Mecanismes fisiopatològics de lesió mitocondrial secundària: antiretrovirals, antibiòtics, antipsicòtics i monòxid de carboni.

[cat] La present tesi doctoral consta de 5 publicacions i un manuscrit en preparació que aprofundeixen en l'estudi dels mecanismes de lesió mitocondrial secundaris al contacte amb determinats agents tòxics pel mitocondri (mitotòxics) com el virus de la immunodeficiència humana (VIH), el tractament antiretroviral (TARV) administrat per tractar aquesta infecció, un antibiòtic anomenat linezolid, diferents tipus d'antipsicòtics i el monòxid de carboni (CO). Tots aquests estudis s'han realitzat sempre ex-vivo emprant mostres humanes.Molts agents mitotòxics poden induir una lesió mitocondrial similar a la característica de les malalties mitocondrials primàries (innates i genètiques) amb les que sovint comparteixen simptomatologia clínica. Si bé les mitocondriopaties primàries no són massa freqüents, gran part de la població està exposada a molts d'aquests agents mitotòxics, molts dels quals són fàrmacs habitualment emprats en la pràctica clínica.Els tres primers treballs tracten sobre la toxicitat mitocondrial del VIH i el TARV i pretenen establir mètodes menys invasius per determinar l'abast de la lesió mitocondrial i la reversibilitat de la mateixa. A través de l'estudi de la funció mitocondrial en teixit muscular, el primer dels treballs valida l'ús de cèl·lules mononuclears de sang perifèrica com a model d'estudi de la funció mitocondrial en pacients VIH-positius que sota TARV desenvolupen una crisis d'hiperlactatèmia. Per això la resta de treballs s'han realitzat en cèl·lules mononuclears. Aquest estudi també valida l'aplicació d'un test d'esforç aeròbic de l'avantbraç, inicialment dissenyat per detectar disfunció mitocondrial primària (genètica), en el seguiment i diagnòstic de la disfunció mitocondrial secundària (tòxica) d'aquest tipus de pacients. Mitjançant tots aquests tests es determina que la funció mitocondrial en aquests individus es recupera un cop superat l'episodi d'hiperlactatèmia.El segon dels treballs determina la reversibilitat de la lesió mitocondrial induïda per un TARV de contrastada potència mitotòxica com són els dideoxinucleòsids quan són substituïts per un tractament teòricament menys lesiu pel mitocondri consistent en saquinavir potenciat amb ritonavir, tenofovir i enfuvirtide. Transcorreguts 6 mesos el canvi de TARV només aconsegueix una recuperació mitocondrial parcial amb una millora de la funció però no de la genètica (contingut en ADN mitocondrial o ADNmt) d'aquest orgànul.El tercer dels treballs avalua com la reducció de la dosi d'un dels components del TARV pot reduir la toxicitat mitocondrial d'aquesta teràpia. Concretament es valora la reducció de dosi de didanosina de 400 a 250 mg/d quan s'administra conjuntament amb tenofovir i nevirapina. Un any de tractament a elevades dosis d'aquest fàrmac disminueix el contingut en ADNmt i la funció mitocondrial en aquests pacients i l'administració consecutiva durant un altre any de la dosi reduïda de l'antiretroviral només permet una recuperació mitocondrial parcial que possibilita que es restableixi el contingut en ADNmt però no la funció d'aquest orgànul.El quart dels treballs avalua la toxicitat mitocondrial de l'antibiòtic linezolid en pacients que desenvolupen hiperlactatèmia associada al tractament prolongat amb aquest fàrmac. Estableix que el linezolid inhibeix la síntesi de proteïnes mitocondrials amb la conseqüent disminució de l'activitat enzimàtica de la cadena respiratòria d'aquest orgànul, malgrat l'augment en la taxa de transcripció mitocondrial (probablement en un intent infructuós d'augmentar la síntesi proteica bloquejada pel linezolid), i que aquesta podria ser la etiologia de la hiperlactatèmia associada a l'administració d'aquest antibiòtic. Totes aquestes alteracions són reversibles en retirar el fàrmac.El cinquè dels treballs estudia la toxicitat mitocondrial dels antipsicòtics, caracteritzada per la inhibició de la funció de la cadena respiratòria mitocondrial a nivell del complex I, i en el cas de l'haloperidol, a més a