Department of Internal Medicine, Pharmacogenomics, Washington University School of Medicine, St Louis, United States; Department of Cardiology, The First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, China
Emily K Walton
Department of Internal Medicine, Pharmacogenomics, Washington University School of Medicine, St Louis, United States
Joshua N Ho
Department of Developmental Biology, Washington University School of Medicine, St Louis, United States; Center for Regenerative Medicine, Washington University School of Medicine, St. Louis, United States
Barbara Zablocka
Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
Cindy Ly
Department of Neurology, Washington University School of Medicine, St Louis, United States
Timothy M Miller
Department of Neurology, Washington University School of Medicine, St Louis, United States
Robert H Baloh
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, United States
Michael E Shy
Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, United States
Department of Developmental Biology, Washington University School of Medicine, St Louis, United States; Center for Regenerative Medicine, Washington University School of Medicine, St. Louis, United States
Charcot–Marie-Tooth disease type 2A (CMT2A) is an untreatable childhood peripheral neuropathy caused by mutations of the mitochondrial fusion protein, mitofusin (MFN) 2. Here, pharmacological activation of endogenous normal mitofusins overcame dominant inhibitory effects of CMT2A mutants in reprogrammed human patient motor neurons, reversing hallmark mitochondrial stasis and fragmentation independent of causal MFN2 mutation. In mice expressing human MFN2 T105M, intermittent mitofusin activation with a small molecule, MiM111, normalized CMT2A neuromuscular dysfunction, reversed pre-treatment axon and skeletal myocyte atrophy, and enhanced axon regrowth by increasing mitochondrial transport within peripheral axons and promoting in vivo mitochondrial localization to neuromuscular junctional synapses. MiM111-treated MFN2 T105M mouse neurons exhibited accelerated primary outgrowth and greater post-axotomy regrowth, linked to enhanced mitochondrial motility. MiM111 is the first pre-clinical candidate for CMT2A.