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Elizondo G, Saini A, Gonzalez de Alba C, Gregor A, Harding CO, Gillingham MB, Vinocur JM. Cardiac phenotype in adolescents and young adults with long-chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) deficiency. Genet Med 2024; 26:101123. [PMID: 38501492 DOI: 10.1016/j.gim.2024.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency (LCHADD) is a rare fatty acid oxidation disorder characterized by recurrent episodes of metabolic decompensation and rhabdomyolysis, as well as retinopathy, peripheral neuropathy, and cardiac involvement, such as infantile dilated cardiomyopathy. Because LCHADD patients are surviving longer, we sought to characterize LCHADD-associated major cardiac involvement in adolescence and young adulthood. METHODS A retrospective cohort of 16 adolescent and young adult participants with LCHADD was reviewed for cardiac phenotype. RESULTS Major cardiac involvement occurred in 9 of 16 participants, including sudden death, out-of-hospital cardiac arrest, acute cardiac decompensations with heart failure and/or in-hospital cardiac arrest, end-stage dilated cardiomyopathy, and moderate restrictive cardiomyopathy. Sudden cardiac arrest was more common in males and those with a history of infant cardiomyopathy. CONCLUSION The cardiac manifestations of LCHADD in adolescence and early adulthood are complex and distinct from the phenotype seen in infancy. Life-threatening arrhythmia occurs at substantial rates in LCHADD, often in the absence of metabolic decompensation or rhabdomyolysis. The potential risk factors identified here-male sex and history of infant cardiomyopathy-may hint at strategies for risk stratification and possibly the prevention of these events.
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Affiliation(s)
- Gabriela Elizondo
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR
| | - Ajesh Saini
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR; Portland State University, Urban Honors College, Portland, OR
| | | | - Ashley Gregor
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR
| | - Cary O Harding
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR
| | - Melanie B Gillingham
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR.
| | - Jeffrey M Vinocur
- Division of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT
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Johansson J, Frykholm C, Ericson K, Kazamia K, Lindberg A, Mulaiese N, Falck G, Gustafsson P, Lidéus S, Gudmundsson S, Ameur A, Bondeson M, Wilbe M. Loss of Nexilin function leads to a recessive lethal fetal cardiomyopathy characterized by cardiomegaly and endocardial fibroelastosis. Am J Med Genet A 2022; 188:1676-1687. [PMID: 35166435 PMCID: PMC9306924 DOI: 10.1002/ajmg.a.62685] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/30/2021] [Accepted: 01/22/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Josefin Johansson
- Department of Immunology, Genetics and Pathology Uppsala University, Science for Life Laboratory Uppsala Sweden
| | - Carina Frykholm
- Department of Immunology, Genetics and Pathology Uppsala University, Science for Life Laboratory Uppsala Sweden
| | - Katharina Ericson
- Department of Clinical Pathology Akademiska University Hospital Uppsala Sweden
| | - Kalliopi Kazamia
- Department of Women's and Children's Health Karolinska Institute Stockholm Sweden
- Children's Heart Center Stockholm‐Uppsala Karolinska University Hospital Stockholm Sweden
- Children’s Heart Center Stockholm‐Uppsala Akademiska University Hospital Uppsala Sweden
| | - Amanda Lindberg
- Department of Immunology, Genetics and Pathology Uppsala University, Science for Life Laboratory Uppsala Sweden
| | - Nancy Mulaiese
- Department of Immunology, Genetics and Pathology Uppsala University, Science for Life Laboratory Uppsala Sweden
| | - Geir Falck
- Department of Internal Medicine Bollnäs Hospital Bollnäs Sweden
| | | | - Sarah Lidéus
- Department of Immunology, Genetics and Pathology Uppsala University, Science for Life Laboratory Uppsala Sweden
| | - Sanna Gudmundsson
- Program in Medical and Population Genetics Broad Institute of Massachusetts Institute of Technology and Harvard Cambridge Massachusetts USA
- Division of Genetics and Genomics Boston Children's Hospital Boston Massachusetts USA
| | - Adam Ameur
- Department of Immunology, Genetics and Pathology Uppsala University, Science for Life Laboratory Uppsala Sweden
| | - Marie‐Louise Bondeson
- Department of Immunology, Genetics and Pathology Uppsala University, Science for Life Laboratory Uppsala Sweden
| | - Maria Wilbe
- Department of Immunology, Genetics and Pathology Uppsala University, Science for Life Laboratory Uppsala Sweden
