Dissertations / Theses on the topic 'Pramipexolo'

Pramipexole (PPX) is a dopamine (DA) D3 and D2 receptors agonist widely used alone or in combination with levodopa as Dopamine Replacement Therapy in Parkinson’s disease. In clinical and preclinical studies, PPX improved motor deficits, this evidence led to lowering daily dose of levodopa, delaying the motor side effects associated with its use. Recently, PPX administration has been associated to the development of addictive-like behaviors related to the DA Dysregulation Syndrome, particularly in a subpopulation of treated patients, characterized by impulsive-compulsive personality traits as well as previous addiction’s experience. Based on these evidences, the aim of this study was twofold: first to investigate the pharmacological action of PPX, using a unilateral model of Parkinson’s disease in which 6-OHDA was injected in the medial forebrain bundle. After two weeks, we tested in primed and naive rats, the ability of three different doses of PPX (0,035; 0,1 and 0,35 mg/kg s.c.), to induce contralateral turning behavior as well c-fos expression after pretreatment of DA D1 antagonist SCH 39166. Next, we checked the ability of PPX to induce contralateral rotations after D2 (eticlopride) and D3 (S33084) DA antagonist pretreatment. In order to investigate the role of PPX (0,05 mg/kg s.c.) in behavioral sensitization, we tested its effect with S33084 pretreatment in levodopa sensitized rats. Second, we assessed the correlation between PPX treatment, Parkinson’s disease and the onset of DA Dysregulation Syndrome on Conditioned Place Preference (CPP) paradigm. To do this, 6-OHDA was injected bilaterally in DA striatal terminals, in three different strains of rat: the addiction prone Lewis (LEW), the addiction resistant Fisher 344 (F344) inbred strains, and the Sprague Dawley (SD) outbred strain. Furthermore, to test its rewarding properties, PPX was directly infused in the nucleus accumbens shell (NAc), a DA mesolimbic region known to be involved in the rewarding effects of drugs of abuse, in healthy rats belonging to the above mentioned strains. We discovered that in primed rats, PPX (0,35 mg/kg s.c.) induced turning behavior that was increased by SCH 39166 pretreatment (0,1 mg/kg s.c.). No effect was seen in naive rats both for turning behavior and c-fos expression. D2 receptors antagonist eticlopride (0,1 mg/kg s.c.) reduced PPX-induced turning behavior more than D3 receptors antagonist S33084 (0,5 mg/kg s.c.), also a previous levodopa sensitization increased PPX-induced turning behavior on its first administration. This suggests that PPX’s action could be related to D2 stimulation, and it seems to require a previous D1/D2 stimulation to observe a behavioral outcome. PPX (1 mg/kg s.c.) was able to induce a significant CPP in SD and LEW lesioned rats but not in F344 and control rats, and the persistence of preference was stronger in LEW than in SD rats. When injected into the NAc shell, PPX (5 μg/0.5 μl) induced CPP in all rat strains, but the persistence of its effect was more strong in LEW compared to SD and F344 rats. These results suggest that the parkinsonian state might be more sensitive to the rewarding properties of PPX, which do not seem entirely influenced by phenotype.

Faced with an intertemporal choice, an organism that chooses a “smaller-sooner” reinforcer over a “larger-later” reinforcer is said to behave impulsively. Individual differences in intertemporal choice are effectively modeled by generalized matching law and delay discounting equations that incorporate parameters corresponding to behavioral processes such as sensitivity to reinforcer amount or delay. By simulating changes in these processes and identifying conditions under which impulsive choice is likely to result, researchers are in a position to anticipate and examine potential behavioral mechanisms underlying clinical instances of impulsivity. Pramipexole, a dopamine agonist medication, is associated with reports of impulsive behavior in populations prescribed the drug, as well as in experimental subjects administered the compound prior to intertemporal choice sessions, although the latter findings are mixed. The present set of experiments was designed (a) to systematically replicate conditions under which pramipexole increased impulsive choice, but also nonspecifically disrupted behavior, and (b) to elucidate behavioral mechanisms of pramipexole-induced impulsivity in rats. In Chapter 2, a behavioral task used previously by researchers reporting a nonspecific effect of pramipexole was modified to include procedural controls common in the intertemporal choice literature (centering response, no-delay sessions). In accord with previous findings, acute pramipexole nonspecifically disrupted choice behavior, while chronic pramipexole partially remediated elements of the disruption (i.e., decrease in initial-block choice). In Chapter 3, three experiments targeted behavioral processes critical for intertemporal choice. Experiment 1 evaluated the acute and chronic effects of pramipexole on rats’ sensitivity to relative reinforcer delays in a concurrent-chains procedure. Contrary to the predicted effect, the drug decreased this measure, indicating the possibility of impaired stimulus control. Experiments 2 and 3 assessed the drug effect on discrimination of response-reinforcer contingencies and of reinforcer amounts, respectively, and revealed deficits in accuracy of similar magnitude across both preparations. Collectively, the results of these experiments suggest that previous findings of pramipexole-induced impulsivity and nonspecific disruption of behavior can be explained as impairments in discrimination processes required for intertemporal choice. Although the generality of the present findings may be limited to experimental settings with nonhumans, they demonstrate the utility of quantitatively modeling impulsivity.

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências Biológicas, Programa de Pós-Graduação em Neurociências, Florianópolis, 2016.
