The assessment of detoxification metabolism in fatty acid oxidation deficiencies

Abstract

The concept of accumulating xenobiotics within the human body as a health risk is well known. However, these compounds can also be endogenous, as in the case of inborn errors of metabolism. Biotransformation of both exogenous and endogenous toxic compounds is an important function of the liver, and the critical balance between these systems is of fundamental importance for cellular health. Fatty acid β-oxidation deficiencies are associated with characteristic clinical symptoms as a consequence of the accumulation of specific metabolites. For these accumulated metabolites various nutrients are indispensable for optimal biotransformation and continuous accumulation of metabolites can ultimately result in the depletion of biotransformation substrates and cofactors. In this study, a novel model (the unbalanced biotransformation metabolism model) is proposed that describes the critical balance between Phase I and Phase II biotransformation and how a disturbance in this balance will increase the oxidative stress status. The significance of this model lies within the treatment possibilities, as the assessment of biotransformation metabolism and oxidative stress status can lead to the development of nutritional treatment strategies to correct imbalances. The value of this model is illustrated by its application to a clinical case investigated. In addition to the use of nutritional supplementation in treatment, biotransformation substrates and cofactors were also used to develop a "substrate loading cocktail". This cocktail ensured sufficient availability of biotransformation substrates and precursors to stimulate coenzyme A biosynthesis. The application of this "substrate loading cocktail" in subjects with both induced and inborn errors in fatty acid oxidation demonstrated that such a novel approach is a useful tool to give new insight into these kinds of deficiencies and open the possibility for the identification of new deficiencies. Interesting observations made in subjects originally referred for biotransformation and oxidative stress status profiles led to the first in vivo evidence of an inhibitory effect of acetylsalicylic acid on short-chain fatty acid metabolism possibly at the level of isobutyryl-CoA dehydrogenase. Since not all individuals were affected to the same degree, this observation can potentially be used to detect individuals with rate-limiting polymorphisms or mutations in the isobutyryl-CoA dehydrogenase enzyme.