Clemastine fumarate enhances myelination and promotes functional recovery in a syndromic ASD mouse model of Pitt-Hopkins Syndrome

Pitt-Hopkins syndrome (PTHS) is an autism spectrum disorder (ASD) caused by autosomal dominant mutations in the Transcription Factor 4 gene (TCF4). One pathobiological process caused by Tcf4 mutation is a cell autonomous reduction in oligodendrocytes (OLs) and myelination. In this study, we show that clemastine is effective at restoring myelination defects in a PTHS mouse model. In vitro, clemastine treatment reduced excess oligodendrocyte precursor cells (OPCs) and normalized OL density. In vivo, two-week intraperitoneal administration of clemastine also normalized OPC and OL density in the cortex of Tcf4 mutant mice and appeared to increase the number of axons undergoing myelination, as EM imaging of the corpus callosum showed a significant increase in uncompacted myelin. Importantly, this treatment paradigm resulted in functional rescue by improving electrophysiology and behavior. Together, these results provide preclinical evidence that remyelination therapies may be beneficial in PTHS and potentially other neurodevelopmental disorders characterized by demyelination.