Cardinali, Daniel P. ; Pagano, Eleonora S. ; Scacchi
Bernasconi, Pablo A. ; Reynoso, Roxana ; Scacchi, Pablo
Melatonin and mitochondrial dysfunction in the
central nervous system
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(Publicado en Hormones and Behavior, 2012,
Melatonin and mitochondrial dysfunction in the Central Nervous System
Daniel P. Cardinali, Eleonora S. Pagano, Pablo A. Scacchi Bernasconi, Roxana Reynoso,
Pontificia Universidad Católica Argentina, Facultad de Ciencias Médicas, 1107 Buenos
D.P. Cardinali MD PhD,
Director, Departamento de Docencia e Investigación,
Facultad de Ciencias Médicas,
Pontificia Universidad Católica Argentina,
Av. Alicia Moreau de Justo 1500, 4o piso
1107 Buenos Aires, Argentina.
Tel: +54 11 43490200 ext 2310
E-mail: firstname.lastname@example.org; email@example.com
Cell death and survival are critical events for neurodegeneration, mitochondria
being increasingly seen as important determinants of both. Mitochondrial dysfunction
is considered a major causative factor in Alzheimer’s disease (AD), Parkinson’s
disease (PD) and Huntington’s disease (HD). Increased free radical generation,
enhanced mitochondrial inducible nitric oxide (NO) synthase activity and NO
production, and disrupted electron transport system and mitochondrial permeability
transition, have all been involved in impaired mitochondrial function. Melatonin, the
major secretory product of the pineal gland, is an antioxidant and an effective
protector of mitochondrial bioenergetic function. Both in vitro and in vivo, melatonin
was effective to prevent oxidative stress/nitrosative stress-induced mitochondrial
dysfunction seen in experimental models of AD, PD and HD. These effects are seen at
doses 2-3 orders of magnitude higher than those required to affect sleep and circadian
rhythms, both conspicuous targets of melatonin action. Melatonin is selectively taken
up by mitochondria, a function not shared by other antioxidants. A limited number of
clinical studies indicate that melatonin can improve sleep and circadian rhythm
disruption in PD and AD patients. More recently, attention has been focused on the
development of potent melatonin analogs with prolonged effects which were
employed in clinical trials in sleep-disturbed or depressed patients in doses
considerably higher than those employed for melatonin. In view that the relative
potencies of the analogs are higher than that of the natural compound, clinical trials
employing melatonin in the range of 50-100 mg/day are needed to assess its
therapeutic validity in neurodegenerative disorders.
Melatonin; mitochondria; free radicals; oxidative stress; aging; Parkinson’s
disease; Alzheimer’s disease; Huntington’s disease; melatonin analogs.
Mitochondrial function and free radical generation
Basic physiology of melatonin
Melatonin and mitochondrial function
Melatonin and mitochondrial dysfunction in AD
Melatonin and mitochondrial dysfunction in PD
Melatonin and mitochondrial dysfunction in HD
Melatonin and its analogs as pharmaceutical tools
Abbreviations: AD, Alzheimer´s disease; AFMK,
methoxykynuramine; AMK, N1-acetyl-5-methoxykynuramine; Aβ, aggregated β-
amyloid; c-mtNOS, constitutive mitochondrial nitric oxide synthase; ETC, electron
transport chain; GPx, glutathione peroxidase; GRd, glutathione reductase; GSH,
reduced glutathione; HD, Huntington´s disease; i-mtNOS, inducible mitochondrial
nitric oxide synthase; iNOS, inducible nitric oxide synthase; MPP+, 1-methyl-4-
phenylpyridinium; mPT, mitochondrial permeability transition; MPTP, 1-methyl-4-
phenyl-1,2,3,6-tetrahydropyridine; MT1, melatonin receptor 1; MT2, melatonin
receptor 2; mtDNA, mitochondrial DNA; nNOS, neuronal nitric oxide synthase; NO,
nitric oxide; OXPHOS, oxidative phosphorylation; PD, Parkinson´s disease; RNS,
reactive nitrogen species; ROS, reactive oxygen species; SOD, superoxide dismutase.
Cell death and survival are critical events in neurodegeneration, and
mitochondria are increasingly seen as important determinants of both. Abnormalities
in mitochondrial functions such as defects in the electron transport chain
(ETC)/oxidative phosphorylation (OXPHOS) system and ATP production have been
suggested as the primary causative factors in the pathogenesis of neurodegenerative
disorders (Beal, 2009; DiMauro and Schon, 2008; Rezin et al., 2009; Rollins et al.,
2009; Schon et al., 2010). Mitochondria act as energy suppliers and signaling
mediators in the capacity of the cells to produce energy from atmospheric oxygen.
Electrons from metabolic substrates are transferred via the ETC to molecular oxygen
(O2), giving rise to a H+ electrochemical gradient whose energy is used to synthesize
ATP (Brand and Nicholls, 2011).
