Activating cannabinoid receptor 2 preserves axonal health through GSK-3β/NRF2 axis in adrenoleukodystrophy

Acta Neuropathol. 2022 Aug;144(2):241-258. doi: 10.1007/s00401-022-02451-2. Epub 2022 Jul 1.

Abstract

Aberrant endocannabinoid signaling accompanies several neurodegenerative disorders, including multiple sclerosis. Here, we report altered endocannabinoid signaling in X-linked adrenoleukodystrophy (X-ALD), a rare neurometabolic demyelinating syndrome caused by malfunction of the peroxisomal ABCD1 transporter, resulting in the accumulation of very long-chain fatty acids (VLCFAs). We found abnormal levels of cannabinoid receptor 2 (CB2r) and related endocannabinoid enzymes in the brain and peripheral blood mononuclear cells (PBMCs) of X-ALD patients and in the spinal cord of a murine model of X-ALD. Preclinical treatment with a selective agonist of CB2r (JWH133) halted axonal degeneration and associated locomotor deficits, along with normalization of microgliosis. Moreover, the drug improved the main metabolic disturbances underlying this model, particularly in redox and lipid homeostatic pathways, including increased lipid droplets in motor neurons, through the modulation of the GSK-3β/NRF2 axis. JWH133 inhibited Reactive Oxygen Species elicited by excess VLCFAs in primary microglial cultures of Abcd1-null mice. Furthermore, we uncovered intertwined redox and CB2r signaling in the murine spinal cords and in patient PBMC samples obtained from a phase II clinical trial with antioxidants (NCT01495260). These findings highlight CB2r signaling as a potential therapeutic target for X-ALD and perhaps other neurodegenerative disorders that present with dysregulated redox and lipid homeostasis.

Keywords: Axonal degeneration; CB2r; Endocannabinoids; GSK-3β/NRF2; Lipid droplets; Redox homeostasis; X-linked adrenoleukodystrophy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • ATP Binding Cassette Transporter, Subfamily D, Member 1
  • Adrenoleukodystrophy* / drug therapy
  • Animals
  • Clinical Trials, Phase II as Topic
  • Endocannabinoids / therapeutic use
  • Glycogen Synthase Kinase 3 beta / metabolism
  • Leukocytes, Mononuclear / metabolism
  • Mice
  • NF-E2-Related Factor 2 / metabolism
  • Receptors, Cannabinoid / metabolism
  • Receptors, Cannabinoid / therapeutic use

Substances

  • ATP Binding Cassette Transporter, Subfamily D, Member 1
  • Abcd1 protein, mouse
  • Endocannabinoids
  • NF-E2-Related Factor 2
  • Receptors, Cannabinoid
  • Glycogen Synthase Kinase 3 beta

Associated data

  • ClinicalTrials.gov/NCT01495260