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Weeks KL, Kiriazis H, Wadley GD, Masterman EI, Sergienko NM, Raaijmakers AJA, Trewin AJ, Harmawan CA, Yildiz GS, Liu Y, Drew BG, Gregorevic P, Delbridge LMD, McMullen JR, Bernardo BC. A gene therapy targeting medium-chain acyl-CoA dehydrogenase (MCAD) did not protect against diabetes-induced cardiac pathology. J Mol Med (Berl) 2024; 102:95-111. [PMID: 37987775 DOI: 10.1007/s00109-023-02397-2] [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: 03/20/2023] [Revised: 10/31/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
Diabetic cardiomyopathy describes heart disease in patients with diabetes who have no other cardiac conditions but have a higher risk of developing heart failure. Specific therapies to treat the diabetic heart are limited. A key mechanism involved in the progression of diabetic cardiomyopathy is dysregulation of cardiac energy metabolism. The aim of this study was to determine if increasing the expression of medium-chain acyl-coenzyme A dehydrogenase (MCAD; encoded by Acadm), a key regulator of fatty acid oxidation, could improve the function of the diabetic heart. Male mice were administered streptozotocin to induce diabetes, which led to diastolic dysfunction 8 weeks post-injection. Mice then received cardiac-selective adeno-associated viral vectors encoding MCAD (rAAV6:MCAD) or control AAV and were followed for 8 weeks. In the non-diabetic heart, rAAV6:MCAD increased MCAD expression (mRNA and protein) and increased Acadl and Acadvl, but an increase in MCAD enzyme activity was not detectable. rAAV6:MCAD delivery in the diabetic heart increased MCAD mRNA expression but did not significantly increase protein, activity, or improve diabetes-induced cardiac pathology or molecular metabolic and lipid markers. The uptake of AAV viral vectors was reduced in the diabetic versus non-diabetic heart, which may have implications for the translation of AAV therapies into the clinic. KEY MESSAGES: The effects of increasing MCAD in the diabetic heart are unknown. Delivery of rAAV6:MCAD increased MCAD mRNA and protein, but not enzyme activity, in the non-diabetic heart. Independent of MCAD enzyme activity, rAAV6:MCAD increased Acadl and Acadvl in the non-diabetic heart. Increasing MCAD cardiac gene expression alone was not sufficient to protect against diabetes-induced cardiac pathology. AAV transduction efficiency was reduced in the diabetic heart, which has clinical implications.
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Affiliation(s)
- Kate L Weeks
- Department of Anatomy and Physiology, University of Melbourne, Parkville, VIC, 3010, Australia
- Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, 3010, Australia
- Department of Diabetes, Central Clinical School, Monash University, Clayton, VIC, 3800, Australia
| | - Helen Kiriazis
- Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, 3010, Australia
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia
| | - Glenn D Wadley
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, 3125, Australia
| | - Emma I Masterman
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia
| | - Nicola M Sergienko
- Department of Diabetes, Central Clinical School, Monash University, Clayton, VIC, 3800, Australia
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia
| | - Antonia J A Raaijmakers
- Department of Anatomy and Physiology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Adam J Trewin
- Department of Anatomy and Physiology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Claudia A Harmawan
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia
| | - Gunes S Yildiz
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia
| | - Yingying Liu
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia
| | - Brian G Drew
- Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, 3010, Australia
- Department of Diabetes, Central Clinical School, Monash University, Clayton, VIC, 3800, Australia
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia
| | - Paul Gregorevic
- Department of Anatomy and Physiology, University of Melbourne, Parkville, VIC, 3010, Australia
- Centre for Muscle Research, University of Melbourne, Parkville, VIC, 3010, Australia
- Department of Biochemistry and Molecular Biology, Monash University, Melbourne, VIC, 3800, Australia
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Lea M D Delbridge
- Department of Anatomy and Physiology, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Julie R McMullen
- Department of Cardiometabolic Health, University of Melbourne, Parkville, VIC, 3010, Australia
- Department of Diabetes, Central Clinical School, Monash University, Clayton, VIC, 3800, Australia
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Bianca C Bernardo
- Department of Diabetes, Central Clinical School, Monash University, Clayton, VIC, 3800, Australia.
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC, 3004, Australia.
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3010, Australia.
