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Pyruvate kinase type M2: a crossroad in the tumor metabolome.

Cell proliferation is a process that consumes large amounts of energy. A reduction in the nutrient supply can lead to cell death by ATP depletion, if cell proliferation is not limited. A key sensor for this regulation is the glycolytic enzyme pyruvate kinase, which determines whether glucose carbons are channelled to synthetic processes or used for glycolytic energy production. In unicellular organisms pyruvate kinase is regulated by ATP, ADP and AMP, by ribose 5-P, the precursor of the nucleic acid synthesis, and by the glycolytic intermediate fructose 1,6-P2 (FBP), thereby adapting cell proliferation to nutrient supply. The mammalian pyruvate kinase isoenzyme type M2 (M2-PK) displays the same kinetic properties as the pyruvate kinase enzyme from unicellular organisms. The mammalian M2-PK isoenzyme can switch between a less active dimeric form and a highly active tetrameric form which regulates the channeling of glucose carbons either to synthetic processes (dimeric form) or to glycolytic energy production (tetrameric form). Tumor cells are usually characterized by a high amount of the dimeric form leading to a strong accumulation of all glycolytic phosphometabolites above pyruvate kinase. The tetramer-dimer ratio is regulated by ATP, FBP and serine and by direct interactions with different oncoproteins (pp60v-src, HPV-16 E7). In solid tumors with sufficient oxygen supply pyruvate is supplied by glutaminolysis. Pyruvate produced in glycolysis and glutaminolysis is used for the synthesis of lactate, glutamate and fatty acids thereby releasing the hydrogen produced in the glycolytic glyceraldehyde 3-phosphate dehydrogenase reaction.

Animals↗

Paradoxical effects of pyruvate on cardiac contractile function under normal and high glucose in ventricular myocytes.

Impaired energy fuel supply and metabolism contribute to the cardiac contractile dysfunctions in diabetes. Pyruvate, a metabolic product of glycolysis and an oxidizable fuel in myocardium, has been demonstrated to enhance cardiac contractile function and alleviate hyperglycemic status. The present study was designed to examine the impact of pyruvate supplementation on cardiac mechanical function under normal glucose (NG) and high glucose (HG) conditions. Isolated adult rat ventricular myocytes were maintained in NG (5.5mM) or HG (25.5mM) medium for 24h in the absence or presence of pyruvate (5mM). Contractile indices were measured with an IonOptix edge-detection system including peak shortening (PS), maximal velocity of shortening/relengthening (+/-dL/dt), time-to-PS (TPS), time-to-90% relengthening (TR(90)), area underneath shortening (A(con)) and relengthening (A(relax)). Myocytes maintained in HG medium displayed abnormal mechanical function simulating in vivo diabetes. These abnormalities included reduced PS, +/-dL/dt, prolonged TPS/TR(90) associated with enhanced A(con) and A(relax) compared to NG myocytes. Interestingly, these HG-induced mechanical dysfunctions were completely abolished by co-incubation of pyruvate. However, NG myocytes developed mechanical defects reminiscent of those of HG following co-incubation with pyruvate. These data suggest that pyruvate may paradoxical affect cardiac mechanical function under different glucose settings and therefore warrant caution when applying pyruvate therapeutically.

Analysis of Variance↗

[Coenzyme-binding sites of the brain pyruvate dehydrogenase complex].

It is shown that the relative amount of the holoenzyme in the highly purified pyruvate dehydrogenase complex from the bovine brain is higher when the enzyme activity is assayed in the reaction of nonoxidative formation of acetaldehyde as compared to the pyruvate: NAD+ reductase reaction. The S0.5 values for thiamine pyrophosphate are as following: (TPP) (0.314 +/- 0.22) x 10(-7) M with reaction of nonoxidative formation of acetaldehyde, (0.188 +/- 0.08) x 10(-6) M and (1.65 +/- 1.16) x 10(-6) M in case of the pyruvate: NAD+ reductase reaction. TPP in the concentration of (0.5-6.0) x 10(-7) M completely protects the sites of nonoxidative formation of acetaldehyde from modification by the coenzyme analogs, 4'-oxythiamine pyrophosphate and tetrahydrothiamine pyrophosphate. However, the pyruvate: NAD+ reductase activity of the pyruvate dehydrogenase complex is inhibited in this case by 30-34%. The data obtained suggest that in contrast to the pyruvate: NAD+ reductase reaction the conversion of pyruvate to acetaldehyde occurs by the sites which tightly bound TPP.

