Drug Used To Treat Enlarged Prostate Appears To Improve Parkinson’s Symptoms In Experimental Models And Human Database Analysis
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- University of Iowa Health Care
- Summary:
- A drug used to treat enlarged prostate may also slow the progression of Parkinson’s disease, according to a new study.
A drug used to treat enlarged prostate may also be able to slow the progression of Parkinson’s disease.
The surprising finding, published Sept. 16 online in the Journal of Clinical Investigation, is the result of an international collaboration involving researchers in China and at the University of Iowa that combines basic molecular biology with big data.
“Current medicines can partially alleviate some of the symptoms of Parkinson’s disease. But today we have zero treatments that change the progressive course of this neurodegenerative disease. That’s a terrible state, because as our population ages Parkinson’s disease is going to become increasingly common,” says senior study author Michael Welsh, MD, UI professor of internal medicine, a Howard Hughes Medical Institute investigator, and director of the Pappajohn Biomedical Institute at the UI. “I’m really excited about this finding because I think it has the opportunity to change the lives of people with Parkinson’s disease “
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Excessive Saliva And Drooling In Parkinsons
Saliva is needed for the first stages of digestion, including chewing and swallowing. This watery substance contains enzymes that start to digest our food.
Many people with Parkinsons experience poor saliva control, which may result in excessive saliva and drooling, or alternatively, in a dry mouth and other eating problems.
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Evaluating And Treating Urinary Issues In Parkinson’s Disease Multiple System Atrophy And The Other Atypical Parkinsonism Disorders
In this hour-long webinar, neuro-urologist Ekene Enemchukwu, MD focuses on urinary incontinence, overactive bladder, urinary retention, and other urinary issues in PD, MSA, and the atypical parkinsonism disorders. Following the presentation, moderator Candy Welch, Brain Support Networks MSA caregiver support group leader, asks Dr. Enemchukwu many questions submitted by webinar participants.
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What Type Of Healthcare Professional Helps People With Speech Problems From Parkinsons Disease
If you have speech and voice problems, see a speech-language therapist. Your primary healthcare provider can help you find a therapist in your local area. Some speech-language pathologists have specialized training that focuses on training people with Parkinsons disease to amplify their voice. This is called the Lee Silverman Voice Treatment.
Speech-language therapists are specifically trained to diagnose and treat speech, language and swallowing disorders. If you have Parkinsons disease, a speech-language pathologist can help you:
- Maintain as many communication skills as possible. Teach you techniques to conserve energy, including using nonverbal communication skills.
- Introduce you to assistive devices and techniques to help improve your communication.
- Recommend exercises to help you improve muscle strength and movements needed to improve your speech and communication options.
Typical Dosing For Myrbetriq
Overactive bladder:
- Myrbetriq is usually started at 25 mg by mouth once a day. It can be taken alone or together with 5 mg of solifenacin.
- If needed, your healthcare provider may increase your Myrbetriq dose to 50 mg once a day after 4 to 8 weeks.
Neurogenic detrusor overactivity:
- Children weighing less than 77 pounds should take Myrbetriq Granules. The dose will depend on the childâs weight. It usually ranges from 3 mL to 8 mL once daily.
- Children weighing 77 pounds or more can take either Myrbetriq tablets or Myrbetriq Granules. If taking Myrbetriq tablets, the dose usually starts at 25 mg once a day and may be increased to 50 mg once a day after 4 to 8 weeks. If taking Myrbetriq Granules, the dose usually starts at 6 mL once a day and is increased to 10 mL once a day after 4 to 8 weeks.
Your dose may differ if you have kidney or liver problems.
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Swallowing And Saliva Management
This one-hour talk is in three parts. What a speech language pathologist is, how they can help someone with PD. Why you should be concerned about swallowing problems, some indications you may have a swallowing issue, what a swallowing assessment by an SLP might look like, and recommendations an SLP might make to improve swallowing. And, why you should be concerned about having either too much or too little saliva and how to manage either situation.
Bladder Irrigation And Clean Catheterization
Bladder irrigation with various solutions such as aminoglycoside, glycosaminoglycans , povidone-iodine , chlorhexidine solution , and saline with acetylcysteine have been advocated as a management strategy for patients with indwelling catheters or those who require intermittent catheterizations . Although several studies have demonstrated the efficacy of bladder irrigation with various agents , gentamicin remains the best intravesical treatment that has shown efficacy in both the prevention and treatment of recurrent UTIs . Furthermore, the risk of developing antibiotic resistance and systemic adverse effects is low in patients treated with bladder irrigation with gentamicin .
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What Has Research Found
The Utah Population Data Base has extensive genealogical information on more than 2.2 million people over 15 generations. It is linked to the statewide cancer registry. A large-scale study out of the University of Utah reviewed records containing information on birth, death and family relationships. They identified 3,000 people with 3 generations who had PD listed as the cause of death.
Results from this extensive data set suggest that the risk of prostate cancer and melanoma within the population was significantly higher than expected. In fact, the increased risk was also evident amongst relatives of people with PD. The Utah database was able to assess risk in first, second and third-degree relatives.2 The findings are statistically significant with first- and second-degree relatives.
