Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/205—Amine addition salts of organic acids; Inner quaternary ammonium salts, e.g. betaine, carnitine
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/24—Antidepressants

Definitions

• This invention relates to the treatment of depression, particularly geriatric subjects.
• FIGURE 1(a) is a graph showing the correlation of PME(s- ⁇ c ) levels from the prefrontal region with HDRS scores for both depressed patients (• subject #1; ⁇ subject #2);
• Figure 1(b) is a graph showing the correlation of PCr levels from the prefrontal region with HDRS scores for both depressed patients (• subject #1; ⁇ subject #2);
• the control values include mean + SD;
• the control values include mean + SD;
• Figure 3(a) is a graph showing the Z-scores of the two depressed subjects compared with controls at entry and 12 weeks for a) PME(s- ⁇ c ) metabolite levels for those regions with significant differences.
• the intensity of the color is scaled to the z-score (mean difference/SD) given on the scale below the image.
• Z-scores for PME(s- ⁇ c ) and PCR levels in the frontal region exceed 3.0 and 2.0, respectively;
• Figure 3(b) ) is a graph showing the Z-scores of the two depressed subjects compared with controls at entry and 12 weeks for a) PCr metabolite levels for those regions with significant differences.
• the intensity of the color is scaled to the z-score (mean difference/SD) given on the scale below the image.
• Z-scores for PME(s- ⁇ c ) and PCR levels in the frontal region exceed 2.0 and 2.0, respectively.
• carnitines or a pharmaceutically acceptable salt thereof for the preparation of a medicament or dietary supplement for the treatment of depression in a subject population, particularly geriatric subjects.
• the medicament comprising L-carnitine or an alkanoyl L-carnitine or one of its pharmacologically acceptable salts
• the alkanoyl L-carnitine is selected from the group consisting of acetyl L-carnitine (hereinafter abbreviated to ALC or ALCAR), propionyl L-carnitine (hereinafter abbreviated to PLC), butyryl L- carnitine, valeryl L-carnitine and isovaleryl L-carnitine, or one of their pharmacologically acceptable salts.
• ALC or ALCAR acetyl L-carnitine
• PLC propionyl L-carnitine
• PLC propionyl L-carnitine
• butyryl L- carnitine valeryl L-carnitine
• valeryl L-carnitine and isovaleryl L-carnitine or one of their pharmacologically acceptable salts.
• the ones preferred are acetyl L- carn
• a pharmacologically acceptable salt of L-carnitine or of an alkanoyl L-carnitine is any salt of the latter with an acid that does not give rise to toxic or side effects.
• Examples of pharmacologically acceptable salts of L-carnitine or of the alkanoyl L-carnitines are chloride; bromide; iodide; aspartate; acid aspartate; citrate; acid citrate; tartrate; acid tartrate; phosphate; acid phosphate; fumarate; acid fumarate; glycerophosphate; glucose phosphate; lactate; maleate; acid maleate; mucate; orotate, oxalate; acid oxalate; sulphate; acid sulphate; trichloroacetate; trifluoroacetate; methane sulphonate; pamoate and acid pamoate.
• a geriatric subject is a subject at 65 or older.
• One preferred form of daily dosing of L-carnitine or alkanoyl L-carnitine for clinical use is a composition comprising an amount of L-carnitine or an alkanoyl L-carnitine, preferably acetyl or propionyl L-carnitine, equivalent to 0.1 to 3 g, and preferably 0.5 to 3 g per day.
• the carnitine is acetyl L-carnitine.
• Phosphorus magnetic resonance spectroscopic imaging ( 31 P MRSI) analysis of two depressed elderly subjects treated with ALCAR for 12 weeks are compared with those of six normal non-demented, non- depressed subjects.
• the two elderly depressed subjects completed baseline Structural Clinical Interview of DSM-IV (SCID) I/P version 2.0, HDRS (17 item), MMSE, UKU Side Effect Rating Scale (UKU), and Cumulative Illness Rating Scale (CIRS) to assess medical burden, baseline physical, ECG, and, laboratory tests for hematology, urine analysis, immunopathology, and blood chemistry.
• SCID Structural Clinical Interview of DSM-IV
• HDRS 17 item
• MMSE UKU Side Effect Rating Scale
• UNU Cumulative Illness Rating Scale
• CIRS Cumulative Illness Rating Scale
• Acetyl-L-carnitine was administered in the form of oral tablets containing 590 mg of acetyl-L-carnitine hydrochloride (500 g acetyl-L-carnitine). The dosage regimen was fixed at three grams of acetyl-L-carnitine given two tablets three times a day for 12 weeks.
• 31 P MRSI acquisition - A custom built, doubly tuned transmit/receive volume head coil was used to acquire the ⁇ MRI and 2D 31 P MRSI data on a GE Signa 1.5 T whole body MR i ager. First, sets of axial and sagittal scout MR images were collected. The 30 mm thick MRSI slice was positioned parallel with the anterior commisure-posterior commisure line to include the right and left prefrontal, basal ganglia, superior temporal, inferior parietal, occipital, and centrum semiovale regions.
