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Zandl-Lang M. Tracing the lipidome in inborn errors of metabolism. Biochim Biophys Acta Mol Cell Biol Lipids 2024; 1869:159491. [PMID: 38565373 DOI: 10.1016/j.bbalip.2024.159491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
Inborn errors of metabolism (IEM) represent a heterogeneous group of more than 1800 rare disorders, many of which are causing significant childhood morbidity and mortality. More than 100 IEM are linked to dyslipidaemia, but yet our knowledge in connecting genetic information with lipidomic data is limited. Stable isotope tracing studies of the lipid metabolism (STL) provide insights on the dynamic of cellular lipid processes and could thereby facilitate the delineation of underlying metabolic (patho)mechanisms. This mini-review focuses on principles as well as technical limitations of STL and describes potential clinical applications by discussing recently published STL focusing on IEM.
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Affiliation(s)
- Martina Zandl-Lang
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
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2
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Torrens SL, Parr EB, McNulty C, Ross L, MacLaughlin H, Robergs RA. Carbohydrate Ingestion before Exercise for Individuals with McArdle Disease: Survey Evidence of Implementation and Perception in Real-World Settings. Nutrients 2024; 16:1423. [PMID: 38794661 PMCID: PMC11124166 DOI: 10.3390/nu16101423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
In individuals with McArdle disease (IWMD), the ingestion of carbohydrates before exercise has previously been shown in laboratory studies to significantly decrease the exercising symptoms of the condition and increase exercise tolerance during the early stages of exercise. As a result, carbohydrate ingestion pre-exercise is currently included in management guidelines, and often advised by medical professionals treating the condition. The aim of the current study was to determine whether positive lab-based results for the ingestion of carbohydrate before exercise in laboratory studies are being effectively translated into practice and produce perceptions of the same positive outcomes in real-world settings (RWS). An online survey method was used to collect responses from 108 IWMD. Data collected on the amount and type of carbohydrate consumed prior to exercise found that most surveyed participants (69.6%) who supplied qualitative data (n = 45) consumed less than the 37 g currently recommended in management guidelines. Survey data also revealed a large variation in the type and amount of carbohydrate ingested when IWMDs are applying carbohydrate ingestion before exercise in RWS. Consistent with these findings, only 17.5% of participants stated that they found carbohydrate ingestion before exercise relieved or minimised their MD symptoms. Results suggest that positive lab-based findings (increased exercise tolerance) of carbohydrate ingestion before exercise are not being effectively translated to RWS for many IWMD. There is a need for improved patient education of IWMD on the application of carbohydrate ingestion before exercise in RWS.
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Affiliation(s)
- Sam L. Torrens
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4058, Australia; (C.M.); (L.R.); (H.M.); (R.A.R.)
| | - Evelyn B. Parr
- Mary Mackillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC 3000, Australia;
| | - Craig McNulty
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4058, Australia; (C.M.); (L.R.); (H.M.); (R.A.R.)
| | - Lynda Ross
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4058, Australia; (C.M.); (L.R.); (H.M.); (R.A.R.)
| | - Helen MacLaughlin
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4058, Australia; (C.M.); (L.R.); (H.M.); (R.A.R.)
| | - Robert A. Robergs
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4058, Australia; (C.M.); (L.R.); (H.M.); (R.A.R.)
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3
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Løkken N, Khawajazada T, Slipsager A, Voermans NC, Vissing J. Repeated oral sucrose dosing after the second wind is unnecessary in patients with McArdle disease: Results from a randomized, placebo-controlled, double-blind, cross-over study. J Inherit Metab Dis 2023; 46:1139-1146. [PMID: 37431283 DOI: 10.1002/jimd.12656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/12/2023]
Abstract
It is well-established that oral sucrose ingested shortly before exercise improves early exercise tolerance in individuals with McArdle disease. This is by supplying blood-borne glucose for muscle metabolism to compensate for the blocked glycogenolysis. The present study investigated if individuals with McArdle disease could benefit further from repeated sucrose ingestion during prolonged exercise. In this double-blind, placebo-controlled, cross-over study, the participants were randomized to ingest either sucrose or placebo first and subsequently the opposite on two separate days. The participants ingested the drink 10 min before and thrice (after 10, 25, and 40 min) during a 60-min submaximal exercise test on a cycle ergometer. The primary outcome was exercise capacity as indicated by heart rate (HR) and perceived exertion (PE) responses to exercise. Secondary outcomes included changes in blood metabolites, insulin and carbohydrate, and fatty acid oxidation rates during exercise. Nine participants with McArdle disease were included in the study. We confirmed improvement of exercise capacity with oral sucrose vs. placebo during early exercise (pre-second wind) indicated by lower peak HR and PE (p < 0.02). We found no further beneficial effect with repeated sucrose versus placebo ingestion during prolonged exercise, as indicated by no difference in HR or PE post-second wind (p > 0.05). Glucose, lactate, insulin, and carbohydrate oxidation rates increased, and fatty acid oxidation decreased with sucrose versus placebo (p ≤ 0.0002). We can conclude that repeated sucrose ingestion is not recommended during prolonged exercise. This finding can prevent excessive caloric intake and reduce the risk of obesity and insulin resistance.
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Affiliation(s)
- Nicoline Løkken
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tahmina Khawajazada
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anna Slipsager
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicol C Voermans
- The Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, The Netherlands
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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4
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Løkken N, Nielsen MR, Stemmerik MG, Ellerton C, Revsbech KL, Macrae M, Slipsager A, Krett B, Beha GH, Emanuelsson F, van Hall G, Quinlivan R, Vissing J. Can a modified ketogenic diet be a nutritional strategy for patients with McArdle disease? Results from a randomized, single-blind, placebo-controlled, cross-over study. Clin Nutr 2023; 42:2124-2137. [PMID: 37769369 DOI: 10.1016/j.clnu.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/13/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND McArdle disease is caused by myophosphorylase deficiency leading to blocked glycogenolysis in skeletal muscle. Consequently, individuals with McArdle disease have intolerance to physical activity, muscle fatigue, and pain. These symptoms vary according to the availability of alternative fuels for muscle contraction. In theory, a modified ketogenic diet (mKD) can provide alternative fuels in the form of ketone bodies and potentially boost fat oxidation. METHODS This randomized, single-blind, placebo-controlled, cross-over study aimed to investigate if a mKD improves exercise capacity in individuals with McArdle disease. Participants were randomized to follow a mKD (75-80% fat, 15% protein, 5-10% carbohydrates) or placebo diet (PD) first for three weeks, followed by a wash-out period, and then the opposite diet. The primary outcome was change in heart rate during constant-load cycling. Secondary outcomes included change in plasma metabolites, perceived exertion, indirect calorimetry measures, maximal exercise capacity, and patient-reported outcomes. RESULTS Fifteen out of 20 patients with genetically verified McArdle disease completed all study visits, and 14 were included in the data analyses. We found that the mKD induced a metabolic shift towards increased fat oxidation (∼60% increase), and a 19-fold increase in plasma β-hydroxybutyrate (p < 0.05). The mKD did not improve heart rate responses during constant-load cycling but did improve patient-reported outcomes and maximal exercise capacity (∼20% increase) compared to the PD. CONCLUSION The mKD did not alleviate all McArdle disease-related symptoms but did induce some positive changes. To date, no satisfactory treatment options exist other than exercise training. To that end, a mKD can be a possible nutritional strategy for some individuals with McArdle disease who are motivated to undertake a restrictive diet. CLINICAL TRIAL REGISTRATION clinical trials.gov: NCT04044508.
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Affiliation(s)
- Nicoline Løkken
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Maja Risager Nielsen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Mads Godtfeldt Stemmerik
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Ellerton
- The Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Karoline Lolk Revsbech
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Margaret Macrae
- The Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Anna Slipsager
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bjørg Krett
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Gry Hatting Beha
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Frida Emanuelsson
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark
| | - Gerrit van Hall
- Clinical Metabolomics Core Facility, Clinical Biochemistry, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rosaline Quinlivan
- The Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Teles JS, Ramos CT, Almeida BM, Sousa AV. A Case Report of McArdle Disease Diagnosed Following Statin-Induced Myositis. Cureus 2023; 15:e44701. [PMID: 37809236 PMCID: PMC10552332 DOI: 10.7759/cureus.44701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
McArdle disease is a rare condition, characterized by a deficiency of phosphorylase muscle isoform, an enzyme responsible for the breaking down of glycogen, necessary for obtaining energy. Patients typically present with exercise intolerance, myalgias, fatigue, cramps, muscle stiffness, and/or weakness induced by physical activity. The diagnosis is generally established late, with a median delay of about 29 years. We present the case of a female patient with a long history of myalgias, muscle weakness, and exercise intolerance, diagnosed with McArdle disease by the age of 74, after statin-induced myopathy. We aim to review the diagnosis and treatment of this disease, as a way to raise awareness among the medical community.
