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Pedersen ZO, Holm-Yildiz S, Dysgaard T. Nutritional Interventions for Patients with Mitochondrial POLG-Related Diseases: A Systematic Review on Efficacy and Safety. Int J Mol Sci 2022; 23:ijms231810658. [PMID: 36142570 PMCID: PMC9502393 DOI: 10.3390/ijms231810658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 12/03/2022] Open
Abstract
Ketogenic diet is recommended as a treatment to reduce seizure frequency in patients with intractable epilepsy. The evidence and safety results are sparse for diet interventions in patients with pathogenic polymerase gamma (POLG) variants and intractable epilepsy. The aim of this systematic review is to summarize the efficacy of diet treatment on seizure frequency, clinical symptoms, and potential deleterious effect of liver involvement in patients with mitochondrial diseases caused by pathogenic POLG variants. Literature was searched in PubMed, Embase; and Cochrane in April 2022; no filter restrictions were imposed. The reference lists of retrieved studies were checked for additional literature. Eligibility criteria included verified pathogenic POLG variant and diet treatment. Overall, 880 studies were identified, providing eight case-reports representing nine patients eligible for inclusion. In eight of nine cases, clinical symptoms were improved; six out of nine cases reported improvements in seizure frequency. However, increasing levels of liver enzymes after initiating ketogenic diet were found in four of the nine cases, with one case revealing decreased levels of liver enzymes after initiating long-chain triglyceride restriction. Viewed together, the studies imply that ketogenic diet can have a positive impact on seizure frequency, but may induce progression of liver impairment in patients with pathogenic POLG variants.
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Assessment of Dietary Patterns and Supplement Use in Mitochondrial Disease. Clin Nutr ESPEN 2022; 51:461-469. [DOI: 10.1016/j.clnesp.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022]
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The ketogenic diet as a therapeutic intervention strategy in mitochondrial disease. Int J Biochem Cell Biol 2021; 138:106050. [PMID: 34298163 DOI: 10.1016/j.biocel.2021.106050] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/02/2021] [Accepted: 07/16/2021] [Indexed: 11/21/2022]
Abstract
Classical mitochondrial disease (MD) represents a group of complex metabolic syndromes primarily linked to dysfunction of the mitochondrial ATP-generating oxidative phosphorylation (OXPHOS) system. To date, effective therapies for these diseases are lacking. Here we discuss the ketogenic diet (KD), being a high-fat, moderate protein, and low carbohydrate diet, as a potential intervention strategy. We concisely review the impact of the KD on bioenergetics, ROS/redox metabolism, mitochondrial dynamics and mitophagy. Next, the consequences of the KD in (models of) MD, as well as KD adverse effects, are described. It is concluded that the current experimental evidence suggests that the KD can positively impact on mitochondrial bioenergetics, mitochondrial ROS/redox metabolism and mitochondrial dynamics. However, more information is required on the bioenergetic consequences and mechanistic mode-of-action aspects of the KD at the cellular level and in MD patients.
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Sofou K, Dahlin M, Hallböök T, Lindefeldt M, Viggedal G, Darin N. Ketogenic diet in pyruvate dehydrogenase complex deficiency: short- and long-term outcomes. J Inherit Metab Dis 2017; 40:237-245. [PMID: 28101805 PMCID: PMC5306430 DOI: 10.1007/s10545-016-0011-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Our aime was to study the short- and long-term effects of ketogenic diet on the disease course and disease-related outcomes in patients with pyruvate dehydrogenase complex deficiency, the metabolic factors implicated in treatment outcomes, and potential safety and compliance issues. METHODS Pediatric patients diagnosed with pyruvate dehydrogenase complex deficiency in Sweden and treated with ketogenic diet were evaluated. Study assessments at specific time points included developmental and neurocognitive testing, patient log books, and investigator and parental questionnaires. A systematic literature review was also performed. RESULTS Nineteen patients were assessed, the majority having prenatal disease onset. Patients were treated with ketogenic diet for a median of 2.9 years. All patients alive at the time of data registration at a median age of 6 years. The treatment had a positive effect mainly in the areas of epilepsy, ataxia, sleep disturbance, speech/language development, social functioning, and frequency of hospitalizations. It was also safe-except in one patient who discontinued because of acute pancreatitis. The median plasma concentration of ketone bodies (3-hydroxybutyric acid) was 3.3 mmol/l. Poor dietary compliance was associated with relapsing ataxia and stagnation of motor and neurocognitive development. Results of neurocognitive testing are reported for 12 of 19 patients. CONCLUSION Ketogenic diet was an effective and safe treatment for the majority of patients. Treatment effect was mainly determined by disease phenotype and attainment and maintenance of ketosis.