Made available in DSpace on 2017-05-23T04:11:56Z (GMT). No. of bitstreams: 1 345666.pdf: 3373156 bytes, checksum: 7027682a29338f16909d04b013f2baf4 (MD5) Previous issue date: 2016
As doenças de Parkinson, de Alzheimer e esclerose múltipla (EM), bem como os transtornos de humor, como a depressão, apresentam componentes inflamatórios. As células do sistema imune possuem 5 receptores que respondem ao neurotransmissor dopamina, os quais modulam diferentemente a inflamação. Assim, é esperado que o pramipexol (PPX), um agonista de receptores dopaminérgicos (D2/D3), tenha efeito imunomodulatório. Para testar essa hipótese foram utilizados dois modelos que causam neuroinflamação: a) a encefalomielite autoimune experimental (EAE), modelo de esclerose múltipla e b) a administração periférica de lipopolissacarídeo (LPS), modelo de transtorno depressivo maior. A EAE foi induzida em camundongos C57BL/6 através da administração do peptídeo 35-55 da glicoproteína de mielina oligodendroglial e o PPX (0,1 e 1 mg/kg/dia) foi administrado pela via intraperitoneal por 40 dias. A dose de 1 mg/kg inibiu completamente o surgimento dos sinais motores induzidos pela EAE, além de prevenir a desmielinização na medula espinhal. Além disso, o PPX teve um forte efeito anti-inflamatório, confirmado através da redução da infiltração de células inflamatórias, da ativação astroglial na medula espinhal, e da redução nos níveis de IL-17 nos linfonodos. Além disto, o PPX reverteu várias alterações induzidas pela EAE na medula espinhal e no estriado, incluindo a redução nos níveis de a-sinucleína, o aumento nos níveis de parkina, alteração na enzima glutationa peroxidase e a produção de espécies reativas de oxigênio. Em conjunto os dados sugerem que o PPX deve ser estudado como um possível agente farmacológico para tratar a EM. No modelo de depressão induzida por inflamação periférica através da injeção de LPS em camundongos Swiss, o PPX (1 mg/kg), foi administrado por 7 dias por via intraperitoneal. Uma hora após a última aplicação de PPX, injetou-se LPS (0,1 mg/kg) via intraperitoneal, 24 h depois foi dado início aos testes comportamentais. O LPS induziu comportamento tipo-depressivo no teste do nado forçado e no splash test, sem alterar a locomoção no teste do campo aberto. Também foi observado o aumento de Interleucina-1ß e adutos de 3-nitrotirosina no hipocampo dos animais tratados com LPS. Todos estes parâmetros foram revertidos pelo PPX, indicando que o PPX é capaz diminuir os eventos inflamatórios que podem estar associados ao comportamento tipo-depressivo. Os antagonistas de receptores dopaminérgicos, haloperidol e sulpirida, não reverteram o efeito tipo-antidepressivo do PPX, indicando que a atuação do PPX parece não ser mediada por estes receptores. Em conjunto, os dados sugerem que o PPX é capaz de causar uma forte diminuição em processos inflamatórios, tanto no modelo de EAE como no modelo de depressão, o que pode ser o mecanismo responsável por sua ação. Porém, mais estudos são necessários para confirmar esta hipótese.

Abstract : Neurologic diseases as Parkinson's, Alzheimer's and multiple sclerosis (MS) as well as mood disorders, like major depression, present inflammatory components. Immune cells express 5 different dopamine receptors, which are known to modulate inflammation. In this context, it is expected that pramipexole (PPX), a dopamine D2/D3 receptor agonist, would have an immunomodulatory effect. To evaluate this hypothesis two neuroinflammatory disease models were used, the experimental autoimmune encephalomyelitis (EAE), a mice model of MS, and the peripheral administration of lipopolysaccharide (LPS), a mice model of major depression disorder (MDD). EAE was induced in C57Bl/6 mice by the injection of the 35-55 peptide of myelin oligodendroglial glycoprotein. PPX (0.1 and 1 mg/kg) was administered by intraperitoneal route for 40 days. The dose of 1 mg/kg of PPX completely abolished motor impairment induced by EAE, and prevented medular demyelination. Besides, PPX had a marked anti-inflammatory effect, which was observed by reduction of inflammatory cells infiltration, astroglyal activation, and by decreasing IL-17 levels in lymph nodes. Besides, PPX reversed several alterations in the spinal cord and striatum induced by EAE, inclunding reduction in a-synuclein levels, enhancement of parkin levels, alteration in glutathione peroxidase activity and reactive oxygen species production. Together, these results suggest that PPX can be studied as a potential drug for MS treatment. In the MDD model induced by peripheral inflammation induced with the bacterial lipopolysacchired (LPS) administration in Swiss mice, PPX (1 mg/kg) was administered for 7 days by intraperitoneal route. One hour after the last PPX injection, LPS (0.1 mg/kg) was administered intraperitoneally, and 24 h later behavioral analysis were performed. LPS induced depressive-like behavior in the forced swimming test and splash test, without locomotor alterations in the open field test. It was also observed enhancement of Interleukin-1ß and 3-nitrotyrosin protein adducts in mice hippocampus of LPS treated animals. PPX reversed all these alterations, indicating that PPX can prevent the inflammatory events related to the depressive-like behavior. Interestingly, the dopamine receptor antagonists, haloperidol and sulpiride, did not reverse the PPX antidepressant-like effect in the forced swimming test, indicating that PPX effect seems to be unrelated by these receptors. Together, these results suggest that PPX present a marked antiinflammatory action, in both EAE and LPS models, suggesting that this could be the mechanism of action of PPX. Nevertheless, further studies are required to confirm this hypothesis.

