Allopregnanolone treatment improves plasma metabolomic profile associated with GABA metabolism in Fragile X-associated Tremor/Ataxia Syndrome: a pilot study

Abstract

Currently there is no effective treatment for the Fragile X-associated Tremor/Ataxia Syndrome (FXTAS), a late-onset neurodegenerative disorder. In this pilot study, we evaluated whether allopregnanolone, a natural neurosteroid that exerts beneficial effects in neurodegenerative diseases, nervous system injury and peripheral neuropathies, could improve lymphocytic bioenergetics and plasma pharmacometabolomics in six males with FXTAS (68 ± 3 y old; FMR1 CGG repeats 94 ± 4; FXTAS stages ranging from 3 to 5) enrolled in a 12-week open-label intervention study conducted at the University of California Davis from December 2015 through July 2016. Plasma pharmacometabolomics and lymphocytic mitochondria function were assessed at baseline (on the day of the first infusion) and at follow-up (at the end of the infusion within 48 h). In parallel, quantitative measurements of tremor and ataxia, and neuropsychological evaluations of mental state, executive function, learning, memory and psychological symptoms were evaluated at the same time points. Allopregnanolone treatment impacted significantly GABA metabolism, oxidative stress and some of the mitochondria-related outcomes. Notably, the magnitude of the individual metabolic response, as well as the correlation with some of the behavioral tests, was overwhelmingly carrier-specific.

Based on this pilot study, allopregnanolone treatment has the potential for improving cognitive and GABA metabolism in FXTAS aligned with the concept of precision medicine.