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Affiliation(s)
- Kalliopi Sofou
- Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Smörslottsgatan 1, 41685, Gothenburg, Sweden.
| | - Maria Dahlin
- Department of Pediatrics, Astrid Lindgren Children's Hospital, Karolinska Institute, Stockholm, Sweden
| | - Tove Hallböök
- Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Smörslottsgatan 1, 41685, Gothenburg, Sweden
| | - Marie Lindefeldt
- Department of Pediatrics, Astrid Lindgren Children's Hospital, Karolinska Institute, Stockholm, Sweden
| | - Gerd Viggedal
- Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Smörslottsgatan 1, 41685, Gothenburg, Sweden
| | - Niklas Darin
- Department of Pediatrics, The Queen Silvia Children's Hospital, University of Gothenburg, Smörslottsgatan 1, 41685, Gothenburg, Sweden
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Verrotti A, Iapadre G, Pisano S, Coppola G. Ketogenic diet and childhood neurological disorders other than epilepsy: an overview. Expert Rev Neurother 2016; 17:461-473. [PMID: 27841033 DOI: 10.1080/14737175.2017.1260004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In the last years, ketogenic diet (KD) has been experimentally utilized in various childhood neurologic disorders such as mitochondriopathies, alternating hemiplegia of childhood (AHC), brain tumors, migraine, and autism spectrum disorder (ASD). The aim of this review is to analyze how KD can target these different medical conditions, highlighting possible mechanisms involved. Areas covered: We have conducted an analysis on literature concerning KD use in mitochondriopathies, AHC, brain tumors, migraine, and ASD. Expert commentary: The role of KD in reducing seizure activity in some mitochondriopathies and its efficacy in pyruvate dehydrogenase deficiency is known. Recently, few cases suggest the potentiality of KD in decreasing paroxysmal activity in children affected by AHC. A few data support its potential use as co-adjuvant and alternative therapeutic option for brain cancer, while any beneficial effect of KD on migraine remains unclear. KD could improve cognitive and social skills in a subset of children with ASD.
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Affiliation(s)
- Alberto Verrotti
- a Department of Pediatrics , University of L'Aquila, San Salvatore Hospital , L'Aquila , Italy
| | - Giulia Iapadre
- a Department of Pediatrics , University of L'Aquila, San Salvatore Hospital , L'Aquila , Italy
| | - Simone Pisano
- b Department of Child and Adolescent Neuropsychiatry , University of Salerno , Salerno , Italy
| | - Giangennaro Coppola
- c Department of Child Neuropsychiatry , University of Salerno , Salerno , Italy
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Pliss L, Jatania U, Patel MS. Beneficial effect of feeding a ketogenic diet to mothers on brain development in their progeny with a murine model of pyruvate dehydrogenase complex deficiency. Mol Genet Metab Rep 2016; 7:78-86. [PMID: 27331005 PMCID: PMC4901178 DOI: 10.1016/j.ymgmr.2016.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 12/12/2022] Open
Abstract
Pyruvate dehydrogenase complex (PDC) deficiency is a major inborn error of oxidative metabolism of pyruvate in the mitochondria causing congenital lactic acidosis and primarily structural and functional abnormalities of the central nervous system. To provide an alternate source of acetyl-CoA derived from ketone bodies to the developing brain, a formula high in fat content is widely employed as a treatment. In the present study we investigated efficacy of a high-fat diet given to mothers during pregnancy and lactation on lessening of the impact of PDC deficiency on brain development in PDC-deficient female progeny. Methods A murine model of systemic PDC deficiency by interrupting the X-linked Pdha1 gene was employed in this study. Results Maternal consumption of a high-fat diet during pregnancy and lactation had no effect on number of live-birth, body growth, tissue PDC activity levels, as well as the in vitro rates of glucose oxidation and fatty acid biosynthesis by the developing brain of PDC-deficient female offspring during the postnatal age 35 days, as compared to the PDC-deficient progeny born to dams on a chow diet. Interestingly, brain weight was normalized in PDC-deficient progeny of high fat-fed mothers with improvement in impairment in brain structure deficit whereas brain weight was significantly decreased and was associated with greater cerebral structural defects in progeny of chow-fed mothers as compared to control progeny of mothers fed either a chow or high fat diet. Conclusion The findings provide for the first time experimental support for beneficial effects of a ketogenic diet during the prenatal and early postnatal periods on the brain development of PDC-deficient mammalian progeny.