Animals↗

Cell cycle-associated expression of M2-type isozyme of pyruvate kinase in proliferating rat thymocytes.

During a complete cell cycle of rat thymocytes stimulated by concanavalin A and interleukin 2, the activity and mRNA level of pyruvate kinase reached a maximum (8-12-fold increase) 48 h after stimulation coinciding with the S-phase of the cell cycle. Increases of cellular enzyme activity, pyruvate kinase protein, and mRNA levels are correlated up to 48 h of culture. Afterwards pyruvate kinase activity and mRNA levels decrease, whereas the pyruvate kinase protein continues to increase throughout mitosis. This change of specific pyruvate kinase activity points to a posttranslational modification of the enzyme besides its transcriptional regulation. The presence of the M2-type isozyme was determined by the following methods: (a) native cellulose acetate electrophoresis and activity staining, (b) Northern blot hybridization with M1- and M2-specific cDNA probes, and (c) determination of kinetic parameters. The isozyme pattern did not change during the cell cycle progression. The induction of pyruvate kinase is completely abolished by 2-difluoromethylornithine-mediated polyamine depletion. However, the proportion of hybridizable pyruvate kinase mRNA was not affected. These data suggest the requirement of polyamines for efficient translation rather than transcription during cell growth.

Animals↗

Isozymes of pyruvate kinase from human brain, meningiomas, and malignant gliomas.

Pyruvate kinase isozymes were studied in normal brain tissue (both fetal and adult) and in meningiomas and malignant gliomas. In fetal brain five different forms could be detected by electrophoresis (K4, K3M, K2M2, KM3, and M4). In adult brain the M4-type, K3M hybrid, and K4-type are present; the M isozyme is largely predominant. Alanine inhibition of pyruvate kinase is in agreement with the electrophoretic pattern. Pyruvate kinase from fetal brain and brain of a newborn is more inhibited compared with pyruvate kinase from adult brain. The Lineweaver-Burk plots for pyruvate kinase from fetal brain and brain of the newborn are nonlinear due to the presence of hybrids. Pyruvate kinase from meningiomas and malignant gliomas is strongly inhibited by alanine. Electrophoresis proved the presence of mainly K4 type and the hybrid K3M, which is in agreement with the alanine inhibition. Determination of the Km's for phosphoenolpyruvate supports this conclusion. The determination of the alanine inhibition of pyruvate kinase may be a diagnostic tool in surgery for gliomas.

Alanine↗

Phosphorylation of L-type pyruvate kinase by a Ca2+/calmodulin-dependent protein kinase.

Rat liver L-type pyruvate kinase was phosphorylated in vitro by a Ca2+/calmodulin-dependent protein kinase purified from rabbit liver. The calmodulin (CaM)-dependent kinase catalyzed incorporation of up to 1.7 mol of 32P/mol of pyruvate kinase subunit; maximum phosphorylation was associated with a 3.0-fold increase in the K0.5 for P-enolpyruvate. This compares to incorporation of 0.7 to 1.0 mol of 32P/mol catalyzed by the cAMP-dependent protein kinase with a 2-fold increase in K0.5 for P-enolpyruvate. When [32P]pyruvate kinase, phosphorylated by the CaM-dependent protein kinase, was subsequently incubated with 5 mM ADP and cAMP-dependent protein kinase (kinase reversal conditions), 50-60% of the 32PO4 was removed from pyruvate kinase, but the K0.5 for P-enolpyruvate decreased only 20-30%. Identification of 32P-amino acids after partial acid hydrolysis showed that the CaM-dependent protein kinase phosphorylated both threonyl and seryl residues (ratio of 1:2, respectively) whereas the cAMP-dependent protein kinase phosphorylated only seryl groups. The two phosphorylation sites were present in the same 3-4-kDa CNBr fragment located near the amino terminus of the enzyme subunit. These results indicate that the CaM-dependent protein kinase catalyzed phosphorylation of L-type pyruvate kinase at two discrete sites. One site is apparently the same serine which is phosphorylated by the cAMP-dependent protein kinase. The second site is a unique threonine residue whose phosphorylation also inactivates pyruvate kinase by elevating the K0.5 for P-enolpyruvate. These results may account for the Ca2+-dependent phosphorylation of pyruvate kinase observed in isolated hepatocytes.

Adenosine Diphosphate↗

Free radical intermediates in the reaction of pyruvate:ferredoxin oxidoreductase in Tritrichomonas foetus hydrogenosomes.

