clinical trials

Estrogen Therapy for Men? Maybe.

Men are more likely to develop Parkinson’s disease (PD) than women, and the onset of PD in men happens at a younger age. However, women with PD have a higher mortality rate, and once they have Parkinson’s, progression is faster. Research suggests that women get the disease at later in life when compared to men, at least in part, due to the natural protection estrogen provides. There are studies that have demonstrated that hormone replacement therapy (HRT) can provide dopaminergic neuroprotection in both young and menopausal female mice.

Could the female sex hormone, estrogen, be a therapeutic approach for delaying or reducing PD symptoms for men?

Recently published in the Journal of Neuroscience, a study titled, “Female Sex and Brain-Selective Estrogen Benefit α-Synuclein Tetramerization and the PD-like Motor Syndrome in 3K Transgenic Mice” (Rajsombath, Nam, Ericsson, & Nuber, 2019) investigated this possible therapeutic neuroprotective effect.

Using mice called 3K that show motor and neural changes associated with PD, researchers injected male mice under the skin with the hormone therapy DHED. What makes DHED so special is that it was designed to only activate estrogen in the brain. This matters because estrogen therapy has been associated with an increase in cancer in other parts of the human body.

The motor performance and brain health of the 3K male and female mice were compared along with whether DHED affects the progression of PD-like symptoms in males. The motor evaluations included their ability to clasp, climb down a pole, gait (walk) and balance on an accelerating rotarod, which is a lot like lumberjack logrolling. There were also highly sophisticated tests to determine possible changes in the build-up or clearing of protein clumping in the brain, along with the decline or increase in the health of dopamine neurons.

Results

Like the sex differences found in people with PD, 3K male mice developed PD-like symptoms faster than female mice. Furthermore, male mice treated with DHED had:

  • Improved clasping abilities
  • Improved downclimbing
  • Improved gait
  • Improved balance
  • Better clearing of risky alpha-synuclein (protein clumps in the brain)
  • Healthier dopamine neurons

What Does This Mean?

This study focused on the 3K male mice and how they responded to the estrogen therapy, DHED. When the male mice were treated with the DHED, they showed improvements in all the motor functions tested. They also showed significant improvements in the brain, including healthier dopamine neurons and lower amounts of alpha-synuclein at risk for clumping. Remember, clumped alpha-synuclein becomes Lewy Bodies ― a hallmark of PD.

It is also important to note that the successful development of the 3K model itself – which duplicates many differences in male and female PD at motor, cellular and molecular levels – is a significant step forward in closing the gender gap in PD research. Having a model that helps unravel how the pathology differently affects the two sexes informs new avenues of research that could lead to the development of tailored medications and interventions to meet the distinct needs of men and women with PD.

Read the study HERE. This article from parkinson.org.

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Protein might become candidate for drug development

Researchers have modified the protein Nurr1 so that it can enter cells from the outside. Nurr1 deficiency may be one of the causes of Parkinson’s disease. Even though Nurr1 has been discussed as a potential target for the treatment of Parkinson’s disease, it is unusable in its normal form, as it cannot penetrate cells. A team from Ruhr-Universität Bochum and the US-American National Institutes of Health (NIH) deployed a bacterial import signal in order to deliver Nurr1 into cells. The researchers also demonstrated that the modified protein may have a positive effect on the survival of dopamine-producing nerve cells. They describe their results in the journal Molecular Neurobiology from 18 August 2018.

For the study, Dennis Paliga, Fabian Raudzus, Dr. Sebastian Neumann, and Professor Rolf Heumann from the work group Molecular Neurobiochemistry collaborated with Professor Stephen Leppla from the NIH.

Bacterial protein building block as import signal

Nurr1 is a transcription factor; this means the protein binds to DNA in the nucleus and regulates which genes get read and translated into proteins. Thereby, it controls many properties in cells that produce the neurotransmitter dopamine and that are affected in Parkinson’s disease. Dopamine withdrawal in certain brain regions is responsible for the slowness of movement that is associated with the disease.

