Les ganglions de la base (GB) sont un ensemble de noyaux sous-corticaux impliqués dans les fonctions motrices, mnésiques et cognitives. Le globus pallidus externe (GPe) est un noyau GABAergique, qui tient la place de structure relais entre le striatum et le noyau sous-thalamique au sein du réseau des GB. Les changements de mode et de fréquence de décharge des neurones du GPe sont connus pour être les signatures électro-physiologiques des maladies de Parkinson (MP) et de Huntington (MH). Dans la MP, où les concentrations de GABA extracellulaires sont anormalement élevées dans le GPe, il est admis que la voie striato-pallidale (STR-GPe) est hyperactive, ce qui contribue à l’hypoactivité des neurones pallidaux. A l’inverse dans la MH, il est admis que l’hyperactivité des neurones du GPe est due à la dégénérescence de la voie STR-GPe levant la principale influence inhibitrice du GPe. Cependant, les mécanismes moléculaires impliqués dans ces changements d’activité pallidale sont encore peu connus. Nous avons donc entrepris des expériences de biologie moléculaire, d’immunohistochimie et d’électrophysiologie sur tranches, afin de mieux caractériser l’origine des modifications de transmission GABAergique conduisant aux changements d’activité électro-physiologique des neurones du GPe dans ces deux pathologies à l’aide de modèles animaux. Mes principaux résultats montrent l’apparition d’une inhibition tonique dans les neurones du GPe due à un déficit de recapture du GABA dans la MP et une réduction précoce de la transmission synaptique GABAergique dans la MH. Ces résultats suggèrent que les altérations de la transmission GABAergique contribuent à la physiopathologie de la MP et la MH. / The basal ganglia (BG) are a group of sub-cortical nuclei involved in motor, memory and cognitive functions. In the BG, the GABAergic external globus pallidus (GPe) holds a position of relay nucleus between the striatum (STR) and the sub thalamic nucleus within the indirect pathway of the BG. Modifications of rate and pattern of activity of this nucleus are known to be the electrophysiological signatures of Parkinson’s (PD) and Huntington’s diseases (HD). In PD, hyperactivity of the striato-pallidal (STR-GPe) pathway is thought to be responsible for the increase of the extracellular GABAergic concentrations in the GPe and participate to the hypoactivity of pallidal neurons observed in experimental Parkinsonism. In contrast, during HD, it is recognized that the hyperactivity of GPe neurons is due to the degeneration of striato-pallidal neurons and thus to the reduction of the main source of pallidal GABAergic inhibition. However, the molecular mechanisms involved in these modifications of pallidal activity are not well characterized. Therefore, using PD and HD animal models, the 6-OHDA rodents and the R6-1 transgenic mice respectively, we have performed molecular biology, immunohistochemistry and electrophysiological in vitro experiments in order to better understand the origin of GABAergic transmission alterations leading to changes in electrophysiological activity of GPe neurons into these two pathologies. My main results show the apparition of a tonic GABAergic inhibition due to a deficit of GABA uptake in PD and a early stage reduction of GABAergic synaptic transmission in HD. Altogether, these results suggest that alterations of GABAergic transmission contribute to the pathophysiology of PD and HD.

La symptomatologie non motrice de la maladie de Parkinson s’accompagne fréquemment d’un défaut de contrôle cognitif. Le contrôle cognitif faisant référence à un ensemble de processus facilitant le traitement de l’information et la production de comportements adaptés, son altération impactera de très nombreuses capacités cognitives. Parmi ces capacités, nous nous intéresserons plus spécifiquement, d’une part, à la production orale de mots évaluée à travers les tests de fluences verbales et, d’autre part, aux processus favorisant la production d’actions intentionnelles en situation motivée comme évaluée par la Simon Task motivée. Par notre première étude nous remettrons en question l’hypothèse d’un défaut de contrôle cognitif comme origine principale de la réduction des performances aux tests de fluences verbales à la suite de la stimulation cérébrale profonde du noyau subthalamique. En effet, nous n’avons pas mis en évidence de relation entre cette altération et une modification de l’activité métabolique des régions frontales supportant le contrôle cognitif, ou une modification des performances à d’autres tests nécessitant un contrôle cognitif efficient. Les travaux suivant, portant sur le contrôle des actions motivées démontrent, d’une part, que la production d’actions guidées, non pas par des tendances d’actions impulsives, mais par des tendances d’actions en accord avec les intentions, est plus ardue lorsqu’une récompense financière est mise en jeu. D’autre part, le traitement de la maladie de Parkinson, aussi bien par dopathérapie que par stimulation cérébrale profonde du noyau sous-thalamique module le fonctionnement des processus impliqués, suggérant un rôle particulier des noyaux gris centraux. Nous discuterons des processus cognitifs et neuronaux impliqués et proposerons des perspectives de recherche aussi bien neuroscientifiques que cliniques. / The nonmotor symptoms of Parkinson’s disease frequently include a cognitive control deficit. Cognitive control refers to a set of processes that promote information processing and the production of appropriate behaviours, so its impairment can have an impact on a wide range of cognitive abilities. We focused on just two of these abilities: oral word production, as assessed with phonemic and semantic verbal fluency tests; and cognitive action control in an incentive context, as assessed with a rewarded Simon Task. In our first study, we questioned the hypothesis that the reduction in verbal fluency performances observed following surgery for subthalamic nucleus deep-brain stimulation is mainly due to a cognitive control deficit. Results failed to reveal a relationship between this reduction and either modified metabolic activity in the frontal regions subtending cognitive control or modified performances on other tests requiring efficient cognitive control. In our second and third studies, investigating cognitive action control in an incentive context, we showed that the production of intention-driven actions, as opposed to impulsive ones, is more difficult when a monetary reward is at stake. We also demonstrated that treatment for Parkinson’s disease, whether it takes the form of dopaminergic medication or subthalamic stimulation, modulates the functioning of these processes, suggesting that the basal ganglia have a role in them. We discuss the cognitive and neural processes involved and outline future avenues for both neuroscientific and clinical research.