Mitochondrial dysfunction underlies neurodegenerative diseases of different
etiologies, including Alzheimer´s disease (AD), Parkinson´s disease (PD) and
Huntington’s disease (HD). Generally these age-related disorders share mitochondrial
dysfunction, oxidative/nitrosative stress and increased apoptosis in different areas of
the brain. In the case of AD, decreases in mRNA expression of mitochondrial DNA
(mtDNA) encoding cytochrome oxidase subunit II have been reported (Bonilla et al.,
1999). Aggregated β-amyloid (Aβ) generates reactive oxygen species (ROS) that
produce neuronal death by damage of neuronal membrane lipids, proteins and nucleic
acids. Protection from Aβ toxicity by melatonin was observed, especially at the
mitochondrial level (Dragicevic et al., 2011; Olcese et al., 2009). This is the basis for
the use of an antioxidant like melatonin in AD patients (see for ref. Cardinali et al.,
Mitochondrial involvement in PD is suggested by deficiencies in components of
the ETC like Complex (C)-I in substantia nigra with a parallel reduction in reduced
glutathione (GSH) levels, indicating the existence of oxidative stress (Navarro and
Boveris, 2010). In platelets of PD patients C-I is also decreased, and in some cases is
accompanied by C-II, C-III and C-IV deficiencies. Studies with cybrids have shown that
alterations in C-I is due to a defect in the mtDNA (Navarro and Boveris, 2010). This
defect is accompanied by an alteration in the expression of C-IV activity and a reduced
H+ electrochemical gradient, which lowers the apoptotic threshold. Mitochondrial
involvement in the pathology of PD has been genetically supported by the finding in
early-onset Parkinsonism of mutations in DNA polymerase γ, which is the only DNA
polymerase present in mitochondria and necessary for mtDNA synthesis (Luoma et
In the case of HD, deficiencies in the activity of C-II, C-III and C-IV in caudate and
to a lesser extent in putamen of patients have been reported (Schapira, 1999). In
mitochondria from frontal and temporal lobes of HD patients a mtDNA deletion was
found (Horton et al., 1995).
Enhanced production of ROS and possibly accumulation of mtDNA mutations in
post mitotic cells are contributory factors in neurodegeneration. Mitochondria not
only generate ROS/reactive nitrogen species (RNS) but are also the main target for
their actions (Raha and Robinson, 2000). As a result, damage occurs in the
mitochondrial respiratory chain, producing further increases in free radical
generation and leading ultimately to a vicious cycle (Genova et al., 2004).
During the last decade a number of studies have demonstrated that melatonin
plays an effective role in regulating mitochondrial homeostasis (see for ref. Acuña-
Castroviejo et al., 2011; Srinivasan et al., 2011c). In addition to being a free radical
scavenger, melatonin reduces nitric oxide (NO) generation within mitochondria. It
maintains the electron flow, the efficiency of OXPHOS, ATP production, the
bioenergetic function of the cell and mitochondrial biogenesis by regulating
respiratory complex activities, Ca2+ influx and the mitochondrial permeability
transition (mPT). This article summarizes the several mechanisms through which
melatonin can exert neuroprotective actions in neurodegenerative disorders like AD,
PD and HD.
Mitochondrial function and free radical generation
The primary function of mitochondria is to generate ATP within the cell through
the ETC resulting in OXPHOS. Mitochondrial energy production requires the
coordination of several sequential steps tightly interconnected. Even under normal
conditions, 1-2 % of electron flux is the consequence of the incomplete reduction of
O2, leading to the production of superoxide anion radical (O2•–) that is subsequently
converted into hydrogen peroxide (H2O2). Hence, the mitochondria are the main
source of ROS production within cells (Beal, 2009; DiMauro and Schon, 2008; Rezin et
al., 2009; Rollins et al., 2009; Schon et al., 2010). For a recent, detailed, review of
mitochondrial physiology see Acuña-Castroviejo a et al. (2011).
While a mild increase in ROS can act as a signal to elicit a number of
physiological responses, a pervasive augment in free radical production or a burst of
oxidative damage risks mitochondrial integrity leading to cell death. For example, O2•–
production is very sensitive to a decrease in H+ electrochemical gradient. The
modulation of H+ permeability at the mitochondrial inner membrane via uncoupling
proteins, mitochondrial ion channels or fatty acids is an important event in the
regulation of free radical production by mitochondria (Beal, 2009; DiMauro and
Schon, 2008; Rezin et al., 2009; Rollins et al., 2009; Schon et al., 2010).
ETC, which is present in the inner mitochondrial membrane, comprises a series
of electron carriers grouped into four enzyme complexes, namely C-I (NADH
ubiquinone reductase), C-II (succinate ubiquinone reductase), C-III (ubiquinol
cytochrome c-reductase), and C-IV (cytochrome c oxidase) (Lenaz and Genova, 2010).
The main function of ETC is to convert redox energy into an electrochemical gradient
of protons that subsequently causes ATP formation. The end product of the
respiratory chain is water that is generated in a four–electron reduction of O2 by C-IV.
During this process (electron leakage, especially at complex I and III), a small
percentage of O2 is converted into ROS, such as O2•– and its secondary products H2O2
and reactive hydroxyl radical (•OH). Under normal conditions, the iron-sulfur cluster
N2 of complex I appears to be the primary source of free radicals in the brain (Lenaz
and Genova, 2010).
Melatonin reacts at a high rate with radicals like •OH and with relative low rates
with other like O2•–. Melatonin is an efficient inhibitor of lipid peroxidation by
scavenging highly reactive species, such as •OH, which initiate the degradation
process, than by directly trapping peroxyl radicals (Galano et al., 2011)..
Mitochondrial NO synthase (mtNOS), localized in the inner mitochondrial
membrane, is responsible for generating NO radical (•NO) from L-arginine (Esposito
and Cuzzocrea, 2010). mtNOS is the neuronal NOS (nNOS) splice variant-α which
interacts with C-IV; mtNOS comprises two isoforms, namely constitutive (c-mtNOS)
and inducible (i-mtNOS). Because of the easy NO diffusion through the mitochondrial
membrane, cytoplasm NOS isoforms are also relevant for generating
intramitochondrial •NO. High rates of •NO synthesis, which typically occur in the Ca2+-
dependent excited state of neurons, contribute to oxidative and nitrosative stress. The
availability of •NO determines the rates at which the adduct peroxynitrite (ONOO–)
and the other decomposition products are generated.