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Key Words
- Brain development
- E18, embryonic day 18
- Glucose metabolism
- HF, high fat
- High fat diet
- LC, laboratory chow
- Mouse model
- P15, postnatal day 15
- PDC, pyruvate dehydrogenase complex
- PDH, pyruvate dehydrogenase
- PDHA1, human gene that encodes α subunit of PDH
- Pdha1, murine orthologue of PDHA1
- Prenatal treatment
- Pyruvate dehydrogenase complex deficiency
- flox8, Pdha1 floxed allele
- wt, wild-type Pdha1 allele
- Δex8, Pdha1 null allele
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Affiliation(s)
- Lioudmila Pliss
- Department of Biochemistry, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Urvi Jatania
- Department of Exercise and Nutrition, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Mulchand S. Patel
- Department of Biochemistry, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA
- Corresponding author at: Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 140 Farber Hall, Buffalo, NY 14214, USA.Department of BiochemistryJacobs School of Medicine and Biomedical SciencesUniversity at Buffalo140 Farber HallBuffaloNY14214USA
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Scholl-Bürgi S, Höller A, Pichler K, Michel M, Haberlandt E, Karall D. Ketogenic diets in patients with inherited metabolic disorders. J Inherit Metab Dis 2015; 38:765-73. [PMID: 26109259 DOI: 10.1007/s10545-015-9872-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/05/2015] [Accepted: 06/05/2015] [Indexed: 01/01/2023]
Abstract
Ketogenic diets (KDs) are diets that bring on a metabolic condition comparable to fasting, usually without catabolism. Since the mid-1990s such diets have been widely used in patients with seizures/epilepsies, mostly children. This review focuses on the use of KDs in patients with various inherited metabolic disorders (IMD). In glucose transporter type 1 deficiency syndrome (GLUT1-DS) and pyruvate dehydrogenase complex (PDHc) deficiency, KDs are deemed the therapy of choice and directly target the underlying metabolic disorder. Moreover, in other IMD, mainly of intermediary metabolism such as glycogen storage diseases and disorders of mitochondrial energy supply, KDs may ameliorate clinical symptoms and laboratory parameters. KDs have also been used successfully to treat symptoms such as seizures/epilepsy in IMD, e.g. in urea cycle disorders and non-ketotic hyperglycinemia. As a note of caution, catabolism may cause the condition of patients with IMD to deteriorate and should thus be avoided during KDs. For this reason, careful monitoring (clinical, laboratory and apparatus-supported) is warranted. In some IMDs specific macronutrient supply is critical. Therefore, in cases of PDHc deficiency the carbohydrate intake tolerated without lactate increase and in urea cycle disorders the protein tolerance should be determined. Considering this, it is particularly important in patients with IMD that the use of KDs be individualized and well documented.
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Affiliation(s)
- S Scholl-Bürgi
- Department of Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria,
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Napoli E, Dueñas N, Giulivi C. Potential therapeutic use of the ketogenic diet in autism spectrum disorders. Front Pediatr 2014; 2:69. [PMID: 25072037 PMCID: PMC4074854 DOI: 10.3389/fped.2014.00069] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/17/2014] [Indexed: 11/13/2022] Open
Abstract
The ketogenic diet (KGD) has been recognized as an effective treatment for individuals with glucose transporter 1 (GLUT1) and pyruvate dehydrogenase (PDH) deficiencies as well as with epilepsy. More recently, its use has been advocated in a number of neurological disorders prompting a newfound interest in its possible therapeutic use in autism spectrum disorders (ASD). One study and one case report indicated that children with ASD treated with a KGD showed decreased seizure frequencies and exhibited behavioral improvements (i.e., improved learning abilities and social skills). The KGD could benefit individuals with ASD affected with epileptic episodes as well as those with either PDH or mild respiratory chain (RC) complex deficiencies. Given that the mechanism of action of the KGD is not fully understood, caution should be exercised in ASD cases lacking a careful biochemical and metabolic characterization to avoid deleterious side effects or refractory outcomes.
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Affiliation(s)
- Eleonora Napoli
- Department of Molecular Biosciences, University of California Davis , Davis, CA , USA
| | - Nadia Dueñas
- Department of Molecular Biosciences, University of California Davis , Davis, CA , USA
| | - Cecilia Giulivi
- Department of Molecular Biosciences, University of California Davis , Davis, CA , USA ; Medical Investigations of Neurodevelopmental Disorders (M. I. N. D.) Institute , Sacramento, CA , USA
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