Treatment with the phosphodiesterase type-4 inhibitor rolipram fails to inhibit blood—brain barrier disruption in multiple sclerosis

• Published in: Multiple sclerosis 2009-10, Vol.15 (10), p.1206-1214
• Main Authors: Bielekova, Bibiana, Richert, Nancy, Howard, Thomas, Packer, Amy N, Blevins, Gregg, Ohayon, Joan, McFarland, Henry F, Stürzebecher, Claus-Steffen, Martin, Roland
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biomarkers - metabolism; Blood-Brain Barrier - drug effects; Blood-Brain Barrier - pathology; Cell Proliferation - drug effects; Contrast Media; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Humans; Immunophenotyping; Inflammation - diagnosis; Inflammation - drug therapy; Inflammation - pathology; Magnetic Resonance Imaging; Medical sciences; Multiple Sclerosis - diagnosis; Multiple Sclerosis - drug therapy; Multiple Sclerosis - immunology; Multiple Sclerosis - metabolism; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Neurology; Phosphodiesterase 4 Inhibitors; Phosphodiesterase Inhibitors - adverse effects; Phosphodiesterase Inhibitors - therapeutic use; Rolipram - adverse effects; Rolipram - therapeutic use; T-Lymphocytes - pathology; Time Factors; Treatment Failure
• ISSN: 1352-4585; 1477-0970; 1477-0970
• DOI: 10.1177/1352458509345903

Rolipram, a prototypic phosphodiesterase-4 inhibitor, is highly effective in suppressing Th1 autoimmunity in multiple animal models, including experimental autoimmune encephalomyelitis. In addition, rolipram has been extensively studied as a potential neuroprotective agent. Based on its anti-inflammatory activity, we tested the efficacy of rolipram in suppressing inflammatory disease activity in multiple sclerosis in a proof-of-principle phase I/II open-label clinical trial. Enrolled MS patients were evaluated by monthly MRI and clinical examinations during 3 months (four MRIs) of pretreatment baseline and 8 months of rolipram therapy. The primary outcome was a change in contrast-enhanced lesions between baseline and the last 4 months of rolipram therapy. Previously defined biomarkers of rolipram-mediated immunomodulation were evaluated during the study. The trial was stopped prematurely because the drug was poorly tolerated and because of safety concerns: we observed an increase, rather than decrease, in the brain inflammatory activity measured by contrast-enhanced lesions on brain MRI. At the administered doses rolipram was active in vivo as documented by immunological assays. We conclude that the reasons underlying the discrepancy between the therapeutic efficacy of rolipram in experimental autoimmune encephalomyelitis versus multiple sclerosis are at present not clear.