•NO strongly interferes with components of the respiratory chain, in particular
cytochrome c oxidase (Esposito and Cuzzocrea, 2010; Mander and Brown, 2004). Its
metabolite ONOO– and radicals derived from this can damage proteins at the
respiratory complexes. Other nitrosation processes, like transnitrosation or reversible
nitrosation and nitration as well as irreversible DNA, protein and lipid oxidation, may
occur. (Stadtman and Levine, 2003). Damage to the mitochondrial ETC can cause a
breakdown of the H+ potential, apoptosis or lead to further generation of free radicals,
thus maintaining a vicious cycle that ultimately results in cell death (Lenaz and
Melatonin protects ETC and mtDNA from ROS/RNS-induced oxidative damage. It
limits the loss of intramitochondrial GSH, reduces mtDNA damage and increases
expression and activity of C-IV and the activity of C-I, thus improving mitochondrial
respiration and increasing ATP production (Acuña-Castroviejo et al., 2011). NO
production is also inhibited at the level of NOS gene transcription (Jiménez-Ortega et
Mitochondrial Ca2+ is crucial in rate control of energy production and plays an
instrumental role in cell apoptosis and necrosis. Mitochondria take up Ca2+ through a
calcium uniporter, highly dependent on H+ electrochemical gradient (Oliveira, 2011).
In the mitochondrial-mediated cell death pathway, a non-specific increase in the
permeability of the inner mitochondrial membrane (mPT) occurs as a consequence of
the increase in mitochondrial matrix Ca2+. mPT defines the sudden increase in
membrane permeability allowing the transfer of molecules up to 1500 Da in size and
causing the dissipation of H+ electrochemical gradient, uncoupling of OXPHOS and
ATP depletion (Lemasters et al., 2009). With Ca2+ overload, there is a complete
uniporter inhibition, mitochondrial swelling, loss of respiratory control and a release
of matrix calcium. Under these conditions, the mitochondria undergo swelling and
mitochondrial apoptosis ensues (Toman and Fiskum, 2011). Although the exact
molecular nature of mPT remains elusive, its contribution to neurodegeneration is
unequivocal and has been extensively reviewed (Gleichmann and Mattson, 2011;
Pivovarova and Andrews, 2010). Melatonin effectively prevents induction of mPT in a
number of circumstances (Andrabi et al., 2004; Karbownik et al., 2000).
Since mitochondria contain specific mechanisms for activating both the intrinsic
apoptotic pathway and necrotic death in a variety of cell types, they can be seen as
central regulators of cell fate. The intrinsic apoptotic pathway involves the activation
and subsequent translocation to mitochondria of the members of the Bcl2 family (Bax,
Bak, and Bid) which after insertion in the mitochondrial outer membrane behave as
death channels. Through these channels a number of apoptogenic proteins e.g.
cytochrome c, are released from the intermembrane space and are responsible for
the activation of the signal cascade to cell death via caspase-9 and -3-dependent
proteolysis (Santucci et al., 2010). Melatonin exerts a strong antiapototic effect (Sainz
et al., 2003).
A number of enzyme mechanisms take part in the control of free radical
production. Among these is the action of the enzyme superoxide dismutase (SOD),
which is found in the inner side of the inner mitochondrial membrane (Mn-SOD) and
that removes O2•– (Liochev and Fridovich, 2010). The •OH generated from H2O2 in the
presence of reduced transition metals is scavenged by the enzyme glutathione
peroxidase (GPx) during the process of GSH oxidation to glutathione disulfide. This is
reduced back to GSH by the enzyme glutathione reductase (GRd). These enzymes form
part of the endogenous antioxidant defense system and suppress ROS levels within
the cell as well as at the mitochondria.
Besides being an antioxidant, melatonin promotes de novo synthesis of GSH by
stimulating the activity of the enzyme γ-glutamyl-cysteine synthetase (Urata et al.,
1999) and also through its effects on gene expression of GPx, GRd, SOD and CAT
(Antolin et al., 1996; Jiménez-Ortega et al., 2009; Pablos et al., 1998; Rodríguez et al.,
2004). This promotes the recycling of GSH and maintains a high GSH/ glutathione
disulfide ratio, thus underlining the important role that melatonin plays in
Basic physiology of melatonin
Melatonin is the major secretory product of the pineal gland released every day
at night. In all mammals, circulating melatonin is synthesized primarily in the pineal
gland (Claustrat et al., 2005). In addition, melatonin is also locally synthesized in
various cells, tissues and organs including lymphocytes, bone marrow, the thymus, the
gastrointestinal tract, skin and the eyes, where it plays either an autocrine or
paracrine role (see for ref. Hardeland et al., 2011).
Both in animals and in humans, melatonin participates in diverse physiological
functions signaling not only the length of the night (and thus time of the day and
season of the year) but also enhancing free radical scavenging and the immune
response, showing relevant cytoprotective properties (Hardeland et al., 2011).
Ass above mentioned, melatonin is a powerful antioxidant that scavenges •OH
radicals as well as other ROS and RNS and that gives rise to a cascade of metabolites
that share also antioxidant properties (Galano et al., 2011). Melatonin also acts
indirectly to promote gene expression of antioxidant enzymes and to inhibit gene
expression of prooxidant enzymes (Antolin et al., 1996; Jimenez-Ortega et al., 2009;
Pablos et al., 1998; Rodríguez et al., 2004). Melatonin has significant anti-
inflammatory properties presumably by decreasing the synthesis of proinflammatory
cytokines like TNF-α and by suppressing inducible NOS (iNOS) gene expression
(Cuzzocrea et al., 1998). It has also a significant antiapototic effect (Sainz et al.,
Circulating melatonin binds to albumin (Cardinali et al., 1972) and is
metabolized mainly in the liver where it is hydroxylated in the C6 position by
cytochrome P450 monooxygenases A2 and 1A (Facciola et al., 2001; Hartter et al.,
2001). Melatonin is then conjugated with sulfate to form 6-sulfatoxymelatonin, the
main melatonin metabolite found in urine. Melatonin is also metabolized in tissues by
oxidative pyrrole-ring cleavage into kynuramine derivatives. The primary cleavage
N1-acetyl-N2-formyl-5-methoxykynuramine (AFMK), which is
deformylated, either by arylamine formamidase or hemoperoxidase to N1-acetyl-5-
methoxykynuramine (AMK) (Hardeland et al., 2009). It has been proposed that AFMK
is the primitive and primary active metabolite of melatonin (Tan et al., 2007).
