Hydromethylthionine enhancement of central cholinergic signalling is blocked by rivastigmine and memantine

Constantin Kondak, Gernot Riedel, Charles R Harrington, Claude M Wischik, Jochen Klein* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
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The prevention of tau protein aggregations is a therapeutic goal for the treatment of Alzheimer's disease (AD), and hydromethylthionine (HMT) (also known as leucomethylthioninium-mesylate (LMTM)), is a potent inhibitor of tau aggregation in vitro and in vivo. In two Phase 3 clinical trials in AD, HMT had greater pharmacological activity on clinical endpoints in patients not receiving approved symptomatic treatments for AD (acetylcholinesterase (AChE) inhibitors and/or memantine) despite different mechanisms of action. To investigate this drug interaction in an animal model, we used tau-transgenic L1 and wild-type NMRI mice treated with rivastigmine or memantine prior to adding HMT, and measured changes of hippocampal acetylcholine (ACh) by microdialysis. HMT given alone doubled hippocampal ACh levels in both mouse lines and increased stimulated ACh release induced by exploration of the open field or by infusion of scopolamine. Rivastigmine increased ACh release in both mouse lines whereas memantine was more active in tau-transgenic L1 mice. Importantly, our study revealed a negative interaction between HMT and symptomatic AD drugs: the HMT effect was completely eliminated in mice that had been pretreated with either rivastigmine or memantine. Rivastigmine was found to inhibit AChE whereas HMT and memantine had no effects on AChE or on choline acetyltransferase (ChAT). The interactions observed in this study demonstrate that HMT enhances cholinergic activity in mouse brain by a mechanism of action unrelated to AChE inhibition. Our findings establish that the drug interaction that was first observed clinically has a neuropharmacological basis and is not restricted to animals with tau aggregation pathology. Given the importance of the cholinergic system for memory function, the potential for commonly used AD drugs to interfere with the treatment effects of disease-modifying drugs needs to be taken into account in the design of clinical trials.

Original languageEnglish
Pages (from-to)172-184
Number of pages13
JournalJournal of Neurochemistry
Early online date15 Dec 2021
Publication statusPublished - 2022

Bibliographical note

The present study was carried out with funds supplied by TauRx Therapeutic Ltd. We are grateful to Helene Lau for assistance with
182 |KONDAK etAl.the analytical determinations. Open access funding enabled and or-ganized by ProjektDEAL

TauRx Therapeutics Ltd., Aberdeen, Grant/Award Number: R0154

Data Availability Statement

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


  • microdialysis
  • acetylcholine
  • hydromethylthionine
  • Alzheimer’s disease
  • hippocampus
  • rivastigmine
  • memantine


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