Dietary anaplerotic therapy improves peripheral tissue energy metabolism in patients with Huntington's disease

Fanny Mochel, Sandrine Duteil, Cécilia Marelli, Céline Jauffret, Agnès Barles, Janette Holm, Lawrence Sweetman, Jean François Benoist, Daniel Rabier, Pierre G. Carlier, Alexandra Durr

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

We previously identified a systemic metabolic defect associated with early weight loss in patients with Huntington's disease (HD), suggesting a lack of substrates for the Krebs cycle. Dietary anaplerotic therapy with triheptanoin is used in clinical trials to promote energy production in patients with peripheral and brain Krebs cycle deficit, as its metabolites-C5 ketone bodies-cross the blood-brain barrier. We conducted a short-term clinical trial in six HD patients (UHDRS (Unified Huntington Disease Rating Scale)=33±13, 15-49) to monitor the tolerability of triheptanoin. We also assessed peripheral markers of short-term efficacy that were shown to be altered in the early stages of HD, that is, low serum IGF1 and 31P-NMR spectroscopy (NMRS) in muscle. At baseline, 31P-NMRS displayed two patients with end-exercise muscle acidosis despite a low work output. On day 2, the introduction of triheptanoin was well tolerated in all patients, and in particular, there was no evidence of mitochondrial overload from triheptanoin-derived metabolites. After 4 days of triheptanoin-enriched diet, muscle pH regulation was normalized in the two patients with pretreatment metabolic abnormalities. A significant increase in serum IGF1 was also observed in all patients (205±60 ng/ml versus 246±68 ng/ml, P=0.010). This study provides a rationale for extending our anaplerotic approach with triheptanoin in HD.

Original languageEnglish (US)
Pages (from-to)1057-1060
Number of pages4
JournalEuropean Journal of Human Genetics
Volume18
Issue number9
DOIs
StatePublished - Sep 2010
Externally publishedYes

Keywords

  • Huntington's disease
  • Krebs cycle
  • clinical trial
  • magnetic resonance spectroscopy
  • triheptanoin

ASJC Scopus subject areas

  • Genetics
  • Genetics(clinical)

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