Melatonin is also converted into cyclic 3-hydroxymelatonin in a process that directly
scavenges two hydroxyl radicals (Tan et al., 2007). However, although direct radical
scavenging has been effective under numerous experimental conditions, at clearly
supraphysiological concentrations, its relevance at physiological levels has been
questioned for reasons of stoichiometry. Despite of this, melatonin was shown to
protect from oxidotoxicity already at physiological concentrations (Galano et al.,
2011; Tan et al., 1994).
Melatonin exerts many physiological actions by acting on membrane and nuclear
receptors while other actions are receptor-independent (e.g., scavenging of free
radicals or interaction with cytoplasm proteins) (Reiter et al., 2009). The two
melatonin receptors cloned so far (MT1 and MT2) are membrane receptors that have
seven membrane domains and that belong to the superfamily of G- protein coupled
receptors (Dubocovich et al., 2010). Melatonin receptor activation induces a variety
of responses that are mediated both by pertussis-sensitive and insensitive Gi proteins.
In the cytoplasm melatonin interacts with proteins like calmodulin and tubulin
(Benitez-King, 2006). Nuclear receptors of retinoic acid receptor superfamily
(retinoid Z receptor/ROR, retinoic acid receptor-related orphan receptor α) have been
identified in several cells, among them in human lymphocytes and monocytes
(Carrillo-Vico et al., 2006).
Melatonin and mitochondrial function
According to Acuña-Castroviejo et al. (2011) a role of melatonin in
mitochondrial homeostasis seems warranted. Melatonin is a powerful scavenger of
ROS and RNS and naturally acts on mitochondria, the site with the highest ROS/RNS
production into the cell. Melatonin improves the GSH redox cycling and increases GSH
content by stimulating its synthesis in the cytoplasm, mitochondria depending on the
GSH uptake from cytoplasm to maintain the GSH redox cycling. Lastly, melatonin
exerts important antiapoptotic effects and most of the apoptotic signals originate from
As above mentioned, data accumulated in the last decade strongly indicate that
melatonin plays an important role in antioxidant defense via the regulation of
enzymes involved in the redox pathway and directly through the non-enzymatic,
radical scavenger effect that melatonin and some of its metabolites (notably AFMK
and AMK) have to scavenge ROS, RNS and organic radicals (Hardeland et al., 2011;
Reiter et al., 2009). Hydrogen transfer and electron transfer have been identified as
the main mechanisms determining the free radical–scavenging activity of melatonin
(Galano et al., 2011). Melatonin reacts at a high rate with radicals like •OH and with
relative low rates with other like O2•–. In any event, melatonin efficiently inhibits lipid
peroxidation by scavenging highly reactive species, such as •OH, which initiate the
degradation process, than by directly trapping peroxyl radicals. An alternate concept
intends to explain the antioxidant effects of melatonin at the level of radical
generation rather than detoxification of radicals already formed (Hardeland et al.,
2003; Hardeland, 2005, 2009).
In a recent publication Galano et al. underlined the reasons why melatonin has
most of the desirable characteristics of a good antioxidant: (i) it is widely distributed
in the body, and is present in adequate concentrations; (ii) it is a broad spectrum
antioxidant; (iii) it easily transported across cellular membranes; (iv) it can be
regenerated, after radical quenching, and its metabolites still present antioxidant
properties; (v) it has minimal toxicity (Galano et al., 2011). These effects of melatonin
and its metabolites may be unique and not shared by MT1/MT2 melatonergic agonists
like ramelteon or agomelatine, in which the indole ring is modified. For example,
ramelteon displayed in vitro no relevant antioxidant capacity in a 2,2-azino-bis-(3-
ethylbenzthiazoline-6-sulfonic acid) assay compared with melatonin (Mathes et al.,
Safeguarding of respiratory electron flux, reduction of oxidant formation by
lowering electron leakage and inhibition of mPT events are among the most important
effects on melatonin in mitochondria. Melatonin has been repeatedly shown to reduce,
under various conditions, the mitochondrial formation of ROS and RNS, to protect
against oxidative, nitrosative or nitrative damage of ETC proteins as well as lipid
peroxidation in the inner membrane and, thus, to favor electron flux and energy
efficiency. Melatonin (10 mg/kg) was found to increase the activity of C-I and C-IV in
mitochondria obtained from rat brain and liver, C-II and C-III being not affected
(Martin et al., 2000b). Injections of melatonin counteracted the inhibitory effect of
ruthenium red on C-I, C-IV and GPx enzyme (Martin et al., 2000b). In another study,
100 nM melatonin was found to prevent the oxidation of GSH to glutathione disulfide
induced by t-butyl hydroperoxide, restoring the normal activity of both GPx and GRd
(Martin et al., 2000a). Melatonin increased C-I and C-IV activities in a dose dependent
manner, the effect being significant at 1nM. Melatonin also counteracted cyanide
induced inhibition of C-IV, showing that it effectively increases the activity of ETC
coupled to OXPHOS and increase ATP synthesis both in normal mitochondria as well
as in mitochondria depleted of ATP by cyanide (Martin et al., 2000a). The effect of
melatonin in regulating C-I and IV presumably do not reflect its antioxidant role but
indicates an interaction with ETC complexes by donating and accepting electrons, an
effect not shared by other antioxidants. For a recent, detailed, revision on melatonin
effect on mitochondrial function see (Acuña-Castroviejo et al., 2011).
