Renin-angiotensin system as a potential target for new therapeutic approaches in Parkinson’s disease

Introduction: Currently, available therapies for Parkinson’s disease (PD) are symptomatic. Therefore, the search for neuroprotective drugs remains a top priority.

Areas covered: In this review, the potential symptomatic or disease-modifying effect of drugs targeting the Renin-Angiotensin System (RAS) in PD will be explored.

Expert opinion: The importance of nigrostriatal local RAS has only begun to be unraveled in the last decades. On one hand, there is a complex feedback cycle between RAS and dopamine (DA). On the other hand, RAS affects dopaminergic neurons vulnerability. Neuroprotective effects in animal PD models have been shown for the angiotensin-converting enzyme (ACE) inhibitors captopril and perindopril, and the AT1 receptor antagonists losartan, candesartan and telmisartan. These effects appear to be mediated by a reduction in the overproduction of reactive oxygen species. In a proof-of-concept, randomized, double-blind, crossover study in PD patients, perindopril enhanced the effect of levodopa without inducing dyskinesias. There has not been any clinical trial exploring the neuroprotective effect of RAS drugs, but one cohort study in hypertensive patients suggested a protective effect of ACE inhibitors on PD risk. RAS is a promising target for symptomatic and neuroprotective therapies in PD. Further studies in PD animal models and patients are warranted.     

Differential changes in taste perception induced by benzoic acid prickling

Benzoic acid (Bz) is a prickling compound used to preserve foods. However, its effects on taste are unknown. This work examines Bz-taste interaction using psychophysical methods [magnitude estimation (ME) and paired comparison (PC)] to measure taste intensity in aqueous solutions of pure tastants (T) and their respective mixtures with 10 mM Bz (Mix). Prototypical tastants induced basic taste qualities (mM): sucrose [90-1440, sweetness (Sw)], citric acid [1-64, sourness (So)], NaCl [15-960, saltiness (Sa)], quinine [0.01-0.64, bitterness (Bitt)], KCl (12.5-400, Sa and Bitt). MEs were analysed using Steven's and Beidler's equations. Bz increased Sw (all concentrations) and ionic tastes (low concentrations) and Bz effects were reduced by concentration increase according with quality and tastant Bz reduced Bitt(Quinine) (high concentrations). Bz reduced taste slopes (percentage decrease): Sw 45% (P<.02), So 34% (P<.01), Sa 35% or 41% (NaCl or KCl, P<.03), Bitt 33% or 60% (quinine P<.01 or KCl P<.04). Bz reduced K(diss) (affinity(-1)) (percentage reduction): Sw 79% (P<.0002), So 40% (P<.03), Sa(NaCl) 63% (P<.005), Sa(KCl) 48% (P<.04), Bitt(KCl) 64% (P<.04). Bz reduced ME(max) (percentage reduction): Sw 31% (P<.004), Bitt(Quinine) 29% (P<.03). PCs confirmed taste increases by Bz (percentage of 'Mix(intensity)>T(intensity)' answers/total answers): Sw 79-69% (90-1440 mM sucrose), So 75% (1 mM citric acid) and 71% (2 mM citric acid), Sa 75-71% (15-120 mM NaCl). Negative concentration dependence of taste increases by Bz suggests different levels of interaction. Biophysical and neurophysiological changes are discussed in relation with Bz properties and mechanism of interaction with taste.     

Prevalence and factors related to orthostatic syndromes in recently diagnosed,drug-naïve patients with Parkinson disease

Clinical Autonomic Research - The aim of this study was to explore the prevalence of and factors related to orthostatic syndromes in recently diagnosed drug-naïve patients with Parkinson...     

Acute changes in 5-HT metabolism after S-adenosyl-L-methionine administration

1. This study investigates S-adenosyl-L-methionine (SAM) (10 mg/kg, i.p.)acute effects upon 5-HT metabolism in rat brain areas. 2. One hour after SAM injection 5-HT biosynthesis was increased in the corpus striatum (55%), the hippocampus (3-fold) (82% 2 hr after SAM injection) and decreased in the olfactory bulbs (34%). 3. 5-HT levels were: (a) increased in the corpus striatum (39%), the hippocampus (44%) and the frontal cortex (27%), and oppositely reduced in the olfactory bulbs (47%) 1 hr after SAM injection; (b) increased in the hippocampus (39%) and reduced in the olfactory bulbs (35%) 1.5 hr after SAM injection; (c) increased in the hippocampus (25%) 2 hr after SAM injection. 4. 5-HIAA levels were reduced in the olfactory bulbs 27% or 21% after 1 hr or 1.5 hr from SAM injection respectively. 5. These area-related changes in 5-HT biosynthesis and metabolism might suggest a possible neurochemical substrate for the antidepressant properties of SAM.     

Droxidopa for the treatment of neurogenic orthostatic hypotension in neurodegenerative diseases

Introduction: L-threo-3,4-dihydroxyphenylserine (droxidopa), a pro-drug metabolized to norepinephrine in nerve endings and other tissues, has been commercially available in Japan since 1989 for treating orthostatic hypotension symptoms in Parkinson’s disease (PD) patients with a Hoehn & Yahr stage III rating, as well as patients with Multiple System Atrophy (MSA), familial amyloid polyneuropathy, and hemodialysis. Recently, the FDA has approved its use in symptomatic neurogenic orthostatic hypotension (NOH).

Areas covered: The authors review the effects of droxidopa in NOH with a focus on the neurodegenerative diseases PD, MSA, and pure autonomic failure (PAF).

Expert opinion: A few small and short placebo-controlled clinical trials in NOH showed significant reductions in the manometric drop in blood pressure (BP) after posture changes or meals. Larger Phase III studies showed conflicting results, with two out of four trials meeting their primary outcome and thus suggesting a positive yet short-lasting effect of the drug on OH Questionnaire composite score, light-headedness/dizziness score, and standing BP during the first two treatment-weeks. Results appear essentially similar in PD, MSA, and PAF. The FDA granted droxidopa approval in the frame of an ‘accelerated approval program’ provided further studies are conducted to assess its long-term effects on OH symptoms.