Since the Nurr1 protein does not usually have the capability of entering cells and, therefore, cannot take effect in the nucleus, the researchers were searching for ways of furnishing the protein with an import signal. They found what they were looking for in bacteria and attached a fragment of a protein derived from Bacillus anthracis to Nurr1. In the bacterium, that protein ensures that the pathogen can infiltrate animal cells. “The fragment of bacterial protein that we used does not trigger diseases; it merely contains the command to transport something into the cell,” explains Rolf Heumann. Once the modified protein has been taken up by the cell, the bacterial protein building block is detached, and the Nurr1 protein can reach its target genes by using the cell’s endogenous nuclear import machinery.

Nurr1 has a positive effect on the key enzyme of dopamine synthesis

The researchers measured the effect of functional delivery of Nurr1 by monitoring the production of the enzyme tyrosine hydroxylase. That enzyme is a precursor in dopamine synthesis – a process that is disrupted in Parkinson’s patients. Cultured cells that were treated with modified Nurr1 produced more tyrosine hydroxylase than untreated cells. At the same time, they produced less Nur77 protein, which is involved in the regulation of programmed cell death.

Protein protects from the effects of neurotoxin

Moreover, the researchers tested the effect of modified Nurr1 on cultured cells that they treated with the neurotoxin 6-hydroxydopamine. It causes the dopamine-producing cells to die and is thus a model for Parkinson’s disease. Nurr1 inhibited the neurotoxin-induced degeneration of cells.

“We hope we can thus pave the way for new Parkinson’s therapy,” concludes Sebastian Neumann. “Still, our Nurr1 fusion protein can merely kick off the development of a new approach. Many steps still remain to be taken in order to clarify if the modified protein specifically reaches the right cells in the brain and how it could be applied.”

Article from Ruhr University Bochum.

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New Reports Measure Parkinson’s Motor Progression

Two recent papers outline the progression of Parkinson’s disease (PD) movement or motor symptoms in distinct study populations. While these findings do not provide an absolute picture of how one person will progress with PD, the results may help researchers design smaller, faster and less expensive clinical trials of new treatments.

Changes in Early Parkinson’s and with Dopamine Therapy

The Parkinson’s Progression Markers Initiative study, sponsored by The Michael J. Fox Foundation (MJFF), reported on changes in motor symptoms over five years from people who joined the study early in their disease (within two years of diagnosis). The largest change (as measured by the Unified Parkinson’s Disease Rating Scale or UPDRS) came in the first year, then symptoms plateaued as people began taking dopamine medication.

Many studies of therapies that aim to slow or stop disease progression recruit people in similar early stage of disease. Understanding what to expect over the first year and as those study participants begin dopamine medication can help drug developers design their trials.

Read the full paper.

Slower Progression in G2019S LRRK2 Mutation Carriers

Analysis from the LRRK2 Ashkenazi Jewish Consortium — part of the MJFF-supported LRRK2 Cohort Consortium — compared progression in people who carry the G2019S mutation in the LRRK2 gene, a leading genetic cause of Parkinson’s disease, to progression in people without a known cause of their disease (so-called sporadic PD).

People in the study who carried a G2019S LRRK2 mutation advanced 30 percent more slowly on the UPDRS than people with sporadic PD. The authors from Mount Sinai Beth Israel Medical Center in New York noted, though, that they could not confirm whether those results were from a subgroup with less severe disease bringing down the average or if most G2019S LRRK2 mutation carriers have less aggressive disease.

It is not to say, either, that if you do not carry this genetic mutation you will definitely progress quickly; Parkinson’s is a highly variable disease.

The results are already helping companies testing therapies against LRRK2 dysfunction. Carole Ho of Denali Therapeutics, which brought the first LRRK2 drug into clinical trials late last year, told research news website AlzForum, “We are using the new data to design trials to test LRRK2 inhibitors. Knowing the natural course of disease is very important.”

Read more on these results.

PPMI is recruiting people of Ashkenazi Jewish descent with a Parkinson’s or Gaucher disease connection. Learn more about the study.

