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Published in: CNS Drugs 1/2002

01-01-2002 | Leading Article

Potential of β2-Adrenoceptor Agonists as Add-On Therapy for Multiple Sclerosis

Focus on Salbutamol (Albuterol)

Authors: Karim Makhlouf, Howard L. Weiner, Dr Samia J. Khoury

Published in: CNS Drugs | Issue 1/2002

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Abstract

The β2-adrenergic receptor agonist salbutamol (albuterol) has been used for many years in the treatment of bronchospasm in patients with asthma. In this patient group, salbutamol is a relatively safe and inexpensive drug, and is easy to administer.
Within the last few years, there has been increasing evidence that salbutamol might have immunomodulatory properties both in vitro and in vivo, in different animal models as well as in humans. This has led researchers to consider salbutamol as a potential therapy for several autoimmune diseases, including multiple sclerosis (MS).
In this article, we review the literature presenting such evidence, and discuss the possible mechanisms by which salbutamol influences the immune system. We conclude that salbutamol might be an interesting add-on therapy in patients with MS and that further research is warranted.
Literature
1.
go back to reference Boulton DW, Fawcett JP. Pharmacokinetics and pharmacodynamics of single oral doses of albuterol and its enantiomers in humans. Clin Pharmacol Ther 1997; 62: 138–44PubMed Boulton DW, Fawcett JP. Pharmacokinetics and pharmacodynamics of single oral doses of albuterol and its enantiomers in humans. Clin Pharmacol Ther 1997; 62: 138–44PubMed
2.
go back to reference Ahrens RC, Smith GD. Albuterol: an adrenergic agent for use in the treatment of asthma pharmacology, pharmacokinetics and clinical use. Pharmacotherapy 1984; 4: 105–21CrossRef Ahrens RC, Smith GD. Albuterol: an adrenergic agent for use in the treatment of asthma pharmacology, pharmacokinetics and clinical use. Pharmacotherapy 1984; 4: 105–21CrossRef
3.
go back to reference Hochhaus G, Mollmann H. Pharmacokinetic/pharmacodynamic characteristics of the beta-2-agonists terbutaline, salbutamol and fenoterol. Int J Clin Pharmacol Ther Toxicol 1992; 30: 342–62PubMed Hochhaus G, Mollmann H. Pharmacokinetic/pharmacodynamic characteristics of the beta-2-agonists terbutaline, salbutamol and fenoterol. Int J Clin Pharmacol Ther Toxicol 1992; 30: 342–62PubMed
4.
go back to reference Morgan DJ, Pauli JD, Richmond BH, et al. Pharmacokinetics of intravenous and oral salbutamol and its sulphate conjugate. Br J Clin Pharmacol 1986; 22: 587–93CrossRef Morgan DJ, Pauli JD, Richmond BH, et al. Pharmacokinetics of intravenous and oral salbutamol and its sulphate conjugate. Br J Clin Pharmacol 1986; 22: 587–93CrossRef
5.
go back to reference Physicians’ desk reference. 54th ed. Montvale (NJ): Medical Economics Company, Inc., 2000: 2832 Physicians’ desk reference. 54th ed. Montvale (NJ): Medical Economics Company, Inc., 2000: 2832
6.
go back to reference Trapp BD, Peterson J, Ransohoff RM, et al. Axonal transection in the lesions of multiple sclerosis. N Engl J Med 1998 Jan 29; 338(5): 278–85CrossRef Trapp BD, Peterson J, Ransohoff RM, et al. Axonal transection in the lesions of multiple sclerosis. N Engl J Med 1998 Jan 29; 338(5): 278–85CrossRef
7.
go back to reference McAlpine D, Compston A. Distribution of multiple sclerosis. Chapter 3. In: Compston DAS, Ebers G, Lassmann H, et al. McAlpine’s multiple sclerosis. 3rd ed. London: Churchill Livingston, 1998: 63–100 McAlpine D, Compston A. Distribution of multiple sclerosis. Chapter 3. In: Compston DAS, Ebers G, Lassmann H, et al. McAlpine’s multiple sclerosis. 3rd ed. London: Churchill Livingston, 1998: 63–100
8.
