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A Mechanistic Rationale for PDE-4 Inhibitors to Treat Residual Cognitive Deficits in Acquired Brain Injury
- Source :
- Current Neuropharmacology
- Publication Year :
- 2020
- Publisher :
- Bentham Science Publishers Ltd., 2020.
-
Abstract
- Patients with acquired brain injury (ABI) suffer from cognitive deficits that interfere significantly with their daily lives. These deficits are long-lasting and no treatment options are available. A better understanding of the mechanistic basis for these cognitive deficits is needed to develop novel treatments. Intracellular cyclic adenosine monophosphate (cAMP) levels are decreased in ABI. Herein, we focus on augmentation of cAMP by PDE4 inhibitors and the potentially synergistic mechanisms in traumatic brain injury. A major acute pathophysiological event in ABI is the breakdown of the blood-brain-barrier (BBB). Intracellular cAMP pathways are involved in the subsequent emergence of edema, inflammation and hyperexcitability. We propose that PDE4 inhibitors such as roflumilast can improve cognition by modulation of the activity in the cAMPPhosphokinase A-Ras-related C3 botulinum toxin substrate (RAC1) inflammation pathway. In addition, PDE4 inhibitors can also directly enhance network plasticity and attenuate degenerative processes and cognitive dysfunction by increasing activity of the canonical cAMP/phosphokinase- A/cAMP Responsive Element Binding protein (cAMP/PKA/CREB) plasticity pathway. Doublecourtin and microtubule-associated protein 2 are generated following activation of the cAMP/PKA/CREB pathway and are decreased or even absent after injury. Both proteins are involved in neuronal plasticity and may consist of viable markers to track these processes. It is concluded that PDE4 inhibitors may consist of a novel class of drugs for the treatment of residual symptoms in ABI attenuating the pathophysiological consequences of a BBB breakdown by their anti-inflammatory actions via the cAMP/PKA/RAC1 pathway and by increasing synaptic plasticity via the cAMP/PKA/CREB pathway. Roflumilast improves cognition in young and elderly humans and would be an excellent candidate for a proof of concept study in ABI patients.
- Subjects :
- 0301 basic medicine
neuroinflammation
cell adhesion molecules
chemistry.chemical_compound
0302 clinical medicine
Brain Injuries, Traumatic
Cyclic AMP
Pharmacology (medical)
biology
traumatic brain injury
General Medicine
Psychiatry and Mental health
ISCHEMIC-STROKE
Neurology
Blood brain barrier
Blood-Brain Barrier
Encephalitis
SIGNALING PATHWAY
WHITE-MATTER
Signal Transduction
medicine.drug
CAMP Responsive Element Binding Protein
Traumatic brain injury
ROLIPRAM
CREB
03 medical and health sciences
Neuropharmacology
INFLAMMATION
PHOSPHODIESTERASE INHIBITORS
medicine
Animals
Humans
Cognitive Dysfunction
Cyclic adenosine monophosphate
Acquired brain injury
cyclic adenosine monophosphate
Neuroinflammation
Roflumilast
Pharmacology
business.industry
BARRIER
medicine.disease
CREB ACTIVATION
cytokines
Disease Models, Animal
030104 developmental biology
chemistry
Synaptic plasticity
biology.protein
Phosphodiesterase 4 Inhibitors
Neurology (clinical)
CAMP
VERBAL WORD MEMORY
business
Neuroscience
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 1570159X
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- Current Neuropharmacology
- Accession number :
- edsair.doi.dedup.....12f1d024342a0ed6cc1c4d96195813ca