Brain, Vol. 122, No. 12, 2401-2411,
December 1999
© 1999 Oxford University Press
Riboflavin therapy
Biochemical heterogeneity in two adult lipid storage myopathies
1 Neuromuscular Center, Department of Neurological Science, 2 Department of Pediatrics, 3 Department of Pharmacology, University of Padova, Padova, 4 Department of Biochemistry and Molecular Biology, University of Bari and Study Center for Mitochondria and Energy Metabolism, Italian Council for Research, Bari, Italy and 5 Department of Molecular Biology, University of Amsterdam, Amsterdam, The Netherlands
Correspondence to:
Lodovica Vergani, Dipartimento di Scienze Neurologiche e Psichiatriche, Via Giustiniani 5, 35128 Padova, Italy E-mail: Ivergani{at}ux1.unipd.it
Two unrelated adult males, aged 36 (patient 1) and 25 (patient 2) years, presented with subacute carnitine-deficient lipid storage myopathy that was totally and partly responsive to riboflavin supplementation in the two patients, respectively. Plasma acyl-carnitine and urinary organic acid profiles indicated multiple acyl coenzyme A dehydrogenase deficiency, which was mild in patient 1 and severe in patient 2. The activities of short-chain and medium-chain acyl coenzyme A dehydrogenases in mitochondrial fractions were decreased, especially in patient 2. This was in agreement with Western blotting results. Flavin-dependent complexes I and II were studied by immunoblotting and densitometric quantification of two-dimensional electrophoresis with comparable results. Complex I was present in normal amounts in both patients, whereas complex II was decreased only in the pretherapy muscle of patient 2. Flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN) concentrations in muscle and isolated mitochondria, and the activity of mitochondrial FAD pyrophosphatase, showed that patient 1 had low levels of FAD (46%) and FMN (49%) in mitochondria, with a significant increase (P < 0.01) in mitochondrial FAD pyrophosphatase (273%) compared with controls. Patient 2 had similar low levels of FAD and FMN in both total muscle (FAD and FMN 22% of controls) and mitochondria (FAD 26%; FMN 16%) and normal activity of mitochondrial FAD pyrophosphatase. All of these biochemical parameters were either totally or partly corrected after riboflavin therapy.
acyl-carnitine profile; flavo-coenzyme; mitochondrial FAD pyrophosphatase; multiple acyl coenzyme A dehydrogenase deficiency; OXPHOS enzymes
CoA = coenzyme A; FAD = flavin adenine dinucleotide; FMN = flavin mononucleotide; OXPHOS = oxidative phosphorylation; MAD = multiple acyl coenzyme A dehydrogenase deficiency; MCAD = medium-chain acyl coenzyme A dehydrogenase; SCAD = short-chain acyl coenzyme A dehydrogenase
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