NSAIDs and enantiomers of flurbiprofen target γ-secretase and lower Aβ 42 in vivo


BIBLIOGRAPHIC THERAPEUTIC AGENT ANIMAL MODEL EXPERIMENTAL DESIGN OUTCOMES

Bibliographic

Year of Publication:
2003
Contact PI Name:
Todd E. Golde
Contact PI Affiliation:
Department of Neuroscience, Mayo Clinic Jacksonville, Florida, USA
Co-Authors:
Jason L. Eriksen, Sarah A. Sagi, Tawnya E. Smith, Sascha Weggen, Pritam Das, D.C. McLendon, Victor V. Ozols, Kevin W. Jessing, Kenton H. Zavitz, Edward H. Koo
Primary Reference (PubMED ID):
Funding Source:
National Institute on Aging (NIA)
Mayo Foundation
John Douglas French Foundation
Study Goal and Principal Findings:

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been suggested for the potential treatment for a number of neurodegenerative diseases, such as Alzheimer's disease (AD). This idea is supported by epidemiological studies, which show that long -term use of some NSAIDS is associated with reduced incidence of AD. Some NSAIDs have been shown to be γ-secretase modulators; they influence production of the longer more amyloidogenic species of Aβ peptide. To further understand the effects of NSAIDs on Aβ production the authors, in this study, examined the activity of 20 of the most commonly used NSAIDs on Aβ42 levels in cultured H4 human glioma cells and in acute dosing studies in APP transgenic Tg2576 mice. Thirteen of the NSAIDs and the enantiomers of flurbiprofen were then tested in acute dosing studies in amyloid β protein precursor (APP) transgenic mice, and plasma and brain levels of Aβ and the drug were evaluated. These studies show that (a) eight FDA-approved NSAIDs lower Aβ42 in vivo, (b) the ability of an NSAID to lower Aβ42 levels in cell culture is highly predicative of its in vivo activity, (c) in vivo Aβ42 lowering in mice occurs at drug levels achievable in humans, and (d) there is a significant correlation between Aβ42 lowering and levels of ibuprofen. Importantly, flurbiprofen and its enantiomers selectively lower Aβ42 levels in broken cell γ-secretase assays, indicating that these compounds directly target the γ-secretase complex that generates Aβ from APP. Of the compounds tested, meclofenamic acid, racemic flurbiprofen, and the purified R and S enantiomers of flurbiprofen lowered Aβ42 levels to the greatest extent. Because R-flurbiprofen reduces Aβ42 levels by targeting γ-secretase and has reduced side effects related to inhibition of cyclooxygenase (COX), it is an excellent candidate for clinical testing as an Aβ42 lowering agent.

 A phase 2 trial of R-flurbiprofen was undertaken and found that patients with mild AD, but not moderate AD, had a dose-related slower rate of decline than those treated with placebo, and that the drug was well tolerated with few adverse effects. On the basis of these promising results, a large phase 3, randomized, placebo controlled trial of R-flurbiprofen (as known as tarenflurbil) was conducted in patients with mild AD. Disappointing results of the phase 3 trial showed no effect of R-flurbiprofen slowing cognitive decline or loss of activities of daily living in patients with mild AD nor did any secondary outcome measure or post hoc analysis favor the drug. 

Therapeutic Agent

Therapeutic Information:
Therapy Type:
Small Molecule
Therapeutic Agent:
R-Flurbiprofen/Tarenflurbil/MPC-7869
Therapeutic Target:
gamma Secretase
Therapy Type:
Small Molecule
Therapeutic Agent:
S-Flurbiprofen/Esflurbiprofen
Therapeutic Target:
Cyclooxygenase 1 (COX 1)
Therapeutic Target:
Cyclooxygenase 2 (COX 2)
Therapy Type:
Small Molecule
Therapeutic Agent:
Flurbiprofen
Therapeutic Target:
Cyclooxygenase 1 (COX 1)
Therapeutic Target:
Cyclooxygenase 2 (COX 2)
Therapy Type:
Small Molecule
Therapeutic Agent:
Ibuprofen
Therapeutic Target:
Cyclooxygenase 1 (COX 1)
Therapeutic Target:
Cyclooxygenase 2 (COX 2)
Therapy Type:
Small Molecule
Therapeutic Agent:
Indomethacin
Therapeutic Target:
Cyclooxygenase 1 (COX 1)
Therapeutic Target:
Cyclooxygenase 2 (COX 2)
Therapeutic Notes:
R-Flurbiprofen is the R-enantiomer of the NSAID Flurbiprofen. It is not a cyclooxygenase (COX 1/COX 2) inhibitor. R-Flurbiprofen has recently been shown to modulate gamma secretase and selectively lower levels of Aβ42 and amyloid pathology in vivo. R-Flurbiprofen also modulates NFκB signaling pathways.

Animal Model

Model Information:
Species:
Mouse
Model Type:
APP
Strain/Genetic Background:
Not Reported

Experimental Design

Is the following information reported in the study?:
Power/Sample Size Calculation
Randomized into Groups
Blinded for Treatment
Blinded for Outcome Measures
Pharmacokinetic Measures
Pharmacodynamic Measures
Toxicology Measures
ADME Measures
Biomarkers
Dose
Formulation
Route of Delivery
Duration of Treatment
Frequency of Administration
Age of Animal at the Beginning of Treatment
Age of Animal at the End of Treatment
Sex as a Biological Variable
Study Balanced for Sex as a Biological Variable
Number of Premature Deaths
Number of Excluded Animals
Statistical Plan
Genetic Background
Inclusion/Exclusion Criteria Included
Conflict of Interest

Outcomes

Outcome Measured
Outcome Parameters
Biochemical
Brain-beta Amyloid Peptide 38
Brain-beta Amyloid Peptide 40
Brain-beta Amyloid Peptide 42
gamma Secretase Activity
Plasma-beta Amyloid Peptide 40
Plasma-beta Amyloid Peptide 42
Biomarker
Plasma-beta Amyloid Peptide 40
Plasma-beta Amyloid Peptide 42
Pharmacokinetics
Drug Concentration-Brain
Drug Concentration-Plasma

Source URL: http://alzped.nia.nih.gov/nsaids-and-enantiomers