Abstract
Metformin is a medication that is widely prescribed for the management of type 2 diabetes. In addition to its anti-diabetic uses, metformin has been proposed as a therapeutically effective drug candidate in various central nervous system disorders, including Parkinson’s disease (PD). PD is characterized by severe movement defects and is commonly treated with the dopamine (DA) precursor 3,4-dihydroxyphenyl-l-alanine (l-DOPA). However, prolonged use of l-DOPA can lead to the development of l-DOPA-induced dyskinesia (LID). Here, we hypothesized that metformin co-treatment would improve LID in the 6-hydroxydopamine (6-OHDA)-lesioned mouse model of PD. Metformin did not interfere the pharmacotherapeutic effects of l-DOPA in the cylinder test. Furthermore, metformin co-treatment with l-DOPA attenuated the development of LID in unilaterally 6-OHDA-lesioned mice. Metformin showed a long-lasting effect on axial, limb, and orofacial abnormal involuntary movement scores for up to 20 days after treatment initiation. Interestingly, persistent enhancement of the mammalian target of rapamycin, dopamine D1 receptor, and extracellular signaling-regulated kinase 1/2 signaling was maintained in the DA-denervated striatum during metformin treatment. Metformin globally normalized the increased glycogen synthase kinase 3β activity induced by chronic treatment of l-DOPA in a manner associated with Akt activation in unilaterally 6-OHDA-lesioned mice. These findings suggest that metformin may have therapeutic potential for the suppression or management of l-DOPA-induced motor complications in patients with PD.
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Acknowledgments
This work was supported by the KRIBB Research Initiative Program of the Republic of Korea and by the Development of Platform Technology for Innovative Medical Measurements funded by Korea Research Institute of Standards and Science (KRISS-2017-GP2017-0020).
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Supplementary Figure 1
Effects of 6-OHDA lesioning in vehicle- and metformin-treated mice. a Number of D-AMPH-induced ipsilateral rotations at 2 weeks after 6-OHDA lesioning. b TH immunoreactivity in the 6-OHDA-lesioned and 6-OHDA-unlesioned striata and SNc regions of the vehicle + l-DOPA (“Vehicle”), 100 mg/kg/day metformin + l-DOPA (“Met100”), and 200 mg/kg/day metformin + l-DOPA (“Met200”) groups. c Percentage losses of TH+ cells in the lesioned SNc regions of the “Vehicle” (n = 17–20), “Met100” (n = 7–10), and “Met200” (n = 16–23) groups. Data are presented as the mean ± SEM. Scale bar = 500 μm. (GIF 441 kb)
Supplementary Figure 2
Simple linear regression analysis of TH depletion and total AIM scores. Simple linear regression analysis detected no significant correlations between TH depletion and total AIM scores in the vehicle + l-DOPA (“Vehicle”; n = 17) (a); 100 mg/kg metformin + l-DOPA (“Met100”; n = 7) (b); and 200 mg/kg metformin + l-DOPA (“Met200”; n = 16) (c) groups. “Vehicle”: r = 0.1170, p = 0.1789; “Met100”: r = 0.2480, p = 0.2553; and “Met200”: r = 0.0251, p = 0.5578. (GIF 62 kb)
Supplementary Figure 3