La maladie de Parkinson (MP) provient de la dégénérescence des cellules du locus nigerproduisant de la dopamine. La barrière hémato-encéphalique (BHE) est un véritable obstacle pour le traitement de la MP car elle empêche ou réduit le passage d’un grand nombre de substances pharmacologiques vers le cerveau. L’encapsulation de ces substances dans des liposomes ou des niosomes avant leur libération intra-cérébrale représente une alternative de choix en raison de la biocompatibilité, la biofragmentation, la non-toxicité et les capacités de ciblage de ces systèmes. A l’heure actuelle le traitement de la MP reste un défi, malgré l’existence de nombreux projets de recherche dans ce domaine. Notre hypothèse est que l’administration de pramipexoleencapsulé dans des liposomes et/ou des niosomes pourrait représenter une approche thérapeutique pertinente. Dans le cadre de la thèse, la caractérisation et la cinétique de diffusion des liposomes et niosomescontenant du pramipexole ont été réalisées. La validation de différentes formulations a été réalisée sur un modèle de BHE constitué de co-cultures cellulaires. Les effets du pramipexoleencapsulé dans des liposomes ou desniosomesont ensuite été étudiés dans un modèle de MP chez le rat obtenu par lésion de la voie dopaminergique nigro-striée à l’aide de 6-hydroxydopamine (6-OHDA). Pour cela, nous avons évalué le comportement rotatoire induit par l’amphétamine et l’expression du transporteur de la dopamine (DAT) par autoradiographie quantitative chez des animaux lésés traités ou non par les nanocapsules. Toutes les formulations que nous avons réalisées ont montré une capacité d’encapsulation d’environ 10% pour une taille de 100 nm, avec une cinétique de dispersion compatible avec une utilisation in vivo. Dans notre modèle de co-culture cellulaire, nous avons déterminé que nos formulations permettent le franchissement de la BHE. Chez les animaux lésés à la 6-OHDA, la quantification du DAT indique que l’administration de pramipexole réduit l’intensité de la lésion, que la substance soit administrée seule ou encapsulée dans des niosomes. Ces travaux montrent l’intérêt potentiel de l’administration de principe actif encapsulé pour le traitement de la MP, et devront être poursuivis afin d’optimiser cette approche thérapeutique, notamment au niveau des doses
Parkinson’s Disease (PD) is degeneration of dopamine producing cells in substantia nigra. Blood-brain barrier (BBB) is a strong obstacle in PD therapy. More penetration and accumulation in the target tissue can be obtained by preventing RES uptake via “stealth effect”. Liposomes and niosomes are the promising systems for being biodegredable, bioavailable, non-toxic and targetable. Although CNS disorders are the first to endorse at their research in the diagnosis and therapy with several framework projects in Europe and over the world, there is still a huge gap in CNS drug delivery and the success of PD therapy. Although different studies have performed with pramipexole, evaluation of penetration and antiparkinsonian effect of pramipexole encapsulated liposomes and niosomes has never been studied before. Among this thesis, nanosized, polyethylene glycol (PEG) coated, neutral and positively charged, pramipexole encapsulated liposomes and noisomes were formulated, characterized and release kinetics of the systems were evaluated. In vitro penetration of all formulations was evaluated in BBB cell co-culture model. Therapeutic efficacy of neutral, pramipexole encapsulated liposomes and niosomes were evaluated in 6-hydroxydopamine (6-OHDA) lesioned rats by rotometer test and autoradiography. All formulations have approximately 10% encapsulation efficiency, around 100 nm particle sizes and fitted to first-order release kinetics. All formulations were found BBB permeable at in vitro cell culture studies. Nanosized, neutral niosomes designated similar but slightly better effect than pramipexole solution in autoradiograhy studies in 6-OHDA lesioned rats. This pramipexole dose is approximately 9 times lesser doses applied with conventional pramipexole tablets for humans in Neurology clinics. Nanosized, pramipexole encapsulated, neutral niosomes showed potential PD therapeutic effect in PD animal model depending on non-ionic surfactant properties of niosomes
Uzm. Ecz. Mine Silindir Gunay, Parkinson Hastalığı’nın Teşhis ve Tedavisi İçin Kullanılacak Nanoboyutlu Teragnostik İmmünolipozom/İmmunoniozomlar Üzerine İn Vitro İn Vivo Çalışmalar, Hacettepe Üniversitesi – François Rabelais de Tours University, Sağlık Bilimleri Enstitüsü, Radyofarmasi Programı, UMR Inserm U 930, Ekip 3, Moleküler Görüntüleme ve Beyin Programı, Doktora Tezi, Ankara-Tours, 2016. Parkinson Hastalığı (PH) substantia nigra’daki dopamin üreten hücrelerin dejenerasyonundan kaynaklanmaktadır. Kan-beyin bariyeri (KBB) PH’nın tedavisinin önünde kuvvetli bir engeldir. Hedef dokudaki yüksek penetrasyon ve tutulum “stealth etki” ile RES tutulumunun engellenmesi ile sağlanabilir. Lipozom ve niozomlar biyoparçalanırlıkları, biyouyumlulukları, non-toksik ve hedeflendirilebilir olmaları nedeniyle en çok tercih edilen sistemlerdendir. Santral sinir sistemi hastalıklarının araştırılması Avrupa ve tüm dünyada yapılan pekçok çerçeve projelerinde ilk sırada olmasına rağmen, halen beyne ilaç