MITOCHONDRIAL CREATINE KINASE Some Clinical, Biochemical and Morphological Aspects
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PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/114105 Please be advised that this information was generated on 2021-10-11 and may be subject to change. MITOCHONDRIAL CREATINE KINASE some clinical, biochemical and morphological aspects Jan A.M. Smeitink MITOCHONDRIAL CREATINE KINASE some clinical, biochemical and morphological aspects Jan A.M. Smeitink MITOCHONDRIAL CREATINE KINASE SOME CLINICAL, BIOCHEMICAL AND MORPHOLOGICAL ASPECTS EEN WETENSCHAPPELIJKE PROEVE OP HET GEBIED VAN DE MEDISCHE WETENSCHAPPEN, IN HET BIJZONDER DE GENEESKUNDE PROEFSCHRIFT TER VERKRIJGING VAN DE GRAAD VAN DOCTOR AAN DE KATHOLIEKE UNIVERSITEIT NIJMEGEN VOLGENS BESLUIT VAN HET COLLEGE VAN DECANEN IN HET OPENBAAR TE VERDEDIGEN OP DINSDAG 6 OKTOBER 1992, DES NAMIDDAGS TE 1.30 UUR PRECIES DOOR JOHANNES ALBERTUS MARIA SMEITINK GEBOREN OP 21 JUNI 1956 TE ARNHEM IV Promotores : Prof. Dr. R.C.A. Sengers Prof. Dr. J.M.F. Trijbels Co-Promotores : Dr. W. Ruitenbeek Dr. R.A. Wevers Aan mijn ouders AanWillemien en Mark CONTEN CHAPTER 1 Introduction and aim of the study CHAPTER 2 Mitochondrial creatine kinase: a key enzyme of aerobic energy metabolism Biochimica et Biophysica Acta (Reviews on Bioenergetics): in press I. Introduction II. Biochemical studies of Mi-CK ΠΙ. Functional studies of Mi-CK IV. Integration of Mi-CK in cellular energy metabolism V. Perspectives CHAPTER 3 A method for quantitative measurement of mitochondrial creatine kinase in human skeletal muscle Annals of Clinical Biochemistry Ì99229:196-201 CHAPTER 4 Maturation of mitochondrial and other isoenzymes of creatine kinase in skeletal muscle of preterm bom infants Annals of Clinical Biochemistry 199229:302-306 CHAPTER 5 Mitochondrial creatine kinase activity in patients with 123 a disturbed energy generation in muscle mitochondria Journal of Inherited Metabolic Disease: accepted CHAPTER 6 Mitochondrial creatine kinase containing crystals, 133 creatine content and mitochondrial creatine kinase activity in chronic progressive external ophthalmoplegia Neuromuscular Disorders: in press CHAPTER 7 Considerations and perspectives 143 Summary 150 Samenvatting 152 Woorden van dank 155 Curriculum vitae 159 List of publications 161 This study was performed at the Department of Pediatrics of the University of Nijmegen, The Netherlands. It is part of the research program "Disorders of the neuromuscular system". Publication of this thesis was financially supported by: Ethifarma, Milupa, Fonds Bevordering Wetenschapsbeoefening Afdeling Kindergeneeskunde (Academisch Ziekenhuis, Nijmegen) en Stichting ter bevordering van Onderwijs en Speurwerk ten behoeve van de Kindergeneeskunde (Wilhelmina Kinderziekenhuis, Utrecht). CIP-DATA KONINKLIJKE BIBLIOTHEEK, DEN HAAG Smeitink, Jan A.M. Mitochondrial creatine kinase : some clinical, biochemical and morphological aspects / Jan A.M. Smeitink. - [S.l. : s.n.] (Wijk bij Duurstede : Addix). - 111. Thesis Nijmegen. - With ref. - With summary in Dutch. ISBN 90-9005239-9 Subject headings: mitochondria/myopathy No part of this book may be reproduced in any form or by any means without permission from the author. Introduction and aim of the study Chapter 1 2 CHAPTER 1 Introduction 3 Introduction and aim of the study Mitochondrial creatine kinase (Mi-CK; EC 2.7.3.2) is localized at the outer surface of the inner mitochondrial membrane. The enzyme catalyzes the transfer of they-phosphate group of adenosine triphosphate (ATP) to creatine (Cr), thereby producing phosphocreatine (PCr) plus adenosine diphosphate (ADP). Mi-CK plays an essential role in the shuttling of high-energy phos phates produced by the intramitochondrially situated energy-generating system in organs with a high and fluctuating energy demand like skeletal muscle, heart and brain. A reduction in the activity of Mi-CK may cause severe problems with respect to energy-consuming processes. Saks and co-workers showed that inhibition of Mi-CK by a specific antibody resulted in a decreased total ATP production by mitoplasts [1 ]. The physiological role of the enzyme has hardly been investigated in human pathology. It may be assumed that a deficiency of Mi-CK leads to a high intra mitochondrial ATP/ADP ratio and a decreased amount of PCr (Figure 1). The ATP/ADP ratio has its influence on several metabolic steps. In the first place, the activity of the pyruvate dehydrogenase complex (PDHc) is inacti vated by a high ATP/ADP ratio mediated by a phosphorylation of the El subunit of PDHc [2]. Furthermore, in the presence of a physiological, intact coupling state of the oxidative phosphorylation, an increased ATP/ADP ratio causes inhibition of the electron