Cumulative effect of simvastatin, l-arginine, and tetrahydrobiopterin on cerebral blood flow and cognitive function in Alzheimer’s disease

作者：Elizabeth DeGrush, Mohammed Salman Shazeeb, David A. Drachman, Zeynep Vardar, Clifford Lindsay, Matthew J. Gounis, Nils Henninger · 发表于：Alzheimer s Research & Therapy · 年份：2022 · DOI：10.1186/s13195-022-01076-7 · 被引用次数：16 · 研究领域：Neurological Disease Mechanisms and Treatments、Neurological Disorders and Treatments、Alzheimer's disease research and treatments

BACKGROUND AND OBJECTIVES: Vascular disease is a known risk factor for Alzheimer's disease (AD). Endothelial dysfunction has been linked to reduced cerebral blood flow. Endothelial nitric oxide synthase pathway (eNOS) upregulation is known to support endothelial health. This single-center, proof-of-concept study tested whether the use of three medications known to augment the eNOS pathway activity improves cognition and cerebral blood flow (CBF). METHODS: Subjects with mild AD or mild cognitive impairment (MCI) were sequentially treated with the HMG-CoA reductase synthesis inhibitor simvastatin (weeks 0-16), L-arginine (weeks 4-16), and tetrahydrobiopterin (weeks 8-16). The primary outcome of interest was the change in CBF as measured by MRI from baseline to week 16. Secondary outcomes included standard assessments of cognition. RESULTS: A total of 11 subjects were deemed eligible and enrolled. One subject withdrew from the study after enrollment, leaving 10 subjects for data analysis. There was a significant increase in CBF from baseline to week 8 by ~13% in the limbic and ~15% in the cerebral cortex. Secondary outcomes indicated a modest but significant increase in the MMSE from baseline (24.2±3.2) to week 16 (26.0±2.7). Exploratory analysis indicated that subjects with cognitive improvement (reduction of the ADAS-cog 13) had a significant increase in their respective limbic and cortical CBF. CONCLUSIONS: Treatment of mild AD/MCI subjects with medications shown to augment t...