Aerobic incubations of the Tritrichomonas foetus hydrogenosomal fraction containing pyruvate, CoA, and the spin trap 5,5-dimethyl-1-pyrroline N-oxide (DMPO) gave spectra of two radical adducts. One was a carbon-centered radical adduct of DMPO. This radical was centered at C-3 of pyruvate as determined in experiments using [13C]pyruvate. The other radical detected was identified as the CoA radical adduct of DMPO by comparison with an adduct obtained by incubating CoA with DMPO, H2O2 and horseradish peroxidase. Deletion of CoA led to an increased stability of the carbon-centered radical adduct of DMPO, disappearance of the thiyl radical adduct of DMPO, and appearance of a hydroxyl radical adduct of DMPO. Superoxide dismutase suppressed the appearance of the DMPO-hydroxyl radical adduct but did not have any inhibitory effect on the appearance of the other adducts. Catalase had no significant effect on any of the adducts. Addition of pyruvate to these hydrogenosomal preparations stimulated oxygen consumption. Addition of CoA led to a further increase in the rate of O2 uptake but had no effect in the absence of pyruvate. The formation of two substrate free radicals as intermediates in the generation of acetyl-CoA represents a novel mechanism for this enzymatic reaction and indicates that the pyruvate:ferredoxin oxidoreductase from T. foetus differs significantly from the pyridine nucleotide-dependent pyruvate dehydrogenase complex of other eukaryotic cells in its catalytic mechanism.

Electron Spin Resonance Spectroscopy↗

[Positron emission tomography using pyruvate-1-11C on mitochondrial encephalomyopathy].

In order to investigate in vivo metabolism of pyruvate in the brain, positron emission tomography (PET) using pyruvate-1-11C were performed on two patients with mitochondrial encephalomyopathy, one patient with Leigh disease and one patient with epilepsy. PET images of epilepsy showed less RI uptakes in brain tissues than in skull muscles. And RI was cleared rapidly from the brain tissues. But PET images of mitochondrial encephalomyopathies showed increased RI uptakes and slow RI clearance in cerebral cortices, basal ganglia and thalamus. Also RI was cleared slowly or accumulated in ventricles. This suggested that pyruvate metabolism may be impaired with metabolical trapping of 11C by lactic acids, since it is said that 11C of pyruvate-1-11C is cleared rapidly from the normal brain tissues by decarboxylation of pyruvate. The usefulness of PET studies with pyruvate-1-11C are suggested for investigating pyruvate metabolism in brain tissues, and for diagnosing mitochondrial encephalomyopathy.

Brain↗

Effect of propionate on pyruvate metabolism in adipose tissue.

Glyceride-glycerol formation in rat adipose tissue from pyruvate-2-(14)C is increased by fasting, while fatty acid synthesis is markedly depressed. In tissues of fasted animals glyceride-glycerol formation is maximal with concentrations of pyruvate exceeding 2.5 mM. With 0.25 mM pyruvate-2-(14)C, glyceride-glycerol formation is increased severalfold by the addition of 0.25 mM propionate. No further increase in synthesis is caused by propionate when pyruvate is supplied in optimal amounts. Addition of equimolar concentrations of acetate or pyruvate does not replace propionate. The effect of propionate on glyceride-glycerol synthesis from pyruvate is also given by a series of even-chain fatty acids. However, only propionate promotes fatty acid synthesis in tissues of fasted and fed animals. Fixation of (14)CO(2) in glyceride-glycerol is dependent on the presence of propionate and is maximal in tissues of fasted rats and when pyruvate is also added. Succinate has no significant effect. Actinomycin treatment blocks glyceride-glycerol synthesis in tissues of fed and fasted animals, in the presence and absence of propionate. At the same time, fatty acid synthesis in tissues of fasted rats is markedly increased.

Adipose Tissue↗

Pyruvate kinase activity in isolated rat hepatocytes during a feeding cycle and during fasting.

