382 385 Edu F Cerebroprotein Hydrosylate

Jain et al: Cerebroprotein hydrolysate
Educational Forum
Cerebroprotein hydrolysate: Innovation in Neurodegenerative
disorders
Jain N1, Yadav S2, Goyal M3, Singal KK4, Gupta P5, Bansal M6
1
Dr Nidhi Jain
Associate Professor, Pathology
2
Dr Shailesh Yadav
Professor, Pharmacology
3
Dr Manoj Goyal
Associate Professor, Pharmacology
4
Dr Kiran Kumar Singal
Assistant Professor,Medicine
5
Dr Parveen Gupta
Assistant Professor,Medicine
6
Dr Monika Bansal
Associate Professor, Physiology
1,2,3,4,5,6
MMIMSR Mullana, Ambala,
Haryana, India
Received: 07-09-2013
Revised: 10-10-2013
Accepted: 06-11-2013
Correspondence to
Dr Shailesh Yadav
09050365854
[email protected]
ABSTRACT
Stroke, traumatic brain injury and neurodegenerative disorders are one of the
leading causes of death and disability in both developing and developed
countries. A number of drugs including neurotrophic drugs are available for
these disorders. Cerebroprotein hydrolysate is the latest one offering new hopes
to patients suffering from these disorders. Its superiority is because of different
actions which help in faster and more complete nerve repair and growth than
other neurotrophic agents. It acts by multiple mechanisms viz.-regulation and
improvement of the neuronal metabolism,
modulation of the synaptic
plasticity, promoting neuronal differentiation and protection against ischemic

and neurotoxin lesion, reducing excitotoxic damage, blocking over activation of
calcium dependent proteases, and scavenging free oxygen radicals. Till now no
serious adversity has been reported.
Keywords:
Neurodegenarative
disorders,
cerebroprotein
hydrolysate,
neurotrophic factors, calpain
Epidemiologic Considerations
Ischemic stroke, traumatic brain injury,
vascular dementia and Alzheimers disease
collectively are responsible for major part of
morbidity and mortality in geriatric as well
as young adult population. Stroke ranks as
the third leading cause of death in the
United States. It is estimated that there are
more than 700 000 incidents of strokes
happening annually and 4.4 million stroke
survivors. [1] In USA on an average,
approximately 1.7 million people sustain a
traumatic brain injury annually. [2]
In a study it is found that on an
average, in the USA, 1300/100,000 people
suffer concussions each year. [3] Out of
those who receive treatment 25 patients

die. Neurodegenerative diseases that affect
the affective, cognitive and psychomotor
functions in the elderly compromise the
quality of life of more than 24 million
people across the world. [4] These disorders
pose some of modern medicines most
difficult
challenges.
Common
pathophysiologic feature in all of these
conditions is same i.e. functional loss of
neurons.
IJMDS www.ijmds.org January 2014; 3(1)
382
Pathophysiology of neuron
Neuron is the basic structural and
functional unit of nervous system. Although
there are some variations depending on the
type of neurons; they all contain four parts:

cell body, dendrites, axon and axon
terminal. They develop from the neural
stem cells known as type 1 cells which
produce progeny called amplifying neural
progenitor cells (also known as type 2 cells)
which proliferate and differentiate into
mature neurons. Till recent past it was
believed that there is no way to repair a
damaged neuron. One of the main goals of
researchers involved in treatment of
neurodegenerative disorders is to develop
drugs to stimulate nerve repair itself. [5]
Several drugs like Edaravone, Citicoline and
Piracetam have been developed based on
neurotrophic factors. Neurotrophic factors
are small proteins that exert survivalpromoting and trophic actions on neuronal
cells. [6] These neurotrophic factors are NGF
(Nerve growth factor), BDNF (Brain-derived
neurotrophic factor), NT-3 (Neurotrophin3), GDNF (Glial cell-derived neurotrophic
factor), GAP-43 (growth associated protein
43) and CNFT (Cilliary neurotrophic factor).
Glial cells continue to undergo cell
division in adulthood and their ability to
proliferate is particularly noticeable after
brain injury (e.g stroke). [7] This is not the
case with neurons; they cannot divide
themselves but they undergo a lot of
activity after injury. Interestingly, studies
demonstrate that neurons in the adult brain
have an unappreciated capacity for
remodeling away from the actual injury,
and that these neurons are attempting to
rewire the brain following an injury. [8]
Cerebroprotein hydrolysate is the latest
weapon in the physicians armamentarium.
It is a neurotrophic drug. It consists of short
biological peptides which act like
endogenous neurotrophic factors.
Pharmacokinetics
It is given in a dose of 60 -180 mg once daily
for 10-20 days. It should be slowly infused
in 250 ml saline in 60-120 minutes.
Maintenance doses (30 mg) can be given by
i.m route. It should not be mixed with
amino acid solutions in the infusion bottle.
Doses of antidepressants should be reduced
if used with Cerebroprotein hydrolysate.
Adverse effects and Contraindications

