U.S. patent application number 16/208115 was filed with the patent office on 2019-07-11 for pharmacological treatment of cognitive impairment.
The applicant listed for this patent is THE BOARD OF TRUSTEES FOR THE LELAND STANFORD JUNIOR UNIVERSITY. Invention is credited to Fabian J. Fernandez, Craig C. Garner.
Application Number | 20190209520 16/208115 |
Document ID | / |
Family ID | 38779185 |
Filed Date | 2019-07-11 |
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United States Patent
Application |
20190209520 |
Kind Code |
A1 |
Garner; Craig C. ; et
al. |
July 11, 2019 |
PHARMACOLOGICAL TREATMENT OF COGNITIVE IMPAIRMENT
Abstract
Methods for treating an individual to improve cognitive function
are provided. In the subject methods, an effective amount of a
noncompetitive GABA.sub.A ionophore blocker is administered to the
individual, resulting in an improvement in cognitive function of
the host. The subject methods find use in a variety of different
applications.
Inventors: |
Garner; Craig C.; (Los
Altos, CA) ; Fernandez; Fabian J.; (Stanford,
CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
THE BOARD OF TRUSTEES FOR THE LELAND STANFORD JUNIOR
UNIVERSITY |
Palo Alto |
CA |
US |
|
|
Family ID: |
38779185 |
Appl. No.: |
16/208115 |
Filed: |
December 3, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14243478 |
Apr 2, 2014 |
10172825 |
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16208115 |
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11752188 |
May 22, 2007 |
8729067 |
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14243478 |
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60802760 |
May 22, 2006 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61K 36/16 20130101;
A61K 31/34 20130101; A61K 31/365 20130101; A61P 25/28 20180101;
A61P 25/00 20180101; A61K 31/55 20130101 |
International
Class: |
A61K 31/365 20060101
A61K031/365; A61K 36/16 20060101 A61K036/16; A61K 31/34 20060101
A61K031/34; A61K 31/55 20060101 A61K031/55 |
Claims
1. A method of improving a cognitive function of child or young
adult mammal suffering from mental retardation, said method
comprising: administering not more than once daily to the child or
young adult an effective amount of a pharmaceutical formulation
comprising a GABA.sub.A receptor chloride ionophore blocker;
wherein cognitive function of the child or young adult is
improved.
2. The method of claim 1, wherein the effective dose is less than
0.1.times. the kindling dose and is effective to transiently alter
the chloride influx at GABA.sub.A receptors in the central nervous
system.
3. The method of claim 1, wherein the GABA.sub.A receptor chloride
ionophore blocker is a noncompetitive antagonist.
4. The method of claim 1, wherein the GABA.sub.A receptor chloride
ionophore blocker is administered orally.
5. The method of claim 1, wherein the GABA.sub.A receptor chloride
ionophore blocker is metrazol.
6. The method of claim 5, wherein the metrazol is administered at a
dose of 0.1 to 3 mg/kg body weight of the child or young adult.
7. The method of claim 6, wherein the metrazol is administered once
daily.
8. The method of claim 1, wherein said GABA.sub.A receptor chloride
ionophore blocker is delivered parenterally.
9. The method of claim 8, wherein said GABA.sub.A receptor chloride
ionophore blocker is chosen from bilobalide, ginkgolide B and
picrotoxin.
10. The method of claim 1, wherein the GABA.sub.A receptor chloride
ionophore blocker is administered daily for a period of at least
about two weeks.
11. The method of claim 10, wherein said cognitive function is at
least one of learning and memory.
12. The method of claim 10, further comprising the step of testing
the child or young adult for improvement in at least one of
learning and memory.
13. The method of claim 1, wherein the young adult or child is
human.
14. A method of improving a cognitive function of an individual
with Down Syndrome, the method comprising: administering not more
than once daily to the individual an effective amount of a
pharmaceutical formulation comprising a GABA.sub.A receptor
chloride ionophore blocker; wherein cognitive function of the
individual is improved.
15. The method of claim 14, wherein the effective dose is less than
0.1.times. the kindling dose and is effective to transiently alter
the chloride influx at GABA.sub.A receptors in the central nervous
system.
16. A kit for use in improving a cognitive function of an
individual mammal suffering from mental retardation, said kit
comprising: GABA.sub.A receptor chloride ionophore blocker in a
non-epileptic dose, in a pharmaceutically acceptable vehicle.
17. The kit according to claim 16, wherein said kit further
comprises instructions for treating said mental retardation.
18. A method of screening a candidate agent for treatment of
cognitive impairment associated with mental retardation, the method
comprising: contacting a GABA.sub.A receptor with a candidate
agent; determining if said agent is an ionophore blocker;
administering said agent to an animal in a model for mental
retardation; determining if said agent improve cognitive function.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This applications claims benefit of priority to U.S.
provisional application 60/802,760, filed May 22, 2006, which is
herein incorporated by reference.
BACKGROUND OF THE INVENTION
[0002] Mental retardation (MR) affects 2-3% of the population in
the industrialized world, and remains a prevalent form of
non-progressive cognitive impairment. Narrowly defined by an IQ of
less than 70 and deficits in academic, adaptive, and interpersonal
skills, disorders involving MR are, nonetheless, spread over a
broad etiology, resulting from both genetic and non-genetic causes.
The breadth and frequency of MR-related cognitive dysfunction is
alarming considering that pharmacological intervention is currently
non-existent.
[0003] Historically, neuroscientists have probed the brain in MR
for clues to possible treatment strategies of MR-related learning
difficulties. In the case of Down syndrome, these pioneering
investigations have led to observations of tissue atrophy, white
matter abnormalities, neuronal cell loss, stunted dendritic
branching, and spine dysgenesis. Interestingly, many of the
histological features noted in the brains of individuals with Down
syndrome parallel phenotypes that have been found in the brains of
individuals with other classes of MR, such as inborn errors of
metabolism and non-genetic insults. Connections among different
X-linked forms of MR have also been made, with disrupted synaptic
structure, synaptic plasticity, and Ras-MAPK signaling as emerging
themes. Similarities across the wide spectrum of MR-related
disorders argue that common mechanisms underlie the manifestation
of learning and memory deficits in intellectually handicapped
children and young adults.
[0004] Down Syndrome (DS) is the most commonly occurring form of
mental retardation in man, with an incidence of 1 in 600 births.
The etiology surrounding the disorder was first described as a
nondisjunctive error during meiosis of human chromosome 21 (hC21),
resulting in the overexpression of an estimated 225 genes normally
found on the chromosome. DS is characterized by congenital heart
disease, endocrine disturbances, and immunologic deficiency, but is
most universally marked by learning and memory difficulties in
affected individuals that preclude adaptive cognitive and
interpersonal function.
[0005] How the presence of hC21 genes in triplicate alters the
maturation of the central nervous system (CNS) and subsequent
cognitive development in DS has remained an open question. DS
brains generally appear normal at birth. Newborns with DS exhibit
typical brain weights, and do not exhibit any differences in gross
neuronal and synaptic structure from children without the disorder.
Quantitative analysis of DS prefrontal layer III pyramidal cells
around birth and at 2.5 months of age indicates no differences in
dendritic differentiation. Brain growth, in fact, proceeds normally
for the first 5 to 6 months of life. However, soon after the
infantile period (>6 months) the DS brain begins to show the
abnormalities that characterize it in adulthood. The emergence of
these cytological abnormalities may coincide with the beginning of
IQ decline in DS-affected children within the first few years of
life.
[0006] Investigation of CNS abnormalities and cognitive dysfunction
in DS has been greatly facilitated by the development of two
segmentally trisomic mouse models of DS: Ts65Dn and Ts1Cje. Ts65Dn
mice are trisomic for segments of mouse chromosome 16 (Mmu 16)
highly homologous to the long arm of hC21, including portions of
the so-called DS "critical region." Phenotypically, Ts65Dn mice
faithfully recapitulate some of the most salient and fundamental
features of DS. The topography of craniofacial maldevelopment in
Ts65Dn mirrors that observed in DS patients; likewise, Ts65Dn mice
exhibit similar patterns of cerebellar atrophy during early
postnatal development. The utility of Ts65Dn as a mouse model of DS
is strengthened further by findings that detail nearly
comprehensive deficits in Ts65Dn short- and long-term spatial
memory, working memory, and reference memory.
[0007] The treatment of mental retardation is of great clinical and
humanitarian interest. The present invention addresses this
issue.
PUBLICATIONS
[0008] The synaptic connections in the Ts65Dn brain have been
assessed by a variety of assays. For example, quantitative electron
microscopy (EM) of Ts65Dn CNS has revealed a loss of asymmetric,
excitatory synapses in Ts65Dn cortex relative to WT tissue, with a
concurrent sparing of symmetric, inhibitory synapses (Kurt et al.,
2000). Reductions in the density of excitatory synapses, and in the
ratio of excitatory-to-inhibitory signaling in the Ts65Dn brain,
have been noted alongside compensatory increases in the synaptic
apposition lengths of asymmetric and symmetric synaptic
junctions.
[0009] Recent studies using lucifer-yellow filling of neurons in
Ts65Dn acute slices have indicated that a widening of synaptic
clefts may relate to the development of enlarged spines in Ts65Dn
cortex (see Belichenko et al. (2004) J Comp Neurol. 480(3):281-98).
In an in vitro system, deficits in Ts65Dn hippocampal LTP were
shown to reverse upon application of picrotoxin (see Kleschevnikov
(2004) J Neurosci. 24(37):8153-60). Costa et al. (2005) Neur. Lett.
382:317-322 report deficits in hippocampal CA1 LTP induced by TBS
but not HFS in the Ts65Dn mouse Levkovitz et al. (1999) J.
Neuroscience 19:10977-10984 discuss upregulation of GABA
neurotransmission in the suppression of hippocampal excitability
and prevention of long-term potentiation in transgenic superoxide
dismutase-over-expressing mice.
[0010] It has been suggested that excessive immunoreactivity of the
glutamine receptor GluR1 may be involved in degeneration of neurons
and the early formation of senile plaques in Down syndrome, as
tissue samples taken from the frontal lobes of patients with Down
syndrome exhibit homeostatic elevations in GluR1 immunoreactivity
(Arai et al. (1996) Pediatr. Neurol. 15:203-206).
[0011] Ginkgo biloba extract was administered to two young patients
with trisomy 21 (Donfrancesco et al. (2004) Phytomedicine 11:469.
Pentylenetetrazol (metrazol) was administered to children with
mental deficiencies by Berman et al. (1957) AMA Journal of Diseases
of Children 94:231; and to psychogeriatric patients by Stotsky et
al. (1972). GABAergic agonist (diazepam) drugs were administered to
children with Down Syndrome by Cocchi (1985) Int. J. Psychosomatics
32:12-16 reducing depression.
[0012] Heteoaryl fused aminoalkyl-imidazole derivatives as
selective modulators of GAGAA receptors are discussed in US Patent
Application 2003/0092912. Use of GABA inverse agonists in
combination with nicotine receptor partial agonist, estrogen,
selective estrogen modulators or vitamin E is discussed in U.S.