Effect of 6-OHDA lesioning in vehicle-, amantadine-, and metformin-treated mice. a Experimental design for 6-OHDA lesioning, drug treatment, and behavioral testing (cylinder test and AIM test). b The number of D-AMPH-induced ipsilateral rotations at 2 weeks after 6-OHDA lesioning. c TH immunoreactivity in the 6-OHDA-lesioned and 6-OHDA-unlesioned SNc regions in the vehicle + l-DOPA (“Vehicle”; n = 7), 40 mg/kg amantadine + l-DOPA (“AM40”; n = 7), and 200 mg/kg metformin + l-DOPA (“Met200”; n = 8) groups. d Percentage losses of TH+ cells in the lesioned SNc regions in the “Vehicle,” “AM40,” and “Met200” groups. e Right forelimb use in the cylinder test before (“Pre-test”) and after 6-OHDA lesioning (“6-OHDA”), and 30 min after the first treatment of l-DOPA with vehicle, 40 mg/kg amantadine, or 200 mg/kg metformin (“6-OHDA/l-DOPA”). ** p < 0.01 vs. “Vehicle” and ## p < 0.01 vs. “6-OHDA” (one-way ANOVA followed by Tukey-Kramer post hoc test). Data are presented as the mean ± SEM. Scale bar = 500 μm. (GIF 547 kb)
Supplementary Figure 4
Time course of total and subscale AIM scores in 6-OHDA mice treated with l-DOPA alone or in combination with amantadine or metformin. Time course of total AIM (a, d), LOC (b, e), and ALO (c, f) scores for 120 min after l-DOPA administration on day 10 (a–c) and day 20 (d–f). Two-way repeated measures ANOVA with Bonferroni post hoc tests. Amantadine on day 10: total AIMs, F (1, 12) = 11.38, p = 0.0055; LOC, F (1, 12) = 2.91, p = 0.1136; and ALO, F (1, 12) = 16.89, p = 0.0014. Amantadine on day 20: total AIMs, F (1, 12) = 5.07, p = 0.0438; LOC, F (1, 12) = 5.54, p = 0.0365; and ALO, F (1, 12) = 2.38, p = 0.1487. Metformin on day 10: total AIMs, F (1, 13) = 9.49, p = 0.0088; LOC, F (1, 13) = 3.49, p = 0.0844; and ALO, F (1, 13) = 9.85, p = 0.0079. Metformin on day 20: total AIMs, F (1, 13) = 12.07, p = 0.0041; LOC, F (1, 13) = 4.29, p = 0.0589; and ALO, F (1, 13) = 13.48, p = 0.0028. Data are presented as the mean ± SEM. (GIF 144 kb)
Supplementary Figure 5
Representative photomicrographs of p-rpS6, p-ERK1/2, PKA substrates, p-AcH3, and ΔFosB immunoreactive cells in the 6-OHDA-lesioned and 6-OHDA-unlesioned striata of the “Vehicle,” “Met100,” and “Met200” groups. Thirty minutes after completion of the 11-day l-DOPA treatment schedule, we performed immunohistochemistry or immunofluorescence of the 6-OHDA-lesioned dorsal striata. Immunofluorescence of p-Ser235/236-rpS6 (a), p-Ser240/244-rpS6 (b), and p- Thr202/Tyr204-ERK1/2 (c) cells and immunoreactivity of PKA substrates (d), p-Ser10-AcH3 (e), and ΔFosB (f) in the vehicle + l-DOPA (“Vehicle”), 100 mg/kg metformin + l-DOPA (“Met100”), and 200 mg/kg metformin + l-DOPA (“Met200”) groups. Scale bar = 200 μm. (GIF 1741 kb)
Supplementary Figure 6
Regulation of AMPK activity in unilaterally 6-OHDA-lesioned mice treated with single or repeated l-DOPA administration. a Thirty minutes after l-DOPA administration on day 1 (single) and day 11 (repeated), western blots were performed with the striata of unilaterally 6-OHDA-lesioned mice. b Metformin (200 mg/kg, “Met200”) was administered 30 min prior to l-DOPA. Quantification of striatal p-Thr172-AMPK levels normalized to β-actin. One asterisk and two asterisks denote the difference between indicated groups at p < 0.05 and p < 0.01, respectively (one-way ANOVA followed by Tukey-Kramer post hoc test). Data are presented as the mean ± SEM. (GIF 193 kb)
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Ryu, YK., Park, HY., Go, J. et al. Metformin Inhibits the Development of l-DOPA-Induced Dyskinesia in a Murine Model of Parkinson’s Disease. Mol Neurobiol 55, 5715–5726 (2018). https://doi.org/10.1007/s12035-017-0752-7
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DOI: https://doi.org/10.1007/s12035-017-0752-7