Composition and Method for Treatment of Senile Dementia

FIG. 1 is a graph of acetylcholine release plotted against log concentration Rb.sub.1 at high and low concentrations of potassium.

FIGS. 2A, 2B, 3A and 3B are graphs plotting electrically stimulated .sup.3 H-acetylcholine release against time.

FIGS. 4 and 5 are a graphs of choline uptake plotted against log concentration Rb.sub.1 and against log concentration Rg.sub.1, respectively.

FIG. 6 is a graph of .sup.45 Ca uptake at high and low concentrations of potassium.

FIG. 7 is a graph showing the effects of Rb.sub.1 on calcium uptake at nerve endings.

FIG. 8 is a graph showing the effects of Rb.sub.1 on intracellular calcium concentration in cultured neuroblastoma cells.

FIG. 9 is a graph illustrating that Rb.sub.1 itself has no anticholinesterase (AChE) activity.

FIG. 10 is a graph showing the inability of Rb.sub.1 to displace QNB from nerve ending receptors.

FIGS. 11 and 12 are graphs illustrating that the increase in ACh content at nerve endings is not caused by an increase in activity choline acetyltransferase (ChAT).

FIG. 13 is a graph illustrating that the increase in the release of ACh is accompanied by an increase in the uptake of choline into the nerve endings. FIGS. 14 and 15 are graphs illustrating the kinetics of that uptake.

FIG. 16 is a graph illustrating that Rb.sub.1 does not displace radio labelled HC-3 and did not increase the number binding sites in the brain.

FIG. 17 is a graph illustrating that the administration of Rb.sub.1, increases the number of choline-uptake sites in the rat.

Our invention is further illustrated by means of the following non-limiting examples:

About 1 g of crude ginsenosides obtained by the procedure described by Shoji in "Advances in Chinese Medicinal Materials Research" was dissolved in 10 ml of methanol. The resultant solution was mixed with 10 g of silica gel (Merck 0.040-0.063 mm particle size, 230-400 mesh ASTM). The silica gel was air dried for about 1 hour and then placed in a column for vacuum chromatography, as described by Coll et al, Aust. J. Chem., 30, 1305 (1977), prepacked with 80 g of silica gel. Elution with a solution of chloroform and methanol (85:15) gave a fraction from which 75mg of >98% pure Rb.sub.1 was obtained. An additional 120 mg of Rb.sub.1, purity about 60%, was recovered from other fractions of the eluate.

600 mg of the crude mixture of ginsenosides obtained by the procedure of Shoji was dissolved in 10 ml water. The aqueous solution was washed with ethyl acetate (2.times.40 ml) and then extracted with a solution of ethyl acetate and 1-butanol (4:1; 4 .times.40 ml) followed by extraction with a 1:1 solution of ethyl acetate-1-butanol (2.times.40 ml) and then 1-butanol presaturated with water (2.times.40 ml). The last three extracts were combined and concentrated to give 140 mg of ginsenosides containing about 60% of Rb.sub.1. Use of that enriched mixture as the starting material in Example 1 gave essentially pure Rb.sub.1.

The following examples illustrate that Rb.sub.1 and Rg.sub.1 directly and selectively increase acetylcholine function in the brain and are useful in the treatment of Alzheimer-type senile dementia.

Pinched off nerve endings (synaptosomes) from whole rat brain were first incubated in the presence of the precursor .sup.3 H-choline, which is converted intracellularly to .sup.3 H-ACh. The release of ACh from synaptosomes was quantitated under low [K]and high [K]conditions intended to simulate physiological stimulation. The addition of Rb.sub.1 increased the release of .sup.3 H-ACh as shown in FIG. 1.