go back to reference Khoury SJ, Weiner HL, Hafler DA. Immunological mechanisms in multiple sclerosis. In: Cook SD, editor. Handbook of multiple sclerosis. 2nd ed. New York: Marcell Dekker Inc., 1996: 145–55 Khoury SJ, Weiner HL, Hafler DA. Immunological mechanisms in multiple sclerosis. In: Cook SD, editor. Handbook of multiple sclerosis. 2nd ed. New York: Marcell Dekker Inc., 1996: 145–55
9.
go back to reference Muraille E, Leo O. Revisiting the Th1/Th2 paradigm. Scand J Immunol 1998; 47(1): 1–9CrossRef Muraille E, Leo O. Revisiting the Th1/Th2 paradigm. Scand J Immunol 1998; 47(1): 1–9CrossRef
10.
go back to reference Trinchieri G. Interleukin-12: a proinflammatory cytokine with immunoregulatory functions that bridge innate resistance and antigen-specific adaptive immunity. Annu Rev Immunol 1995; 13: 251–76CrossRef Trinchieri G. Interleukin-12: a proinflammatory cytokine with immunoregulatory functions that bridge innate resistance and antigen-specific adaptive immunity. Annu Rev Immunol 1995; 13: 251–76CrossRef
11.
go back to reference Trembleau S, Germann T, Gately MK, et al. The role of IL-12 in the induction of organ-specific autoimmune diseases. Immunol Today 1995; 16: 383–6CrossRef Trembleau S, Germann T, Gately MK, et al. The role of IL-12 in the induction of organ-specific autoimmune diseases. Immunol Today 1995; 16: 383–6CrossRef
12.
go back to reference Karp C, Biron C, Irani D. Interferon beta in multiple sclerosis: is IL-12 suppression the key? Immunol Today 2000; 21(1): 24–8CrossRef Karp C, Biron C, Irani D. Interferon beta in multiple sclerosis: is IL-12 suppression the key? Immunol Today 2000; 21(1): 24–8CrossRef
13.
go back to reference Balashov KE, Smith DR, Khoury SJ, et al. Increased interleukin 12 production in progressive multiple sclerosis: induction by activated CD4+ T cells via CD40 ligand. Proc Natl Acad Sci U S A 1997; 94: 599–603CrossRef Balashov KE, Smith DR, Khoury SJ, et al. Increased interleukin 12 production in progressive multiple sclerosis: induction by activated CD4+ T cells via CD40 ligand. Proc Natl Acad Sci U S A 1997; 94: 599–603CrossRef
14.
go back to reference Comabella M, Balashov K, Issazadeh S, et al. Elevated interleukin-12 in progressive multiple sclerosis correlates with disease activity and is normalized by pulse cyclophosphamide therapy. J Clin Invest 1998; 102: 671–8CrossRef Comabella M, Balashov K, Issazadeh S, et al. Elevated interleukin-12 in progressive multiple sclerosis correlates with disease activity and is normalized by pulse cyclophosphamide therapy. J Clin Invest 1998; 102: 671–8CrossRef
15.
go back to reference Chelmicka-Schorr E, Kwasniewski MN, Thomas BE, et al. The beta-adrenergic agonist isoproterenol suppresses experimental allergic encephalomyelitis in Lewis rats. J Neuroimmunol 1989; 25: 203–7CrossRef Chelmicka-Schorr E, Kwasniewski MN, Thomas BE, et al. The beta-adrenergic agonist isoproterenol suppresses experimental allergic encephalomyelitis in Lewis rats. J Neuroimmunol 1989; 25: 203–7CrossRef
16.
go back to reference Muthyala S, Wiegmann K, Kim DH, et al. Experimental allergic encephalomyelitis, beta-adrenergic receptors and interferon gamma-secreting cells in beta-adrenergic agonist-treated rats. Int J Immunopharmacol 1995; 17: 895–901CrossRef Muthyala S, Wiegmann K, Kim DH, et al. Experimental allergic encephalomyelitis, beta-adrenergic receptors and interferon gamma-secreting cells in beta-adrenergic agonist-treated rats. Int J Immunopharmacol 1995; 17: 895–901CrossRef
17.
