Long-term follow-up of bezafibrate treatment in patients with the myopathic form of carnitine palmitoyltransferase 2 deficiency

Clin Pharmacol Ther. 2010 Jul;88(1):101-8. doi: 10.1038/clpt.2010.55. Epub 2010 May 26.

Abstract

Carnitine palmitoyltransferase 2 (CPT2) deficiency is a rare mitochondrial fatty acid oxidation (FAO) disorder characterized by myalgia, exercise intolerance, and rhabdomyolysis. We evaluate the efficacy of bezafibrate (BZ), a hypolipidemic drug, as a treatment for this form of CPT2 deficiency. A pilot trial was conducted with BZ in six patients for 6 months. There was a follow-up period of 3 years. The oxidation rates of the long-chain fatty acid derivative palmitoyl-CoA, measured in the mitochondria of the patients' muscles, were markedly lower than normal before treatment and increased significantly (+39 to +206%; P = 0.028) in all patients after BZ treatment. The evaluation of the therapeutic effects by the patients themselves (using the Short Form Health Survey (SF-36)), as well as by the physicians, indicated an improvement in the condition of the patients; there was an increase in physical activity and a decline in muscular pain. The results suggest that BZ has a therapeutic effect in the muscular form of CPT2 deficiency.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Acyl-CoA Dehydrogenase, Long-Chain / biosynthesis
  • Acyl-CoA Dehydrogenase, Long-Chain / genetics
  • Adult
  • Bezafibrate / therapeutic use*
  • Carnitine O-Palmitoyltransferase / biosynthesis*
  • Carnitine O-Palmitoyltransferase / deficiency*
  • Carnitine O-Palmitoyltransferase / genetics
  • Exercise Test
  • Female
  • Follow-Up Studies
  • Gene Expression Regulation, Enzymologic / drug effects
  • Humans
  • Hypolipidemic Agents / therapeutic use*
  • Lymphocytes / drug effects
  • Lymphocytes / enzymology
  • Male
  • Middle Aged
  • Mitochondria, Muscle / enzymology
  • Muscle, Skeletal / drug effects
  • Muscle, Skeletal / enzymology
  • Muscular Diseases / drug therapy*
  • Muscular Diseases / etiology*
  • Muscular Diseases / genetics
  • Oxidation-Reduction
  • Oxygen Consumption / drug effects
  • Pain / epidemiology
  • Pain / etiology
  • Palmitoyl Coenzyme A / metabolism
  • Pilot Projects
  • Rhabdomyolysis / drug therapy
  • Rhabdomyolysis / enzymology
  • Treatment Outcome
  • Young Adult

Substances

  • Hypolipidemic Agents
  • Palmitoyl Coenzyme A
  • Acyl-CoA Dehydrogenase, Long-Chain
  • Carnitine O-Palmitoyltransferase
  • Bezafibrate