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10 Nanodelivery of Polyphenols as Nutraceuticals in Anticancer Interventions
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Polyphenols: Food, Nutraceutical, and Nanotherapeutic Applications, First Edition. Edited by Mithun Rudrapal.
© 2024 John Wiley & Sons, Inc. Published 2024 by John Wiley & Sons, Inc.
11
Nanodelivery of Polyphenols as Nutraceuticals for CNS Disorders
Puneet K. Samaiya, Rakesh Sagar, Sharad P. Pandey, Gourav Jain, and
Abhishek K. Sah*
Department of Pharmacy, Shri Govindram Seksariya Institute of Technology & Science (SGSITS), Indore, Madhya Pradesh, India
* Corresponding author
The prevalence of central nervous system (CNS) disorders is on the rise, presenting significant
challenges to human survival and resulting in a surge in healthcare costs. Neurological disorders
are the leading cause of global disability-adjusted life-years (DALYs), accounting for 45%–11.6%
of global DALYs and 16.5% of deaths in 2019. Serious threats to human health include major
CNS disorders such as brain tumors, neurodegenerative diseases, and cerebrovascular diseases
(Figure 11.1). The effective treatment of CNS disorders is impeded by the blood–brain barrier
(BBB), which comprises various cell types such as endothelial cells, astrocytes, microglial cells,
and pericytes.
11.1 Gliomas
A glioma is a type of tumor that arises from the supportive cells of the CNS, known as glial cells.
These tumors are the most common type of primary CNS tumors, accounting for approximately
24% of all cases [1]. There are various types of gliomas, including ependymomas, astrocytomas
(including glioblastoma [GBM]), oligodendrogliomas, mixed gliomas, as well as optic nerve and
brain stem gliomas [2]. In the recent classification of gliomas, in addition to histological findings
supported by ancillary tissue-based tests (e.g., immunohistochemical, ultrastructural), molecular
biomarkers have gained importance in providing both ancillary and defining diagnostic informa-
tion. In the recent 5th edition of the World Health Organization (WHO) classification of CNS
tumors, classification of gliomas has been based on key diagnostic genes, molecules, pathways,
and/or their combinations in gliomas [3]. The median survival time of patients suffering from glio-
mas is approximately 10 months. The United States Food and Drug Administration (US FDA)
granted accelerated approval of bevacizumab, a humanized monoclonal antibody against vascular
endothelial growth factor, for the treatment of recurrent glioblastomas [4]. However, in recent
years, oncolytic virus therapy, stem cell therapy, immunotherapy, and electric field therapy have
been available [5]. These emerging treatments are expected to improve the prospect of treating
recurrent high-grade gliomas.
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11 Nanodelivery of Polyphenols as Nutraceuticals for CNS Disorders
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11.2 Neurodegenerative Disorders
11.2.1 Alzheimer’s Disease
Alzheimer’s disease (AD) is the most common cause of dementia in adults. AD is a progressive
disorder with the pathological hallmarks of extracellular amyloid-β (Aβ) plaques and neurofibril-
lary tangles of intraneuronal hyperphosphorylated tau protein. According to The World Alzheimer
Report 2021 [6], AD-related dementia is the 7
th
leading cause of mortality globally. Currently,
approximately 55 million people have dementia worldwide, with Alzheimer’s accounting for nearly
70% of diagnoses. According to the World Health Organization, 10 million cases are reported each
year, with projections of 78 million people affected by 2030 and 139 million by 2050[7]. The progres-
sion from being an average person to an AD patient typically occurs in the following manner: first,
there is no cognitive impairment (NCI), then there is mild cognitive impairment (MCI), and finally,
there is AD (dementia) [8, 9]. The earliest stages of AD are asymptomatic, which are no different
from normal aging. The mild cognitive impairment (MCI) stage is characterized by a slight impair-
ment of cognition (orientation, language, attention, and executive functions might be affected), usu-
ally in memory, though not demented [10]. The last stage is AD dementia, characterized by a
significant loss of memory and cognitive functions [11]. Two forms of AD have been reported: early
onset AD occurring before 65 years of age, manifesting in 5%–10% of the population, and late onset
of AD manifesting after 65 years of age [12]. The clinical trials have failed so far as it is very difficult
to detect the pathology in the early state in most high-risk individuals [13]. This can also be why
therapeutic interventions can only offer symptomatic relief to AD patients and do not prevent AD
from originating in the individual or curing it. Researchers have proposed various hypotheses for
Cerebrovascular disease
Gliomas
Alzheimer's
Parkinson's
Amyotrophic
lateral sclerosis
Huntington's disease
Central nervous
system disorders
Figure 11.1 Types of central nervous system (CNS) disorders.