Patent Application 2004/0082555. Combination use of
acetylcholinesterase inhibitors and GABA.sub.A inverse agonists for
the treatment of cognitive disorders is discussed in U.S. Patent
Application 2002/0151591. L-655,708 is reported to enhance
cognition in rats but is not pro-convulsant at a dose selective for
a5-containing GABA.sub.A receptors.
SUMMARY OF THE INVENTION
[0013] Methods are provided for improving the cognitive function of
an individual suffering from mental retardation. The individual is
administered an effective, non-epileptic dose of a GABA.sub.A
receptor chloride ionophore blocker, for a period of time
sufficient to improve cognitive function. Long term cognitive
improvement can be obtained from the methods of the invention,
which can persist after cessation of treatment. Conditions of
interest for treatment include Down Syndrome, and other congenital
or acquired conditions that impair cognitive function. Also
provided are kits for use in practicing the subject methods.
[0014] In another embodiment of the invention, methods are provided
for screening drug candidates for effectiveness in treating
cognitive impairment associated with mental retardation. Such
methods may include screening assays with animal or cell models,
and may include a comparison with a reference value obtained from
known GABA.sub.A receptor chloride ionophore blockers. Screening
may be used to identify agents that selectively target specific
cells to improve targeting specificity of the intervention.
BRIEF DESCRIPTION OF THE FIGURES
[0015] FIGS. 1A-1B. Chronic Administration of PTX or BB Rescues and
Maintains Ts65Dn Object Recognition Memory.
[0016] FIG. 2. Topography of WT' and Ts65Dn Object Recognition
Performance before and after Drug Treatment with PTX.
[0017] FIGS. 3A-3C. PTX and BB, Control Data.
[0018] FIG. 4. Like PTX and BB, Metrazol improves Ts65Dn memory in
the object recognition task.
[0019] FIGS. 5A-5B. MTZ, Control Data.
[0020] FIG. 6. The Effects of Metrazol on Ts65Dn Cognitive
Behavior, like those of PTX, are Long-Lasting.
[0021] FIGS. 7A-7C. WT and Ts65Dn Locomotor Habituation during the
Light Cycle, and Indices of Mouse Habituation to the Med Associates
Activity Monitors.
[0022] FIG. 8. Absolute Object Novelty Preference among Vehicle-
and Drug-Treated WT and Ts65Dn Mice.
[0023] FIGS. 9A-9B. Object Recognition Validation: One-Object Based
and Two-Object Based Tasks.
[0024] FIG. 10. Chronic, but not Acute, Application of PTX Restores
Ts65Dn Object Recognition Memory in a One-Object Based Task.
[0025] FIG. 11. Acute PTX is Unable to Reliably Rescue Ts65Dn
Performance in a 2-Object Based Object Recognition Test.
[0026] FIG. 12. Motor Learning in WT and Ts65Dn Mice: Chronic PTX
Treatment does not influence Ts65Dn Rotorod Performance.
DESCRIPTION OF THE SPECIFIC EMBODIMENTS
[0027] The cognitive function of an individual suffering from
mental retardation is alleviated by administration of a GABA.sub.A
receptor chloride ionophore blacker for a period of time sufficient
to improve cognitive function. Cognitive improvement is provided by
"therapeutic kindling" of neural circuits, and is achieved by
administering the active agent at very low, non-epileptic, doses,
which in one embodiment of the invention are administered not more
than about once a day; and/or which can administered with a sleep
period between doses. In other embodiments of the invention, a very
low dose is administered, which is optionally provided in a
continuous dosing regimen. The dosing regimen is usually maintained
for at least about one week, at least about two weeks, at least
about three weeks, at least about one month, or more. In some
embodiments of the invention, the active agent is fast acting and
short lived. In some embodiments of the invention, the active agent
is noncompetitive in character and is not selective for a specific
GABA.sub.A alpha subunit, e.g. .alpha.1, .alpha.5, etc.
[0028] Before the subject invention is further described, it is to
be understood that the invention is not limited to the particular
embodiments of the invention described below, as variations of the
particular embodiments may be made and still fall within the scope
of the appended claims. It is also to be understood that the
terminology employed is for the purpose of describing particular
embodiments, and is not intended to be limiting. Instead, the scope
of the present invention will be established by the appended
claims.
[0029] In this specification and the appended claims, the singular
forms "a," "an," and "the" include plural reference unless the
context clearly dictates otherwise. Unless defined otherwise, all
technical and scientific terms used herein have the same meaning as
commonly understood to one of ordinary skill in the art to which
this invention belongs.
[0030] .gamma.-Aminobutyric acid (GABA) is the major inhibitory
neurotransmitter in the mammalian central nervous system. The
predominant effect of GABA is the interaction with a specific
receptor protein which results in an increase of the chloride ion
conductance of the postsynaptic membrane to produce an inhibition
of neuronal firing. In recent years, much attention has been
focused on this specific receptor, the GABA.sub.A receptor.
[0031] As shown in the examples provided herein, decreased
functionality in cognitive performance of an individual suffering
from mental retardation can be associated with increased inhibition
in the brain. Treatment by chronically administering low doses of
drugs that globally reduce chloride influx mediated by GABA.sub.A
channels is shown to improve cognitive function. Compounds of
interest specifically reduce the activity of GABA.sub.A receptors
via block of the GABA.sub.A receptor-chloride ionophore complex.
Detailed studies with three different GABA.sub.A antagonists within
this class, in a model of Down syndrome, reveal that normal
cognitive performance can be achieved after long-term
administration of these drugs, demonstrating their utility as a
treatment for Down syndrome, and other forms of mental
retardation.
[0032] Neurite outgrowth and on-going synaptogenesis are critically
influenced by the balance of circulating glutamate and GABA during
development of the cerebral cortex. During the early phases of
neurite outgrowth, GABA acts like an "excitatory" agent in the
brain, as the neuronal chloride gradient in maturing cells is
reversed; facilitating neuronal calcium entry, and positively
regulating neurite extension. GABA's traditional role as an
inhibitory transmitter in the brain emerges during the
activity-dependent refinement of cortical circuits, entailing the
pruning of arbors in the outer fringes of the dendritic field and
the strengthening of remaining synaptic connections.
[0033] Molecular cloning data indicate that the
GABA.sub.A-benzodiazepine receptor complex is comprised of at least
five subunits; these in turn may have various isoforms. Each
subunit is comprised of four membrane-spanning regions. The
intracellular loops of some subunits contain phosphorylation sites,
which have been hypothesized to be a locus of receptor modulation.
A complete system of .alpha., .beta., and .gamma. subunits are
needed for a fully responsive receptor.
[0034] At least four interacting allosteric drug binding sites are
known to occur within this receptor. These include those for the
site of action of the tranquillizer drugs, the benzodiazepines, the
neurosteroids, and barbiturates. These sites correspond to the
binding sites for benzodiazepines, for GABA, for steroids, and for
picrotoxin. The various types of drug binding site on the
GABA.sub.A receptor may allosterically interact with each other.
Compounds that bind to any one of these sites may have agonist,
reverse agonist, or antagonist activity. Uniquely, opposing
pharmacological actions appear to be mediated through this one
receptor protein. Thus compounds which interact at the
benzodiazepine site can be anxiolytic, or conversely they can have
anxiogenic and convulsant properties.
[0035] Compounds of interest for use in the methods of the
invention specifically block the chloride ionophore site of
GABA.sub.A. and are antagonists, i.e. reduce chloride influx. In
some embodiments of the invention, the therapeutic compound is a
non-competitive antagonist at the GABA-A receptor that binds to a
chloride ionophore pore forming region of the receptor to interfere
with chloride conductance; it does not interfere with GABA
transmitter binding, nor does it allosterically modulate the
receptor. Picrotoxin, Metrazol and bilobalide have been shown to
function in this manner. Suitable GABA.sub.A receptor chloride
ionophore blockers that may be used in the subject methods include,
but are not limited to: metrazol; picrotoxin, bilobamide,
ginkgolide B, penicillin, etc.
[0036] Compounds of interest for use on the methods of the
invention may have epileptic activity, and therefore the dose is
carefully selected. A compound of interest is administered at a
dose below the dose that will kindle seizures. Such a "low" dose is
usually less than about 0.5.times. the kindling dose, more usually
less than about 0.1.times. the kindling dose, less than about
0.05.times. the kindling dose; less than about 0.01.times. or less
than about 0.005.times. the kindling dose. The determination of a
kindling dose for an agent of interest may be empirically
determined, e.g. in an animal model, or may be based on known
kindling dosage. For example, the effect of pentylenetetrazole in
kindling is well-known in the art. In some embodiments of the
invention an effective dose will at least transiently alter the
chloride influx at GABA.sub.A receptors in the central nervous
system, i.e. for a period of at least about 1 minute, at least
about 5 minutes, at least about 30 minutes, at least about 1 hours,
or more, usually not more than about 4 hours; not more than about 3
hours; not more than about 2 hours.
[0037] However, there may also be embodiments where the effective
dose provides for a longer lasting effect, for example where the
dose, e.g. a very low dose, provides for a longer lasting
alteration of calcium influx at GABA.sub.A receptors in the central
nervous system, e.g. for at least about 12 hours, at least about 24
hours, or longer. Such embodiments may utilize doses that are less
than about 0.05.times. the kindling dose; less than about
0.01.times. or less than about 0.005.times. the kindling dose. In
such embodiments the dosing may provide for a more continuous
activity profile, e.g. where an effective dose of the agent is
provided with a continuous pump, or is administered more than once
a day, e.g. twice, 3 times, 4 times per day, and the like.
[0038] Pentylenetetrazole is a pharmaceutical agent that displays
activity as a central nervous system and respiratory stimulant. It
is considered a non-competitive GABA antagonist. Pentylenetetrazole
has been used experimentally to study seizure phenomenon and to
identify pharmaceuticals that may control seizure susceptibility.
In the class of drugs exemplified by pentamethylenetetrazol (also
referred to as metrazol). An effective dose may range from at least
about 0.1 mg/kg, at least about 0.2 mg/kg, at least about 0.5
mg/kg, at least about 1 mg/kg to not more than about 2, about 2.5,
or about 3 mg/kg. The compounds are orally active, and cross the
blood brain barrier.
[0039] Related compounds may also be of interest, for example where
one or more annular carbons of the 7-membered ring are optionally
substituted with a lower alkyl of from 1-6 carbon atoms, a hydroxyl
group, a sulfhydryl group, an amine or substituted amine, a nitro
group, Br, CI, F, I, and the like.
[0040] Pentylenetetrazol has been demonstrated to facilitate normal
learning and memory in rats and mice when administered acutely
post-training (peripheral injection or oral intake) in avoidance-
and discrimination-based tasks. Chronic subcutaneous administration
of the drug in a relatively high dose (at approximately 10.0 mg/kg)
to rats for .about.9 months curtails signs of neuronal aging in the
hippocampus; long-term Metrazol treatment preserves hippocampal
neuronal density and nuclear "roundedness," reduces the appearance
of reactive astrocytes, and elevates reversal learning in a
shock-motivated, spatial maze task.
[0041] There is no critical period for Metrazol-guided changes in
brain circuitry; it can occur in the young, as well as in the aged.
