4.7 Article

Repurposing of Trimetazidine for amyotrophic lateral sclerosis: A study in SOD1(G93A) mice

Journal

BRITISH JOURNAL OF PHARMACOLOGY
Volume 179, Issue 8, Pages 1732-1752

Publisher

WILEY
DOI: 10.1111/bph.15738

Keywords

amyotrophic lateral sclerosis; hypermetabolism; mitochondria; neurodegeneration; SOD1(G93A) mice; Trimetazidine

Funding

  1. Agenzia di Ricerca per la Sclerosi Laterale Amiotrofica (AriSLA) through the HyperALS project
  2. AFM-Telethon project [2018, 21021]
  3. Ministero della Salute [RF2019-12369105]
  4. Ministero della Salute, Italy-United States of America [PGR01040]
  5. Australian National Health and Medical Research Council [1185427]
  6. FightMND: Mid-Career Research Fellowship
  7. Agenzia Spaziale Italiana [ASI_MARS-PRE 2019-11-Udine.0]
  8. Fondazione Umberto Veronesi: Grant 2021
  9. National Health and Medical Research Council of Australia [1185427] Funding Source: NHMRC

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The therapeutic potential of the multi-target drug trimetazidine was evaluated in SOD1(G93A) mice. The results showed that trimetazidine delayed disease progression, improved motor function and metabolism, and increased overall survival of the mice.
Background and Purpose Amyotrophic lateral sclerosis (ALS), a neurodegenerative disease characterized by the degeneration of upper and lower motor neurons, progressive wasting and paralysis of voluntary muscles and is currently incurable. Although considered to be a pure motor neuron disease, increasing evidence indicates that the sole protection of motor neurons by a single targeted drug is not sufficient to improve the pathological phenotype. We therefore evaluated the therapeutic potential of the multi-target drug used to treatment of coronary artery disease, trimetazidine, in SOD1(G93A) mice. Experimental Approach As a metabolic modulator, trimetazidine improves glucose metabolism. Furthermore, trimetazidine enhances mitochondrial metabolism and promotes nerve regeneration, exerting an anti-inflammatory and antioxidant effect. We orally treated SOD1(G93A) mice with trimetazidine, solubilized in drinking water at a dose of 20 mg kg(-1), from disease onset. We assessed the impact of trimetazidine on disease progression by studying metabolic parameters, grip strength and histological alterations in skeletal muscle, peripheral nerves and the spinal cord. Key Results Trimetazidine administration delays motor function decline, improves muscle performance and metabolism, and significantly extends overall survival of SOD1(G93A) mice (increased median survival of 16 days and 12.5 days for male and female respectively). Moreover, trimetazidine prevents the degeneration of neuromuscular junctions, attenuates motor neuron loss and reduces neuroinflammation in the spinal cord and in peripheral nerves. Conclusion and Implications In SOD1(G93A) mice, therapeutic effect of trimetazidine is underpinned by its action on mitochondrial function in skeletal muscle and spinal cord.

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