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Affiliation(s)
- João S Teles
- Family Medicine, Unidade de Saúde Familiar (USF) Brás-Oleiro, Agrupamento de Centros de Saúde (ACeS) Gondomar, Porto, PRT
| | - Catarina T Ramos
- Family Medicine, Unidade de Saúde Familiar (USF) Brás-Oleiro, Agrupamento de Centros de Saúde (ACeS) Gondomar, Porto, PRT
| | - Beatriz M Almeida
- Family Medicine, Unidade de Saúde Familiar (USF) Brás-Oleiro, Agrupamento de Centros de Saúde (ACeS) Gondomar, Porto, PRT
| | - Anabela V Sousa
- Family Medicine, Unidade de Saúde Familiar (USF) Brás-Oleiro, Agrupamento de Centros de Saúde (ACeS) Gondomar, Porto, PRT
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Batten K, Bhattacharya K, Simar D, Broderick C. Exercise testing and prescription in patients with inborn errors of muscle energy metabolism. J Inherit Metab Dis 2023; 46:763-777. [PMID: 37350033 DOI: 10.1002/jimd.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 06/24/2023]
Abstract
Skeletal muscle is a dynamic organ requiring tight regulation of energy metabolism in order to provide bursts of energy for effective function. Several inborn errors of muscle energy metabolism (IEMEM) affect skeletal muscle function and therefore the ability to initiate and sustain physical activity. Exercise testing can be valuable in supporting diagnosis, however its use remains limited due to the inconsistency in data to inform its application in IEMEM populations. While exercise testing is often used in adults with IEMEM, its use in children is far more limited. Once a physiological limitation has been identified and the aetiology defined, habitual exercise can assist with improving functional capacity, with reports supporting favourable adaptations in adult patients with IEMEM. Despite the potential benefits of structured exercise programs, data in paediatric populations remain limited. This review will focus on the utilisation and limitations of exercise testing and prescription for both adults and children, in the management of McArdle Disease, long chain fatty acid oxidation disorders, and primary mitochondrial myopathies.
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Affiliation(s)
- Kiera Batten
- School of Health Sciences, University of New South Wales, Sydney, Australia
- The Children's Hospital at Westmead, Sydney, Australia
| | - Kaustuv Bhattacharya
- The Children's Hospital at Westmead, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - David Simar
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Carolyn Broderick
- School of Health Sciences, University of New South Wales, Sydney, Australia
- The Children's Hospital at Westmead, Sydney, Australia
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7
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Nielsen J. An experiment of nature links muscle glycogen unavailability with very high fat oxidation rates despite low aerobic fitness. J Physiol 2023; 601:389-390. [PMID: 36601698 DOI: 10.1113/jp284098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Affiliation(s)
- Joachim Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Rodriguez-Lopez C, Santalla A, Valenzuela PL, Real-Martínez A, Villarreal-Salazar M, Rodriguez-Gomez I, Pinós T, Ara I, Lucia A. Muscle glycogen unavailability and fat oxidation rate during exercise: Insights from McArdle disease. J Physiol 2023; 601:551-566. [PMID: 36370371 PMCID: PMC10099855 DOI: 10.1113/jp283743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022] Open
Abstract
Carbohydrate availability affects fat metabolism during exercise; however, the effects of complete muscle glycogen unavailability on maximal fat oxidation (MFO) rate remain unknown. Our purpose was to examine the MFO rate in patients with McArdle disease, comprising an inherited condition caused by complete blockade of muscle glycogen metabolism, compared to healthy controls. Nine patients (three women, aged 36 ± 12 years) and 12 healthy controls (four women, aged 40 ± 13 years) were studied. Several molecular markers of lipid transport/metabolism were also determined in skeletal muscle (gastrocnemius) and white adipose tissue of McArdle (Pygm p.50R*/p.50R*) and wild-type male mice. Peak oxygen uptake ( V ̇ O 2 peak ${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{peak}}}}$ ), MFO rate, the exercise intensity eliciting MFO rate (FATmax) and the MFO rate-associated workload were determined by indirect calorimetry during an incremental cycle-ergometer test. Despite having a much lower V ̇ O 2 peak ${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{peak}}}}$ (24.7 ± 4 vs. 42.5 ± 11.4 mL kg-1 min-1 , respectively; P < 0.0001), patients showed considerably higher values for the MFO rate (0.53 ± 0.12 vs. 0.33 ± 0.10 g min-1 , P = 0.001), and for the FATmax (94.4 ± 7.2 vs. 41.3 ± 9.1 % of V ̇ O 2 peak ${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{peak}}}}$ , P < 0.0001) and MFO rate-associated workload (1.33 ± 0.35 vs. 0.81 ± 0.54 W kg-1 , P = 0.020) than controls. No between-group differences were found overall in molecular markers of lipid transport/metabolism in mice. In summary, patients with McArdle disease show an exceptionally high MFO rate, which they attained at near-maximal exercise capacity. Pending more mechanistic explanations, these findings support the influence of glycogen availability on MFO rate and suggest that these patients develop a unique fat oxidation capacity, possibly as an adaptation to compensate for the inherited blockade in glycogen metabolism, and point to MFO rate as a potential limiting factor of exercise tolerance in this disease. KEY POINTS: Physically active McArdle patients show an exceptional fat oxidation capacity. Maximal fat oxidation rate occurs near-maximal exercise capacity in these patients. McArdle patients' exercise tolerance might rely on maximal fat oxidation rate capacity. Hyperpnoea might cloud substrate oxidation measurements in some patients. An animal model revealed overall no higher molecular markers of lipid transport/metabolism.
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Affiliation(s)
- Carlos Rodriguez-Lopez
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Alfredo Santalla
- Department of Sport and Computer Science, Section of Physical Education and Sports, Faculty of Sport, Universidad Pablo de Olavide, Seville, Spain.,EVOPRED Research Group, Universidad Europea de Canarias, Tenerife, Spain
| | - Pedro L Valenzuela
- Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), Madrid, Spain
| | - Alberto Real-Martínez
- Mitochondrial and Neuromuscular Disorders Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER for rare disease (CIBERER), Madrid, Spain
| | - Mónica Villarreal-Salazar
- Mitochondrial and Neuromuscular Disorders Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER for rare disease (CIBERER), Madrid, Spain
| | - Irene Rodriguez-Gomez
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Tomàs Pinós
- Mitochondrial and Neuromuscular Disorders Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER for rare disease (CIBERER), Madrid, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, Toledo, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Alejandro Lucia
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,Instituto de Investigación Sanitaria Hospital '12 de Octubre' ('imas12'), Madrid, Spain.,Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
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Løkken N, Storgaard JH, Revsbech KL, Voermans NC, Van Hall G, Vissing J, Ørngreen MC. No effect of oral ketone ester supplementation on exercise capacity in patients with McArdle disease and healthy controls: A randomized placebo-controlled cross-over study. J Inherit Metab Dis 2022; 45:502-516. [PMID: 35150142 PMCID: PMC9304134 DOI: 10.1002/jimd.12484] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/27/2022] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
Patients with glycogen storage disease type V (GSDV), also known as McArdle disease, have blocked glycogen breakdown due to myophosphorylase deficiency, leading to exercise intolerance, muscle pain, and risk of muscle damage. Blood-derived ketone bodies (KBs) constitute an alternative energy source that could fuel the muscle independent of glycogenolysis. However, except for long-time fasting or ketogenic dieting, KBs are present in low quantities. This led us to explore the effects of a drink containing exogenously produced KBs in the form of D-β-hydroxybutyrate esters (KE) on exercise capacity and metabolism in patients with GSDV. Eight GSDV patients and four healthy controls (HC) were included in this placebo-controlled, cross-over study where subjects were randomized to receive a KE drink with 395 mgKE/kg or placebo drink on two separate days 25 min before a submaximal cycle exercise test. The primary outcome was exercise capacity as indicated by heart rate response (HR) to exercise. Secondary outcomes included perceived exertion (PE) and measures of KB, carbohydrate, and fat metabolism during exercise. In GSDV, the KE drink vs. placebo increased plasma KBs and KB oxidation (p ≤ 0.0001) but did not improve exercise capacity as judged from HR (p = 0.120) and PE (p = 0.109). In addition, the KE drink lowered plasma glucose, free fatty acids, and lowered lipolytic rate and glucose rate of appearance compared with placebo. Similar results were found in the HC group. The present study indicates that an increase in KB oxidation by oral KE supplementation does not improve exercise capacity in GSDV possibly because of KB-induced inhibition of lipolysis and liver glucose output. Thus, oral KE supplementation alone cannot be recommended as a treatment option for patients with GSDV.
