Pharmacological BET Protein Inhibition Reverts Niemann-Pick Type C Disease-Associated Changes in Human iPSC-Derived Cortical Neurons

Abstract

Niemann-Pick type C1 (NPC1) disease is a fatal lysosomal disorder caused by impaired intracellular cholesterol trafficking, leading to progressive neurodegeneration and premature death. Despite advances in disease modelling, therapeutic development remains limited, partly due to the lack of human neuronal systems that accurately recapitulate disease-relevant phenotypes. Here, we generated a patient-specific neuronal model by differentiating induced pluripotent stem cells (iPSCs) carrying the most common NPC1 p.I1061T variant into cortical neurons. These cells exhibit hallmarks of neuronal pathology associated with NPC1 disease, providing a platform to investigate pathological mechanisms and to validate therapeutic candidates in a human context. Using this experimental model, we explored the effects of pharmacological inhibition of bromodomain and extraterminal (BET) proteins. Treatment with the BET inhibitor JQ1 attenuated disease-associated phenotypes, improving neuronal viability and modulating intracellular cholesterol accumulation. Overall, our findings identify BET inhibition as a novel strategy to ameliorate NPC1-associated neuronal pathology and uncover a previously underexplored link between epigenetic regulation and cholesterol homeostasis, highlighting iPSC-derived neurons as a powerful platform for therapeutic discovery.