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A combination of metformin and galantamine exhibits synergistic benefits in the treatment of sarcopenia
Caterina Tezze, … , Marco Sandri, Evi M. Mercken
Caterina Tezze, … , Marco Sandri, Evi M. Mercken
Published August 8, 2023
Citation Information: JCI Insight. 2023;8(15):e168787. https://doi.org/10.1172/jci.insight.168787.
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Research Article Aging Muscle biology

A combination of metformin and galantamine exhibits synergistic benefits in the treatment of sarcopenia

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Abstract

Age-associated sarcopenia, characterized by a progressive loss in muscle mass and strength, is the largest cause of frailty and disability in the elderly worldwide. Current treatments involve nonpharmacological guidelines that few subjects can abide by, highlighting the need for effective drugs. Preclinical models were employed to test the benefits of RJx-01, a combination drug composed of metformin and galantamine, on sarcopenia. In worms, RJx-01 treatment improved lifespan, locomotion, pharyngeal pumping, and muscle fiber organization. The synergistic effects of RJx-01 were recapitulated in a transgenic mouse model that displays an exacerbated aging phenotype (Opa1–/–). In these mice, RJx-01 ameliorated physical performance, muscle mass and force, neuromuscular junction stability, and systemic inflammation. RJx-01 also improved physical performance and muscle strength in 22-month-old WT mice and also improved skeletal muscle ultrastructure, mitochondrial morphology, autophagy, lysosomal function, and satellite cell content. Denervation and myofiber damage were decreased in RJx-01–treated animals compared with controls. RJx-01 improved muscle quality rather than quantity, indicating that the improvement in quality underlies the beneficial effects of the combination drug. The studies herein indicate synergistic beneficial effects of RJx-01 in the treatment of sarcopenia and support the pursuit of RJx-01 in a human clinical trial as a therapeutic intervention for sarcopenia.

Authors

Caterina Tezze, Francesco Ivan Amendolagine, Leonardo Nogara, Martina Baraldo, Stefano Ciciliot, Diletta Arcidiacono, Alice Zaramella, Giulio Masiero, Giulia Ferrarese, Stefano Realdon, Bert Blaauw, Giel Detienne, Ann T.J. Beliën, Marco Sandri, Evi M. Mercken

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Figure 1

RJx-01 synergistically extends lifespan and improves fitness in C. elegans.

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RJx-01 synergistically extends lifespan and improves fitness in C. elega...
(A) The manual lifespan of worms treated with 25 mM Met, 100 μM Gal, the combination drug RJx-01 (25 mM Met and 100 μM of Gal), or with vehicle (water). For additional data, see Supplemental Table 3. (B–E) Locomotion of worms at day 7 of adulthood in worms treated with 25 mM Met, 100 μM Gal, the combination drug RJx-01, or vehicle (n = 60–80 per group). (F) Pharyngeal pumping at day 7 of adulthood in worms treated with 25 mM Met, 100 μM Gal, the combination drug RJx-01, or vehicle (water) (n = 10). (G) Representative images of muscle morphology at day 14 of adulthood of RW1596 worms treated with the combination drug RJx-01 or vehicle. Scale bar: 10 μm. Data are representative of at least 3 independent experiments. Data are shown as mean ± SEM. *P < 0.05; ***P < 0.001; ****P < 0.0001. In A, Kaplan-Meier curves were generated, and statistical significance was calculated using the log-rank test followed by Benjamini-Hochberg. One-way ANOVA followed by Holm step-down method (2-tailed Student’s t test) was performed in B–F.

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