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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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Mason E, Hindmarch CCT, Dunham‐Snary KJ. Medium-chain Acyl-COA dehydrogenase deficiency: Pathogenesis, diagnosis, and treatment. Endocrinol Diabetes Metab 2022; 6:e385. [PMID: 36300606 PMCID: PMC9836253 DOI: 10.1002/edm2.385] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/09/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Medium-Chain Acyl-CoA Dehydrogenase Deficiency (MCADD) is the most common inherited metabolic disorder of β-oxidation. Patients with MCADD present with hypoketotic hypoglycemia, which may quickly progress to lethargy, coma, and death. Prognosis for MCADD patients is highly promising once a diagnosis has been established, though management strategies may vary depending on the severity of illness and the presence of comorbidities. METHODS AND RESULTS Given the rapid developments in the world of gene therapy and implementation of newborn screening for inherited metabolic disorders, the provision of concise and contemporary knowledge of MCADD is essential for clinicians to effectively manage patients. Thus, this review aims to consolidate current information for physicians on the pathogenesis, diagnostic tools, and treatment options for MCADD patients. CONCLUSION MCADD is a commonly inherited metabolic disease with serious implications for health outcomes, particularly in children, that may be successfully managed with proper intervention.
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Affiliation(s)
- Emily Mason
- Department of Biomedical and Molecular SciencesQueen's UniversityKingstonOntarioCanada
| | | | - Kimberly J. Dunham‐Snary
- Department of Biomedical and Molecular SciencesQueen's UniversityKingstonOntarioCanada,Department of MedicineQueen's UniversityKingstonOntarioCanada
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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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Bentler K, Zhai S, Elsbecker SA, Arnold GL, Burton BK, Vockley J, Cameron CA, Hiner SJ, Edick MJ, Berry SA. 221 newborn-screened neonates with medium-chain acyl-coenzyme A dehydrogenase deficiency: Findings from the Inborn Errors of Metabolism Collaborative. Mol Genet Metab 2016; 119:75-82. [PMID: 27477829 PMCID: PMC5031545 DOI: 10.1016/j.ymgme.2016.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/08/2016] [Accepted: 07/09/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is limited understanding of relationships between genotype, phenotype and other conditions contributing to health in neonates with medium-chain acyl-coenzyme A dehydrogenase deficiency (MCADD) identified through newborn screening. METHODS Retrospective analysis of comprehensive data from a cohort of 221 newborn-screened subjects identified as affected with MCADD in the Inborn Errors of Metabolism - Information System (IBEM-IS), a long term follow-up database of the Inborn Errors of Metabolism Collaborative, was performed. RESULTS The average age at notification of first newborn screen results to primary care or metabolic providers was 7.45days. The average octanoylcarnitine (C8) value on first newborn screen was 11.2μmol/L (median 8.6, range 0.36-43.91). A higher C8 level correlated with an earlier first subspecialty visit. Subjects with low birth weight had significantly lower C8 values. Significantly higher C8 values were found in symptomatic newborns, in newborns with abnormal lab testing in addition to newborn screening and/or diagnostic tests, and in subjects homozygous for the c.985A>G ACADM gene mutation or compound heterozygous for the c.985A>G mutation and deletions or other known highly deleterious mutations. Subjects with neonatal symptoms, or neonatal abnormal labs, or neonatal triggers were more likely to have at least one copy of the severe c.985A>G ACADM gene mutation. C8 and genotype category were significant predictors of the likelihood of having neonatal symptoms. Neonates with select triggers were more likely to have symptoms and laboratory abnormalities. CONCLUSIONS This collaborative study is the first in the United States to describe health associations of a large cohort of newborn-screened neonates identified as affected with MCADD. The IBEM-IS has utility as a platform to better understand the characteristics of individuals with newborn-screened conditions and their follow-up interactions with the health system.
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Affiliation(s)
- Kristi Bentler
- Minnesota Department of Health, St. Paul, MN, United States
| | - Shaohui Zhai
- Michigan Public Health Institute, Okemos, MI, United States
| | - Sara A Elsbecker
- University of Minnesota, Department of Pediatrics, Minneapolis, MN, United States
| | - Georgianne L Arnold
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Barbara K Burton
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Jerry Vockley
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | - Sally J Hiner
- Michigan Public Health Institute, Okemos, MI, United States
| | - Mathew J Edick
- Michigan Public Health Institute, Okemos, MI, United States
| | - Susan A Berry
- University of Minnesota, Department of Pediatrics, Minneapolis, MN, United States.
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