Using a different protocol, synaptosomes, which had been previously incubated with .sup.3 H-choline, as in the first series of experiments, were continually perfused with HEPES-buffered Krebs solution. The release of ACh was effected by subjecting the synaptosomes to electrical field stimulation, which more closely mimics physiological stimulation. In FIG. 2 and 3, the left panel shows the release pattern in the absence of any added drug, and the right panel shows the release pattern in the presence of 10 .sup.-6 M drug during the last 25 minutes of perfusion. The results obtained by calculating the ratio of the amounts of ACh released during the two periods of electrical stimulation (the areas under the curves, S2/S1) indicate that both Rb.sub.1 and Rg.sub.1 increase the electrically stimulated release. In addition, Rg.sub.1 stimulates the resting release of .sup.3 H-ACh, as indicated, by the increase in the resting afflux of .sup.3 H-ACh when the drug was first added. While the net amount of .sup.3 H-ACh released in each run can vary, depending on the amount of protein on the filter and aging of the synaptosomes, the S2/S1 ratio remains quite constant from run to run using a given chamber. Therefore, in each experiment the same chamber was used for both control and test-drug runs.

The stimulation of ACh release is also associated with an increase in the specific uptake of the precursor .sup.3 H choline as shown in FIGS. 4 and 5. Although the magnitude of stimulation of choline uptake is not as great as the magnitude of stimulation of ACh release, it is a consistent and significant effect, and can still quantitatively account for the increase in release. This suggests a general stimulation of brain cholinergic function. Further, preliminary experiments show that of three cholinergic brain regions examined, cortex, stratum, and hippocampus, stimulation of ACh release from synaptosomes is most pronounced in the hippocampus, a brain region strongly implicated in memory functions, and to a lesser extent in the cortex.

This example confirms that Rb.sub.1 and Rg.sub.1 do not stimulate the release of neurotransmitter by non-selectively depolarizing nerve endings. The effects of Rb.sub.1 on the resting voltage dependent uptake of .sup.45 Ca into rat brain synaptosomes are shown in FIG. 6. these results indicate that the dramatic stimulation of .sup.3 H-ACh release is associated with only a minimal increase in the resting uptake of Ca, upon which ACh release is dependent. If this compound were acting as a non-specific depolarizing agent, one would predict the resting uptake of .sup.45 Ca would be stimulated several fold, to the same level as the depolarized (52.5 K) uptake.

Table 1 below contains data illustrating the effect of Rb.sub.1 on the release of acetylcholine from hippocampal tissue, a brain region which is associated with memory and learning. These data indicate that Rb.sub.1 can stimulate the release of ACh from brain tissue. This effect is observed in the presence or absence (10 mM EGTA) of calcium, which may suggest that the source of the stimulated release of ACh is not from the vesicular pool, as is normally the case, but from the cytoplasmic pool. Furthermore the stimulation of release in the absence of calcium is more pronounced in the simultaneous presence of a cholinesterase inhibitor, paraxon. This type of drug is also known to increase the amount of ACh in the cytoplasm, by virtue of its ability to inhibit intracellular AChE, and this observation would be consistent with the notion that the source of ACh which is stimulated by Rb.sub.1 is the cytoplasm.

The stimulation of ACh release is not accompanied by an increase in intracellular calcium in nerves. FIG. 7 shows the effects of Rb.sub.1 on nerve ending calcium uptake, and FIG. 8 shows the effects of Rb.sub.1 on the intracellular calcium concentration in cultured neuroblastoma cells.

FIG. 9 shows that Rb.sub.1 itself also has no anticholinesterase activity.

Table 2 below summarizes the effect of Rb.sub.1 on the intracellular stores of choline and ACh when tissues are incubated in low or high potassium, and in the absence or presence of Rb.sub.1. Rb.sub.1 produces an increase in and in the absence or presence of Rb.sub.1. Rb.sub.1 produces an increase in the total .sup.3 H contents (choline and ACh) and in the ACh contents of the cytoplasmic fraction (S3), but not in the vesicular (P3) fraction.

The stimulation in activity is not mediated by autoreceptors. FIG. 10 shows the lack of ability of Rb.sub.1 to bind to nerve ending muscarinic receptors (displace QNB from its nerve ending receptor).

The increase in the nerve ending ACh content is not caused by an increase in the activity of the synthetic enzyme choline acetyltransferase (ChAT) as is shown in FIGS. 11 and 12.

The increase in the release of ACh is accompanied by an increase in the uptake of the precursor choline into nerve endings, which is shown in FIG. 13. The kinetics of the increase in uptake are presented in FIGS. 14 and 15, and the kinetic contents are presented in Table 3. These results indicate that the increase in choline uptake is not due to an increase in the affinity of the carrier for the substrate choline, but to an increase in the maximum velocity of the carrier.