Metrazol has a long history of clinical usage in humans, showing a
mixed ability to treat age-related senility and dementia. Metrazol,
when taken at a dose range of less than about 100-400 mg/day,
possesses little to no adverse or toxic effects. Patients on
Metrazol exhibited no changes in temperature curves, respiration,
blood sugar, icteric index or pulse rate, and exhibited no
abnormalities in their electrocardiographic tracings. Basic
personality structure and reaction patterns were also conserved in
those taking the drug.
[0042] Radioactive studies with C.sup.14 and HPLC analysis
demonstrate that Metrazol is fast acting, and is very rapidly
adsorbed after oral intake or systemic injection (maximum
physiological levels being achieved within 5-10 min of drug
administration), readily crosses the blood-brain barrier, and
partitions seamlessly between blood serum and brain, soon reaching
an equilibrium between both compartments where the volume of
distribution approximates the volume of total body water.
Similarly, kinetic patterns within various brain regions after
intraperitoneal injection (half-life absorption phase, half-life
distribution phase, half-life elimination phase, etc) indicate that
Metrazol is allocated evenly between the 3 major brain divisions:
cerebellum, midbrain and the cortex. Subsequently, the main
elimination pathway of the drug is biotransformation in the liver
and urinary excretion. Metrazol is short-lived, where the half-life
has been estimated to be 1-2 h.
##STR00001##
[0043] Picrotoxin is a noncompetitive antagonist at GABA-A
receptors, and has been classified as a convulsant. Picrotoxin
blocks the GABA-activated chloride ionophore. It has been used as a
CNS stimulant and an antidote in poisoning by CNS depressants,
especially the barbiturates. Picrotoxin and related compounds are
administered at an effective dose that may range from at least
about 0.5 mg/kg, to not more than about 1 mg/kg. A kindling dose
may be as little as 2.0 mg/kg, or 1.5 mg/kg. The compounds may be
administered systemically, usually by injection.
##STR00002##
[0044] Bilobalide and ginkgolide B comprise part of a novel class
of compounds called terpene trilactones, unique constituents of
Ginkgo Biloba that are found exclusively in the Ginkgo Biloba tree.
The compounds function as potent non-competitive antagonists at
GABA-A receptors, acting as open-channel blockers of the chloride
ionophore associated with the receptor complex. Consistent with
this pharmacological action, bilobalide has been shown to
significantly increase the amplitude of hippocampal population
spikes in a muscimol-dependent manner, and to decrease paired pulse
inhibition. Additionally, both bilobalide and Ginkgolide B have
been demonstrated to shorten sleeping time during barbital-induced
narcosis. As constituents of Ginkgo Biloba, they, likewise,
activate the EEG, enhance the pro-convulsant effects of PTX, and
trigger seizures in refractory epilepsy.
[0045] Pharmacokinetic studies in humans reveal that bilobalide is
70% bioavailable after oral intake of a 80-120 mg dose of ginkgo
biloba leaf extract (with a half-life of 3 h), while that of
Ginkgolide B is at least 80% (with a half-life of 6 h). In this
form, approximately, 30-50% of bilobalide and ginkgolide B is
excreted unchanged in the urine. To date, a systematic
pharmacokinetic evaluation of bilobalide or ginkgolide B following
oral administration of purified compound remains to be conducted.
However, the terpene trilactones' amphiphilic behavior suggests
that they would accumulate particularly well in brain tissue after
passing through the blood brain barrier (BBB). Clinical studies
evaluating the terpene trilactones are very limited. However, to
date, no serious side effects have been reported for ginkgolide B
during clinical trials designed to evaluate the drug's efficacy in
treating allergy (asthma, skin disorders), burn injury, sepsis, and
blood clotting.
[0046] A pharmaceutical formulation of bilobalide or ginkgolide B
is substantially free of other pharmaceutically active agents
presents in Ginkgo biloba extracts, particularly being
substantially free of ginkgolytic acids. In such pharmaceutical
formulations, the desired active agent, i.e. bilobalide or
ginkgolide B may be at least about 50% of the Ginkgo biloba-derived
material, usually at least about 75% of the Ginkgo biloba-derived
material, at least about 85% of the Ginkgo biloba-derived material,
at least about 95% of the Ginkgo biloba-derived material, or more.
As known in the art, a pharmaceutical formulation may comprise
pharmaceutically acceptable excipients and carriers.
[0047] An effective dose of bilobalide or ginkgolide B may range
from at least about 0.1 mg/kg, at least about 0.2 mg/kg, at least
about 0.5 mg/kg, at least about 1 mg/kg to not more than about 5
mg/kg, not more than about 2.5 mg/kg. The compounds are orally
active, and cross the blood brain barrier.
Conditions of Interest
[0048] Various forms of MR may be attributed to the over-inhibition
of cortical circuits, resulting in major homeostatic disturbances
in circuit activity that underlie learning and memory. By
inhibition of GABA.sub.A for an effective period of time at a
non-epileptic dose, over-inhibition is relieved, allowing for long
term changes to neuronal interactions. A number of conditions may
be treated by the methods of the invention. Such conditions
include, without limitation, those listed below.
[0049] Down Syndrome. Down syndrome is the most frequent genetic
cause of mild to moderate mental retardation and associated medical
problems and occurs in one out of 800 live births, in all races and
economic groups. Down syndrome is a chromosomal disorder caused by
the presence of an additional third chromosome 21 or "trisomy 21."
Three genetic variations can cause Down syndrome. In approximately
92% of the time, Down syndrome is caused by the presence of an
extra chromosome 21 in all cells of the individual. In
approximately 2-4% of cases, Down syndrome is due to mosaic trisomy
21, and the remaining cases result from a translocation trisomy
21.
[0050] Most people with Down syndrome have IQ's that fall in the
mild to moderate range of retardation. Premature aging is a
characteristic of adults with Down syndrome. In addition, dementia,
or memory loss and impaired judgment similar to that occurring in
Alzheimer disease patients, may appear in adults with Down
syndrome. This condition often occurs when the person is younger
than forty years old.
[0051] Observations of patients with DS suggest that imbalances in
GABAergic and glutamatergic transmission, favoring a greater
efficacy of GABAergic signaling, may be present during initial
neurological developmental events. The methods of the invention
demonstrate that targeted pharmacological intervention with GABA-A
receptor antagonists can result in lasting increases in circuit
excitability, and improvement in adult learning and memory.
[0052] Phenylketonuria is a mental retardation disorder caused by
the deficiency of the hepatic enzyme phenylalanine-4 hydroxylase
and the build-up of CNS phenylalanine. L-phenylalanine at
concentrations observed in untreated PKU depresses the amplitude
and frequency of both NMDA and non-NMDA components of mEPSP's in
dissociated cortical cultures. Mechanistically, these effects are
mediated in large part by phenylalanine's competitive antagonism of
the obligatory agonist site of the NMDA receptor, but may involve
other postsynaptic and presynaptic mechansisms as well. Golgi
studies performed on children with PKU reveal a prevalence of
immature dendritic spines in pyramidal cells of the cerebral
cortex.
[0053] Neonatal Protein Malnutrition.
[0054] Non-genetic forms of cognitive impairment can be induced by
protein or caloric malnutrition. Morphological hallmarks of
excessive inhibition can be observed in the cerebral cortex of
malnourished individuals, with the proliferation of unusually long,
narrow spines.
[0055] Fragile X Syndrome.
[0056] MR syndromes brought about by specific deficits in neuronal
signal transduction provide evidence for excessive inhibition as a
major contributing factor to cognitive dysfunction. Fragile X
syndrome is due to a trinucleotide repeat expansion in the FMR1
gene that prevents expression of its encoded protein
product--fragile X mental retardation protein (FMRP). X-linked
mental retardation associated with marXq28, or fragile X syndrome,
is characterized by moderate to severe mental retardation,
macroorchidism, large ears, prominent jaw, and high-pitched jocular
speech. Expression is variable, with mental retardation being the
most common feature.
[0057] Cortical cultures in an animal model of Fragile X syndrome
display delayed formation and maturation of neuronal network
activity, and decreased BDNF expression compared to cultures
prepared from wild-type (WT) littermates. These animals also show
scaled reductions in cortical and hippocampal GABA.sub.A receptor
subunit immunoreactivity, and increases in olfactory bulb GluR1
immunoreactivity. Complementing these electrophysiological findings
are studies documenting a higher density of unusually long
dendritic spines in fragile X patients.
[0058] Neuroimaging studies using fMRI have shown that FMRP levels
are positively correlated with activation of the prefrontal cortex
in individuals with fragile X during performance of a working
memory task. These results suggest that FMRP is required during
especially demanding cognitive exercises, and that failure to meet
these demands with appropriate concentrations of FMRP result in
decreased network activity. FMRP's role as a regulator of
site-specific protein translation in dendritic spines may account
for many of the observations that have been made in fragile X
patients and in animal models of the disorder.
[0059] Neurofibromatosis 1. This condition is attributed to genetic
mutations in the NF1 gene and loss of function of neurofibromin's
ras guanosine triphosphatase (rasGAP) activity, presents the most
direct link between overinhibition in the brain and mental
retardation. Animals carrying a heterozygous null mutation of the
NF1 gene (Nf1.sup.+/) exhibit spatial learning deficits in the
Morris water maze that intimately relate with increases in
GABA-mediated inhibition. Nf1.sup.+/- mice have larger mIPSP's and
evoked IPSP's than WT controls, and decreases in hippocampal LTP.
Thus, partial loss of neurofibromin's rasGAP activity, and
subsequent unregulated ras activation, leads to abnormally high
GABA-mediated inhibition, which underlies impairments in Hebbian
plasticity and learning and memory. This devastating cascade of
events can be prevented by administration of farnesyl transferase
inhibitors, anti-ras agents, which return learning and memory in
Nf1.sup.+/- adult mice to control levels.
[0060] Maple Syrup Urine Disease is a mental retardation disorder
resulting from the loss of function of the branched chain L-a-keto
acid dehydrogenase complex and a subsequent accumulation of the
metabolic substrates a-ketoisocaproic acid (KIC),
a-keto-.beta.-methylvaleric acid (KMV), and a-ketoisovaleric acid
(KIV). Experiments have shown that .alpha.-keto acids dampen
cortical excitation and reduce learning in a dose-dependent
fashion. Administration of physiologically relevant concentrations
of KIV to dissociated cortical neurons significantly reduces
spontaneous network activity, while intra-hippocampal infusion of
KIC, KMV and KIV severely disrupts the acquisition of an inhibitory
avoidance task. The effects of .alpha.-keto acids on cortical
activity and cognition appear to be mediated via direct
interactions of the metabolites with the vesicular glutamate
transporter. Application of .alpha.-keto acids inhibits glutamate
uptake into synaptic vesicles in a competitive manner and changes
the chloride dependence for the activation of vesicular glutamate
transport. Alpha-keto acid inhibition of the vesicular glutamate
transporter is dramatic during the acute phase of MSUD]. Young
children with MSUD demonstrate changes in neuronal morphology,
exhibiting a conspicuous abundance of long, thin dendritic spines
in the cerebral cortex.
[0061] Autism, often referred to as autistic disorder or infantile
autism, is a complex behavioral disorder which, by definition,
develops prior to age three years. Autism is defined completely on
the basis of impairments in social interaction, impairments in
communication, and repetitive and stereotypic behaviors. For most
children, the onset of autism is gradual; however, approximately
30% have a "regressive" onset. Fifty to seventy percent of children
with autism are defined as mentally retarded by nonverbal IQ
testing. Seizures develop in approximately 25% of children with
autism.