The possible mechanism by which systemically administered melatonin controls
mitochondrial respiration in the liver includes depression of Krebs’s cycle substrate-
induced respiration (Reyes Toso et al., 2006). In vitro studies in mitochondria from
mouse liver cells, 1 nM to 1 mM melatonin decreased oxygen consumption, inhibited
the increase in oxygen flux in the presence of excess of ADP, reduced membrane
potential and inhibited the production of O2•– and H2O2. Melatonin was also effective
to maintain the efficiency of OXPHOS and ATP synthesis by increasing the activity of
C-I, C-III and C-IV (López et al., 2009).
Interestingly, co-treatment with melatonin prevented the decrease in
mitochondrial membrane fluidity caused by δ-aminolevulinic acid, which disrupts H+
electrochemical gradient and mPT, in the absence of changes in mitochondrial
membrane lipid peroxidation (Karbownik et al., 2000). This effect of melatonin may
depend on its capacity to localize in the membrane itself, in a superficial position in
lipid bilayers near the polar heads of membrane phospholipids (Ceraulo et al., 1999).
Melatonin’s action in preventing t-butyl hydroperoxide induction of mPT was
shown in primary skeletal muscle cultures. Melatonin (1-100 μM) desensitized the
mPT to Ca2+ and prevented t-butyl hydroperoxide-induced mitochondrial swelling
and GSH oxidation (Karbownik et al., 2000). Melatonin has also been reported to
directly inhibit mPT with a Ki value of 0.8 µM (Andrabi et al., 2004). The high
melatonin concentrations needed should be considered in the context of the reported
mitochondrial accumulation of melatonin (López et al., 2009; Messner et al., 1998;
Venegas et al., 2011). Melatonin has been repeatedly shown to prevent, at
pharmacological concentrations, a fatal decline in H+ electrochemical gradient in
various cell types and with high efficacy against different noxa (Hardeland and Pandi-
Perumal, 2005). In cardiomyocytes, astrocytes and striatal neurons, it prevented
calcium overload (Andrabi et al., 2004; Jou et al., 2004) and counteracted the collapse
of the mitochondrial membrane potential induced by H2O2 (Jou et al., 2004; Jou et al.,
2007), doxorubicin (Xu and Ashraf, 2002) or oxygen/glucose deprivation (Andrabi et
Recently the role of melatonin on cardiolipin and mitochondrial bioenergetics
was explored (Paradies et al., 2010; Petrosillo et al., 2008). Cardiolipin, a
phospholipid located at the level of inner mitochondrial membrane, is required for
several mitochondrial bioenergetic processes as well as in mitochondrial-dependent
steps of apoptosis. Alterations in cardiolipin structure, content and acyl chain
composition have been associated with mitochondrial dysfunction in various tissues
under a variety of pathophysiological conditions (Paradies et al., 2010). Melatonin
was reported to protect the mitochondria from oxidative damage in part by
preventing cardiolipin oxidation (Paradies et al., 2010; Petrosillo et al., 2008) (Fig. 1).
Melatonin can also act on mitochondrial biogenesis via sirtuins. Sirtuins are
NAD+-dependent protein deacetylases that promote longevity in numerous organisms.
The 7 mammalian subforms, SIRT1 to SIRT7, are involved in mitochondrial function.
At least SIRT3, SIRT4 and SIRT5 are localized in mitochondria, SIRT3 preventing
mitochondrial lysine hyperacetylation (Lombard et al., 2007). SIRT3 interacts with
the C-I subunit, the 39-kDa protein NDUFA9, to enhance C-I activity and ATP levels
(Ahn et al., 2008). Sirtuins also stimulate mitochondrial biogenesis (Guarente, 2008).
Several studies have reported upregulation of SIRT1 by melatonin, e.g., in the brain of
senescence-accelerated SAMP8 mice (Gutierrez-Cuesta et al., 2008) and neuronal
primary cultures from neonatal rat cerebellum (Tajes et al., 2009), or the prevention
of SIRT1 decrease in the hippocampus of sleep-deprived rats (Chang et al., 2009). In
neuronal cultures from cerebellum, melatonin enhanced the deacetylation of various
SIRT1 substrates, effects which were largely reversed by the SIRT1 inhibitor sirtinol
(Tajes et al., 2009). The melatonin-induced deacetylation of SIRT1 substrates
indicates that mitochondrial biogenesis might be stimulated by the methoyindole in
vivo. Indeed, chronic melatonin administration increases the number and size of
mitochondria in the pineal and in ependymal epithelium of the choroid plexus
(Barratt et al., 1977; Decker and Quay, 1982).
Melatonin and mitochondrial dysfunction in AD
Several recent studies have supported the involvement of mitochondrial ROS
and RNS production and abnormal mitochondrial function in the pathophysiology of
AD (Bobba et al., 2010; Galindo et al., 2010; Manczak et al., 2010; Massaad et al.,
2009; Muller et al., 2010; Santos et al., 2010; Trancikova et al., 2011). AD is
characterized by extracellular senile plaques of aggregated β-amyloid (Aβ) and
intracellular neurofibrillary tangles that contain hyperphosphorylated tau protein.
