Instituut voor Neuropathische Pijn
English articles Low dose naltrexone for MS: a pilot trial
| Low dose naltrexone for MS: a pilot trial |
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Presentation FP48-TH-05 of the 19th World Congress of Neurology, titel: "Study of low dose naltrexone modulation of the endocannabinoid system in patients with multiple sclerosis" from the studygroup from Italy (M. Gironi ety al) discussed the use of low dose naltrexone (LDN) in Multiple Sclerosis (MS. They showed that LDN (4 mg/day) administered daily for 6 months in 40 patients with primary progressive (PP) MS (Gironi et al., 2008) was safe, well tolerated and partially efficacious on spasticity.
They described that therapeutic efficacy was associated with a prolonged release of endogenous opioids such as Beta-endorphin (BE) from peripheral mononuclear cells (PBL). In order to describe the interaction between opioids and the endocannabinoid system (ECS) they investigated the expression of anandamide-binding type-1 and type-2 cannabinoid receptors (CB1R and CB2R), as well as of NAPE- PLD and FAAH, in 13 PP-MS patients treated daily for 6 months with LDN. Fifteen healthy subjects (HC) were used as control group. They found CB1R and CB2R expression levels were 18-fold and 21-fold increased in MS compared to controls, respectively (p < 0.001). Furthermore: CB1R and CB2R decreased after 6 months of LDN therapy, altough CB1R tended to increase to normal values one month after drug discontinuation. NAPE (23-fold increase) and FAAH (7-fold increase) levels were higher in PP-MS compared to HC (p < 0.01) irrespective of the time point of measurement. The conclusion was that LDN treatment might reduce the expression of anandamide-metabolizing enzymes and anandamide- binding receptors. Furthermore: This observation is noteworthy, because it suggests that whatever the molecular details of ECS dysregulation, the drug is able to alleviate it. Moreover it suggest a biological activity of LDN in MS patients. 19th World Congress of Neurology, Free Paper Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S57–S154 Jan M. Keppel Hesselink, MD, PhD, June 2010 |