[0062] The standard diagnostic criteria for autism, compiled by the
American Psychiatric Association Manual of Psychiatric Diseases,
4th edition (DSM-IV), are the primary diagnostic reference used in
the United States. The causes of autism can be divided into
"idiopathic," which comprises the majority of cases, and
"secondary," in which an environmental agent, chromosome
abnormality, or single-gene disorder can be identified.
[0063] The standard diagnostic criteria include qualitative
impairment in social interaction, as manifested by at least two of
the following; qualitative impairments in communication;
stereotyped and repetitive use of language or idiosyncratic
language; lack of varied, spontaneous make-believe play or social
imitative play appropriate to developmental level; restricted
repetitive and stereotyped patterns of behavior, interests, and
activities. Criteria also include delays or abnormal functioning in
at least one of the following areas, with onset prior to age three
years: social interaction, language as used in social
communication, or symbolic or imaginative play
[0064] Impairment in social interaction separates individuals with
autism from the people around them. Children with autism are unable
to "read" other people, ignoring them and often strenuously
avoiding eye contact. Most children with autism fail to develop
reciprocal communication either by speech, gestures, or facial
expressions. Deficits in pragmatic skills are present throughout
life and affect both language and social interaction. In contrast
to the child with nonspecific mental retardation or a primary
developmental language disorder, who usually has better receptive
than expressive language, the child with autism has impaired
receptive language. Fifty to seventy percent of autistic children
are defined as mentally retarded by nonverbal IQ testing.
[0065] Children with Down syndrome have autism more commonly than
expected. The incidence was at least 7% in one study. This finding
suggests that chromosome abnormalities may lower the threshold for
the expression of autism.
[0066] Whereas a very small percentage of children with autism have
fragile X syndrome, at least half of children with fragile X
syndrome have autistic behaviors, including avoidance of eye
contact, language delays, repetitive behaviors, sleep disturbances,
tantrums, self-injurious behaviors, hyperactivity, impulsiveness,
inattention, and sound sensitivities.
[0067] One of the DSM-IV-defined pervasive developmental disorders,
Rett syndrome exhibits considerable phenotypic overlap with autism;
children with both disorders often have a period of normal
development followed by loss of language with stereotypic hand
movements. Decreasing rate of head growth over time and
hand-wringing in female individuals may suggest the diagnosis of
Rett syndrome. Molecular genetic testing for MECP2 mutations that
cause Rett syndrome is clinically available. Only 1% of individuals
with the diagnosis of autism have been reported to have a MECP2
coding region mutation, however these two disorders may be causally
related based on reports of variants in the 3'-UTR of MECP2 in
three of 24 individuals with autism and variable MeCP2 expression
in the brains of individuals with both Rett syndrome and
autism.
Assessment
[0068] By mental retardation is meant a cognitive impairment with a
pattern of persistently slow learning of basic motor and language
skills during childhood, and a significantly below-normal global
intellectual capacity as an adult. One common criterion for
diagnosis of mental retardation is a tested intelligence quotient
(IQ) of 70 or below. Conditions of interest for treatment include
Down Syndrome, and other congenital or acquired conditions that
impair cognitive function. Included in the conditions of interest
for treatment are those in which there is an impairment, often from
early childhood, of at least one cognitive function, such as a
impairment in memory, impairment in learning ability, etc.
[0069] By treatment is meant at least an amelioration of the
symptoms associated with the pathological condition afflicting the
host, where amelioration is used in a broad sense to refer to at
least a reduction in the magnitude of a parameter, e.g. symptom,
associated with the pathological condition being treated, such as
impairment in memory or learning ability or other cognitive
function. As such, treatment also includes situations where the
pathological condition, or at least symptoms associated therewith,
are completely inhibited, e.g. prevented from happening, or
stopped, e.g. terminated, such that the host no longer suffers from
the pathological condition, or at least the symptoms that
characterize the pathological condition.
[0070] As mentioned above, in these applications an effective
amount of GABA.sub.A receptor chloride ionophore blocker is
administered to the host. By "effective amount" is meant a dosage
sufficient to produce a desired result, where the desired result is
generally an amelioration or alleviation, if not complete
cessation, of one or more symptoms of the disease being treated,
particularly the cognitive impairment symptoms, e.g., memory,
learning ability, and the like.
[0071] As used herein, the terms "treatment", "treating", and the
like, refer to obtaining a desired pharmacologic and/or physiologic
effect. The effect may be prophylactic in terms of completely or
partially preventing a disease or symptom thereof and/or may be
therapeutic in terms of a partial or complete cure for a disease
and/or adverse affect attributable to the disease. "Treatment", as
used herein, covers any treatment of a disease in a mammal,
particularly in a human, and includes: (a) preventing the disease
from occurring in a subject which may be predisposed to the disease
but has not yet been diagnosed as having it; (b) inhibiting the
disease, i.e., arresting its development; and (c) relieving the
disease, i.e., causing regression of the disease.
[0072] In addition to the above methods of treatment, the subject
methods also find use in the prophylactic or preventative treatment
regimens. In such methods, the host is administered an amount of a
direct GABA.sub.A inhibitor, typically according to a dosage
schedule (e.g., daily, weekly, monthly etc.), that is sufficient to
prevent the occurrence of at least symptoms of the disorder, e.g.,
impaired cognition.
[0073] In the treatment of a patient, assessment will usually
include a clinical history and the collection of standardized
information. Assessment may also include IQ testing. In animal
models, a variety of standardized tests may be utilized for
evaluation of learning and memory. Examples include analysis of
sustained and non-sustained attention and impulsivity, e.g.
acquisition inhibitory avoidance responding; 5-choice serial
reaction time testing in rodents and a distractor version of a
Delayed Match to Sample test in monkeys. Analysis of social and
working memory may include social recognition model; spatial
working memory using a water maze in rats; and spontaneous
alternation Y mazes. Mazes, e.g. water maze with a hidden platform;
2-choice visual discrimination water maze; "dry land" Barnes
circular maze; etc. are useful in testing spatial reference memory.
Different configurations of the water maze measure different forms
of learning and utilize different brain systems. A second commonly
used paradigm for studying learning and memory is the conditioned
fear test. The direct measure of freezing behavior in response to
discrete conditioned stimuli such as tones or lights as a measure
of learning can evaluate two discrete forms of learning, cued and
contextual. A passive avoidance model is useful in assessing
recall.
[0074] Many assessment tests are available. For example, memory,
attention and executive function (planning abilities) can be
assessed by direct testing with the participants using the DAME
battery. The DAME battery has been validated as a measure that is
sensitive to change in older people with Down's syndrome. The range
of scores is 0-241 and can be completed in 45 minutes by most
people with mild-moderate learning disability.
[0075] Independent functioning can be evaluated using the Adaptive
Behavioural Scale (ABS, Nihira, 1974). This is an informant based
instrument and is part of the assessment used by the American
Association on Mental Deficiency to assess daily living skills in
people with learning disabilities. The ABS measures ten groups of
skills related to self-care and socialization. The ten skills
groups: independent functioning, physical development, economic
activity, language development, numbers and time, domestic
activity, vocational activity, self-direction, responsibility, and
socialization.
[0076] The Clinician's Global Impression of Change (CGI/C) has been
one of the most commonly used test to assess overall change in
clinical trials. The validity of this type of measure is based on
the ability of an experienced clinician to detect clinically
relevant against trivial change in a patient's overall clinical
state.
[0077] In certain situations, treatment according to the subject
methods results in a complete removal of a deficit in the cognitive
function. The amount of improvement is at least about 2 fold,
usually at least about 5 fold and more usually at least about 10
fold as compared to a suitable control, e.g., an otherwise
substantially identical host not administered a GABA.sub.A receptor
chloride ionophore blocker, e.g., a host having similar level of
cognitive ability that has been administered a placebo, where in
certain embodiments the amount of improvement is at least about 25
fold, 50 fold, 75 fold, 100 fold or greater. The cognitive function
improvement can be evaluated using any convenient protocol, where
suitable protocols include, but are not limited to: Wechsler Adult
Intelligence Scale (WAIS_-R) [Wechsler, D. WAIS-R Manual. New York:
Psychological Corporation, 1981; Mini-Mental State Examination
(MMSE) [Folstein et al. Mini Mental State: a practical method for
grading the cognitive state of patients for the clinician. J
Psychiat Res 1975; 12:189-98; Information-Memory-Concentration
test; Fuld Object Memory Evaluation (FOSE) [Fuld, P A. The Fuld
Object Memory Test. Chicago: The Stoeltimg Instrument Company,
1981]; The Buschke Selective Reminding Test (BSRT) [Buschke, H.
Selective reminding for analysis of memory and learning. J Verbal
Learn Verb Behav 1973; 12:543-50]; The Rey Auditory Recall Test
[Buschke, H. Selective reminding for analysis of memory and
learning. J Verbal Learn Verb Behav 1973; 12:543-50]; The Beton
Visual Retention Test (BVRT) [Benton, A L. The revised visual
attention test, 4.sup.th edn. New York: Psychological Corporation,
1974]; The California Verbal Learning Test [Delis et al. The
California Verbal Learning Test. New York: Psychological
Corporation, 1987]; Assessment of navigation in humans [Maguire et
al. Knowing where and getting there; a human navigation network
[Science 1998; 280:921-924]; and the like.
Methods
[0078] In the broadest sense, methods are provided for improving a
cognitive function in a mammalian host. The host is generally a
mammal, e.g mouse, rat, monkey, etc. and in many embodiments is a
human. The GABA.sub.A receptor chloride ionophore blocker is
administered at regular intervals, usually at least weekly, more
usually daily, or every two days, and usually with a sleep period
between doses. Typically, the active agent is fast acting, and
after administration the blocker reaches therapeutic levels across
the blood brain barrier at least transiently, e.g. for around about
1 minute, at least about 5 minutes, at least about 30 minutes, at
least about 1 hour, or more. It is not believed to be necessary to
maintain such levels throughout the treatment period, as effective
treatment is observed even with compounds have a short half-live
after administration. The agent may be short lived, where half-life
in the blood is less than about 4 hours, less than about 3 hours,
less than about two hours.
[0079] Administration of the treatment is maintained for a period
of time sufficient to effect a change in cognitive function. Such
treatment may involve dosing for at least about one week, at least
about two weeks; at least about 3 weeks; at least about one month;
at least about two months; at least about four to six months; or
longer, for example at least about one or more years. For extended
treatment; e.g. treatment of one or more years, a schedule may
involve intermittent periods, such as one week on and one week off;
two weeks on and two weeks off; one week in a month, etc.
[0080] Patients that can benefit from the present invention may be
of any age and include adults and children, e.g. young adults.
Children, e.g. neonate, infant, early childhood, adolescent, etc.
in particular may benefit prophylactic treatment. Children suitable
for prophylaxis can be identified by genetic testing for
predisposition, e.g. by chromosome typing; by family history, or by
other medical means. As is known in the art, dosages may be
adjusted for pediatric use.
