Tampilkan postingan dengan label Benefit. Tampilkan semua postingan
Tampilkan postingan dengan label Benefit. Tampilkan semua postingan

Jumat, 25 November 2016

How Keeping Axons Alive May Benefit Neuropathy Patients


Today's post from futurity.org (see link below) tries to explain the new findings regarding the death of nerve cells and nerve axons and how this may eventually lead to significantly better treatments for neuropathy patients. Another post here a few days ago (scroll down to May 3rd) announced the results of this research but as with many articles like this, many people might have found it difficult to follow. This article takes care to explain the science in words we can all understand and for that reason deserves a gold star from this blog. Worth a read - they may be onto something here.


Can saving axons keep nerves alive?
Washington University in St. Louis rightOriginal Study Posted by Caroline Arbanas-WUSTL on May 5, 2015

You are free to share this article under the Attribution 4.0 International license.

New research highlights how nerves—whether harmed by disease or traumatic injury—start to die.

The discovery unveils new targets for developing drugs to slow or halt peripheral neuropathies and devastating neurodegenerative disorders such as Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS).

Peripheral neuropathy damages nerves in the body’s extremities and can cause unrelenting pain, stinging, burning, itching, and sensitivity to touch. The condition is commonly associated with diabetes or develops as a side effect of chemotherapy.

Nerve cells talk to each other by transmitting signals along communication cables called axons. Such signals underlie vital activities, such as thinking and memory, movement, and language.

As part of a study published in Science, the researchers showed they could prevent axons from dying, a finding that suggests therapies could be developed to counteract the withering away of nerve axons.

“We have uncovered new details that let us piece together a major pathway involved in axon degeneration,” says senior author Jeffrey Milbrandt, professor in, and head of, the genetics department at Washington University School of Medicine in St. Louis.

“This is an important step forward and helps to identify new therapeutic targets. That we were able to block axon degeneration in the lab also gives us hope that drugs could be developed to treat patients suffering from a variety of neurological conditions.” 


Energy supply


A common thread among many neurological disorders and traumatic nerve injuries is the degeneration of axons, which interrupts nerve signaling and prevents nerves from communicating with one another. Axon degeneration is thought to be an initiating event in many of these disorders. In fact, an unhealthy axon is known to trigger its own death, and researchers are keenly interested in understanding how this happens.

Working in cell cultures, fruit flies, and mice, Milbrandt and coauthor Aaron DiAntonio, professor of developmental biology, and their colleagues showed that a protein already known to be involved in axon degeneration acts like a switch to trigger axon degeneration after an injury.

Moreover, they found that this protein, once unleashed, causes a rapid decline in the energy supply within axons. Within minutes after the protein—called SARM1—is activated in neurons, a massive loss of nicotinamide adenine dinucleotide (NAD), a chemical central to a cell’s energy production, occurs within the axon.

“When a nerve is diseased or injured, SARM1 becomes more active, initiating a series of events that quickly causes an energetic catastrophe within the axon, and the axon undergoes self-destruction,” says first author Josiah Gerdts, an MD/PhD student in Milbrandt’s laboratory.
Keeping axons alive

Working in neurons in which SARM1 was activated, the researchers showed they could completely block axon degeneration and neuron cell death by supplementing the cells with a precursor to NAD, a chemical called nicotinamide riboside. The neurons were able to use nicotinamide riboside to keep the axons energized and healthy.

Nicotinamide riboside has been linked in animal studies to good health and longevity, but its benefits have not been shown in people. The researchers say much more research is needed to know whether the chemical could slow or halt axon degeneration in the body.

“We are encouraged by the findings and think that identifying a class of drugs that block SARM1 activity has therapeutic potential in neurological disorders,” Milbrandt says. “The molecular details this pathway provides give us a number of therapeutic avenues to attack.”

The National Institutes of Health (NIH) and Vertex Pharmaceuticals supported the work.

Source: Washington University in St. Louis 


http://www.futurity.org/nerves-neuropathy-axons-914382/

Sabtu, 20 Agustus 2016

Is Amitriptyline Of Benefit To Neuropathy Patients


Today's post from nzdoctor.co.nz (see link below) talks about the effectiveness of Amitriptyline for the relief of neuropathic symptoms. Amitriptyline is one of the first line of drugs generally prescribed for neuropathy problems, after the over the counter analgesics. It's an anti-depressant and seems to work for some patients and not others. The article here suggests that it is probably ineffective for chemotherapy or HIV-related forms of neuropathy but possibly works for diabetes-related nerve problems and neuropathy stemming from other conditions. Unfortunately, it doesn't explain why or how these conclusions have been reached and that is what we really need to know. Doing further research on the internet yourself will undoubtedly give you more information, or failing that, doing a search here on this blog (on the right of the page) for amitriptyline will bring up more articles about its use in treating neuropathy. You could also ask your doctor, or specialist to explain the differences in effectiveness. Many patients will be confused that a medication is thought to work for neuropathy caused by one disease but not another, especially when the symptoms are very much the same, irrespective of the cause - further information is therefore necessary. The article also fails to mention the possible side effects of taking amitriptyline, which once again, can be a problem for some but not for others.

Limited evidence for benefit of amitriptyline for neuropathic pain and fibromyalgia in adults
Wednesday 13 March 2013, 11:23AM

PEARLS 382, February 2013, written by Brian R McAvoy.

(DownloadsPEARLS 383 PDF)

Clinical question
How effective is amitriptyline for neuropathic pain and fibromyalgia in adults?


Bottom line
Amitriptyline probably does not work in neuropathic pain associated with HIV or treatments for cancer. Amitriptyline probably does work in other types of neuropathic pain (painful diabetic neuropathy, post-herpetic neuralgia, and post-stroke pain, and in fibromyalgia), though we cannot be certain of this. A best estimate is that amitriptyline provides pain relief in about 1 in 4 (25%) more people than does placebo (NNT* = 4.6 [95% confidence interval 3.6Ð6.6]), and about 1 in 4 (25%) more people than placebo report having at least 1 adverse event, probably not serious but disconcerting.*NNT = number needed to treat to benefit 1 individual.

Caveat
There were no studies that could provide an answer that was trustworthy or reliable because most studies were relatively old, and used methods or reported results that we now recognise can make benefits seem better than they are.

Context
Amitriptyline is a tricyclic antidepressant that is widely used to treat chronic neuropathic pain and fibromyalgia, and is recommended in many guidelines. These types of pain can be treated with antidepressant drugs in doses below those at which the drugs act as antidepressants.

Cochrane Systematic Review
Moore RA et al. Amitriptyline for neuropathic pain and fibromyalgia in adults. Cochrane Reviews, 2012, Issue 12. Art. No.: CD008242.DOI: 10.1002/14651858. CD008242.pub2.
This review contains 21 studies involving 1437 participants.

http://www.nzdoctor.co.nz/gp-resources/pearls/2013/march-2013/13/limited-evidence-for-benefit-of-amitriptyline-for-neuropathic-pain-and-fibromyalgia-in-adults.aspx