taşınması ve PH’nin tedavi başarısı konusunda büyük boşluklar bulunmaktadır. Pramipeksol ile pek çok çalışma yapılmasına karşılık, bizim çalışmamız pramipeksol enkapsüle edilmiş lipozom ve niozomların beyin penetrasyonunun ve antiparkinson etkisinin değerlendirilmesi konusunda yenidir. Tez kapsamında, nanoboyutlu, PEG kaplı, nötral ve pozitif yüklü lipozom ve niozomların formüle edilmiş, karakterizasyon ve salım kinetikleri değerlendirilmiştir. Tüm formülasyonların KBB geçirgenliği, hücre KBB ko-kültürü çalışmalarında incelenmiştir. Nötral, pramipeksol enkapsüle edilen lipozom ve niozomların tedavi etkinliği in vivo olarak 6-hidroksidopamin (6-OHDA) ile lezyon yapılarak PH modeli oluşturulan sıçanlarda rotametre ve otoradyografi çalışmaları ile incelenmiştir. Tüm formülasyonlar yaklaşık %10 enkapsülasyon etkinliği ve 100 nm civarında partikül boyutu dağılımı ve birinci derece salım kinetiği göstermiştir. Hücre kültürü çalışmalarında, tüm formülasyonların KBB’nden penetre olabildiği saptamıştır. 6-OHDA lezyonlu sıçanlarda Parkinson hastalığının tedavisinde nanoboyutlu, nötral, pramipeksol enkapsüle edilen niozomlar, aynı dozdaki pramipeksol çözeltisi ile benzer hatta biraz daha iyi sonuçlar göstermiştir. Bu doz Nöroloji kliniklerinde Parkinson tedavisinde rutin olarak kullanılan konvansiyonel pramipeksol tabletlerindeki dozun yaklaşık olarak 9 kat düşük dozlarıdır. Nanoboyutlu, pramipeksol enkapsüle edilen, nötral niozomlar, niozomların non-iyonik sürfaktan özellikleri nedeniyle PH modeli sıçanlarda potansiyel bir antiparkinson terapötik etki göstermiştir

Dans la maladie de Parkinson (MP), la perte progressive des neurones dopaminergiques (DA) touche principalement la substantia nigra pars compacta (SNc). Les symptômes moteurs sont classiquement gérés par une thérapie dopaminergique de remplacement (TDR). Conjointement à la levodopa, l’utilisation d’agonistes dopaminergiques permet de prévenir les complications motrices mais peut être associée à des troubles du système de récompense. Jusqu’à 14% des patients parkinsoniens sous TRD peuvent souffrir de comportement « addiction-like » tels que le pari pathologique, l’hypersexualité ou une prise compulsive de la médication DA. A ce jour la seule solution thérapeutique consiste à diminuer la TRD ce qui détériore les symptômes moteurs. Les neuroadaptations conduisant à ces troubles du système de récompense demeurent mal comprises. Nous proposons un travail dans lequel nous avons évalué les propriétés appétitives de l’agoniste D2/D3 pramipexole (ppx) après une exposition chronique à la L-dopa dans un modèle de rat parkinsonien alpha-synucléine. Dans une première étude, nous avons évalué l’effet d’une stimulation répétée des récepteurs DA sur la sensibilisation du système de récompense en contexte parkinsonien. Nos résultats montrent un effet récompensant du ppx après administrations chronique de L-dopa et perte DA nigrostriatal induite par surexpression de l’alpha-synucléine. Aucune modification transcriptionnelle n’a été observée pour les récepteurs DA. Cependant, nous avons identifié une association entre lésion/traitement pharmacologique et des changements transcriptionnels potentiellement liés à un contexte d’addiction aux psychostimulants. Cette étude fournit des preuves suggérant fortement la lésion parkinsonienne et la thérapie L-dopa comme des facteurs conjointement impliqués dans le remodelage cérébral sous-tendant une préférence de place conditionnée pour le ppx. Les données moléculaires et pharmacologiques générées ont suggéré un rôle clé de la voie glutamatergique dans cette réponse comportementale. Ce résultat est cohérent avec la littérature décrivant un déséquilibre glutamatergique striatal dans les contextes d’addiction aux psychostimulants et de complications motrices associées à la MP. Ainsi, nous avons conçu une deuxième étude visant à investiguer plus avant le potentiel thérapeutique d’une inhibition des récepteurs glutamatergiques. Une lésion bilatérale de la SNc a été réalisée par surexpression de la protéine alpha-synucléine au moyen d’un vecteur AAV. Suite à cette lésion, un traitement chronique à la L-dopa a été réalisé. L’effet de l’antagoniste des récepteurs mGluR5 (metabotropic glutamate receptor 5) MPEP sur les propriétés renforçatrices du ppx a été évalué dans un paradigme de préférence de place conditionnée. Enfin, une analyse des changements d’expression de protéines d’intérêt a été réalisé afin d’associer changements comportementaux drogue/lésion induits et paramètres moléculaires. L’acquisition et l’expression de la préférence de place ppx-induite a été abolie par le MPEP. De plus, nous avons identifié des réseaux neuraux et des modifications d’expression protéiques sous-tendant les plasticités striatales associées à la réponse comportementale. L’ensemble de ces travaux apporte de nouvelles idées sur le contexte physiopathologique associé aux troubles du système de récompense dans la MP. Des données moléculaires et pharmacologiques convergentes suggèrent fortement le mGluR5 comme une cible thérapeutique prometteuse