[0081] The GABA.sub.A receptor chloride ionophore blocker is
generally administered to the host as a pharmaceutical composition
that includes an effective amount of the GABA.sub.A receptor
chloride ionophore blocker in a pharmaceutically acceptable
vehicle. In the subject methods, the active agent(s) may be
administered to the host using any convenient means capable of
resulting in the desired improvement on cognitive function.
[0082] Therapeutic agents can be incorporated into a variety of
formulations for therapeutic administration by combination with
appropriate pharmaceutically acceptable carriers or diluents, and
may be formulated into preparations in solid, semi-solid, liquid or
gaseous forms, such as tablets, capsules, powders, granules,
ointments, solutions, suppositories, injections, inhalants, gels,
microspheres, and aerosols. As such, administration of the
compounds can be achieved in various ways, including oral, buccal,
rectal, parenteral, intraperitoneal, intradermal, transdermal,
intrathecal, nasal, intracheal, etc., administration. The active
agent may be systemic after administration or may be localized by
the use of regional administration, intramural administration, or
use of an implant that acts to retain the active dose at the site
of implantation.
[0083] Many GABA.sub.A receptor chloride ionophore blockers are
known to be bioactive in the central nervous system after oral or
parenteral administration. For those that are not, one strategy for
drug delivery through the blood brain barrier (BBB) entails
disruption of the BBB, either by osmotic means such as mannitol or
leukotrienes, or biochemically by the use of vasoactive substances
such as bradykinin. The potential for using BBB opening to target
specific agents is also an option. A BBB disrupting agent can be
co-administered with the therapeutic compositions of the invention
when the compositions are administered by intravascular injection.
Other strategies to go through the BBB may entail the use of
endogenous transport systems, including carrier-mediated
transporters such as glucose and amino acid carriers,
receptor-mediated transcytosis for insulin or transferrin, and
active efflux transporters such as p-glycoprotein. Active transport
moieties may also be conjugated to the therapeutic or imaging
compounds for use in the invention to facilitate transport across
the epithelial wall of the blood vessel. Alternatively, drug
delivery behind the BBB is by intrathecal delivery of therapeutics
or imaging agents directly to the cranium, as through an Ommaya
reservoir.
[0084] Pharmaceutical compositions can include, depending on the
formulation desired, pharmaceutically-acceptable, non-toxic
carriers of diluents, which are defined as vehicles commonly used
to formulate pharmaceutical compositions for animal or human
administration. The diluent is selected so as not to affect the
biological activity of the combination. Examples of such diluents
are distilled water, buffered water, physiological saline, PBS,
Ringer's solution, dextrose solution, and Hank's solution. In
addition, the pharmaceutical composition or formulation can include
other carriers, adjuvants, or non-toxic, nontherapeutic,
nonimmunogenic stabilizers, excipients and the like. The
compositions can also include additional substances to approximate
physiological conditions, such as pH adjusting and buffering
agents, toxicity adjusting agents, wetting agents and detergents.
The composition can also include any of a variety of stabilizing
agents, such as an antioxidant for example.
[0085] Further guidance regarding formulations that are suitable
for various types of administration can be found in Remington's
Pharmaceutical Sciences, Mace Publishing Company, Philadelphia,
Pa., 17th ed. (1985). For a brief review of methods for drug
delivery, see, Langer, Science 249:1527-1533 (1990).
[0086] Toxicity and therapeutic efficacy of the active ingredient
can be determined according to standard pharmaceutical procedures
in cell cultures and/or experimental animals, including, for
example, determining the LD50 (the dose lethal to 50% of the
population, or for the methods of the invention, may alternatively
by the kindling dose) and the ED50 (the dose therapeutically
effective in 50% of the population). The dose ratio between toxic
and therapeutic effects is the therapeutic index and it can be
expressed as the ratio LD50/ED50 Compounds that exhibit large
therapeutic indices are preferred.
[0087] The data obtained from cell culture and/or animal studies
can be used in formulating a range of dosages for humans. The
dosage of the active ingredient typically lines within a range of
circulating concentrations that include the ED50 with low toxicity.
The dosage can vary within this range depending upon the dosage
form employed and the route of administration utilized.
[0088] The pharmaceutical compositions described herein can be
administered in a variety of different ways. Examples include
administering a composition containing a pharmaceutically
acceptable carrier via oral, intranasal, rectal, topical,
intraperitoneal, intravenous, intramuscular, subcutaneous,
subdermal, transdermal, intrathecal, and intracranial methods.
[0089] For oral administration, the active ingredient can be
administered in solid dosage forms, such as capsules, tablets, and
powders, or in liquid dosage forms, such as elixirs, syrups, and
suspensions. The active component(s) can be encapsulated in gelatin
capsules together with inactive ingredients and powdered carriers,
such as glucose, lactose, sucrose, mannitol, starch, cellulose or
cellulose derivatives, magnesium stearate, stearic acid, sodium
saccharin, talcum, magnesium carbonate. Examples of additional
inactive ingredients that may be added to provide desirable color,
taste, stability, buffering capacity, dispersion or other known
desirable features are red iron oxide, silica gel, sodium lauryl
sulfate, titanium dioxide, and edible white ink. Similar diluents
can be used to make compressed tablets. Both tablets and capsules
can be manufactured as sustained release products to provide for
continuous release of medication over a period of hours. Compressed
tablets can be sugar coated or film coated to mask any unpleasant
taste and protect the tablet from the atmosphere, or enteric-coated
for selective disintegration in the gastrointestinal tract. Liquid
dosage forms for oral administration can contain coloring and
flavoring to increase patient acceptance.
[0090] Formulations suitable for parenteral administration include
aqueous and non-aqueous, isotonic sterile injection solutions,
which can contain antioxidants, buffers, bacteriostats, and solutes
that render the formulation isotonic with the blood of the intended
recipient, and aqueous and non-aqueous sterile suspensions that can
include suspending agents, solubilizers, thickening agents,
stabilizers, and preservatives.
[0091] The components used to formulate the pharmaceutical
compositions are preferably of high purity and are substantially
free of potentially harmful contaminants (e.g., at least National
Food (NF) grade, generally at least analytical grade, and more
typically at least pharmaceutical grade). Moreover, compositions
intended for in vivo use are usually sterile. To the extent that a
given compound must be synthesized prior to use, the resulting
product is typically substantially free of any potentially toxic
agents, particularly any endotoxins, which may be present during
the synthesis or purification process. Compositions for parental
administration are also sterile, substantially isotonic and made
under GMP conditions.
[0092] The compositions of the invention may be administered using
any medically appropriate procedure, e.g. intravascular
(intravenous, intraarterial, intracapillary) administration,
injection into the cerebrospinal fluid, intracavity or direct
injection in the brain. Intrathecal administration maybe carried
out through the use of an Ommaya reservoir, in accordance with
known techniques. (F. Balis et al., Am J. Pediatr. Hematol. Oncol.
11, 74, 76 (1989).
[0093] The effective amount of a therapeutic composition to be
given to a particular patient will depend on a variety of factors,
several of which will be different from patient to patient. A
competent clinician will be able to determine an effective amount
of a therapeutic agent to administer to a patient. Dosage of the
agent will depend on the treatment, route of administration, the
nature of the therapeutics, sensitivity of the patient to the
therapeutics, etc. Utilizing LD50 animal data, and other
information, a clinician can determine the maximum safe dose for an
individual, depending on the route of administration. Utilizing
ordinary skill, the competent clinician will be able to optimize
the dosage of a particular therapeutic composition in the course of
routine clinical trials. The compositions can be administered to
the subject in a series of more than one administration. For
therapeutic compositions, regular periodic administration will
sometimes be required, or may be desirable. Therapeutic regimens
will vary with the agent.
[0094] The invention also provides a pharmaceutical pack or kit
comprising one or more containers filled with one or more of the
ingredients of the pharmaceutical compositions of the invention.
Associated with such container(s) can be a notice in the form
prescribed by a governmental agency regulating the manufacture, use
or sale of pharmaceuticals or biological products, which notice
reflects approval by the agency of manufacture, use or sale for
human administration.
[0095] In another aspect of the invention, candidate agents are
screened for the ability to improve cognitive impairment. Such
compound screening may be performed using an in vitro model, a
genetically altered cell or animal, or purified protein,
particularly the human GABA.sub.A receptor or cells expressing such
a receptor. A wide variety of assays may be used for this purpose.
In one embodiment, compounds that are active in binding assays with
the channel proteins, or are predicted to be antagonists of the
receptor are then tested in an in vitro culture system.
Alternatively, candidate agents are tested for GABA.sub.A chloride
ionophore blocking activity, and may then be assessed in animal
models for treatment of cognitive impairment. Drug testing may
further assess the activity of a compound in kindling seizures or
convulsions, where a compound with a broad dosage difference
between the desired and undesired activity may be selected.
[0096] For example, candidate agents may be identified by known
pharmacology, by structure analysis, by rational drug design using
computer based modeling, by binding assays, and the like. Such
candidate compounds are used to contact cells in an environment
permissive GABA.sub.A channel function. Such compounds may be
further tested in an in vivo model for improvement of cognitive
impairment.
[0097] The term "agent" as used herein describes any molecule, e.g.
protein or pharmaceutical, with the capability of modulating
cognitive impairment by acting through neuronal inhibitory
pathways. Candidate agents encompass numerous chemical classes,
though typically they are organic molecules, preferably small
organic compounds having a molecular weight of more than 50 and
less than about 2,500 daltons. Candidate agents comprise functional
groups necessary for structural interaction with proteins,
particularly hydrogen bonding, and typically include at least an
amine, carbonyl, hydroxyl or carboxyl group, preferably at least
two of the functional chemical groups. The candidate agents often
comprise cyclical carbon or heterocyclic structures and/or aromatic
or polyaromatic structures substituted with one or more of the
above functional groups. Candidate agents are also found among
biomolecules including peptides, saccharides, fatty acids,
steroids, purines, pyrimidines, derivatives, structural analogs or
combinations thereof. Generally a plurality of assay mixtures are
run in parallel with different agent concentrations to obtain a
differential response to the various concentrations. Typically one
of these concentrations serves as a negative control, i.e. at zero
concentration or below the level of detection.
[0098] Candidate agents are obtained from a wide variety of sources
including libraries of synthetic or natural compounds. For example,
numerous means are available for random and directed synthesis of a
wide variety of organic compounds and biomolecules, including
expression of randomized oligonucleotides and oligopeptides.
Alternatively, libraries of natural compounds in the form of
bacterial, fungal, plant and animal extracts are available or
readily produced. Additionally, natural or synthetically produced
libraries and compounds are readily modified through conventional
chemical, physical and biochemical means, and may be used to
produce combinatorial libraries. Known pharmacological agents may
be subjected to directed or random chemical modifications, such as
acylation, alkylation, esterification, amidification, etc. to
produce structural analogs. Test agents can be obtained from
libraries, such as natural product libraries or combinatorial
libraries, for example.
[0099] Libraries of candidate compounds can also be prepared by
rational design. (See generally, Cho et al., Pac. Symp. Biocompat.
305-16, 1998); Sun et al., J. Comput. Aided Mol. Des. 12:597-604,
1998); each incorporated herein by reference in their entirety).