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Janeiro P, Jotta R, Ramos R, Florindo C, Ventura FV, Vilarinho L, Tavares de Almeida I, Gaspar A. Follow-up of fatty acid β-oxidation disorders in expanded newborn screening era. Eur J Pediatr 2019; 178:387-394. [PMID: 30617651 DOI: 10.1007/s00431-018-03315-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/21/2018] [Accepted: 12/26/2018] [Indexed: 01/25/2023]
Abstract
Fatty acid β-oxidation (FAO) disorders have a wide variety of symptoms, not usually evident between episodes of acute decompensations. Cardiac involvement is frequent, and severe ventricular arrhythmias are suspected of causing sudden death. Expanded newborn screening (ENS) for these disorders, hopefully, contribute to prevent potentially acute life-threatening events. In order to characterize acute decompensations observed in FAO-deficient cases identified by ENS, a retrospective analysis was performed, covering a period of 9 years. Demographic data, number/type of acute decompensations, treatment, and follow-up were considered. Eighty-three clinical charts, including 66 medium-chain acyl-CoA dehydrogenase deficiency (MCADD), 5 carnitine-uptake deficiency (CUD), 3 carnitine palmitoyltransferase I and II (CPT I/II) deficiency, 5 very long-chain acyl-CoA dehydrogenase deficiency (VLCADD), and 4 multiple acyl-CoA dehydrogenase deficiency (MADD) cases were reviewed. Nineteen patients had acute decompensations (1 CPT I, 1 CPT II, 3 MADD, 14 MCADD). Six patients developed symptoms previously to ENS diagnosis. Severe clinical manifestations included multiple organ failure, liver failure, heart failure, and sudden death. Long-chain FAO disorders had the highest number of decompensations per patient.Conclusion: Despite earlier diagnosis by ENS, sudden deaths were not avoided and acute decompensations with severe clinical manifestations still occur as well. What is Known: • Severe ventricular arrhythmias are suspected to cause unexpected death in FAO disorders. • Neonatal screening intends to reduce the incidence of severe metabolic crisis and death. What is New: • Acute severe decompensations occurred in FAO disorders diagnosed through neonatal screening. • Sudden deaths were not avoided by starting treatment precociously.
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Affiliation(s)
- Patrícia Janeiro
- Centro de Referência de Doenças Hereditárias do Metabolismo, Departamento de Pediatria Médica, Hospital de Santa Maria - CHULN, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
| | - Rita Jotta
- Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria - CHULN, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal
| | - Ruben Ramos
- Laboratório de Metabolismos e Genética, Faculdade de Farmácia da Universidade de Lisboa, Av. Prof. Gama Pinto Edificio F, 1649-099, Lisbon, Portugal
| | - Cristina Florindo
- Laboratório de Metabolismos e Genética, Faculdade de Farmácia da Universidade de Lisboa, Av. Prof. Gama Pinto Edificio F, 1649-099, Lisbon, Portugal
| | - Fátima V Ventura
- Laboratório de Metabolismos e Genética, Faculdade de Farmácia da Universidade de Lisboa, Av. Prof. Gama Pinto Edificio F, 1649-099, Lisbon, Portugal
| | - Laura Vilarinho
- Unidade de Rastreio Neonatal Metabolismo e Genética, Departamento de Genética Humana, Instituto Nacional de Saúde Dr. Ricardo Jorge, Rua Alexandre Herculano 321, 4000-055, Porto, Portugal
| | - Isabel Tavares de Almeida
- Laboratório de Metabolismos e Genética, Faculdade de Farmácia da Universidade de Lisboa, Av. Prof. Gama Pinto Edificio F, 1649-099, Lisbon, Portugal
| | - Ana Gaspar
- Centro de Referência de Doenças Hereditárias do Metabolismo, Departamento de Pediatria Médica, Hospital de Santa Maria - CHULN, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal
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Gene delivery of medium chain acyl-coenzyme A dehydrogenase induces physiological cardiac hypertrophy and protects against pathological remodelling. Clin Sci (Lond) 2018; 132:381-397. [PMID: 29358507 DOI: 10.1042/cs20171269] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/10/2018] [Accepted: 01/22/2018] [Indexed: 02/06/2023]
Abstract
We previously showed that medium chain acyl-coenzyme A dehydrogenase (MCAD, key regulator of fatty acid oxidation) is positively modulated in the heart by the cardioprotective kinase, phosphoinositide 3-kinase (PI3K(p110α)). Disturbances in cardiac metabolism are a feature of heart failure (HF) patients and targeting metabolic defects is considered a potential therapeutic approach. The specific role of MCAD in the adult heart is unknown. To examine the role of MCAD in the heart and to assess the therapeutic potential of increasing MCAD in the failing heart, we developed a gene therapy tool using recombinant adeno-associated viral vectors (rAAV) encoding MCAD. We hypothesised that increasing MCAD expression may recapitulate the cardioprotective properties of PI3K(p110α). rAAV6:MCAD or rAAV6:control was delivered to healthy adult mice and to mice with pre-existing pathological hypertrophy and cardiac dysfunction due to transverse aortic constriction (TAC). In healthy mice, rAAV6:MCAD induced physiological hypertrophy (increase in heart size, normal systolic function and increased capillary density). In response to TAC (~15 weeks), heart weight/tibia length increased by ~60% in control mice and ~45% in rAAV6:MCAD mice compared with sham. This was associated with an increase in cardiomyocyte cross-sectional area in both TAC groups which was similar. However, hypertrophy in TAC rAAV6:MCAD mice was associated with less fibrosis, a trend for increased capillary density and a more favourable molecular profile compared with TAC rAAV6:control mice. In summary, MCAD induced physiological cardiac hypertrophy in healthy adult mice and attenuated features of pathological remodelling in a cardiac disease model.
