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Camp KM, Krotoski D, Parisi MA, Gwinn KA, Cohen BH, Cox CS, Enns GM, Falk MJ, Goldstein AC, Gopal-Srivastava R, Gorman GS, Hersh SP, Hirano M, Hoffman FA, Karaa A, MacLeod EL, McFarland R, Mohan C, Mulberg AE, Odenkirchen JC, Parikh S, Rutherford PJ, Suggs-Anderson SK, Tang WHW, Vockley J, Wolfe LA, Yannicelli S, Yeske PE, Coates PM. Nutritional interventions in primary mitochondrial disorders: Developing an evidence base. Mol Genet Metab 2016; 119:187-206. [PMID: 27665271 PMCID: PMC5083179 DOI: 10.1016/j.ymgme.2016.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/16/2016] [Accepted: 09/17/2016] [Indexed: 12/22/2022]
Abstract
In December 2014, a workshop entitled "Nutritional Interventions in Primary Mitochondrial Disorders: Developing an Evidence Base" was convened at the NIH with the goals of exploring the use of nutritional interventions in primary mitochondrial disorders (PMD) and identifying knowledge gaps regarding their safety and efficacy; identifying research opportunities; and forging collaborations among researchers, clinicians, patient advocacy groups, and federal partners. Sponsors included the NIH, the Wellcome Trust, and the United Mitochondrial Diseases Foundation. Dietary supplements have historically been used in the management of PMD due to their potential benefits and perceived low risk, even though little evidence exists regarding their effectiveness. PMD are rare and clinically, phenotypically, and genetically heterogeneous. Thus patient recruitment for randomized controlled trials (RCTs) has proven to be challenging. Only a few RCTs examining dietary supplements, singly or in combination with other vitamins and cofactors, are reported in the literature. Regulatory issues pertaining to the use of dietary supplements as treatment modalities further complicate the research and patient access landscape. As a preface to exploring a research agenda, the workshop included presentations and discussions on what PMD are; how nutritional interventions are used in PMD; challenges and barriers to their use; new technologies and approaches to diagnosis and treatment; research opportunities and resources; and perspectives from patient advocacy, industry, and professional organizations. Seven key areas were identified during the workshop. These areas were: 1) defining the disease, 2) clinical trial design, 3) biomarker selection, 4) mechanistic approaches, 5) challenges in using dietary supplements, 6) standards of clinical care, and 7) collaboration issues. Short- and long-term goals within each of these areas were identified. An example of an overarching goal is the enrollment of all individuals with PMD in a natural history study and a patient registry to enhance research capability. The workshop demonstrates an effective model for fostering and enhancing collaborations among NIH and basic research, clinical, patient, pharmaceutical industry, and regulatory stakeholders in the mitochondrial disease community to address research challenges on the use of dietary supplements in PMD.
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Affiliation(s)
- Kathryn M Camp
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Danuta Krotoski
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Melissa A Parisi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Katrina A Gwinn
- National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Bruce H Cohen
- Department of Pediatrics, Akron Children's Hospital, Akron, OH 44308, USA.
| | | | - Gregory M Enns
- Division of Medical Genetics, Stanford University, Stanford, CA 94305, USA.
| | - Marni J Falk
- The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
| | - Amy C Goldstein
- Division of Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
| | - Rashmi Gopal-Srivastava
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Gráinne S Gorman
- Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
| | - Stephen P Hersh
- J. Willard & Alice S. Marriott Foundation, Bethesda, MD 20817, USA.
| | - Michio Hirano
- Columbia University Medical Center, New York, NY 10032, USA.
| | | | - Amel Karaa
- Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Erin L MacLeod
- Division of Genetics and Metabolism, Children's National Health System, Washington, DC 20010, USA.
| | - Robert McFarland
- Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
| | - Charles Mohan
- United Mitochondrial Disease Foundation, Pittsburgh, PA 15239, USA.
| | - Andrew E Mulberg
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20903, USA.
| | - Joanne C Odenkirchen
- National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Sumit Parikh
- Neurosciences, Cleveland Clinic, Cleveland, OH 44195, USA.
| | | | - Shawne K Suggs-Anderson
- Office of Nutrition and Food Labeling, Food and Drug Administration, College Park, MD 20740, USA.
| | - W H Wilson Tang
- Center for Clinical Genomics, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Jerry Vockley
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA.
| | - Lynne A Wolfe
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Steven Yannicelli
- Medical and Scientific Affairs, Nutricia North America, Rockville, MD 20850, USA.
| | - Philip E Yeske
- United Mitochondrial Disease Foundation, Pittsburgh, PA 15239, USA.
| | - Paul M Coates
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892, USA.
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Picard M, Wallace DC, Burelle Y. The rise of mitochondria in medicine. Mitochondrion 2016; 30:105-16. [PMID: 27423788 PMCID: PMC5023480 DOI: 10.1016/j.mito.2016.07.003] [Citation(s) in RCA: 300] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/04/2016] [Accepted: 07/12/2016] [Indexed: 12/11/2022]
Abstract
Once considered exclusively the cell's powerhouse, mitochondria are now recognized to perform multiple essential functions beyond energy production, impacting most areas of cell biology and medicine. Since the emergence of molecular biology and the discovery of pathogenic mitochondrial DNA defects in the 1980's, research advances have revealed a number of common human diseases which share an underlying pathogenesis involving mitochondrial dysfunction. Mitochondria undergo function-defining dynamic shape changes, communicate with each other, regulate gene expression within the nucleus, modulate synaptic transmission within the brain, release molecules that contribute to oncogenic transformation and trigger inflammatory responses systemically, and influence the regulation of complex physiological systems. Novel mitopathogenic mechanisms are thus being uncovered across a number of medical disciplines including genetics, oncology, neurology, immunology, and critical care medicine. Increasing knowledge of the bioenergetic aspects of human disease has provided new opportunities for diagnosis, therapy, prevention, and in connecting various domains of medicine. In this article, we overview specific aspects of mitochondrial biology that have contributed to - and likely will continue to enhance the progress of modern medicine.
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Affiliation(s)
- Martin Picard
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, NY, USA; Department of Neurology and CTNI, H Houston Merritt Center, Columbia University Medical Center, New York, NY, USA.
| | - Douglas C Wallace
- The Center for Mitochondrial and Epigenomic Medicine, Children's Hospital of Philadelphia and Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yan Burelle
- Faculty of Pharmacy, Université de Montreal, Montreal, QC, Canada
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Szeto HH, James LP, Atkinson AJ. Mitochondrial pharmacology: its future is now. Clin Pharmacol Ther 2015; 96:629-33. [PMID: 25399706 DOI: 10.1038/clpt.2014.177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mitochondrial medicine is an evolving discipline whose importance derives from the central function of mitochondria in adenosine triphosphate (ATP) production, generation of reactive oxygen species, and cell death by necrosis or apoptosis. Consequently, mitochondrial dysfunction plays an important role in the progression of aging and the pathophysiology of many common diseases and off-target drug effects. This provides an impetus for the development of mitochondrial pharmacology, and some promising therapeutic targets for mitochondrial protective therapy have been identified.
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Affiliation(s)
- H H Szeto
- Department of Pharmacology, Joan and Sanford I. Weill Medical College of Cornell University, New York, New York, USA
| | - L P James
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - A J Atkinson
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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