Pyridostigmine brain penetration under stress enhances neuronal excitability and induces early immediate transcriptional response.

Pyridostigmine, a carbamate acetylcholinesterase (AChE) inhibitor, is routinely employed in the treatment of the autoimmune disease myasthenia gravis. Pyridostigmine is also recommended by most Western armies for use as pretreatment under threat of chemical warfare, because of its protective effect against organophosphate poisoning. Because of this drug's quaternary ammonium group, which prevents its penetration through the blood-brain barrier, the symptoms associated with its routine use primarily reflect perturbations in peripheral nervous system functions. Unexpectedly, under a similar regimen, pyridostigmine administration during the Persian Gulf War resulted in a greater than threefold increase in the frequency of reported central nervous system symptoms. This increase was not due to enhanced absorption (or decreased elimination) of the drug, because the inhibition efficacy of serum butyryl-cholinesterase was not modified. Because previous animal studies have shown stress-induced disruption of the blood-brain barrier, an alternative possibility was that the stress situation associated with war allowed pyridostigmine penetration into the brain. Here we report that after mice were subjected to a forced swim protocol (shown previously to simulate stress), an increase in blood-brain barrier permeability reduced the pyridostigmine dose required to inhibit mouse brain AChE activity by 50% to less than 1/100th of the usual dose. Under these conditions, peripherally administered pyridostigmine increased the brain levels of c-fos oncogene and AChE mRNAs. Moreover, in vitro exposure to pyridostigmine increased both electrical excitability and c-fos mRNA levels in brain slices, demonstrating that the observed changes could be directly induced by pyridostigmine. These findings suggest that peripherally acting drugs administered under stress may reach the brain and affect centrally controlled functions.
AuthorsA Friedman, D Kaufer, J Shemer, I Hendler, H Soreq, I Tur-Kaspa
JournalNature medicine (Nat Med) Vol. 2 Issue 12 Pg. 1382-5 (Dec 1996) ISSN: 1078-8956 [Print] UNITED STATES
PMID8946841 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
Chemical References
  • Cholinesterase Inhibitors
  • Proto-Oncogene Proteins c-fos
  • RNA, Messenger
  • Acetylthiocholine
  • Physostigmine
  • Pyridostigmine Bromide
  • Acetylthiocholine (analysis)
  • Animals
  • Blood-Brain Barrier (drug effects, physiology)
  • Brain (enzymology)
  • Cell Membrane Permeability (drug effects)
  • Cholinesterase Inhibitors (adverse effects)
  • Evoked Potentials
  • Gene Expression Regulation (drug effects)
  • Genes, Immediate-Early (genetics)
  • Hippocampus (physiology)
  • Mice
  • Molecular Sequence Data
  • Persian Gulf Syndrome (etiology)
  • Physostigmine (pharmacology)
  • Proto-Oncogene Proteins c-fos (genetics)
  • Pyridostigmine Bromide (adverse effects)
  • RNA, Messenger (analysis)
  • Stress, Physiological (physiopathology)
  • Transcription, Genetic (drug effects)

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