The short-term regulation of pyruvate kinase in rat hepatocytes was studied during a feeding cycle or progressive fasting. In fed and fasted rats, the activity ratio of pyruvate kinase (V0.5-mMPEP/Vmax) in crude extracts was directly correlated with the concentration of glucose 1,6-bisphosphate++ in hepatocytes. Precipitation of the enzyme from homogenates with ammonium sulphate, which removes fructose 1,6-bisphosphate, induced in both groups of animals a low activity ratio of pyruvate kinase which remained unchanged during the whole experiment. These results show that in absence of added glucagon in hepatocytes, the activity of pyruvate kinase is mainly controlled by the intracellular level of fructose 1,6-bisphosphate. Addition of glucagon to hepatocytes from fed or fasted rats inactivated pyruvate kinase and decreased the concentration of fructose 1,6-bisphosphate in cells. However, in crude extracts both the activity ratio of pyruvate kinase and fructose 1,6-biphosphate levels were higher in fed rats than in starved rats. These findings suggest that glucagon-induced inactivation of pyruvate kinase also depends upon the concentration of fructose 1,6-biphosphate in hepatocytes.

Animals↗

Gluconeogenesis and phosphate reabsorption in isolated lactate- or pyruvate-perfused rat kidneys.

Recent experiments suggest that cytoplasmic free NAD inhibits renal phosphate reabsorption and that gluconeogenesis, by increasing NAD concentration, inhibits phosphate reabsorption. To examine these relationships further we measured phosphate reabsorption by isolated kidneys perfused with either lactate or pyruvate. Lactate perfusion increased the ratio of the cytoplasmic redox couple (glycerol-3-phosphate/dihydroxyacetone phosphate) in snap-frozen kidneys 3-fold relative to the ratio with pyruvate perfusion (p less than 0.001). Inulin clearance and fractional phosphate reabsorption were lower with lactate than with pyruvate perfusion. Phosphate reabsorption decreased throughout the lactate perfusion but was constant for 1 h of pyruvate perfusion. Basal and norepinephrine (NE)-stimulated gluconeogenesis were lower with lactate than with pyruvate perfusion. With lactate and pyruvate perfusions, NE induced equal increases in fractional sodium reabsorption, although only with pyruvate perfusion was there increased phosphate reabsorption. In these experiments, oxidative phosphorylation, not cytoplasmic free NAD concentrations, influenced phosphate reabsorption, and NE-stimulated gluconeogenesis was associated with increased phosphate reabsorption.

Absorption↗

Dietary control of aldolase B and L-type pyruvate kinase mRNAs in rat. Study of translational activity and hybridization with cloned cDNA probes.

Liver L-type pyruvate kinase and aldolase B mRNAs are the two species whose translational activity increases the most after feeding starved rats a high carbohydrate diet (Simon, M. P., Besmond, C., Cottreau, D., Weber, A., Chaumet-Riffaud, P., Dreyfus, J. C., Sala Trépat, J., Marie, J., and Kahn, A. (1984) J. Biol. Chem., in press). We therefore compared the pattern of this induction in three tissues synthesizing these enzymes, e.g. the liver, small intestine, and kidney. Influence of high lipid and protein diets on liver L-type pyruvate kinase and aldolase B mRNAs was also investigated. In the starved rat livers, L-type pyruvate kinase mRNA was practically undetectable. Carbohydrate diet induced an increase of both mRNA concentrations, with a maximum at the 12-18th h; at this time, mRNA concentration was increased about 4-8 times for aldolase B and 40-100 times for L-type pyruvate kinase, translational activities representing about 1% of the total mRNA activity for both enzymes. After the 24th h of carbohydrate diet, mRNA concentrations decreased slightly, then remained in plateau. In animals refed the high carbohydrate diet, starvation as well as high lipid and protein diets provoked a rapid decrease of both mRNA concentrations and translational activities. In the kidney, aldolase B mRNA synthesis was high in starved rats and was only slightly stimulated by carbohydrates (1.5-2.5 times). L-type pyruvate kinase mRNA concentration was increased 6-15-fold after feeding a high carbohydrate diet. In the small intestine, in contrast, the extent of aldolase B mRNA induction by a carbohydrate diet was similar to that in the liver, while L-type pyruvate kinase mRNA concentration was practically similar in starved and refed rats (about 1:10 of the concentration observed in refed rat liver). These results seem to indicate that the mechanisms responsible for carbohydrate induction of L-type pyruvate kinase and aldolase B are different. In addition, dietary control of each enzyme is also different in the various tissues which synthesize them.

Animals↗

Molecular cloning of cDNA for rat L-type pyruvate kinase and aldolase B.

