Journal of Inherited Metabolic Disease

, Volume 33, Issue 5, pp 555–561

Current issues regarding treatment of mitochondrial fatty acid oxidation disorders

  • Ute Spiekerkoetter
  • Jean Bastin
  • Melanie Gillingham
  • Andrew Morris
  • Frits Wijburg
  • Bridget Wilcken
Fatty Acid Oxidation

Abstract

Treatment recommendations in mitochondrial fatty acid oxidation (FAO) defects are diverse. With implementation of newborn screening and identification of asymptomatic patients, it is necessary to define whom to treat and how strictly. We here discuss critical questions that are currently under debate. For some asymptomatic long-chain defects, long-chain fat restriction plays a minor role, and a normal diet may be introduced. For patients presenting only with myopathic symptoms, e.g., during exercise, treatment may be adapted to energy demand. As a consequence, patients with exercise-induced myopathy may be able to return to normal activity when provided with medium-chain triglycerides (MCT) prior to exercise. There is no need to limit participation in sports. Progression of retinopathy in disorders of the mitochondrial trifunctional protein complex is closely associated with hydroxyacylcarnitine accumulation. A strict low-fat diet with MCT supplementation is recommended to slow or prevent progression of chorioretinopathy. Additional docosahexanoic acid does not prevent the decline in retinal function but does promote nonspecific improvement in visual acuity and is recommended. There is no evidence that L-carnitine supplementation is beneficial. Thus, supplementation with L-carnitine in a newborn identified by screening with either a medium-chain or long-chain defect is not supported. With respect to the use of the odd-chain medium-chain triglyceride triheptanoin in myopathic phenotypes, randomized trials are needed to establish whether triheptanoin is more effective than even-chain MCT. With increasing pathophysiological knowledge, new treatment options have been identified and are being clinically evaluated. These include the use of bezafibrates in myopathic long-chain defects.

Abbreviations

CPT2

carnitine palmitoyl-CoA transferase 2

CPT2D

carnitine palmitoyl-CoA transferase 2 deficiency

DHA

docosahexanoic acid

FAO

fatty acid oxidation

FAOD

fatty acid oxidation defects

LCHAD

long-chain 3-hydroxy-acyl-CoA dehydrogenase

LCHADD

long-chain 3-hydroxy-acyl-CoA dehydrogenase deficiency

LCT

long-chain trigylcerides

MCAD

medium-chain acyl-CoA dehydrogenase

MCADD

medium-chain acyl-CoA dehydrogenase deficiency

MCT

medium-chain triglycerides

mTFP

mitochondrial trifunctional protein

PPAR

peroxisome-proliferator-activated receptor

VLCAD

very-long-chain acyl-CoA dehydrogenase

VLCADD

very-long-chain acyl-CoA dehydrogenase deficiency

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Copyright information

© SSIEM and Springer 2010

Authors and Affiliations

  • Ute Spiekerkoetter
    • 1
  • Jean Bastin
    • 2
  • Melanie Gillingham
    • 3
  • Andrew Morris
    • 4
  • Frits Wijburg
    • 5
  • Bridget Wilcken
    • 6
  1. 1.Department of General PediatricsUniversity Children’s HospitalDuesseldorfGermany
  2. 2.Faculté Necker-Enfants MaladesParisFrance
  3. 3.Oregon Health & Science UniversityPortlandUSA
  4. 4.Willink Biochemical Genetics Unit, Genetic MedicineSt Mary’s HospitalManchesterUK
  5. 5.Department of PediatricsUniversity of AmsterdamAmsterdamThe Netherlands
  6. 6.Children’s Hospital at Westmead and University of SydneySydneyAustralia

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