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
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
  • A61K31/4025—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil not condensed and containing further heterocyclic rings, e.g. cromakalim
• • 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
• • 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
  • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia

Definitions

• the invention relates to the treatment of diseases or conditions associated with central or peripheral nervous system demyelination in human subject.
• the invention relates to a causal therapy of multiple sclerosis (MS).
• MS Multiple Sclerosis
• MS is an autoimmune disease which occurs when T lymphocytes invade the CNS and damage the oligodendrocytes responsible for the maintenance of axonal myelin sheaths, resulting in impaired neuronal activity.
• the disease is characterised symptomatically by varying degrees of visual, motor, sensory and cognitive dysfunction.
• MS is broadly classified into four categories, defined by the progress pattern of the disease (Lublin and Reingold, 1996). For most patients, the disease begins as relapsing-remitting MS, characterised by periods of spontaneous remission between symptomatic relapses. This often progresses to a form where remissions cease, resulting in continuous neurological decline, a type classified as secondary progressive MS.
• progressive-relapsing MS is the rarest subtype, and is characterised by a steady increase in severity of the neurological impairments, with superimposed acute attacks of greater severity.
• NEFIRACETAM N-(2,6-dimethylphenyl)-2-(2-oxo-l-pyrrolidinyl)acetamide
• NEFIRACETAM N-(2,6-dimethylphenyl)-2-(2-oxo-l-pyrrolidinyl)acetamide
• the invention is based on the surprising finding that 2-oxopyrrolidine compounds (hereafter "Active”) are capable of maintaining the integrity (for example, preventing deymelination and/or promoting remyelination) of axonal myelin sheaths in cell and animal models of diseases associated with CNS or PNS demyelination.
• Active 2-oxopyrrolidine compounds
• Data is provided below which clearly shows that the Active accelerates myelin repair in axonal cells that have been damaged in a cuprizone animal model of demyelination, and restores myelin expression following 6 days of treatment (See Figs. 4A to 4C).
• Data is also provided which shows the effects of the Active is a non-immune mediated effect (See Figs.
• the invention broadly relates to the use of the Active in the causal treatment of a disease caused by axonal demyelination, in which the Active maintains the integrity of myelination (for example by promoting remyelination, and/or preventing demyelination, of the axonal sheaths).
• the invention is particularly directed to the causal treatment of CNS demyelination diseases, for example MS, especially primary progressive MS and/or relapse remitting MS, and PNS demyelination diseases, for example Charcot-Marie-Tooth Disease.
• the Active of the invention may be suitably administered when a patient is in relapse (i.e. upon relapse), and be continued while the patient is in relapse, with a view to attenuating the severity of the relapse, and/or accelerating disease remission.
• the Active may be administered continuously with a view to prolonging the remission period, and/or attenuating the severity of the relapse, and/or preventing relapse.
• the invention also relates to the use of the Active as a treatment for symptoms of demyelination disease, especially MS, selected from vision deficits, motor control deficits, and sensation deficits.
• the invention broadly relates to an Active for use in the causal treatment or prevention of a disease or condition associated with central nervous system (CNS) or peripheral nervous system (PNS) demyelination in a mammal by maintaining the integrity of myelination of axonal cells.
• CNS central nervous system
• PNS peripheral nervous system
• the term "maintaining the integrity of myelination of axonal cells” should be understood to mean effecting remyelination of axonal cells, inhibiting or preventing demyelination of axonal cells, or both.
• the term “causal” treatment should be understood to mean a treatment of demyelination as an underlying cause of the disease, and to exclude treatments that are intended to directly address clinical symptoms of the disease (symptomatic treatment).
• the invention broadly relates to a method for the treatment or prevention of a disease or condition associated with central nervous system (CNS) or peripheral nervous system (PNS) demyelination in a mammal by maintaining the integrity of myelination of axonal cells, the method comprising a step of administering a clinically effective amount of an Active to an individual in need thereof.
• CNS central nervous system
• PNS peripheral nervous system
• the invention in another aspect, relates to a method for treating a relapse, especially an acute relapse, of a disease or condition associated with central nervous system (CNS) or peripheral nervous system (PNS) demyelination in a mammal by maintaining the integrity of myelination of axonal cells.