Two double-stranded cDNA recombinant pBR322 plasmid libraries were constructed starting from high carbohydrate diet rat liver poly(A)+ mRNA, either fractionated by denaturing sucrose gradient centrifugation for the cloning of L-type pyruvate kinase cDNA, or nonfractionated for aldolase B. Both libraries were screened with single-stranded cDNA probes reverse transcribed from fasted or high carbohydrate diet rat liver mRNAs. mRNAs from fasted animals were also fractionated by sucrose gradient centrifugation and mRNAs from the fed animals were, in addition, further purified by high performance liquid gel filtration chromatography. Those clones hybridizing with the "positive" probe (from animals fed the high carbohydrate diet) and not with the "negative" one (from fasted animals) were preselected and their plasmid DNA was purified and analyzed by positive hybridization-selection. Thirty of 4500 bacteria colonies transformed by recombinant plasmids were preselected by differential screening for pyruvate kinase, and 8 of 864 colonies for aldolase B. Twenty-two recombinant plasmids for pyruvate kinase and two for aldolase B were shown to contain specific cDNA inserts by positive hybridization-selection. Plasmids DNAs of some pyruvate kinase and aldolase B clones (whose inserts ranged from 700 to 1050 bases in length) were labeled by nick translation and used as probes for Northern blot hybridization. The pyruvate kinase cDNA probes recognized mainly a 3400-base RNA species which was detected in high carbohydrate diet rat liver, but not in fasted rat liver and in tissues which do not synthesize L-type pyruvate kinase. In addition, some pyruvate kinase probes hybridized with minor RNA species of about 2000 bases in length, only observed after carbohydrate diet. For aldolase B, the recombinant plasmid DNA hybridized with a single RNA species of 1750 bases. This RNA, detected in kidney, small intestine and liver, was induced by a high carbohydrate diet and increased with liver development. The rat probe cross-hybridized with human aldolase B messenger RNA.

Animals↗

[Effect of calcium and other cations on pyruvate transport in rat liver mitochondria].

The effect of Ca2+ and other cations on the initial rate of pyruvate translocation by rat liver mitochondria has been studied. It has been found that added Ca2+ strongly stimulates the rate of pyruvate uptake by non-respiring mitochondria. Mn2+ and to lesser extent Sr2+ could replace Ca2+ whilst Mg2+ has only little effect. The stimulation of pyruvate uptake by Ca2+ is completely abolished by alpha-cyanocinnamate a specific inhibitor of pyruvate translocation but not by lanthanide which inhibits Ca2+ uptake. Direct measurements of the transmembrane delta pH in mitochondria show no appreciable changes following the addition of Ca2+, this excluding the possibility that the Ca2+ dependent stimulation of pyruvate uptake might be due to an increase of transmembrane delta pH. It is therefore conceivable that the effect of Ca2+ can be ascribed to an interaction of this cation with the translocator on the external of the mitochondrial membrane. Although the data obtained do not warrant postulation of the nature of the calcium induced stimulation of mitochondrial pyruvate transport it is likely that this effect may be of a great importance in the regulation of pyruvate transport and metabolism in mitochondria.

Animals↗

A re-examination of the electron microscopic appearance of pyruvate carboxylase from chicken liver.

Electron microscopic studies of chicken liver pyruvate carboxylase conducted under a variety of conditions show that this enzyme has an overall rhombic appearance and is comprised of four nonspherical subunits. The square planar tetramers originally identified by Valentine et al. (Valentine, R.C., Wrigley, N.G., Scrutton, M.C., Irias, J.J., and Utter, M.F. (1966) Biochemistry 5, 3111-3116) as pyruvate carboxylase have been shown to represent a minor protein contaminant found in many impure preparations of this enzyme. The contaminating protein has been separated from pyruvate carboxylase and further purified. It does not contain biotin and its constituent polypeptides are smaller than those of pyruvate carboxylase. This protein, whose function is not yet identified, shows a strong tendency to aggregate and is highly visible under many conditions of electron microscopy. Several lines of evidence support the thesis that the nonsquare tetramers are pyruvate carboxylase. When essentially homogeneous material is examined with a variety of different negative stains, numbers of intact molecules represent 20 to 70% of the visible protein. These tetramers, like pyruvate carboxylase, are very cold-labile and are protected from dissociation under these conditions by acetyl-CoA, a specific activator of this enzyme. Also, the structures form complexes with avidin and antibiotin antibody and thus, like pyruvate carboxylase, contain biotin.

Animals↗

Comparison of pyruvate kinase variants from rat liver and Morris hepatoma 7777, obtained by an affinity chromatography on blue sepharose CL-6B.