The study sought to validate its results by cross-examining data. Researchers identified people diagnosed with melanoma or prostate cancer and found that they were also at a significantly increased risk of death from Parkinsons disease.1
Could A Common Prostate Drug Help Prevent Parkinsons
HealthDay Reporter
MONDAY, Feb. 8, 2021 While scientists still dont know what causes Parkinsons disease, new research shows an association between a drug that some men take for an enlarged prostate condition and a reduced risk of developing the illness.
A team led by scientists at the University of Iowa, working in collaboration with researchers in Denmark and China, found that the drug terazosin and similar medications may have the potential to prevent or delay this debilitating neurodegenerative condition.
The researchers found that men taking terazosin were between 12% and 37% less likely to develop Parkinsons disease during the follow-up period than men taking another drug for an enlarged prostate called tamsulosin.
We dont really have anything that can slow down the progression of the disease or stop the disease from progressing, said study author Jacob Simmering, an assistant professor in the College of Medicine at the University of Iowa, in Iowa City.
We dont have any neuroprotective treatments and weve tried things and nothings really panned out in human trials so far. Theres really a critical need to have something to try to slow this down, not just to alleviate some of the symptoms, but actually make peoples lives better, Simmering said.
Using data from the two different countries offered a more complete picture, Simmering said. The data are from 1996 to 2017 in Denmark and 2001 to 2017 in the United States.
More information
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Institutional Characteristics And Patient Selection
This study was approved by the institutional review board at Yale University School of Medicine. Subjects were selected from patients followed by 1 physician at the Yale Urology Medical Group Clinic. All patient visits at the clinic are logged by the Patient Financial Services Department under corresponding diagnosis codes. Follow-up notes from clinic visits or phone calls are recorded in patient charts by the same physician after each encounter.
Inclusion criteria for the study were as follows: neurogenic bladder dysfunction stable traumatic SCI at least 1 year after injury bladder management with CIC minimum of 1 year follow-up by the same physician at the Yale Urology Clinic seen between the 2000 and 2010. Exclusion criteria were other etiology for neurogenic bladder such as multiple sclerosis, Parkinson disease, spina bifida, or diabetes other methods of bladder management, including other catheterization methods or Crede maneuver or had undergone urinary diversion.
| Age, years |
Note: Data presented as mean ±SD, unless noted otherwise data in parentheses are percentages. PRx = prophylaxis UTI = urinary tract infection.
What The Team Did
The researchers showed that the prostate drug was able to slow the loss of brain cells in various models of Parkinsons, including in mice. This led to increased dopamine levels and improved movement symptoms.
The reason for this protection was thought to be because the drug may provide brain cells with more energy by boosting an enzyme called PGK1.
In addition to studying the potential of terazosin in the lab, the researchers also looked at existing data from those taking the drug.
Existing data from people with Parkinsons who have been treated for an enlarged prostate was also used in the study. And the researchers found that those treated with terazosin seemed to have less severe symptoms and slower progression of their Parkinsons.
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Mirabegron In Patients With Parkinson Disease And Overactive Bladder Symptoms: A Retrospective Cohort
This is the first series reporting the use of mirabegron in Parkinsonâs disease patients.
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50% of Parkinsonâs disease patients had improved overactive bladder symptoms after 6 weeks of mirabegron.
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Mirabegron appeared safe with only two mild adverse events .
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The persistence rate with mirabegron was high .
Amit Batla and Natalie Tayim each declare no potential conflicts of interest.
Mahreen Pakzad has been a speaker for Astellas.
Jalesh N. Panicker has received royalties from Cambridge University Press, has been involved in trials supported by FirstKind Ltd, Allergan and Ipsen and has received speaker honoraria from Wellspect, Astellas and Allergan.
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Urinary Dysfunction And Parkinsons
This one-page fact sheet explains that urinary dysfunction is one of several non-motor symptoms of Parkinsons disease that are the result of Parkinsons impairing proper function of the autonomic nervous system, especially in later stages of the disease process. Several types of urinary dysfunction and treatment options are outlined.
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Further Analysis In Female Patients
Because of the sex difference in obstructive symptoms, the relation between voiding dysfunction and the indices of the disease was further examined in the data only from female patients.
A single regression analysis indicated that the correlation of the total symptom index score with the disease duration or the age was less significant than that with the stage of disability . The relation of the total symptom index score with the stage of disability, the disease duration, and the age was examined by the use of linear multiple regression analysis . These results suggested that the stage of disability is the better determinant in predicting the total symptom index score =2.4, p< 0.007) than is the disease duration or the age .
The relation between the incidence of symptomatic patients and the three indices of the disease was examined by the use of logistic multiple regression analysis. This analysis again suggested that the stage of disability is the major determinant of the incidence of symptomatic patient , compared with the disease duration or the age .
The results of multiple regression analysis in the total population were basically the same as in the female population.
