Readers may be wondering at what point Peter will run out of things to write about. I do sometimes wonder the same thing. I was going to also write about Loperamide (Imodium), but the post would have been too long. Next time!
Pentoxifylline
Pentoxifylline
has been in use to treat autism for 50 years. The original studies did suggest
its effect was greatest among small children.
I have been in some discussions with a US psychiatrist, Dr Powell, who
is a big fan of the off-label use of this drug to affect the brain in adults. He has even written a book on the subject.
My previous posts on Pentoxifylline can be found here:
https://www.epiphanyasd.com/search/label/Pentoxifylline
Dr Powell’s patients with autism tend to be older children, not the toddlers who did well in clinical trials in Japan in the 1970s. He sees significant improvement in many, but not all, of his patients with autism. The parents report improved social interactions and having higher-level discussions with their child.
What
is notable is that he uses frequent dosing, 4 times a day, always after food to
avoid the GI side effects.
Pentoxifylline
is inexpensive, but its effect does not last long, hence the frequent
dosing. Some people take taking this
drug 5-6 times a day.
Pentoxifylline
has multiple modes of action, it should increase blood flow to the brain and it
is broadly anti-inflammatory. It is a
non-selective PDE inhibitor, normally used treat muscle pain in people with
peripheral artery disease. It increases red blood cell flexibility and it
reduces the viscosity of blood.
There
are PDEs 1 to 11. It all gets quite complicated, for example PDE1 subtype A2
has a potential role in neurodegenerative diseases, including:
· Parkinson's disease
· Axonal neurofilament degradation
· Motorneuronal degradation
· Neuronal ischemia
· Alzheimer's disease
· Epilepsy
Recall
that PDE4 inhibitors are used to treat asthma and COPD. We can potentially repurpose
those to improve myelination in MS, or autism, and at specific low doses they
can improve cognition.
cGP (from Black Currants)
I did write quite a lot in this blog about growth factors and autism. The familiar ones are BDNF, NGF and IGF-1, but there are many more.
My previous posts on IGF-1 can be found here:
https://www.epiphanyasd.com/search/label/IGF-1
We know that growth signaling in autism is disturbed, but it is not simple. As the disease progresses (the fetus develops, the baby is born and grows into a toddler) the imbalance in growth signaling changes. This means that what would be helpful in a 6 month old baby might well be inappropriate in a 6 year old. This is a good example of what I call the what, when and where of treating autism. Here it is the “when” that matters.
Some
people lack BDNF while others have too much. Very possibly, this changes over
time in the same child.
One
possible therapy for autism is injections of IGF-1 (Insulin-like Growth Factor
1). IGF-1 plays an important role in
childhood growth.
A
synthetic analog of IGF-1 is used in children for the treatment of growth failure. This
drug called Mecasermin
was used in autism trials and in Rett syndrome trials.
In Rett
syndrome the search has been on for an oral therapy.
Trofinetide
(NNZ-2566) is a potential therapy
for Rett
syndrome being developed by Neuren Pharmaceuticals in Australia.
Trofinetide is derived from IGF-1.
Trofinetide got to phase 2 trials as a therapy for Fragile-X in
2015.
The second product in development at Neuren is NNZ-2591. It is aimed at normalizing the level of
IGF-1.
This is in the pipeline to treat:
- Phelan-McDermid syndrome (Shank3 gene and others not working)
- Angelman syndrome (UBE3A gene not working)
- Pitt Hopkins syndrome (TCF4 gene not working)
- Prader-Willi syndrome (MAGEL2 gene and others not working)
https://www.neurenpharma.com/irm/content/product-development-pipeline.aspx?RID=483&RedirectCount=1
What is NNZ-2591?
It is
an analogue (modified version) of cyclic glycine proline (cGP)
Cyclic
glycine-proline (cGP), a metabolite of IGF-1, is neuroprotective through
improving IGF-1 function.
There
is also research focused on Parkinson’s and Alzheimer’s where it seems that cGP
is reduced.
In New
Zealand they found that supplementation of Blackcurrant anthocyanins (pigments)
increased cGP in the spinal fluid of patients with Parkinson’s.
This
also led the way to the idea of increasing cGP as means of protecting the brain
during aging. There is now a commercial OTC product in New Zealand to do just
this.
Our
reader Daniel, who has a daughter with Rett syndrome, is assessing the benefit
of cGP, using the OTC product cGPMAX. The results so far are promising.
Rett
is very specific because we know for sure that IGF-1 and NGF are disturbed.
Is
cGP going to be beneficial in broader autism?
May be yes, but we come back to the what, when and where. It may well depend on when a specific person
takes it. We have both hypoactive
pro-growth signalling autism and hyperactive pro-growth signalling autism.
Unfortunately, what the clever researchers who came up with the above concept did not consider is that you may start out hyper in the womb and switch to hypo a few short years later.
Conclusion
Frequently
dosed Pentoxifylline looks like a potentially interesting therapy for many with
autism, including some with high IQ.
Take note our Aspie readers.
Daniel’s
idea to look at the Neuren’s non-Rett therapy as a Rett therapy is
interesting. In effect you do not need
to wait for the Australian drug, you can hop across the Tasman Sea to New
Zealand and use their cGP supplement, developed for protection against
dementia.
You would also think that parents of
children with:
- Phelan-McDermid syndrome (Shank3 gene and others not working)
- Angelman syndrome (UBE3A) gene not working)
- Pitt Hopkins syndrome (TCF4 gene not working)
- Prader-Willi syndrome (MAGEL2 gene and others not working)
might want to follow Daniel’s lead.
As you can see, there is a lot of trial and error in
science. Back in 2009 NNZ-2566 was in clinical trials for the
treatment of cognitive deficits following traumatic brain injury. That must not have worked out. Fragile-X did not work out and now it is
phase 3 for Rett girls, which seems to be going well.
IGF-1 for old
people
The
same growth factor IGF-1 that is key during development also plays a key role
in aging. Dr Jian
Guan made a world first discovery. She discovered that cGP (cyclic
Glycine-Proline) was responsible for controlling the IGF-1 hormone in our body.
Thus by increasing the level of cGP in our body, the cGP will essentially
command the IGF-1 to build more blood vessels.
Dr Jian Guan, was then recognised as the world-wide
authority on cGP. In 2017 she discovered that New Zealand blackcurrants
contained high volumes of natural cGP which could regulate optimum levels of
IGF-1 in the body.
So now we have Antipodeans/Kiwis fending
off dementia, and potentially metabolic syndrome, by taking their locally made
cGPMax.
Will it help you case of autism? Who
knows, but if it does not, just give the leftover pills to Grandma, Granddad or
take them yourself!
All the supporting papers from New Zealand.