• the method comprising the step of administering a clinically effective amount of an Active to the mammal upon relapse of the disease or condition.
• the administration of the clinically effective amount of the Active is continued during a period of relapse of the disease or condition and is preferably discontinued upon remission of the disease or condition.
• the invention in another aspect, relates to a method of prolonging a period of remission of a disease or condition associated with central nervous system (CNS) or peripheral nervous system (PNS) demyelination in a mammal by maintaining the integrity of myelination of axonal cells, the method comprising the step of administering a clinically effective amount of an Active to the mammal during a period of remission of the disease or condition.
• the administration of the clinically effective amount of the Active is continued during a period of relapse of the disease or condition.
• the invention in another aspect, relates to a non-immune mediated therapy (preferably a nonimmune mediated causal therapy) for a disease or condition associated with central nervous system (CNS) or peripheral nervous system (PNS) demyelination in a mammal, especially multiple sclerosis (MS), especially primary progressive MS, the method comprising a step of administering a clinically effective amount of an Active to the mammal in an amount sufficient to result in a clinically significant remyelination, or inhibition of demyelination, of axonal sheaths in the mammal.
• non-immune mediated therapy should be understood to mean a therapy which is not directed at dampening down of the immune response in the mammal.
• the methods and uses of the invention comprise a combination therapy or use comprising the administration of an Active in parallel with administration of an immune mediated therapeutic.
• immune mediated therapeutic or “immunosuppressant” are used interchangeably and should be understood to mean a causal therapeutic that is aimed at modulating the immune response in a mammal to prevent, inhibit or ameliorate demyelination of axonal sheaths of CNS or PNS neuronal cells.
• immune mediated therapeutics or immunosuppressants are well known in the field, and include Natalizumab or TYSABRI (Elan), Interferon beta lb (BETASERON), Interferon beta la (AVONEX), glatiramer acetate or COPAXONE (Teva), and daclizumab (ZENEMAX).
• the Active may be administered at the same time as the immune mediated therapeutic, or the two medicaments may be administered in a staggered manner.
• the Active and immune mediated therapeutic are provided in a single unit dose form, for example, a liquid or tablet or the like.
• the invention relates to a combination therapy for a disease or condition associated with central nervous system (CNS) or peripheral nervous system (PNS) demyelination in a mammal, for example multiple sclerosis, the method comprising a step of treating the mammal with (a) an immune mediated therapeutic to dampen or suppress an immune mediated response in the mammal in tandem with (b) an Active to promote remyelination of CNS or PNS neurons.
• CNS central nervous system
• PNS peripheral nervous system
• the invention relates to a method for the causal treatment of diseases or conditions associated with CNS or PNS demyelination in a human subject by inhibiting, ameliorating or reversing demyelination of CNS or PNS neuronal cells, the method comprising the steps of administering to the subject an amount of the Active effective to cause a clinically significant level of inhibition, amelioration, or reversal of demyelination of a CNS or PNS neuronal cells.
• the invention in another aspect, relates to a method for inhibiting, ameliorating or reversing demyelination of CNS or PNS cells in a human subject in need thereof, the method comprising the steps of administering to the subject an amount of the Active effective to inhibit, ameliorate, or reverse demyelination of a CNS or PNS neuronal cells.
• the invention in another aspect, relates to a method for preventing, or slowing the progression of diseases or conditions associated with CNS or PNS demyelination in a human subject by inhibiting, ameliorating or reversing demyelination of CNS or PNS cells, the method comprising the steps of administering to the subject an amount of the Active effective to inhibit, ameliorate, or reverse demyelination of a CNS or PNS neuronal cells.
• the invention in another aspect, relates to a method for the treatment of one or more symptoms of a disease or condition associated with CNS or PNS demyelination in a human subject, the method comprising the steps of administering to the subject an amount of the Active effective to inhibit, ameliorate, or reverse demyelination of a CNS or PNS cell type.
• the symptoms are typically selected from the group consisting of vision deficits, motor control deficits, sensation deficits, and cognitive function deficits.
• the symptoms are selected from vision, motor control, and sensation, deficits.
• the Active is NEFIRACETAM.
• condition associated with CNS or PNS demyelination is MS.
