Jocelyn M. Madeira, Stephanie M. Schindler, Andis Klegeris

Department of Biology, University of British Columbia Okanagan Campus, Kelowna, British Columbia, V1V 1V7 Canada

A new look at auranofn, dextromethorphan and rosiglitazone for reduction of glia-mediated infammation in neurodegenerative diseases

Jocelyn M. Madeira, Stephanie M. Schindler, Andis Klegeris＊

Department of Biology, University of British Columbia Okanagan Campus, Kelowna, British Columbia, V1V 1V7 Canada

Neurodegenerative disorders including Alzheimer’s disease are characterized by chronic infammation in the central nervous system. The two main glial types involved in infammatory reactions are microglia and astrocytes. While these cells normally protect neurons by providing nutrients and growth factors, disease specifc stimuli can induce glial secretion of neurotoxins. It has been hypothesized that reducing glia-mediated infammation could diminish neuronal loss. This hypothesis is supported by observations that chronic use of non-steroidal anti-infammatory drugs (NSAIDs) is linked with lower incidences of neurodegenerative disease. It is possible that the NSAIDs are not potent enough to appreciably reduce chronic neuroinfammation after disease processes are fully established. Gold thiol compounds, including auranofn, comprise another class of medications effective at reducing peripheral infammation. We have demonstrated that auranofin inhibits human microglia- and astrocyte-mediated neurotoxicity. Other drugs which are currently used to treat peripheral infammatory conditions could be helpful in neurodegenerative disease. Three different classes of anti-infammatory compounds, which have a potential to inhibit neuroinfammation are highlighted below.

auranofin; dextromethorphan; rosiglitazone; Alzheimer’s disease; neuroinflammation; neurodegeneration; microglia; astrocytes

Funding:This work was supported by a grant from the Jack Brown and Family Alzheimer’s Disease Research Foundation.

Madeira JM, Schindler SM, Klegeris A (2015) A new look at auranofin, dextromethorphan and rosiglitazone for reduction of glia-mediated inflammation in neurodegenerative diseases. Neural Regen Res 10(3)∶391-393.

Introduction

Infammation in the central nervous system (CNS) contributes to several neurodegenerative diseases (Jonsson et al., 2013). Gene mutations affecting inflammatory pathways have been linked to poorer cognitive functioning in elderly patients and to date no effective treatments for preventing or reducing this inflammation exist (Jonsson et al., 2013). CNS infammation is driven by two glial cell types: microglia and astrocytes (Gonzalez et al., 2014; Hostenbach et al., 2014); therefore, these cells are the primary targets for novel anti-inflammatory drugs (Lee et al., 2013). Under normal physiological conditions these cells provide trophic support to neurons; however, in neuroinfammation, increased secretion of proinflammatory mediators, glial toxins, excitatory molecules, such as glutamate, as well as decreased release of neurotrophic factors from glia can damage healthy surrounding neurons (Lee et al., 2013). Drugs that counteract these pathological changes without affecting the physiological activity of glia, such as clearing amyloid beta deposits, are excellent candidates for the treatment of neuroinfammatory conditions (Lee et al., 2013). Several classes of anti-infammatory drugs have been well studied and are considered safe. They include non-steroidal anti-infammatory drugs (NSAIDs), which inhibit cyclooxygenase (COX) enzymes; glucocorticoids; and disease modifying anti-rheumatic drugs (DMARDs), such as methotrexate, which have several mechanisms of action (Dinarello, 2010). While most of these drugs have been studied extensively as inhibitors of peripheral inflammation, few have been investigated for their effects on neuroinflammation (Tansey and Goldberg, 2010). This brief highlight will summarize the available evidence of anti-neuroinflammatory activity of three drugs currently approved for use in other disorders.