The mechanism of the increase in the velocity of the carrier could be accounted for in two ways (1) an increase in the turnover rate of the carriers, or (2) in increase in the number of carriers in the plasma membrane. In order to discriminate between these two possibilities, the number of carrier sites was probed with radiolabelled hemicholinium-3 (HC-3). In in vitro administration experiments, presented in FIG. 16, Rb.sub.1 did not displace radiolabelled HC-3 (unlabelled HC-3 was also used as a displacer, as a positive control), and did not increase the apparent number of binding sites. Initially, Rb.sub.1 seems to increase the uptake of choline by simply increasing the turnover rate of the carriers. When rats were administered with Rb.sub.1 (5mg/kg/day) for three days, there was an increase in the number of choline uptake sites, suggesting that chronic administration of the compound increases the number of carriers (FIG. 17).

When using Rb.sub.1 and Rg.sub.1 to alleviate the symptoms of Alzheimer-type senile dementia, Rb.sub.1 and Rg.sub.1 can be processed by conventional methods of galenic pharmacy into pharmaceutical preparations for oral or parenteral administration, e.g., to mammals including humans. Conventional excipients are pharmaceutically acceptable organic or inorganic carrier substances suitable for parenteral, enteral or topical application which do not deleterious react with Rb.sub.1 or Rg.sub.1. Suitable pharmaceutically acceptable carriers include but are not limited to water, salt solutions, alcohols, gum arabic, vegetable oils, polyethylene glycols, gelatine, lactose, amylose, magnesium stearate, talc, silicic acid, viscous paraffin, perfume oil, fatty acid monoglycerides and diglycerides, pentaerythritol fatty acid esters, hydroxy-methylcellulose, polyvinyl pyrrolidone, etc. The pharmaceutical preparations can be sterilized and if desired mixed with auxiliary agents, e.g., lubricants, preservatives, stabilizers, wetting agents, emulsifiers, salts for influencing osmotic pressure, buffers, coloring, flavoring and/or aromatic substances and the like which do not deleteriously react with Rb.sub.1 and Rg.sub.1.

For parental application, particularly suitable are injectable sterile solutions, preferably oily or aqueous solutions, as well as suspensions, emulsions, or implants, including suppostories.

For enteral application, particularly suitable are tablets, dragees, suppositories or capsules having talc and/or sa carbohydrate carrier or binder or the like, the carrier preferably being lactose and/or corn starch and/or potato starch.

A syrup, elixir or the like can be used wherein a sweetened vehicle is employed. Sustained release compositions can be formulated including those wherein Rb1 and Rg1 is protected with differential degradable coatings, e.g., by microencapsulation, multiple coatings, etc.

Depending on the type of mammal to which it is being administered, the daily dosage of Rb.sub.1 or Rg.sub.1 for a mammal weighing 50 kg is generally about 100-1000 mg. preferably administered 3 or 4 times a day in divided doses. Thus, a suitable dosage form would contain 25-250 mg of Rb.sub.1 or Rg.sub.1. Suitable daily dosages of metabolic precursors of acetylcholine, and of cholinesterase inhibitors, are well known to those skilled in the art. For example, acetylcholine precursor, such as choline, usually as its chloride or bitartrate, dimethylaminoethanol, a synthetic precursor of choline, phosphatidylcholine and lecithin, are generally administered in amounts ranging from 5 to 50 g/day. Choline and lecithin are sometimes administered in conjunction with nootropic agents such as piracetam, amalogues of piracetam and aminopyridines. As for acetylcholinesterase inhibitors, the usual dose for neostigmine is 15-30 mg, for pyridostigmine 60-180 mg, for ambenonium 10-20 mg, and for tetrahydroacridine 25-150 mg. When Rb.sub.1 or Rg.sub.1 is administered together with a metabolic precursor acetylcholine and/or a cholinesterase inhibitor, the dosage form will generally contain the usual dosage of the acetylcholine precursor and/or the usual dosage of the cholinesterase inhibitor. Appropriate dosages and regimens for a given host can be determined using conventional considerations, e.g., by customary comparison of the differential activities of the subject compound and of a known agent, e.g., by means of conventional pharmacological protocols.