For example, libraries of GABA.sub.A inhibitors can be prepared by
syntheses of combinatorial chemical libraries (see generally DeWitt
et al., Proc. Nat. Acad. Sci. USA 90:6909-13, 1993; International
Patent Publication WO 94/08051; Baum, Chem. & Eng. News,
72:20-25, 1994; Burbaum et al., Proc. Nat. Acad. ScL USA
92:6027-31, 1995; Baldwin et al., J. Am. Chem. Soc. 117:5588-89,
1995; Nestler et al., J. Org. Chem. 59:4723-24, 1994; Borehardt et
al., J. Am. Chem. Soc. 116:373-74, 1994; Ohlmeyer et al., Proc.
Nat. Acad. ScL USA 90:10922-26, all of which are incorporated by
reference herein in their entirety.)
[0100] A "combinatorial library" is a collection of compounds in
which the compounds comprising the collection are composed of one
or more types of subunits. Methods of making combinatorial
libraries are known in the art, and include the following: U.S.
Pat. Nos. 5,958,792; 5,807,683; 6,004,617; 6,077,954; which are
incorporated by reference herein. The subunits can be selected from
natural or unnatural moieties. The compounds of the combinatorial
library differ in one or more ways with respect to the number,
order, type or types of modifications made to one or more of the
subunits comprising the compounds. Alternatively, a combinatorial
library may refer to a collection of "core molecules" which vary as
to the number, type or position of R groups they contain and/or the
identity of molecules composing the core molecule. The collection
of compounds is generated in a systematic way. Any method of
systematically generating a collection of compounds differing from
each other in one or more of the ways set forth above is a
combinatorial library.
[0101] A combinatorial library can be synthesized on a solid
support from one or more solid phase-bound resin starting
materials. The library can contain five (5) or more, preferably ten
(10) or more, organic molecules that are different from each other.
Each of the different molecules is present in a detectable amount.
The actual amounts of each different molecule needed so that its
presence can be determined can vary due to the actual procedures
used and can change as the technologies for isolation, detection
and analysis advance. When the molecules are present in
substantially equal molar amounts, an amount of 100 picomoles or
more can be detected. Preferred libraries comprise substantially
equal molar amounts of each desired reaction product and do not
include relatively large or small amounts of any given molecules so
that the presence of such molecules dominates or is completely
suppressed in any assay.
[0102] Combinatorial libraries are generally prepared by
derivatizing a starting compound onto a solid-phase support (such
as a bead). In general, the solid support has a commercially
available resin attached, such as a Rink or Merrifield Resin. After
attachment of the starting compound, substituents are attached to
the starting compound. Substituents are added to the starting
compound, and can be varied by providing a mixture of reactants
comprising the substituents. Examples of suitable substituents
include, but are not limited to, hydrocarbon substituents, e.g.
aliphatic, alicyclic substituents, aromatic, aliphatic and
alicyclic-substituted aromatic nuclei, and the like, as well as
cyclic substituents; substituted hydrocarbon substituents, that is,
those substituents containing nonhydrocarbon radicals which do not
alter the predominantly hydrocarbon substituent (e.g., halo
(especially chloro and fluoro), alkoxy, mercapto, alkylmercapto,
nitro, nitroso, sulfoxy, and the like); and hetero substituents,
that is, substituents which, while having predominantly hydrocarbyl
character, contain other than carbon atoms. Suitable heteroatoms
include, for example, sulfur, oxygen, nitrogen, and such
substituents as pyridyl, furanyl, thiophenyl, imidazolyl, and the
like. Heteroatoms, and typically no more than one, can be present
for each carbon atom in the hydrocarbon-based substituents.
Alternatively, there can be no such radicals or heteroatoms in the
hydrocarbon-based substituent and, therefore, the substituent can
be purely hydrocarbon.
[0103] Compounds that are initially identified by any screening
methods can be further tested to validate the apparent activity.
The basic format of such methods involves administering a lead
compound identified during an initial screen to an animal that
serves as a model for humans and then determining the effects on
cognitive impairment. The animal models utilized in validation
studies generally are mammals. Specific examples of suitable
animals include, but are not limited to, primates, mice, and
rats.
[0104] Those of skill will readily appreciate that dose levels can
vary as a function of the specific compound, the severity of the
symptoms and the susceptibility of the subject to side effects.
Preferred dosages for a given compound are readily determinable by
those of skill in the art by a variety of means.
[0105] The following examples are offered by way of illustration
and not by way of limitation.
EXPERIMENTAL
[0106] Investigation of CNS abnormalities and cognitive dysfunction
in DS has been greatly facilitated by the development of a
segmentally trisomic mouse model of DS: Ts65Dn. Ts65Dn mice are
trisomic for segments of mouse chromosome 16 (Mmu 16) highly
homologous to the long arm of hC21, including portions of the
so-called DS "critical region." Ts65Dn orthologues of hC21 include
APP and GRIK1, and extend along the length of Mmu16 to genes
encoding myxovirus resistance-2 (Mx2) and zinc finger protein 295
(znf295; approximately 17 Mb of DNA containing 108 of the 225 genes
catalogued to hC21). Phenotypically, Ts65Dn mice faithfully
recapitulate some of the most salient and fundamental features of
DS. The topography of craniofacial maldevelopment in Ts65Dn mirrors
that observed in DS patients, with concomitant changes seen at the
level of individual bones of the craniofacial skeleton. Likewise,
Ts65Dn mice exhibit similar patterns of cerebellar atrophy during
early postnatal development, a function of reduced granule cell
density in the internal granule layer (IGL) of the cerebellum. The
utility of Ts65Dn as a mouse model of DS is strengthened further by
findings that detail nearly comprehensive deficits in Ts65Dn short-
and long-term spatial memory, working memory, and reference memory,
and is punctuated by findings detailing the age-related atrophy of
basal forebrain cholinergic groups (BFCNs) in Ts65Dn mouse brain
(first evident at 6 months of age), a characteristic of both human
DS and human Alzheimer's disease (AD).
[0107] In the past decade, a handful of studies have
ultrastructurally described, and functionally assessed synaptic
connections in the brain of a mouse model of DS, Ts65Dn.
Quantitative electron microscopy (EM) of Ts65Dn CNS has revealed a
loss of asymmetric, excitatory synapses in Ts65Dn cortex relative
to WT tissue, with a concurrent sparing of symmetric, inhibitory
synapses. Reductions in the density of excitatory synapses, and in
the ratio of excitatory-to-inhibitory signaling in the Ts65Dn
brain, have been noted alongside compensatory increases in the
synaptic apposition lengths of asymmetric and symmetric synaptic
junctions. There may be a rearrangement of GABAergic inhibitory
connections onto principal excitatory neurons that would hinder
excitatory drive, demonstrating more conspicuous GABAergic
innervation of dendritic spines in the Ts65Dn brain.
Electrophysiologically, isolated Ts65Dn hippocampus has been shown
to exhibit reduced induction and maintenance of LTP after delivery
of an LTP-eliciting tetanus, decreased PPF in the perforant path,
and dramatically enhanced LTD, all functional manifestations of
poor circuit activity. Circulating levels of frontal cortical BDNF,
a neurotrophic agent released in an activity-dependent manner,
correlate directly with Ts65Dn performance in the radial-arm maze
task.
[0108] See, for example, Olson et al., Down syndrome mouse models
Ts65Dn, Ts1Cje, and Ms1CjefTs65Dn exhibit variable severity of
cerebellar phenotypes. Developmental Dynamics, 230: 581-589 (2004).
Escorihuela et al., Impaired short- and long-term memory in Ts65Dn
mice, a model for Down syndrome. Neuroscience Letters, 247: 171-174
(1998). Demas et al., Spatial memory deficits in segmental trisomic
Ts65Dn mice. Behavioral Brain Research, 82: 85-92 (1996). Holtzman
et al., Developmental abnormalities and age-related
neurodegeneration in a mouse model of Down syndrome. Proceedings of
the National Academy of Science USA, 93: 13,333-13,338 (1996). Hyde
and Crnic, Age-related deficits in context discrimination learning
in Ts65Dn mice that model Down's syndrome and Alzheimer's disease.
Behavioral Neuroscience, 115: 1239-1246 (2001). Hyde et al., Ts65Dn
mice, a model for Down syndrome, have deficits in context
discrimination learning suggesting impaired hippocampal function.
Behavioural Brain Research, 118: 53-60 (2001). Bimonte-Nelson et
al., Frontal cortex BDNF levels correlate with working memory in an
animal model of Down syndrome. Behavioural Brain Research, 139:
47-57 (2003). Hunter et al., Behavioral comparison of 4 and 6
month-old Ts65Dn mice: Age-related impairments in working and
reference memory. Behavioural Brain Research, 138: 121-131 (2003).
Wenger et al. Operant conditioning in the Ts65Dn mouse: Learning.
Behavior Genetics, 34: 105-119 (2004). Kurt et al., Synaptic
deficit in the temporal cortex of partial trisomy 16 Ts65Dn mice.
Brain Research, 858: 191-197 (2000). Siarey et al., Altered
long-term potentiation in the young and old Ts65Dn mouse, a model
for Down syndrome. Neuropharmacology, 36: 1549-1554 (1997). Siarey
et al. Increased synaptic depression in the Ts65Dn mouse, a model
for mental retardation in Down syndrome. Neuropharmacology, 38:
1917-1920 (1999).
[0109] The relative balance of excitation and inhibition in the
brain, mediated respectively by the amino acid neurotransmitters
glutamate and GABA, governs the assembly of neural circuits
throughout development and the ability of the mature brain to
undergo plastic responses thought to underlie adult learning and
memory. Recent neuroanatomical and electrophysiological findings
from a mouse model of Down syndrome (DS), Ts65Dn, suggest that
cognitive impairment in the disorder arises from an offset of this
critical balance, tilting decisively in favor of inhibition. Due to
the tight convergence between structural and electrophysiological
data suggesting excessive GABAergic inhibition in the Ts65Dn brain,
we put together a program of study to assess the relationship
between this overinhibition and learning deficits in Ts65Dn
mice.
[0110] The results provided below indicate that increased GABAergic
signaling does play a pivotal role in Ts65Dn learning deficits.
Administration of picrotoxin (PTX) i.p., aquintessential
non-competitive antagonist of the GABA.sub.A receptor that blocks
chloride ionophore conductance, normalizes learning of Ts65Dn mice
in an object recognition task when delivered chronically on a daily
regiment, but not with acute application. Likewise, this
improvement in Ts65Dn cognition is persistent, as PTX-treated
animals maintain normal object recognition memory for at least 2
weeks post-treatment.
[0111] Subsequently the generality of this phenomenon was
determined, and it was found that other compounds also thought to
act as GABA.sub.A chloride ionophore blockers rescue Ts65Dn
learning deficits in the object recognition task. The most
clinically relevant of these, Metrazol, was administered via
voluntary oral feeding in mice to mimic the most typical route of
drug delivery in humans, and like PTX, was found to have longevity
in its effects for weeks after treatment. Further data indicate
that the effects of GABA-A antagonists in Ts65Dn mice are
restricted to particular functionalities. Whereas PTX is able to
recover Ts65Dn declarative memory in the object recognition test, a
rodent cognitive task that requires the integrity of higher-order
brain areas in the cortex and hippocampus, the drug does not
influence Ts65Dn motor learning in an accelerating rotorod test, a
task that requires the integrity of the cerebellum.