Studies [9, 10] have revealed that most of the
side effects are minor. Most common side
effects include headache, nausea, vertigo,
increased sweating, agitation, fever,
hallucinations, confusion, and flu like
syndrome.
Contraindications
include
hypersensitivity, epilepsy and severe renal
impairment. Safety has not been
established in pregnancy and lactation.
Indications
Acute ischemic stroke
Traumatic brain injury
Vascular dementia
Alzheimers disease
Mechanism of action and pharmacological
effects
It acts by multiple mechanisms viz.
Regulation and improvement of the
neuronal metabolism.
Modulation of the synaptic plasticity.
Neuronal differentiation and protection
against ischemic and neurotoxin lesion.
Cerebroprotein
hydrolysate
reduces
excitotoxic damage, blocks over activation
of calcium dependent proteases, and
scavenges free oxygen radicals.
Cerebroprotein hydrolysate has been
shown to counteract the negative effect of
383
the elevated EGF-2 on neurogenesis and

neuromodulation. [11]
Cerebroprotein
hydrolysate
augmented proliferation, differentiation,
and migration of adult sub ventricular zone
(SVZ) neural progenitor cells results in
increased number of neural progenitor cells
and neuroblasts to contribute to
neurogenesis. This may be the mechanism
for beneficial effect in acute ischemic stroke
and traumatic brain injury.
Enhancement of neuronal survival is
produced through effect on calpain. The
hyper activation of calpain is implicated in a
number of neurodegenerative disorders.
Calpain is inhibited by Cerebroprotein
hydrolysate.
Neuromodulatory effect is produced
by increasing glucose transporter1 (GLUT-1)
expression which is responsible for more
than 90% of glucose transport to brain. [12]
Neuronal plasticity is produced by reduction
of amyloid beta accumulation, increased
MAP 2 and Synaptophysin synthesis.
Neuro-immunotrophic activity is produced
by inhibition of microglial activation and
expression of IL-1 beta. This results in
reduction
of
inflammation.
Other
neurotrophic drugs and nootropics are not
having so much broad spectrum of different
actions possessed by Cerebroprotein
hydrolysate.
The
patients
of
neurodegenerative disorders now can be
managed in a better way with the advent of
Cerebroprotein hydrolysate.
from the Stroke Council of the American

Heart Association. Stroke 2001;32:28099.
2. Injury Prevention & Control: Traumatic
Brain Injury. Available from:http://
www.cdc.gov/traumaticbraininjury/.
[last accessed on 30-nov-2011].
3. Aziz-Sultan A, Baimeedi P, Benzel EC,
References
1. Larry BG, Robert A, Kyra B, Curt DF,
Philip BG, George H et al. Primary
Prevention of Ischemic Stroke. A
Statement for Healthcare Professionals
9.
Berger MS, Brandner S, Butowski N et al.
4.
5.
6.
7.
8.
Introduction to traumatic brain injury. In

Samandouras G, editor. Traumatic brain
injury: The Neurosurgeon's Handbook.
Ist ed. Oxford: Oxford University Press;
2010.p.207-8.
Sanjeev V Thomas. Addressing problems
of
dementia
in
India.
Ann Indian Acad Neurol 2011;14:147.
Introduction to neurogenesis. Available
fromhttp://www.neurogenesis .iord.org
/.[Last accessed on 15th Oct. 2011].
Available from: http://www.ceregene.
com / neurotrophic.asp. [Last accessed
on 30 Oct. 2011].
Barrett KE, Barman SM, Boitano S,
Brooks HL. Excitable Tissue: Nerve. In
Ganong WF, editor. Physiology of nerve
and muscle cells: Review of Medical
Physiology. 23 rd ed. Lange: Mc Graw
Hill; 2010.p.80.
Gopalan T. Neurons: Key To Healing Of
Brain Injuries Identified. August 24,
2010. Research News [online] Available
from: http://www.medindia.net /news
/Neurons-Key-ToHealing-Of-BrainInjuries-Identified-73058-2.htm.
[Last
accessed on Nov 28 2011].
Long J, Wei GZ, Xu ZB, Feng YB. Injection
of cerebroprotein hydrolysate vs
Cerebrolysin in treating cerebrovascular
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cnki.com.cn/Article_en / CJFDTOTAL-
384
XYYL606.002.htm. [Last accessed on

March 07 2012].
10. Sui CM, Kam WC, Jia-Hong L, Durairajan
SSK, Liang-Feng L, Min L. Systematic
Review on the Efficacy and Safety of
Herbal
Medicines
for
Vascular
Dementia. Available from: http:// www.
ncbi.nlm.nih.gov/pmc/articles/PMC325
0997. [Last accessed on March 07 2012].
11. Honghui C, Tung YC, Li B, Iqbal K, Iqbal IG.
Trophic factors counteract elevated
EGF-2-induced inhibition of adult
neurogenesis. Neurobiol Aging 2007
Aug;28(8):1148-62.
12. Ruben JB, Dafang Wu, Manfred W. In
Vivo upregulation of the bloodbrain
barrier GLUT1 glucose transporter by
brain-derived peptides. Neuroscience
Research 1999;34:217-224.
Cite this article as: Jain N, Yadav S, Goyal

M, Singal KK, Gupta P, Bansal M.
Cerebroprotein hydrolysate: Innovation
in Neurodegenerative disorders. Int J
Med and Dent Sci 2014; 3(1):382-385.
Source of Support: Nil
Conflict of Interest: No
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Jain et al: Cerebroprotein hydrolysate

modulation of the synaptic

plasticity, promoting neuronal differentiation and protection against ischemic

neurotrophic factors, calpain

those who receive treatment 25 patients

IJMDS www.ijmds.org January 2014; 3(1)

Jain et al: Cerebroprotein hydrolysate

type of neurons; they all contain four parts:

IJMDS www.ijmds.org January 2014; 3(1)

Adverse effects and Contraindications

Jain et al: Cerebroprotein hydrolysate

the elevated EGF-2 on neurogenesis and

from the Stroke Council of the American

IJMDS www.ijmds.org January 2014; 3(1)

Berger MS, Brandner S, Butowski N et al.

Introduction to traumatic brain injury. In

Jain et al: Cerebroprotein hydrolysate

XYYL606.002.htm. [Last accessed on

IJMDS www.ijmds.org January 2014; 3(1)

Cite this article as: Jain N, Yadav S, Goyal

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