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Renard P, Caccavelli L, Legendre A, Tuchmann-Durand C, Balakirouchenane D, Blanchet B, Narjoz C, Straube M, Hubas A, Garros A, Mention K, Bednarek N, Goudin N, Broissand C, Schlatter J, Cisternino S, Cagnard N, van Endert P, Diana J, de Calbiac H, de Lonlay P. Hydroxychloroquine sulfate: A novel treatment for lipin-1 deficiency? Biomed Pharmacother 2023; 163:114813. [PMID: 37150031 DOI: 10.1016/j.biopha.2023.114813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Lipin-1 deficiency is a life-threatening disease that causes severe rhabdomyolysis (RM) and chronic symptoms associated with oxidative stress. In the absence of treatment, Hydroxychloroquine sulfate (HCQ) was administered to patients off label use on a compassionate basis in order to improve their physical conditions. METHODS Eleven patients with LPIN1 mutations were treated with HCQ. Clinical and biological efficacy and tolerance were assessed, including pain and quality of life, physical capacities, cardiopulmonary parameters, creatine kinase levels and plasma proinflammatory cytokines. To explore a dose-dependent effect of HCQ, primary myoblasts from 4 patients were incubated with various HCQ concentrations in growth medium (GM) or during starvation (EBSS medium) to investigate autophagy and oxidative stress. FINDINGS Under HCQ treatment, patient physical capacities improved. Abnormal cardiac function and peripheral muscle adaptation to exercise were normalized. However, two patients who had the highest mean blood HCQ concentrations experienced RM. We hypothesized that HCQ exerts deleterious effects at high concentrations by blocking autophagy, and beneficial effects on oxidative stress at low concentrations. We confirmed in primary myoblasts from 4 patients that high in vitro HCQ concentration (10 µM) but not low concentration (1 µM and 0.1 µM) induced autophagy blockage by modifying endolysosomal pH. Low HCQ concentration (1 µM) prevented reactive oxygen species (ROS) and oxidized DNA accumulation in myoblasts during starvation. INTERPRETATION HCQ improves the condition of patients with lipin-1 deficiency, but at low concentrations. In vitro, 1 µM HCQ decreases oxidative stress in myoblasts whereas higher concentrations have a deleterious effect by blocking autophagy.
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Affiliation(s)
- Perrine Renard
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France
| | - Laure Caccavelli
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France; Centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Filière G2M, MetabERN, F-75015 Paris, France
| | - Antoine Legendre
- Centre de référence Malformations Cardiaques Congénitales Complexes M3C - Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015 Paris, France
| | - Caroline Tuchmann-Durand
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Filière G2M, MetabERN, F-75015 Paris, France; Institut Imagine, Centre d'Investigation Clinique pour les Thérapies innovantes, Département de Biothérapie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015 Paris, France
| | - David Balakirouchenane
- Département de pharmacocinétique et pharmacochimie, Centre Hospitalier Universitaire Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), CARPEM, F-75014 Paris, France
| | - Benoit Blanchet
- Département de pharmacocinétique et pharmacochimie, Centre Hospitalier Universitaire Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), CARPEM, F-75014 Paris, France; Université Paris Cité, PRES Sorbonne Paris Cité, CARPEM, Faculté de Pharmacie, INSERM U-1268 / CNRS UMR-8038, FR-750006 Paris, France
| | - Céline Narjoz
- Service de Biochimie, Hôpital Universitaire Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015 Paris, France
| | - Marjolène Straube
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France; Centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Filière G2M, MetabERN, F-75015 Paris, France
| | - Arnaud Hubas
- Service de biochimie et Génétique Moléculaire, Laboratoire de culture cellulaire, Hôpital Universitaire Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75014 Paris, France
| | - Alexa Garros
- Centre de compétence des maladies héréditaires du métabolisme, Hôpital Universitaire Grenoble Alpes, Filière G2M, Grenoble, France
| | - Karine Mention
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Jeanne de Flandre, Filière G2M, MetabERN, Lille, France
| | - Nathalie Bednarek
- Centre de compétence des maladies héréditaires du métabolisme, Hôpital Universitaire, Filière G2M, Reims, France
| | - Nicolas Goudin
- Cell Imaging & Flow Cytometry Core Facilities, Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS3633, Paris, France
| | - Christine Broissand
- Service de Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015 Paris, France
| | - Joel Schlatter
- Service de Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015 Paris, France
| | - Salvatore Cisternino
- Service de Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015 Paris, France; Université Paris Cité, Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM UMRS-1144, F-75006 Paris, France
| | - Nicolas Cagnard
- Université Paris Cité, Bioinformatiques, SFR Necker, INSERM US-24 / CNRS UAR-3633, F-75015 Paris, France
| | - Peter van Endert
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France; Service Immunologie Biologique, AP-HP, Hôpital Universitaire Necker-Enfants Malades, F-75015 Paris, France
| | - Julien Diana
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France
| | - Hortense de Calbiac
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France; Centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Filière G2M, MetabERN, F-75015 Paris, France
| | - Pascale de Lonlay
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France; Centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Filière G2M, MetabERN, F-75015 Paris, France.
