Perispinal etanercept: a new therapeutic paradigm in neurology

Abstract

Etanercept is a potent antagonist of TNF, a pleotropic immune signaling molecule that is also a pivotal regulator of synaptic function. Excess TNF is centrally involved in the pathogenesis of a variety of inflammatory neurological disorders, including Alzheimer’s disease, sciatica, traumatic brain injury and spinal cord injury. Perispinal etanercept produces rapid improvement in both Alzheimer’s disease and sciatica and in other forms of disc-related pain. Basic research and the observed clinical effects suggest that etanercept has the surprising ability to penetrate into the cerebrospinal fluid after perispinal administration. Perispinal administration is a novel method of delivery designed to introduce this anti-TNF molecule into the bidirectional cerebrospinal venous system and the cerebrospinal fluid to facilitate its selective delivery to either spinal structures or the brain. The scientific rationale, physiologic mechanisms, clinical effects and potential clinical indications of this therapeutic approach are the subject of this article.

Keywords::

• Alzheimer’s
• cerebrospinal venous
• choroid plexus
• dementia
• etanercept
• radiculopathy
• sciatica
• synaptic
• TNF

Acknowledgements

The author would like to acknowledge the contributions of the physicians who were coinvestigators in the clinical trials conducted utilizing perispinal etanercept, including Hart Cohen, Hyman Gross and Alan Weinberger; and the Stanford scientists who collaborated in the performance or interpretation of the radiolabeled etanercept experiment, Xiaoyuan Chen, Kai Chen and Zhen Cheng.

Financial & competing interests disclosure

The author has multiple issued and pending US and foreign patents detailing methods of use of etanercept and other anti-TNF biologics for neurological indications, including epidural etanercept for sciatica, perispinal etanercept for Alzheimer’s disease, disc-related pain, traumatic brain injury, stroke and spinal cord injury, including US patents 6015557, 6177077, 6419934, 6419944, 6537549, 6982089, 7214658, 7629311 and Australian patent 758523, all assigned to TACT IP, LLC. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.