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Gillingham MB, Heitner SB, Martin J, Rose S, Goldstein A, El-Gharbawy AH, Deward S, Lasarev MR, Pollaro J, DeLany JP, Burchill LJ, Goodpaster B, Shoemaker J, Matern D, Harding CO, Vockley J. Triheptanoin versus trioctanoin for long-chain fatty acid oxidation disorders: a double blinded, randomized controlled trial. J Inherit Metab Dis 2017; 40:831-843. [PMID: 28871440 PMCID: PMC6545116 DOI: 10.1007/s10545-017-0085-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Observational reports suggest that supplementation that increases citric acid cycle intermediates via anaplerosis may have therapeutic advantages over traditional medium-chain triglyceride (MCT) treatment of long-chain fatty acid oxidation disorders (LC-FAODs) but controlled trials have not been reported. The goal of our study was to compare the effects of triheptanoin (C7), an anaplerotic seven-carbon fatty acid triglyceride, to trioctanoin (C8), an eight-carbon fatty acid triglyceride, in patients with LC-FAODs. METHODS A double blinded, randomized controlled trial of 32 subjects with LC-FAODs (carnitine palmitoyltransferase-2, very long-chain acylCoA dehydrogenase, trifunctional protein or long-chain 3-hydroxy acylCoA dehydrogenase deficiencies) who were randomly assigned a diet containing 20% of their total daily energy from either C7 or C8 for 4 months was conducted. Primary outcomes included changes in total energy expenditure (TEE), cardiac function by echocardiogram, exercise tolerance, and phosphocreatine recovery following acute exercise. Secondary outcomes included body composition, blood biomarkers, and adverse events, including incidence of rhabdomyolysis. RESULTS Patients in the C7 group increased left ventricular (LV) ejection fraction by 7.4% (p = 0.046) while experiencing a 20% (p = 0.041) decrease in LV wall mass on their resting echocardiogram. They also required a lower heart rate for the same amount of work during a moderate-intensity exercise stress test when compared to patients taking C8. There was no difference in TEE, phosphocreatine recovery, body composition, incidence of rhabdomyolysis, or any secondary outcome measures between the groups. CONCLUSIONS C7 improved LV ejection fraction and reduced LV mass at rest, as well as lowering heart rate during exercise among patients with LC-FAODs. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT01379625.
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Affiliation(s)
- Melanie B Gillingham
- Department of Molecular and Medical Genetics, Graduate Programs in Human Nutrition, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Stephen B Heitner
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Julie Martin
- Department of Molecular and Medical Genetics, Graduate Programs in Human Nutrition, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Sarah Rose
- Department of Molecular and Medical Genetics, Graduate Programs in Human Nutrition, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- PRA Health Sciences, Raleigh, NC, USA
| | - Amy Goldstein
- Neurogenetics and Metabolism, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Areeg Hassan El-Gharbawy
- Division of Medical Genetics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Stephanie Deward
- Division of Medical Genetics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- GeneDx, Gaithersburg, MD, USA
| | - Michael R Lasarev
- Center for Research on Occupational and Environmental Toxicology, Oregon Health & Science University, Portland, OR, USA
| | - Jim Pollaro
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - James P DeLany
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Luke J Burchill
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Bret Goodpaster
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- The Florida Hospital Translational Research Institute, and the Sanford Burnham Institute, Orlando, FL, USA
| | - James Shoemaker
- Department of Biochemistry and Molecular Biology, Saint Louis University, Saint Louis, MO, USA
| | - Dietrich Matern
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Cary O Harding
- Department of Molecular and Medical Genetics, Graduate Programs in Human Nutrition, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Jerry Vockley
- Division of Medical Genetics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Dyke PC, Konczal L, Bartholomew D, McBride KL, Hoffman TM. Acute dilated cardiomyopathy in a patient with deficiency of long-chain 3-hydroxyacyl-CoA dehydrogenase. Pediatr Cardiol 2009; 30:523-6. [PMID: 19083141 DOI: 10.1007/s00246-008-9351-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 11/11/2008] [Accepted: 11/14/2008] [Indexed: 11/30/2022]
Abstract
Deficiency of long-chain 3-hydroxyacyl-coenzyme A (CoA) dehydrogenase (LCHADD) is a rare inborn error of metabolism. It is associated with hypertrophic cardiomyopathy and less frequently with dilated cardiomyopathy. The incidence and pathophysiology of cardiac involvement in LCHADD is poorly understood. This report describes the acute decompensation of a 3-year-old girl who had LCHADD with rapidly developing dilated cardiomyopathy. A review of the literature and possible causes of cardiomyopathy in LCHADD are explored.
