FDA-approved PDE4 inhibitors alleviate the dominant toxicity of ALS-FTD-associated CHCHD10(S59L) in Drosophila and human cells.

Mutations in CHCHD10 are a genetic cause of ALS-FTD. In our previous studies using Drosophila expressing C2C10H(S81L) and human cells expressing CHCHD10(S59L), we found that the aberrant activation of the PINK1/Parkin pathway drives cellular toxicity, and pseudo-substrate inhibitors of PINK1 or mitofusin-2 agonists can mitigate these effects. Evidence from in vitro, in vivo, and chemical approaches supports PINK1 inhibition as a promising strategy for CHCHD10(S59L)-associated disease. Here, we show that FDA-approved PDE4 inhibitors significantly reduce CHCHD10(S59L)-induced mitochondrial morphological and functional defects in both human cells and Drosophila. These protective effects occur through a cAMP/PKA-dependent mechanism, indicating that elevated cAMP signaling attenuates aberrant PINK1/Parkin activation. Moreover, forskolin combined with PDE4 inhibitors synergistically decreases mitochondrial toxicity at lower concentrations. Together, our findings suggest that clinically available PDE4 inhibitors could be repurposed for CHCHD10(S59L)-linked ALS-FTD, while emphasizing the need to carefully consider the effects of the PINK1/Parkin pathway, as it is generally recognized as a protective pathway.