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Affiliation(s)
- Nicoline Løkken
- Copenhagen Neuromuscular CenterCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Jesper H. Storgaard
- Copenhagen Neuromuscular CenterCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Karoline L. Revsbech
- Copenhagen Neuromuscular CenterCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Nicol C. Voermans
- The Department of Neurology, Donders Institute for Brain, Cognition and BehaviourRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
| | - Gerrit Van Hall
- Clinical Metabolomics Core Facility, Clinical BiochemistryCopenhagen University HospitalCopenhagenDenmark
- Department of Biomedical Sciences, Faculty of Health & Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - John Vissing
- Copenhagen Neuromuscular CenterCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Mette C. Ørngreen
- Copenhagen Neuromuscular CenterCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
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10
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Raaschou-Pedersen DE, Madsen KL, Løkken N, Storgaard JH, Quinlivan R, Laforêt P, Lund A, Van Hall G, Vissing J, Ørngreen M. No effect of triheptanoin in patients with phosphofructokinase deficiency. Neuromuscul Disord 2022; 32:295-304. [DOI: 10.1016/j.nmd.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
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11
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Treatment and Management of Hereditary Metabolic Myopathies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Bordoli C, Murphy E, Varley I, Sharpe G, Hennis P. A Systematic Review investigating the Effectiveness of Exercise training in Glycogen Storage Diseases. THERAPEUTIC ADVANCES IN RARE DISEASE 2022; 3:26330040221076497. [PMID: 37180413 PMCID: PMC10032442 DOI: 10.1177/26330040221076497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/04/2022] [Indexed: 05/16/2023]
Abstract
Introduction Glycogen storage diseases (GSDs) are rare inborn errors of carbohydrate metabolism typically with skeletal muscle and liver involvement. In those with skeletal muscle involvement, the majority display symptoms of exercise intolerance which can cause profound exercise limitation and impair everyday living and quality of life (QoL). There are no curative treatments for GSDs, thus therapeutic options, such as exercise training, are aimed at improving QoL by alleviating signs and symptoms. In order to investigate the effectiveness of exercise training in adults with GSDs, we systematically reviewed the literature. Methods In this review we conducted searches within SCOPUS and MEDLINE to identify potential papers for inclusion. These papers were independently assessed for inclusion and quality by two authors. We identified 23 studies which included aerobic training, strength training or respiratory muscle training in patients with McArdles (n = 41) and Pompe disease (n = 139). Results In McArdle disease, aerobic exercise training improved aerobic capacity (VO2 peak) by 14-111% with further benefits to functional capacity and well-being. Meanwhile, strength training increased muscle peak power by 100-151% and reduced disease severity. In Pompe disease, a combination of aerobic and strength training improved VO2 peak by 9-10%, muscle peak power by 64%, functional capacity and well-being. Furthermore, respiratory muscle training (RMT) improved respiratory muscular strength [maximum inspiratory pressure (MIP) increased by up to 65% and maximum expiratory pressure (MEP) by up to 70%], with additional benefits shown in aerobic capacity, functional capacity and well-being. Conclusion This adds to the growing body of evidence which suggests that supervised exercise training is safe and effective in improving aerobic capacity and muscle function in adults with McArdle or Pompe disease. However, the literature base is limited in quality and quantity with a dearth of literature regarding exercise training in other GSD subtypes.
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Affiliation(s)
- Claire Bordoli
- Sport, Health and Performance Enhancement
(SHAPE) Research Centre, Nottingham Trent University, Clifton Lane, Clifton,
Nottingham NG11 8NS, UK
| | - Elaine Murphy
- Charles Dent Metabolic Unit, The National
Hospital for Neurology and Neurosurgery, London, UK
| | - Ian Varley
- Sport, Health and Performance Enhancement
(SHAPE) Research Centre, Nottingham Trent University, Nottingham, UK
| | - Graham Sharpe
- Sport, Health and Performance Enhancement
(SHAPE) Research Centre, Nottingham Trent University, Nottingham, UK
| | - Philip Hennis
- Sport, Health and Performance Enhancement
(SHAPE) Research Centre, Nottingham Trent University, Nottingham, UK
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Buch AE, Musumeci O, Wigley R, Stemmerik MPG, Eisum AV, Madsen KL, Preisler N, Hilton‐Jones D, Quinlivan R, Toscano A, Vissing J. Energy metabolism during exercise in patients with β-enolase deficiency (GSDXIII). JIMD Rep 2021; 61:60-66. [PMID: 34485019 PMCID: PMC8411107 DOI: 10.1002/jmd2.12232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/28/2021] [Accepted: 05/10/2021] [Indexed: 11/08/2022] Open
Abstract
AIM To investigate the in vivo skeletal muscle metabolism in patients with β-enolase deficiency (GSDXIII) during exercise, and the effect of glucose infusion. METHODS Three patients with GSDXIII and 10 healthy controls performed a nonischemic handgrip test as well as an incremental cycle ergometer test measuring maximal oxidative consumption (VO2max) and a 1-hour submaximal cycle test at an intensity of 65% to 75% of VO2max. The patients repeated the submaximal exercise after 2 days, where they received a 10% iv-glucose supplementation. RESULTS Patients had lower VO2max than healthy controls, and two of three patients had to stop prematurely during the intended 1-hour submaximal exercise test. During nonischemic forearm test, all patients were able to produce lactate in normal amounts. Glucose infusion had no effect on patients' exercise capacity. CONCLUSIONS Patients with GSDXIII experience exercise intolerance and episodes of myoglobinuria, even to the point of needing renal dialysis, but still retain an almost normal anaerobic metabolic response to submaximal intensity exercise. In accordance with this, glucose supplementation did not improve exercise capacity. The findings show that GSDXIII, although causing episodic rhabdomyolysis, is one of the mildest metabolic myopathies affecting glycolysis.
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Affiliation(s)
- Astrid Emilie Buch
- Copenhagen Neuromuscular Center, Rigshospitalet, University of CopenhagenCopenhagenDenmark
| | - Olimpia Musumeci
- Neurology and Neuromuscular Disorders Unit, Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - Ralph Wigley
- Enzyme Laboratory, Department of Chemical PathologyCameilia Botnar Laboratories, Great Ormond Street Hospital for Sick ChildrenLondonUK
| | | | - Anne‐Sofie Vibæk Eisum
- Copenhagen Neuromuscular Center, Rigshospitalet, University of CopenhagenCopenhagenDenmark
| | - Karen Lindhardt Madsen
- Copenhagen Neuromuscular Center, Rigshospitalet, University of CopenhagenCopenhagenDenmark
| | - Nicolai Preisler
- Copenhagen Neuromuscular Center, Rigshospitalet, University of CopenhagenCopenhagenDenmark
| | - David Hilton‐Jones
- Department of Clinical NeurologyWest Wing, John Radcliffe HospitalOxfordUK
| | - Ros Quinlivan
- Dubowitz Neuromuscular Centre, Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Antonio Toscano
- Neurology and Neuromuscular Disorders Unit, Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly
| | - John Vissing
- Copenhagen Neuromuscular Center, Rigshospitalet, University of CopenhagenCopenhagenDenmark
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Løkken N, Hansen KK, Storgaard JH, Ørngreen MC, Quinlivan R, Vissing J. Titrating a modified ketogenic diet for patients with McArdle disease: A pilot study. J Inherit Metab Dis 2020; 43:778-786. [PMID: 32060930 DOI: 10.1002/jimd.12223] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/05/2020] [Accepted: 02/12/2020] [Indexed: 01/01/2023]
Abstract
Glycogen storage disease type V (GSDV) is a rare inborn error of carbohydrate metabolism. Patients present with exercise intolerance due to blocked glycogen breakdown in skeletal muscle. Introducing alternative fuel substrates, such as ketone bodies (KBs), could potentially alleviate muscle symptoms. This pilot study investigates which of three different modified ketogenic diet regimes is optimal for GSDV-patients to follow in a future large-scale study. Participants were randomised to follow one of three diet regimes for 3 weeks (#1: 65%/15%/20%; #2: 75%/15%/10%, or #3: 80%/15%/5%, fat/protein/carbohydrate). The primary outcome was exercise tolerance assessed by heart rate (HR) changes during constant load cycling. Secondary outcomes included levels of ketosis, and changes in perceived exertion and indirect calorimetry measures during exercise. Ten GSDV-patients were included. Eight completed the study. The other two were excluded. Diet #3 showed the highest average KB level (1.1 mmol/L) vs #2 (0.5 mmol/L) and #1 (0.3 mmol/L). Five patients reported subjective symptom relief, all of whom were on diets #2 and #3. All diet regimes seemed to improve fatty acid oxidation rates and exercise capacity as indicated by a small decrease in HR and perceived exertion. The results of this open-label pilot study show that diets #2 and #3 induce ketosis and improve symptoms and exercise capacity in GSDV-patients. Diet #2 had the highest acceptability score and was superior or equal to diet #3 in all other parameters, except level of ketosis. Based on this, we suggest testing diet #2 in a large-scale, placebo-controlled study in GSDV.
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Affiliation(s)
- Nicoline Løkken
- Copenhagen Neuromuscular Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kit K Hansen
- The Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jesper H Storgaard
- Copenhagen Neuromuscular Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette C Ørngreen
- Copenhagen Neuromuscular Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ros Quinlivan
- The Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - John Vissing
- Copenhagen Neuromuscular Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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15
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Storgaard JH, Madsen KL, Løkken N, Vissing J, van Hall G, Lund AM, Ørngreen MC. Impaired lipolysis in propionic acidemia: A new metabolic myopathy? JIMD Rep 2020; 53:16-21. [PMID: 32395405 PMCID: PMC7203654 DOI: 10.1002/jmd2.12113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
The objective of this study was to investigate the fat and carbohydrate metabolism in a patient with propionic acidemia (PA) during exercise by means of indirect calorimetry and stable isotope technique. A 34-year-old patient with PA performed a 30-minute submaximal cycle ergometer test. Data were compared to results from six gender- and age-matched healthy controls. Main findings are that the patient with PA had impaired lipolysis, blunted fatty acid oxidation, compensatory increase in carbohydrate utilization, and low work capacity. Our findings indicate that PA should be added to the list of metabolic myopathies.