Auranofn

Gold compounds including 2,3,4,6-tetra-o-acetyl-l-thio-β-D-glucopyrano-sato-S-(triethyl-phosphine) gold, manufactured as auranofn (AF), are used to treat infammation associated with rheumatoid arthritis (Kean, 1990). While their exact mechanism of action is unclear, it is known that AF inhibits several infammatory pathways including nuclearfactor kappa-light-chain-enhancer of activated B cells (NF-κB) activation and tumor necrosis factor (TNF)-α production and secretion (Madeira et al., 2012).

Our studies indicate that AF possesses both anti-neuroinfammatory and neuroprotective activities. AF at low micromolar concentrations inhibited human microglia- and astrocyte-mediated neurotoxicity (Madeira et al., 2013, 2014). The anti-neuroinfammatory activity of AF was selective; it inhibited priming of phagocyte respiratory burst and microglial secretion of TNF-α and nitric oxide (NO) (Madeira et al., 2014). AF upregulated hemeoxygenase (HOX)-1, an anti-infammatory and neuroprotective enzyme in astrocytes (Cuadrado and Rojo, 2008; Madeira et al., 2013). Moreover, AF directly protected neuronal cells from toxicity induced by hydrogen peroxide or stimulated glial supernatants; however, it did not inhibit secretion of interleukin (IL)-6 and IL-8 (Madeira et al., 2013, 2014). After oral administration in rats and mice, AF has been shown to reach CNS concentrations above 0.1 μM required for its protective effects (Madeira et al., 2012, 2013); therefore, AF may be useful in the treatment of neuroinfammation.

dextromethorphan

Dextromethorphan (DM; d-3-methoxy-17-methylmorphinan) is an anti-tussive agent used in cough medicines (Tortella et al., 1989). DM has been shown to inhibit peripheral production and secretion of several infammatory mediators including TNF-α, IL-6, NO and superoxide anion (O2·) (Liu et al., 2003). Several studies have shown that DM reduces glia-mediated neuroinfammation and may have neuroprotective effects (Liu et al., 2003; Keller et al., 2008; Chechneva et al., 2011). DM inhibited microglia-mediated degeneration of dopaminergic neuronsin vitroand inhibited the production of TNF-α, NO, and O2·by stimulated microglia (Liu et al., 2003). Furthermore, DM is a known N-methyl-d-aspartate receptor (NMDAR) antagonist (Tortella et al., 1989). In a mouse model of excitotoxic brain damage, DM reduced lesion size and neuronal cell death, possibly by reducing microglial activation. Low concentrations of DM reduced inflammation-primed NMDAR-mediated excitotoxic brain damage without inducing neuronal apoptosis (Keller et al., 2008). In animal models of multiple sclerosis, DM was shown to reduce the transcription of NOX-2 and O2·production in microglia (Chechneva et al., 2011). A phase II clinical trial investigating a combination of DM and quinidine sulfate (a metabolic inhibitor that affects DM concentration in the body) for the treatment of Alzheimer’s disease (AD) is currently underway, but results have not yet been released (Misra and Medhi, 2013).

Rosiglitazone

Rosiglitazone (RSG) is currently used in the treatment of type 2 diabetes. RSG is a thiazolidinedione, which activates peroxisome proliferator-activated receptor-γ (PPAR-γ) (Haffner et al., 2002). PPAR-γ agonists are anti-infammatory by suppressing NF-κB and by directing macrophages towards the anti-inflammatory M2 phenotype (Bouhlel et al., 2007; Gold et al., 2010). RSG may be helpful in the treatment of neuroinflammatory conditions. Hyong et al. (2008) demonstrated that RSG improved neurological status in rats after surgical brain injury. This improvement could be due to decreased IL-1β and TNF-α expression. In a similar study using a stroke model, RSG treatment decreased infarct volume, improved post ischemic neurological function, and reduced neutrophil accumulation in the brain parenchyma of mice. RSG inhibited TNF-α, IL-1β, and IL-6 secretion by cultured cortical microglia (Luo et al., 2006) and has also shown direct neuroprotective activity in the models of traumatic brain injury (Yi et al., 2008). Treatment of mice with RSG enhanced post-traumatic brain expression of neuroprotective heat shock proteins, HOX-1, and anti-oxidant enzymes. Luna-Medina et al. (2005) demonstrated that RSG signifcantly reduced expression of TNF-α, IL-6, inducible nitric oxide synthase, and COX-2 by stimulated astrocytes through PPAR-γ activation. While complete suppression of COX-2 may cause undesirable CNS effects, such adverse activity has not been reported with RSG treatment (Gold et al., 2010). Studies of the effects of RSG on Alzheimer’s disease (AD) progression have yielded mixed results depending on whether or not the patients were carriers of the apolipoprotein E (APOE) allele which is correlated with late-onset AD (Gold et al., 2010).