In Parkinson’s Disease (PD), the progressive dopaminergic (DA) cell loss mainly affects the substantia nigra pars compacta (SNc). The motor symptoms are classically managed by DA replacement therapies (DRT). Although adding DA agonists to levodopa treatment may contribute to prevent motor complications, it may be associated with drug‑induced changes in reward related pathways. Up to 14% of PD patients under DRT may suffer from ‘addiction‑like’ behavior such as pathological gambling, hypersexuality or DA medication‑induced substance abuse. To date, the only therapeutic answer consists in lowering the DA medications which deteriorates the motor symptoms. Neuroadaptations leading to reward bias in PD patients under DRT are still poorly understood. To address this challenge, we propose a work in which we have assessed the rewarding effect of the D2/D3 agonist pramipexole (ppx) after chronic exposure to L‑dopa in an alpha-synuclein PD rat model. In a first study, we assessed the effect of repeated DA receptors stimulations on sensitization of the reward system in a parkinsonian context. Our findings demonstrated that ppx had a rewarding effect after chronic L-dopa administrations and alpha-synuclein-mediated nigral loss. No transcriptional changes within DA receptors were highlighted. However, we identified an association between the main drug or lesion and transcriptional changes which were potentially related to the context of psychostimulant addiction. This study provides evidences strongly suggesting that PD-like lesion and L-dopa therapy were concomitant factors involved in striatal remodeling underlying the ppx-induced place preference. Molecular and pharmacological data suggested a key involvement ofthe glutamatergic pathway in this behavioral outcome. These data were consistent with literature describing major striatal glutamate imbalance as a common feature of drug addiction and Parkinson’s disease physiopathological contexts. Hence, we designed a second study aiming to further investigate the therapeutic potential of glutamatergic receptors inhibition. A bilateral lesion of the SNc was performed in the rat using AAV-mediated overexpression of the alpha-synuclein. This lesion was followed by chronic L-dopa administrations. Then, the effect of the metabotropic glutamate receptor 5 (mGluR5) antagonist MPEP on ppx reinforcing properties was assessed in a place conditioning paradigm. Finally, analysis at the protein level was conducted to associate drug and lesion induced behavioral changes to molecular endpoints. Acquisition and expression of the ppx-induced place preference was abolished by the MPEP. Furthermore, we identified neural networks and protein changes underlying the striatal remodeling associated with the behavioral outcome. All this work provides new insights into the physiopathological context associated to the PD/DRT related reward bias. Convergent molecular and pharmacological data strongly suggest mGluR5 as a promising therapeutic target

La maladie de Parkinson (MP) se caractérise par une dégénérescence progressive et irréversible des neurones dopaminergiques de la substance noire induisant une perte de dopamine (DA) dans les structures cibles. Lorsque cette perte DA se situe entre 60 % et 80 %, les patients présentent des symptômes moteurs (rigidité, tremblement, akinésie) et non-moteurs très variés (dépression, anxiété, apathie). Ces derniers apparaissent avant et/ou en même temps que les symptômes moteurs. La dopathérapie permet de contrecarrer certains symptômes, mais tous ne sont pas sensibles à cette médication. Parallèlement à la dégénérescence DA, le système sérotoninergique (5-HT) serait aussi altéré de façon précoce dans la maladie. Cette dégénérescence est liée par l’expression de symptômes moteurs et non-moteurs. Néanmoins, aucun lien causal n’a été mis en évidence entre cette lésion 5-HT et la symptomatologie parkinsonienne. Ainsi, il était primordial de déterminer le rôle de la 5-HT dans 1) l’expression des troubles moteurs et non-moteurs 2) dans la réponse au traitement sérotoninergique et dopaminergique. Nous avons utilisé un nouveau modèle animal primate ayant une lésion 5-HT (via la MDMA) puis une lésion DA (via le MPTP). Ce modèle nous permet de mettre en évidence l’impact d’une lésion 5-HT précoce dans la symptomatologie. Des approches comportementales, pharmacologiques, d’imagerie et de neuroanatomie ont été utilisées. La lésion 5-HT a induit un trouble anxieux chez les animaux lésés à la MDMA, qui ne sont pas contrecarrer avec un traitement sérotoninergique (antidépresseur). Cette lésion a également induit une sévérité et une progression plus rapide des symptômes moteurs induits par la lésion DA
Parkinson’s disease (PD) is characterized by a progressive and irreversible degeneration of dopaminergic (DA) neurons localized in the substantia nigra, leading to a loss of dopamine within the target structures. When the loss of DA reaches 60 to 80 %, PD patients develop a wide range of motor (rigidity, tremor, akinesia fro example) and non-motor (depression, anxiety, apathy for example) symptoms. Dopatherapy allows the reduction of symptoms expression. But some motor and non-motor symptoms are not counteracted by those DA drugs. In addition to DA degeneration, patients present an early serotonergic (5-HT) lesion. This lesion is linked to the severity of some motor and non-motor symptoms. However, there is no causal link established between 5-HT lesion and parkinsonian symptoms. Therefore, it was essential to determine the role of 5-HT 1) in the expression of motor and non-motor symptoms 2) and in the response of DA and 5-HT treatments. For that, we used a new monkey model of PD, exhibiting a 5-HT lesion (with MDMA ‘”ecstasy”)) followed by a DA lesion (with MPTP). This model allowed us to evaluate the impact of an early 5-HT lesion on parkinsonian symptoms. We used different approaches: PET imaging, pharmacology, behavioral and neuroanatomy. The MDMA-driven early 5-HT lesion induced an anxious-like behavior on MDMA treatedmonkeys. This behavioral modification was not counteracted by 5-HT drugs (antidepressant). This MDMA lesion has also increased the severity and the progression of parkinsonian symptoms induced by DA lesion with MPTP

