Acetyl-leucine slows disease progression in lysosomal storage disorders

Kaya, Ecem; Smith, David A; Smith, Claire; Morris, Lauren; Brémovà-Ertl, Tatiana; Cortina-Borja, Mario; Fineran, Paul; Morten, Karl J; Poulton, Joanna; Boland, Barry; Spencer, John; Strupp, Michael; Platt, Frances M (2020). Acetyl-leucine slows disease progression in lysosomal storage disorders. Brain Communications, 3(1) Oxford University Press 10.1093/braincomms/fcaa148

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Acetyl-DL-leucine is a derivative of the branched chain amino acid leucine. In observational clinical studies acetyl-DL-leucine improved symptoms of ataxia, in particular in patients with the lysosomal storage disorder, Niemann-Pick disease type C1. Here, we investigated acetyl-DL-leucine and its enantiomers acetyl-L-leucine and acetyl-D-leucine in symptomatic Npc1-/- mice and observed improvement in ataxia with both individual enantiomers and acetyl-DL-leucine. When acetyl-DL-leucine and acetyl-L-leucine were administered pre-symptomatically to Npc1-/- mice, both treatments delayed disease progression and extended life span, whereas acetyl-D-leucine did not. These data are consistent with acetyl-L-leucine being the neuroprotective enantiomer. Altered glucose and antioxidant metabolism were implicated as one of the potential mechanisms of action of the L enantiomer in Npc1-/- mice. When the standard of care drug miglustat and acetyl-DL-leucine were used in combination significant synergy resulted. In agreement with these pre-clinical data, when Niemann-Pick disease type C1 patients were evaluated after 12 months of acetyl-DL-leucine treatment, rates of disease progression were slowed, with stabilisation or improvement in multiple neurological domains. A beneficial effect of acetyl-DL-leucine on gait was also observed in this study in a mouse model of GM2 gangliosidosis (Sandhoff disease) and in Tay-Sachs and Sandhoff disease patients in individual cases of off-label-use. Taken together, we have identified an unanticipated neuroprotective effect of acetyl-L-leucine and underlying mechanisms of action in lysosomal storage diseases, supporting its further evaluation in clinical trials in lysosomal disorders.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Brémovà-Ertl, Tatiana

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2632-1297

Publisher:

Oxford University Press

Language:

English

Submitter:

Chantal Kottler

Date Deposited:

16 Nov 2020 13:35

Last Modified:

18 Jan 2021 01:32

Publisher DOI:

10.1093/braincomms/fcaa148

BORIS DOI:

10.7892/boris.147410

URI:

https://boris.unibe.ch/id/eprint/147410

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