1
|
Stefanik E, Dubińska-Magiera M, Lewandowski D, Daczewska M, Migocka-Patrzałek M. Metabolic aspects of glycogenolysis with special attention to McArdle disease. Mol Genet Metab 2024; 142:108532. [PMID: 39018613 DOI: 10.1016/j.ymgme.2024.108532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/03/2024] [Accepted: 07/03/2024] [Indexed: 07/19/2024]
Abstract
The physiological function of muscle glycogen is to meet the energy demands of muscle contraction. The breakdown of glycogen occurs through two distinct pathways, primarily cytosolic and partially lysosomal. To obtain the necessary energy for their function, skeletal muscles utilise also fatty acids in the β-oxidation. Ketogenesis is an alternative metabolic pathway for fatty acids, which provides an energy source during fasting and starvation. Diseases arising from impaired glycogenolysis lead to muscle weakness and dysfunction. Here, we focused on the lack of muscle glycogen phosphorylase (PYGM), a rate-limiting enzyme for glycogenolysis in skeletal muscles, which leads to McArdle disease. Metabolic myopathies represent a group of genetic disorders characterised by the limited ability of skeletal muscles to generate energy. Here, we discuss the metabolic aspects of glycogenosis with a focus on McArdle disease, offering insights into its pathophysiology. Glycogen accumulation may influence the muscle metabolic dynamics in different ways. We emphasize that a proper treatment approach for such diseases requires addressing three important and interrelated aspects, which include: symptom relief therapy, elimination of the cause of the disease (lack of a functional enzyme) and effective and early diagnosis.
Collapse
Affiliation(s)
- Ewa Stefanik
- Department of Animal Developmental Biology, Faculty of Biological Sciences, University of Wroclaw, Sienkiewicza 21, 50-335 Wrocław, Poland..
| | - Magda Dubińska-Magiera
- Department of Animal Developmental Biology, Faculty of Biological Sciences, University of Wroclaw, Sienkiewicza 21, 50-335 Wrocław, Poland..
| | - Damian Lewandowski
- Department of Animal Developmental Biology, Faculty of Biological Sciences, University of Wroclaw, Sienkiewicza 21, 50-335 Wrocław, Poland..
| | - Małgorzata Daczewska
- Department of Animal Developmental Biology, Faculty of Biological Sciences, University of Wroclaw, Sienkiewicza 21, 50-335 Wrocław, Poland..
| | - Marta Migocka-Patrzałek
- Department of Animal Developmental Biology, Faculty of Biological Sciences, University of Wroclaw, Sienkiewicza 21, 50-335 Wrocław, Poland..
| |
Collapse
|
2
|
Valenzuela PL, Santalla A, Alejo LB, Merlo A, Bustos A, Castellote-Bellés L, Ferrer-Costa R, Maffiuletti NA, Barranco-Gil D, Pinós T, Lucia A. Dose-response effect of pre-exercise carbohydrates under muscle glycogen unavailability: Insights from McArdle disease. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:398-408. [PMID: 38030066 PMCID: PMC11116998 DOI: 10.1016/j.jshs.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/13/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND This study aimed to determine the effect of different carbohydrate (CHO) doses on exercise capacity in patients with McArdle disease-the paradigm of "exercise intolerance", characterized by complete muscle glycogen unavailability-and to determine whether higher exogenous glucose levels affect metabolic responses at the McArdle muscle cell (in vitro) level. METHODS Patients with McArdle disease (n = 8) and healthy controls (n = 9) underwent a 12-min submaximal cycling constant-load bout followed by a maximal ramp test 15 min after ingesting a non-caloric placebo. In a randomized, double-blinded, cross-over design, patients repeated the tests after consuming either 75 g or 150 g of CHO (glucose:fructose = 2:1). Cardiorespiratory, biochemical, perceptual, and electromyographic (EMG) variables were assessed. Additionally, glucose uptake and lactate appearance were studied in vitro in wild-type and McArdle mouse myotubes cultured with increasing glucose concentrations (0.35, 1.00, 4.50, and 10.00 g/L). RESULTS Compared with controls, patients showed the "classical" second-wind phenomenon (after prior disproportionate tachycardia, myalgia, and excess electromyographic activity during submaximal exercise, all p < 0.05) and an impaired endurance exercise capacity (-51% ventilatory threshold and -55% peak power output, both p < 0.001). Regardless of the CHO dose (p < 0.05 for both doses compared with the placebo), CHO intake increased blood glucose and lactate levels, decreased fat oxidation rates, and attenuated the second wind in the patients. However, only the higher dose increased ventilatory threshold (+27%, p = 0.010) and peak power output (+18%, p = 0.007). In vitro analyses revealed no differences in lactate levels across glucose concentrations in wild-type myotubes, whereas a dose-response effect was observed in McArdle myotubes. CONCLUSION CHO intake exerts beneficial effects on exercise capacity in McArdle disease, a condition associated with total muscle glycogen unavailability. Some of these benefits are dose dependent.
