Abstract

During fasting, mitochondrial fatty-acid β-oxidation (mFAO) is essential for the generation of glucose by the liver. Children with a loss-of-function deficiency in the mFAO enzyme medium-chain acyl-Coenzyme A dehydrogenase (MCAD) are at serious risk of life-threatening low blood glucose levels during fasting in combination with intercurrent disease. However, a subset of these children remains asymptomatic throughout life. In MCAD-deficient (MCAD-KO) mice, glucose levels are similar to those of wild-type (WT) mice, even during fasting. We investigated if metabolic adaptations in the liver may underlie the robustness of this KO mouse. WT and KO mice were given a high- or low-fat diet and subsequently fasted. We analyzed histology, mitochondrial function, targeted mitochondrial proteomics, and transcriptome in liver tissue. Loss of MCAD led to a decreased capacity to oxidize octanoyl-CoA. This was not compensated for by altered protein levels of the short- and long-chain isoenzymes SCAD and LCAD. In the transcriptome, we identified subtle adaptations in the expression of genes encoding enzymes catalyzing CoA- and NAD(P)(H)-involving reactions and of genes involved in detoxification mechanisms. We discuss how these processes may contribute to robustness in MCAD-KO mice and potentially also in asymptomatic human subjects with a complete loss of MCAD activity.

Highlights

  • During fasting, mitochondrial fatty-acid β-oxidation is essential for the generation of glucose by the liver

  • MCAD deficiency (MCADD) patients are most vulnerable during infancy, when they are more dependent on a high mitochondrial fatty-acid β-oxidation (mFAO) capacity

  • We aimed to explore the role of the liver in the MCADD phenotype in the C57BL/6J medium-chain acyl-Coenzyme A dehydrogenase (MCAD)-KO mouse model

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Summary

Introduction

Mitochondrial fatty-acid β-oxidation (mFAO) is essential for the generation of glucose by the liver. Children with a loss-of-function deficiency in the mFAO enzyme medium-chain acyl-Coenzyme A dehydrogenase (MCAD) are at serious risk of life-threatening low blood glucose levels during fasting in combination with intercurrent disease. Children with a loss-of-function c.985A > G mutation in the ACADM gene, encoding the mFAO enzyme medium-chain acyl-CoA dehydrogenase (MCAD), run a severe risk of life-threatening hypoglycemia[1,2]. The MCAD-KO mouse has so far not been a useful model for the acute hypoglycemia observed in symptomatic MCADD patients It may, be an excellent model to identify potential compensatory mechanisms to explain why some humans remain asymptomatic despite a homozygous loss-of-function mutation in the Acadm gene that encodes the MCAD enzyme. This may help to identify patients who are not at risk and are currently overtreated[29] and provide clues for prevention in patients who are still at risk

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