Neuroactive steroids are endogenousn euromodulators that, by binding to membrane receptors and tuning gene expression via intracellular receptors, regulate many physiological functions. They can be synthesized in the brain de novo, so that they are termedn eurosteroids, or reach the central nervous system (CNS) from peripheral steroidogenico rgans,s uch as adrenals and gonads, and are locally metabolized. Neurosteroid levels are alteredi ns everal psychiatric and neurodegenerative diseases as ac onsequence of an impairment of neurosteroidogenesis;b oth preclinical and clinical studies emphasize atherapeutic potentialofn euroactive steroids for these diseases, whereby symptomatology ameliorates upon restoration of neuroactive steroid concentrations. [1][2][3] Neuroactive steroids exert potent anxiolytic, antidepressant, anticonvulsant, sedative, analgesic and amnesic effects, mainly acting as positive allosteric modulators at specific sites on the a-subunit of the g-aminobutyric acid type Ar eceptor (GABA A R).[4] In addition, neuroactive steroids exert neuroprotective, neurotrophic, anti-inflammatory and anti-apoptotic activitiesi ns everala nimal modelso ft raumatic brain and spinal cord injury,c erebral ischemia, peripheraln europathy,a nd neurodegeneratived iseases (e.g.,A lzheimer's and Parkinson's diseases,m ultiple sclerosis, etc.). [2] However,d irect administration of neuroactive steroids has several challenges, including short half-life,l ow bioavailability, poor aqueouss olubility,d evelopmento ft olerance, and undesired side effects such as sedationa nd memory impairment that limit their therapeutic use. Consequently,m odulation of neurosteroidogenesis to restoret he alterede ndogenous neuroactive steroidt one may be ab etter therapeutic approach. [1][2][3] The neuroactive steroidb iosynthetic pathway may be targeted at variousl evels in order to promote neurosteroidogenesis, [3] including the 18 kDat ranslocator protein (TSPO), an outer mitochondrial membrane protein expressed at high levels in peripheral and CNS steroid-producing cells.[5] TSPO plays ak ey role in the rate-limiting step of neuroactive steroid synthesis, consistingo fc holesterol translocation into mitochondria in order to supply it to the cytochrome P450 enzyme CYP11A1 for conversion into pregnenolone, the precursor of all neurosteroids. [6] Numerous TSPO ligandsa re able to potently and dose-dependently stimulate steroid biosynthesis in steroidogenic cells, and they have been proposed as innovative therapeutic tools in several pathological conditions, due to their neuroprotective, anxiolytic, anti-inflammatory,a nd regenerating properties in different in vitro andi nvivo models. [7][8][9][10] To date, phase II clinicalt rials have been concluded for the treatment of diabetic peripheral neuropathy (ClinicalTrials.gov identifier:Ta rgeting the biosyntheticp athway of neuroactive steroids with specific 18 kDa translocator protein (TSPO) ligandsm ay be av iable therapeutic approachf or av ariety of neurodegenerativea nd neuropsychiatri...