• the invention relates to a method for treating one or more symptoms of MS in a mammal selected from vision deficits, sensation deficits, and motor control deficits by promoting remyelination and/or inhibiting demyelination of axonal myelin sheaths, the method comprising the step of administering to the subject a clinically effective amount of an Active.
• the invention relates to a method for treating primary progressive MS in a human subject, especially symptomatic treatment of vision deficits, sensation deficits, and/or motor control deficits, and optionally cognitive function deficits, the method comprising the step of administering to the subject an amount of NEFIRACETAM effective to inhibit, ameliorate or reverse demyelination of axonal cells in the CNS.
• the invention relates to a method for treating one or more symptoms of primary progressive MS in a human subject selected from vision deficits, sensation deficits, and motor control deficits, and optionally cognitive function deficits, the method comprising the step of administering to the subject an amount of NEFIRACETAM effective to inhibit, ameliorate or reverse demyelination of axonal cells in the CNS.
• the invention also relates to a pharmaceutical formulation comprising a combination therapy of an immune mediated therapeutic of the type capable of reducing the length and/or degree of inflammation-mediated damage to insulating cells around nerve fibres, and an Active.
• a pharmaceutical formulation comprising a combination therapy of an immune mediated therapeutic of the type capable of reducing the length and/or degree of inflammation-mediated damage to insulating cells around nerve fibres, and an Active.
• Such a formulation would be especially suitable for causal or symptomatic treatment, or prevention of autoimmune demyelinating diseases or conditions.
• the term clinically effective amount should be taken to mean an amount of Active which results in a clinically significant inhibition, amelioration or reversal of demyelination, or clinically significant remyelination, of CNS or PNS neuronal cells. Details of dosages of NEFIRACETAM that are readily tolerated and readily orally administered are described in the literature (Robinson et al. 2009).
• the Active is administered at a dose of between 1 microgram and 50 milligrams daily, preferably between 1 milligram and 40 milligrams daily, more preferably between 5 milligrams and 40 milligrams daily.
• 2-oxopyrrolidine compounds (the "Active") are described in Japanese Patent Application Publication No: 56.2960/1981 and in International Patent Application Publication No: WO2006113937, the contents of which are incorporated herein by reference.
• the term "2-oxopyrrolidine compound” or “Active” refers to a compound of general formula I:
• R is hydrogen, hydroxyl or aminomethyl
• R' is hydrogen or piperidinocarbonyl group
• R" is hydrogen, aminocarbonylalkyl optionally N-substituted with a di(C 1 -C 4 )alkylamino- (C 2 -C 4 )alkyl group, anilinocarbonylalky optionally mono or disubstituted on the benzene ring with methyl, methoxy, or halogen; benzyl, optionally mono or disubstituted on the benzene ring with methyl, methoxy, or halogen;
• R,R' and R' ' is hydrogen
• R and R' ' are both hydrogen, and when R is other then hydrogen, then R' is hydrogen, or a pharmaceutically acceptable salt thereof.
• Examples of 2-oxopyrrolidine compound of general Formula (I) useful for the present invention are:
• racetams included within the scope of the invention include Phenylpiracetam (Carphedon), Etiracetam, Nicoracetam (racetam structure bonded to niacin), Rolziracetam, Nebracetam, Imuracetam, Coluracetam (potential use in prevention and treatment of ischemic retinopathy and retinal and optic nerve injury), Dimiracetam, Brivaracetam, and Seletracetam.
• the Active is selected from the group consisting of: PIRACETAM, ANIRACETAM, PRAMIRACETAM, NEBRACETAM, FASORACETAM, LEVETIRACETAM and OXIRACETAM.
• the Active is selected from the group consisting of PIRACETAM, ANIRACETAM, LEVETIRACETAM and NEFIRACETAM.
• the Active is NEFIRACETAM (N-(2, 6-dimethylphenyl)-2-(2-oxo-l- pyrrolidinyl)acetamide).
• diseases or conditions associated with CNS or PNS demyelination should be understood to mean a pathology in which axonal demyelination of a CNS or PNS neuronal cell types is an underlying cause of the symptoms of the pathology.
