title: Phenylbutyrate therapy for pyruvate dehydrogenase complex deficiency and lactic acidosis.
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 E1α 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 E1α in brain, muscle, and liver compared to saline-treated mice. By means of recombinant enzymes, we showed that phenylbutyrate prevents phosphorylation of E1α 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.
authors: Telethon Institute of Genetics and Medicine, Naples 80131, Italy.
authors: Rosa
authors: R
authors: Ferriero
authors: Giuseppe
authors: G
authors: Manco
authors: Eleonora
authors: E
authors: Lamantea
authors: Edoardo
authors: E
authors: Nusco
authors: Maria I
authors: MI
authors: Ferrante
authors: Paolo
authors: P
authors: Sordino
authors: Peter W
authors: PW
authors: Stacpoole
authors: Brendan
authors: B
authors: Lee
authors: Massimo
authors: M
authors: Zeviani
authors: Nicola
authors: N
authors: Brunetti-Pierri
mesh_terms: D000140:Acidosis, Lactic / Q000188:drug therapy*; D000818:Animals; D001921:Brain / Q000187:drug effects / Q000201:enzymology; D008099:Liver / Q000187:drug effects / Q000201:enzymology; D051379:Mice; D018482:Muscle, Skeletal / Q000187:drug effects / Q000201:enzymology; D010654:Phenylbutyrates / Q000627:therapeutic use*; D010766:Phosphorylation; D015325:Pyruvate Dehydrogenase Complex Deficiency Disease / Q000188:drug therapy*
chemical_list: D010654:Phenylbutyrates