The resulting clinical effect is a progressive loss of memory and deterioration of
Aβ is reported to accumulate in subcellular compartments and to impair
neuronal function (Reddy et al., 2010). There is substantial evidence to prove that
mitochondrial toxicity is linked to the progressive accumulation of mitochondrial Aβ
(Chen and Yan, 2010). In the early phase of AD inhibitors of β and γ-secretase can be
therapeutically effective to halt AD disease progression by inhibition of the Aβ protein
misfolding into neurotoxic oligomeric aggregates.
Mitochondrial O2•– production plays a critical role in the pathological events
following Aβ elevation. An increased expression of mitochondrial antioxidant enzyme
SOD-2 has been shown to prevent memory deficits and amyloid plaque deposition
associated with AD (Massaad et al., 2009). Although a hypothetical occurrence of
mutations in mtDNA could cause increased oxidative stress and energy failure, no
causative mutations in mtDNA have been detected in AD so far.
Several actions of melatonin have been described which antagonize the
deleterious effects of Aβ. The effects of melatonin can be grouped as (i) antioxidant,
including influences on mitochondrial metabolism; (ii) antifibrillogenic, blocking Aβ
synthesis; (iii) cytoskeletal, including suppression of tau protein
hyperphosphorylation. The antifibrillogenic effects of melatonin were observed not
only in vitro but also in vivo in transgenic mouse models (Feng et al., 2004;
Matsubara et al., 2003; Olcese et al., 2009).
Protection from Aβ toxicity by melatonin was observed, especially at the
mitochondrial level. In a mutant Aβ transgenic mouse model of familial AD melatonin
can prevent toxic aggregation of Aβ peptide and, when taken long term, can protect
against cognitive deficits (Olcese et al., 2009). In a recent study APP/PS1 transgenic
mice were treated for 1 month with melatonin and the analysis of isolated brain
mitochondria indicated that melatonin treatment decreased mitochondrial Aβ levels
to 25-50 % of controls in several brain regions (Dragicevic et al., 2011). This was
accompanied by a near complete restoration of mitochondrial respiratory rates,
membrane potential, and ATP levels of isolated mitochondria from the hippocampus,
cortex, or striatum. In APP-expressing neuroblastoma cells in culture, mitochondrial
function was restored by melatonin or by its structurally related compounds AFMK or
indole-3-propionic acid. This was partially blocked by melatonin receptor antagonists
indicating that melatonin receptor signaling is required for the full effect. The authors
concluded that treatment stimulating melatonin receptor signaling can be beneficial
for restoring mitochondrial function in AD (Dragicevic et al., 2011).
Melatonin also activates the survival signal pathways. One such pathway is the
Bcl-2 pathway, which stabilizes mitochondrial function by antiapoptotic Bcl-2 family
modulators. Bcl-2-expression was enhanced by melatonin concomitantly with
inhibition of Aβ-induced cell death (Jang et al., 2005). Melatonin inhibited free radical
formation in microglia exposed to amyloid-β1-42 by preventing the phosphorylation of
the p47 Nox subunit via the PI3K/Akt pathway (Zhou et al., 2008).
In view of the consequences of excitation-dependent Ca2+ overload on
mitochondrial membrane potential and mPT sensitivity towards excitotoxins like Aβ,
the actions of melatonin at the level of this important cellular compartment deserve
particular attention. Modulation of mitochondrial Ca2+ handling has been suggested as
the potential pharmacological target for AD (Hung et al., 2010). In a recent study a
possible melatonin prevention of damage induced by Aβ was evaluated in young and
senescent hippocampal neurons. Rat hippocampal neurons were incubated with Aβ25-
35 and cell viability, mitochondrial membrane potential, ATP and the activity of the
respiratory chain complexes were measured (Dong et al., 2010). Cells exposed to
Aβ25-35 showed decreased mitochondrial membrane potential, inhibited activity of
respiratory chain complexes and a depletion of ATP levels. Melatonin attenuated Aβ25-
35 -induced mitochondrial damage in senescent hippocampal neurons (Dong et al.,
2010). Molecular studies undertaken with mitochondrial preparations suggest that
melatonin has a therapeutic value in treating AD through its antiapoptotic activities
(Wang et al., 2009).
As outlined, melatonin acts at different levels relevant to the development and
manifestation of AD. The antioxidant, mitochondrial and antiamyloidogenic effects
may be seen as a possibility of interfering with the onset of the disease. Therefore,
early beginning of treatment may be decisive (Quinn et al., 2005). Mild cognitive
impairment is an etiologically heterogeneous syndrome characterized by cognitive
impairment shown by objective measures adjusted for age and education in advance
of dementia (Gauthier et al., 2006). Some of these patients develop AD. A small
number of controlled trials indicate that melatonin can be useful to treat mild
cognitive impairment and to prevent progression to AD (Cardinali et al., 2010).
Melatonin and mitochondrial dysfunction in PD
PD is a neurodegenerative disorder with a multifactorial etiology, mainly
characterized by the death of dopaminergic neurons in the substantia nigra pars
compacta and by the formation of Lewy bodies. The initiating factor in PD is still
unknown. The possible involvement of an increased release of free radicals has been
entertained in view of enhanced signs of oxidative stress found in brain of PD patients
(Gibson et al., 2010).
A reduced C-I activity in the substantia nigra pars compacta and loss of GSH have
been reported in PD patients (Navarro and Boveris, 2010). The inhibition of ETC
proteins compromises energy availability and leads to apoptosis and death of the
dopaminergic cells. Defects in the mtDNA, a reduced H+ electrochemical gradient and
increased apoptosis may underlie specific neuronal death (Luoma et al., 2004;
Navarro and Boveris, 2010).