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Affiliation(s)
- Jesper H. Storgaard
- Department of Neurology, Copenhagen Neuromuscular Center, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Karen L. Madsen
- Department of Neurology, Copenhagen Neuromuscular Center, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Nicoline Løkken
- Department of Neurology, Copenhagen Neuromuscular Center, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - John Vissing
- Department of Neurology, Copenhagen Neuromuscular Center, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Gerrit van Hall
- Department of Biomedical SciencesRigshospitalet, University of CopenhagenCopenhagenDenmark
| | - Allan M. Lund
- Department of Clinical GeneticsCentre for Inherited Metabolic Diseases, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
- Department of Pediatrics and Adolescent MedicineCentre for Inherited Metabolic Diseases, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Mette C. Ørngreen
- Department of Neurology, Copenhagen Neuromuscular Center, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
- Department of Clinical GeneticsCentre for Inherited Metabolic Diseases, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
- Department of Pediatrics and Adolescent MedicineCentre for Inherited Metabolic Diseases, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
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16
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Similä ME, Auranen M, Piirilä PL. Beneficial Effects of Ketogenic Diet on Phosphofructokinase Deficiency (Glycogen Storage Disease Type VII). Front Neurol 2020; 11:57. [PMID: 32117019 PMCID: PMC7010930 DOI: 10.3389/fneur.2020.00057] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background: A deficiency of muscle phosphofructokinase (PFKM) causes a rare metabolic muscle disease, the Tarui disease (Glycogen storage disease type VII, GSD VII) characterized by exercise intolerance with myalgia due to an inability to use glucose as an energy resource. No medical treatment for GSD VII currently exists. The aim of this study was to determine whether a dietary intervention with excessive fat intake would benefit GSD VII. Patient and Methods: A ketogenic diet (KD) intervention implemented as a modified Atkins diet was established for one patient with PFKM deficiency, with a low late lactate response and very high ammonia levels associated with exercise. We recorded the KD intervention for a total of 5 years with clinical and physiotherapeutic evaluations and regular laboratory parameters. Cardiopulmonary exercise testing, including breath gas analysis and venous lactate and ammonia measurements, was performed before KD and at 3, 8 months and 5 years after initiation of KD. Results: During the 5 years on KD, the patient's muscle symptoms had alleviated and exercise tolerance had improved. In exercise testing, venous ammonia had normalized, the lactate profile remained similar, but oxygen uptake and mechanical efficiency had increased and parameters showing ventilation had improved. Conclusions: This study is the first to show a long-term effect of KD in GSD VII with an alleviation of muscle symptoms, beneficial effects on breathing, and improvement in exercise performance and oxygen uptake. Based on these findings, KD can be recommended under medical and nutritional supervision for selected patients with GSD VII, although further research of this rare disease is warranted.
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Affiliation(s)
- Minna E Similä
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mari Auranen
- Clinical Neurosciences, Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Päivi Liisa Piirilä
- Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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17
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Madsen KL, Laforêt P, Buch AE, Stemmerik MG, Ottolenghi C, Hatem SN, Raaschou-Pedersen DT, Poulsen NS, Atencio M, Luton MP, Ceccaldi A, Haller RG, Quinlivan R, Mochel F, Vissing J. No effect of triheptanoin on exercise performance in McArdle disease. Ann Clin Transl Neurol 2019; 6:1949-1960. [PMID: 31520525 PMCID: PMC6801166 DOI: 10.1002/acn3.50863] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/21/2019] [Accepted: 06/22/2019] [Indexed: 12/25/2022] Open
Abstract
Objective To study if treatment with triheptanoin, a 7‐carbon triglyceride, improves exercise tolerance in patients with McArdle disease. McArdle patients have a complete block in glycogenolysis and glycogen‐dependent expansion of tricarboxylic acid cycle (TCA), which may restrict fat oxidation. We hypothesized that triheptanoin metabolism generates substrates for the TCA, which potentially boosts fat oxidation and improves exercise tolerance in McArdle disease. Methods Double‐blind, placebo‐controlled, crossover study in patients with McArdle disease completing two treatment periods of 14 days each with a triheptanoin or placebo diet (1 g/kg/day). Primary outcome was change in mean heart rate during 20 min submaximal exercise on a cycle ergometer. Secondary outcomes were change in peak workload and oxygen uptake along with changes in blood metabolites and respiratory quotients. Results Nineteen of 22 patients completed the trial. Malate levels rose on triheptanoin treatment versus placebo (8.0 ± SD2.3 vs. 5.5 ± SD1.8 µmol/L, P < 0.001), but dropped from rest to exercise (P < 0.001). There was no difference in exercise heart rates between triheptanoin (120 ± SD16 bpm) and placebo (121 ± SD16 bpm) treatments. Compared with placebo, triheptanoin did not change the submaximal respiratory quotient (0.82 ± SD0.05 vs. 0.84 ± SD0.03), peak workload (105 ± SD38 vs. 102 ± SD31 Watts), or peak oxygen uptake (1938 ± SD499 vs. 1977 ± SD380 mL/min). Interpretation Despite increased resting plasma malate with triheptanoin, the increase was insufficient to generate a normal TCA turnover during exercise and the treatment has no effect on exercise capacity or oxidative metabolism in patients with McArdle disease.
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Affiliation(s)
- Karen L Madsen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Pascal Laforêt
- Centre de référence des maladies neuromusculaires Nord/Est/Ile de France, Service de Neurologie, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - Astrid E Buch
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Mads G Stemmerik
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Chris Ottolenghi
- Metabolomics Unit, Service des Explorations fonctionnelles, Necker Hospital and Descartes University of Paris, AP-HP, Paris, France
| | - Stéphane N Hatem
- Institute of Cardiometabolism and Nutrition, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Cardiology Institute, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Daniel T Raaschou-Pedersen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Nanna S Poulsen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Maria Atencio
- Inserm U 1127, CNRS UMR 7225, ICM, F-75013, Paris, France
| | | | - Alexandre Ceccaldi
- Institute of Cardiometabolism and Nutrition, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Cardiology Institute, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Ronald G Haller
- Neuromuscular Center, Institute for Exercise and Environmental Medicine of Texas Health Presbyterian Hospital, Dallas, Texas.,Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical Center Dallas, Dallas, Texas
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, Queen Square, London, England
| | - Fanny Mochel
- Inserm U 1127, CNRS UMR 7225, ICM, F-75013, Paris, France.,Sorbonne Université, UPMC-Paris 6, UMR S 1127, Paris, France.,Department of Genetics and Reference Center for Adult Neurometabolic diseases, La Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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18
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Cade WT, Bohnert KL, Peterson LR, Patterson BW, Bittel AJ, Okunade AL, de las Fuentes L, Steger-May K, Bashir A, Schweitzer GG, Chacko SK, Wanders RJ, Pacak CA, Byrne BJ, Reeds DN. Blunted fat oxidation upon submaximal exercise is partially compensated by enhanced glucose metabolism in children, adolescents, and young adults with Barth syndrome. J Inherit Metab Dis 2019; 42:480-493. [PMID: 30924938 PMCID: PMC6483838 DOI: 10.1002/jimd.12094] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/27/2019] [Indexed: 12/26/2022]
Abstract
Barth syndrome (BTHS) is a rare X-linked condition resulting in abnormal mitochondria, cardioskeletal myopathy, and growth delay; however, the effects of BTHS on substrate metabolism regulation and their relationships with tissue function in humans are unknown. We sought to characterize glucose and fat metabolism during rest, submaximal exercise, and postexercise rest in children, adolescents, and young adults with BTHS and unaffected controls and examine their relationships with cardioskeletal energetics and function. Children/adolescents and young adults with BTHS (n = 29) and children/adolescent and young adult control participants (n = 28, total n = 57) underwent an infusion of 6'6'H2 glucose and U-13 C palmitate and indirect calorimetry during rest, 30-minutes of moderate exercise (50% V˙O2peak ), and recovery. Cardiac function, cardioskeletal mitochondrial energetics, and exercise capacity were examined via echocardiography, 31 P magnetic resonance spectroscopy, and peak exercise testing, respectively. The glucose turnover rate was significantly higher in individuals with BTHS during rest (33.2 ± 9.8 vs 27.2 ± 8.1 μmol/kgFFM/min, P < .01) and exercise (34.7 ± 11.2 vs 29.5 ± 8.8 μmol/kgFFM/min, P < .05) and tended to be higher postexercise (33.7 ± 10.2 vs 28.8 ± 8.0 μmol/kgFFM/min, P < .06) compared to controls. Increases in total fat (-3.9 ± 7.5 vs 10.5 ± 8.4 μmol/kgFFM/min, P < .0001) and plasma fatty acid oxidation rates (0.0 ± 1.8 vs 5.1 ± 3.9 μmol/kgFFM/min, P < .0001) from rest to exercise were severely blunted in BTHS compared to controls. Conclusion: An inability to upregulate fat metabolism during moderate intensity exercise appears to be partially compensated by elevations in glucose metabolism. Derangements in fat and glucose metabolism are characteristic of the pathophysiology of BTHS. A severely blunted ability to upregulate fat metabolism during a modest level of physical activity is a defining pathophysiologic characteristic in children, adolescents, and young adults with BTHS.
