In a double-blind, placebo-controlled, parallel-group, randomized clinical trial, we studied the efficacy of long-term (1-year) oral treatment with acetyl-L-carnitine in 130 patients with a clinical diagnosis of Alzheimer's disease. We employed 14 outcome measures to assess functional and cognitive impairment. After 1 year, both the treated and placebo groups worsened, but the treated group showed a slower rate of deterioration in 13 of the 14 outcome measures, reaching statistical significance for the Blessed Dementia Scale, logical intelligence, ideomotor and buccofacial apraxia, and selective attention. Adjusting for initial scores with analysis of covariance, the treated group showed better scores on all outcome measures, reaching statistical significance for the Blessed Dementia Scale, logical intelligence, verbal critical abilities, long-term verbal memory, and selective attention. The analysis for patients with good treatment compliance showed a greater drug benefit than for the overall sample. Reported adverse events were relatively mild, and there was no significant difference between the treated and placebo groups either in incidence or severity.
A new class of hydrogen sulfide (H(2)S)-donating hybrids combined with pharmacologically active compounds is presented in this article. The pharmacological profiles of some hybrid lead compounds in the areas of inflammation, H(2)S-donating diclofenac (ACS 15); cardiovascular, H(2)S-donating aspirin (ACS 14); urology, H(2)S-donating sildenafil (ACS 6); and neurodegenerative, H(2)S-donating latanoprost (ACS 67) for glaucoma treatment and H(2)S-donating levodopa (ACS 84) for Parkinson's disease, are described. The new H(2)S-releasing hybrids demonstrate remarkable improvement in activity and tolerability as compared with the related parent compounds, suggesting an active pharmacological role for H(2)S. Finally the mechanism(s) of action of glutathione-dependent and independent, and of gas (H(2)S) release (spontaneous or enzymatic) and its implications for clinical pharmacology perspectives will be also discussed.
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