Les ganglions de la base (GB) forment une boucle complexe avec le cortex et le thalamus qui est impliquée dans la sélection de l’action et le contrôle du mouvement. Les activités oscillatoires synchronisées dans le réseau des GB ont été proposées comme pouvant jouer un rôle essentiel dans la coordination du flux de l’information au sein de ces circuits neuronaux. Ainsi, leur dérégulation dans le temps et l’espace pourrait devenir pathologique. Dans la maladie de Parkinson (MP), l’expression anormalement élevée d’oscillations neuronales comprises dans les gammes de fréquences beta (β, 10-30 Hz) serait la cause des déficits moteurs (akinétique et bradykinétique) de cette maladie. Cependant, les réseaux neuronaux à l’origine des oscillations β et l’implication physiopathologique de celles-ci restent encore inconnus. Le noyau sous-thalamique (NST) est un carrefour anatomique des GB situé au centre de réseaux potentiellement impliqués dans l’émergence de ces états hyper-synchronisés. L’objectif de cette thèse était de déterminer le rôle causal des principales entrées du NST (i.e. le cortex moteur, le globus pallidus, et le noyau parafasciculaire du thalamus) dans le maintien et la propagation des oscillations β. Pour cela, nous avons développé des approches de manipulation optogénétique combinées à des enregistrements électrophysiologiques in vivo dans un modèle rongeur de la MP. L’ensemble de nos travaux démontre la contribution respective des différents circuits neuronaux interrogés et souligne l’importance du globus pallidus dans le contrôle de la propagation et du maintien des oscillations β dans l’ensemble de la boucle des GB. / The basal-ganglia (BG) form a complex loop with the cortex and the thalamus that is involved in action selection and movement control. Synchronized oscillatory activities in basal-ganglia neuronal circuits have been proposed to play a key role in coordinating information flow within this neuronal network. If synchronized oscillatory activities are important for normal motor function, their dysregulation in space and time could be pathological. Indeed, in Parkinson’s disease (PD), many studies have reported an abnormal increase in the expression level of neuronal oscillations contain in the beta (β) frequency range (15-30 Hz). These abnormal β oscillations have been correlated with two mains symptoms of PD: akinesia/bradykinesia. However, which BG neuronal circuits generate those abnormal β oscillations, and whether they play a causal role in PD motor dysfunction is not known. The subthalamic nucleus (STN) is a key nucleus in BG that receives converging inputs from the motor cortex, the parafascicular thalamic nucleus and the globus pallidus. Here, we used a rat model of PD combined with in vivo electrophysiological recordings and optogenetic silencing to investigate how selective manipulation of STN inputs causally influence BG network dynamic. Our data highlight the causal role of the globus pallidus in the generation and propagation mechanisms of abnormal β-oscillations.