• demyelinating diseases of the central nervous system such as: Multiple sclerosis including relapse remitting MS (RRMS), primary progressive MS, secondary progressive MS, and progressive relapsing MS; Idiopathic inflammatory demyelinating diseases; Transverse myelitis; Devic's disease; Progressive multifocal leukoencephalopathy; Optic neuritis; and Leukodystrophies, and demyelinating diseases of the peripheral nervous system such as: Guillain-Barre syndrome and its chronic counterpart, chronic inflammatory demyelinating polyneuropathy; anti-MAG peripheral neuropathy; Charcot-Marie-Tooth Disease; and Vitamin B12 deficiency (change— > B12 deficiency causes subacute combined degeneration of the spinal cord... spinal cord is part of the CNS, disease is "combined" b/c of demyelination of the Dorsal Columns— decreased vibration and proprioception sensation— and Corticospinal Tract— upper motor neuron disease symptoms).
• RRMS re
• the disease or condition is one associated with CNS demyelination. In another embodiment, the disease or conditions is associated with PNS demyelination.
• administering should be taken to include any form of delivery that is capable of delivering the Active to the CNS or PNS, including intravenous delivery, oral delivery, intramuscular delivery, intrathecal delivery, and inhaled delivery. Methods for achieving these means of delivery will be well known to those skilled in the art of drug delivery, and include:
• Implant- can be prepared in an implant (eg small silicon implant) that will release Active. Implant can be placed at muscles or directly onto the spinal cord (Kieran and Greensmith, 2004 Neurosci 125(2):427-39). Additionally, administration of an Active to humans and animals is described in the following publications: «Feys P, D'hooghe MB, Nagels G, Helsen WF. The effect of levetiracetam on tremor severity and functionality in patients with multiple sclerosis. Mult Scler. 2009 Mar;15(3):371-8. Epub 2009 Jan 23. PubMed PMID: 19168602.
• the Active is formulated for oral administration and contains between 1 and 50mg of active.
• Inactive ingredients include lactose mono ydrate, microcrystalline cellulose, pregelatinized starch, croscarmellose sodium, magnesium stearate, hypromeliose, polyethylene glycol, polysorbate 80, and titanium dioxide.
• the inactive ingredients may include colloidal silicon dioxide, crospovidone, hypromeliose, lactose monohydrate, magnesium stearate, polyethylene glycol, polysorbate 80, povidone, pregelatinized starch, and titanium dioxide.
• the term "combination therapy” should be taken to mean that the two therapies (immune mediated therapy and Active-mediated remyelination therapy) are carried out at the same time on the mammal.
• the two pharmaceutically- active agents for example an immune mediated therapeutic such a TYSABRI and an Active such as NEFIRACETAM
• compositions comprising a therapeutically effective amount of an Active, and immunosuppressasnt (as defined above) and a pharmaceutically acceptable carrier or diluent.
• pharmaceutically acceptable means approved by a regulatory agency of the Federal or a state government or listed in the U.S. Pharmacopeia or other generally recognized pharmacopeia for use in animals, and more particularly in humans.
• carrier refers to a diluent, adjuvant, excipient, or vehicle with which the 2-oxypyrollidone compound is administered.
• Such pharmaceutical carriers can be sterile liquids, such as water and oils, including those of petroleum, animal, vegetable or synthetic origin, such as peanut oil, soybean oil, mineral oil, sesame oil and the like. Water is a preferred carrier when the pharmaceutical composition is administered intravenously. Saline solutions and aqueous dextrose and glycerol solutions can also be employed as liquid carriers, particularly for injectable solutions. Suitable pharmaceutical excipients include starch, glucose, lactose, sucrose, gelatin, malt, rice, flour, chalk, silica gel, sodium stearate, glycerol monostearate, talc, sodium chloride, water, dried skim milk, glycerol, and propylene glycol.
• compositions can also contain minor amounts of wetting or emulsifying agents, or pH buffering agents.
• These compositions can take the form of solutions, suspensions, emulsion, tablets, pills, capsules, powders, and sustained-release formulations
• compositions can be formulated as a suppository, with traditional binders and carriers such as triglycerides.
• Oral formulation can include standard carriers such as pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharine, cellulose, magnesium carbonate, etc. Examples of suitable pharmaceutical carriers are described in "Remington's Pharmaceutical Sciences” by E. W. Martin.
