A comprehensive discovery platform for ELOVL1 small-molecule inhibitors targeting very long-chain fatty acid synthesis in adrenoleukodystrophy.

Adrenoleukodystrophy (ALD or X-ALD) is a rare devastating neurological disease caused by mutations in the ATP binding cassette D1 (ABCD1) gene, the product of which is involved in the transport of very long-chain fatty acids (VLCFAs) into peroxisomes for degradation by β-oxidation. Deficiency in ABCD1 results in VLCFAs accumulation in many tissues, including the brain and spinal cord. Elevated VLCFA levels, specifically C26:0, are consistent biochemical markers of ALD and are implicated in the ALD pathogenesis. ALD disease is manifested by multiple phenotypes: the most severe cerebral disease (cerebral ALD, cALD), adrenomyeloneuropathy (AMN) and adrenal insufficiency (Addison disease). VLCFA accumulation is a hallmark of all ALD phenotypes, and reduction/normalization of VLCFA levels is an attractive approach for the treatment of all ALD manifestations. VLCFAs synthesis involves enzymes from elongase of very long-chain fatty acids (ELOVL) enzyme family with ELOVL1 being a rate-limiting enzyme in C26:0 synthesis, making ELOVL1 an attractive target for medical intervention in ALD via Substrate Reduction Therapy (SRT). In this paper, we describe the in vitro assays established to support medicinal chemistry efforts to develop small-molecule ELOVL1 inhibitors for ALD. Notably, we developed novel, breakthrough in vitro methods to monitor enzymatic and cellular ELOVL1 activity, enabling high-throughput screening (HTS) of Sanofi library collections. We successfully identified CNS-active, small-molecule ELOVL1 inhibitors shown to be efficacious in the reduction of C26:0 VLCFA levels in cells and multiple tissues, including brain and spinal cord, in animal models.