L’objectif de cette thèse était de déterminer si différentes psychothérapies préopératoires, et notamment une prise en charge de restructuration cognitive, avaient un impact sur le profil psychiatrique et psychologique de patients parkinsoniens subissant une stimulation cérébrale profonde des noyaux sous thalamiques. On cherchait d’une part à montrer l’impact de cette prise en charge restructurative sur les variables psychiatriques (dépression, anxiété, apathie), la perception de la maladie et les attentes concernant le résultat de la chirurgie, le déploiement de stratégies de coping, la qualité de vie et l’adaptation sociale. On cherchait, d’autre part, à déterminer l’interaction entre les capacités neuropsychologiques et le bénéfice que les patients pouvaient retirer de la prise en charge restructurative. Il apparaît que la prise en charge psychothérapique préopératoire, surtout restructurative, permette aux patients de moduler leur perception de la maladie et leurs attentes du résultat de la chirurgie. Certaines variables de la qualité de vie, notamment des variables mentales, apparaissent également plus améliorées chez les patients ayant bénéficié de la restructuration cognitive. L’ensemble des patients présente une utilisation forte de stratégies d’adaptation basée sur le soutien instrumental en préopératoire, alors qu’ils utilisent davantage la stratégie d’adaptation basée sur l’accommodation à leurs troubles en postopératoire. Par ailleurs, il existe un lien entre les performances neuropsychologiques et le bénéfice de la prise en charge psychothérapique préopératoire, à savoir la préservation des capacités exécutives de déduction, d’adaptation à un feedback, de conceptualisation et de mémoire de travail ainsi qu’une préservation des capacités mnésiques épisodiques verbales, sont liées à un meilleur bénéfice de la prise en charge psychothérapique sur la perception de la maladie et les attentes du résultat de la chirurgie. On n’observe pas d’impact de la prise en charge préopératoire sur le profil psychiatrique ou l’adaptation sociale. / The purpose of this thesis was to determine the impact of different preoperative psychotherapies, particularly one based on cognitive restructuration, on the psychiatric and psychological profile of parkinson’s disease patients candidate to deep brain stimulation. On the one hand, we wanted to determine the impact of the restructurative therapy on psychiatric variables (depression, anxiety, apathy), disease perception, expectations for surgery, coping strategies, quality of life and social adjustment. On the other hand, we wanted to determine the possible interaction between neuropsychological variables and the impact of cognitiverestructuration. Parkinsonian patients can modulate their disease perception and their expectations toward the result of surgery, thanks to preoperative preparation, notably the restructurative one. Some quality of life variables, in particular the mental one, seem to be more improved after cognitive restructuration. The whole sample uses higher instrumental support preoperatively, whereas they use more accomodation strategy based on acceptation postoperatively. What is more, neuropsychological performances and impact of preoperative psychotherapy seem to be linked, as preservation of deducation, conceptualisation, feedback adaptation, working memory, are linked to a better impact of psychotherapy on disease perception and surgical expectations. No impact of preoperative preparation on psychiatric profile or social adjustment was observed.

La maladie de Parkinson (MP) provient de la dégénérescence des cellules du locus nigerproduisant de la dopamine. La barrière hémato-encéphalique (BHE) est un véritable obstacle pour le traitement de la MP car elle empêche ou réduit le passage d’un grand nombre de substances pharmacologiques vers le cerveau. L’encapsulation de ces substances dans des liposomes ou des niosomes avant leur libération intra-cérébrale représente une alternative de choix en raison de la biocompatibilité, la biofragmentation, la non-toxicité et les capacités de ciblage de ces systèmes. A l’heure actuelle le traitement de la MP reste un défi, malgré l’existence de nombreux projets de recherche dans ce domaine. Notre hypothèse est que l’administration de pramipexoleencapsulé dans des liposomes et/ou des niosomes pourrait représenter une approche thérapeutique pertinente. Dans le cadre de la thèse, la caractérisation et la cinétique de diffusion des liposomes et niosomescontenant du pramipexole ont été réalisées. La validation de différentes formulations a été réalisée sur un modèle de BHE constitué de co-cultures cellulaires. Les effets du pramipexoleencapsulé dans des liposomes ou desniosomesont ensuite été étudiés dans un modèle de MP chez le rat obtenu par lésion de la voie dopaminergique nigro-striée à l’aide de 6-hydroxydopamine (6-OHDA). Pour cela, nous avons évalué le comportement rotatoire induit par l’amphétamine et l’expression du transporteur de la dopamine (DAT) par autoradiographie quantitative chez des animaux lésés traités ou non par les nanocapsules. Toutes les formulations que nous avons réalisées ont montré une capacité d’encapsulation d’environ 