Document Type

Conference Proceeding

Publication Date


Publication Title

Eur J Neurol


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.



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