Document Type

Conference Proceeding

Publication Date

7-2022

Publication Title

Eur J Neurol

Abstract

Background and aims: X-linked Adrenoleukodystrophy (ALD) is a rare neurometabolic disorder caused by ABCD1- gene mutations, leading to Very-Long-Chain Fatty Acids (VLCFA; in particular C26:0) accumulation, inflammation, mitochondrial impairment and demyelination. PXL065, a clinical-stage deuterium-stabilized(R)-stereoisomer of pioglitazone, retains pioglitazone non-genomic actions but lacks PPARγ activity. As pioglitazone exhibits beneficial effects in ALD models and PXL065 may avoid PPARγ- related side effects, we investigated PXL065 effects of in preclinical models.

Methods: Patient-derived fibroblasts and lymphocytes and Abcd1-KO mouse glial cells were exposed to PXL065 (5-10μM) and pioglitazone (10μM) for 7 days. VLCFA content was measured by mass spectrometry, selected gene expression by RT-qPCR, and mitochondrial function using a Seahorse Analyzer (after 72hr). PXL065 or pioglitazone (15mg/kg QD) were administered to 6-8-week or 13-month old Abcd1-KO mice for 8 and 12 weeks, respectively. VLCFA content (mass spectrometry), sciatic nerve axonal morphology (electronic microscopy), and locomotor function (open field test) were measured.

Results: In patient and mouse glial cells, PXL065 and pioglitazone corrected C26:0, improved mitochondrial function, increased compensatory Abcd2-3 transporter gene expression, and decreased inflammatory gene expression. In Abcd1-KO mice, C26:0 levels were normalized in plasma and decreased in spinal cord (-55%, p<0.01) and brain (-49%, p<0.0001). Pioglitazone had no effect in spinal cord. Following PXL065 and pioglitazone treatment, abnormal axonal morphology (stellate-shaped cells) was improved but only PXL065 showed significantly improved locomotor test results.

Conclusion: Despite reduced PPARγ activity, PXL065 showed substantial signs of efficacy and superior therapeutic potential vs. pioglitazone (in vivo) supporting clinical development for ALD. A Phase 2a study is planned in 2022.

Volume

29

First Page

293

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.