10% pour une taille de 100 nm, avec une cinétique de dispersion compatible avec une utilisation in vivo. Dans notre modèle de co-culture cellulaire, nous avons déterminé que nos formulations permettent le franchissement de la BHE. Chez les animaux lésés à la 6-OHDA, la quantification du DAT indique que l’administration de pramipexole réduit l’intensité de la lésion, que la substance soit administrée seule ou encapsulée dans des niosomes. Ces travaux montrent l’intérêt potentiel de l’administration de principe actif encapsulé pour le traitement de la MP, et devront être poursuivis afin d’optimiser cette approche thérapeutique, notamment au niveau des doses. / Parkinson’s Disease (PD) is degeneration of dopamine producing cells in substantia nigra. Blood-brain barrier (BBB) is a strong obstacle in PD therapy. More penetration and accumulation in the target tissue can be obtained by preventing RES uptake via “stealth effect”. Liposomes and niosomes are the promising systems for being biodegredable, bioavailable, non-toxic and targetable. Although CNS disorders are the first to endorse at their research in the diagnosis and therapy with several framework projects in Europe and over the world, there is still a huge gap in CNS drug delivery and the success of PD therapy. Although different studies have performed with pramipexole, evaluation of penetration and antiparkinsonian effect of pramipexole encapsulated liposomes and niosomes has never been studied before. Among this thesis, nanosized, polyethylene glycol (PEG) coated, neutral and positively charged, pramipexole encapsulated liposomes and noisomes were formulated, characterized and release kinetics of the systems were evaluated. In vitro penetration of all formulations was evaluated in BBB cell co-culture model. Therapeutic efficacy of neutral, pramipexole encapsulated liposomes and niosomes were evaluated in 6-hydroxydopamine (6-OHDA) lesioned rats by rotometer test and autoradiography. All formulations have approximately 10% encapsulation efficiency, around 100 nm particle sizes and fitted to first-order release kinetics. All formulations were found BBB permeable at in vitro cell culture studies. Nanosized, neutral niosomes designated similar but slightly better effect than pramipexole solution in autoradiograhy studies in 6-OHDA lesioned rats. This pramipexole dose is approximately 9 times lesser doses applied with conventional pramipexole tablets for humans in Neurology clinics. Nanosized, pramipexole encapsulated, neutral niosomes showed potential PD therapeutic effect in PD animal model depending on non-ionic surfactant properties of niosomes. / Uzm. Ecz. Mine Silindir Gunay, Parkinson Hastalığı’nın Teşhis ve Tedavisi İçin Kullanılacak Nanoboyutlu Teragnostik İmmünolipozom/İmmunoniozomlar Üzerine İn Vitro İn Vivo Çalışmalar, Hacettepe Üniversitesi – François Rabelais de Tours University, Sağlık Bilimleri Enstitüsü, Radyofarmasi Programı, UMR Inserm U 930, Ekip 3, Moleküler Görüntüleme ve Beyin Programı, Doktora Tezi, Ankara-Tours, 2016. Parkinson Hastalığı (PH) substantia nigra’daki dopamin üreten hücrelerin dejenerasyonundan kaynaklanmaktadır. Kan-beyin bariyeri (KBB) PH’nın tedavisinin önünde kuvvetli bir engeldir. Hedef dokudaki yüksek penetrasyon ve tutulum “stealth etki” ile RES tutulumunun engellenmesi ile sağlanabilir. Lipozom ve niozomlar biyoparçalanırlıkları, biyouyumlulukları, non-toksik ve hedeflendirilebilir olmaları nedeniyle en çok tercih edilen sistemlerdendir. Santral sinir sistemi hastalıklarının araştırılması Avrupa ve tüm dünyada yapılan pekçok çerçeve projelerinde ilk sırada olmasına rağmen, halen beyne ilaç taşınması ve PH’nin tedavi başarısı konusunda büyük boşluklar bulunmaktadır. Pramipeksol ile pek çok çalışma yapılmasına karşılık, bizim çalışmamız pramipeksol enkapsüle edilmiş lipozom ve niozomların beyin penetrasyonunun ve antiparkinson etkisinin değerlendirilmesi konusunda yenidir. Tez kapsamında, nanoboyutlu, PEG kaplı, nötral ve pozitif yüklü lipozom ve niozomların formüle edilmiş, karakterizasyon ve salım kinetikleri değerlendirilmiştir. Tüm formülasyonların KBB geçirgenliği, hücre KBB ko-kültürü çalışmalarında incelenmiştir. Nötral, pramipeksol enkapsüle edilen lipozom ve niozomların tedavi etkinliği in vivo olarak 6-hidroksidopamin (6-OHDA) ile lezyon yapılarak PH modeli oluşturulan sıçanlarda rotametre ve otoradyografi çalışmaları ile incelenmiştir. Tüm formülasyonlar yaklaşık %10 enkapsülasyon etkinliği ve 100 nm civarında partikül boyutu dağılımı ve birinci derece salım kinetiği göstermiştir. Hücre kültürü çalışmalarında, tüm formülasyonların KBB’nden penetre olabildiği saptamıştır. 6-OHDA lezyonlu sıçanlarda Parkinson hastalığının tedavisinde nanoboyutlu, nötral, pramipeksol enkapsüle edilen niozomlar, aynı dozdaki pramipeksol çözeltisi ile benzer hatta biraz daha iyi sonuçlar göstermiştir. Bu doz Nöroloji kliniklerinde Parkinson tedavisinde rutin olarak kullanılan konvansiyonel pramipeksol tabletlerindeki dozun yaklaşık olarak 9 kat düşük dozlarıdır. Nanoboyutlu, pramipeksol enkapsüle edilen, nötral niozomlar, niozomların non-iyonik sürfaktan özellikleri nedeniyle PH modeli sıçanlarda potansiyel bir antiparkinson terapötik etki göstermiştir.

