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Fatty acid amide hydrolase inhibition for treatment of amyotrophic lateral sclerosis
Daisuke Ito, Madoka Iida, Yohei Iguchi, Atsushi Hashizume, Shinichiro Yamada, Yoshiyuki Kishimoto, Shota Komori, Kazuki Obara, Shuto Nishisaki, Satoshi Yokoi, Teppei Shimamura, Yuto Takemoto, Masahiro Nakatochi, Tomohiro Akashi, Kunihiko Hinohara, Hyeon-Cheol Lee-Okada, Yohei Okada, Junichi Niwa, Gen Sobue, Shinji Tanaka, Ken Takashina, Takehiko Yokomizo, Masahisa Katsuno
Daisuke Ito, Madoka Iida, Yohei Iguchi, Atsushi Hashizume, Shinichiro Yamada, Yoshiyuki Kishimoto, Shota Komori, Kazuki Obara, Shuto Nishisaki, Satoshi Yokoi, Teppei Shimamura, Yuto Takemoto, Masahiro Nakatochi, Tomohiro Akashi, Kunihiko Hinohara, Hyeon-Cheol Lee-Okada, Yohei Okada, Junichi Niwa, Gen Sobue, Shinji Tanaka, Ken Takashina, Takehiko Yokomizo, Masahisa Katsuno
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Research Article Metabolism Neuroscience

Fatty acid amide hydrolase inhibition for treatment of amyotrophic lateral sclerosis

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Abstract

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease caused by the selective loss of upper and lower motor neurons. There is a considerable variability in the disease progression of sporadic ALS, but the molecular basis for phenotypic heterogeneity remains largely unknown. Patients with ALS often manifest systemic metabolic abnormalities such as glucose intolerance and hypermetabolic state. We conducted reverse translational research to explore therapeutic targets in ALS based on the systemic metabolic alterations in patients and identified several metabolites associated with the disease progression, including metabolites involved in the expanded endocannabinoid system (ECS). In particular, the levels of N-acyl taurines (NATs) were correlated with the longitudinal change in the revised ALS functional rating scale and survival. Experiments with ALS cellular models and induced pluripotent stem (iPS) cells derived from patients with ALS and SOD1G93A transgenic mice revealed that PF-04457845, a fatty acid amide hydrolase inhibitor, upregulated the expanded ECS, particularly the levels of NATs and ameliorated motor neuron degeneration through the regulation of microglial environment, synapse plasticity, and neuronal development. These results collectively indicate that dysregulation of NATs is associated with ALS progression and PF-04457845 may represent a potential disease-modifying therapy for ALS.

Authors

Daisuke Ito, Madoka Iida, Yohei Iguchi, Atsushi Hashizume, Shinichiro Yamada, Yoshiyuki Kishimoto, Shota Komori, Kazuki Obara, Shuto Nishisaki, Satoshi Yokoi, Teppei Shimamura, Yuto Takemoto, Masahiro Nakatochi, Tomohiro Akashi, Kunihiko Hinohara, Hyeon-Cheol Lee-Okada, Yohei Okada, Junichi Niwa, Gen Sobue, Shinji Tanaka, Ken Takashina, Takehiko Yokomizo, Masahisa Katsuno

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Figure 2

Alteration in N-acyl taurine metabolism among patients with rapidly progressive ALS, patients with slowly progressive ALS, and healthy individuals and their correlation with disease progression in the discovery cohort and the replication cohort.

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Alteration in N-acyl taurine metabolism among patients with rapidly prog...
(A) Volcano plot of serum metabolomics analysis comparing between patients with rapid ALS and patients with slow ALS in the discovery cohort. (B) Volcano plot of serum lipid mediator analysis comparing between patients with rapid ALS and patients with slow ALS in the replication cohort. (C–F) Serum levels of N-acyl taurine metabolism in the discovery cohort (C, N-oleoyl taurine; D, N-stearoyl taurine; E, N-linoleoyl taurine; F, N-palmitoyl taurine). (G–J) Correlation between the serum levels of N-acyl taurines and the prospective, longitudinal change in ALSFRS-R between the first and second evaluations (slope ALSFRS-R) in the discovery cohort (G, N-oleoyl taurine; H, N-stearoyl taurine; I, N- linoleoyl taurine; J, N-palmitoyl taurine). (K–N) Serum levels of N-acyl taurine metabolism in the replication cohort (K, N-oleoyl taurine; L, N-stearoyl taurine; M, N- linoleoyl taurine; N, N-palmitoyl taurine). (O–R) Correlation between the serum levels of N-acyl taurines and slope ALSFRS-R in the replication cohort (O, N-oleoyl taurine; P, N-stearoyl taurine; Q, N-linoleoyl taurine; R, N-palmitoyl taurine). The discovery cohort was analyzed by broad untargeted metabolomics, whereas the replication cohort was analyzed using a targeted lipid mediator panel; therefore, the total number of detected analytes differed between the 2 cohorts. ALSFRS-R slope values were transformed using the Yeo-Johnson transformation before correlation analysis. One-way ANOVA and Tukey’s post hoc analysis were performed (*P < 0.05, **P < 0.01, and ***P < 0.001). HC, healthy controls; R, Rapid ALS; S, Slow ALS. A coefficient value (r) of 0.40–0.59 is considered moderate, while 0.60–0.79 is considered strong in Spearman’s rank correlation coefficient. Data are shown as mean ± SEM.

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