Idebenone treatment in Friedreich patients: One-year-long randomized placebo-controlled trial
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To the Editor:
In 1996, the gene responsible for Friedreich’s ataxia (FRDA) was shown to encode a small protein, frataxin.1 Decreased frataxin was found to cause a deficiency of mitochondrial iron-sulphur proteins (ISP) in endomyocardial biopsies from FRDA patients.1 The function of this mitochondrial protein is unknown, but recent data support the view that it plays a role in the synthesis of iron-sulphur clusters (ISP) that are subsequently delivered to the various compartments of the cell. The decreased amount of ISP can in turn be the target of a second injury, i.e., an oxidative stress resulting from abnormal mitochondrial iron handling in affected tissues.1 This provided the rationale for an antioxidant treatment by idebenone.2
Altogether, a subsequent large open trial3 and two additional studies recently published in Neurology4,5⇓ showed that idebenone had a significant effect on heart hypertrophy and function in a majority of patients, but not on the neurologic condition in FRDA. The mechanism by which idebenone protects the heart remained to be established. Here, we describe the normalization of mitochondrial ISP activities …
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