New biomarkers are needed to improve knowledge about pathophysiology, in order to provide earlier correct diagnosis and to follow disease progression of the neurodegenerative diseases amyotrophic lateral sclerosis (ALS) and Parkinson's disease (PD). The aim of this thesis was to find new biomarkers for these diseases. First, increased serum levels and unchanged levels in postmortal spinal cord of vascular endothelial growth factor (VEGF) were demonstrated. VEGF was not detected in cerebrospinal fluid (CSF) in ALS. Second, increased levels of fibroblast growth factor 2 were found in the CSF and serum of ALS patients. Both studies used enzyme-linked immunoassays. Third, a proteomics method for CSF analysis was explored, based on tryptic digestion and subsequent separation and detection of the peptides by on-line liquid chromatography-Fourier transform ion cyclotron resonance mass spectrometry. ALS-specific patterns were observed. Four out of five samples were correctly assigned, but no single protein biomarker could be identified. Fourth, [11C](L)-deprenyl-D2 (DED) positron emission tomography (PET) demonstrated increased retention in the pons and white matter in ALS. DED binds to monoamino oxidase B, which in the brain is primarily located in astrocytes. Thus evidence was provided that astrocytosis may be detected in vivo in ALS. Fifth, normal [11C]-PIB binding in five nondemented patients with PD was reported, in contrast to previous findings of increased retention in Alzheimer's disease reflecting amyloid aggregation. Finally, the combined use of fluorodeoxyglucose and L-[β 11C]-DOPA PET for the differential diagnosis of parkinsonian syndromes was evaluated. PET provided support for the clinical diagnosis in 62 out of 75 patients, and served to exclude suspected diagnoses in another five patients.

The overall aim of this thesis was to develop, deploy and evaluate new IT-based methods for supporting treatment and assessment of treatment of advanced Parkinson’s disease. In this condition a number of different motor and non-motor symptoms occur in episodes of varying frequency, duration and severity. In order to determine outcome of treatment changes, repeated assessments are necessary. Hospitalization for observation is expensive and may not be representative for the situation at home. Paper home diaries have questionable reliability and storage and retrieval of results are problematic. Approaches for monitoring using wearable sensors are unable to address important non-motor symptoms. A test battery system consisting of both self-assessments of symptoms and motor function tests was constructed for a touch screen mobile phone. Tests are performed on several occasions per day during test periods of one week. Data is transmitted over the mobile net to a central server where summaries in different symptom dimensions and an overall test score per patient and test period are calculated. There is a web application that graphically presents the results to treating clinical staff. As part of this work, a novel method for assessment of spiral drawing impairment useful during event-driven sampling was developed. To date, the system has been used by over 100 patients in 10 clinics in Sweden and Italy. Evidence is growing that the test battery is useful, reliable and valid for assessment of symptoms during advanced Parkinson’s disease. Infusion of a levodopa/carbidopa gel into the small intestine has been shown to reduce variation in plasma drug levels and improve clinical response in this patient category. A pharmacokinetic-pharmacodynamic model of this intestinal gel infusion was constructed. Possibly this model can assist the process of individualization of dosage for this treatment through in numero simulations. Results from an exploratory data analysis indicate that severity measures during oral levodopa treatment may be factors to consider when deciding candidates for infusion treatment.

A challenge for the clinical management of Parkinson's disease (PD) is the large within- and between-patient variability in symptom profiles as well as the emergence of motor complications which represent a significant source of disability in patients. This thesis deals with the development and evaluation of methods and systems for supporting the management of PD by using repeated measures, consisting of subjective assessments of symptoms and objective assessments of motor function through fine motor tests (spirography and tapping), collected by means of a telemetry touch screen device. One aim of the thesis was to develop methods for objective quantification and analysis of the severity of motor impairments being represented in spiral drawings and tapping results. This was accomplished by first quantifying the digitized movement data with time series analysis and then using them in data-driven modelling for automating the process of assessment of symptom severity. The objective measures were then analysed with respect to subjective assessments of motor conditions. Another aim was to develop a method for providing comparable information content as clinical rating scales by combining subjective and objective measures into composite scores, using time series analysis and data-driven methods. The scores represent six symptom dimensions and an overall test score for reflecting the global health condition of the patient. In addition, the thesis presents the development of a web-based system for providing a visual representation of symptoms over time allowing clinicians to remotely monitor the symptom profiles of their patients. The quality of the methods was assessed by reporting different metrics of validity, reliability and sensitivity to treatment interventions and natural PD progression over time. Results from two studies demonstrated that the methods developed for the fine motor tests had good metrics indicating that they are appropriate to quantitatively and objectively assess the severity of motor impairments of PD patients. The fine motor tests captured different symptoms; spiral drawing impairment and tapping accuracy related to dyskinesias (involuntary movements) whereas tapping speed related to bradykinesia (slowness of movements). A longitudinal data analysis indicated that the six symptom dimensions and the overall test score contained important elements of information of the clinical scales and can be used to measure effects of PD treatment interventions and disease progression. A usability evaluation of the web-based system showed that the information presented in the system was comparable to qualitative clinical observations and the system was recognized as a tool that will assist in the management of patients.