flow through the respiratory chain. The resulting increase of the NADH/NAD+ ratio also produces a feedback inhibition of the PDHc, leading to accumulation of pyruvate and lactate. As a result of the increased intrami tochondrial NADH /N AD+ ratio the cy tosolic NADH/NAD+ ratio is shifted likewise through the action of the malate- aspartate shuttle. The final result is an increased lactate/pyruvate (L/P) ratio in body fluids. Both lactic acidosis and an increased L/P ratio is frequently found in body fluids of patients with mitochondrial myopathy. A mitochondrial myopathy can be defined as a muscle disease characterized by structurally or numerically abnormal mitochondria and / or abnormal functioning of mitochondria. Such a disease may be expected in patients with muscle weakness and exercise intolerance. In most of the laboratories involved in the diagnosis of mitochondrial disorders the follow ing biochemical measurements are performed in skeletal muscle biopsies of such patients: substrate oxidation rates, ATP production rates and activities of PDHc and respiratory chain complexes [e.g. 3]. However, despite these intensive studies, no specific enzyme deficiency could be detected in approximately 30% of the muscle samples with a disturbed pyruvate and 4 CHAPTER 1 malate oxidation rate. Therefore, extension of the diagnostic program includ ing determination of Mi-CK activity is warranted. The aim of this study was to develop a method to measure Mi-CK activity in human skeletal muscle and to study its applicability with respect to mitochondrial myopathies. Outline of the study In this study the results of investigations of Mi-CK activity in human skeletal muscle are described. A critical study of the literature concerning Mi-CK is presented in Chapter 2. The first objective of this study was to develop a method to determine Mi-CK activity in a small amount of human skeletal muscle and to collect reference values for Mi-CK activity. Method and reference values are presented in Chapter 3. From scarce literature data and the experience from oui group it appears that the activity of enzymes involved in the energy metabolism of muscle mitochondria inaeases with age during development and reaches adult levels approximately a few months post partum [4,5]. Knowledge about the existence of age-dependency is important to the interpretation of the biochemical studies performed in the very young age group with the suspicion of a mitochondrial disorder. Chapter 4 contains data concerning the development of Mi-CK and other CK isoenzymes in preterm born infants. Reference values for this specific age group are given. Sub sequently Mi-CK activity in patients with a disturbed pyruvate and malate oxidation rate, in which no specific defect of the pyruvate dehydrogenase complex and the respiratory chain could be established, was studied. Results of this investigation are presented in Chapter 5. A striking structural ab normality regularly observed in the intermembrane space of mitochondria of patients suffering from mitochondrial myopathies is the occurrence of crystals. Recently it was shown that these crystals contain Mi-CK protein [6,7]. We studied the relationship between Mi-CK containing crystals and the muscle aeatine content. This is presented in Chapter 6. Finally, considera tions about the work performed in this study and recommendations for future investigation are given in Chapter 7. Introduction 5 Glucose . LDH \ Cr^/^ PCr | Lactate f -^ *- Pyruvate · j j Cytosol Fig. 1. Hypothetical biochemical consequences of a Mi-CK deficiency. LDH = Lactate dehydrogenase; PDHc = Pyruvate dehydrogenase complex; OM = Outer mitochondrial membrane; IM = Inner mitochondrial membrane. = porm = adenine nucleotide translocator = pyruvate translocator = long chain fatty acids are, in contrast to medium and short chain fatty acids, transported via a carnitine dependent transport system = respiratory chain •• F^-ATPase 6 CHAPTER 1 References 4. Smeitink JAM, Sengers RCA, Trijbele JMF, et al. Fatal neonatal cardiomyopathy 1. Kuznetsov AV, Khuchua ZA, Saks VA. associated with cataract and mitochondrial Mitochondrial synthesis of phosphocrcatine myopathy. Eur J Pediatr 1989;148:656-659 . under physiological conditions. In: Creatine 5. Speri W, Sengers RCA, Trijbels JMF, et al. phosphate. Biochemistry.pharmacologyand Enzymeactivitiesofthemitochondrial energy clinical efficiency (Saks VA, Bobkov YG, generating system in skeletal muscle tissue Strumia E, eds) 1987:15-30, Edizioni Minerva of preterm and full term neonates. Ann Clin Medica, Torino. Biochem: in press. 2. Wieland OH. The mammalian pyruvate 6. Stadhouders A, Jap P, Wallimann T. dehydrogenase complex: structure and Biochemical nature of mitochondrial crystals. regulation.