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Houten SM, Violante S, Ventura FV, Wanders RJA. The Biochemistry and Physiology of Mitochondrial Fatty Acid β-Oxidation and Its Genetic Disorders. Annu Rev Physiol 2015; 78:23-44. [PMID: 26474213 DOI: 10.1146/annurev-physiol-021115-105045] [Citation(s) in RCA: 469] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mitochondrial fatty acid β-oxidation (FAO) is the major pathway for the degradation of fatty acids and is essential for maintaining energy homeostasis in the human body. Fatty acids are a crucial energy source in the postabsorptive and fasted states when glucose supply is limiting. But even when glucose is abundantly available, FAO is a main energy source for the heart, skeletal muscle, and kidney. A series of enzymes, transporters, and other facilitating proteins are involved in FAO. Recessively inherited defects are known for most of the genes encoding these proteins. The clinical presentation of these disorders may include hypoketotic hypoglycemia, (cardio)myopathy, arrhythmia, and rhabdomyolysis and illustrates the importance of FAO during fasting and in hepatic and (cardio)muscular function. In this review, we present the current state of knowledge on the biochemistry and physiological functions of FAO and discuss the pathophysiological processes associated with FAO disorders.
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Affiliation(s)
- Sander M Houten
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029; ,
| | - Sara Violante
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029; ,
| | - Fatima V Ventura
- Metabolism and Genetics Group, Research Institute for Medicines and Pharmaceutical Sciences, iMed.ULisboa, 1649-003 Lisboa, Portugal; .,Department of Biochemistry and Human Biology, Faculty of Pharmacy, University of Lisbon, 1649-003 Lisboa, Portugal
| | - Ronald J A Wanders
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, University of Amsterdam, 1100 DE Amsterdam, The Netherlands; .,Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Bala P, Ferdinandusse S, Olpin SE, Chetcuti P, Morris AAM. Recurrent Ventricular Tachycardia in Medium-Chain Acyl-Coenzyme A Dehydrogenase Deficiency. JIMD Rep 2015; 27:11-5. [PMID: 26404458 DOI: 10.1007/8904_2015_463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/12/2015] [Accepted: 05/17/2015] [Indexed: 12/25/2022] Open
Abstract
We report a baby with medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency who presented on day 2 with poor feeding and lethargy. She was floppy with hypoglycaemia (1.8 mmol/l) and hyperammonaemia (182 μmol/l). Despite correction of these and a continuous intravenous infusion of glucose at 4.5-6.2 mg/kg/min, she developed generalised tonic clonic seizures on day 3. She also suffered two episodes of pulseless ventricular tachycardia, from which she was resuscitated successfully. Unfortunately, she died on day 5, following a third episode of pulseless ventricular tachycardia. Arrhythmias are generally thought to be rarer in MCAD deficiency than in disorders of long-chain fatty acid oxidation. This is, however, the sixth report of ventricular tachyarrhythmias in MCAD deficiency. Five of these involved neonates and it may be that patients with MCAD deficiency are particularly prone to ventricular arrhythmias in the newborn period. Three of the patients (including ours) had normal blood glucose concentrations at the time of the arrhythmias and had been receiving intravenous glucose for many hours. These cases suggest that arrhythmias can be induced by medium-chain acylcarnitines or other metabolites accumulating in MCAD deficiency. Ventricular tachyarrhythmias can occur in MCAD deficiency, especially in neonates.
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Affiliation(s)
- P Bala
- Department of Paediatrics, Airedale General Hospital, Keighley, UK
| | - S Ferdinandusse
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - S E Olpin
- Department of Clinical Chemistry, Sheffield Children's Hospital, Sheffield, UK
| | - P Chetcuti
- Department of Paediatrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A A M Morris
- Willink Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK.
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