Role of dichloroacetate in the treatment of genetic mitochondrial diseases.
Dichloroacetate (DCA) is an investigational drug for the treatment of genetic mitochondrial diseases. Its primary site of action is the pyruvate dehydrogenase (PDH) complex, which it stimulates by altering its phosphorylation state and stability. DCA is metabolized by and inhibits the bifunctional zeta-1 family isoform of glutathione transferase/maleylacetoacetate isomerase. Polymorphic variants of this enzyme differ in their kinetic properties toward DCA, thereby influencing its biotransformation and toxicity, both of which are also influenced by subject age. Results from open label studies and controlled clinical trials suggest chronic oral DCA is generally well-tolerated by young children and may be particularly effective in patients with PDH deficiency. Recent in vitro data indicate that a combined DCA and gene therapy approach may also hold promise for the treatment of this devastating condition.
Stacpoole
Peter W
PW
Department of Medicine, Division of Endocrinology and Metabolism, College of Medicine, University of Florida, Gainesville, FL 32610-0226, USA. peter.stacpoole@medicine.ufl.edu
Kurtz
Tracie L
TL
Han
Zongchao
Z
Langaee
Taimour
T
D000328:Adult; D000375:Aging / Q000378:metabolism; D002648:Child; D003999:Dichloroacetic Acid / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D005982:Glutathione Transferase / Q000235:genetics / Q000378:metabolism; D006239:Haplotypes; D006801:Humans; D007527:Isoenzymes / Q000235:genetics / Q000378:metabolism; D028361:Mitochondrial Diseases / Q000188:drug therapy* / Q000235:genetics*; D020641:Polymorphism, Single Nucleotide; D011768:Pyruvate Dehydrogenase Complex / Q000378:metabolism; D015325:Pyruvate Dehydrogenase Complex Deficiency Disease / Q000188:drug therapy / Q000235:genetics; D016032:Randomized Controlled Trials as Topic; D019745:cis-trans-Isomerases / Q000235:genetics / Q000378:metabolism
D007527:Isoenzymes; D011768:Pyruvate Dehydrogenase Complex; D003999:Dichloroacetic Acid; D005982:Glutathione Transferase; D019745:cis-trans-Isomerases; C021531:maleylacetoacetate isomerase