HMTM-Mediated Enhancement of Brain Bioenergetics in a Mouse Tauopathy Model Is Blocked by Chronic Administration of Rivastigmine

Renato X. Santos, Valeria Melis, Elizabeth A. Goatman, Michael Leith, Thomas C. Baddeley, John M.D. Storey, Gernot Riedel, Claude M. Wischik*, Charles R. Harrington

*Corresponding author for this work

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The tau protein aggregation inhibitor hydromethylthionine mesylate (HMTM) was shown recently to have concentration-dependent pharmacological activity in delaying cognitive decline and brain atrophy in phase 3 Alzheimer’s disease (AD) clinical trials; the activity was reduced in patients receiving symptomatic therapies. The methylthionine (MT) moiety has been reported to increase the clearance of pathological tau and to enhance mitochondrial activity, which is impaired in AD patients. In line 1 (L1) mice (a model of AD), HMTM (5/15 mg/kg) was administered either as a monotherapy or as an add-on to a chronic administration with the cholinesterase inhibitor rivastigmine (0.1/0.5 mg/kg) to explore mitochondrial function and energy substrate utilization as potential targets of drug interference. Compared with wild-type NMRI mice, the L1 mice accumulated greater levels of L-lactate and of the LDH-A subunit responsible for the conversion of pyruvate into L-lactate. In contrast, the levels of LDH-B and mitochondrial ETC subunits and the activity of complexes I and IV was not altered in the L1 mice. The activity of complex I and complex IV tended to increase with the HMTM dosing, in turn decreasing L-lactate accumulation in the brains of the L1 mice, despite increasing the levels of LDH-A. The chronic pre-dosing of the L1 mice with rivastigmine partially prevented the enhancement of the activity of complexes I and IV by HMTM and the increase in the levels of LDH-A while further reducing the levels of L-lactate. Thus, HMTM in combination with rivastigmine leads to a depletion in the energy substrate L-lactate, despite bio-energetic production not being favoured. In this study, the changes in L-lactate appear to be regulated by LDH-A, since neither of the experimental conditions affected the levels of LDH-B. The data show that HMTM monotherapy facilitates the use of substrates for energy production, particularly L-lactate, which is provided by astrocytes, additionally demonstrating that a chronic pre-treatment with rivastigmine averted most of the HMTM-associated effects.

Original languageEnglish
Article number867
Number of pages21
Issue number4
Publication statusPublished - 7 Apr 2022

Bibliographical note

Funding: This study was sponsored by WisTa Laboratories Ltd., Singapore. (grant PAR1577).

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, C.M.W., upon reasonable request.


  • Alzheimer’s disease
  • bioenergetics
  • HMTM
  • hydromethylthionine
  • lactate
  • mitochondria
  • rivastigmine
  • tau aggregation inhibitor
  • tauopathy


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