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11.2 Neurodegenerative Disorders 227
the progression and development of AD; however, the cause and actual mechanism of AD remains
known. A fast response to the first symptoms of AD is crucial in diagnosing the early stages of the
disease so that treatment can be initiated and the quality of life extended [14]. In the conventional
pharmacological treatment of AD, cholinesterase inhibitors (ChEIs), such as donepezil, tacrine,
berberine, and galantamine, are employed for symptomatic treatment of AD. Many other therapeu-
tic strategies have been explored for several decades in clinical trials; however, the currently avail-
able treatments are primarily treatments of symptoms rather than actual curative therapies [15].
Because of this, attention has turned towards prevention or reducing AD risk.
11.2.2 Parkinson’s Disease
Parkinson’s disease (PD) is the second most prevalent neurodegenerative disorder, impacting
1%–2% of the population aged 65 and older [16]. The characteristic features of PD include the spe-
cific degeneration of dopaminergic neurons in the substantia nigra, as well as the accumulation of
misfolded and aggregated alpha-synuclein in the brainstem, resulting in challenges with the motor
function. Some other molecular pathogenic mechanisms include mitochondrial dysfunction,
impairment of protein clearance (associated with deficient ubiquitin-proteasome and autophagy-
lysosomal systems), neuroinflammation, and oxidative stress [17]. Enhancing the level of dopa-
mine in the brain is the most common treatment strategy to improve the symptoms in PD patients.
However, this treatment does not alter the progression of the disease or restore the affected dopa-
minergic neurons. L-dopa, amantadine, metatyrosine, melatonin, thyrotrophin-releasing hor-
mone, lithium, baclofen, electroconvulsive shock therapy, vitamin E, and marijuana are some
regimes to provide symptomatic relief in PD [18]. One of the biggest challenges in the development
of potential neuroprotective therapies has been the lack of reliable and sensitive biomarkers of
disease progression. Immunotherapies, such as the use of vaccination or monoclonal antibodies
directed against aggregated, toxic α-synuclein as well as anti-aggregation or protein clearance
strategies, are currently being investigated in clinical trials [17, 19].
11.2.3 Amyotrophic Lateral Sclerosis
Amyotrophic lateral sclerosis (ALS) is a degenerative neurological condition that gradually causes
motor neurons in the CNS to deteriorate, ultimately resulting in paralysis [20]. It has been reported
that ALS affects approximately 16,000 individuals, with a prognosis for survival of 2–5 years [21].
There are two types of ALS diseases differentiated by genetics: familial and sporadic (idiopathic)
[22]. Diagnosis is determined by excluding other conditions and utilizing clinical examinations,
laboratory tests, and nerve conduction/electromyography studies [20]. The pathogenesis of ALS
comprises of failure of the upper motor neurons leading to abrupt reflexes and reduced coordina-
tion of the limbs with stiffness of the muscles. Alternatively, the failure of lower motor neurons
causes progressive atrophies when the synapses connecting the muscles are lost, which tends to
begin in the limbs and progresses to the eye and sphincter muscle neurons in the late stages.
Overall, the patients has difficulty with speaking, chewing, or swallowing [23].
11.2.4 Huntington’s Disease
Huntington’s disease (HD) is an inherited neurodegenerative disease characterized by neuropsychi-
atric symptoms, a movement disorder (most commonly choreiform) and progressive cognitive
impairment [24]. HD is triggered by mutation of the Huntingtin gene, leading to anomalies in the
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