Targeted Therapies for Leigh Syndrome: Systematic Review and Steps Towards a 'Treatabolome'

Background: Leigh syndrome (LS) is the most frequent paediatric clinical presentation of mitochondrial disease. The clinical phenotype of LS is highly heterogeneous. Though historically the treatment for LS is largely supportive, new treatments are on the horizon. Due to the rarity of LS, large-scale interventional studies are scarce, limiting dissemination of information of therapeutic options to the wider scientific and clinical community. Objective: We conducted a systematic reviewof pharmacological therapies of LS following the guidelines for FAIR-compliant datasets. Methods: We searched for interventional studies within Clincialtrials.gov and European Clinical trials databases. Randomised controlled trials, observational studies, case reports and case series formed part of a wider MEDLINE search. Results: Of the 1,193 studies initially identified, 157 met our inclusion criteria, of which 104 were carried over into our final analysis. Treatments for LS included very few interventional trials using EPI-743 and cysteamine bitartrate. Wider literature searches identified case series and reports of treatments repleting glutathione stores, reduction of oxidative stress and restoration of oxidative phosphorylation. Conclusions: Though interventional randomised controlled trials have begun for LS, the majority of evidence remains in case reports and case series for a number of treatable genes, encoding cofactors or transporter proteins of the mitochondria. Our findings will form part of the international expert-led Solve-RD efforts to assist clinicians initiating treatments in patients with treatable variants of LS.

Automated summary

LS, the most common pediatric clinical presentation of mitochondrial disease, is highly heterogeneous in its clinical phenotype. While historically treatment has been supportive, new therapies are emerging. However, due to the rarity of LS, large-scale interventional studies are limited, with evidence largely remaining in case reports and case series.