Understanding the mechanisms of food effect on omaveloxolone pharmacokinetics through physiologically based biopharmaceutics modeling

Pepin XJH, Hynes SM, Zahir H, Walker D, Semmens LQ, Suarez-Sharp S. Understanding the mechanisms of food effect on omaveloxolone pharmacokinetics through physiologically based biopharmaceutics modeling. CPT Pharmacometrics Syst Pharmacol. 2024 Sep 2. doi: 10.1002/psp4.13221. Epub ahead of print. PMID: 39219492. 

Mechanistically, in vivo omaveloxolone absorption was solubility and dissolution rate limited. However, in the fed state, higher bile salt solubilization led to more rapid dissolution with predominant absorption in the upper gastrointestinal tract, resulting in increased susceptibility to first-pass gut extraction; this accounts for the lack of correlation between Cmax and AUC for omaveloxolone.

ASSAIGS CLÍNICS I REVISIÓ FARMACOLÒGICA DE L’ATÀXIA DE FRIEDREICH

Treball Final de Grau Grau de Farmàcia ASSAIGS CLÍNICS I REVISIÓ FARMACOLÒGICA.NÚRIA BAIGES BEGUER. Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona Barcelona, Juny 2024 

 Aquest treball fa una anàlisi dels assaigs clínics actius en l’actualitat, relacionant-los amb les dianes terapèutiques definides pels mecanismes d’acció dels diferents fàrmacs. En el treball s’analitzen tretze fàrmacs, incloent-hi el fàrmac recentment aprovat, i es fa una breu referència a la recerca preclínica que encara no ha estat provada en persones, fixant-me especialment en aquelles recerques en teràpies avançades, ja que són prometedores per les malalties d’origen genètic.

This paper analyses the clinical trials currently active, relating them to the therapeutic targets defined by the mechanisms of action of the different drugs. Thirteen drugs are analysed, including the recently approved drug, and a brief reference is made to preclinical research that has not yet been tested in humans, focusing especially on research into advanced therapies, as these are promising for diseases of genetic origin. 

Case Report of Friedreich's Ataxia and ALG1-Related Biochemical Abnormalities in a Patient With Progressive Spastic Paraplegia

Quinlan, A., Rodan, L., Barkoudah, E., Tam, A., Saffari, A., Shammas, I., Ranatunga, W., Morava-Kozicz, E., Oglesbee, D., Berry, G., Ebrahimi-Fakhari, D. and Srivastava, S. (2024), Case Report of Friedreich's Ataxia and ALG1-Related Biochemical Abnormalities in a Patient With Progressive Spastic Paraplegia. Am J Med Genet e63890. doi:10.1002/ajmg.a.63890 

 Our findings underscore the importance of considering FRDA as a differential diagnosis in cases of complex HSP and demonstrate the utility of unbiased genome sequencing approaches that include detection of trinucleotide repeat expansions for progressive motor disorders.

VIDEOFLUOROSCOPIC SWALLOWING STUDY FINDINGS AND RESPIRATORY FUNCTION TESTING IN PATIENTS WITH FRIEDREICH ATAXIA

VIDEOFLUOROSCOPIC SWALLOWING STUDY FINDINGS AND RESPIRATORY FUNCTION TESTING IN PATIENTS WITH FRIEDREICH ATAXIA. LEON ASTUDILLO, CARMEN E et al.. CHEST, Volume 166, Issue 4, A6528 - A6529 doi:10.1016/j.chest.2024.07.118

 Dysphagia was present in 2 subjects based on PAS score, and in 3 subjects based on DIGEST scores. Although EAT-10 was abnormal in 4 out of 5 subjects, the results did not correspond to objective findings on VFSS. Similarly, VFSS results did not correspond with other clinical metrics including pulmonary function testing, EAT-10 or IOPI. Four subjects received interventions or dietary modifications based on VFSS results. Our study is limited by the small sample. 

CLINICAL IMPLICATIONS: Dysphagia can be seen in FRDA regardless of respiratory or functional testing results. VFSS or fiberoptic endoscopic evaluation of swallowing (FEES) can be considered as an objective tool for evaluation of swallowing in this population. Further research is needed to identify risk factors, correlation with other clinical metrics and outcomes.

Early Genetic Testing Avoids Treatment Delays for Patients with Friedreich Ataxia

EMJ. 2024;9[3]:14-23. doi:10.33590/emj/RSCJ7037 

This industry-sponsored symposium took place during the European Association of Neurology (EAN) Congress held in Helsinki, Finland, 29 June−2 July, 2024.

At the 2024 European Association of Neurology (EAN) Congress, one satellite symposium discussed the recognition, diagnosis, and treatment of Friedreich ataxia (FA), the most common hereditary ataxia. This condition is characterised by progressive neurodegeneration, multisystem complications, loss of ambulation, and reductions in the ability to carry out activities of daily living (ADL). For many, there is also a premature death. FA is caused by guanine-adenine-adenine triplet (GAA) repeat expansions in the gene FXN. This codes for the protein frataxin, loss of which is associated with impaired mitochondrial function, increased sensitivity to oxidative stress and reactive oxygen species levels, increased inflammation, and cell death.

