Role of dichloroacetate in the treatment of genetic mitochondrial diseases

Adv Drug Deliv Rev. Oct-Nov 2008;60(13-14):1478-87. doi: 10.1016/j.addr.2008.02.014. Epub 2008 Jul 4.

Abstract

Dichloroacetate (DCA) is an investigational drug for the treatment of genetic mitochondrial diseases. Its primary site of action is the pyruvate dehydrogenase (PDH) complex, which it stimulates by altering its phosphorylation state and stability. DCA is metabolized by and inhibits the bifunctional zeta-1 family isoform of glutathione transferase/maleylacetoacetate isomerase. Polymorphic variants of this enzyme differ in their kinetic properties toward DCA, thereby influencing its biotransformation and toxicity, both of which are also influenced by subject age. Results from open label studies and controlled clinical trials suggest chronic oral DCA is generally well-tolerated by young children and may be particularly effective in patients with PDH deficiency. Recent in vitro data indicate that a combined DCA and gene therapy approach may also hold promise for the treatment of this devastating condition.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Aging / metabolism
  • Child
  • Dichloroacetic Acid / adverse effects
  • Dichloroacetic Acid / pharmacology*
  • Dichloroacetic Acid / therapeutic use*
  • Glutathione Transferase / genetics
  • Glutathione Transferase / metabolism
  • Haplotypes
  • Humans
  • Isoenzymes / genetics
  • Isoenzymes / metabolism
  • Mitochondrial Diseases / drug therapy*
  • Mitochondrial Diseases / genetics*
  • Polymorphism, Single Nucleotide
  • Pyruvate Dehydrogenase Complex / metabolism
  • Pyruvate Dehydrogenase Complex Deficiency Disease / drug therapy
  • Pyruvate Dehydrogenase Complex Deficiency Disease / genetics
  • Randomized Controlled Trials as Topic
  • cis-trans-Isomerases / genetics
  • cis-trans-Isomerases / metabolism

Substances

  • Isoenzymes
  • Pyruvate Dehydrogenase Complex
  • Dichloroacetic Acid
  • Glutathione Transferase
  • cis-trans-Isomerases
  • maleylacetoacetate isomerase