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

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.This study was funded by the Institute of Health Carlos III through projects [PI19/01008] to SF and [PI20/00759] to AP (co-funded by the European Regional Development Fund, ERDF, a way to build Europe), Miguel Servet program [CPII16/00016] to SF and [PFIS, FI18/00141] to LPS (co-funded by the European Social Fund, ESF investing in your future). This study was also funded by grants from the Spanish Ministry of Health, Social Services and Equality (EC10-137), the Autonomous Government of Catalonia [2017SGR1206], the Hesperia Foundation, CERTIS Obres i Serveis, and the Crowd funding Campaign Arnau’97 to AP. JP was a predoctoral fellow of IDIBELL. The Center for Biomedical Research on Rare Diseases (CIBERER), an initiative of the Institute of Health Carlos III, funded the position of MR. Locomotor experiments were performed by the SEFALer unit F5 led by AP, which belongs to the CIBERER structure. We thank the CERCA Program/Generalitat de Catalunya for institutional support