 

Article from Michael J. Fox Foundation for Parkinson’s Research.

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LRRK2 Drug Trial Shares Promising Results

In December, Denali Therapeutics announced positive results from its first-in-human LRRK2 inhibitor clinical trial. The experimental treatment is safe, and it lowers LRRK2 protein activity in humans’ body cells. This is a meaningful milestone in the clinical development of a drug with potential to slow or stop Parkinson’s progression (something no currently available treatment can do).

Denali also shared it is testing a second compound in a separate Phase I trial in control volunteers. Following completion of both trials, one of the two compounds will move into studies in people with Parkinson’s carrying a LRRK2 mutation.

In a press release, the company announced its first trial showed greater than 90 percent inhibition of LRRK2 activity at peak drug levels. This is a critical early step in testing a drug — does it do what you want it to do in the cell? Denali used two tests to measure inhibition, including one based on a finding from a Michael J. Fox Foundation-organized consortium linking LRRK2 to another protein.

“Mutations in LRRK2 are a major risk factor for Parkinson’s disease. Targeting this degenogene represents a promising approach to develop disease-modifying medicines,” said Ryan Watts, PhD, Denali CEO.

Read more on the findings and next steps.

Article from Michael J. Fox Foundation for Parkinson’s Research.

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Longtime Antidepressant Could Slow Parkinson’s

Michigan State University scientists now have early proof that an antidepressant drug that’s been around for more than 50 years could slow the progression of Parkinson’s.

In a proof-of-concept study, published in the journal Neurobiology of Disease, the drug nortriptyline, which has been used to treat depression and nerve pain, stopped the growth of abnormal proteins that can build up in the brain and lead to the development of the disease.

“Depression is a very frequent condition associated with Parkinson’s, so we became interested in whether an antidepressant could modify how the disease progresses,” said Tim Collier, lead author of the federally funded study and a neuroscientist at MSU.

Collier and collaborator Katrina Paumier, an assistant professor of molecular medicine, began looking at previous patient data to see if individuals who were on antidepressants experienced any delay in their need to go on a standard Parkinson’s therapy called levodopa. This type of therapy increases levels of dopamine, a natural chemical in the body that sends signals to other nerve cells and can significantly decrease in cases of Parkinson’s.

The medication also treats many of the symptoms associated with the disease such as tremors and poor muscle control.

“We found that those on a certain class of antidepressant, called tricyclics, didn’t need the levodopa therapy until much later compared to those who weren’t on that type of antidepressant medication,” Collier said.

Collier then began testing rats with the tricyclic antidepressant nortriptyline and found that it indeed was able to decrease the amount of abnormal protein that can build up in the brain. This protein, known as alpha-synuclein, can cause the brain’s nerve cells to die when in a clustered state and is a hallmark sign of the disease.

To further back up his research, he enlisted the help of his colleague and co-author Lisa Lapidus, who in previous studies had already detected whether certain compounds could bind to alpha-synuclein and stop it from accumulating.

“Proteins are constantly moving and changing shape,” said Lapidus, a professor in the Department of Physics and Astronomy. “By using a test tube model, we found that by adding nortriptyline to the alpha-synuclein proteins, they began to move and change shape much faster, preventing the proteins from clumping together. The idea that this clustering effect is controlled by how fast or slow a protein reconfigures itself is typically not a standard way of thinking in research on proteins, but our work has been able to show these changes.”

Understanding how these proteins can clump together could point researchers in new directions and help them find other possible drugs that could potentially treat Parkinson’s.

“What we’ve essentially shown is that an already FDA-approved drug that’s been studied over 50 years and is relatively well tolerated could be a much simpler approach to treating the disease itself, not just the symptoms,” Collier said.

Collier is already looking for funding for the next phase of his research and hopes to lead a human clinical trial using the drug in the future.

The National Institutes of Health, as well as the Michael J. Fox and Saint Mary’s Foundations, funded the study.

 

Article from Michigan State University.