Fractions A (salted out by ammonium sulphate between 21-30% saturation), and fractions B (salted out between 51-70% saturation) of pyruvate kinase (EC 2.7.1.40.) corresponding respectively to pyruvate kinase types L and M2 from rat liver and Morris hepatoma 7777 were purified by an affinity chromatography on Blue Sepharose CL-6B. Peaks of inactive proteins were eliminated and the enzyme fractions bound biospecifically to the gels were eluted by free ADP. The molecular mass of purified hepatoma pyruvate kinase fraction B was smaller than that of liver pyruvate kinase fraction B. Morris hepatoma pyruvate kinase fraction B represented a variant of type M2, characterised by greatest affinity to 2-phosphoenolpyruvate as a main substrate and different sensitivity to low-molecular effectors in comparison with types L from both liver and hepatoma and in comparison with type M2 from normal rat liver. Only this hepatoma fraction B showed a tumour specific sensitivity to L-cysteine and was insensitive to normal signal molecules i.e. to ATP and fructose-1,6-diphosphate which influence liver pyruvate kinase activity. L-Cysteine inhibited the tumour fraction B of pyruvate kinase by decreasing its Vmax and increasing the Km values in relation to 2-phosphoenolpyruvate.

Animals↗

Primary structure of pyruvate dehydrogenase kinase establishes a new family of eukaryotic protein kinases.

We recently reported molecular cloning of the branched chain alpha-ketoacid dehydrogenase kinase, the first mitochondrial protein kinase to be cloned (Popov, K. M., Zhao, Y., Shimomura, Y., Kuntz, M. J., and Harris, R. A. (1992) J. Biol. Chem. 267, 13127-13130). From a search for proteins related to the branched chain alpha-ketoacid dehydrogenase kinase, a cDNA encoding the 434 amino acid residues corresponding to pyruvate dehydrogenase kinase has been cloned from a rat heart cDNA library. Evidence that the clone codes for pyruvate dehydrogenase kinase includes: (a) the deduced amino acid sequence is identical to the partial sequence of the kinase determined by direct sequencing; (b) expression of the cDNA in Escherichia coli resulted in synthesis of a protein that phosphorylated and inactivated the pyruvate dehydrogenase complex; (c) kinase activity of the recombinant protein is sensitive to inhibition by a specific inhibitor of pyruvate dehydrogenase kinase; and (d) antiserum raised against the recombinant protein recognized the protein subunit known to correspond to pyruvate dehydrogenase kinase in a highly purified preparation of the pyruvate dehydrogenase complex. Like the branched chain alpha-ketoacid dehydrogenase kinase, pyruvate dehydrogenase kinase lacks motifs usually associated with eukaryotic Ser/Thr-protein kinases. Considerable sequence similarity exists between these mitochondrial protein kinases and members of the prokaryotic histidine kinase family, a diverse set of sensing and response systems important in the regulation of bacterial processes. Thus, molecular cloning of these proteins establishes a new eukaryotic family of protein kinases that is related to a prokaryotic family of protein kinases.

Amino Acid Sequence↗

A family with pyruvate dehydrogenase complex deficiency due to a novel C>T substitution at nucleotide position 407 in exon 4 of the X-linked Epsilon1alpha gene.

UNLABELLED: The pyruvate dehydrogenase complex (PDHc; McKusick 312170), localised in the mitochondrial matrix, is a multienzyme complex which converts pyruvate to acetyl-CoA. A deficiency of PDHc leads to inadequate removal of pyruvate and lactate resulting in lactic acidaemia and insufficient energy production. The major cause of PDHc deficiency is a defect in the E1alpha component. The gene of this component is localised to Xp22.1. We describe two brothers with a relatively mild clinical phenotype of PDHc deficiency. Onset of disease was associated with muscle weakness and swallowing difficulties in both. At follow-up, the older brother developed encephalopathic features consistent with Leigh syndrome. Lactate to pyruvate ratios were low, consistent with a PDHc deficiency which was confirmed by measurements of PDHc activity in thrombocytes. A 407C>T change in exon 4 of the E1alpha gene was found in both brothers and their mother. This substitution predicts a replacement of a conserved alanine at position 136 by valine. CONCLUSION: Due to the X-linked inheritance pattern combined with the overall results of clinical investigations, molecular genetic findings and a corresponding functional deficiency of the gene product we believe that this substitution in the pyruvate dehydrogenase E1alpha gene is a mutation leading to pyruvate dehydrogenase complex deficiency in this family.

Amino Acid Substitution↗