α-Synuclein assembly is a critical step in the development of Lewy body diseases
such as PD and dementia with Lewy bodies. Melatonin attenuated kainic acid-induced
neurotoxicity (Chang et al., 2011) and arsenite-induced apoptosis (Lin et al., 2007)
via inhibition α-synuclein aggregation. Melatonin also decreased the expression of α-
synuclein in dopamine containing neuronal regions after amphetamine both in vivo
(Sae-Ung et al., 2012) and in vitro (Klongpanichapak et al., 2008). In a recent study
melatonin effectively blocked α-synuclein fibril formation and destabilized preformed
fibrils. It also inhibited protofibril formation, oligomerization, and secondary
structure transitions of α-synuclein as well as reduced α-synuclein cytotoxicity (Ono
et al., 2011).
A commonly accepted model of PD is that achieved by the systemic or
intracerebral administration of the neurotoxin 1-methyl-4-phenyl-1,2,3,6
tetrahydropyridine (MPTP) (Schober, 2004; Terzioglu and Galter, 2008). Its active
glial metabolite, 1-methyl-4-phenylpyridinium (MPP+), is taken up into the
dopaminergic neurons through the dopamine transporter, and then accumulates in
the mitochondria of substantia nigra. By binding to C-I, MPP+ increases the production
of ROS and enhances oxidative stress causing reduction of ATP and death of cells. A
neuroprotective effect of melatonin in isolated rat striatal synaptosomes and liver
mitochondria treated with MPTP has been demonstrated (Absi et al., 2000).
Melatonin prevented the inhibition of mitochondrial respiration by limiting the
interaction of MPP+ with C-I of ETC. In a study conducted in adult male mice, MTPT
was administered at a dose of 15 mg/kg in four separate doses (Tapias et al., 2009).
The concomitant administration of melatonin or its metabolite AMK (20 mg/kg)
significantly reduced the iNOS activity stimulated by MPP+.
A small number of controlled trials indicate that melatonin is useful to treat
disturbed sleep in PD, particularly rapid eye movement-associated sleep behavior
disorder (see for ref. (Srinivasan et al., 2011a). Whether melatonin has the potential
for treating insomnia in PD patients and, more generally, for arresting the progression
of PD merits further investigation.
Melatonin and mitochondrial dysfunction in HD
HD is a neurodegenerative disorder that leads to ataxia, chorea and dementia. It
may be produced by a genomic alteration in the DNA encoding huntingtin, a protein of
unknown function but associated with increased apoptosis. Lesions in HD include
predominantly the γ-aminobutyric acid containing neurons of the caudate nucleus
(Schapira, 1999). Mitochondrial dysfunction occurs in HD (Chen, 2011). A mtDNA
deletion (mtDNA4977) was found in HD patients particularly in frontal and temporal
lobes but its significance is unknown (Horton et al., 1995). There are deficiencies in
the activity of C-II, C-III and C-IV in caudate and in a lesser extend in putamen in HD.
A Huntington’s chorea animal model was developed by using 3-nitropropionic
acid, an inhibitor of mitochondrial C-II. In this model, that replicates the
neurochemical, histological and clinical features of HD, melatonin administration was
reported to defer the clinical signs of HD (Tunez et al., 2004). However, although
current evidence from genetic models of HD including mutation of the huntingtin gene
(mHtt) supports the mitochondrial dysfunction as major cause of the disease,
impairment of ETC appears to be a late secondary event (Oliveira, 2010). Upstream
events include defective mitochondrial calcium handling and impaired ATP
production. Also, transcription abnormalities affecting mitochondria composition,
reduced mitochondria trafficking to synapses, and direct interference with
mitochondrial structures enriched in striatal neurons, are possible mechanisms by
which mHtt amplifies striatal vulnerability (Oliveira, 2010). Evidence is lacking as to
whether melatonin´s action on mitochondria could affect disease´s evolution in the
genetic model of HD. At least on the accumulation of insoluble protein aggregates in
intra- and perinuclear inclusions in HD melatonin had little or no inhibitory effect on
huntingtin aggregation (Heiser et al., 2000).
Melatonin and its analogs as pharmaceutical tools
As melatonin exhibits both hypnotic and chronobiotic properties, it has been
therapeutically used for treatment of age-related insomnia as well as of other primary
and secondary insomnia (Leger et al., 2004; Zhdanova et al., 2001). A recent
consensus of the British Association for Psychopharmacology on evidence-based
treatment of insomnia, parasomnia and circadian rhythm sleep disorders concluded
that melatonin is the first choice treatment when a hypnotic is indicated in patients
over 55 years (Wilson et al., 2010). Since melatonin has a short half life (less than 30
min) its efficacy in promoting and maintaining sleep has not been uniform in the
studies undertaken so far. Thus the need for the development of prolonged release
preparations of melatonin or of melatonin agonists with a longer duration of action on
sleep regulatory structures in the brain arose (Turek and Gillette, 2004). Slow release
forms of melatonin (e.g., Circadin®, a 2 mg- preparation developed by Neurim, Tel
Aviv, Israel, and approved by the European Medicines Agency in 2007) and the
melatonin analogs ramelteon, agomelatine, tasimelteon and TK-301 are examples of
Ramelteon (Rozerem®, Takeda Pharmaceuticals, Kyoto, Japan) is a melatonergic
hypnotic analog approved by the FDA for treatment of insomnia in 2005. It is a
selective agonist for MT1/MT2 receptors without significant affinity for other receptor
sites (Kato et al., 2005; Miyamoto, 2009). In vitro binding studies have shown that
ramelteon affinity for MT1 and MT2 receptors is 3-16 times higher than that of
melatonin. Doses of ramelteon varies from 8 to 32 mg/day.
