1. Phenylbutyrate Therapy for Pyruvate Dehydrogenase Complex Deficiency and Lactic Acidosis
- Author
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Mariella I. Ferrante, Edoardo Nusco, Brendan Lee, Rosa Ferriero, Paolo Sordino, Giuseppe Manco, Peter W. Stacpoole, Nicola Brunetti-Pierri, Eleonora Lamantea, Massimo Zeviani, Ferriero, R, Manco, G, Lamantea, E, Nusco, E, Ferrante, Mi, Sordino, P, Stacpoole, Pw, Lee, B, Zeviani, M, and BRUNETTI PIERRI, Nicola
- Subjects
Pyruvate dehydrogenase kinase ,Biology ,Phenylbutyrate ,Article ,Acidosis, Lactic ,Animals ,Brain ,Liver ,Mice ,Muscle, Skeletal ,Phenylbutyrates ,Phosphorylation ,Pyruvate Dehydrogenase Complex Deficiency Disease ,CONTROLLED CLINICAL-TRIAL ,SODIUM PHENYLBUTYRATE ,PHOSPHORYLATION SITES ,LACTATE METABOLISM ,BEHAVIORAL SCREEN ,INTRACELLULAR PH ,STRUCTURAL BASIS ,KINASE-ACTIVITY ,PROTEIN-KINASE ,LEIGH-SYNDROME ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,030304 developmental biology ,Acidosis ,0303 health sciences ,Lactic ,Skeletal ,General Medicine ,Pyruvate dehydrogenase complex ,medicine.disease ,3. Good health ,Pyruvate dehydrogenase deficiency ,Lactic acid ,Biochemistry ,chemistry ,Lactic acidosis ,Muscle ,medicine.symptom ,030217 neurology & neurosurgery - Abstract
Lactic acidosis is a buildup of lactic acid in the blood and tissues, which can be due to several inborn errors of metabolism as well as nongenetic conditions. Deficiency of pyruvate dehydrogenase complex (PDHC) is the most common genetic disorder leading to lactic acidosis. Phosphorylation of specific serine residues of the E1 alpha subunit of PDHC by pyruvate dehydrogenase kinase (PDK) inactivates the enzyme, whereas dephosphorylation restores PDHC activity. We found that phenylbutyrate enhances PDHC enzymatic activity in vitro and in vivo by increasing the proportion of unphosphorylated enzyme through inhibition of PDK. Phenylbutyrate given to C57BL/6 wild-type mice results in a significant increase in PDHC enzyme activity and a reduction of phosphorylated E1 alpha in brain, muscle, and liver compared to saline-treated mice. By means of recombinant enzymes, we showed that phenylbutyrate prevents phosphorylation of E1 alpha through binding and inhibition of PDK, providing a molecular explanation for the effect of phenylbutyrate on PDHC activity. Phenylbutyrate increases PDHC activity in fibroblasts from PDHC-deficient patients harboring various molecular defects and corrects the morphological, locomotor, and biochemical abnormalities in the noa(m631) zebrafish model of PDHC deficiency. In mice, phenylbutyrate prevents systemic lactic acidosis induced by partial hepatectomy. Because phenylbutyrate is already approved for human use in other diseases, the findings of this study have the potential to be rapidly translated for treatment of patients with PDHC deficiency and other forms of primary and secondary lactic acidosis.
- Published
- 2013
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