title: Combined lithium and valproate treatment delays disease onset, reduces neurological deficits and prolongs survival in an amyotrophic lateral sclerosis mouse model.
abstract: Lithium and valproic acid (VPA) are two primary drugs used to treat bipolar disorder, and have been shown to have neuroprotective properties in vivo and in vitro. A recent study demonstrated that combined treatment with lithium and VPA elicits synergistic neuroprotective effects against glutamate excitotoxicity in cultured brain neurons, and the synergy involves potentiated inhibition of glycogen synthase kinase-3 (GSK-3) activity through enhanced GSK-3 serine phosphorylation [Leng Y, Liang MH, Ren M, Marinova Z, Leeds P, Chuang DM (2008) Synergistic neuroprotective effects of lithium and valproic acid or other histone deacetylase inhibitors in neurons: roles of glycogen synthase kinase-3 inhibition. J Neurosci 28:2576-2588]. We therefore investigated the effects of lithium and VPA cotreatment on the disease symptom onset, survival time and neurological deficits in cooper zinc superoxide dismutase (SOD1) G93A mutant mice, a commonly used mouse model of amyotrophic lateral sclerosis (ALS). The G93A ALS mice received twice daily i.p. injections with LiCl (60 mg/kg), VPA (300 mg/kg) or lithium plus VPA, starting from the 30(th) day after birth and continuing until death. We found that combined treatment with lithium and VPA produced a greater and more consistent effect in delaying the onset of disease symptoms, prolonging the lifespan and decreasing the neurological deficit scores, compared with the results of monotreatment with lithium or VPA. Moreover, lithium in conjunction with VPA was more effective than lithium or VPA alone in enhancing the immunostaining of phospho-GSK-3beta(Ser9) in brain and lumbar spinal cord sections. To our knowledge, this is the first demonstration of enhanced neuroprotection by a combinatorial approach using mood stabilizers in a mouse ALS model. Our results suggest that clinical trials using lithium and VPA in combination for ALS patients are a rational strategy.
authors.affiliation: Neurology Department, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, PR China. fenghonglin567@sina.com
authors.forename: H-L
authors.initials: HL
authors.lastname: Feng
authors.forename: Y
authors.initials: Y
authors.lastname: Leng
authors.forename: C-H
authors.initials: CH
authors.lastname: Ma
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.forename: M
authors.initials: M
authors.lastname: Ren
authors.forename: D-M
authors.initials: DM
authors.lastname: Chuang
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000367:Age Factors; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D000818:Animals; D000927:Anticonvulsants / Q000627:therapeutic use*; D001522:Behavior, Animal / Q000187:drug effects; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D038362:Glycogen Synthase Kinase 3 / Q000378:metabolism; D019417:Hindlimb Suspension / Q000379:methods; D006801:Humans; D018021:Lithium Chloride / Q000627:therapeutic use*; D051379:Mice; D008822:Mice, Transgenic; D009043:Motor Activity / Q000187:drug effects; D053580:Muscle Strength / Q000187:drug effects; D009154:Mutation; D009422:Nervous System Diseases / Q000188:drug therapy* / Q000209:etiology; D011597:Psychomotor Performance / Q000187:drug effects; D012018:Reflex / Q000187:drug effects; D045442:Rotarod Performance Test / Q000379:methods; D013482:Superoxide Dismutase / Q000235:genetics; D016019:Survival Analysis; D014635:Valproic Acid / Q000627:therapeutic use*
chemical_list: D000276:Adjuvants, Immunologic; D000927:Anticonvulsants; D014635:Valproic Acid; C109415:SOD1 G93A protein; D013482:Superoxide Dismutase; D038362:Glycogen Synthase Kinase 3; D018021:Lithium Chloride