ALSUntangled No. 37: Inosine*

Inosine in Neurodegenerative Diseases: From the Bench to the Bedside

“…A noteworthy advantage is that inosine is a low-cost supplement. Indeed, the cost for a monthly supply of inosine is nearly USD 10–60, depending on the brand and the dose of inosine necessary to achieve the required blood levels of urate [ 9 ]. Furthermore, due to its ready availability as an over-the-counter supplement, inosine might represent a quite simple strategy for symptomatic relief and possible treatment of different neurological impairments [ 73 ].…”

“…Although the biological mechanisms that lead to ALS are not fully clarified, both autopsy and laboratory studies have shown that they can include damage to motor neurons from oxidative stress, thus laying the groundwork for the use of edaravone in ALS and for the possibility that antioxidants in general, including urate or agents able to raise urate levels (e.g., inosine), might be neuroprotective in ALS [ 9 , 58 ]. Of note, blood urate levels are lower in ALS patients than in healthy controls [ 16 ].…”

“…Of note, blood urate levels are lower in ALS patients than in healthy controls [ 16 ]. Several studies, but not all, have shown that high urate levels are associated with better survival in ALS [ 9 ]. In addition to the neuroprotective action mediated by a urate increase, inosine could boost reinnervation in ALS [ 9 ].…”

“…Several studies, but not all, have shown that high urate levels are associated with better survival in ALS [ 9 ]. In addition to the neuroprotective action mediated by a urate increase, inosine could boost reinnervation in ALS [ 9 ]. Furthermore, different studies have revealed that metabolic dysfunction is a pivotal mechanism involved in the pathogenesis of ALS and that it might influence the rate of disease progression [ 19 ].…”

“…Inosine is available as an oral supplement that can raise blood levels of urate and can also pass through the blood–brain barrier and increase cerebrospinal fluid (CSF) levels of urate [ 7 , 9 ]. While urate seems to be quickly degraded in the intestinal tract by bacterial flora, the oral administration of inosine can rapidly increase serum urate [ 10 ].…”