Agomelatine (Valdoxan®, Servier, Neuilly-sur-Seine, France) is a recently
introduced melatonergic antidepressant that acts on both MT1 and MT2 melatonergic
receptors with a similar affinity to that of melatonin; it also acts as an antagonist to
serotonin2C receptors at a 3 orders of magnitude greater concentration (Millan et al.,
2003). Agomelatine has been licensed by EMEA for treatment of major depressive
disorder at doses of 25 – 50 mg/day.
Tasimelteon, [VES-162] is a MT1/MT2 agonist developed by Vanda
Pharmaceuticals, Washington DC, USA, that completed phase III trial in 2010. In
animal studies, tasimelteon exhibited the circadian phase shifting properties of
melatonin (Vachharajani et al., 2003). In clinical studies involving healthy human
subjects, tasimelteon was administered at doses of 10 to 100 mg/day (Rajaratnam et
al., 2009). The FDA granted tasimelteon orphan drug designation status for blind
individuals without light perception with non-24-hour sleep-wake disorder in 2010.
TIK-301 (formerly LY-156,735) has been in a phase II clinical trial in the USA
since 2002. Originally it was developed by Eli Lilly and Company, Indianapolis, USA,
and called LY-156,735. In 2007 Tikvah Pharmaceuticals, Atlanta, USA, took over the
development and named it TIK-301. It is a chlorinated derivative of melatonin with
MT1/MT2 agonist activity and 5HT2C antagonist activity. TIK-301 pharmacokinetics,
pharmacodynamics and safety have been examined in a placebo controlled study
using 20 to 100 mg/day doses in healthy volunteers (Mulchahey et al., 2004). The
FDA granted TIK-301 orphan drug designation in 2004, to use as a treatment for
circadian rhythm sleep disorder in blind individuals without light perception and
individuals with tardive dyskinesia.
As shown by the binding affinities, half-life and relative potencies of the different
melatonin agonists it is clear that studies using 2-5 mg melatonin/day are unsuitable
to give appropriate comparison with the effect of the above mentioned compounds,
which in addition to being generally more potent than the native molecule are
employed in considerably higher amounts (Cardinali et al., 2011). Melatonin has a
high safety profile and it is usually remarkably well tolerated. In some studies
melatonin has been administered to patients at large doses. Melatonin (300 mg/day)
given for up to 3 years decreased oxidative stress in patients with amyotrophic lateral
sclerosis (Weishaupt et al., 2006). In children with muscular dystrophy, 70 mg/day of
melatonin reduced cytokines and lipid peroxidation (Chahbouni et al., 2010). Doses of
80 mg melatonin hourly for 4 h were given to healthy men with no undesirable effects
other than drowsiness (Waldhauser et al., 1984). In healthy women given 300 mg
melatonin/day for 4 months there were no side effects (Voordouw et al., 1992).
Therefore, further studies employing melatonin doses in the 100 mg/day are needed
to clarify its potential therapeutical implications in humans. From animal studies it is
clear that a number of preventive effects of melatonin, like those in neurodegenerative
disorders, need high doses of melatonin to become apparent (Cardinali et al., 2010;
Srinivasan et al., 2011b; Srinivasan et al., 2011a). If one expects melatonin to be an
effective neuroprotector, especially in aged people, it is likely that the low doses of
melatonin employed so far are not very beneficial.
Abnormal mitochondrial function, decreased respiratory enzyme complex
activities, increased electron leakage and mPT, and increased Ca2+ entry have all been
shown to play a role in the pathophysiology of neurodegenerative disorders. In
various neurodegenerative diseases, such as AD, PD or HD, mitochondrial changes are
not only observed at the level of ETC dysfunction, electron leakage and oxidative,
nitrosative or nitrative damage, but also in a disturbed balance between
mitochondrial fusion and fission, with consequences for intracellular distribution of
these organelles (Wang et al., 2009). In the course of disease progression,
mitochondrial density decreases preferentially in the cell periphery of neurons. The
peripheral mitochondrial depletion is associated with reduced H+ electrochemical
gradient and ATP production, increases in radical formation and losses of spines at
neurites (Wang et al., 2008; Wang et al., 2009).
This key role of mitochondria in neurodegenerative diseases indicates that
supporting the integrity and functioning of these organelles should be given a high
priority, thereby reducing electron leakage and radical formation. To what extent this
is possible with melatonin, perhaps, in conjunction with photic stimulation of the
circadian oscillators remains to be thoroughly studied.
Studies in authors´ laboratories were supported by grants from the Agencia
Nacional de Promoción Científica y Tecnológica, Argentina and the University of
Buenos Aires. DPC is a Research Career Awardee from the Argentine Research Council
(CONICET) and Professor Emeritus, University of Buenos Aires. ESP and PS are
Research Career Awardees from CONICET.
Conflict of interest
None is declared.
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Melatonin and mitochondrial physiopathology. The mechanisms involved in ETC
failure mainly depend on the generation of ROS and RNS in the mitochondria leading
to oxidative stress and ATP depletion. Respiratory chain–mediated ROS production,
partly via cardiolipin (CL) peroxidation, brings about the detachment of cytochrome c
from the inner mitochondrial membrane and changes in mPT that leads to
mitochondrial swelling and the release of cytochrome c and other proapoptotic
proteins. Apoptosis ensues by activation of the caspase cascade in the cytoplasm
leading to cell death. Melatonin and its metabolites (AFMK, AMK) prevent this cascade
by acting at multiple sites at the mitochondria. Scavenging of ROS and RNS prevents
free radical attack against ETC complexes and mtDNA. Melatonin protects mPT
disruption and proapoptotic signal release to the cytoplasm. Melatonin also increases
transcriptional activity of the mtDNA, improving mitochondrial physiology.
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