Conclusion

Neuroinflammation contributes to the pathogenesis of a wide range of neurodegenerative disorders especially during their early stages before irreversible changes, such as plaque formation, have occured (Lucas et al., 2006). Currently no effective treatments directed at reducing this infammation exist (Klegeris et al., 2007). Development of novel therapeutics is a lengthy process, which can be expedited by developing new applications for drugs that are already approved for use in humans. A number of such approved drugs with known peripheral anti-infammatory activity have yet to be studied for their effects on neuroinflammation (Dinarello, 2010). By re-purposing old drugs, the time it takes for an effective anti-neuroinfammatory drug to be found and put into clinical trials could be signifcantly reduced.

Bouhlel MA, Derudas B, Rigamonti E, Dievart R, Brozek J, Haulon S, Zawadzki C, Jude B, Torpier G, Marx N, Staels B, Chinetti-Gbaguidi G (2007) PPARgamma activation primes human monocytes into alternative M2 macrophages with anti-infammatory properties. Cell Metab 6:137-143.

Chechneva OV, Mayrhofer F, Daugherty DJ, Pleasure DE, Hong JS, Deng W (2011) Low dose dextromethorphan attenuates moderate experimental autoimmune encephalomyelitis by inhibiting NOX2 and reducing peripheral immune cells infltration in the spinal cord. Neurobiol Dis 44:63-72.

Cuadrado A, Rojo AI (2008) Heme oxygenase-1 as a therapeutic target in neurodegenerative diseases and brain infections. Curr Pharm Des 14:429-442.

Dinarello CA (2010) Anti-infammatory agents: Present and future. Cell 140:935-950.

Gold M, Alderton C, Zvartau-Hind M, Egginton S, Saunders AM, Irizarry M, Craft S, Landreth G, Linnamagi U, Sawchak S (2010) Rosiglitazone monotherapy in mild-to-moderate Alzheimer’s disease: results from a randomized, double-blind, placebo-controlled phase III study. Dement Geriatr Cogn Disord 30:131-146.

Gonzalez H, Elgueta D, Montoya A, Pacheco R (2014) Neuroimmune regulation of microglial activity involved in neuroinfammation and neurodegenerative diseases. J Neuroimmunol 274:1-13.

Haffner SM, Greenberg AS, Weston WM, Chen H, Williams K, Freed MI (2002) Effect of rosiglitazone treatment on nontraditional markers of cardiovascular disease in patients with type 2 diabetes mellitus. Circulation 106:679-684.

Hostenbach S, Cambron M, D’Haeseleer M, Kooijman R, De Keyser J (2014) Astrocyte loss and astrogliosis in neuroinflammatory disorders. Neurosci Lett 565:39-41.

Hyong A, Jadhav V, Lee S, Tong W, Rowe J, Zhang JH, Tang J (2008) Rosiglitazone, a PPAR gamma agonist, attenuates infammation after surgical brain injury in rodents. Brain Res 1215:218-224.

