Fragile X Syndrome: Lessons Learned from the Most Translated Neurodevelopmental Disorder in Clinical Trials

Abstract Fragile X syndrome (FXS) is the leading genetic cause of autism spectrum disorder (ASD) and inherited intellectual disability (ID) worldwide. Preclinical successes in understanding the biology of FXS have led to numerous translational attempts in human clinical trials of therapeutics that target the excitatory/inhibitory neural signaling imbalances thought to underlie FXS. Despite the preclinical success story, the negative results of the human clinical trials have been deemed to be at least in part disappointing by the field. In this commentary, we contend that such negative studies results in clinical trials may actually propel the FXS field forward by serving as important lessons for designing and implementing improved future clinical trials such that can objectively assess the full range of responses to new therapeutics.

[1]  Kenny Q. Ye,et al.  De Novo Gene Disruptions in Children on the Autistic Spectrum , 2012, Neuron.

[2]  Stephen T Warren,et al.  Molecular mechanisms of fragile X syndrome: a twenty-year perspective. , 2012, Annual review of pathology.

[3]  Janice Branson,et al.  Epigenetic Modification of the FMR1 Gene in Fragile X Syndrome Is Associated with Differential Response to the mGluR5 Antagonist AFQ056 , 2011, Science Translational Medicine.

[4]  C. Bagni,et al.  Fragile X syndrome: causes, diagnosis, mechanisms, and therapeutics. , 2012, The Journal of clinical investigation.

[5]  W. Kaufmann,et al.  What Can We Learn about Autism from Studying Fragile X Syndrome? , 2011, Developmental Neuroscience.

[6]  M. Bear,et al.  Reversal of Disease-Related Pathologies in the Fragile X Mouse Model by Selective Activation of GABAB Receptors with Arbaclofen , 2012, Science Translational Medicine.

[7]  Sébastien Jacquemont,et al.  Mavoglurant in fragile X syndrome: Results of two randomized, double-blind, placebo-controlled trials , 2016, Science Translational Medicine.

[8]  Ilse Gantois,et al.  Chronic administration of AFQ056/Mavoglurant restores social behaviour in Fmr1 knockout mice , 2013, Behavioural Brain Research.

[9]  Mark F Bear,et al.  The mGluR theory of fragile X mental retardation , 2004, Trends in Neurosciences.

[10]  J. Wettstein,et al.  Metabotropic glutamate receptor 5 as drug target for Fragile X syndrome. , 2015, Current opinion in pharmacology.

[11]  Uwe Ohler,et al.  FMR1 targets distinct mRNA sequence elements to regulate protein expression , 2012, Nature.

[12]  Aaron Isaacs,et al.  Rescue of dendritic spine phenotype in Fmr1 KO mice with the mGluR5 antagonist AFQ056/Mavoglurant , 2012, Psychopharmacology.

[13]  R. Rosenfeld Nature , 2009, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[14]  M. Bear,et al.  Effects of STX209 (Arbaclofen) on Neurobehavioral Function in Children and Adults with Fragile X Syndrome: A Randomized, Controlled, Phase 2 Trial , 2012, Science Translational Medicine.

[15]  I. Deary IQ and Human Intelligence, by N.J. Mackintosh , 1999, Trends in Neurosciences.

[16]  D. Budimirovic,et al.  Neurobehavioral features and targeted treatments in fragile X syndrome: Current insights and future directions , 2015 .

[17]  B. Pitt Psychopharmacology , 1968, Mental Health.