Cited by 24Parkinson's Disease Mechanisms and TreatmentsNeuroinflammation and Neurodegeneration MechanismsAlzheimer's disease research and treatments

Novel therapeutic approaches in multiple system atrophy

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Palma, Jose-Alberto, Kaufmann, Horacio·2015·Clinical Autonomic Research

Abstract

Multiple system atrophy (MSA) is a sporadic, adult onset, relentlessly progressive neurodegenerative disease characterized by autonomic abnormalities associated with parkinsonism, cerebellar dysfunction, pyramidal signs, or combinations thereof. Treatments that can halt or reverse the progression of MSA have not yet been identified. MSA is neuropathologically defined by the presence of α-synuclein-containing inclusions, particularly in the cytoplasm of oligodendrocytes (glial cytoplasmic inclusions, GCIs), which are associated with neurodegeneration. The mechanisms by which oligodendrocytic α-synuclein inclusions cause neuronal death in MSA are not completely understood. The MSA neurodegenerative process likely comprises cell-to-cell transmission of α-synuclein in a prion-like manner, α-synuclein aggregation, increased oxidative stress, abnormal expression of tubulin proteins, decreased expression of neurotrophic factors, excitotoxicity and microglial activation, and neuroinflammation. In an attempt to block each of these pathogenic mechanisms, several pharmacologic approaches have been tried and shown to exert neuroprotective effects in transgenic mouse or cellular models of MSA. These include sertraline, paroxetine, and lithium, which hamper arrival of α-synuclein to oligodendroglia; rifampicin, lithium, and non-steroidal anti-inflammatory drugs, which inhibit α-synuclein aggregation in oligodendrocytes; riluzole, rasagiline, fluoxetine and mesenchymal stem cells, which exert neuroprotective actions; and minocycline and intravenous immunoglobulins, which reduce neuroinflammation and microglial activation. These and other potential therapeutic strategies for MSA are summarized in this review.

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  • In PD patients fluoxetine is being used as adjuvant therapy to reduce neurodegeneration and inflammation, or more generally, the depression symptoms, and is effective in rodent models of PD as well as of multiple system atrophy.

    “Furthermore, in PD patients fluoxetine is being used as adjuvant therapy to reduce neurodegeneration and inflammation, or more generally, the depression symptoms, and is effective in rodent models of PD as well as of multiple system atrophy, a disease conducive to PD (Zhang et al., 2015;Boggio et al., 2005;Palma and Kaufmann, 2015).”

    From Depression and adult neurogenesis: Positive effects of the antidepressant fluoxetine and of physical exercise (2018) · cites this paper as Palma and Kaufmann, 2015

    Section 3.3, “Providing neuroprotection” (page unavailable), reports that fluoxetine increased neurotrophic factors in an α-synuclein mouse model and suppressed pro-inflammatory factors in cell cultures. It does not establish fluoxetine’s effectiveness in separate rodent models of both PD and MSA, or its use as an adjunct treatment for neurodegeneration, inflammation, or depression in PD patients. It says results of a fluoxetine trial in MSA patients had not yet been published. (LLM, conf=0.86)

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Authors
Palma, J.-A., & Kaufmann, H.
Affiliations
NYU Langone Health (US)
Corresponding author
Kaufmann, Horacio
Venue
Clinical Autonomic Research
Published
2014-06-14
Volume
25
Issue
1
Pages
37-45
ISSN
  • 0959-9851 (ISSN-L)
  • 1619-1560
OpenAlex
W2103207481
Cited by
24
References
6
Citations by year
2026: 3 · 2025: 2 · 2023: 1 · 2022: 1 · 2020: 3 · 2019: 2 · 2018: 2 · 2017: 3 · 2016: 1 · 2015: 4 · 2014: 2
FWCI
0.46
Type
journal article
Language
en
Open access
Locations
  • Clinical Autonomic Research (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Dysautonomia Foundation
  • Rare Diseases Clinical Research Network
  • Multiple System Atrophy Coalition
  • National Institutes of Health
  • National Institute of Neurological Disorders and Stroke (U54NS065736)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
  • Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
Keywords
multiple system atrophy, alpha-synuclein, glial cytoplasmic inclusions, oligodendrocytes, neurodegeneration, alpha-synuclein aggregation, oxidative stress, neuroinflammation, microglial activation, neuroprotection, sertraline, paroxetine, lithium, rifampicin, riluzole, rasagiline, fluoxetine, mesenchymal stem cells, minocycline, intravenous immunoglobulin, autonomic dysfunction, parkinsonism, cerebellar dysfunction
MeSH terms
Animals, Anti-Inflammatory Agents, Disease Models, Animal, Humans, Oligodendroglia, Disease Progression, Neuroprotective Agents, Multiple System Atrophy, Neurodegenerative Diseases, Mice, alpha-Synuclein

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