Treatment with penicillin G and hydrocortisone reduces ALS-associated symptoms: a case series of three patients

Abstract

Three male Caucasian patients with ALS were admitted to the hospital due to progressive dysphagia and dysarthria. During two 21-day courses of penicillin G and hydrocortisone, these patients’ dysphagia and dysarthria resolved. The patient’s other ALS-associated symptoms also improved, including respiratory function, coordination, walking, and muscle strength. This is the first report of a treatment with a protocol for treating dysphagia, dysarthria, respiratory depression and other ALS-related symptoms. Furthermore, the observations are consistent with the recent hypothesis that the successful treatment of ALS symptoms with this treatment course in six patients with syphilitic ALS was not directly due to the treatment of syphilis; but that the administered penicillin G and/or hydrocortisone treated these patients’ ALS symptoms due the off-target pharmacological activity of penicillin G and/or hydrocortisone. This report therefore underscores the need to evaluate the efficacy of this treatment course in a clinical trial.

Oh my gut! Is the microbial origin of neurodegenerative diseases real?

“…Sun et al analyzed antibiotic use among 2,484 Swedish ALS patients and found an increased risk associated with all antibiotics, especially β-lactamase-sensitive penicillin ( 44 ). While these results suggest that the disruption of the protective microbiota might contribute to the disease pathogenesis, other studies showed a protective effect of penicillin ( 45 ). Such discrepancy in the influence of antibiotics on ALS pathogenicity is likely attributed to two factors: disruption of the protective microbiota and elimination of proteotoxic bacteria.…”

New developments and opportunities in drugs being trialed for amyotrophic lateral sclerosis from 2020 to 2022

“…Penicillin G/hydrocortisone may suppress gamma aminobutyric acid (GABA). In three Caucasian patients, it was reported that their symptoms were improved with the treatment ( Tuk et al, 2017 ). However, data from a 16-person phase 2 trial showed that it could not halt the progression of disease ( Van Es et al, 2020 ).…”

ALSUntangled 46: penicillin G/hydrocortisone

“…Of potential interest, Tuk cites one study in an ALS preclinical model utilizing glucocorticoids (21). In this study, mutant SOD1 mice were given either saline, the synthetic glucocorticoid steroid methylprednisolone in free form or methylprednisolone in a special molecular packaging.…”

“…The only published case reports we found describing PALS without syphilis taking PNG/HC were the case series authored by Dr. Tuk (21). He describes three patients reportedly diagnosed with ALS at the Netherlands National ALS Center that were given at least two 21-day rounds of intravenous PNG with a 10-week break between infusions.…”

“…Glucocorticoids have many associated dose-dependent side-effects from different organ systems including hypertension and adrenal insufficiency (57). In Dr. Tuk's case series, two of the three treated PALS experienced hypertension with associated headaches that required an anti-hypertensive medication to treat and resolved on discontinuation of the HC (21). Based on the available evidence, ALSUntangled assigns PNG/HC a "risks" grade of D (Table 1).…”