més, per l'augment de l'estrès oxidatiu. La capacitat mitotòxica dels antipsicòtics és proporcional al grau de manifestacions adverses de tipus extrapiramidal associades per a cadascun dels fàrmacs considerats (haloperidol > risperidona > clozapina), i podria ser doncs part de la base fisiopatològica responsable de l'aparició dels efectes secundaris. El sisè dels treballs (l'únic que no està publicat) empra l'estudi de la funció mitocondrial per avaluar les diferents opcions terapèutiques disponibles per tractar la intoxicació aguda per CO. El CO inhibeix la funció del complex IV de la cadena respiratòria independentment de la gravetat de la intoxicació, sense que augmenti el nivell d'estrès oxidatiu. En els intoxicats la funció mitocondrial es recupera al llarg del temps, de manera independent al tractament d'oxigen aplicat. Per tant, la recuperació de la funció mitocondrial només requereix una sessió d'oxigen hiperbàric per als intoxicats greus i l'oxigen normobàric per als lleus. Caldrà cerciorar aquests resultats un cop finalitzada la inclusió de pacients.[eng] This thesis is composed by 5 articles and one manuscript on preparation which analyse the mechanisms of mitochondrial lesion induced by some mitochondrial toxic (mitotoxic) agents such as the human immunodeficiency virus (HIV), the antiretroviral treatment (ARVT) used to treat HIV infection, an antibiotic named linezolid, different antipsychotics and carbon monoxide (CO). All these studies have been performed on humans samples that have been analysed ex-vivo.Many mitotoxic agents induce mitochondrial lesion and clinical symptoms common to primary (hereditary or genetic) mitochondriopathies. Primary mitochondrial disorders are not much frequent on general population, but many people is exposed to mitotoxic agents, many of them, because are routinely drugs in clinical practice.The first three studies of the present thesis analyse mitochondrial toxicity of both HIV and ARVT to establish less invasive methods to study mitochondrial dysfunction and the reversibility of HIV and ARVT-induced mitochondrial damage. They have validated the use of peripheral blood mononuclear cells and the forearm aerobic effort test to study mitochondrial lesion in HIV-infected and ARV-treated patients. These studies have determined that mitochondrial lesion reverts after an hyperlactatemic episode and partially recovers after changing potent mitotoxic ARVT (dideoxynucleosides) by theoretically less mitotoxic drugs (saquinavir/ritonavir+tenofovir+enfuvirtide) or after reducing ARV doses (didanosine from 400 to 250 mg/d+tenofovir+nevirapine).The forth study analyses mitochondrial toxicity of linezolid in patients suffering from hyperlactatemia. It demonstrates that linezolid inhibits mitochondrial protein synthesis and respiratory chain function, albeit increased mitochondrial transcription rates (maybe as an homeostatic intent to upregulate linezolid inhibited translation), and that all these mitochondrial abnormalities revert with linezolid withdrawal.The fifth study analyses mitochondrial toxicity of antipsychotics, which inhibit mitochondrial complex I function, and in case of haloperidol, indeed, increases oxidative stress. Antipsychotic mitochondrial lesion is proportional to their capacity to induce extrapiramidal disorders (haloperidol > risperidona > clozapina). Maybe mitochondrial lesion could be partially responsible of clinical adverse manifestations.The sixth study (unique work not published) use mitochondrial function monitorisation to evaluate different therapeutic options to treat acute CO intoxication. CO binds to mitochondrial complex IV inhibiting its function, independent to intoxication severity, without increasing oxidative stress. In CO poisoning mitochondrial function is recovered along the time independent to oxygen treatment option. Thus, recover of mitochondrial function after CO intoxication only requires of one hyperbaric oxygen session for severe poisoned patients and normobaric oxygen for the moderate ones, although these results have to be validated with a bigger amount of patients

