Adjuvant Therapies

Adjuvant Therapies
 \  Adjuvant Therapies

ADJUVANT THERAPIES BEING EXPLORED TO IMPROVE QUALITY OF LIFE IN ALS:

HORMONE THERAPY

What is Hormone therapy?

Hormone therapy involves the replacement of deficient hormone levels within the body The may include:

DHEA, Testosterone, Estradiol, Progesterone, Growth Hormones, Thyroid Hormones, Insulin, Cortisol.

A published scientific study showed that as ALS disease progressed (ALS FRS-R score and King’s stage of the patients) plasma Total Testosterone levels decline.

Adjuvant Fig 1
Adjuvant Fig 2

IV VITAMIN THERAPY?

IV Vitamin Therapy replenishes essential nutrients rapidly in the body intravenously.

 

Some of these nutrients are:

  • Glutathione
  • Vitamin C
  • Myers’ cocktail
  • L-Carnitine
  • a-Lipoic acid
Adjuvant Fig 3

IV VITAMIN: GLUTATHIONE

Glutathione is a powerful antioxidant present naturally in the cells but is depleted in ALS.

IV VITAMIN: VITAMIN C

Vitamin C slows progression in mouse models of ALS. (Padayatty et al., 2003)

It is also a powerful antioxidant, and may scavenge molecules that cause oxidative stress in ALS. (Orrell et al., 2004)

IV VITAMIN: MYERS’ COCKTAIL

Myers cocktail was first developed by John Myers, MD Baltimore, Maryland

It is used widely and is safe for a variety of conditions: Fibromyalgia, migraines, and muscle spasms. (Gaby A, 2002). It is completely safe for patient suffering from Musculoskeletal conditions like fibromyalgia. (Ali et al., 2009)

IV VITAMIN: L-CARNITINE

Reduces neuronal excitotoxicity and increases motor neuron activity. (Bigini et al., 2002)
Suppresses onset of neuromuscular degeneration and increases lifespan. (Kira et al., 2006)
Ameliorates oxidative damage, enzyme activity, and mitochondrial dysfunction.

IV VITAMIN THERAPY: A-LIPOIC ACID

Exerts strong and positive antioxidant and neuroprotective effects in ALS models. (Wang et al., 2018)
Improves mitochondrial health, reduces oxidative damage, and improves enzyme function. (Liu J., 2019)
Improves lifespan of ALS mouse model (Andreassen et al., 2001)
Isn’t available in India yet, but has been used abroad.

HYPERBARIC OXYGEN THERAPY (HBOT)

Principle: Improving oxygenation of tissues throughout the body with 100% Oxygen.

  • HBOT is a treatment modality where pure 100% oxygen is given to the patient in a special enclosed chamber at higher pressure
  • It increases the amount of oxygen inhaled in an environment under increased pressure resulting in high concentrations of oxygen being forced deep into the tissues.
  • HBOT delayed the onset of weakness in the als mouse model
  • In a study Five patients with ALS were treated for 60min with 100% oxygen at 2 atmospheres pressure daily for five days a week for four weeks. The results showed Four patients had decreased fatigue, Maximum isometric voluntary contraction (MVIC) of muscles except right hand grip improved significantly (Steele J 2004)
Adjuvant Fig 4
Adjuvant Fig 5

REFERENCES

Glutathione
Weschawalit S, Thongthip S, Phutrakool P, Asawanonda P. Glutathione and its antiaging and antimelanogenic effects. Clin Cosmet Investig Dermatol. 2017 Apr 27;10:147-153. doi: 10.2147/CCID.S128339. PMID: 28490897; PMCID: PMC5413479.

Marí M, Morales A, Colell A, García-Ruiz C, Fernández-Checa JC. Mitochondrial glutathione, a key survival antioxidant. Antioxid Redox Signal. 2009 Nov;11(11):2685-700. doi: 10.1089/ARS.2009.2695. PMID: 19558212; PMCID: PMC2821140.

Ribas V, García-Ruiz C, Fernández-Checa JC. Glutathione and mitochondria. Front Pharmacol. 2014 Jul 1;5:151. doi: 10.3389/fphar.2014.00151. PMID: 25024695; PMCID: PMC4079069.

Ross EK, Gray JJ, Winter AN, Linseman DA. Immunocal® and preservation of glutathione as a novel neuroprotective strategy for degenerative disorders of the nervous system. Recent Pat CNS Drug Discov. 2012 Dec;7(3):230-5. doi: 10.2174/157488912803252014. PMID: 22742422.