Common Prostate Drug May Slow Progression Of Parkinson Researchers Say
Terazosin, a drug used to treat enlarged prostate, may also be able to slow the progression of Parkinson disease.
Terazosin , a drug used to treat enlarged prostate, may also be able to slow the progression of Parkinson disease , according to a study published this week in the Journal of Clinical Investigation.
The finding is the result of a collaboration involving researchers in China and at the University of Iowa , combining observations from animal experiments with information from clinical databases regarding men taking the drug.
Lei Liu, PhD, at Capital Medical University in Beijing, China, found that terazosin could block cell death. Using toxin-induced and genetic PD models in mice, rats, flies, and induced pluripotent stem cells, the drug increased brain adenosine triphosphate levels and slowed or prevented neuron loss if it was given before the onset of cell death. In addition, the drug could slow or stop neurodegeneration, even if treatment was delayed until after neurodegeneration had started to develop. Liu’s team discovered that the cell-protective activity was due to terazosin’s ability to activate phosphoglycerate kinase 1 , an enzyme critical for cellular energy production.
Researchers then probed databases looking at patients who took terazosin and found slower disease progression, decreased PD-related complications, and a reduced frequency of PD diagnoses.
Patients using terazosin also had a reduced risk of a PD diagnosis, the researchers said.
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Urinary Problems In Parkinsons Disease
This 1-hour webinar is an interview with Dr. Janis Miyasaki, Dr. Jorges Juncos, and retired movement disorder specialist and young onset Parkinsons patient, Dr. Maria De Leon. They discuss the effect of Parkinsons disease on the autonomic nervous system, which regulates many body functions, including bladder control. Urinary problem diagnosis, symptom management and ongoing research on the topic wrap up the hour.
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Clean Intermittent Self Catheterization
The finding of a high post-void residue is unusual in patients with PD. If the PVR volume is consistently more than 100 mL, clean intermittent catheterization has been advocated. Specific issues related to dexterity in PD may make this challenging. Experienced health-care professionals, such as a continence adviser, should be involved in teaching the technique and exploring possible barriers to successful catheterization. Complications include UTI and trauma .
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Bladder Problems In Parkinsons
The primary function of the bladder is twofold to store urine as it is made and then to empty the urine. With Parkinsons, problems can emerge in both areas.
Recent studies suggest that 30-40% of people with Parkinsons have urinary difficulties. Despite the frequency of urinary dysfunction, actual urinary incontinence is relatively uncommon. Troublesome incontinence develops in only about 15% of people with Parkinsons.
The most common urinary symptoms experienced by people with Parkinsons are:
- The need to urinate frequently
- Trouble delaying urination once the need is perceived, creating a sense of urinary urgency
These symptoms usually mean you have an irritable or overactive bladder. Your bladder is signaling the brain that it is full and needs to empty when, in fact, it is not. This can happen at any time, so you might have to get up multiple times during the night to go to the bathroom.
Impairment of bladder emptying is a less frequent but still troublesome feature of urinary dysfunction in Parkinsons. This may be caused by delay or difficulty in relaxation of the urethral sphincter muscles. These muscles must relax for the bladder to empty. This can result in hesitancy in initiating urination, difficulty in generating a stream and incomplete emptying of the bladder. Dystonia involuntary muscle contractions of the urethral sphincter has also been described.
Same Types Of Bladder Issues
The most common type of bladder problem has been difficulties in holding urine. As a result, individuals are unable to hold urine for sufficient lengths of time and this results in an increased frequency to urinate in the day and night. Individuals may need to rush to the toilet and this may sometimes lead to incontinence. Additionally, individuals may report problems with urination such as difficulties in starting their urinary stream, known as urinary hesitancy, a weak and interrupted urinary stream and, occasionally, may also experience retention of urine. Difficulties in urination are not as noticeable as problems with holding urine, and some individuals may unknowingly leave behind urine in their bladder after urinating. This is known as the post-void residual volume, and as a routine should be measured through a simple bedside ultrasound scan. Holding back a significant quantity of urine in the bladder after urinating can increase the risk for developing urinary tract infections.
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A Faster Route To New Treatments
Terazosin is a drug that has already been shown to be safe and approved as a treatment and the results from this study highlight the potential for this drug to be investigated as a repurposed drug for Parkinsons. Repurposing can allow new treatments to become available much more easily, quickly and cheaply.
The prostate drug now needs to be tested in clinical trials to see if it alters the progression of Parkinsons, clinical trials are currently being planned in the US.
Professor David Dexter, Deputy Director of Research at Parkinson’s UK, says:
“These exciting results show that terazosin may have hidden potential for slowing the progression of Parkinson’s, something that is desperately needed to help people live well for longer.
“While it is early days, both animal models and studies looking at people who already take the drug show promising signs that need to be investigated further.”
Parkinson’s Disease And Voiding Dysfunction
In this 54-minute webinar, urologist Dr. Sidney Radomski explains how voiding function is affected by Parkinsons disease in both men and women. He discusses how an enlarged prostate contributes to voiding problems and management options of voiding dysfunction for those with Parkinsons disease and MSA.
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