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Affiliation(s)
- W. Todd Cade
- Program in Physical Therapy, 4444 Forest Park Avenue, Washington University School of Medicine, St. Louis, MO
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Kathryn L. Bohnert
- Program in Physical Therapy, 4444 Forest Park Avenue, Washington University School of Medicine, St. Louis, MO
| | - Linda R. Peterson
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Bruce W. Patterson
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Adam J. Bittel
- Program in Physical Therapy, 4444 Forest Park Avenue, Washington University School of Medicine, St. Louis, MO
| | - Adewole L. Okunade
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Lisa de las Fuentes
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Karen Steger-May
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Adil Bashir
- Department of Radiology, Washington University School of Medicine, St. Louis, MO
- Department of Electrical and Computer Engineering, Auburn University, Auburn, AL
| | | | - Shaji K. Chacko
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Ronald J. Wanders
- Department of Pediatrics, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Barry J Byrne
- Department of Pediatrics, University of Florida, Gainesville, FL
| | - Dominic N. Reeds
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
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19
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Abstract
Most of the glycogen metabolism disorders that affect skeletal muscle involve enzymes in glycogenolysis (myophosphorylase (PYGM), glycogen debranching enzyme (AGL), phosphorylase b kinase (PHKB)) and glycolysis (phosphofructokinase (PFK), phosphoglycerate mutase (PGAM2), aldolase A (ALDOA), β-enolase (ENO3)); however, 3 involve glycogen synthesis (glycogenin-1 (GYG1), glycogen synthase (GSE), and branching enzyme (GBE1)). Many present with exercise-induced cramps and rhabdomyolysis with higher-intensity exercise (i.e., PYGM, PFK, PGAM2), yet others present with muscle atrophy and weakness (GYG1, AGL, GBE1). A failure of serum lactate to rise with exercise with an exaggerated ammonia response is a common, but not invariant, finding. The serum creatine kinase (CK) is often elevated in the myopathic forms and in PYGM deficiency, but can be normal and increase only with rhabdomyolysis (PGAM2, PFK, ENO3). Therapy for glycogen storage diseases that result in exercise-induced symptoms includes lifestyle adaptation and carefully titrated exercise. Immediate pre-exercise carbohydrate improves symptoms in the glycogenolytic defects (i.e., PYGM), but can exacerbate symptoms in glycolytic defects (i.e., PFK). Creatine monohydrate in low dose may provide a mild benefit in PYGM mutations.
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Affiliation(s)
- Mark A Tarnopolsky
- Division of Neuromuscular & Neurometabolic Disorders, Departments of Pediatrics and Medicine, McMaster University, Hamilton Health Sciences Centre, Rm 2H26, Hamilton, ON, L8S 4L8, Canada.
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20
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Quinlivan R, Andreu AL, Marti R. 211th ENMC International Workshop:: Development of diagnostic criteria and management strategies for McArdle Disease and related rare glycogenolytic disorders to improve standards of care. 17-19 April 2015, Naarden, The Netherlands. Neuromuscul Disord 2017; 27:1143-1151. [PMID: 29079393 DOI: 10.1016/j.nmd.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/04/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Ros Quinlivan
- MRC Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK.
| | - Antoni L Andreu
- Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, CIBERER, Barcelona, Catalonia, Spain
| | - Ramon Marti
- Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, CIBERER, Barcelona, Catalonia, Spain
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22
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Preisler N, Laforêt P, Madsen KL, Husu E, Vissing CR, Hedermann G, Galbo H, Lindberg C, Vissing J. Skeletal muscle metabolism during prolonged exercise in Pompe disease. Endocr Connect 2017; 6:384-394. [PMID: 28490439 PMCID: PMC8450668 DOI: 10.1530/ec-17-0042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pompe disease (glycogenosis type II) is caused by lysosomal alpha-glucosidase deficiency, which leads to a block in intra-lysosomal glycogen breakdown. In spite of enzyme replacement therapy, Pompe disease continues to be a progressive metabolic myopathy. Considering the health benefits of exercise, it is important in Pompe disease to acquire more information about muscle substrate use during exercise. METHODS Seven adults with Pompe disease were matched to a healthy control group (1:1). We determined (1) peak oxidative capacity (VO2peak) and (2) carbohydrate and fatty acid metabolism during submaximal exercise (33 W) for 1 h, using cycle-ergometer exercise, indirect calorimetry and stable isotopes. RESULTS In the patients, VO2peak was less than half of average control values; mean difference -1659 mL/min (CI: -2450 to -867, P = 0.001). However, the respiratory exchange ratio increased to >1.0 and lactate levels rose 5-fold in the patients, indicating significant glycolytic flux. In line with this, during submaximal exercise, the rates of oxidation (ROX) of carbohydrates and palmitate were similar between patients and controls (mean difference 0.226 g/min (CI: 0.611 to -0.078, P = 0.318) and mean difference 0.016 µmol/kg/min (CI: 1.287 to -1.255, P = 0.710), respectively). CONCLUSION Reflecting muscle weakness and wasting, Pompe disease is associated with markedly reduced maximal exercise capacity. However, glycogenolysis is not impaired in exercise. Unlike in other metabolic myopathies, skeletal muscle substrate use during exercise is normal in Pompe disease rendering exercise less complicated for e.g. medical or recreational purposes.
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Affiliation(s)
- Nicolai Preisler
- Copenhagen Neuromuscular CenterDepartment of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Pascal Laforêt
- Centre de Référence de Pathologie Neuromusculaire Paris-EstInstitut de Myologie, GH Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karen Lindhardt Madsen
- Copenhagen Neuromuscular CenterDepartment of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Edith Husu
- Copenhagen Neuromuscular CenterDepartment of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Rasmus Vissing
- Copenhagen Neuromuscular CenterDepartment of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Hedermann
- Copenhagen Neuromuscular CenterDepartment of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Galbo
- Department of Inflammation ResearchRigshospitalet, Copenhagen, Denmark
| | | | - John Vissing
- Copenhagen Neuromuscular CenterDepartment of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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23
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Vissing J. Exercise training in metabolic myopathies. Rev Neurol (Paris) 2016; 172:559-565. [DOI: 10.1016/j.neurol.2016.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 08/22/2016] [Accepted: 08/25/2016] [Indexed: 10/21/2022]
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24
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van Hall G. The Physiological Regulation of Skeletal Muscle Fatty Acid Supply and Oxidation During Moderate-Intensity Exercise. Sports Med 2016; 45 Suppl 1:S23-32. [PMID: 26553490 PMCID: PMC4672010 DOI: 10.1007/s40279-015-0394-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Energy substrates that are important to the working muscle at moderate intensities are the non-esterified fatty acids (NEFAs) taken up from the circulation and NEFAs originating from lipolysis of the intramuscular triacylglycerol (IMTAG). Moreover, NEFA from lipolysis via lipoprotein lipase (LPL) in the muscle of the very-low-density lipoproteins and in the (semi) post-prandial state chylomicrons may also contribute. In this review, the NEFA fluxes and oxidation by skeletal muscle during prolonged moderate-intensity exercise are described in terms of the integration of physiological systems. Steps involved in the regulation of the active muscle NEFA uptake include (1) increased energy demand; (2) delivery of NEFA to the muscle; (3) transport of NEFA into the muscle by NEFA transporters; and (4) activation of the NEFAs and either oxidation or re-esterification into IMTAG. The increased metabolic demand of the exercising muscle is the main driving force for all physiological regulatory processes. It elicits functional hyperemia, increasing the recruitment of capillaries and muscle blood flow resulting in increased NEFA delivery and accessibility to NEFA transporters and LPL. It also releases epinephrine that augments adipose tissue NEFA release and thereby NEFA delivery to the active muscle. Moreover, NEFA transporters translocate to the plasma membrane, further increasing the NEFA uptake. The majority of the NEFAs taken up by the active muscle is oxidized and a minor portion is re-esterified to IMTAG. Net IMTAG lipolysis occurs; however, the IMTAG contribution to total fat oxidation is rather limited compared to plasma-derived NEFA oxidation, suggesting a complex role and regulation of IMTAG utilization.
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Affiliation(s)
- Gerrit van Hall
- Clinical Metabolomics Core Facility, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, Rigshospitalet, University of Copenhagen, Section 7652, 9 Blegdamsvej, 2100, Copenhagen, Denmark.
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25
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Adeva-Andany MM, González-Lucán M, Donapetry-García C, Fernández-Fernández C, Ameneiros-Rodríguez E. Glycogen metabolism in humans. BBA CLINICAL 2016; 5:85-100. [PMID: 27051594 PMCID: PMC4802397 DOI: 10.1016/j.bbacli.2016.02.001] [Citation(s) in RCA: 262] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/10/2016] [Accepted: 02/16/2016] [Indexed: 12/31/2022]
Abstract
In the human body, glycogen is a branched polymer of glucose stored mainly in the liver and the skeletal muscle that supplies glucose to the blood stream during fasting periods and to the muscle cells during muscle contraction. Glycogen has been identified in other tissues such as brain, heart, kidney, adipose tissue, and erythrocytes, but glycogen function in these tissues is mostly unknown. Glycogen synthesis requires a series of reactions that include glucose entrance into the cell through transporters, phosphorylation of glucose to glucose 6-phosphate, isomerization to glucose 1-phosphate, and formation of uridine 5'-diphosphate-glucose, which is the direct glucose donor for glycogen synthesis. Glycogenin catalyzes the formation of a short glucose polymer that is extended by the action of glycogen synthase. Glycogen branching enzyme introduces branch points in the glycogen particle at even intervals. Laforin and malin are proteins involved in glycogen assembly but their specific function remains elusive in humans. Glycogen is accumulated in the liver primarily during the postprandial period and in the skeletal muscle predominantly after exercise. In the cytosol, glycogen breakdown or glycogenolysis is carried out by two enzymes, glycogen phosphorylase which releases glucose 1-phosphate from the linear chains of glycogen, and glycogen debranching enzyme which untangles the branch points. In the lysosomes, glycogen degradation is catalyzed by α-glucosidase. The glucose 6-phosphatase system catalyzes the dephosphorylation of glucose 6-phosphate to glucose, a necessary step for free glucose to leave the cell. Mutations in the genes encoding the enzymes involved in glycogen metabolism cause glycogen storage diseases.