Vitamin C

Basambombo LL, Carmichael PH, Côté S, Laurin D. Use of vitamin E and C supplements for the prevention of cognitive decline. Annals of Pharmacotherapy. 2017 Feb;51(2):118-24.

Monacelli F, Acquarone E, Giannotti C, Borghi R, Nencioni A. Vitamin C, aging and Alzheimer’s disease. Nutrients. 2017 Jul;9(7):670.

Razmkon A, Sadidi A, Sherafat-Kazemzadeh E, Mehrafshan A, Jamali M, Malekpour B, Saghafinia M. Administration of vitamin C and vitamin E in severe head injury: a randomized double-blind controlled trial. Neurosurgery. 2011 Sep 1;58(CN_suppl_1):133-7.

Zhang C, Li JM, Hu JL, Zhou X. The effects of large doses of vitamin C and vitamin E on nerve injury, neurotrophic and oxidative stress in patients with acute craniocerebral injury. Journal of Acute Disease. 2018 Mar 1;7(2):69.

Leichtle SW, Sarma AK, Strein M, Yajnik V, Rivet D, Sima A, Brophy GM. High-Dose Intravenous Ascorbic Acid: Ready for Prime Time in Traumatic Brain Injury?. Neurocritical care. 2020 Feb;32(1):333-9.

Myers’ Cocktail
Ali A, Njike VY, Northrup V, Sabina AB, Williams AL, Liberti LS, Perlman AI, Adelson H, Katz DL. Intravenous micronutrient therapy (Myers’ Cocktail) for fibromyalgia: a placebo-controlled pilot study. J Altern Complement Med. 2009 Mar;15(3):247-57. doi: 10.1089/acm.2008.0410. PMID: 19250003; PMCID: PMC2894814.

Sriram K, Lonchyna VA. Micronutrient supplementation in adult nutrition therapy: practical considerations. JPEN J Parenter Enteral Nutr. 2009 Sep-Oct;33(5):548-62. doi: 10.1177/0148607108328470. Epub 2009 May 19. PMID: 19454751.

Gaby AR. Intravenous nutrient therapy: the “Myers’ cocktail”. Altern Med Rev. 2002 Oct;7(5):389-403. PMID: 12410623.

Acetyl-l-Carnitine
Beghi E, Pupillo E, Bonito V, Buzzi P, Caponnetto C, Chiò A, Corbo M, Giannini F, Inghilleri M, Bella VL, Logroscino G, Lorusso L, Lunetta C, Mazzini L, Messina P, Mora G, Perini M, Quadrelli ML, Silani V, Simone IL, Tremolizzo L; Italian ALS Study Group. Randomized double-blind placebo-controlled trial of acetyl-L-carnitine for ALS. Amyotroph Lateral Scler Frontotemporal Degener. 2013 Sep;14(5-6):397-405. doi: 10.3109/21678421.2013.764568. Epub 2013 Feb 19. PMID: 23421600.

Rossini M, Di Munno O, Valentini G, Bianchi G, Biasi G, Cacace E, Malesci D, La Montagna G, Viapiana O, Adami S. Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients. Clin Exp Rheumatol. 2007 Mar-Apr;25(2):182-8. PMID: 17543140.

Lipoic Acid
Maczurek A, Hager K, Kenklies M, Sharman M, Martins R, Engel J, Carlson DA, Münch G. Lipoic acid as an anti-inflammatory and neuroprotective treatment for Alzheimer’s disease. Adv Drug Deliv Rev. 2008 Oct-Nov;60(13-14):1463-70. doi: 10.1016/j.addr.2008.04.015. Epub 2008 Jul 4. PMID: 18655815.

Seifar F, Khalili M, Khaledyan H, Amiri Moghadam S, Izadi A, Azimi A, Shakouri SK. α-Lipoic acid, functional fatty acid, as a novel therapeutic alternative for central nervous system diseases: A review. Nutr Neurosci. 2019 May;22(5):306-316. doi: 10.1080/1028415X.2017.1386755. Epub 2017 Nov 29. PMID: 29185388.

Steele J, Matos LA, Lopez EA, Perez-Pinzon MA, Prado R, Busto R, Arheart KL, Bradley WG. A Phase I safety study of hyperbaric oxygen therapy for amyotrophic lateral sclerosis. Amyotroph Lateral Scler Other Motor Neuron Disord. 2004 Dec;5(4):250-4. doi: 10.1080/14660820410021285. PMID: 15799556.

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