Bezafibrate lowers very long-chain fatty acids in X-linked adrenoleukodystrophy fibroblasts by inhibiting fatty acid elongation

J Inherit Metab Dis. 2012 Nov;35(6):1137-45. doi: 10.1007/s10545-012-9471-4. Epub 2012 Mar 24.

Abstract

X-linked adrenoleukodystrophy (X-ALD) is caused by mutations in the ABCD1 gene encoding ALDP, an ATP-binding-cassette (ABC) transporter located in the peroxisomal membrane. ALDP deficiency results in impaired peroxisomal β-oxidation and the subsequent accumulation of very long-chain fatty acids (VLCFA; > C22:0) in plasma and tissues. VLCFA are primarily derived from endogenous synthesis by ELOVL1. Therefore inhibiting this enzyme might constitute a feasible therapeutic approach. In this paper we demonstrate that bezafibrate, a PPAR pan agonist used for the treatment of patients with hyperlipidaemia reduces VLCFA levels in X-ALD fibroblasts. Surprisingly, the VLCFA-lowering effect was independent of PPAR activation and not caused by the increase in either mitochondrial or peroxisomal fatty acid β-oxidation capacity. In fact, our results show that bezafibrate reduces VLCFA synthesis by decreasing the synthesis of C26:0 through a direct inhibition of fatty acid elongation activity. Taken together, our data indicate bezafibrate as a potential pharmacotherapeutic treatment for X-ALD. A clinical trial is currently ongoing to evaluate the effect in patients with X-ALD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • ATP Binding Cassette Transporter, Subfamily D, Member 1
  • ATP-Binding Cassette Transporters / deficiency
  • ATP-Binding Cassette Transporters / genetics
  • Acetyltransferases / antagonists & inhibitors
  • Acetyltransferases / genetics
  • Adrenoleukodystrophy / drug therapy*
  • Adrenoleukodystrophy / genetics
  • Adrenoleukodystrophy / metabolism*
  • Animals
  • Bezafibrate / pharmacology*
  • Cells, Cultured
  • Enzyme Inhibitors / pharmacology
  • Fatty Acid Elongases
  • Fatty Acids / chemistry
  • Fatty Acids / metabolism*
  • Humans
  • Hypolipidemic Agents / pharmacology
  • Male
  • Mice
  • Mice, Transgenic
  • Microsomes, Liver / drug effects
  • Microsomes, Liver / metabolism
  • Oxidation-Reduction
  • Peroxisome Proliferator-Activated Receptors / metabolism
  • Recombinant Proteins / antagonists & inhibitors
  • Recombinant Proteins / genetics

Substances

  • ABCD1 protein, human
  • ATP Binding Cassette Transporter, Subfamily D, Member 1
  • ATP-Binding Cassette Transporters
  • ELOVL1 protein, human
  • Enzyme Inhibitors
  • Fatty Acids
  • Hypolipidemic Agents
  • Peroxisome Proliferator-Activated Receptors
  • Recombinant Proteins
  • hexacosanoic acid
  • Acetyltransferases
  • Fatty Acid Elongases
  • Bezafibrate