Jonsson T, Stefansson H, Steinberg S, Jonsdottir I, Jonsson PV, Bjornsson S, Huttenlocber J, Levey AI, Lah JJ, Rujescu D, Hampel H, Giegling I, Andreassen OA, Engedasl K, Ulstein I, Djurovic S, Ibrahim-Verbaas C, Hofman A, Ikram MA, van Duijn CM, et al. (2013) Variant of TREM2 associated with the risk of Alzheimer’s disease. N Engl J Med 368:107-116.

Kean WF (1990) Intramuscular versus oral gold therapy. Baillieres Clin Rheumatol 4:219-246.

Keller M, Griesmaier E, Auer M, Schlager G, Urbanek M, Simbruner G, Gressens P, Sarkozy G (2008) Dextromethorphan is protective against sensitized N-methyl-D-aspartate receptor-mediated excitotoxic brain damage in the developing mouse brain. Eur J Neurosci 27:874-883.

Klegeris A, McGeer EG, McGeer PL (2007) Therapeutic approaches to infammation in neurodegenerative disease. Curr Opin Neurol 20:351-357.

Lee M, McGeer E, Kodela R, Kashf K, McGeer PL (2013) NOSH-aspirin (NBS-1120), a novel nitric oxide and hydrogen sulfide releasing hybrid, attenuates neuroinfammation induced by microglial and astrocytic activation: a new candidate for treatment of neurodegenerative disorders. Glia 61:1724-1734.

Liu Y, Qin L, Li G, Zhang W, An L, Liu B, Hong JS (2003) Dextromethorphan protects dopaminergic neurons against infammation-mediated degeneration through inhibition of microglial activation. J Pharmacol Exp Ther 305:212-218.

Lucas SM, Rothwell NJ, Gibson RM (2006) The role of inflammation in CNS injury and disease. Br J Pharmacol 147 Suppl 1:S232-240.

Luna-Medina R, Cortes-Canteli M, Alonso M, Santos A, Martinez A, Perez-Castillo A (2005) Regulation of infammatory response in neural cells in vitro by thiadiazolidinones derivatives through peroxisome proliferator-activated receptor gamma activation. J Biol Chem 280:21453-21462.

Luo Y, Yin W, Signore AP, Zhang F, Hong Z, Wang S, Graham SH, Chen J (2006) Neuroprotection against focal ischemic brain injury by the peroxisome proliferator-activated receptor-gamma agonist rosiglitazone. J Neurochem 97:435-448.

Madeira JM, Gibson DL, Kean WF, Klegeris A (2012) The biological activity of auranofn: implications for novel treatment of diseases. Infammopharmacology 20:297-306.

Madeira JM, Bajwa E, Stuart MJ, Hashioka S, Klegeris A (2014) Gold drug auranofn could reduce neuroinfammation by inhibiting microglia cytotoxic secretions and primed respiratory burst. J Neuroimmunol 276:71-79.

Madeira JM, Renschler CJ, Mueller B, Hashioka S, Gibson DL, Klegeris A (2013) Novel protective properties of auranofn: inhibition of human astrocyte cytotoxic secretions and direct neuroprotection. Life Sci 92:1072-1080.

Misra S, Medhi B (2013) Drug development status for Alzheimer’s disease: present scenario. Neurol Sci 34:831-839.

Tansey MG, Goldberg MS (2010) Neuroinflammation in Parkinson’s disease: its role in neuronal death and implications for therapeutic intervention. Neurobiol Dis 37:510-518.

Tortella FC, Pellicano M, Bowery NG (1989) Dextromethorphan and neuromodulation: old drug coughs up new activities. Trends Pharmacol Sci 10:501-507.

Yi JH, Park SW, Brooks N, Lang BT, Vemuganti R (2008) PPARgamma agonist rosiglitazone is neuroprotective after traumatic brain injury via anti-inflammatory and anti-oxidative mechanisms. Brain Res 1244:164-172.

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10.4103/1673-5374.153686

http://www.nrronline.org/

Accepted: 2015-01-30