IGF1 peptide targets Rett Syndrome astrocytes to degrade IGF binding protein, rescue synaptogenesis and restore mitochondrial function

Rett syndrome (RTT), a severe neurodevelopmental disorder caused by mutations in MECP2, leads to profound synaptic and circuit deficits in the brain. While neurons have historically been the focus of RTT pathology, emerging evidence implicates astrocytes in non-cell autonomous mechanisms that impair synaptic structure, function and development. Here, we uncover a central role for astrocyte-secreted IGFBP2 in mediating these deficits and demonstrate that treatment with an IGF1-derived peptide restores synapse formation by promoting IGFBP2 degradation. Using an indirect astrocyte-neuron co-culture system, we show that astrocytes derived from RTT model mice suppress excitatory synapse formation in wild-type neurons and that this impairment is reversed when RTT astrocytes are treated with IGF1(1-3) peptide. Proteomic analysis reveals elevated levels of IGFBP2 in RTT astrocytes and their conditioned media. IGF1(1-3) peptide treatment leads to proteasomal degradation of IGFBP2, increasing IGF1 bioavailability, restoring mitochondrial function, and enhancing downstream PI3K/Akt signaling in neurons. Our data define a molecular mechanism by which astrocyte dysfunction in RTT can be rescued and provide a mechanistic basis for the therapeutic efficacy of IGF1(1-3) peptide, including Trofinetide, an FDA-approved IGF1 peptide mimetic, in RTT. Significance Statement Astrocyte dysfunction is increasingly recognized as a contributor to neurodevelopmental disorders, yet precise mechanisms remain elusive. Here, we identify IGFBP2 as a key astrocyte-derived inhibitor of synaptogenesis in Rett syndrome. We show that an IGF1-derived peptide, IGF1(1-3), depletes IGFBP2 via proteasomal degradation. This restores IGF1 bioavailability and rescues synaptic function in a non-cell-autonomous manner. These findings provide a mechanistic explanation for the clinical efficacy of IGF1 peptide and its mimetics in Rett syndrome, and highlight astrocytes as rational therapeutic targets in neurodevelopmental and other disorders.