Au-delà des symptômes moteurs, la maladie de Parkinson (MP) est également caractérisée par une myriade de symptômes neuropsychiatriques allant de l’apathie et la dépression aux troubles du contrôle des impulsions (TCI). Les TCI représentent un groupe d’addictions comportementales incluant le jeu pathologique, l’hypersexualité et les achats faits de manière compulsive. Observés chez 10 à 14 % des patients parkinsoniens sous traitement dopaminergique, ils affectent fortement leur qualité de vie. L’impulsivité cognitive reflétant notamment l’incapacité à tolérer les délais de renforcements, est au cœur des TCI. En effet, différentes études suggèrent que cette impulsivité serait exacerbée dans la MP et sous traitements dopaminergiques. Cependant, les mécanismes sous-tendant les TCI dans la MP demeurent méconnus, et la contribution respective de la lésion, du traitement dopaminergique, et de certains facteurs de vulnérabilité reste à déterminer. De plus, l’impulsivité d’attente, une autre forme de déficit d’inhibition qui peut conduire au développement de comportements compulsifs, a été peu étudiée dans le cadre des TCI.L’objectif de ce projet de thèse a été d’évaluer l’influence d’une dénervation dopaminergique de la voie nigrostriée, avec ou sans adjonction d’agoniste dopaminergique, sur le développement d’impulsivité. Pour cela, nous avons utilisé un modèle lésionnel des troubles non-moteurs de la MP. Ces rats ont reçu une injection bilatérale de neurotoxine 6-OHDA dans la SNc, afin d’induire une dénervation sélective, bilatérale et partielle du striatum dorsal. Ils ont ensuite été traités avec du pramipexole, un agoniste des récepteurs D2/3, connu pour favoriser le développement de TCI chez les patients parkinsoniens. Les tâches d’intolérance au délai et de réaction en série à 5 choix (5-CSRTT) ont été utilisées pour évaluer respectivement l’impulsivité cognitive et l’impulsivité d’attente. Dans le premier paradigme, les rats doivent appuyer sur un levier pour choisir entre une petite récompense immédiate, ou une plus grosse récompense, avec un un délai. Dans le second paradigme, ils doivent inhiber l’émission d’une réponse motrice jusqu’à l’apparition d’un stimulus lumineux. Le traitement chronique au pramipexole augmente considérablement les choix impulsifs effectués dans la tâche d’intolérance au délai, mais seulement chez les rats non lésés. En effet, la lésion dopaminergique seule ou avec le traitement ne favorise pas les comportements impulsifs. Dans la tâche de 5-CSRTT, le pramipexole semble également promouvoir l’émission de réponses prématurées (effet pro-impulsif), lorsque l’intervalle inter-essais est constant. Cependant, lorsque cet intervalle augmente, le pramipexole provoque à l’inverse une diminution des réponses prématurées (effet anti-impulsif). Cette modulation d’impulsivité étant seulement observée chez les rats hautement impulsifs, ceci suggère qu’un endophénotype impulsif puisse être un facteur de vulnérabilité à l’effet iatrogène du pramipexole.A l’échelle neuronale, ce traitement favorise la surexpression des ARNm codants pour les récepteurs dopaminergiques D2 dans le striatum et y modifie la connectivité glutamatergique telle qu’observée en microscopie électronique. De plus, nous avons observé une suractivation de la voie mTORC1 dans le noyau accumbens, comme déjà constaté dans les processus addictifs. Afin d’apporter un lien causal à cette étude, nous avons bloqué l’activité de la voie mTORC1 par un inhibiteur spécifique, la rapamycine, chez des rats traités au pramipexole. Etonnamment, cette combinaison accentue fortement l’intolérance au délai, alors que la rapamycine seule ne provoque aucun effet notable. Ceci pourrait s’expliquer par une cinétique d’activation et d’inhibition complexe de cette voie. L’ensemble de ces résultats suggère que l’impulsivité observée dans la MP serait causée par une action iatrogène du pramipexole via une activation anormale de la voie mTORC1 dans le noyau accumbens
