Neuroprotective effect of flupirtine in prion disease

Apoptotic neuronal cell death is a hallmark of prion diseases. The apoptotic process in neuronal cells is thought to be caused by the scrapie prion protein, PrPSc, and can be experimentally induced by its peptide fragment, PrP106-126. This process is a target for potential drugs to combat prion disease or to ameliorate its symptoms. Flupirtine (Katadolon), a pyridine derivative that is in clinical use as a nonopioid analgesic, has a potent cytoprotective effect, at concentrations above 1 microg/mL, on neuronal cells treated with PrP(Sc) or PrP106-126. This drug acts as an N-methyl-D-aspartate (NMDA) antagonist, but does not bind to NMDA receptors. Flupirtine normalizes the level of intracellular glutathione and increases the expression of the antiapoptotic Bcl-2 protein in neuronal cells exposed to prion protein. In view of its favorable pharmacokinetic profile, flupirtine is the first drug to be considered as a potential treatment for Creutzfeldt-Jakob disease, the human form of prion diseases. Clinical trials are underway.