Papillon Therapeutics Receives Orphan Drug Designation from the U.S. Food and Drug Administration for PPL-001 for the Treatment of Friedreich's Ataxia

SAN DIEGO--(BUSINESS WIRE)--Sep 17, 2024-- Papillon Therapeutics Inc., today announced that the U.S. Food and Drug Administration (FDA) has granted Orphan Drug Designation to Papillon’s PPL-001, an experimental treatment for Friedreich's ataxia. 

PPL-001 is an experimental gene-corrected CD34+ hematopoietic stem and progenitor cell (HSPC) therapy. This therapeutic’s novel approach utilizes targeted excision to correct the GAA repeat expansion in Intron 1 of the FXN gene.

Mitotech Presents Promising Results in Friedreich's Ataxia

LONDON, Sept. 17, 2024 /PRNewswire-PRWeb/ -- Mitotech Ltd, a mitochondria-focused clinical-stage biotechnology company, presented new data for its mitochondria-targeted ferroptosis inhibitor in Friedreich's Ataxia (FA) model at the 149th annual meeting of the American Neurological Association. The conference took place on September 14-17, 2024, in Orlando, FL. 

Those new data demonstrated high level of efficacy of the company's lead compound SkQ1 – a mitochondria-targeted ferroptosis inhibitor – against ferroptosis and oxidative stress at strikingly low doses.The Friedreich's Ataxia-specific model has not only demonstrated SkQ1's great potential as a monotherapy for FA, but also highlighted its MoA as complementary to that of the currently available therapy – omaveloxolone. The latter aspect of our latest dataset opens the door for studying SkQ1 in a combination treatment in the clinic,"

Skeletal Muscle Involvement in Friedreich Ataxia

Indelicato, E.; Wanschitz, J.; Löscher, W.; Boesch, S. Skeletal Muscle Involvement in Friedreich Ataxia. Int. J. Mol. Sci. 2024, 25, 9915. doi:10.3390/ijms25189915 

 Moreover, FRDA displays skeletal muscle involvement, which contributes to the weakness and marked fatigue evident throughout the course of the disease. Herein, we review skeletal muscle findings in FRDA generated by functional imaging, histology, as well as multiomics techniques in both disease models and in patients. Altogether, these findings corroborate a disease phenotype in skeletal muscle and support the notion of progressive mitochondrial damage as a driver of disease progression in FRDA. Furthermore, we highlight the relevance of skeletal muscle investigations in the development of biomarkers for early-phase trials and future therapeutic strategies in FRDA.

Deciphering the ferroptosis pathways in dorsal root ganglia of Friedreich ataxia models. The role of LKB1/AMPK, KEAP1, and GSK3β in the impairment of the NRF2 response

Arabela Sanz-Alcázar, Marta Portillo-Carrasquer, Fabien Delaspre, Maria Pazos-Gil, Jordi Tamarit, Joaquim Ros, Elisa Cabiscol, Deciphering the ferroptosis pathways in dorsal root ganglia of Friedreich ataxia models. The role of LKB1/AMPK, KEAP1, and GSK3β in the impairment of the NRF2 response, Redox Biology, Volume 76, 2024, 103339, ISSN 2213-2317, doi:10.1016/j.redox.2024.103339

Unusual Age-Dependent Behavior of Leukocytes Telomere Length in Friedreich's Ataxia

Scarabino D, Veneziano L, Nethisinghe S, Mantuano E, Fiore A, Granata G, Solanky N, Zanni G, Cavalcanti F, Corbo RM, Giunti P. Unusual Age-Dependent Behavior of Leukocytes Telomere Length in Friedreich's Ataxia. Mov Disord. 2024 Sep 5. doi: 10.1002/mds.29976. Epub ahead of print. PMID: 39235665. 

 The results showed that before 35 years of age, leukocyte telomeres were longer in patients than in controls, whereas the reverse applies in patients above 36 years of age. Interestingly, LTL was greater than controls at any age in heterozygous subjects. Overall, the present study indicates that telomere length analysis in FRDA may be a relevant biomarker for following the stages of the disease.

A Pilot Phase 2 Randomized Trial to Evaluate the Safety and Potential Efficacy of Etravirine in Friedreich Ataxia Patients

Paparella, G.; Stragà, C.; Pesenti, N.; Dal Molin, V.; Martorel, G.A.; Merotto, V.; Genova, C.; Piazza, A.; Piccoli, G.; Panzeri, E.; et al. A Pilot Phase 2 Randomized Trial to Evaluate the Safety and Potential Efficacy of Etravirine in Friedreich Ataxia Patients. Children 2024, 11, 958, doi:10.3390/children11080958.

Etravirine was well tolerated. Etravirine completely stopped the progression of the SARA score during the 4-months treatment period, compared to the 4 months pre and post treatment. It increased peak workload, while the improvement of peak oxygen uptake was not statistically significant. No changes in the cardiac measures were observed. Health and QoL measures showed a worsening at the suspension of the drug. In this open trial etravirine significantly improved neurological function and was generally safe and reasonably tolerated. This suggests that etravirine represents a potential therapeutic agent in FRDA deserving testing in a randomized placebo controlled clinical trial.