Purpose Monoamine oxidase (MAO) consists of two isoforms, namely MAO-A and MAO-B. Both these isoforms are involved in the oxidation of dopamine. In Parkinson’s disease (PD) therapy, the inhibition of the oxidation of dopamine by MAO may elevate the levels of dopamine in the brain and prevent the generation of toxic by-products such as hydrogen peroxide. MAO-B inhibitors have found application as monotherapy in PD and it has been shown that MAO-B inhibitors may also be useful as adjuvants to L-dopa in PD therapy. For example, an earlier study has shown that the combination of L-dopa with (R)-deprenyl (a selective MAO-B inhibitor), may lead to a reduction of the dose of L-dopa required for alleviating the motor symptoms in PD patients. However, older MAO inhibitors may possess adverse side effects such as psychotoxicity, liver toxicity and cardiovascular effects. The irreversible mode of inhibition of the older MAO-B inhibitors, such as (R)-deprenyl, may also be considered as less desirable. After the use of irreversible inhibitors, it may require several weeks for the MAO enzyme to recover activity. In contrast, after administration of a reversible inhibitor, enzyme activity is recovered as soon as the inhibitor is cleared form the tissues. The adverse effects and disadvantages of the older MAO-B inhibitors prompted us to undertake the discovery of safer and reversible inhibitors of MAO-B. Such compounds may find application in the treatment of PD. Rationale It was recently discovered that (E)-8-(3-chlorostyryl)caffeine (CSC) is a potent inhibitor of MAO-B, with an IC50 value of 0.128 µM. CSC has a caffeine moiety, which is thought to be essential for MAO-B inhibition. It was also reported that a related series of 8- (phenoxymethyl)caffeine derivatives are potent and reversible inhibitors of MAO-A and –B. The IC50 values of the 8-(phenoxymethyl)caffeines ranged from 0.148–5.78 µM for the inhibition of MAO-B. For the purpose of this study the phenoxymethyl side-chain was replaced with a phenylsulfanyl moiety at C8. The aim of this study was therefore to synthesize a series of 8-[(phenylsulfanyl)methyl]caffeine analogues and to compare their MAO-B inhibition potencies to the previously synthesised 8-(phenoxymethyl)caffeine derivatives. A series of five 8-[(phenylsulfanyl)ethyl]caffeine analogues was also synthesized in order to determine the effect of carbon chain elongation on the potency of MAO inhibition. O C-8 N N O N N Caffeine Cl O N N (E) O N N CSC O N N O O N N 8-(Phenoxymethyl)caffeine O N N O N N S 8-[(Phenylsulfanyl)methyl]caffeine O N N S O N N 8-[(Phenylsulfanyl)ethyl]caffeine Compound R1 R2 1a H H 1b Cl H 1c Br H 1d F H 1e CH3 H 1f OCH3 H 1g OCH2CH3 H 1h H Cl 1i H Br Compound R1 R2 2a H H 2b Cl H 2c Br H 2d H Cl 2e H Br Methods The C8 substituted caffeine analogues were synthesised by reacting 1,3-dimethyl-5,6-diaminouracil with an appropriately substituted 2-(phenylsulfanyl)acetic acid or 3-(phenylsulfanyl)propanoic acid in the presence of a carbodiimide activating reagent, N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride (EDAC). Ring closure of the intermediary amide was effected by reaction with sodium hydroxide. Resulting theophylline analogues were subsequently methylated in the presence of iodomethane to yield the target compounds. The structures of the C8 substituted caffeine analogues were verified by NMR and MS analysis. The purities thereof were subsequently estimated by HPLC analysis. The 8-[(phenylsulfanyl)methyl]caffeine and 8-[(phenylsulfanyl)ethyl]caffeine analogues were evaluated as MAO-A and –B inhibitors. The recombinant human enzymes were used as enzyme sources. The inhibitory potencies of the caffeine derivatives were expressed as IC50 values (the concentration of a drug that is required for 50% inhibition in vitro). The time- dependency of inhibition of MAO-B by the most potent inhibitor was also evaluated in order to determine the reversibility of inhibition of the test compound. A study was also conducted to determine the inhibition mode of the most potent test compound, by constructing a set of Lineweaver Burk plots. Results The results showed that the 8-[(phenylsulfanyl)methyl]caffeine analogues were inhibitors of MAO-A and –B. The most potent inhibitor in the first series (1a–i) of this study were 8-[(3- bromophenylsulfanyl)methyl]caffeine and 8-[(4-bromophenylsulfanyl)methyl]caffeine with IC50 values of 4.90 and 4.05 µM, respectively. When these results were compared to those of the previously studied 8-(phenoxymethyl)caffeine derivatives it was found that, for these compounds, the bromine substituted homologues were also the most potent MAO-B inhibitors. The bromine substituted 8-(phenoxymethyl)caffeine derivatives exhibited IC50 values of 0.148 and 0.189 µM for those homologues containing bromine