Beyond motor symptoms, Parkinson’s disease (PD) is also characterized by a plethora of neuropsychiatric deficits, ranging from apathy and depression to Impulse control disorders (ICDs). ICDs represent a complex group of behavioral addictions including gambling disorders, hypersexuality and compulsive shopping, displayed by 10 to 14% of PD patients under dopamine replacement therapies, whose quality of life is greatly diminished. Importantly, cognitive impulsivity reflecting in particular, an inability to tolerate delays to reinforcements, appears as a core symptom of ICDs. Indeed, recent evidence suggested that this kind of impulsivity would be exacerbated in PD and under treatment by dopaminergic D2/3 receptor agonists. However, the mechanisms underlying ICDs in PD remain unknown and the respective contribution of dopamine lesion and treatment, combined with factors of vulnerability, remain to be determined. Moreover, waiting impulsivity, another form of behavioral inhibition which may lead to compulsive behaviors, has been poorly investigated in the framework of ICDs.In this thesis project, using a lesional rodent model of non-motor symptoms of PD, we addressed the question of whether denervation of the dopaminergic nigrostriatal system would promote the development of impulsivity when combined with dopamine agonist treatments. Rats were bilaterally injected in the SNc with the neurotoxin 6-OHDA to induce selective and partial denervation of the dorsal striatum. We then treated them with the dopamine D2/3 receptor agonist, pramipexole, a medication known to favor the development of ICDs in PD patients. Two different tasks were used to measure cognitive and motor impulsivity: the delay discounting task (DDT) and the 5-choice serial reaction time task (5-CSRTT) respectively. In the former, rats have to press a lever and choose between a smaller, but immediate reward and a larger, but delayed reward. For the latter, they have to wait for a stimulus light to come on. In the DDT, chronic administration of pramipexole treatment only increased impulsive choices in non-lesioned rats. Indeed, the dopaminergic lesion by itself, or in adjunction with the treatment, did not increase impulsivity. In the 5-CSRTT, pramipexole progressively increased premature responses, reflecting a pro-impulsive effect when the inter-trial interval is constant. However, when the interval was increased, pramipexole reduced the premature responses, exhibiting an anti-impulsive effect. Interestingly, this modulation of motor impulsivity was only observed in rats with a high level of impulsivity, suggesting that an impulsive endophenotype might be an important factor of vulnerability to the iatrogenic effects of pramipexole.The effect of this treatment was then investigated at a cellular level. It promotes overexpression of the dopamine D2 receptor mRNA within the striatum, and seems to alter glutamatergic synaptic connectivity suggested by electron microscopy. Moreover, we showed that the mammalian target of rapamycin complex 1 (mTORC1) pathway is lastingly over-activated in the nucleus accumbens, as already observed in drug addictions. In an attempt to make a causal link between this pathway and the behavioral changes, we treated rats with pramipexole and rapamycine, a specific inhibitor of this pathway. Surprisingly, this combination accentuated impulsivity even more, whereas rapamycine by itself did not promote impulsivity. This effect may be explained by the complexity of the kinetics of activation and inhibition of mTORC1 pathway.Taken together, these results suggest that impulsivity in PD may be triggered by an iatrogenic effect of the dopaminergic pramipexole treatment through an abnormal activation of the mTORC1 pathway within the nucleus accumbens

Parkinsons sjukdom (PD) är ett tillstånd som ger en försvårad och försämrad livskvalité. I dagsläget finns det endast symtomatiska läkemedel men ingen bot med vilken sjukdomen upphör eller som bromsar förloppet. Pågående forskningsarbete utgår bland annat från att ta fram nya läkemedel men även också undersöka om redan befintliga läkemedel går att använda som behandling av PD. Många av de redan befintliga läkemedlen som testas är de som har förmågan att påverka proteinet α-synuklein (α-syn) och dess aggregering, som visats vara en central orsak till uppkomsten av PD. I föreliggande litteraturstudie undersöktes på vilket sätt en del läkemedel vars indikation är PD och även andra sjukdomstillstånd såsom astma, påverkar (ex. påskyndar eller inhiberar) in-vitro aggregering av α-syn. Därutöver genomfördes en detaljerad analys av de utvalda läkemedlen och deras effekt på α-syn aggregering utifrån deras kemiska egenskaper med avseende på löslighet (hydrofila, lipofila, amfifila) och inbindning till α-syn. Här kunde det visas att aggregering av α-syn inhiberades av alla utvalda läkemedel förutom dexametason, som istället påskyndade aggregeringskinetiken för proteinet. Dessutom uppvisade fasudil, ceftriaxon, dopamin, entakapon och tolkapon inbindning till delar av (hydrofila, hydrofoba eller amfifila) vilka delade samma fysikalkemiska egenskaper som α-syn. Därtill uppvisade utvalda läkemedel med till viss del plana strukturer (ex. aromatiska ringar) direkt inbindning till α-syn, vilka också rapporterats ha en något högre grad av transport över blod-hjärnbarriären, dock måste dessa fynd mer noggrant undersökas. Sammanfattningsvis visade alla utvalda läkemedel förutom dexametason anti-aggregeringsegenskaper (hämmande) mot α-syn genom att antingen indirekt eller direkt binda till proteinet och därmed hindra proteinet från att börja binda till sig själv. Mer studier måste genomföras för att studera effekten av läkemedelsexponering på α-syn för att identifiera viktiga segment av proteinet som kan utgöra läkemedelsmål för inhibering av α-syn aggregering.