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Affiliation(s)
- María M. Adeva-Andany
- Nephrology Division, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
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Godfrey R, Quinlivan R. Skeletal muscle disorders of glycogenolysis and glycolysis. Nat Rev Neurol 2016; 12:393-402. [DOI: 10.1038/nrneurol.2016.75] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Ørngreen MC, Jeppesen TD, Taivassalo T, Hauerslev S, Preisler N, Heinicke K, Haller RG, Vissing J, van Hall G. Lactate and Energy Metabolism During Exercise in Patients With Blocked Glycogenolysis (McArdle Disease). J Clin Endocrinol Metab 2015; 100:E1096-104. [PMID: 26030324 DOI: 10.1210/jc.2015-1339] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Patients with blocked muscle glycogen breakdown (McArdle disease) have severely reduced exercise capacity compared to healthy individuals and are not assumed to produce lactate during exercise. OBJECTIVES The objectives were: 1) to quantify systemic and muscle lactate kinetics and oxidation rates and muscle energy utilization during exercise in patients with McArdle disease; and 2) to elucidate the role of lactate formation in muscle energy production. DESIGN AND SETTING This was a single trial in a hospital. PARTICIPANTS Participants were four patients with McArdle disease and seven healthy subjects. INTERVENTION Patients and healthy controls were studied at rest, which was followed by 40 minutes of cycle-ergometer exercise at 60% of the patients' maximal oxygen uptake (∼35 W). MAIN OUTCOME MEASURES Main outcome measures were systemic and leg skeletal muscle lactate, alanine, fatty acid, and glucose kinetics. RESULTS McArdle patients had a marked decrease in plasma lactate concentration at the onset of exercise, and the concentration remained suppressed during exercise. A substantial leg net lactate uptake and subsequent oxidation occurred over the entire exercise period in patients, in contrast to a net lactate release or no exchange in the healthy controls. Despite a net lactate uptake by the active leg, a simultaneous unidirectional lactate release was observed in McArdle patients at rates that were similar to the healthy controls. CONCLUSION Lactate is an important energy source for contracting skeletal muscle in patients with myophosphorylase deficiency. Although McArdle patients had leg net lactate consumption, a simultaneous release of lactate was observed at rates similar to that found in healthy individuals exercising at the same very low workload, suggesting that lactate formation is mandatory for muscle energy generation during exercise.
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Affiliation(s)
- Mette Cathrine Ørngreen
- Neuromuscular Research Unit, Department of Neurology (M.C.O., T.D.J., S.H., N.P., J.V.), Copenhagen Muscle Research Center (M.C.O., T.D.J., S.H., N.P., J.V., G.H.), and Clinical Metabolomics Core Facility (G.H.), Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Biomedical Sciences (G.H.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark; Neuromuscular Center (T.T., K.H., R.G.H.), Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and the Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas 75235; and Department of Neurology (R.G.H.), North Texas VA Medical Center, Dallas, Texas 75216
| | - Tina Dysgaard Jeppesen
- Neuromuscular Research Unit, Department of Neurology (M.C.O., T.D.J., S.H., N.P., J.V.), Copenhagen Muscle Research Center (M.C.O., T.D.J., S.H., N.P., J.V., G.H.), and Clinical Metabolomics Core Facility (G.H.), Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Biomedical Sciences (G.H.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark; Neuromuscular Center (T.T., K.H., R.G.H.), Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and the Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas 75235; and Department of Neurology (R.G.H.), North Texas VA Medical Center, Dallas, Texas 75216
| | - Tanja Taivassalo
- Neuromuscular Research Unit, Department of Neurology (M.C.O., T.D.J., S.H., N.P., J.V.), Copenhagen Muscle Research Center (M.C.O., T.D.J., S.H., N.P., J.V., G.H.), and Clinical Metabolomics Core Facility (G.H.), Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Biomedical Sciences (G.H.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark; Neuromuscular Center (T.T., K.H., R.G.H.), Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and the Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas 75235; and Department of Neurology (R.G.H.), North Texas VA Medical Center, Dallas, Texas 75216
| | - Simon Hauerslev
- Neuromuscular Research Unit, Department of Neurology (M.C.O., T.D.J., S.H., N.P., J.V.), Copenhagen Muscle Research Center (M.C.O., T.D.J., S.H., N.P., J.V., G.H.), and Clinical Metabolomics Core Facility (G.H.), Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Biomedical Sciences (G.H.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark; Neuromuscular Center (T.T., K.H., R.G.H.), Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and the Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas 75235; and Department of Neurology (R.G.H.), North Texas VA Medical Center, Dallas, Texas 75216
| | - Nicolai Preisler
- Neuromuscular Research Unit, Department of Neurology (M.C.O., T.D.J., S.H., N.P., J.V.), Copenhagen Muscle Research Center (M.C.O., T.D.J., S.H., N.P., J.V., G.H.), and Clinical Metabolomics Core Facility (G.H.), Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Biomedical Sciences (G.H.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark; Neuromuscular Center (T.T., K.H., R.G.H.), Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and the Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas 75235; and Department of Neurology (R.G.H.), North Texas VA Medical Center, Dallas, Texas 75216
| | - Katja Heinicke
- Neuromuscular Research Unit, Department of Neurology (M.C.O., T.D.J., S.H., N.P., J.V.), Copenhagen Muscle Research Center (M.C.O., T.D.J., S.H., N.P., J.V., G.H.), and Clinical Metabolomics Core Facility (G.H.), Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Biomedical Sciences (G.H.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark; Neuromuscular Center (T.T., K.H., R.G.H.), Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and the Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas 75235; and Department of Neurology (R.G.H.), North Texas VA Medical Center, Dallas, Texas 75216
| | - Ronald G Haller
- Neuromuscular Research Unit, Department of Neurology (M.C.O., T.D.J., S.H., N.P., J.V.), Copenhagen Muscle Research Center (M.C.O., T.D.J., S.H., N.P., J.V., G.H.), and Clinical Metabolomics Core Facility (G.H.), Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Biomedical Sciences (G.H.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark; Neuromuscular Center (T.T., K.H., R.G.H.), Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and the Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas 75235; and Department of Neurology (R.G.H.), North Texas VA Medical Center, Dallas, Texas 75216
| | - John Vissing
- Neuromuscular Research Unit, Department of Neurology (M.C.O., T.D.J., S.H., N.P., J.V.), Copenhagen Muscle Research Center (M.C.O., T.D.J., S.H., N.P., J.V., G.H.), and Clinical Metabolomics Core Facility (G.H.), Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Biomedical Sciences (G.H.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark; Neuromuscular Center (T.T., K.H., R.G.H.), Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and the Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas 75235; and Department of Neurology (R.G.H.), North Texas VA Medical Center, Dallas, Texas 75216
| | - Gerrit van Hall
- Neuromuscular Research Unit, Department of Neurology (M.C.O., T.D.J., S.H., N.P., J.V.), Copenhagen Muscle Research Center (M.C.O., T.D.J., S.H., N.P., J.V., G.H.), and Clinical Metabolomics Core Facility (G.H.), Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Biomedical Sciences (G.H.), Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark; Neuromuscular Center (T.T., K.H., R.G.H.), Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and the Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas 75235; and Department of Neurology (R.G.H.), North Texas VA Medical Center, Dallas, Texas 75216
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Preisler N, Haller RG, Vissing J. Exercise in muscle glycogen storage diseases. J Inherit Metab Dis 2015; 38:551-63. [PMID: 25326273 DOI: 10.1007/s10545-014-9771-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 09/09/2014] [Indexed: 12/11/2022]
Abstract
Glycogen storage diseases (GSD) are inborn errors of glycogen or glucose metabolism. In the GSDs that affect muscle, the consequence of a block in skeletal muscle glycogen breakdown or glucose use, is an impairment of muscular performance and exercise intolerance, owing to 1) an increase in glycogen storage that disrupts contractile function and/or 2) a reduced substrate turnover below the block, which inhibits skeletal muscle ATP production. Immobility is associated with metabolic alterations in muscle leading to an increased dependence on glycogen use and a reduced capacity for fatty acid oxidation. Such changes may be detrimental for persons with GSD from a metabolic perspective. However, exercise may alter skeletal muscle substrate metabolism in ways that are beneficial for patients with GSD, such as improving exercise tolerance and increasing fatty acid oxidation. In addition, a regular exercise program has the potential to improve general health and fitness and improve quality of life, if executed properly. In this review, we describe skeletal muscle substrate use during exercise in GSDs, and how blocks in metabolic pathways affect exercise tolerance in GSDs. We review the studies that have examined the effect of regular exercise training in different types of GSD. Finally, we consider how oral substrate supplementation can improve exercise tolerance and we discuss the precautions that apply to persons with GSD that engage in exercise.
