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Open Access Research article

Lovastatin improves impaired synaptic plasticity and phasic alertness in patients with neurofibromatosis type 1

Florian Mainberger1, Nikolai H Jung1, Martin Zenker2, Ute Wahlländer3, Leonie Freudenberg9, Susanne Langer1, Steffen Berweck4, Tobias Winkler5, Andreas Straube5, Florian Heinen6, Sofia Granström7, Victor-Felix Mautner7, Karen Lidzba8 and Volker Mall1*

Author Affiliations

1 Department of Pediatrics, Technical University Munich, Kinderzentrum München gemeinnützige GmbH, Heiglhofstrasse 63, 81377 Munich, Germany

2 Institute of Human Genetics, University Hospital Erlangen and Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany

3 Institut for General Medicine Ludwig-Maximilians-University Munich, Munich, Germany

4 Schön Klinik Vogtareuth, Vogtareuth, Germany

5 Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany

6 Department of Paediatric Neurology and Developmental Medicine, Dr von Hauner’s Children’s Hospital, Ludwig-Maximilians-University Munich, Munich, Germany

7 Department of Neurology, University Medical Centre, Hamburg-Eppendorf, Germany

8 Department of Neuropediatrics, University Children’s Hospital Tübingen, Tübingen, Germany

9 Division of Neuropaediatrics and Muscular Disorders, Department of Paediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany

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BMC Neurology 2013, 13:131  doi:10.1186/1471-2377-13-131

Published: 2 October 2013

Abstract

Background

Neurofibromatosis type 1 (NF1) is one of the most common genetic disorders causing learning disabilities by mutations in the neurofibromin gene, an important inhibitor of the RAS pathway. In a mouse model of NF1, a loss of function mutation of the neurofibromin gene resulted in increased gamma aminobutyric acid (GABA)-mediated inhibition which led to decreased synaptic plasticity and deficits in attentional performance. Most importantly, these defictis were normalized by lovastatin. This placebo-controlled, double blind, randomized study aimed to investigate synaptic plasticity and cognition in humans with NF1 and tried to answer the question whether potential deficits may be rescued by lovastatin.

Methods

In NF1 patients (n = 11; 19–44 years) and healthy controls (HC; n = 11; 19–31 years) paired pulse transcranial magnetic stimulation (TMS) was used to study intracortical inhibition (paired pulse) and synaptic plasticity (paired associative stimulation). On behavioural level the Test of Attentional Performance (TAP) was used. To study the effect of 200 mg lovastatin for 4 days on all these parameters, a placebo-controlled, double blind, randomized trial was performed.

Results

In patients with NF1, lovastatin revealed significant decrease of intracortical inhibition, significant increase of synaptic plasticity as well as significant increase of phasic alertness. Compared to HC, patients with NF1 exposed increased intracortical inhibition, impaired synaptic plasticity and deficits in phasic alertness.

Conclusions

This study demonstrates, for the first time, a link between a pathological RAS pathway activity, intracortical inhibition and impaired synaptic plasticity and its rescue by lovastatin in humans. Our findings revealed mechanisms of attention disorders in humans with NF1 and support the idea of a potential clinical benefit of lovastatin as a therapeutic option.

Keywords:
Transcranial magnetic stimulation (TMS); Paired associative stimulation (PAS); Long-term potentiation (LTP); Synaptic plasticity; RAS-pathway; Developmental disorder; NF1; Attention; Lovastatin