Parkinson's disease (PD) is a condition that leads to an aggravated and worsened quality of life. At present, there are only symptomatic drugs for PD but no cure that eradicate the disease nor halter the disease progression have been found. Current research is being carried out to develop new drugs, but efforts also investigate whether existing drugs can be used as treatment for PD. Many of the already existing drugs being tested are those that have the ability to interact with a protein called α-synuclein (α-syn), that has been implicated to be a major player for onset of PD. In the present literature study, it was investigated in what way some drugs, whose indication is PD but also other diseases such as asthma, affect (i.e. propagate or inhibit) the in-vitro aggregation kinetics of αsyn. Additionally, a detailed analysis of the investigated drugs and their effect on the aggregation pathway was made to characterize common chemical features of the selected drugs based upon choice of solvents and binding to α-syn. Here, it could be shown that aggregation of α-syn is inhibited upon exposure to all selected drugs except dexametason which instead propagated aggregation of α-syn. In addition, fasudil, ceftriaxone, dopamine, entacapone and tolcapone was found to bind to parts (hydrophilic, hydrophobic or amphiphilic) of α-syn similar to their solubility features. Moreover, the selected drugs that were found to bind to α-syn seemed to exhibit planar in structure (i.e. aromatic rings) and also be associated to pass the blood-brain barrier to a greater extent, however these findings need to be more thoroughly investigated. In summary, all drugs but dexametason were shown to inhibit aggregation of α-syn invitro by either indirectly or directly affecting the aggregation of the protein. Further investigations need to be carried out to study the effect of drug exposure on α-syn aggregation in order to propose key segments of α-syn that can act as drug targets for inhibition of protein aggregation.

碩士
臺北醫學大學
藥學研究所
97
Background: Dopamine receptor agonists (DAs), especially D2 subtype could be used as monotherapy in patients with early Parkinson’s disease (PD) or adjunctive therapy to L-DOPA in advanced PD with motor complications. DAs are divided into ergot and non-ergot agents. Recent studies indicate that taking high dosages of ergot-derived DAs are associated with valvular heart disease. Therefore, switching from ergot to non-ergot DAs to prevent such adverse drug reactions is the main research goal of many clinical trials. To the best of our knowledge, very few studies have investigated the direct switch between non-ergot DAs. The conversion factor between ropinirole and pramipexole is calculated indirectly and thus the published values are inconsistent. Pramipexole is a non-ergot DA, which has more bioavailability (> 90% vs. 50%) and longer half-life (8~12 hours vs. 6 hours) than ropinirole. Moreover, pramipexole is not metabolized by cytochrome P450 enzymes and it does not have interactions with this enzyme system; pramipexole is primarily eliminated through the kidneys. Furthermore, pramipexole has been shown to have relatively high affinity for the D3 receptor and putative neuroprotective effects. These properties of pramipexole may lead to additional antidepressant action. Objectives: The mission of this study was to determine the conversion factor between two non-ergot DAs, ropinirole (Requip®) and pramipexole (Mirapex®) in Taiwanese PD patients and evaluated the possible antidepressant effect of pramipexole. Methods: In this prospective open-label pilot study, a small-scale phase IV clinical trial of two non-ergot DAs was carried out at Taipei Medical University Hospital, during the period of June, 2008 to June, 2009. Patients with PD (aged 45 to 80 years old) had taken stable doses of ropinirole with or without L-DOPA (Madopar®) for at least 28 days were recruited. After stopping ropinirole treatment, patients were switched to pramipexole with a log escalating dose until reaching the optimal motor control. The effective dosage of pramipexole was kept unchanged in the three-month maintenance period. This paired design would minimize confounding factors and thus a small sample size was needed for studying the primary and secondary endpoints. The primary endpoint was to determine the conversion factor between ropinirole and pramipexole at the end of the 12-week maintenance period, assessed by the Unified Parkinson’s Disease Rating Scale, part III (UPDRS-III). The secondary outcomes included changes in the Beck Depression Inventory-Second Edition (BDI-II) and the 39-item Parkinson''s Disease Questionnaire (PDQ-39) scores during the study period. Patient’s satisfaction with pramipexole by Treatment Satisfaction Questionnaire for Medication (TSQM) and safety of the switch were also evaluated. Results: A total of 17 PD patients were recruited and 10 of them completed the 12-week maintenance course. The pre-switch dosage of ropinirole was 3.1 mg/day and the post-switch maintenance dosage of pramipexole was 0.6 mg/day. The dosage of pramipexole was lower than that in the western countries. The conversion factor was 5.6±2.8 (n=10), that was directly derived from each patient’s paired data. The UPDRS-III score showed a significant decrease from 22.4±10.2 to 15.8±6.6 (p<0.05), reflecting an improvement in motor performance. There was no significant change in the BDI-II during the switch period. However, a significant difference in the PDQ-39 summary index was obtained after the second month of the maintenance period. There were significant changes in both effectiveness and global satisfaction scores of the TSQM simultaneously. The most common adverse events while switching to pramipexole were dizziness and constipation. Conclusions: In summary, a directly slow switch from ropinirole to pramipexole at a conversion factor of 5.6 showed the motor improvement after a 12-week maintenance period. This factor derived from the present study could be useful in developing a protocol of an overnight switch from ropinirole to pramipexole in Taiwanese patients with PD.

Dopamine agonist therapy and deep brain stimulation (DBS) are both linked to increased impulsivity in Parkinson’s disease (PD), but the underlying mechanisms remain unclear. We trained intact and PD-like rats on a rat gambling task (rGT) measuring impulsive choice and premature responding. Animals were then retested with/without treatment, pramipexole (PPX) or DBS, administered chronically prior to rGT testing. Early PD-like rats did not exhibit major differences in rGT performance or treatment response. Our work suggests that DBS and PPX are not intrinsically linked with increases in impulsivity. Neither DBS nor PPX disrupted gambling-like behaviour in our paradigm, while differential effects on premature and perseverant responding in the task were observed with treatment. Based on our findings, the previously reported ability of PPX to increase impulsive choice might not be mediated by the dopamine D3 receptor. Interestingly, our work suggests that the effects of STN-DBS on impulse control might be amplitude-dependent.