Patent Document:

the present invention is related to methods of using ryanodine receptor antagonists to protect cns neurons , particularly the retinal neurons , from injuries caused by acute and chronic noxious provocations . the drawing will first be briefly described . [ 0024 ] fig1 is a bar graph showing the neuroprotective effect of dantrolene on nmda - induced injury of retinal ganglion cells in vivo in rabbits . intravitreal injection of nmda caused retinal ganglion cell loss in control animals . application of dantrolene ameliorated nmda - induced damage to ganglion cells . as mentioned above , excessive release of calcium from intracellular stores under disease conditions is cytotoxic to neurons . nmda receptor mediated excitotoxicity is believed to be a common cause that can trigger excessive calcium release from intracellular stores in acute and chronic disorders mentioned above . for example , nmda receptor antagonist memantine protects rgcs in glaucomatous monkeys , suggesting that the nmda receptor mediates , at least in part , glutamate excitotoxicity in glaucoma . there is strong evidence that damage to cns neurons often has two stages : primary and secondary degeneration . initially , direct neuronal insults , such as local ischemia , trauma etc ., lead to degeneration of the affected neurons . however , the associated pathophysiological and biochemical events occurring in the injured neurons are probably responsible for the subsequent progressive ( secondary ) degeneration of the neighboring neurons that are not directly affected by the primary insults . these secondary effects largely determine the long - term functional outcome . the immediate injury - induced response strongly influences the subsequent degenerative response . treatment that reduces or attenuates the injury to the primary insults is therefore likely to generate optimal results by preventing or delaying the secondary degenerative processes . it has now been discovered that neuroprotection is conferred upon retinal neurons by administration of a ryanodine antagonist , e . g . dantrolene , to the retina of a mammal within a period prior to , or following an primary insult to the retinal neurons but prior to cell death , the terms noxious actions or noxious provocations are defined as an occurrence which is harmful or destructive to a nerve cell . it is not limited to events extrinsic to the mammal being treated but includes disease states and pathological occurrences or events , such as , for example , stroke or heart attack , that are harmful or destructive to the nerve cell via a chain of events . non - limiting examples of noxious actions include : compressive or mechanical effects or trauma or stress factors , such as glutamate neurotoxicity , impaired blood flow to the nerves ( ischemia ) and with respect to the retina , glaucoma , diabetic retinopathy , retinitis pigmentosa and age - related macular degeneration . the methods of this invention are useful in treating any mammal , including humans . according to this invention , mammals are treated with pharmaceutically effective amount of a neuroprotective agent for a period of time and at a time such that noxious provocations do not kill or permanently damage the nerve cells . protective agents may be administered orally , topically to the eye or by any other appropriate means of delivery described below or known in the art . in accordance with this invention , pharmaceutically effective amounts of a protective agent can be administered alone to treat neural injury or to prevent nerve cell death . alternatively a protective agent may be administered sequentially or concurrently with another drug . for example , it may be used with an antiglaucoma drug , such as a beta - blocker , an alpha2 agonist , a muscarinic agent such as pilocarpine , a carbonic anhydrase inhibitor ( cai ), or other intraocular pressure ( iop ) lowering drugs . it may also be used with an anti - angiogenesis drug for the treatment of armd and diabetic retinopathy . the most effective mode of administration and dosage regimen of protective agent will depend on the type of disease to be treated , the severity and course of that disease , previous therapy , the patient &# 39 ; s health status , and response to the drug and the judgment of the treating physician . generally , the neuroprotective agent should be administered in a dose to achieve a serum or intravitreal concentration of 0 . 01 nm to 5 μm . preferably the neuroprotective agent is administered prior to injury to the nerve , but can be administered after injury has occurred with lessened effect . conventional modes of administration and standard dosage regimens of neuroprotective agents can be used . optimal dosages for co - administration of a drug , e . g . an iop - lowering drug , with a neuroprotective agent can be determined using methods known in the art . dosages of neuroprotective agents may be adjusted to the individual patient based on the dosage of the drug with which the agent is coadministered and the response of the patient to the treatment regimen . the neuroprotective agent may be administered to the patient at one time or over a series of treatments . the agent may be administered locally , e . g . intravitreally by intrabulbar injection for ocular neuroprotection , or by intrathecal or epidural administration for spinal protection . many of the agents of the invention can be administered systemically , e . g ., orally , or intravenously , or by intramuscular injection . additionally , agents for protection of the retina and optic nerve that are capable of passing through the cornea , and achieving sufficient concentration in the vitreous humor , may also be administered topically to the eye . the composition used in these therapies may also be in a variety of forms . these include , for example , solid , semi - solid , and liquid dosage forms , such as tablets , pills , powders , preserved or non - preserved liquid solution or suspension , liposomes , suppositories , injectable and infusible solutions . the compositions also preferably include conventional pharmaceutically acceptable carriers which are known to those of skill in the art . the following non - limiting examples describe assays and measurements used in 1 ) evaluating efficacy of neuroprotecting agents and 2 ) selecting ryanodine antagonists other than dantrolene . to evaluate in vivo neuroprotective effects of dantrolene ( dtl ) on nmda - induced injury of rgcs an imaging method to count cell numbers at the rgc layer in the isolated retinas was developed . briefly , two weeks following intravitreal injection of vehicle or various test agents , a rabbit was euthanized and the treated eye was enucleated . a piece of retina ( 8 mm in diameter ) was cut immediately below the optic nerve head , flat - mounted in a plastic chamber filled with hepes - buffered ames medium , and imaged at 25 fields in a 5 × 5 array with a 40 × water immersion objective using an olympus microscope ( bx50wi ) equipped with an epi - fluorescence unit . the images were taken with a hamamatsu c4742 - 95 digital camera and image - pro plus software ( v4 . 5 ). the total number of neurons at the ganglion cell layer in these 25 fields was counted . the same measurements were conducted in one control group ( rabbits treated with vehicle ) and 4 test groups treated with 1 ) nmda , 2 ) dantrolene + nmda , 3 ) veratridine ( verat ) a neurotoxin that damages retinal ganglion cells with intracellular sodium overload , and 4 ) dantrolene + veratridine . the results from the 4 test groups are normalized with respect to that of control . the results are reported in fig1 . nmda caused a loss of 53 % of cells at the rgc layer . pretreatment with dantrolene significantly reduced nmda - induced cell death to 35 %. dantrolene also reduced cell loss caused by veratridine from 56 % to 50 %. assays for determining ryanodine antagonist may be conducted following procedures modified from that described by laver et al ., ( j . physiol . 537 : 763 - 778 , 2001 ). briefly , purified ryanodine receptor - channel complexes are incorporated into planar phospholipid bilayers with resting calcium gradient similar to that in a normal neuron at rest ( 100 nm cytoplasmic and 1 mm luminal ). the level of channel activation can be determined in the presence of various ligands that activate ryanodine receptors . effective antagonistic action of the compounds to be selected can be determined by a reduction of agonist - induced activation of the channel . the specificity of the antagonists can be determined by commercially available standard screens , such as novascreens . while this invention has been described with respect to various specific examples and embodiments , it is to be understood that the invention is not limited thereby and should only be construed by interpretation of the scope of the appended claims .

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