Editorial: Mitochondrial OXPHOS System: Emerging Concepts and Technologies and Role in Disease.

Mitochondria are eukaryotic organelles responsible for generating the main bulk of ATP, the cellular energy currency, via the process of oxidative phosphorylation (OXPHOS). The OXPHOS system is unique because it comprises subunits of dual genetic origin, encoded in the mitochondrial and the nuclear genomes. Therefore, to form the multimeric membrane-bound complexes responsible for this energy production process, proteins translated inside the organelle must be assembled in coordination with those expressed in the cytosol and imported into mitochondria by using a sophisticated import and translocation machiner

Nutrition, bioenergetics, and metabolic syndrome

According to the World Health Organization (WHO), the global nutrition report shows that whilst part of the world's population starves, the other part suffers from obesity and associated complications. A balanced diet counterparts these extreme conditions with the proper proportion, composition, quantity, and presence of macronutrients, micronutrients, and bioactive compounds. However, little is known on the way these components exert any influence on our health. These nutrients aiming to feed our bodies, our tissues, and our cells, first need to reach mitochondria, where they are decomposed into CO2 and H2O to obtain energy. Mitochondria are the powerhouse of the cell and mainly responsible for nutrients metabolism, but they are also the main source of oxidative stress and cell death by apoptosis. Unappropriated nutrients may support mitochondrial to become the Trojan horse in the cell. This review aims to provide an approach to the role that some nutrients exert on mitochondria as a major contributor to high prevalent Western conditions including metabolic syndrome (MetS), a constellation of pathologic conditions which promotes type II diabetes and cardiovascular risk. Clinical and experimental data extracted from in vitro animal and cell models further demonstrated in patients, support the idea that a balanced diet, in a healthy lifestyle context, promotes proper bioenergetic and mitochondrial function, becoming the best medicine to prevent the onset and progression of MetS. Any advance in the prevention and management of these prevalent complications help to face these challenging global health problems, by ameliorating the quality of life of patients and reducing the associated sociosanitary burden

The impact of mitochondrial deficiencies in neuromuscular diseases

Neuromuscular diseases (NMDs) are a heterogeneous group of acquired or inherited rare disorders caused by injury or dysfunction of the anterior horn cells of the spinal cord (lower motor neurons), peripheral nerves, neuromuscular junctions, or skeletal muscles leading tomuscle weakness and waste. Unfortunately, most of them entail serious or even fatal consequences. The prevalence rates among NMDs range between 1 and 10 per 100,000 population, but their rarity and diversity pose diffculties for healthcare and research. Some molecular hallmarks are being explored to elucidate the mechanisms triggering disease, to set the path for further advances. In fact, in the present review we outline the metabolic alterations of NMDs, mainly focusing on the role of mitochondria. The aim of the review is to discuss the mechanisms underlying energy production, oxidative stress generation, cell signaling, autophagy, and inflammation triggered or conditioned by the mitochondria. Briefly, increased levels of inflammation have been linked to reactive oxygen species (ROS) accumulation, which is key in mitochondrial genomic instability and mitochondrial respiratory chain (MRC) dysfunction. ROS burst, impaired autophagy, and increased inflammation are observed in many NMDs. Increasing knowledge of the etiology of NMDs will help to develop better diagnosis and treatments, eventually reducing the health and economic burden of NMDs for patients and healthcare systems

Bioenergetics and Autophagic imbalance in Patients-Derived Cell Models of Parkinson Disease Supports Systemic Dysfunction in Neurodegeneration

Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder worldwide affecting 2-3% of the population over 65 years. This prevalence is expected to rise as life expectancy increases and diagnostic and therapeutic protocols improve. PD encompasses a multitude of clinical, genetic, and molecular forms of the disease. Even though the mechanistic of the events leading to neurodegeneration remain largely unknown, some molecular hallmarks have been repeatedly reported in most patients and models of the disease. Neuroinflammation, protein misfolding, disrupted endoplasmic reticulum-mitochondria crosstalk, mitochondrial dysfunction and consequent bioenergetic failure, oxidative stress and autophagy deregulation, are amongst the most commonly described. Supporting these findings, numerous familial forms of PD are caused by mutations in genes that are crucial for mitochondrial and autophagy proper functioning. For instance, late and early onset PD associated to mutations in Leucine-rich repeat kinase 2 (LRRK2) and Parkin (PRKN) genes, responsible for the most frequent dominant and recessive inherited forms of PD, respectively, have emerged as promising examples of disease due to their established role in commanding bioenergetic and autophagic balance. Concomitantly, the development of animal and cell models to investigate the etiology of the disease, potential biomarkers and therapeutic approaches are being explored. One of the emerging approaches in this context is the use of patient's derived cells models, such as skin-derived fibroblasts that preserve the genetic background and some environmental cues of the patients. An increasing number of reports in these PD cell models postulate that deficient mitochondrial function and impaired autophagic flux may be determinant in PD accelerated nigral cell death in terms of limitation of cell energy supply and accumulation of obsolete and/or unfolded proteins or dysfunctional organelles. The reliance of neurons on mitochondrial oxidative metabolism and their post-mitotic nature, may explain their increased vulnerability to undergo degeneration upon mitochondrial challenges or autophagic insults. In this scenario, proper mitochondrial function and turnover through mitophagy, are gaining in strength as protective targets to prevent neurodegeneration, together with the use of patient-derived fibroblasts to further explore these events. These findings point out the presence of molecular damage beyond the central nervous system (CNS) and proffer patient-derived cell platforms to the clinical and scientific community, which enable the study of disease etiopathogenesis and therapeutic approaches focused on modifying the natural history of PD through, among others, the enhancement of mitochondrial function and autophagy