go back to reference Wiegmann K, Muthyala S, Kim DH, et al. Beta-adrenergic agonists suppress chronic/relapsing experimental allergic encephalomyelitis (CREAE) in Lewis rats. J Neuroimmunol 1995; 56: 201–6CrossRef Wiegmann K, Muthyala S, Kim DH, et al. Beta-adrenergic agonists suppress chronic/relapsing experimental allergic encephalomyelitis (CREAE) in Lewis rats. J Neuroimmunol 1995; 56: 201–6CrossRef
18.
go back to reference Malfait AM, Malik AS, Marinova-Mutafchieva L, et al. The beta2-adrenergic agonist salbutamol is a potent suppressor of established collagen-induced arthritis: mechanisms of action. J Immunol 1999; 162: 6278–83PubMed Malfait AM, Malik AS, Marinova-Mutafchieva L, et al. The beta2-adrenergic agonist salbutamol is a potent suppressor of established collagen-induced arthritis: mechanisms of action. J Immunol 1999; 162: 6278–83PubMed
19.
go back to reference van der Pouw Kraan TC, Boeije LC, Smeenk RJ, et al. Prostaglandin-E2 is a potent inhibitor of human interleukin 12 production. J Exp Med 1995; 181: 775–9CrossRef van der Pouw Kraan TC, Boeije LC, Smeenk RJ, et al. Prostaglandin-E2 is a potent inhibitor of human interleukin 12 production. J Exp Med 1995; 181: 775–9CrossRef
20.
go back to reference Vulliemoz Y, Verosky M, Triner L. Effect of albuterol and terbutaline, synthetic beta adrenergic stimulants, on the cyclic 3′,5′-adenosine monophosphate system in smooth muscle. J Pharmacol Exp Ther 1975; 195: 549–56PubMed Vulliemoz Y, Verosky M, Triner L. Effect of albuterol and terbutaline, synthetic beta adrenergic stimulants, on the cyclic 3′,5′-adenosine monophosphate system in smooth muscle. J Pharmacol Exp Ther 1975; 195: 549–56PubMed
21.
go back to reference Butcher FR, Goldman JA, Nemerovski M. Effect of adrenergic agents on alpha-amylase release and adenosine 3′,5′-monophosphate accumulation in rat parotid tissue slices. Biochim Biophys Acta 1975; 392(1): 82–94CrossRef Butcher FR, Goldman JA, Nemerovski M. Effect of adrenergic agents on alpha-amylase release and adenosine 3′,5′-monophosphate accumulation in rat parotid tissue slices. Biochim Biophys Acta 1975; 392(1): 82–94CrossRef
22.
go back to reference Panina-Bordignon P, Mazzeo D, Lucia PD, et al. Beta2-agonists prevent Th1 development by selective inhibition of interleukin 12. J Clin Invest 1997; 100: 1513–9CrossRef Panina-Bordignon P, Mazzeo D, Lucia PD, et al. Beta2-agonists prevent Th1 development by selective inhibition of interleukin 12. J Clin Invest 1997; 100: 1513–9CrossRef
23.
go back to reference Arnason BG, Brown M, Maselli R, et al. Blood lymphocyte beta-adrenergic receptors in multiple sclerosis. Ann N Y Acad Sci 1988; 540: 585–8CrossRef Arnason BG, Brown M, Maselli R, et al. Blood lymphocyte beta-adrenergic receptors in multiple sclerosis. Ann N Y Acad Sci 1988; 540: 585–8CrossRef
24.
go back to reference Zoukos Y, Kidd D, Woodroofe MN, et al. Increased expression of high affinity IL-2 receptors and beta-adrenoceptors on peripheral blood mononuclear cells is associated with clinical and MRI activity in multiple sclerosis. Brain 1994; 117: 307–15CrossRef Zoukos Y, Kidd D, Woodroofe MN, et al. Increased expression of high affinity IL-2 receptors and beta-adrenoceptors on peripheral blood mononuclear cells is associated with clinical and MRI activity in multiple sclerosis. Brain 1994; 117: 307–15CrossRef
25.
