Pathological expansions of GAA repeats in the first intron of the frataxin gene cause most cases of Friedreich ataxia, a progressively debilitating neurodegenerative disease. The disease is inherited in an autosomal recessive manner and the GAA repeats are suspected to form unusual non B-DNA conformations that decrease transcription and subsequently reduce levels of the encoded protein, frataxin. Recent work has shown that GAA repeats induce heterochromatin formation and silencing of the frataxin gene locus. Frataxin plays a crucial role in iron metabolism and detoxification and interacts with electron transport chain proteins. Clinical trials are currently underway to examine the efficacy of antioxidants in the treatment of Friedreich ataxia, but therapeutics designed to  increase frataxin message levels are still in the developmental stages. This review will focus on the progress of potential treatment strategies for Friedreich ataxia that target the GAA expanded gene and seek to increase the level of frataxin message and protein.

Santhera Announces Start of US Phase III Clinical Trial with SNT-MC17 in Friedreich’s Ataxia and Provides Details on Study Design

Initiation of a six month study with 51 FRDA patients and ICARS as primary endpoint expected shortly. Fast-track designation granted by FDA.

Liestal, Switzerland, September 28, 2007 – Santhera Pharmaceuticals (SWX:SANN), a Swiss specialty pharmaceutical company focused on neuromuscular diseases, announced today that it has reached an agreement with the US Food and Drug Administration (FDA) under the Special Protocol Assessment (SPA) procedure relating to the Phase III clinical trial to evaluate SNT-MC17 (INN: idebenone) for the treatment of Friedreich’s Ataxia (FRDA). The protocol incorporates advice provided by the FDA on the design of the study, its endpoints, statistical analysis and conduct. The FDA granted a fast track designation to Santhera’s compound in FRDA.

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Friedreich's ataxia is the most common hereditary neurodegenerative disorder, and more than half of all patients show echocardiographic evidence of cardiomyopathy. Although angina has been reported in these patients, the role of coronary artery disease has previously been dismissed and is therefore underestimated. Premature obstructive coronary disease has rarely been angiographically demonstrated in patients with Friedreich's ataxia. We present an unusual case of a 35-year-old woman with Friedreich's ataxia who presented with intermittent chest pressure associated with dyspnea and diaphoresis.

Cardiac catheterization revealed a chronically occluded left circumflex coronary artery and a high-grade stenosis of the left anterior descending coronary artery. A Cypher stent, placed within the left anterior descending artery, left no residual stenosis. This case illustrates the importance of fully investigating anginal symptoms in patients with Friedreich's ataxia, because coronary artery disease is likely underdiagnosed in  this population. Early diagnosis may permit aggressive management and may delay the progression to end-stage cardiomyopathy.

Read More: Mortality in Friedreich's Ataxia

A team of researchers from the “Medical Genetic Clinic and Research Unit” Inserm Unit 781 directed by Arnold Munnich (Necker - Sick Children’s Hospital, Paris) in collaboration with Ioav Cabantchik (Hebrew University, Jerusalem) have just obtained promising results for the treatment of neurological damage from Friedreich Ataxia, the most frequent of hereditary ataxias. Movement coordination, speech as well as certain sensory disorders were improved under the effect of deferiprone, a molecule which traps the iron accumulated abnormally in certain regions of the brain. These positive results, obtained right from phase I/II of the trail, offer short term therapeutic prospects for this severely disabling disease.

Read More: Results Announced Phase I/II Study of Deferiprone