Biomarkers to predict disease progression and therapeutic response in isolated methylmalonic acidemia.

Abstract

Methylmalonic Acidemia (MMA) is a heterogenous group of inborn errors of metabolism caused by a defect in the methylmalonyl-CoA mutase (MMUT) enzyme or the synthesis and transport of its cofactor, 5'-deoxy-adenosylcobalamin. It is characterized by life-threatening episodes of ketoacidosis, chronic kidney disease, and other multiorgan complications. Liver transplantation can improve patient stability and survival and thus provides clinical and biochemical benchmarks for the development of hepatocyte-targeted genomic therapies. Data are presented from a US natural history protocol that evaluated subjects with different types of MMA including mut-type (N = 91), cblB-type (15), and cblA-type MMA (17), as well as from an Italian cohort of mut-type (N = 19) and cblB-type MMA (N = 2) subjects, including data before and after organ transplantation in both cohorts. Canonical metabolic markers, such as serum methylmalonic acid and propionylcarnitine, are variable and affected by dietary intake and renal function. We have therefore explored the use of the 1-13 C-propionate oxidation breath test (POBT) to measure metabolic capacity and the changes in circulating proteins to assess mitochondrial dysfunction (fibroblast growth factor 21 [FGF21] and growth differentiation factor 15 [GDF15]) and kidney injury (lipocalin-2 [LCN2]). Biomarker concentrations are higher in patients with the severe mut0 -type and cblB-type MMA, correlate with a decreased POBT, and show a significant response postliver transplant. Additional circulating and imaging markers to assess disease burden are necessary to monitor disease progression. A combination of biomarkers reflecting disease severity and multisystem involvement will be needed to help stratify patients for clinical trials and assess the efficacy of new therapies for MMA.

• Authors: Irini Manoli, Abigael Gebremariam, Samantha McCoy, Alexandra R Pass, Jack Gagné, Camryn Hall, Susan Ferry, Carol Van Ryzin, Jennifer L Sloan, Elisa Sacchetti, Giulio Catesini, Cristiano Rizzo, Diego Martinelli, Marco Spada, Carlo Dionisi-Vici, Charles P Venditti
• Journal: Journal of inherited metabolic disease (J Inherit Metab Dis) Vol. 46 Issue 4 Pg. 554-572 (07 2023) ISSN: 1573-2665 [Electronic] United States
• PMID: 37243446 (Publication Type: Journal Article, Review, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Intramural)
• Copyright: © 2023 SSIEM. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Chemical References

• Biomarkers
• Methylmalonic Acid
• Methylmalonyl-CoA Mutase

Topics

• Humans
• Mutation
• Amino Acid Metabolism, Inborn Errors (diagnosis, therapy, complications)
• Biomarkers
• Disease Progression
• Methylmalonic Acid
• Methylmalonyl-CoA Mutase (genetics, metabolism)