Mitochondrial dysfunction precedes neurodegeneration in DRPLA patient-derived neurons, and phenylbutyrate improves survival.

Dentatorubral-pallidoluysian atrophy (DRPLA) is a progressive autosomal-dominant neurodegenerative disorder caused by a CAG repeat expansion in the ATN1 gene, which encodes the transcriptional corepressor Atrophin-1. The temporal sequence of molecular mechanisms driving neuronal dysfunction and degeneration in DRPLA is poorly understood, limiting therapeutic development. We generated patient-derived induced pluripotent stem cells and differentiated them into cortical excitatory glutamatergic neurons to model early pathogenic processes. Early pathological features of DRPLA patient-derived neurons included mitochondrial dysfunction and oxidative stress. These alterations occurred before overt neuronal loss, highlighting bioenergetic stress as a key early driver of disease progression toward neurodegeneration. Pharmacological treatment with phenylbutyrate significantly improved neuronal survival and reduced mitochondrial reactive oxygen species production, demonstrating the therapeutic potential of targeting mitochondrial dysfunction and oxidative stress. These findings challenge the conventional aggregation-centric model of polyglutamine disease pathogenesis and position mitochondrial stress as a central and early promoter of neuronal degeneration in DRPLA. By providing mechanistic insight into early-stage disease processes, our study lays the foundation for therapeutic strategies targeting mitochondrial dysfunction in DRPLA and related polyglutamine disorders.