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First Drug Approved for Dyskinesia in Parkinson’s Disease

Adamas Pharmaceuticals recently announced U.S. Food and Drug Administration (FDA) approval of an extended-release formulation of amantadine (GOCOVRI) to treat dyskinesia in Parkinson’s disease. This is the first drug indicated specifically for dyskinesia — uncontrolled, involuntary movements that can develop with long-term levodopa use.

Extended-release amantadine is intended to be taken once daily at bedtime. In this way it can control dyskinesia during the day, when it typically is most prevalent. The new therapy’s approval is based on data from three placebo-controlled trials that demonstrated safety and efficacy. In addition to easing dyskinesia, the drug also may lessen total daily “off” time, when Parkinson’s symptoms return because medication is not working optimally.

The Michael J. Fox Foundation (MJFF) helped move this drug to market by supporting the creation and authentication of the Unified Dyskinesia Rating Scale, a tool that was used to measure the drug’s impact in trials.

“Dyskinesia can significantly compromise quality of life for people with Parkinson’s,” says Todd Sherer, MJFF CEO. “We are pleased that patients have another option to manage this aspect of the disease and glad the Unified Dyskinesia Rating Scale — a tool our support helped develop and validate — could show clinical efficacy of GOCOVRI for the treatment of dyskinesia.”

Extended-release amantadine is a reformulation of a currently available generic immediate-release version, which is approved to treat Parkinson’s symptoms.

 

Article from Michael J. Fox Foundation for Parkinson’s Research.

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Free Water Levels Provide a New Biomarker for PD Progression

According to a recent study, a newly discovered biomarker, free water, can track changes in the brain that are associated with Parkinson’s disease, which ultimately may aid in developing new drugs that could slow disease progression.

“This finding is a potential game changer as it could shift the way Parkinson’s disease clinical trials are designed and conducted,” said Michael S. Okun, MD, a professor and chair of neurology at the University of Florida and medical director for the Parkinson’s Foundation. “Free-water is a validated measurement that will likely decrease the number of patients required to demonstrate the slowing of clinical progression.”

The study titled, “Progression marker of Parkinson’s disease: a 4-year multi-site imaging study,” was published in the journal Brain.

One of the issues in developing disease-modifying therapies for Parkinson’s disease has been a lack of an accurate biomarker that can detect changes in the brain as the disease progresses. Recently, a new imaging technique was developed that can accurately detect the volume of water in brain tissue and separate that measurement from the water outside the brain tissue. The latter type of water is known as free water and has been known to increase in neurodegenerative disorders.

In 2015, researchers demonstrated that free water levels were increased in the posterior substantia nigra (PSN) of patients with Parkinson’s disease. The motor symptoms that accompany a diagnosis of Parkinson’s disease tend to emanate from the area of the brain that includes the nigrostriatal pathway, which is part of PSN.

In another study, researchers discovered that the free water levels in the PSN increased over one year in newly diagnosed Parkinson’s disease patients, but not in control groups. However, no studies have investigated how free water in the PSN changes over an extended period of time.

Therefore, researchers at the University of Florida conducted a multicenter international longitudinal study to determine the pattern of change in free water in patients with Parkinson’s disease over four years.

Results from this study showed that free water levels in PSN increased over one year in newly diagnosed Parkinson’s disease patients. Furthermore, free water levels continuously increased over four years. The research team also showed that sex and baseline free water predicted four-year changes in free water levels. Additionally, researchers showed that free water increasing over one or two years leads to worsening stages on the Hoehn and Yahr scale over a four-year period.

One of the most important things to result from this study has been the discovery of a biomarker that determines the progression of Parkinson’s disease and one that can potentially be used in future clinical trials as an endpoint.

“This means if you want to start designing studies to slow the progression of Parkinson’s disease, testing a drug on that measurement in the substantia nigra might be a good way to go,” said David Vaillancourt, PhD, professor of applied physiology and kinesiology at the University of Florida in a press release. “If the measurement in the substantia nigra is increasing year after year after year, and if you can stop that from occurring, you’re likely to slow or possibly stop the progression of the disease. This could change the way studies are conducted for disease-modifying trials in Parkinson’s disease.”