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Affiliation(s)
- Nicolai Preisler
- Neuromuscular Research Unit, Section 3342, Department of Neurology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark,
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Quinlivan R, Martinuzzi A, Schoser B. Pharmacological and nutritional treatment for McArdle disease (Glycogen Storage Disease type V). Cochrane Database Syst Rev 2014; 2014:CD003458. [PMID: 25391139 PMCID: PMC7173724 DOI: 10.1002/14651858.cd003458.pub5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background McArdle disease (Glycogen Storage Disease type V) is caused by an absence of muscle phosphorylase leading to exercise intolerance,myoglobinuria rhabdomyolysis and acute renal failure. This is an update of a review first published in 2004.Objectives To review systematically the evidence from randomised controlled trials (RCTs) of pharmacological or nutritional treatments for improving exercise performance and quality of life in McArdle disease.Search methods We searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE and EMBASE on 11 August 2014.Selection criteria We included RCTs (including cross-over studies) and quasi-RCTs. We included unblinded open trials and individual patient studies in the discussion. Interventions included any pharmacological agent or nutritional supplement. Primary outcome measures included any objective assessment of exercise endurance (for example aerobic capacity (VO2) max, walking speed, muscle force or power and fatigability). Secondary outcome measures included metabolic changes (such as reduced plasma creatine kinase and a reduction in the frequency of myoglobinuria), subjective measures (including quality of life scores and indices of disability) and serious adverse events.Data collection and analysis Three review authors checked the titles and abstracts identified by the search and reviewed the manuscripts. Two review authors independently assessed the risk of bias of relevant studies, with comments from a third author. Two authors extracted data onto a specially designed form.Main results We identified 31 studies, and 13 fulfilled the criteria for inclusion. We described trials that were not eligible for the review in the Discussion. The included studies involved a total of 85 participants, but the number in each individual trial was small; the largest treatment trial included 19 participants and the smallest study included only one participant. There was no benefit with: D-ribose,glucagon, verapamil, vitamin B6, branched chain amino acids, dantrolene sodium, and high-dose creatine. Minimal subjective benefit was found with low dose creatine and ramipril only for patients with a polymorphism known as the D/Dangiotens in converting enzyme(ACE) phenotype. A carbohydrate-rich diet resulted in better exercise performance compared with a protein-rich diet. Two studies of oral sucrose given at different times and in different amounts before exercise showed an improvement in exercise performance. Four studies reported adverse effects. Oral ribose caused diarrhoea and symptoms suggestive of hypoglycaemia including light-headedness and hunger. In one study, branched chain amino acids caused a deterioration of functional outcomes. Dantrolene was reported to cause a number of adverse effects including tiredness, somnolence, dizziness and muscle weakness. Low dose creatine (60 mg/kg/day) did not cause side-effects but high-dose creatine (150 mg/kg/day) worsened the symptoms of myalgia.Authors' conclusions Although there was low quality evidence of improvement in some parameters with creatine, oral sucrose, ramipril and a carbohydrate rich diet, none was sufficiently strong to indicate significant clinical benefit.
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Affiliation(s)
- Rosaline Quinlivan
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery and Great Ormond StreetMRC Centre for Neuromuscular Diseases and Dubowitz Neuromuscular CentrePO Box 114LondonUKWC1B 3BN
| | - Andrea Martinuzzi
- Medea Scientific InstituteThe Conegliano‐Pieve Research CentreVia Costa Alta 37ConeglianoItaly31015
| | - Benedikt Schoser
- Friedrich‐Baur Institute Ludwig‐Maximilians University MunichDepartment of NeurologyZiemssenstr. 1aD‐80336 MunichGermany
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McArdle Disease and Exercise Physiology. BIOLOGY 2014; 3:157-66. [PMID: 24833339 PMCID: PMC4009758 DOI: 10.3390/biology3010157] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 02/19/2014] [Accepted: 02/20/2014] [Indexed: 11/17/2022]
Abstract
McArdle disease (glycogen storage disease Type V; MD) is a metabolic myopathy caused by a deficiency in muscle glycogen phosphorylase. Since muscle glycogen is an important fuel for muscle during exercise, this inborn error of metabolism provides a model for understanding the role of glycogen in muscle function and the compensatory adaptations that occur in response to impaired glycogenolysis. Patients with MD have exercise intolerance with symptoms including premature fatigue, myalgia, and/or muscle cramps. Despite this, MD patients are able to perform prolonged exercise as a result of the “second wind” phenomenon, owing to the improved delivery of extra-muscular fuels during exercise. The present review will cover what this disease can teach us about exercise physiology, and particularly focuses on the compensatory pathways for energy delivery to muscle in the absence of glycogenolysis.
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Ørngreen MC, Madsen KL, Preisler N, Andersen G, Vissing J, Laforêt P. Bezafibrate in skeletal muscle fatty acid oxidation disorders: a randomized clinical trial. Neurology 2014; 82:607-13. [PMID: 24453079 DOI: 10.1212/wnl.0000000000000118] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To assess whether bezafibrate increases fatty acid oxidation (FAO) and lowers heart rate (HR) during exercise in patients with carnitine palmitoyltransferase (CPT) II and very long-chain acyl-CoA dehydrogenase (VLCAD) deficiencies. METHODS This was a 3-month, randomized, double-blind, crossover study of bezafibrate in patients with CPT II (n = 5) and VLCAD (n = 5) deficiencies. Primary outcome measures were changes in FAO, measured with stable-isotope methodology and indirect calorimetry, and changes in HR during exercise. RESULTS Bezafibrate lowered low-density lipoprotein, triglyceride, and free fatty acid concentrations; however, there were no changes in palmitate oxidation, FAO, or HR during exercise. CONCLUSION Bezafibrate does not improve clinical symptoms or FAO during exercise in patients with CPT II and VLCAD deficiencies. These findings indicate that previous in vitro studies suggesting a therapeutic potential for fibrates in disorders of FAO do not translate into clinically meaningful effects in vivo. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that bezafibrate 200 mg 3 times daily is ineffective in improving changes in FAO and HR during exercise in adults with CPT II and VLCAD deficiencies.
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Affiliation(s)
- Mette Cathrine Ørngreen
- From the Neuromuscular Clinic and Research Unit (M.C.Ø, K.L.M., N.P., G.A., J.V.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Centre de Référence de pathologie neuromusculaire Paris-Est (P.L.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
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Spread of hatch and delayed feed access affect post hatch performance of female broiler chicks up to day 5. Animal 2014; 8:610-7. [DOI: 10.1017/s175173111400007x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Preisler N, Laforêt P, Echaniz-Laguna A, Ørngreen MC, Lonsdorfer-Wolf E, Doutreleau S, Geny B, Stojkovic T, Piraud M, Petit FM, Vissing J. Fat and carbohydrate metabolism during exercise in phosphoglucomutase type 1 deficiency. J Clin Endocrinol Metab 2013; 98:E1235-40. [PMID: 23780368 DOI: 10.1210/jc.2013-1651] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Phosphoglucomutase type 1 (PGM1) deficiency is a rare metabolic myopathy in which symptoms are provoked by exercise. OBJECTIVE Because the metabolic block is proximal to the entry of glucose into the glycolytic pathway, we hypothesized that iv glucose could improve the exercise intolerance experienced by the patient. DESIGN This was an experimental intervention study. SETTING The study was conducted in an exercise laboratory. SUBJECTS Subjects were a 37-year-old man with genetically and biochemically verified PGM1 deficiency and 6 healthy subjects. INTERVENTIONS Cycle ergometer, peak and submaximal exercise (70% of peak oxygen consumption), and exercise with an iv glucose infusion tests were performed. MAIN OUTCOME MEASURES Peak work capacity and substrate metabolism during submaximal exercise with and without an iv glucose infusion were measured. RESULTS Peak work capacity in the patient was normal, as were increases in plasma lactate during peak and submaximal exercise. However, the heart rate decreased 11 beats minute⁻¹, the peak work rate increased 12.5%, and exercise was rated as being easier with glucose infusion in the patient. These results were in contrast to those in the control group, in whom no improvements occurred. In addition, the patient tended to become hypoglycemic during submaximal exercise. CONCLUSIONS This report characterizes PGM1 deficiency as a mild metabolic myopathy that has dynamic exercise-related symptoms in common with McArdle disease but no second wind phenomenon, thus suggesting that the condition clinically resembles other partial enzymatic defects of glycolysis. However, with glucose infusion, the heart rate decreased 11 beats min⁻¹, the peak work rate increased 12.5%, and exercise was considered easier by the patient.
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Affiliation(s)
- Nicolai Preisler
- Neuromuscular Research Unit, Department of Neurology, Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark.
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Abstract
Exertional fatigue early in exercise is a clinical hallmark of muscle glycogenoses, which is often coupled with painful muscle contractures and episodes of myoglobinuria. A fundamental biochemical problem in these conditions is the impaired generation of ATP to fuel muscle contractions, which relates directly to the metabolic defect, but also to substrate-limited energy deficiency, as exemplified by the "second wind" phenomenon in McArdle disease. A number of secondary events may also play a role in inducing premature fatigue in glycogenoses, including (1) absent or blunted muscle acidosis, which may be important for maintaining muscle membrane excitability by decreasing chloride permeability, (2) loss of the osmotic effect related to lactate accumulation, which may account for absence of the normal increase in water content of exercised muscle, and thus promote higher than normal concentrations of extracellular potassium in exercising muscle and (3) exaggerated accumulation of ADP during exercise that may inhibit sodium-potassium and calcium-ATPases. Disorders of muscle glycogenolysis and glycolysis reveal the crucial role of these metabolic processes for supplying both anaerobic and aerobic energy for muscle contraction; and the pathological fatigue that occurs when glycogenolysis and/or glycolysis is blocked imply an important role for theses metabolic pathways in normal muscle fatigue.
