TY - JOUR
T1 - Safety and efficacy of (+)-epicatechin in subjects with Friedreich's ataxia
T2 - A phase II, open-label, prospective study
AU - Qureshi, Muhammad Yasir
AU - Patterson, Marc C.
AU - Clark, Vicki
AU - Johnson, Jonathan N.
AU - Moutvic, Margaret A.
AU - Driscoll, Sherilyn W.
AU - Kemppainen, Jennifer L.
AU - Huston, John
AU - Anderson, Jeff R.
AU - Badley, Andrew D.
AU - Tebben, Peter J.
AU - Wackel, Philip
AU - Oglesbee, Devin
AU - Glockner, James
AU - Schreiner, George
AU - Dugar, Sundeep
AU - Touchette, Jillienne C.
AU - Gavrilova, Ralitza H.
N1 - Publisher Copyright:
© 2020 SSIEM
PY - 2021/3
Y1 - 2021/3
N2 - Background: (+)-Epicatechin (EPI) induces mitochondrial biogenesis and antioxidant metabolism in muscle fibers and neurons. We aimed to evaluate safety and efficacy of (+)-EPI in pediatric subjects with Friedreich's ataxia (FRDA). Methods: This was a phase II, open-label, baseline-controlled single-center trial including 10 participants ages 10 to 22 with confirmed FA diagnosis. (+)-EPI was administered orally at 75 mg/d for 24 weeks, with escalation to 150 mg/d at 12 weeks for subjects not showing improvement of neuromuscular, neurological or cardiac endpoints. Neurological endpoints were change from baseline in Friedreich's Ataxia Rating Scale (FARS) and 8-m timed walk. Cardiac endpoints were changes from baseline in left ventricular (LV) structure and function by cardiac magnetic resonance imaging (MRI) and echocardiogram, changes in cardiac electrophysiology, and changes in biomarkers for heart failure and hypertrophy. Results: Mean FARS/modified (m)FARS scores showed nonstatistically significant improvement by both group and individual analysis. FARS/mFARS scores improved in 5/9 subjects (56%), 8-m walk in 3/9 (33%), 9-peg hole test in 6/10 (60%). LV mass index by cardiac MRI was significantly reduced at 12 weeks (P =.045), and was improved in 7/10 (70%) subjects at 24 weeks. Mean LV ejection fraction was increased at 24 weeks (P =.008) compared to baseline. Mean maximal septal thickness by echocardiography was increased at 24 weeks (P =.031). There were no serious adverse events. Conclusion: (+)-EPI was well tolerated over 24 weeks at up to 150 mg/d. Improvement was observed in cardiac structure and function in subset of subjects with FRDA without statistically significant improvement in primary neurological outcomes. Synopsis: A (+)-epicatechin showed improvement of cardiac function, nonsignificant reduction of FARS/mFARS scores, and sustained significant upregulation of muscle-regeneration biomarker follistatin.
AB - Background: (+)-Epicatechin (EPI) induces mitochondrial biogenesis and antioxidant metabolism in muscle fibers and neurons. We aimed to evaluate safety and efficacy of (+)-EPI in pediatric subjects with Friedreich's ataxia (FRDA). Methods: This was a phase II, open-label, baseline-controlled single-center trial including 10 participants ages 10 to 22 with confirmed FA diagnosis. (+)-EPI was administered orally at 75 mg/d for 24 weeks, with escalation to 150 mg/d at 12 weeks for subjects not showing improvement of neuromuscular, neurological or cardiac endpoints. Neurological endpoints were change from baseline in Friedreich's Ataxia Rating Scale (FARS) and 8-m timed walk. Cardiac endpoints were changes from baseline in left ventricular (LV) structure and function by cardiac magnetic resonance imaging (MRI) and echocardiogram, changes in cardiac electrophysiology, and changes in biomarkers for heart failure and hypertrophy. Results: Mean FARS/modified (m)FARS scores showed nonstatistically significant improvement by both group and individual analysis. FARS/mFARS scores improved in 5/9 subjects (56%), 8-m walk in 3/9 (33%), 9-peg hole test in 6/10 (60%). LV mass index by cardiac MRI was significantly reduced at 12 weeks (P =.045), and was improved in 7/10 (70%) subjects at 24 weeks. Mean LV ejection fraction was increased at 24 weeks (P =.008) compared to baseline. Mean maximal septal thickness by echocardiography was increased at 24 weeks (P =.031). There were no serious adverse events. Conclusion: (+)-EPI was well tolerated over 24 weeks at up to 150 mg/d. Improvement was observed in cardiac structure and function in subset of subjects with FRDA without statistically significant improvement in primary neurological outcomes. Synopsis: A (+)-epicatechin showed improvement of cardiac function, nonsignificant reduction of FARS/mFARS scores, and sustained significant upregulation of muscle-regeneration biomarker follistatin.
KW - Friedreich ataxia
KW - ataxia
KW - epicatechin
KW - hypertrophy, left ventricular
KW - motor
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UR - http://www.scopus.com/inward/citedby.url?scp=85088514996&partnerID=8YFLogxK
U2 - 10.1002/jimd.12285
DO - 10.1002/jimd.12285
M3 - Article
C2 - 32677106
AN - SCOPUS:85088514996
SN - 0141-8955
VL - 44
SP - 502
EP - 514
JO - Journal of inherited metabolic disease
JF - Journal of inherited metabolic disease
IS - 2
ER -