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Ketogenic diet treatment of defects in the mitochondrial malate aspartate shuttle and pyruvate carrier

The mitochondrial malate aspartate shuttle system (MAS) maintains the cytosolic NAD+/NADH redox balance, thereby sustaining cytosolic redox-dependent pathways, such as glycolysis and serine biosynthesis. Human disease has been associated with defects in four MAS-proteins (encoded by MDH1, MDH2, GOT2...

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Hauptverfasser: Bölsterli Heinzle, Bigna (VerfasserIn) , Boltshauser, Eugen (VerfasserIn) , Palmieri, Luigi (VerfasserIn) , Spenger, Johannes (VerfasserIn) , Brunner-Krainz, Michaela (VerfasserIn) , Distelmaier, Felix (VerfasserIn) , Freisinger, Peter (VerfasserIn) , Geis, Tobias (VerfasserIn) , Gropman, Andrea L. (VerfasserIn) , Häberle, Johannes (VerfasserIn) , Hentschel, Julia (VerfasserIn) , Jeandidier, Bruno (VerfasserIn) , Karall, Daniela (VerfasserIn) , Keren, Boris (VerfasserIn) , Klabunde-Cherwon, Annick (VerfasserIn) , Konstantopoulou, Vassiliki (VerfasserIn) , Kottke, Raimund (VerfasserIn) , Lasorsa, Francesco M. (VerfasserIn) , Makowski, Christine (VerfasserIn) , Mignot, Cyril (VerfasserIn) , O’Gorman Tuura, Ruth (VerfasserIn) , Porcelli, Vito (VerfasserIn) , Santer, René (VerfasserIn) , Sen, Kuntal (VerfasserIn) , Steinbrücker, Katja (VerfasserIn) , Syrbe, Steffen (VerfasserIn) , Wagner, Matias (VerfasserIn) , Ziegler, Andreas (VerfasserIn) , Zöggeler, Thomas (VerfasserIn) , Mayr, Johannes A. (VerfasserIn) , Prokisch, Holger (VerfasserIn) , Wortmann, Saskia B. (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 31 August 2022
In: Nutrients
Year: 2022, Jahrgang: 14, Heft: 17, Pages: 1-30
ISSN:2072-6643
DOI:10.3390/nu14173605
Online-Zugang:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.3390/nu14173605
Verlag, lizenzpflichtig, Volltext: https://www.mdpi.com/2072-6643/14/17/3605
Volltext
Verfasserangaben:Bigna K. Bölsterli, Eugen Boltshauser, Luigi Palmieri, Johannes Spenger, Michaela Brunner-Krainz, Felix Distelmaier, Peter Freisinger, Tobias Geis, Andrea L. Gropman, Johannes Häberle, Julia Hentschel, Bruno Jeandidier, Daniela Karall, Boris Keren, Annick Klabunde-Cherwon, Vassiliki Konstantopoulou, Raimund Kottke, Francesco M. Lasorsa, Christine Makowski, Cyril Mignot, Ruth O’Gorman Tuura, Vito Porcelli, René Santer, Kuntal Sen, Katja Steinbrücker, Steffen Syrbe, Matias Wagner, Andreas Ziegler, Thomas Zöggeler, Johannes A. Mayr, Holger Prokisch and Saskia B. Wortmann

MARC

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520 |a The mitochondrial malate aspartate shuttle system (MAS) maintains the cytosolic NAD+/NADH redox balance, thereby sustaining cytosolic redox-dependent pathways, such as glycolysis and serine biosynthesis. Human disease has been associated with defects in four MAS-proteins (encoded by MDH1, MDH2, GOT2, SLC25A12) sharing a neurological/epileptic phenotype, as well as citrin deficiency (SLC25A13) with a complex hepatopathic-neuropsychiatric phenotype. Ketogenic diets (KD) are high-fat/low-carbohydrate diets, which decrease glycolysis thus bypassing the mentioned defects. The same holds for mitochondrial pyruvate carrier (MPC) 1 deficiency, which also presents neurological deficits. We here describe 40 (18 previously unreported) subjects with MAS-/MPC1-defects (32 neurological phenotypes, eight citrin deficiency), describe and discuss their phenotypes and genotypes (presenting 12 novel variants), and the efficacy of KD. Of 13 MAS/MPC1-individuals with a neurological phenotype treated with KD, 11 experienced benefits—mainly a striking effect against seizures. Two individuals with citrin deficiency deceased before the correct diagnosis was established, presumably due to high-carbohydrate treatment. Six citrin-deficient individuals received a carbohydrate-restricted/fat-enriched diet and showed normalisation of laboratory values/hepatopathy as well as age-adequate thriving. We conclude that patients with MAS-/MPC1-defects are amenable to dietary intervention and that early (genetic) diagnosis is key for initiation of proper treatment and can even be lifesaving. 
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