• Such compositions will contain a therapeutically effective amount of the therapeutic, preferably in purified form, together with a suitable amount of carrier so as to provide the form for proper administration to the patient.
• the composition is formulated in accordance with routine procedures as a pharmaceutical composition adapted for intravenous administration to human beings.
• compositions for intravenous administration are solutions in sterile isotonic aqueous buffer.
• the composition may also include a solubilizing agent and a local anesthetic such as lignocaine to, ease pain at the, site of the injection.
• the ingredients are supplied either separately or mixed together in unit dosage form, for example, as a dry lyophilized powder or water free concentrate in a hermetically sealed container such as an ampoule or sachette indicating the quantity of active agent.
• composition is to be administered by infusion, it can be dispensed with an infusion bottle containing sterile pharmaceutical grade water or saline.
• an ampoule of sterile water for injection or saline can be provided so that the ingredients may be mixed prior to administration.
• the mammal is a human, typically a human suffering from a disease or condition characterised by demyelination of CNS or PNS neuronal cells (i.e. a demyelination disease) such as MS.
• a demyelination disease such as MS.
• FIG. 1 Accelerated repair of LPC-induced dem elination in hippocampal organotypic slice culture is a property of racetams in general.
• Panel A Representative images showing the persisting decrease in myelin basic protein (MBP; green) in LPC-treated slices compared to control 24h post-LPC treatment. Nefiracetam, piracetam, aniracetam and levetiracetam all restored MBP expression to control levels or above.
• Panel B Quantification of the effect of LPC on MBP expression in the slice culture model and the ability of racetams to restore MBP expression to normal. Data are Mean+SEM percent of field of view positive for MBP, 6 ⁇ n ⁇ 9. * Significantly different (Student's t-test, p ⁇ 0.05) from preLPC control. ⁇ Significantly different (Student's t-test, p ⁇ 0.05) from saline-treated control.
• Figure 2 Effect of nefiracetam in the EAE animal model of multiple Sclerosis.
• Panel A Study design.
• Figure 3 Effect of nefiracetam in the EAE animal model of multiple Sclerosis.
• Panel A Study design.
• Panel B shows the magnitude and timing of clinical symptoms in the EAE model in saline-treated controls and animals treated with increasing doses of nefiracetam (9, 15 and 30mg/kg) from onset of clinical symptoms.
• FIG. 4 Nefiracetam accelerates myelin repair in the cuprizone animal model.
• Panel A Study design.
• Panel B Representative images showing decreased myelination (dark staining) in the corpus callosum of the adult C57BL/6 mice following 6 weeks on a cuprizone (0.2% wt/wt) diet.
• Panel C Quantification of the effect of cuprizone on myelin expression and its recovery 1, 3 and 7days following return to normal diet. Nefiracetam treatment (30mg/kg/day) completely restored myelin levels to nromal at the lday time-point. Data are Mean+SEM myelin density in arbitrary units, 7 ⁇ n ⁇ 10
• the present invention is based on the use of 2-oxopyrrolidine compounds (“Active”), especially NEFIRACETAM, as a non-immunomodulatory treatment for demyelinating diseases, especially MS, in which the Active acts to maintain the integrity of myelination.
• Active 2-oxopyrrolidine compounds
• NEFIRACETAM NEFIRACETAM
• This therapeutic approach is distinct from all the disease modifying drugs currently used in the treatment of MS, and is also applicable for non-autoimmune demyelinating diseases, such as Charcot Marie Tooth type 1 (CMT1).
• CMT1 Charcot Marie Tooth type 1
• NEFIRACETAM a member of the racetam family of nootropic drugs, is primarily known for its ability to enhance cognitive function, believed to be due to its modulation of cholinergic nicotinic and glutamatergic NMD A receptors (Narahashi et al, 2004). Clinical studies have already shown that nefiracetam is well tolerated and readily orally administered in humans (Robinson et al, 2009), making it an attractive prospect for application in previously untargeted patient cohorts.