Relevance of sex-differenced analyses in bioenergetics and nutritional studies

Sex-biased analyses still remain as one of the biggest limitations to obtain universal conclusions. In biomedicine, the majority of experimental analyses and a significant amount of patient-derived cohort studies exclusively included males. In nutritional and molecular medicine, sex-influence is also frequently underrated, even considering maternal-inherited organelles such as mitochondria. We herein illustrate with in-house original data examples of how sex influences mitochondrial homeostasis, review these topics and highlight the consequences of biasing scientific analyses excluding females as differentiated entities from males

Comprehensive summary of mitochondrial DNA alterations in the postmortem human brain: A systematic review

Background: Mitochondrial DNA (mtDNA) encodes 37 genes necessary for synthesizing 13 essential subunits of the oxidative phosphorylation system. mtDNA alterations are known to cause mitochondrial disease (MitD), a clinically heterogeneous group of disorders that often present with neuropsychiatric symptoms. Understanding the nature and frequency of mtDNA alterations in health and disease could be a cornerstone in disentangling the relationship between biochemical findings and clinical symptoms of brain disorders. This systematic review aimed to summarize the mtDNA alterations in human brain tissue reported to date that have implications for further research on the pathophysiological significance of mtDNA alterations in brain functioning. Methods: We searched the PubMed and Embase databases using distinct terms related to postmortem human brain and mtDNA up to June 10, 2021. Reports were eligible if they were empirical studies analysing mtDNA in postmortem human brains. Findings: A total of 158 of 637 studies fulfilled the inclusion criteria and were clustered into the following groups: MitD (48 entries), neurological diseases (NeuD, 55 entries), psychiatric diseases (PsyD, 15 entries), a miscellaneous group with controls and other clinical diseases (5 entries), ageing (20 entries), and technical issues (5 entries). Ten entries were ascribed to more than one group. Pathogenic single nucleotide variants (pSNVs), both homo- or heteroplasmic variants, have been widely reported in MitD, with heteroplasmy levels varying among brain regions; however, pSNVs are rarer in NeuD, PsyD and ageing. A lower mtDNA copy number (CN) in disease was described in most, but not all, of the identified studies. mtDNA deletions were identified in individuals in the four clinical categories and ageing. Notably, brain samples showed significantly more mtDNA deletions and at higher heteroplasmy percentages than blood samples, and several of the deletions present in the brain were not detected in the blood. Finally, mtDNA heteroplasmy, mtDNA CN and the deletion levels varied depending on the brain region studied. Interpretation: mtDNA alterations are well known to affect human tissues, including the brain. In general, we found that studies of MitD, NeuD, PsyD, and ageing were highly variable in terms of the type of disease or ageing process investigated, number of screened individuals, studied brain regions and technology used. In NeuD and PsyD, no particular type of mtDNA alteration could be unequivocally assigned to any specific disease or diagnostic group. However, the presence of mtDNA deletions and mtDNA CN variation imply a role for mtDNA in NeuD and PsyD. Heteroplasmy levels and threshold effects, affected brain regions, and mitotic segregation patterns of mtDNA alterations may be involved in the complex inheritance of NeuD and PsyD and in the ageing process. Therefore, more information is needed regarding the type of mtDNA alteration, the affected brain regions, the heteroplasmy levels, and their relationship with clinical phenotypes and the ageing process. Funding: Hospital Universitari Institut Pere Mata; Institut d'Investigació Sanitària Pere Virgili; Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación (PI18/00514)

Mitochondrial toxicity in human pregnancy: an update on clinical and experimental approaches in the last 10 years