on the meta and para positions of the phenoxy side chain, respectively. In general, the 8- [(phenylsulfanyl)methyl]caffeine derivatives were found to be less potent MAO-B inhibitors than the 8-(phenoxymethyl)caffeine derivatives. The 8-[(phenylsulfanyl)methyl]caffeine derivatives also did not show as high a degree of selectivity for MAO-B (compared to MAO- A) as did the 8-(phenoxymethyl)caffeines. Similar to the 8-(phenoxymethyl)caffeines, the 8- [(phenylsulfanyl)methyl]caffeines also proved to be weak MAO-A inhibitors. The most potent inhibitor of MAO-A among the test compounds exhibited an IC50 value of 19.4 µM. The most potent MAO-A inhibitor among the previously studied 8-(phenoxymethyl)caffeines was more potent with an IC50 value of 4.59 µM. From these results it may be concluded that the phenoxy side chain is more suited for the design of caffeine derived MAO inhibitors than the phenylsulfanyl side chain. The results for the second series investigated in this study, the 8-[(phenylsulfanyl)ethyl]caffeines (2a–e), revealed the chlorine substituted derivatives to be the most potent MAO-B inhibitors. The meta and para chlorine substituted derivatives exhibited IC50 values of 5.67 and 7.79 µM, respectively, for the inhibition of MAO-B. Interestingly, the meta substituted derivative exhibited no inhibition toward the MAO-A isoenzyme. However, the 8-[(phenylsulfanyl)ethyl]caffeine derivatives were found to be very weak inhibitors of both MAO-A and –B and may be considered as less potent than the 8-[(phenylsulfanyl)methyl]caffeine derivatives. Since one of the aims of this study was to synthesise reversible MAO inhibitors, a time- dependency study was carried out with the best inhibitor (1i). The aim of this study was to determine the reversibility of inhibition by the 8-[(phenylsulfanyl)methyl]caffeine derivatives. From the results, it was concluded that the inhibition of MAO-B by compound 1i is reversible. To determine the mode of inhibition, a set of Lineweaver-Burk plots was constructed and since the plots were linear and intersected on the y-axis, it was concluded that 1i is a competitive inhibitor of MAO-B. Conclusion This study concludes that the phenoxymethyl side-chain is more suited for the design of caffeine derived MAO-B inhibitors than the (phenylsulfanyl)methyl side-chain. / Thesis (MSc (Pharmaceutical Chemistry))--North-West University, Potchefstroom Campus, 2013.

Purpose Monoamine oxidase (MAO) consists of two isoforms, namely MAO-A and MAO-B. Both these isoforms are involved in the oxidation of dopamine. In Parkinson’s disease (PD) therapy, the inhibition of the oxidation of dopamine by MAO may elevate the levels of dopamine in the brain and prevent the generation of toxic by-products such as hydrogen peroxide. MAO-B inhibitors have found application as monotherapy in PD and it has been shown that MAO-B inhibitors may also be useful as adjuvants to L-dopa in PD therapy. For example, an earlier study has shown that the combination of L-dopa with (R)-deprenyl (a selective MAO-B inhibitor), may lead to a reduction of the dose of L-dopa required for alleviating the motor symptoms in PD patients. However, older MAO inhibitors may possess adverse side effects such as psychotoxicity, liver toxicity and cardiovascular effects. The irreversible mode of inhibition of the older MAO-B inhibitors, such as (R)-deprenyl, may also be considered as less desirable. After the use of irreversible inhibitors, it may require several weeks for the MAO enzyme to recover activity. In contrast, after administration of a reversible inhibitor, enzyme activity is recovered as soon as the inhibitor is cleared form the tissues. The adverse effects and disadvantages of the older MAO-B inhibitors prompted us to undertake the discovery of safer and reversible inhibitors of MAO-B. Such compounds may find application in the treatment of PD. Rationale It was recently discovered that (E)-8-(3-chlorostyryl)caffeine (CSC) is a potent inhibitor of MAO-B, with an IC50 value of 0.128 µM. CSC has a caffeine moiety, which is thought to be essential for MAO-B inhibition. It was also reported that a related series of 8- (phenoxymethyl)caffeine derivatives are potent and reversible inhibitors of MAO-A and –B. The IC50 values of the 8-(phenoxymethyl)caffeines ranged from 0.148–5.78 µM for the inhibition of MAO-B. For the purpose of this study the phenoxymethyl side-chain was replaced with a phenylsulfanyl moiety at C8. The aim of this study was therefore to synthesize a series of 8-[(phenylsulfanyl)methyl]caffeine analogues and to compare their MAO-B inhibition potencies to the previously synthesised 8-(phenoxymethyl)caffeine derivatives. A series of five 8-[(phenylsulfanyl)ethyl]caffeine analogues was also synthesized in order to determine the effect of carbon chain elongation on