This application is for support to conduct a controlled clinical trial to evaluate the safety and efficacy of methionine in the treatment of AIDS myelopathy and dementia. The hypothesis is that abnormal metabolism of methionine may play an important role in the pathogenesis of vacuolar myelopathy. Methionine is a direct precursor of S-adenosyl methionine (SAM), the major methyl group donor in the nervous system. Vacuolar myelopathy is similar to the myelopathy of vitamin B12 deficiency, and can be induced by blocking methionine-synthetase and decreasing production of methionine. The result is decreased production of cystathionine and glutathione, rendering the CNS more vulnerable to oxidative stress. In experimental models, myelopathy caused by methionine synthase block can be abrogated by treatment with methionine. Finally, in AIDS, methionine levels in plasma and CSF are low. In the pilot studies, the Principal Investigator demonstrated clear clinical improvement of AIDS patients following treatment with oral methionine, thereby justifying a more extensive and double-blinded trial. The primary specific aim is to assess the efficacy of methionine in improving the clinical manifestations of AIDS-associated vacuolar myelopathy, and the safety and tolerability of oral methionine in the treatment of AIDS myelopathy. The secondary specific aim is to assess the efficacy of methionine in improving central conduction time of somatosensory evoked potentials and cognitive functions, and to evaluate serum levels of methionine, SAM, cystein homocysteine and glutathione in relation to severity of myelopathy in patients with AIDS vacuolar myelopathy, before and after treatment with methionine.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
3R01NS035745-04S1
Application #
6020182
Study Section
AIDS and Related Research Study Section 7 (ARRG)
Program Officer
Kerza-Kwiatecki, a P
Project Start
1996-08-01
Project End
2000-04-30
Budget Start
1998-05-01
Budget End
2000-04-30
Support Year
4
Fiscal Year
1999
Total Cost
Indirect Cost
Name
Beth Israel Medical Center (New York)
Department
Type
DUNS #
075255364
City
New York
State
NY
Country
United States
Zip Code
10003
Di Rocco, A; Werner, P; Bottiglieri, T et al. (2004) Treatment of AIDS-associated myelopathy with L-methionine: a placebo-controlled study. Neurology 63:1270-5
Di Rocco, A; Bottiglieri, T; Werner, P et al. (2002) Abnormal cobalamin-dependent transmethylation in AIDS-associated myelopathy. Neurology 58:730-5
Geraci, A P; Di Rocco, A (2000) Anti-HIV therapy. AIDS 14:2059-61
di Rocco, A; Bottiglieri, T; Dorfman, D et al. (2000) Decreased homovanilic acid in cerebrospinal fluid correlates with impaired neuropsychologic function in HIV-1-infected patients. Clin Neuropharmacol 23:190-4
Geraci, A; Di Rocco, A; Liu, M et al. (2000) AIDS myelopathy is not associated with elevated HIV viral load in cerebrospinal fluid. Neurology 55:440-2
Tagliati, M; Di Rocco, A; Danisi, F et al. (2000) The role of somatosensory evoked potentials in the diagnosis of AIDS-associated myelopathy. Neurology 54:1477-82
Di Rocco, A (1999) Diseases of the spinal cord in human immunodeficiency virus infection. Semin Neurol 19:151-5
Chong, J; Di Rocco, A; Tagliati, M et al. (1999) MR findings in AIDS-associated myelopathy. AJNR Am J Neuroradiol 20:1412-6
Di Rocco, A; Tagliati, M; Danisi, F et al. (1998) A pilot study of L-methionine for the treatment of AIDS-associated myelopathy. Neurology 51:266-8