go back to reference Makhlouf K, Comabella M, Imitola J, et al. Oral salbutamol decreases IL-12 in patients with secondary progressive multiple sclerosis. J Neuroimmunol. In press Makhlouf K, Comabella M, Imitola J, et al. Oral salbutamol decreases IL-12 in patients with secondary progressive multiple sclerosis. J Neuroimmunol. In press
26.
go back to reference Brindle PK, Montminy MR. The CREB family of transcription activators. Curr Opin Genet Dev 1992; 2: 199–204CrossRef Brindle PK, Montminy MR. The CREB family of transcription activators. Curr Opin Genet Dev 1992; 2: 199–204CrossRef
27.
go back to reference Farmer P, Pugin J. β-Adrenergic agonists exert their ‘anti-inflammatory’ effects in monocytic cells through the IκB/NF-κB pathway. Am J Physiol Lung Cell Mol Physiol 2000; 279(4): L675–82CrossRef Farmer P, Pugin J. β-Adrenergic agonists exert their ‘anti-inflammatory’ effects in monocytic cells through the IκB/NF-κB pathway. Am J Physiol Lung Cell Mol Physiol 2000; 279(4): L675–82CrossRef
28.
go back to reference Ghosh S, Baltimore D. Activation in vitro of NF-kappa B by phosphorylation of its inhibitor I kappa B. Nature 1990; 344: 678–82CrossRef Ghosh S, Baltimore D. Activation in vitro of NF-kappa B by phosphorylation of its inhibitor I kappa B. Nature 1990; 344: 678–82CrossRef
29.
go back to reference Du C, Sriram S. Induction of interleukin-12/p40 by superantigens in macrophages is mediated by activation of nuclear factor-kappaB. Cell Immunol 2000; 199: 50–7CrossRef Du C, Sriram S. Induction of interleukin-12/p40 by superantigens in macrophages is mediated by activation of nuclear factor-kappaB. Cell Immunol 2000; 199: 50–7CrossRef
30.
go back to reference Ghosh S, May MJ, Kopp EB. NF-kappa B and Rel proteins: evolutionarily conserved mediators of immune responses. Annu Rev Immunol 1998; 16: 225–60CrossRef Ghosh S, May MJ, Kopp EB. NF-kappa B and Rel proteins: evolutionarily conserved mediators of immune responses. Annu Rev Immunol 1998; 16: 225–60CrossRef
31.
go back to reference Zhong H, Voll RE, Ghosh S. Phosphorylation of NF-kappa B p65 by PKA stimulates transcriptional activity by promoting a novel bivalent interaction with the coactivator CBP/p 300. Mol Cell 1998; 1:661–71CrossRef Zhong H, Voll RE, Ghosh S. Phosphorylation of NF-kappa B p65 by PKA stimulates transcriptional activity by promoting a novel bivalent interaction with the coactivator CBP/p 300. Mol Cell 1998; 1:661–71CrossRef
32.
go back to reference Zhong H, SuYang H, Erdjument-Bromage H, et al. The transcriptional activity of NF-kappaB is regulated by the IkappaB-associated PKAc subunit through a cyclic AMP-independent mechanism. Cell 1997; 89(3): 413–24CrossRef Zhong H, SuYang H, Erdjument-Bromage H, et al. The transcriptional activity of NF-kappaB is regulated by the IkappaB-associated PKAc subunit through a cyclic AMP-independent mechanism. Cell 1997; 89(3): 413–24CrossRef
33.
go back to reference Parry GC, Mackman N. Role of cyclic AMP response element-binding protein in cyclic AMP inhibition of NF-kappaB-mediated transcription. J Immunol 1997; 159: 5450–6PubMed Parry GC, Mackman N. Role of cyclic AMP response element-binding protein in cyclic AMP inhibition of NF-kappaB-mediated transcription. J Immunol 1997; 159: 5450–6PubMed
34.