Mitochondrial toxicity can be one of the most dreadful consequences of exposure to a wide range of external agents including pathogens, therapeutic agents, abuse drugs, toxic gases and other harmful chemical substances. However, little is known about the effects of mitochondrial toxicity on pregnant women exposed to these agents that may exert transplacental activity and condition fetal remodeling. It has been hypothesized that mitochondrial toxicity may be involved in some adverse obstetric outcomes. In the present study, we investigated the association between exposure to mitochondrial toxic agents and pathologic conditions ranging from fertility defects, detrimental fetal development and impaired newborn health due to intra-uterine exposure. We have reviewed data from studies in human subjects to propose mechanisms of mitochondrial toxicity that could be associated with the symptoms present in both exposed pregnant and fetal patients. Since some therapeutic interventions or accidental exposure cannot be avoided, further research is needed to gain insight into the molecular pathways leading to mitochondrial toxicity during pregnancy. The ultimate objective of these studies should be to reduce the mitochondrial toxicity of these agents and establish biomarkers for gestational monitoring of harmful effects

Physiopathological bases of the disease caused by HACE1 mutations: alterations in autophagy, mitophagy and oxidative stress response

Recessive HACE1 mutations are associated with a severe neurodevelopmental disorder (OMIM: 616756). However, the physiopathologycal bases of the disease are yet to be completely clarified. Whole-exome sequencing identified homozygous HACE1 mutations (c.240C>A, p.Cys80Ter) in a patient with brain atrophy, psychomotor retardation and 3-methylglutaconic aciduria, a biomarker of mitochondrial dysfunction. To elucidate the pathomechanisms underlying HACE1 deficiency, a comprehensive molecular analysis was performed in patient fibroblasts. Western Blot demonstrated the deleterious effect of the mutation, as the complete absence of HACE1 protein was observed. Immunofluorescence studies showed an increased number of LC3 puncta together with the normal initiation of the autophagic cascade, indicating a reduction in the autophagic flux. Oxidative stress response was also impaired in HACE1 fibroblasts, as shown by the reduced NQO1 and Hmox1 mRNA levels observed in H2O2-treated cells. High levels of lipid peroxidation, consistent with accumulated oxidative damage, were also detected. Although the patient phenotype could resemble a mitochondrial defect, the analysis of the mitochondrial function showed no major abnormalities. However, an important increase in mitochondrial oxidative stress markers and a strong reduction in the mitophagic flux were observed, suggesting that the recycling of damaged mitochondria might be targeted in HACE1 cells. In summary, we demonstrate for the first time that the impairment of autophagy, mitophagy and oxidative damage response might be involved in the pathogenesis of HACE1 deficiency

Decreased myocardial Titin expression in chronic alcoholic cardiomyopathy

Aims: Cardiomyopathy (CMP) with a reduced ejection fraction develops in a dose-28 dependent manner in one- third of subjects with a long-term history of heavy daily alcohol consumption. Ethanol alters heart transduction signals including excitation- contraction sarcomeric coupling, causing diastolic and systolic left-ventricular (LV) dysfunction. Titin is a giant structural sarcomeric filament macro protein involved in contractile heart function and contributes to cardiac myocyte elastic recoil, a key factor for diastolic LV filling. We evaluated whether titin expression is affected by chronic high-dose ethanol 35 consumption in alcoholic CMP. Methods and Results: We analyzed a total of 30 heart samples from human organ 37 donors: 20 from high alcohol consumers (10 without CMP and 10 with CMP) and 10 healthy controls. Patient evaluation comprised daily and lifetime ethanol consumption, chest X ray, 2-D echocardiography and LV histology. CMP was assessed by functional 40 and histological criteria. Titin activity was evaluated by specific immunohistochemical 41 (IHC) and transcript expression (rtPCR) assays. Titin IHC expression was clearly present in sarcomere areas of myocytes. Compared to healthy donors (82.58±3.36), alcohol consumers showed a significantly lower cardiac titin expression (71.29±3.16; 13.67±3.83% decrease; p=0.04), being significantly lower in alcohol consumers with CMP (62.31±4.18; 24.54±5.06% decrease, p<0.0009), compared to both their counter-parts without CMP (80.27±2.62; 2.80±3.17% decrease 47 vs. controls; p<0.0030 vs. alcoholic CMP). Titin transcript levels confirmed similar patterns of expression