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Legendre A, Khraiche D, Ou P, Mauvais FX, Madrange M, Guemann AS, Jais JP, Bonnet D, Hamel Y, de Lonlay P. Cardiac function and exercise adaptation in 8 children with LPIN1 mutations. Mol Genet Metab 2018; 123:375-381. [PMID: 29325813 DOI: 10.1016/j.ymgme.2017.12.429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Lipin-1 deficiency is a major cause of rhabdomyolysis that are precipitated by febrile illness. The prognosis is poor, with one-third of patients dying from cardiac arrest during a crisis episode. Apart from acute rhabdomyolysis, most patients are healthy, showing normal clinical and cardiac ultrasound parameters. PATIENTS AND METHODS We report cardiac and exercise examinations of 8 children carrying two LPIN1 mutations. The examinations were performed outside of a myolysis episode, but one patient presented with fever during one examination. RESULTS All but one patient displayed normal resting cardiac function, as determined by echocardiography. One patient exhibited slight left ventricular dysfunction at rest and a lack of increased stroke volume during cycle ramp exercise. During exercise, peripheral muscle adaptation was impaired in 2 patients compared to healthy controls: they presented an abnormal increase in cardiac output relative to oxygen uptake: dQ/dVO2=8.2 and 9.5 (>2DS of controls population). One patient underwent 2 exercise tests; during one test, the patient was febrile, leading to acute rhabdomyolysis in the following hours. He exhibited changes in recovery muscle reoxygenation parameters and an increased dQ/dVO2 during exercise compared with that under normothermia (7.9 vs 6), which did not lead to acute rhabdomyolysis. The four patients assessed by cardiac 1H-magnetic resonance spectroscopy exhibited signs of intracardiac steatosis. CONCLUSION We observed abnormal haemodynamic profiles during exercise in 3/8 patients with lipin-1 deficiency, suggesting impaired muscle oxidative phosphorylation during exercise. Fever appeared to be an aggravating factor. One patient exhibited moderate cardiac dysfunction, which was possibly related to intracardiac stored lipid toxicity.
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Affiliation(s)
- Antoine Legendre
- Pediatric Cardiology, Centre de Référence des Malformations Cardiaques Congénitales Complexes-M3C, Necker Hospital for Sick Children, Paris, France.
| | - Diala Khraiche
- Pediatric Cardiology, Centre de Référence des Malformations Cardiaques Congénitales Complexes-M3C, Necker Hospital for Sick Children, Paris, France
| | - Phalla Ou
- Pediatric Cardiology, Centre de Référence des Malformations Cardiaques Congénitales Complexes-M3C, Necker Hospital for Sick Children, Paris, France; Department of Radiology, Hospital Bichat, APHP, University Paris Diderot, Paris, France
| | - François-Xavier Mauvais
- Reference Centre of Inherited Metabolic Diseases, Hospital Necker Enfants Malades, APHP, Institute Imagine, University Paris Descartes, Paris, France; Institut National de la Sante et de la Recherche Médicale, Unité 1151, Paris 75015, France
| | - Marine Madrange
- Reference Centre of Inherited Metabolic Diseases, Hospital Necker Enfants Malades, APHP, Institute Imagine, University Paris Descartes, Paris, France
| | - Anne-Sophie Guemann
- Reference Centre of Inherited Metabolic Diseases, Hospital Necker Enfants Malades, APHP, Institute Imagine, University Paris Descartes, Paris, France
| | - Jean-Philippe Jais
- Université Paris Descartes, Department of Biostatistics and Medical Informatics, Paris, France
| | - Damien Bonnet
- Pediatric Cardiology, Centre de Référence des Malformations Cardiaques Congénitales Complexes-M3C, Necker Hospital for Sick Children, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Yamina Hamel
- Reference Centre of Inherited Metabolic Diseases, Hospital Necker Enfants Malades, APHP, Institute Imagine, University Paris Descartes, Paris, France
| | - Pascale de Lonlay
- Reference Centre of Inherited Metabolic Diseases, Hospital Necker Enfants Malades, APHP, Institute Imagine, University Paris Descartes, Paris, France
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