐酸多奈哌齐片治疗,实验组患者在对照组基础上给予重酒石酸卡巴拉汀胶囊治疗。观察并比较两组患者治疗前后简易智能状态量表(MMSE)评分、痴呆量表(Blessed-Roth)评分、阿尔兹海默症评定量表(ADAS-Cog)评分以及血清缓激肽(BK)水平的变化情况。结果:与治疗前相比,两组患者治疗后MMSE评分升高(P0.05),Blessed-Roth评分以及ADAS-Cog评分下降(P0.05),血清BK水平下降(P0.05);与对照组相比,实验组患者的MMSE评分较高(P0.05),Blessed-Roth评分,ADAS-Cog评分以及血清BK水平较低(P0.05);结论:重酒石酸卡巴拉汀联合盐酸多奈哌齐能够更有效改善阿尔兹海默症患者的认知功能,可与其降低血清BK水平有关。     

A fluorescent biosensor based on acetylcholinesterase and 5-oxazolone derivative immobilized in polyvinylchloride (PVC) matrix

A new 2-phenyl-4-[4-(1,4,7,10-tetraoxa-13-azacyclopentadecyl)benzylidene]-5-oxazolone (CPO) derivative was utilized to develop an optical acetylcholinesterase (AChE) biosensor in which the azlactone derivative was embedded in plasticized polyvinylchloride (PVC) matrix. The sensor system was calibrated for the detection of acetylcholine (ACh) and donepezil which is a competitive cholinesterase (ChE) inhibitor. Two different biosensing systems were developed by using AChE enzyme in solution and immobilized together with the fluorescent derivative (CPO) doped in transparent PVC membrane. The enzymatic hydrolysis of ACh was monitored by following changes in the pH induced fluorescence intensity. When AChE enzyme was immobilized in PVC matrix together with CPO, the sensitivity of the measuring system has increased approximately three times for ACh, in comparison to the sensing system where AChE enzyme was in solution phase.

The photophysical parameters of CPO were also examined in solvents of tetrahydrofuran (THF), acetonitrile (ACN) and dichloromethane (DCM) and in solid matrix of PVC. The azlactone derivative exhibits excellent photostability in PVC matrix.