• Emerging therapies for cerebrovascular disorders

      Fisher, Marc; Davalos, Antonio (2004-02-01)
    • Long-term statin therapy and CSF cholesterol levels: implications for Alzheimer's disease

      Evans, Barbara A.; Evans, James E.; Baker, Stephen P.; Kane, Kevin J.; Swearer, Joan M.; Hinerfeld, Douglas A.; Caselli, Richard J.; Rogaeva, Ekaterina; St. George-Hyslop, Peter; Moonis, Majaz; et al. (2009-05-30)
      BACKGROUND/AIMS: It is not yet established whether statins (lipophilic or hydrophilic) reduce the risk of Alzheimer's disease and, if so, by differentially modifying brain lipid levels. Our aim was to assess changes in brain cholesterol metabolism as reflected in the cerebrospinal fluid (CSF) before and after treatment with either atorvastatin or simvastatin. METHODS: We carried out a longitudinal analysis of CSF cholesterol, lathosterol and 24(S)-hydroxycholesterol before and after treatment with maximum doses of statins in 10 asymptomatic subjects, 8 of whom were heterozygous for apolipoprotein E epsilon4, and in 6 presymptomatic PS1 subjects. RESULTS: Statins initially reduced CSF lathosterol cholesterol and 24(S)-hydroxycholesterol in both PS1 and non-PS1 subjects reaching a nadir at 6-7 months, followed by a return to baseline at 15 months with an overshoot at 2 years, tending to return to baseline thereafter. CONCLUSIONS: Possible long-term protective effects of statins are not likely largely related to the temporally-dependent biphasic effects of statin therapy upon the magnitude and direction of changes in CSF lipid levels and their subsequent return to baseline levels.
    • Rapamycin weekly maintenance dosing and the potential efficacy of combination sorafenib plus rapamycin but not atorvastatin or doxycycline in tuberous sclerosis preclinical models

      Lee, Nancy; Woodrum, Chelsey L.; Nobil, Alison M.; Rauktys, Aubrey E.; Messina, Michael P.; Dabora, Sandra L. (2009-04-15)
      BACKGROUND: Tuberous sclerosis complex (TSC) is an autosomal dominant tumor suppressor syndrome, characterized by hamartomatous growths in the brain, skin, kidneys, lungs, and heart, which lead to significant morbidity. TSC is caused by mutations in the TSC1 or TSC2 genes, whose products, hamartin and tuberin, form a tumor suppressor complex that regulates the PI3K/Akt/mTOR pathway. Early clinical trials show that TSC-related kidney tumors (angiomyolipomas) regress when treated with the mammalian target of rapamycin (mTOR) inhibitor, rapamycin (also known as sirolimus). Although side effects are tolerable, responses are incomplete, and tumor regrowth is common when rapamycin is stopped. Strategies for future clinical trials may include the investigation of longer treatment duration and combination therapy of other effective drug classes. RESULTS: Here, we examine the efficacy of a prolonged maintenance dose of rapamycin in Tsc2+/- mice with TSC-related kidney tumors. Cohorts were treated with rapamycin alone or in combination with interferon-gamma (IFN-g). The schedule of rapamycin included one month of daily doses before and after five months of weekly doses. We observed a 94.5% reduction in kidney tumor burden in Tsc2+/- mice treated (part one) daily with rapamycin (8 mg/kg) at 6 months ≤ age < 7 months, (part 2) weekly with rapamycin (16 mg/kg) at 7 months ≤ age < 12 months, and (part 3) daily with rapamycin (8 mg/kg) at 12 months ≤ age < 13 months; but we did not observe any improvement with combination IFN-g plus rapamycin in this study. We also used a Tsc2-/- subcutaneous tumor model to evaluate other classes of drugs including sorafenib, atorvastatin, and doxycycline. These drugs were tested as single agents and in combination with rapamycin. Our results demonstrate that the combination of rapamycin and sorafenib increased survival and may decrease tumor volume as compared to rapamycin treatment alone while sorafenib as a single agent was no different than control. Atorvastatin and doxycycline, either as single agents or in combination with rapamycin, did not improve outcomes as compared with controls. CONCLUSION: Our results indicate that prolonged treatment with low doses of mTOR inhibitors may result in more complete and durable TSC-related tumor responses, and it would be reasonable to evaluate this strategy in a clinical trial. Targeting the Raf/Mek/Erk and/or VEGF pathways in combination with inhibiting the mTOR pathway may be another useful strategy for the treatment of TSC-related tumors.
    • Upregulation of Heme Pathway Enzyme ALA Synthase-1 by Glutethimide and 4,6-Dioxoheptanoic Acid and Downregulation by Glucose and Heme: A Dissertation