• OTC Optimal Cutting Temperature
• Organotypic cultures of rat hippocampus were generated from 400 ⁇ slices of hippocampus from 9 day old Wistar rats using the interface method of Stoppini L, Buchs PA, Muller D. (1991) Neurosci Methods. 37: 173-82. Slices were maintained in normal organotypic medium for 10 days, at which point demyelination was induced by exposing the cultures to 250 ⁇ g/ml lysophosphatidylcholine (LPC) in the medium for 18 hours. After the LPC exposure, slices were returned to LPC free medium containing either ⁇ nefiracetam, ⁇ piracetam, ⁇ levetiracetam, ⁇ aniracetam, or no drug.
• LPC lysophosphatidylcholine
• MBP myelin basic protein
• mice model an acute MS relapse To better understand the capacity of racetams to alleviate motor, sensory and visual symptoms of MS that are due to the demyelination the mouse model of EAE is employed with the C57BL/6 strain as in this model there is poor natural recovery and symptoms persist due to the demyelination (Gatson et al., 2010 J. Neuroimmunology). A total of 40 female mice are used in this study. Mice are maintained with food and water ad libitum in a 12 h light/dark cycle throughout the study.
• each mouse receives an emulsion containing of guinea pig MBP, incomplete Freud's adjuvant and 0.2mg of Mycobacterium tuberculosis H37 Ra, via subcutaneous injection at the base of the tail.
• Reduction in these clinical scores by racetam treatment demonstrates effective treatment of motor symptoms associated with MS.
• these mice are assessed for a normal electroretinogram (ERG) and optic nerve activity by the methods described in Palfi et al. (2010 Hum Gene Ther. 21:311) to show a beneficial effect of racetam treatment on the visual/sensory symptoms seen in MS.
• a sample size of 20 animals was used by Khajavi et al (2007) to demonstrate the effectiveness of curcumin in ameliorating the effects of the PMP22 trembler- J mutation on motor control and sciatic nerve structure and function, and was sufficient to detect significant therapeutic effects of treatment, and the same model species and sample size is employed. All experiments are carried out in four treatment groups, 20 mice / group. The first two groups, one of wild type mice, and one of trembler- J mice, each receive 15mg/kg/day intraperitoneal nefiracetam, while the second two groups (again one wild type and one trembler-J) receive intraperitoneal vehicle daily. Treatment commences in animals at 8 weeks old, i.e.
• Treatment is administered for a period of thirty days, and behavioural assessment carried out during two windows; mid- treatment (days 13-15) and at end of treatment (days 28-30).
• Behavioural assessment of motor coordination and balance is carried out in all animals using standard rotarod (ENV- 575MA, Med Associates) analysis, as used previously to test for therapeutic effects on motor deficits in the trembler-J mice (Khajavi et al, 2007).
• the rotarod test involves placing the animal on an elevated rod rotating at increasing speed, with time spent on the rod used as an indicator of motor performance. Additionally, during behavioural evaluation windows animals are observed in an open field arena to assess basic locomotor behaviour.
• the arena consists of a white box 55cm wide, 55cm long and 45cm high. Animals are placed into the box, facing the corner, allowed to explore for a 5 minute period, and tracked using a computerised tracking system (Ethovision 3.1, Noldus) to record the distance moved during the testing period. This observation is used to ensure nefiracetam does not cause a generalized increase in locomotor activity which would affect the interpretation of the rotarod experimental observations.
• nefiracetam or vehicle administration and behavioural monitoring animals are sacrificed, and the sciatic nerves dissected bilaterally. In each animal, one of each pair of nerves is used to assess nerve conduction. Isolated nerves are electrically stimulated at the spinal end, and the evoked compound action potential measured distally. The neurogram compound action potential is assessed to establish the effect of nefiracetam on the changes in amplitude and conduction velocity in the trembler-J mice relative to wild type. The contralateral sciatic nerve is analysed for changes in myelin and axonal structure.
• Nerves are fixed, immunofluorescently labelled for markers of myelin (MBP) and axons (neurofilament- H), imaged using confocal microscopy, and analysed to assess the degree of cellular dysfunction in each group. Immunofluorescence images are analysed on an axon-by-axon basis using customised automated image analysis software we used previously (O' Sullivan et al, 2010). Parameters to be measured are axon diameter, myelin thickness and number of myelinated axons.

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