 

Article from Parkinson’s News Today.

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Study Making Strides Toward Parkinson’s Biomarker

At the current time, there is no identified biomarker for Parkinson’s disease (PD). In other words, there is no objective measure — no lab or imaging test, for example — that can tell whether a person has PD, what type of motor and non-motor symptoms will predominate and how those symptoms will change over time.

Having a biomarker for Parkinson’s would both inform clinical care and accelerate research. A key potential biomarker is alpha-synuclein, the sticky protein that clumps in the brains of people with PD. These protein clumps — called Lewy bodies — are a hallmark of the disease thought to cause damage or death to dopamine-producing brain cells. Researchers can’t currently visualize alpha-synuclein in the brains of people with PD while they’re living. (This is, however, a priority area for the Foundation and MJFF is funding efforts to develop an agent to image alpha-synuclein in the brain.) They can, however, measure the protein in several areas outside of the brain, as alpha-synuclein is found throughout the body.

Researchers haven’t yet determined the optimal location(s) or method(s) to sample alpha-synuclein. To meet this need, in 2016, MJFF launched the Systemic Synuclein Sampling Study (S4), an observational clinical study involving 60 people at varied stages of Parkinson’s disease and 20 healthy volunteers. A new report, published in Biomarkers in Medicine, details the study’s procedures and goals. The article describes the standardized collection and analysis protocols used to measure alpha-synuclein in each participant’s spinal fluid, saliva and blood, as well as their skin, colon and salivary gland tissues.

S4 is the first study to evaluate alpha-synuclein in multiple body fluids and tissues within the same person and across a population of people at various points in PD. These results may lead to recommendations for optimal alpha-synuclein measurements in clinical trial participants as well as an understanding of how alpha-synuclein changes throughout the disease course.

As the study authors write, “The development of a peripheral alpha-synuclein biomarker would provide a valuable tool for confirming the diagnosis of PD, and possibly identification of the disease in its earliest stages, and provide a potential means of monitoring efficacy of potential disease modifying agents.”

A tool that could facilitate diagnosis and gauge the impact of therapies in development would truly change the way we’re able to conduct research and how quickly we can move therapies through the pipeline. That’s why finding a biomarker and research such as this are so critical.

Visit Fox Trial Finder to learn more about how you can participate in S4 and other Parkinson’s research studies.

https://www.michaeljfox.org/foundation/news-detail.php?mjff-study-making-strides-toward-parkinson-biomarker

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FDA approves drug to treat Parkinson’s disease

The U.S. Food and Drug Administration recently approved Xadago (safinamide) tablets as an add-on treatment for patients with Parkinson’s disease who are currently taking levodopa/carbidopa and experiencing “off” episodes. An “off” episode is a time when a patient’s medications are not working well, causing an increase in Parkinson’s symptoms, such as tremor and difficulty walking.

“Parkinson’s is a relentless disease without a cure,” said Eric Bastings, M.D., deputy director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “We are committed to helping make additional treatments for Parkinson’s disease available to patients.”

The efficacy of Xadago in treating Parkinson’s disease was shown in a clinical trial of 645 participants who were also taking levodopa and were experiencing “off” time. Those receiving Xadago experienced more beneficial “on” time, a time when Parkinson’s symptoms are reduced, without troublesome uncontrolled involuntary movement (dyskinesia), compared to those receiving a placebo. The increase in “on” time was accompanied by a reduction in “off” time and better scores on a measure of motor function assessed during “on” time than before treatment.

In another clinical trial of 549 participants, the participants adding Xadago to their levodopa treatment had more “on” time without troublesome uncontrolled involuntary movement compared to those taking a placebo, and also had better scores on a measure of motor function assessed during “on” time than before treatment.

The FDA granted approval of Xadago to Newron Pharmaceuticals.

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm547852.htm

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