• 31 P MRSI 360 mm field of view, 30 mm slice thickness, 8x8 phase encoding steps [45x45x30 mm 3 nominal voxel dimensions], 2s TR, 1024 data points, 4.0 kHz spectral bandwidth and 16 NEX).
• the 8x8 31 P grid was shifted with respect to the anatomical MRI and a mild spatial apodization (i.e., Fermi window with 90% diameter and 5% transition width) was applied prior to the inverse Fourier transform. The remaining processing steps were 100% automated.
• the PME(s- ⁇ c ) i.e., phosphoethanolamine, phosphocholine, and inositol-1-phosphate
• the PME(s- ⁇ c ) are predominantly building blocks of phospholipids and therefore, the relative concentrations of these metabolites are a measure of the active synthesis of membranes;
• the PDE(s- ⁇ c ) i.e., glycerophosphocholine and glycerophosphoethanolamine
• the FIDs were modeled a second time but with omitting the first 0.75 ms of the FID and then taking the difference between the PME and PDE amplitudes of the two modeled results.
• PME(J-V) moieties include less mobile molecules such as phosphorylated proteins and PMEs that are tightly coupled (in terms of MRS) to macromolecules [i.e., PMEs inserting into membrane phospholipids.
• PDE(i-V) moieties include less mobile PDEs that are part of small membrane phospholipid structures such as micelles, synaptic vesicles, and transport/secretory vesicles and PDE moieties coupled to larger molecular structures (i.e., PDEs inserting into membrane phospholipid structures.
• the right/left side effect was eliminated by averaging the signal from the two voxels, prior to fitting (which included correcting for phase and resonance frequency). Additionally, metabolite levels are expressed as a mole % relative to the total 31 P signal.
• the statistical analysis was done using the Statview (SAS Institute, Inc.) software package.
• the pearson t correlation test used to correlate between variables.
• the two elderly depressed subjects were diagnosed with MDD according to DSM-IN criteria. No previous antidepressant medications were taken by the subjects in the three months prior to the study.
• Subject #1 has baseline, 6 and 12 week HDRS scores of 15, 1 and 0 and subject #2 had scores of 20, 17, and 3, respectively.
• both depressed subjects were clinically improved at endpoint, fulfilling criteria for remission (HDRS ⁇ 8).
• Medical conditions diagnosed in the depressed subjects included s/p knee arthroscopy, s/p cervical disk removal, hearing loss and benign prostatic hypertrophy in subject #1 and benign prostatic hypertrophy in subject #2. No clinically significant abnormalities were found in the laboratory exams and EKG of either depressed subject.
• Figure 2 illustrates the prefrontal and basal ganglia PCr and PME(s- ⁇ c ) levels at baseline, 6 and 12 weeks for the two depressed subjects and the mean PCr and PME(s- ⁇ c ) levels for the six normal controls.
• Baseline prefrontal PME(s- ⁇ c ) levels in the depressed subjects were 1.5 to 2.0 SD higher than the mean of the controls and this increase was normalized with ALCAR treatment. Both depressed subjects had prefrontal PCr levels one SD higher than the mean of controls and ALCAR treatment further increased PCr levels by 27% and 31%, respectively.
• the PME(s- ⁇ c ) resonance is predominantly composed of phosphocholine, phosphoethanolamine and inositol-1 -phosphate which are precursors in membrane phospholipid metabolism.
• the increased PME(s- ⁇ c ) in depression, as also observed by others is not fully understood and will require further study.
• ALCAR treatment seems to restore PME(s- ⁇ c ) levels to normal and there was a trend for the decreasing PME levels to correlate with clinical improvement.
• twelve weeks of ALCAR treatment also elevated PCr, a high-energy phosphate metabolite which is an immediate precursor of ATP.

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• 2003
  • 2003-01-23 JP JP2003565465A patent/JP2005523269A/ja active Pending
  • 2003-01-23 WO PCT/IT2003/000023 patent/WO2003066041A1/en not_active Ceased
  • 2003-01-23 AU AU2003219511A patent/AU2003219511A1/en not_active Abandoned
  • 2003-01-23 MX MXPA04007506A patent/MXPA04007506A/es unknown
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  • 2003-01-23 CA CA002469925A patent/CA2469925A1/en not_active Abandoned
  • 2003-01-23 EP EP03715324A patent/EP1471904A1/en not_active Withdrawn
  • 2003-01-23 KR KR10-2004-7009147A patent/KR20040083471A/ko not_active Ceased
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  • 2003-02-07 US US10/359,560 patent/US20040009926A1/en not_active Abandoned

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