[0112] These results demonstrate that mental retardation in DS can
be amenable to pharmacological treatment, with compounds that have
had a history of clinical use. It is believed that chronic,
repetitive exposure to low doses of GABA.sub.A chloride ionophore
blockers is causing semi-permanent circuit rewiring that allows for
greater circuit efficacy in higher order brain areas, and better
learning and memory. This interpretation is in agreement with data
showing that acute exposure to these same drugs does not lead to
reliable improvements in Ts65Dn memory, and that Ts65Dn cognitive
improvement during chronic drug administration is subsequently
maintained after the cessation of drug treatment. It is further
bolstered by data in normal rodents, where chronic, yet
circumscribed, regiments of GABA antagonists are also able to exert
beneficial effects on cognition that outlive the timing of drug
application. In the context of clinical research, these finings
translate into drug regimens that can begin in children with DS at
early adolescence, extending into early adulthood, and that would
be monitored via modern neuropsychological testing and non-invasive
functional imaging.
Methods and Results
[0113] The object recognition task, a behavioral assay not
requiring explicit rule learning or prolonged training, is based on
the innate tendency of mice to differentially explore novel objects
over familiar ones. Animals are submitted to daily handling
sessions and are given an opportunity to habituate to a black
acrylic, boxed enclosure, where they are exposed to two different
objects during a 15-min training session. These objects are made
from various nonporous materials (ceramic, metal, glass, etc.), and
possess various color schemes. All are generally consistent in
height and volume, and are symmetrical on a horizontal plane. They
are set in two corners of the apparatus, positioned across from one
another along its diameter. Subsequently, a 15-min. testing session
is conducted 24 h after training. Here, the mice are presented with
the object they had explored the previous day, and a new item (the
objects being alternatively positioned in one corner or another in
a balanced fashion).
[0114] Memory is operationally defined as the proportion of time
animals spend investigating the novel object minus the proportion
spent investigating the familiar one (Discrimination Index,
DI=[Novel Object Exploration Time/Total Exploration Time-Familiar
Object Exploration Time/Total Exploration Time].times.100), where
exploration constitutes any investigative behavior (i.e., head
orientation, sniffing) or deliberate contact (i.e. rearing,
licking) that occurs with each object. Behavioral trials are
recorded by a tripod-mounted digital camera. Importantly, the
object recognition task can be used repeatedly to evaluate rodent
memory across time, and across various drug treatment regiments.
Mice are trained and tested once per week, each experimental
session separated by a 1-week interval, and are serially presented
with new sets of objects. In this scheme, each mouse is considered
a naive subject, and each week's performance is considered an
independent observation. Finally, all behavioral data are analyzed
by Student's unpaired t tests.
[0115] The object recognition test has been shown to reliably
distinguish drug-induced effects on memory in rodents. Moreover,
learning performance in the test is not confounded by task
aversiveness, a variable common in avoidance paradigms, in
food-motivated tasks, and in the Morris water maze (MWM). This is
critical when evaluating Ts65Dn mouse learning and memory, as
Ts65Dn mice are naturally more emotionally labile than WT mice, and
their performance in cognitive tests has been demonstrated to be
disproportionately influenced by stress. Additionally, rodent
execution of the object recognition task does not involve strenuous
or highly coordinated movement, a requirement that can also
potentially confound Ts65Dn performance in tests like the MWM, as
Ts65Dm mice exhibit abnormal gait dynamics. Thus, object
recognition is an appropriate rodent cognitive task to assess
Ts65Dn learning and memory deficits, and the mitigation of these
deficits with pharmacological treatment. Importantly, object
recognition is a test that can also be directly translated to
humans, as children with DS exhibit difficulties in a humanized
version of the task.
[0116] Shown in FIG. 1. Chronic Administration of PTX or BB Rescues
and Maintains Ts65Dn Object Recognition Memory. The present
experiment was carried out in a longitudinal, cross-over fashion,
submitting four cohorts of WT and Ts65Dn experiment al pairs to a
4-week testing schedule. (A) Here, WT and trisomic mice were
randomly assigned to groups receiving daily injections of saline or
PTX (1 mg/kg), and were submitted to two repetitions of object
recognition testing (Weeks 1-2). Note that untreated WT and Ts65Dn
pairs had been previously run in order to validate the 2-object
recognition test. As expected, untreated and saline-injected Ts65Dn
mice had lower DI scores than their WT counterparts (p<0.04 and
p<0.05, respectively; n=14-18 for each genotype in the untreated
or saline condition). However, Ts65Dn mice chronically administered
PTX performed cognitively at levels comparable to untreated WT mice
(p=0.50) and to WT mice receiving chronic saline (p=0.16) or PTX
(p=0.38; n=9-10 for each genotype treated with PTX). (B)
Subsequently, saline-injected WT and Ts65Dn mice were randomly
segregated into groups that would continue to receive daily saline
injections during the third and fourth repetitions of object
recognition testing, or into groups that would undergo daily
picrotoxin injections during the second testing period (Weeks 3-4).
WT and Ts65Dn mice that had been chronically administered PTX, now
received daily injections of saline. Not surprisingly, Ts65Dn mice
continuing to receive saline had significantly lower DI scores than
WT mice also continuing to receive saline (p<0.05; n=6 for each
genotype in this condition), than WT mice receiving PTX for the
first time (p<0.02), and lower scores than WT mice having been
kindled with PTX (p<0.10). Conversely, Ts65Dn mice undergoing
chronic PTX administration for the first time (n=8-9 for each
genotype in this condition), showed no significant differences from
WT mice continuing to receive saline (p=0.21), from WT mice also
newly submitted to the chronic PTX regiment (p=0.18), or to WT mice
having underwent kindling in weeks 1-2 (p=0.41). Interestingly,
kindled Ts65Dn mice (n=6-7 for each genotype having undergone
kindling and now receiving saline) exhibited similar object
recognition performance as WT mice in all treatment conditions
(p=0.23, p=0.20, and p=0.43, for comparisons with saline, PTX, and
kindled groups, respectively), and resembled Ts65Dn mice given
daily PTX for the first time (p=0.48). Finally, Ts65Dn mice
receiving bilobalide (BB) throughout the 4-week testing schedule
(30 daily i.p. injections total; n=14-18 for each genotype in this
treatment condition), resembled Ts65Dn mice receiving PTX. N values
reflect the number of observations (repetitions) per treatment. DI
values are expressed as mean.+-.SEM.
[0117] Shown in FIG. 2. Topography of VVT and Ts65Dn Object
Recognition Performance before and after Drug Treatment with PTX.
In FIG. 3. PTX and BB, Control Data: All mice in the object
recognition experiment were exposed to standardized sets of objects
presented serially each week in a uniform fashion. Note that VVT
and Ts65Dn mice showed nearly identical amounts of total object
exploration time during the object recognition training and testing
periods spread across the 4-week schedule of object recognition
testing, spending invariably 20-25% of their experimental sessions
investigating objects (FIG. 3A). Total object exploration was not
influenced by genotype or by treatment regiment (FIG. 3B).
Likewise, with the exception of Week 4, neither WT or Ts65Dn mice
exhibited an object bias during the four individual training
sessions conducted weekly across the 4-week testing schedule,
spending similar amounts of time with each familiar object
encountered during the training period (FIG. 3C). Notably, the
exploration bias in Week 4 occurred to the same degree in both WT
and Ts65Dn mice, suggesting similar mnemonic encoding during the
15-min training session. Values are expressed as mean.+-.SEM.
[0118] Shown in FIG. 4. Like PTX and BB, Metrazol improves Ts65Dn
memory in the object recognition task. WT and Ts65Dn mice were
handled, habituated, and tested as outlined in experiments with PTX
and BB. The animals were randomly assigned to groups receiving
daily servings of chocolate milk or Metrazol (3 mg/kg), and were
submitted to two repetitions of object recognition testing. For the
purposes of drug delivery, all mice were conditioned to drinking
chocolate milk in their home cages and then in cylindrical feeding
tubes for 4 days. Subsequent to this conditioning, they were placed
daily into the feeding tubes, and presented with small eppendorf
caps of milk or a milk-Metrazol cocktail. The milk solutions were
typically consumed within 10 min, after which the mice were
returned to their home cages. In the current experiment, two
cohorts of WT and Ts65Dn mice were submitted to a twoweek testing
schedule. Consistent with the PTX and BB experiments, Ts65Dn mice
receiving milk (n=18) exhibited impaired object recognition
performance relative to WT mice also receiving milk (n=18;
p<0.004) or WT mice receiving Metrazol (n=20; p<0.02).
However, Ts65Dn given daily servings of Metrazol (n=19) had DI
scores on par with those of WT mice given milk (p<0.16) or
Metrazol (p<0.47), and had scores that were significantly higher
than Ts65Dn mice administered milk alone (p<0.03). N values
reflect the number of observations (repetitions) per treatment. DI
values are expressed as mean.+-.SEM.
[0119] Shown in FIG. 5. MTZ, Control Data. Total object exploration
during the training and testing periods, was unaffected by genotype
or by milk-MTZ treatment (FIG. 5A). Exploration of individual
familiar objects during the training sessions, likewise, was
similar across all the treatment conditions, but for a slight
object bias in Week 2 (FIG. 5B). Values are expressed as
mean.+-.SEM.
[0120] Shown in FIG. 6. The Effects of Metrazol on Ts65Dn Cognitive
Behavior, like those of PTX, are Long-Lasting. One cohort of WT and
Ts65Dn mice, used to determine the effects of chronic Metrazol on
Ts65Dn object recognition performance, were submitted to a
spontaneous holeboard task approximately 1 month after the end of
Metrazol treatment and object recognition testing. Here, milk- and
drug-treated animals (now 5.0 months of age) were habituated to Med
Associates open field activity monitors (27.9 cm.times.27.9 cm)
(FIGS. 7b and 7c), and then evaluated for holeboard exploration
during a 7-min session. Please note that 2 rounds of holeboard
testing were conducted during the light phase of the light/dark
cycle, and were separated by a 1-week interval. As would be
predicted from results in the object recognition test, Ts65Dn mice
formerly given milk (n=10) exhibited decreased exploration
"efficiency," showing a greater number of head-dips into previously
explored holes, relative to WT mice also formerly given milk (n=6;
p<0.03) or WT mice that had been treated with Metrazol (n=12;
p<0.04). In contrast, Ts65Dn mice that had received Metrazol
(n=14) showed similar exploration efficiency (p>0.07 and
p<0.31, for comparisons with WT-milk and WT-Metrazol groups,
respectively). N values reflect the number of observations
(repetitions) per treatment. Values are expressed as
mean.+-.SEM.
[0121] Shown in FIG. 7. WT and Ts65Dn Locomotor Habituation during
the Light Cycle, and Indices of Mouse Habituation to the Med
Associates Activity Monitors. (A) One cohort of WT and Ts65Dn mice
(n=6 for each genotype), naive to drug treatment, was evaluated for
habituation to a novel cage environment during the light cycle.