      Kolluri, Sridevi (2004-03-17)
      5-Aminolevulinic acid synthase-1 (ALAS-1) is the first and normally rate-controlling enzyme for hepatic heme biosynthesis. ALAS-1 is highly inducible, especially in liver, in response to changes in nutritional status, and to drugs that induce cytochrome P-450. The critical biochemical abnormality of the acute porphyrias, a group of disorders of heme synthesis, is an uncontrolled up-regulation of ALAS-1. High intakes of glucose or other metabolizable sugars and intravenous heme are the cornerstones of therapy for acute attacks of porphyrias and both repress the over-expression ALAS-1, although their mechanisms of action have not been fully characterized. In this work, the chick hepatoma cell line, LMH, was characterized with respect to its usefulness in studies of heme biosynthesis and compared with chick embryo liver cells (CELCs), a widely used model for studies of heme metabolism. The inducibility of ALAS-1 mRNA and enzyme activity and accumulation of porphyrins by chemicals were used to evaluate heme biosynthesis in LMH cells. Repression of ALAS-1 mRNA and induced activity by exogenous heme (20 μM) was shown to occur in LMH cells as in CELCs. In addition, a synergistic induction of ALAS-1 enzyme activity was observed in LMH cells, as shown previously in CELCs, by treatment with a barbiturate-like chemical, Glutethimide (Glut), in combination with an inhibitor of heme synthesis, 4,6-dioxoheptanoic acid (DHA). This induction of ALAS-1 enzyme activity is analogous to what occurs in patients with acute hepatic porphyrias and LMH cells were used to further characterize effects of Glut, DHA, glucose, and heme on ALAS-1. A "glucose effect" to decrease Glut and DHA-induced ALAS-1 enzyme activity was obtained in LMH cells and CELCs in the absence of serum or hormones. This "glucose effect" was further characterized in LMH cells using a construct containing approximately 9.1 kb of chick ALAS-1 5'- flanking and 5' -UTR region attached to a luciferase/reporter gene (pGcALAS9.1-Luc). Glut (50 μM) and DHA (250 μM) synergistically induced luciferase activity (5-fold) in LMH cells transiently transfected with pGcALAS9.l-Luc. Addition of glucose (11 or 33 mM), in a dose-dependent manner, decreased the Glut+DHA up-regulation of pGcALAS9.1-Luc activity. Gluconeogenic or glycolytic substrates such as fructose, galactose, glycerol and lactate, but not the non-metabolizable sugar sorbitol, also down-regulated pGcALAS9.1-Luc in LMH cells. The cAMP analog 8-CPT-cAMP, augmented Glut induction of ALAS-1, indicating that the glucose effect may be partly mediated by changes in cAMP levels. The remaining studies focused on delineating the synergistic effect of Glut and DHA, and heme-dependent repression of ALAS-1. The 9.1 kb construct was compared with a construct containing the first 3.5 kb (pGcALAS3.5-Luc). The drug and heme effects were shown to be separate as drug induction was present in -3.4 to +0.082 kb region while the heme responsiveness was present in the -9.1 to -3.4 kb region. Using computer sequence analysis, several consensus activator protein-1 (AP-1) sites were found in the 9.1 kb ALAS-1 sequence but no consensus direct repeat (DR)-4 or DR-5 type recognition sequences for nuclear receptors were identified in the drug-responsive 3.5 kb region. Deletion constructs containing +0.082 to -7.6 kb (pGcALAS7.6-Luc) and +0.082 to -6.2 kb (pGcALAS6.3-Luc) cALAS 5'- flanking and 5' - UTR region were generated and tested and pGcALAS6.3-Luc was shown to have heme-dependent repression of basal and Glut and DHA-induced activity. A recently identified 167 bp chick ALAS-1 drug responsive enhancer (DRE) was PCR amplified and inserted upstream of the 9.1 kb (pGcALAS9.1+DRE), a 0.399 kb (+0.082 to -0.317) (pGcALAS0.3+DRE), and pGL3SV40 construct (pGL3SV40+DRE). DRE mediated the up-regulation of pGL3SV40+DRE construct by Glut was ~ 15-30 fold but interestingly only 3.2 and 3.7-fold for pGcALAS9.l +DRE and pGcALAS0.3+DRE constructs, respectively. In summary, in LMH cells drugs up-regulate ALAS-1 through non-DRE element(s) in the first 3.5 kb of ALAS-1 5'-flanking and 5'-UTR region and heme down-regulates ALAS-1 and determines the extent of the drug response through element(s) in the -6.3 to -3.5 kb region of ALAS-1 5'- flanking region.