Collapse
Affiliation(s)
- Pedro L Valenzuela
- Physical Activity and Health Research Group ("PaHerg"), Research Institute of Hospital "12 de Octubre" ("imas12"), Madrid 28041, Spain; Department of Systems Biology, University of Alcalá, Madrid 28871, Spain.
| | - Alfredo Santalla
- Department of Sport and Computer Science, Section of Physical Education and Sports, Faculty of Sport, Universidad Pablo de Olavide, Sevilla 41013, Spain; EVOPRED Research Group, Universidad Europea de Canarias, Tenerife 38300, Spain
| | - Lidia B Alejo
- Physical Activity and Health Research Group ("PaHerg"), Research Institute of Hospital "12 de Octubre" ("imas12"), Madrid 28041, Spain; Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid 28670, Spain
| | - Andrea Merlo
- Gait & Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera di Rimini (RN) 47922, Italy
| | - Asunción Bustos
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid 28670, Spain
| | - Laura Castellote-Bellés
- Department of Clinical Biochemistry, Laboratoris Clínics, Hospital Universitari Vall d'Hebron, Barcelona 08035, Spain
| | - Roser Ferrer-Costa
- Department of Clinical Biochemistry, Laboratoris Clínics, Hospital Universitari Vall d'Hebron, Barcelona 08035, Spain
| | | | - David Barranco-Gil
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid 28670, Spain
| | - Tomás Pinós
- Biomedical Research Networking Center on Rare Disorders (CIBERER), Barcelona 08035, Spain; Mitochondrial and Neuromuscular Disorders Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona 08035, Spain.
| | - Alejandro Lucia
- Physical Activity and Health Research Group ("PaHerg"), Research Institute of Hospital "12 de Octubre" ("imas12"), Madrid 28041, Spain; Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid 28670, Spain
| |
Collapse
|
3
|
Valenzuela PL, Santalla A, Alejo LB, Bustos A, Ozcoidi LM, Castellote-Bellés L, Ferrer-Costa R, Villarreal-Salazar M, Morán M, Barranco-Gil D, Pinós T, Lucia A. Acute ketone supplementation in the absence of muscle glycogen utilization: Insights from McArdle disease. Clin Nutr 2024; 43:692-700. [PMID: 38320460 DOI: 10.1016/j.clnu.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND & AIMS Ketone supplementation is gaining popularity. Yet, its effects on exercise performance when muscle glycogen cannot be used remain to be determined. McArdle disease can provide insight into this question, as these patients are unable to obtain energy from muscle glycogen, presenting a severely impaired physical capacity. We therefore aimed to assess the effects of acute ketone supplementation in the absence of muscle glycogen utilization (McArdle disease). METHODS In a randomized cross-over design, patients with an inherited block in muscle glycogen breakdown (i.e., McArdle disease, n = 8) and healthy controls (n = 7) underwent a submaximal (constant-load) test that was followed by a maximal ramp test, after the ingestion of a placebo or an exogenous ketone ester supplement (30 g of D-beta hydroxybutyrate/D 1,3 butanediol monoester). Patients were also assessed after carbohydrate (75 g) ingestion, which is currently considered best clinical practice in McArdle disease. RESULTS Ketone supplementation induced ketosis in all participants (blood [ketones] = 3.7 ± 0.9 mM) and modified some gas-exchange responses (notably increasing respiratory exchange ratio, especially in patients). Patients showed an impaired exercise capacity (-65 % peak power output (PPO) compared to controls, p < 0.001) and ketone supplementation resulted in a further impairment (-11.6 % vs. placebo, p = 0.001), with no effects in controls (p = 0.268). In patients, carbohydrate supplementation resulted in a higher PPO compared to ketones (+21.5 %, p = 0.001) and a similar response was observed vs. placebo (+12.6 %, p = 0.057). CONCLUSIONS In individuals who cannot utilize muscle glycogen but have a preserved ability to oxidize blood-borne glucose and fat (McArdle disease), acute ketone supplementation impairs exercise capacity, whereas carbohydrate ingestion exerts the opposite, beneficial effect.
Collapse
Affiliation(s)
- Pedro L Valenzuela
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of Hospital '12 de Octubre' ('imas12'), Madrid, Spain; Department of Systems Biology, University of Alcalá, Madrid, Spain.
| | - Alfredo Santalla
- Department of Sport and Computer Science, Section of Physical Education and Sports, Faculty of Sport, Universidad Pablo de Olavide, Sevilla, Spain; EVOPRED Research Group, Universidad Europea de Canarias, Tenerife, Spain
| | - Lidia B Alejo
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of Hospital '12 de Octubre' ('imas12'), Madrid, Spain; Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Asunción Bustos
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Laureano M Ozcoidi
- Hospital Reina Sofía de Tudela, Servicio Navarro de Salud, Navarra, Spain
| | - Laura Castellote-Bellés
- Department of Clinical Biochemistry, Laboratoris Clínics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Roser Ferrer-Costa
- Department of Clinical Biochemistry, Laboratoris Clínics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mónica Villarreal-Salazar
- Mitochondrial and Neuromuscular Disorders Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Biomedical Research in Rare Diseases (CIBERER), U723, Madrid, Spain
| | - María Morán
- Spanish Network for Biomedical Research in Rare Diseases (CIBERER), U723, Madrid, Spain; Mitochondrial and Neuromuscular Diseases Laboratory, Research Institute of Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | - Tomàs Pinós
- Mitochondrial and Neuromuscular Disorders Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Biomedical Research in Rare Diseases (CIBERER), U723, Madrid, Spain.
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| |
Collapse
|