Here, the number of central line crossings between the left half
and the right half of the cage, were tabulated over 1 h. Consistent
with previous literature, WT and Ts65Dn mice exhibited nearly
identical declines in locomotor activity over the 1-h evaluation
period. Values are expressed as mean.+-.SEM. (B) Milk-fed and
MTZ-treated WT and Ts65Dn mice, prior to holeboard testing (FIG.
6), exhibited similar indices of activity habituation to the Med
Associates automated open field across 4 staggered sessions (the
last 2 sessions separated by a--1 week interval), suggesting that
the increase in repeat hole entries exhibited by milk-fed Ts65Dn
mice was not a byproduct of general hyperactivity. Values are
expressed as mean.+-.SEM. (C) A closer look at Ts65Dn habituation
in the Med Associates automated open field reveals particular
similarities between milk- and MTZ-treated Ts65Dn mice, further
stipulating a cognitive component for the differences observed
between milk- and drug-treated, trisomic animals in the holeboard
task. Values are expressed as mean.+-.SEM. FIG. 8. Absolute Object
Novelty Preference among Vehicle- and Drug-Treated WT and Ts65Dn
Mice. FIG. 9. Object Recognition Validation: One-Object Based and
Two-Object Based Tasks.
[0122] Shown in FIG. 10. Chronic, but not Acute, Application of PTX
Restores Ts65Dn Object Recognition Memory in a One-Object Based
Task. In the current experiment, a cohort of WT and Ts65Dn mice
(n=6 for each genotype) was evaluated in the object recognition
task across 4 sequential weeks. In the first week, untreated WT
mice exhibited significantly higher DI scores than untreated Ts65Dn
mice (p<0.05), whose scores were not statistically different
from zero (p=0.31). In the second week, WT and Ts65Dn were randomly
assigned to control and drug treatment groups (n=3 for each
genotype/treatment group). Animals received an acute injection of
saline or picrotoxin (PTX; 1 mg/kg) immediately after object
recognition training, and the effects of these treatments were
evaluated 24-h later during object recognition testing. Here, WT
and Ts65Dn mice exhibited performances, on average, similar to
those in Week 1, suggesting that acute PTX is unable to improve
memory in WT mice and is unable to rescue memory deficits in Ts65Dn
mice. Subsequently, in preliminary work, we evaluated the ability
of chronic PTX administration to ameliorate Ts65Dn object
recognition performance in Weeks 3 and 4. Indeed, daily injections
of PTX (1 mg/kg) in Ts65Dn mice (n=6; 12 observations total),
beginning a day after Week 2 testing and conducted on object
recognition training days right after the training session, were
able to increase Ts65Dn performance to the level of WT mice
receiving daily injections of saline (n=6; 12 observations total).
Shown in FIG. 11. Acute PTX is Unable to Reliably Rescue Ts65Dn
Performance in a 2-Object Based Object Recognition Test. Shown in
FIG. 12. Motor Learning in WT and Ts65Dn Mice: Chronic PTX
Treatment does not influence Ts65Dn Rotorod Performance.
[0123] In summary, these data demonstrate that Picrotoxin, a
non-competitive GABAA receptor antagonist and chloride ionophore
blocker, normalizes object recognition memory in Ts65Dn mice at 3
month of age with chronic, but not acute, administration. Improved
Ts65Dn learning with PTX is maintained post drug treatment. Other
non-competitive GABAA antagonists that directly block chloride
conductance, namely Metrazol and Bilobalide, also restore Ts65Dn
object recognition performance with chronic application. Other
aspects of cognition, such as holeboard exploration efficiency, are
rescued and persevere in Ts65Dn mice after GABA antagonist
treatment with Metrazol. The effects of GABA antagonists on Ts65Dn
learning and memory are restricted to specific functionalities;
whereas they improve Ts65Dn object recognition and exploration
efficiency, they do not influence Ts65Dn motor learning.
Example 2
[0124] Mental retardation (MR) remains a prevalent form of
non-progressive cognitive impairment, affecting 2-3% of the
population in the industrialized world. Disorders involving MR,
though narrowly defined by an IQ<70 and by deficits in academic,
adaptive and interpersonal skills, are nonetheless spread over a
broad etiology resulting from both genetic and non-genetic causes.
The breadth and frequency of MR-related cognitive dysfunction is
alarming considering that pharmacological intervention is currently
non-existent. Historically, neuroscientists have probed the brain
in MR for clues to possible treatment strategies for MR-related
learning difficulties. In the case of Down syndrome, these
pioneering investigations have led to observations of neuronal cell
loss, stunted dendritic branching, and spine dysgenesis.
Interestingly, many of the histological features noted in the
brains of individuals with Down syndrome parallel phenotypes that
have been found in the brains of individuals with other classes of
MR, such as inborn errors of metabolism and non-genetic insults.
Connections among different X-linked forms of MR have also been
made, with disrupted synaptic structure, synaptic plasticity, and
Ras-MAPK signaling as emerging themes. Similarities across the wide
spectrum of MR-related disorders argue that common mechanisms
underlie the manifestation of learning and memory deficits in
intellectually handicapped children and young adults.
[0125] The data provided above indicate that MR is the byproduct of
long-term changes in neural excitability, driven by increases in
the contribution of inhibition to neural circuits, which is treated
by "therapeutic kindling".
[0126] Traditional forms of synaptic plasticity (i.e., long-term
potentiation and long-term depression) occur in the context of
stabilizing forces that allow a circuit to maintain a
physiologically relevant level of activity. That way, the circuit
does not spiral into excessive excitation or total quiescence.
These compensatory mechanisms, collectively referred to as
"homeostatic plasticity," occur over broad time scales, and then,
only in response to chronic excitation or inhibition of neuronal
networks.
[0127] Homeostatic plasticity is observed at virtually all levels
of hierarchical organization in the mammalian brain. At the
broadest level, chronic changes in central nervous system (CNS)
activity can directly modify the cellular composition of a neural
circuit, setting the ratio of inter-neurons to principal cells. It
can also reconfigure established circuits with a defined cellular
composition by manipulating the degree of connectivity between
inhibitory and excitatory elements in the circuit. Beyond these
alterations, homeostasis of neuronal activity may be achieved by
changes in the molecular composition and the morphology of
synapses. Molecular changes occurring at the synaptic level can
involve scaling responses of
a-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) and
N-methyl-D-aspartic acid (NMDA) receptors, their
membrane-associated guanylate kinase like (MAGUK) adaptors (i.e.,
PSD-95 and SAP102), and y-aminobutyric acid A (GABA.sub.A)
receptors. Alternatively, morphological change can occur with the
shape of postsynaptic dendritic spines.
[0128] The mammalian brain has been adapted with a comprehensive
set of mechanisms integrated at the circuit, single-cell, and
molecular level that functions to maintain a specific range of
neuronal activity. The drive to conserve activity in neuronal
networks, particularly in those that comprise the neocortex and
hippocampus, suggests that an inability to properly balance
excitation and inhibition would lead to neurological disorder and
cognitive impairment, and various forms of MR have been attributed
to the over-inhibition of neural circuits. Such a state is expected
to compromise the capacity of the circuit to undergo Hebbian forms
of associative plasticity (LTP, PPF) thought to underlie learning
and memory.
[0129] The term "kindling" refers to an animal model of
epileptogenesis, in which the periodic introduction of an initially
sub-convulsive electrical or chemical stimulus to the brain
progressively leads to electrographic and behavioral seizure
activity (Goddard (1967) Nature 214, 1020-1021). Once in this
state, animals show a permanent (lifetime) enhancement in their
sensitivity to stimulus-induced seizures, suggesting that the
synaptic responsiveness of the stimulated circuits undergoes an
augmentation that persists in the absence of further reinforcement
(McNamara et al. (1980) Prog. Neurobiol. 15, 139-159). The
long-lasting properties of kindling suggest that it is a model of
neural plasticity. In keeping with this suggestion, kindling via
repetitive site-specific electrical stimulation or repetitive
systemic administration of high doses of GABA.sub.A receptor
antagonists (typically pentylenetetrazole; PTZ, see Mason and
Cooper (1972) Epilepsia 13, 663-674), shares characteristics with
LTP (Malenka (2003) Nat. Rev. Neurosci. 4, 923-9267), the foremost
synaptic model of learning and memory. Each phenomenon is dependent
on NMDA receptor activation, protein synthesis, and on specific
patterns of stimulation for proper induction. Likewise, kindling
and LTP both demonstrate some degree of specificity. While the
effects of LTP are restricted to neural circuits that are directly
stimulated, the effects of kindling extend only along circuits that
are synaptically linked.
[0130] However, there are significant differences between kindling
and LTP. Whereas the functional consequence of LTP is the
incorporation of AMPA receptors at synaptic sites, that of kindling
seems to be the gross removal of GABAergic inhibition from
stimulated and adjoining circuits (Stelzer et a/. (1987) Nature
326, 698-701). Indeed, electrical stimulation, or chronic
administration of PTZ, has been continually shown to result in
decreased electrophysiological or biochemical indices of GABAergic
function.
[0131] The close correspondence between kindling and epilepsy in
animals has created the perception that kindling is pathological to
the CNS, despite the fact that the neuronal interactions that are
catalyzed in response to kindling are presumed to be available to
the normal brain.
[0132] The data provided in Example 1 demonstrates the use of low
doses of an agent that can cause kindling, i.e. "therapeutic
kindling" doses, to treat an animal model for DS. It is shown that
chronic (but not acute) once a day drug administration in Ts65Dn
mice was able to normalize cognitive performance in the novel
object recognition and spontaneous alteration tasks, and to rescue
hippocampal LTP (see also Fernandez et al. (2007) Nat. Neurosci.
10, 411-413, herein specifically incorporated by reference).
Importantly, PTZ led to a persistent, post-drug recovery of Ts65Dn
cognition and LTP lasting for several months, demonstrating that
the regimen induced long-term neuroadaptations in the
hippocampus.
[0133] The efficacy of therapeutic kindling in Ts65Dn DS mice
provides a process with widespread clinical utility. Traditionally,
MR disorders have been unresponsive to pharmacological
interventions, perpetuating the notion that they are
treatment-resistant vestiges of abnormal brain development. The
data on adult mice, however, indicates that this is not the case.
The findings also point to the possibility that mature, but faulty
circuits in MR, can be reopened from their present adult
configuration and rewired to increase synaptic plasticity. If so,
therapeutic kindling could be a frontline mechanism of adaptive
change that could overturn MR in affected individuals, restoring to
them a sense of self and improving their quality of life.
[0134] It is evident from the above results and discussion that
improved methods for treating cognitive impairment are provided.
The subject methods provide an effective means for improving
cognitive function, particularly in individuals suffering from
cognitive impairment disorders, e.g., Down syndrome, etc. As such,
the subject methods represent an important contribution to the
art.
[0135] All publications and patent applications cited in this
specification are herein incorporated by reference as if each
individual publication or patent application were specifically and
individually indicated to be incorporated by reference. The
citation of any publication is for its disclosure prior to the
filing date and should not be construed as an admission that the
present invention is not entitled to antedate such publication by
virtue of prior invention.
[0136] Although the foregoing invention has been described in some
detail by way of illustration and example for purposes of clarity
of understanding, it is readily apparent to those of ordinary skill
in the art in light of the teachings of this invention that certain
changes and modifications may be made thereto without departing
from the spirit or scope of the appended claims.
* * * * *