the potency of MAO inhibition. O C-8 N N O N N Caffeine Cl O N N (E) O N N CSC O N N O O N N 8-(Phenoxymethyl)caffeine O N N O N N S 8-[(Phenylsulfanyl)methyl]caffeine O N N S O N N 8-[(Phenylsulfanyl)ethyl]caffeine Compound R1 R2 1a H H 1b Cl H 1c Br H 1d F H 1e CH3 H 1f OCH3 H 1g OCH2CH3 H 1h H Cl 1i H Br Compound R1 R2 2a H H 2b Cl H 2c Br H 2d H Cl 2e H Br Methods The C8 substituted caffeine analogues were synthesised by reacting 1,3-dimethyl-5,6-diaminouracil with an appropriately substituted 2-(phenylsulfanyl)acetic acid or 3-(phenylsulfanyl)propanoic acid in the presence of a carbodiimide activating reagent, N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride (EDAC). Ring closure of the intermediary amide was effected by reaction with sodium hydroxide. Resulting theophylline analogues were subsequently methylated in the presence of iodomethane to yield the target compounds. The structures of the C8 substituted caffeine analogues were verified by NMR and MS analysis. The purities thereof were subsequently estimated by HPLC analysis. The 8-[(phenylsulfanyl)methyl]caffeine and 8-[(phenylsulfanyl)ethyl]caffeine analogues were evaluated as MAO-A and –B inhibitors. The recombinant human enzymes were used as enzyme sources. The inhibitory potencies of the caffeine derivatives were expressed as IC50 values (the concentration of a drug that is required for 50% inhibition in vitro). The time- dependency of inhibition of MAO-B by the most potent inhibitor was also evaluated in order to determine the reversibility of inhibition of the test compound. A study was also conducted to determine the inhibition mode of the most potent test compound, by constructing a set of Lineweaver Burk plots. Results The results showed that the 8-[(phenylsulfanyl)methyl]caffeine analogues were inhibitors of MAO-A and –B. The most potent inhibitor in the first series (1a–i) of this study were 8-[(3- bromophenylsulfanyl)methyl]caffeine and 8-[(4-bromophenylsulfanyl)methyl]caffeine with IC50 values of 4.90 and 4.05 µM, respectively. When these results were compared to those of the previously studied 8-(phenoxymethyl)caffeine derivatives it was found that, for these compounds, the bromine substituted homologues were also the most potent MAO-B inhibitors. The bromine substituted 8-(phenoxymethyl)caffeine derivatives exhibited IC50 values of 0.148 and 0.189 µM for those homologues containing bromine on the meta and para positions of the phenoxy side chain, respectively. In general, the 8- [(phenylsulfanyl)methyl]caffeine derivatives were found to be less potent MAO-B inhibitors than the 8-(phenoxymethyl)caffeine derivatives. The 8-[(phenylsulfanyl)methyl]caffeine derivatives also did not show as high a degree of selectivity for MAO-B (compared to MAO- A) as did the 8-(phenoxymethyl)caffeines. Similar to the 8-(phenoxymethyl)caffeines, the 8- [(phenylsulfanyl)methyl]caffeines also proved to be weak MAO-A inhibitors. The most potent inhibitor of MAO-A among the test compounds exhibited an IC50 value of 19.4 µM. The most potent MAO-A inhibitor among the previously studied 8-(phenoxymethyl)caffeines was more potent with an IC50 value of 4.59 µM. From these results it may be concluded that the phenoxy side chain is more suited for the design of caffeine derived MAO inhibitors than the phenylsulfanyl side chain. The results for the second series investigated in this study, the 8-[(phenylsulfanyl)ethyl]caffeines (2a–e), revealed the chlorine substituted derivatives to be the most potent MAO-B inhibitors. The meta and para chlorine substituted derivatives exhibited IC50 values of 5.67 and 7.79 µM, respectively, for the inhibition of MAO-B. Interestingly, the meta substituted derivative exhibited no inhibition toward the MAO-A isoenzyme. However, the 8-[(phenylsulfanyl)ethyl]caffeine derivatives were found to be very weak inhibitors of both MAO-A and –B and may be considered as less potent than the 8-[(phenylsulfanyl)methyl]caffeine derivatives. Since one of the aims of this study was to synthesise reversible MAO inhibitors, a time- dependency study was carried out with the best inhibitor (1i). The aim of this study was to determine the reversibility of inhibition by the 8-[(phenylsulfanyl)methyl]caffeine derivatives. From the results, it was concluded that the inhibition of MAO-B by compound 1i is reversible. To determine the mode of inhibition, a set of Lineweaver-Burk plots was constructed and since the plots were linear and intersected on the y-axis, it was concluded that 1i is a competitive inhibitor of MAO-B. Conclusion This study concludes that the phenoxymethyl side-chain is more suited for the design of caffeine derived MAO-B inhibitors than the (phenylsulfanyl)methyl side-chain. / Thesis (MSc (Pharmaceutical Chemistry))--North-West University, Potchefstroom Campus, 2013.