Glial-specific mitochondrial failure and redox imbalance drive regional vulnerability in Friedreich ataxia

Glial-specific mitochondrial failure and redox imbalance drive regional vulnerability in Friedreich ataxia. Arabela Sanz-Alcazar, Marta Portillo-Carrasquer, Israel Manjarres-Raza, Maria Pazos-Gil, Fabien Delaspre, Jordi Tamarit, Juan P. Bolanos, Joaquim Ros, Elisa Cabiscol; bioRxiv 2026.05.01.722124; doi:10.64898/2026.05.01.722124 

 These results highlight the vulnerability of sensory neurons and their supporting satellite glial cells. In contrast, in the cerebrum and cerebellum, astrocytes displayed earlier and more severe alterations than neurons, including impaired respiratory chain efficiency, disrupted complex I-III supercomplex interaction, elevated ROS, and hallmarks of ferroptosis. Neuronal abnormalities emerged later, suggesting that glial dysfunction precedes -or drives- neuronal pathology within the central nervous system. Overall, these findings reveal pronounced region and cell-type-specific vulnerabilities in FA and support the importance of targeting glial mechanisms -particularly iron dysregulation, oxidative stress, and ferroptosis- as targets for potential therapeutic strategies.

Voyager Reports First Quarter 2026 Financial and Operating Results

LEXINGTON, Mass., May 07, 2026 (GLOBE NEWSWIRE) -- Voyager Therapeutics, Inc Neurocrine partnership update: Neurocrine completed GLP toxicology with NBIB-‘223 for Friedreich’s ataxia (FA) and received FDA orphan drug designation. Neurocrine has stated that it intends to initiate a clinical trial with NBIB-‘223 in H2 2026, pending successful FDA IND clearance.

Solid Biosciences Testing Dual Delivery Gene Therapy in First-in-Human Friedreich's Ataxia Trial

Precision Medicine Online. Apr 16, 2026. NEW YORK – Solid Biosciences is advancing its first-in-human trial of SGT-212, an experimental gene therapy for the rare neuromuscular disorder Friedreich's ataxia. 

The dual route of administration is intriguing to Kisanuki, since Friedreich's ataxia implicates multiple tissues in the body. "If we used just systemic delivery, we might not fully benefit the neuro phenotype," he said. "But if we just focus on brain delivery, we're ignoring the cardiac phenotype."

Exploring US patient and caregiver perspectives on burden associated with Friedreich Ataxia

Lawson, R., Natarajan, S., Correll, J.R. et al. Exploring US patient and caregiver perspectives on burden associated with Friedreich Ataxia. J Patient Rep Outcomes (2026). doi:10.1186/s41687-026-01067-4  

Friedreich ataxia (FA) is a hereditary degenerative disease with clinical manifestations in multiple organs characterized by progressive gait and limb ataxia. Qualitative interviews were conducted with patients and caregivers to characterize the burden experienced related to FA symptoms and impacts.

PO-04-187 OVERACTIVITY OF MONOAMINE OXIDASE A IN A MOUSE MODEL OF FRIEDREICH’S ATAXIA CONTRIBUTES TO CATECHOLAMINERGIC ARRHYTHMIAS AND OXIDATIVE STRESS

Figueroa F, Bahriz S, Sellers R ... PO-04-187 OVERACTIVITY OF MONOAMINE OXIDASE A IN A MOUSE MODEL OF FRIEDREICH’S ATAXIA CONTRIBUTES TO CATECHOLAMINERGIC ARRHYTHMIAS AND OXIDATIVE STRESS Heart Rhythm, 23S711. doi:10.1016/j.hrthm.2026.03.1185 

 These findings identify impaired SR-localized β1AR signaling as a novel mechanism driving catecholaminergic arrhythmias in FA. Combined targeting of MAO-A and Nrf2 yields complementary benefits: clorgyline improving autonomic balance and OMAV enhancing redox defense, thereby restoring cardiac conduction and contractile function in FA hearts.

Dimethyl Fumarate Normalizes Expression of Friedreich Ataxia Gene

Neurology Today - American Academy of Neurology; APRIL 20, 2026,  Dan Hurley. 

Dr. Gramaglia said some patients already on omaveloxolone might be interested in combining it with DF. But “we don’t know if DMF as an add-on therapy with omaveloxolone would result in clinical improvements over either one individually,” she added. “We need to study it.”

Efficacy and Safety of Dimethyl Fumarate in Friedreich Ataxia: Primary Results From the Phase Two, Randomized, Double-blind, Placebo-controlled DMF-FA-201 Trial

S26 - Movement Disorders: Clinical Trials and Therapeutics. American Academy of Neurology. Francesco Sacca et al. 

DMF significantly increases transcription of the FXN gene, with long-term stability, to a degree that restores expression levels to those of healthy carriers. The drug appeared safe, with adverse events consistent with DMF pharmacovigilance.

Clinical Challenges in Managing Diabetes Mellitus in Friedreich’s Ataxia

Clinical Challenges in Managing Diabetes Mellitus in Friedreich’s Ataxia. Aarya Naik, Hooman Oktaei, Endocrine Practice , 32, S66-S67.   Doi:10.1016/j.eprac.2026.01.168 

In patients with FRDA, hyperglycemia generally develops at an average of 15 years after the onset of neurologic symptoms. Diabetes onset is often acute and ketosis-prone; appropriate management includes insulin at diagnosis. Past research has shown that often, the first presentation of diabetes in FRDA is ketoacidosis. In any given patient, diabetes may result from defects in insulin secretion by the pancreatic β-cells, impaired insulin action, or both. In FRDA, both insulin deficiency and insulin resistance have been reported.

Because metformin inhibits complex I of the mitochondrial respiratory chain, it should be used with caution. Exogenous insulin administration is often the best choice of treatment for FRDA patients. Regular screening for onset of diabetes as well as early initiation of insulin therapy should be part of overall management of FRDA.

Beyond the Diagnosis of Friedreich’s Ataxia: International Cultural Factors in Patient Decisions

Lauren Mitchell, Cara Stricklin, Nikola Dragojlovic, Beyond the Diagnosis of Friedreich’s Ataxia: International Cultural Factors in Patient Decisions, Archives of Physical Medicine and Rehabilitation, Volume 107, Issue 5, 2026, Page e42, ISSN 0003-9993, doi:10.1016/j.apmr.2026.02.108. 

To investigate the effectiveness of multiple interventions by an interdisciplinary team aimed at improving the functional level of a young woman with Friedreich's Ataxia (FA). Multiple interventions were trialed to include: neurolytic injections, high intensity gait training with various devices, various custom and prefabricated orthoses, neuromuscular re-education, a swallow study, expiratory muscular strength training, familial psychoeducation and community reintegration.

TLR4-mediated neuroimmune signalling drives proprioceptive neuron degeneration in Friedreich ataxia

TLR4-mediated neuroimmune signalling drives proprioceptive neuron degeneration in Friedreich ataxia, Deepika Mokkachamy Chellapandi, Peio Antoine-Uhart, Federica Pilotto, Helene Puccio. bioRxiv 2026.04.28.721289; doi:10.64898/2026.04.28.721289. 

 We identify Toll-like receptor 4 (TLR4) signaling as a key link between neuronal dysfunction and inflammatory response. Inhibition of TLR4 reduces cellular stress, restores neuronal integrity, and delays disease progression in vivo. These findings redefine FA as a disorder involving neuroimmune crosstalk and highlight TLR4 signaling as a potential therapeutic target.