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Affiliation(s)
- John Vissing
- Neuromuscular Research Unit, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Preisler N, Laforet P, Madsen KL, Hansen RS, Lukacs Z, Ørngreen MC, Lacour A, Vissing J. Fat and carbohydrate metabolism during exercise in late-onset Pompe disease. Mol Genet Metab 2012; 107:462-8. [PMID: 22981821 DOI: 10.1016/j.ymgme.2012.08.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 08/25/2012] [Accepted: 08/26/2012] [Indexed: 10/27/2022]
Abstract
Pompe disease is caused by absence of the lysosomal enzyme acid alpha-glucosidase. It is generally assumed that intra-lysosomal hydrolysis of glycogen does not contribute to skeletal muscle energy production during exercise. However, this hypothesis has never been tested in vivo during exercise. We examined the metabolic response to exercise in patients with late-onset Pompe disease, in order to determine if a defect in energy metabolism may play a role in the pathogenesis of Pompe disease. We studied six adult patients with Pompe disease and 10 healthy subjects. The participants underwent ischemic forearm exercise testing, and peak work capacity was determined. Fat and carbohydrate metabolism during cycle exercise was examined with a combination of indirect calorimetry and stable isotope methodology. Finally, the effects of an IV glucose infusion on heart rate, ratings of perceived exertion, and work capacity during exercise were determined. We found that peak oxidative capacity was reduced in the patients to 17.6 vs. 38.8 ml kg(-1) min(-1) in healthy subjects (p = 0.002). There were no differences in the rate of appearance and rate of oxidation of palmitate, or total fat and carbohydrate oxidation, between the patients and the healthy subjects. None of the subjects improved exercise tolerance by IV glucose infusion. In conclusion, peak oxidative capacity is reduced in Pompe disease. However, skeletal muscle fat and carbohydrate use during exercise was normal. The results indicate that a reduced exercise capacity is caused by muscle weakness and wasting, rather than by an impaired skeletal muscle glycogenolytic capacity. Thus, it appears that acid alpha-glucosidase does not play a significant role in the production of energy in skeletal muscle during exercise.
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Affiliation(s)
- Nicolai Preisler
- Neuromuscular Research Unit, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Abstract
BACKGROUND McArdle disease is a rare metabolic myopathy caused by a complete absence of the enzyme muscle glycogen phosphorylase. Affected people experience symptoms of fatigue and cramping within minutes of exercise and are at risk for acute muscle injury (rhabdomyolysis) and acute renal failure. If the first few minutes of exercise are paced, a 'second wind' will occur enabling exercise to continue. This is due to mobilisation and utilisation of alternative fuel substrates. Aerobic training appears to improve work capacity by increasing cardiovascular fitness. OBJECTIVES To assess the effects of aerobic training in people with McArdle disease. SEARCH METHODS We searched the Cochrane Neuromuscular Disease Group Specialized Register (11 January 2011), CENTRAL (2010, Issue 4), MEDLINE (January 1966 to January 2011) and EMBASE (January 1980 to January 2011). SELECTION CRITERIA All randomised and quasi-randomised controlled studies of aerobic exercise training in people of all ages with McArdle disease. DATA COLLECTION AND ANALYSIS Two authors identified possible studies for inclusion and assessed their methodological quality. Had more than one study of sufficient methodological quality been identified we would have undertaken a meta-analysis. MAIN RESULTS There were no randomised or quasi-randomised controlled trials of aerobic training in people with McArdle disease. However, three open studies using small numbers of participants provided some evidence that aerobic training improves fitness without adverse events in people with McArdle disease. AUTHORS' CONCLUSIONS Evidence from non-randomised studies using small numbers of patients suggest that it would be safe and worthwhile for larger controlled trials of aerobic training to be undertaken in people with McArdle disease.
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Affiliation(s)
- Rosaline Quinlivan
- MRC Centre for Neuromuscular Diseases and Dubowitz Neuromuscular Centre, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery and Great Ormond Street, PO Box 114, London, UK, WC1B 3BN
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Quinlivan R, Martinuzzi A, Schoser B. Pharmacological and nutritional treatment for McArdle disease (Glycogen Storage Disease type V). Cochrane Database Syst Rev 2010:CD003458. [PMID: 21154353 DOI: 10.1002/14651858.cd003458.pub4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND McArdle disease (Glycogen Storage Disease type V) is caused by an absence of muscle phosphorylase leading to exercise intolerance, myoglobinuria rhabdomyolysis and acute renal failure. OBJECTIVES To review systematically the evidence from randomized controlled trials of pharmacological or nutritional treatments for improving exercise performance and quality of life in McArdle disease. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Specialised Register (17 May 2010), the Cochrane Central Register of Controlled Trials (Issue 2, 2010 in The Cochrane Library), MEDLINE (January 1966 to May 2010) and EMBASE (January 1980 to May 2010) using the search terms 'McArdle disease', 'Glycogen Storage Disease type V' and 'muscle phosphorylase deficiency'. SELECTION CRITERIA We included randomized controlled trials (including cross-over studies) and quasi-randomised trials. Unblinded open trials and individual patient studies were included in the discussion. Interventions included any pharmacological agent or nutritional supplement. Primary outcome measures included any objective assessment of exercise endurance (for example aerobic capacity (VO(2)) max, walking speed, muscle force or power and fatigability). Secondary outcome measures included metabolic changes (such as reduced plasma creatine kinase and a reduction in the frequency of myoglobinuria), subjective measures (including quality of life scores and indices of disability) and serious adverse events. DATA COLLECTION AND ANALYSIS Three review authors checked the titles and abstracts identified by the search and reviewed the manuscripts. In the first review two authors (RQ and RB) independently assessed methodological quality of relevant studies and extracted data onto a specially designed form. In this update methodological quality of data was assessed by RQ and AM with comments from BS. MAIN RESULTS We identified 31 studies,13 fulfilled the criteria for inclusion. Excluded trials are included in the Discussion. The largest treatment trial included 19 subjects. There was no benefit with: D-ribose, glucagon, verapamil, vitamin B(6), branched chain amino acids, dantrolene sodium, and high dose creatine. Minimal benefit was found with low dose creatine and ramipril only for patients with a polymorphism known as the D/D angiotensin converting enzyme (ACE) phenotype. A carbohydrate-rich diet resulted in better exercise performance compared with a protein-rich diet. Two studies of oral sucrose given at different times and in different amounts before exercise showed an improvement in exercise performance. AUTHORS' CONCLUSIONS Although there was low quality evidence of improvement in some parameters with creatine, oral sucrose, ramipril and a carbohydrate rich diet, none was sufficiently strong to indicate significant clinical benefit.
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Affiliation(s)
- Rosaline Quinlivan
- MRC Centre for Neuromuscular Diseases and Dubowitz Neuromuscular Centre, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery and Great Ormond Street, PO Box 114, London, UK, WC1B 3BN
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Abstract
We consider recent developments in disorders affecting three areas of metabolism: glycogen, fatty acids, and the mitochondrial respiratory chain. Among the glycogenoses, new attention has been directed to defects of glycogen synthesis resulting in absence rather than excess of muscle glycogen ("aglycogenosis"). These include defects of glycogen synthetase and defects of glycogenin, the primer of glycogen synthesis. Considerable progress also has been made in our understanding of alterations of glycogen metabolism that result in polyglucosan storage. Among the disorders of lipid metabolism, mutations in the genes encoding two triglyceride lipases acting hand in hand cause severe generalized lipid storage myopathy, one associated with ichthyosis (Chanarin-Dorfman syndrome), the other dominated by juvenile-onset weakness. For the mitochondrial myopathies, we discuss the importance of homoplasmic mitochondrial DNA mutations and review the rapid progress made in our understanding of the coenzyme Q(10) deficiencies, which are often treatable.
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Affiliation(s)
- Salvatore DiMauro
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, Room 4-424B, 630 West 168th Street, New York, NY 10032, USA.
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Vissing J, Duno M, Schwartz M, Haller RG. Splice mutations preserve myophosphorylase activity that ameliorates the phenotype in McArdle disease. Brain 2009; 132:1545-52. [PMID: 19433441 DOI: 10.1093/brain/awp065] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Over 100 mutations in the myophosphorylase gene, which cause McArdle disease, are known. All these mutations have resulted in a complete block of muscle glycogenolysis, and accordingly, no genotype-phenotype correlation has been identified in this condition. We evaluated physiologic and genetic features of two patients with a variant form of McArdle disease, associated with unusually high exercise capacity. Physiologic findings were compared to those in 47 patients with typical McArdle disease, and 17 healthy subjects. Subjects performed an ischaemic forearm exercise test to assess lactate and ammonia production. Peak oxidative capacity (VO2max) and cardiac output were determined, using cycle ergometry as the exercise modality. The two patients with atypical McArdle disease carried common mutations on one allele (R50X and G205S), and novel splice mutations in introns 3 [IVS3-26A>G (c.425-26A>G)] and 5 [IVS5-601G>A (c.856-601G>A)] on the other allele. Plasma lactate after ischaemic exercise decreased in all typical McArdle patients, but increased in the two atypical McArdle patients (10% of that in healthy subjects). Peak workload and oxidative capacity were 2-fold higher in patients with atypical McArdle disease compared to typical McArdle patients. Oxygen uptake, relative to cardiac output, was severely impaired in the 47 patients with typical McArdle disease, and partially normalized in the milder affected McArdle patients. These findings identify the first distinct genotype-phenotype relationship in McArdle disease, and indicate that minimal myophosphorylase activity ameliorates the typical McArdle disease phenotype by augmenting muscle oxidative capacity. The milder form of McArdle disease provides important clues to the level of functional myophosphorylase needed to support muscle oxidative metabolism.
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Affiliation(s)
- John Vissing
- Department of Neurology 2082, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
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