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Affiliation(s)
- Peter C Dyke
- Department of Pediatrics, Nationwide Children's Hospital Heart Center, Columbus, OH 43205-2696, USA
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Rakheja D, Bennett MJ, Rogers BB. Long-chain L-3-hydroxyacyl-coenzyme a dehydrogenase deficiency: a molecular and biochemical review. J Transl Med 2002; 82:815-24. [PMID: 12118083 DOI: 10.1097/01.lab.0000021175.50201.46] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Since the first report of long-chain L-3-hydroxyacyl-coenzyme A dehydrogenase deficiency a little more than a decade ago, its phenotypic and genotypic heterogeneity in individuals homozygous for the enzyme defect has become more and more evident. Even more interesting is its association with pregnancy-specific disorders, including preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), hyperemesis gravidarum, acute fatty liver of pregnancy, and maternal floor infarct of the placenta. In this review we discuss the biochemical and molecular basis, clinical features, diagnosis, and management of long-chain L-3-hydroxyacyl-coenzyme A dehydrogenase deficiency.
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Affiliation(s)
- Dinesh Rakheja
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
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Guertl B, Noehammer C, Hoefler G. Metabolic cardiomyopathies. Int J Exp Pathol 2000; 81:349-72. [PMID: 11298185 PMCID: PMC2517748 DOI: 10.1046/j.1365-2613.2000.00186.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2001] [Accepted: 01/29/2001] [Indexed: 01/27/2023] Open
Abstract
The energy needed by cardiac muscle to maintain proper function is supplied by adenosine Ariphosphate primarily (ATP) production through breakdown of fatty acids. Metabolic cardiomyopathies can be caused by disturbances in metabolism, for example diabetes mellitus, hypertrophy and heart failure or alcoholic cardiomyopathy. Deficiency in enzymes of the mitochondrial beta-oxidation show a varying degree of cardiac manifestation. Aberrations of mitochondrial DNA lead to a wide variety of cardiac disorders, without any obvious correlation between genotype and phenotype. A completely different pathogenetic model comprises cardiac manifestation of systemic metabolic diseases caused by deficiencies of various enzymes in a variety of metabolic pathways. Examples of these disorders are glycogen storage diseases (e.g. glycogenosis type II and III), lysosomal storage diseases (e.g. Niemann-Pick disease, Gaucher disease, I-cell disease, various types of mucopolysaccharidoses, GM1 gangliosidosis, galactosialidosis, carbohydrate-deficient glycoprotein syndromes and Sandhoff's disease). There are some systemic diseases which can also affect the heart, for example triosephosphate isomerase deficiency, hereditary haemochromatosis, CD 36 defect or propionic acidaemia.
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Affiliation(s)
- B Guertl
- Institute of Pathology, University of Graz, Austria.
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Abstract
Inborn errors of the mitochondrial beta-oxidation of long-chain fatty acids represent an evolving field of inherited metabolic disease. Fatty acid oxidation defects demonstrate an abnormal response to the process of fasting adaptation and affect those tissues that utilize fatty acids as an energy source. These tissues include cardiac and skeletal muscle and liver. Muscle directly uses fatty acids as an energy source whilst hepatic metabolism of fatty acids is mostly directed toward the synthesis of ketone bodies for energy utilization by tissues such as brain. The clinical phenotypes of fatty acid oxidation disorders include disease of one or more of these fatty acid-metabolizing tissues. In this review, we provide an overview of the pathway, discuss the disorders that are well established, and describe recent advances in the field. Currently available diagnostic procedures are critically evaluated.
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Affiliation(s)
- M J Bennett
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235, USA.
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Abstract
Long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency is a rare autosomal recessive disorder with varied expression, from severe hypoglycemia and possible sudden infant death to neurosensory deficits secondary to the acute onset. The neurosensory deficits can include clinical features such as seizure disorders, mental retardation, neuropathy, and retinopathy. The basic defect is the lack of the LCHAD enzyme in the liver, which is necessary for fatty acid metabolism. The condition is usually precipitated by infection and dehydration. A case example of a preschooler with LCHAD deficiency is presented to show the complexity of this disorder and resultant developmental disabilities. Implications for nursing practice, education, and research are discussed in relation to the needs of families with complex, developmental disabilities.
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Affiliation(s)
- M S Faulkner
- Boling Center for Developmental Disabilities, College of Nursing, University of Tennessee, Memphis 38163, USA
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