Targeting proximal tubule mitochondrial dysfunction attenuates the renal disease of methylmalonic acidemia.

Journal Article (Clinical Trial;Journal Article)

Isolated methylmalonic acidemia (MMA), caused by deficiency of the mitochondrial enzyme methylmalonyl-CoA mutase (MUT), is often complicated by end stage renal disease that is resistant to conventional therapies, including liver transplantation. To establish a viable model of MMA renal disease, Mut was expressed in the liver of Mut(-/-) mice as a stable transgene under the control of an albumin (INS-Alb-Mut) promoter. Mut(-/-);Tg(INS-Alb-Mut) mice, although completely rescued from neonatal lethality that was displayed by Mut(-/-) mice, manifested a decreased glomerular filtration rate (GFR), chronic tubulointerstitial nephritis and ultrastructural changes in the proximal tubule mitochondria associated with aberrant tubular function, as demonstrated by single-nephron GFR studies. Microarray analysis of Mut(-/-);Tg(INS-Alb-Mut) kidneys identified numerous biomarkers, including lipocalin-2, which was then used to monitor the response of the GFR to antioxidant therapy in the mouse model. Renal biopsies and biomarker analysis from a large and diverse patient cohort ( identifier: NCT00078078) precisely replicated the findings in the animals, establishing Mut(-/-);Tg(INS-Alb-Mut) mice as a unique model of MMA renal disease. Our studies suggest proximal tubular mitochondrial dysfunction is a key pathogenic mechanism of MMA-associated kidney disease, identify lipocalin-2 as a biomarker of increased oxidative stress in the renal tubule, and demonstrate that antioxidants can attenuate the renal disease of MMA.

Full Text

Duke Authors

Cited Authors

  • Manoli, I; Sysol, JR; Li, L; Houillier, P; Garone, C; Wang, C; Zerfas, PM; Cusmano-Ozog, K; Young, S; Trivedi, NS; Cheng, J; Sloan, JL; Chandler, RJ; Abu-Asab, M; Tsokos, M; Elkahloun, AG; Rosen, S; Enns, GM; Berry, GT; Hoffmann, V; DiMauro, S; Schnermann, J; Venditti, CP

Published Date

  • August 13, 2013

Published In

Volume / Issue

  • 110 / 33

Start / End Page

  • 13552 - 13557

PubMed ID

  • 23898205

Pubmed Central ID

  • PMC3746875

Electronic International Standard Serial Number (EISSN)

  • 1091-6490

Digital Object Identifier (DOI)

  • 10.1073/pnas.1302764110


  • eng

Conference Location

  • United States