go back to reference Platzer C, Fritsch E, Eisner T, et al. Cyclic adenosine monophosphate-responsive elements are involved in the transcriptional activation of the human IL-10 gene in monocytic cells. Eur J Immunol 1999; 29: 3098–104CrossRef Platzer C, Fritsch E, Eisner T, et al. Cyclic adenosine monophosphate-responsive elements are involved in the transcriptional activation of the human IL-10 gene in monocytic cells. Eur J Immunol 1999; 29: 3098–104CrossRef
35.
go back to reference Suberville S, Bellocq A, Fouqueray B, et al. Regulation of interleukin-10 production by beta-adrenergic agonists. Eur J Immunol 1996; 26: 2601–5CrossRef Suberville S, Bellocq A, Fouqueray B, et al. Regulation of interleukin-10 production by beta-adrenergic agonists. Eur J Immunol 1996; 26: 2601–5CrossRef
36.
go back to reference Hasko G, Szabo C, Nemeth ZH, et al. Suppression of IL-12 production by phosphodiesterase inhibition in murine endotoxemia is IL-10 independent. Eur J Immunol 1998; 28: 468–72CrossRef Hasko G, Szabo C, Nemeth ZH, et al. Suppression of IL-12 production by phosphodiesterase inhibition in murine endotoxemia is IL-10 independent. Eur J Immunol 1998; 28: 468–72CrossRef
37.
go back to reference Sommer N, Loschmann PA, Northoff GH, et al. The antidepressant rolipram suppresses cytokine production and prevents autoimmune encephalomyelitis. Nat Med 1995; 1: 244–8CrossRef Sommer N, Loschmann PA, Northoff GH, et al. The antidepressant rolipram suppresses cytokine production and prevents autoimmune encephalomyelitis. Nat Med 1995; 1: 244–8CrossRef
38.
go back to reference Genain CP, Roberts T, Davis RL, et al. Prevention of autoimmune demyelination in non-human primates by a cAMP-specific phosphodiesterase inhibitor. Proc Natl Acad Sci U S A 1995; 92: 3601–5CrossRef Genain CP, Roberts T, Davis RL, et al. Prevention of autoimmune demyelination in non-human primates by a cAMP-specific phosphodiesterase inhibitor. Proc Natl Acad Sci U S A 1995; 92: 3601–5CrossRef
39.
go back to reference Folcik VA, Smith T, O’Bryant S, et al. Treatment with BBB022A or rolipram stabilizes the blood-brain barrier in experimental autoimmune encephalomyelitis: an additional mechanism for the therapeutic effect of type IV phosphodiesterase inhibitors. J Neuroimmunol 1999; 97: 119–28CrossRef Folcik VA, Smith T, O’Bryant S, et al. Treatment with BBB022A or rolipram stabilizes the blood-brain barrier in experimental autoimmune encephalomyelitis: an additional mechanism for the therapeutic effect of type IV phosphodiesterase inhibitors. J Neuroimmunol 1999; 97: 119–28CrossRef
40.
go back to reference Bielekova B, Lincoln A, McFarland H, et al. Therapeutic potential of phosphodiesterase-4 and -3 inhibitors in Th1-mediated autoimmune diseases. J Immunol 2000; 164: 1117–24CrossRef Bielekova B, Lincoln A, McFarland H, et al. Therapeutic potential of phosphodiesterase-4 and -3 inhibitors in Th1-mediated autoimmune diseases. J Immunol 2000; 164: 1117–24CrossRef
Metadata
Title
Potential of β2-Adrenoceptor Agonists as Add-On Therapy for Multiple Sclerosis
Focus on Salbutamol (Albuterol)
Authors
Karim Makhlouf
Howard L. Weiner
Dr Samia J. Khoury
Publication date
01-01-2002
Publisher
Springer International Publishing
Published in
CNS Drugs / Issue 1/2002
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI
https://doi.org/10.2165/00023210-200216010-00001

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