ETFDH Mutations and Flavin Adenine Dinucleotide Homeostasis Disturbance Are Essential for Developing Riboflavin-Responsive Multiple Acyl-Coenzyme A Dehydrogenation Deficiency.

OBJECTIVE: Riboflavin-responsive multiple acyl-coenzyme A dehydrogenation deficiency (RR-MADD) is an inherited fatty acid metabolism disorder mainly caused by genetic defects in electron transfer flavoprotein-ubiquinone oxidoreductase (ETF:QO). The variant ETF:QO protein folding deficiency, which can be corrected by therapeutic dosage of riboflavin supplement, has been identified in HEK-293 cells and is believed to be the molecular mechanism of this disease. To verify this hypothesis in vivo, we generated Etfdh (h)A84T knockin (KI) mice. METHODS: Tissues from these mice as well as muscle biopsies and fibroblasts from 7 RR-MADD patients were used to examine the flavin adenine dinucleotide (FAD) concentration and ETF:QO protein amount. RESULTS: All of the homozygous KI mice (Etfdh (h)A84T/(h)A84T , KI/KI) were initially normal. After being given a high-fat and vitamin B2 -deficient (HF-B2 D) diet for 5 weeks, they developed weight loss, movement ability defects, lipid storage in muscle and liver, and elevated serum acyl-carnitine levels, which are clinically and biochemically similar to RR-MADD patients. Both ETF:QO protein and FAD concentrations were significantly decreased in tissues of HF-B2 D-KI/KI mice and in cultured fibroblasts from RR-MADD patients. After riboflavin treatment, ETF:QO protein increased in proportion to elevated FAD concentrations, but not related to mRNA levels. These results were further confirmed in cultured fibroblasts from RR-MADD patients. INTERPRETATION: For the first time, we successfully developed a RR-MADD mice model and confirmed that FAD homeostasis disturbances played a crucial role on the pathomechanism of RR-MADD in this mouse model and culture cells from patients. Supplementation of riboflavin may stabilize variant ETF:QO protein by rebuilding FAD homeostasis. Ann Neurol 2018;84:667-681.

Integration of traditional Chinese medicines and Western medicines for treating diabetes mellitus with coronary heart disease: a systematic review.

PURPOSE: Diabetes mellitus with coronary heart disease (DM with CHD) poses a health challenge to people in China and elsewhere in the world. In Traditional Chinese Medicine (TCM), DM with CHD is classified as a type of disease called Xiaoke and Xiongbi. In Asia, TCM has been used to treat Xiaoke and Xiongbi conditions for centuries, especially in China. In this study, it was evaluated whether integrated strategies incorporating both TCM and Western medicines (iTCWM) could improve the curative efficacy of DM with CHD. METHODS: An extensive search for randomized clinical trials (RCTs) published up to November 2011 in either English or Chinese about iTCWM for DM with CHD was conducted. All listings in PubMed, EMBASE, the Cochrane Library, CBM, CNKI, VIP, and the Wanfang database were included in the literature search. The quality of each trial was assessed using the Cochrane Reviewers' Handbook 5.0. Data analysis was performed by the RevMan 5.0 provided by the Cochrane Collaboration. RESULTS: After an initial selection of 207 articles, 21 RCTs and quasi-RCTs were ultimately included in the analysis for this study. All of these trials were conducted in China and published in Chinese journals. The methodological quality of the trials was low in most studies. Selection bias and measurement bias were common in all of the studies. A meta-analysis was not conducted, due to the poor quality of the available studies. CONCLUSIONS: The current state of the literature regarding the utility of iTCWM for the treatment of DM with CHD is inadequate. The poor quality of the available trials makes it difficult to draw any conclusions regarding the efficacy of iTCWM for the treatment of DM with CHD. This study highlights the paucity of reliable clinical evidence for iTCWM and the need for higher quality RCTs to be conducted in the future.

[The value of Roferon-A combined with hepatic artery chemoembolization and portal vein chemotherapy after radical resection in hepatocellular carcinoma for preventing recurrence].

OBJECTIVE: To explore the change of T cell subsets in patients suffered from hepatocellular carcinoma (HCC) before and after hepatectomy, and study the value of Roferon-A (interferon alpha-2a) combined with hepatic artery chemoembolization (HACE) and portal vein chemotherapy (PVC) after radical resection of HCC for preventing recurrence. METHODS: On 75 HCC patients, PVC and HACE were respectively given at 2 weeks and 4 weeks after radical tumor resection. In 2nd week after surgery, 33 cases of them accepted Roferon-A treatment for 1 week. Seventy-two patients were followed up over 3 years. Effect of Roferon-A combined with HACE and PVC on postoperative recurrence rate was compared with that of HACE and PVC. Changes of T cell subsets in peripheral blood were examined with labeled monoclonal antibodies before and after hepatectomy or using interferon. Forty cholecystolithiasis patients received cholecystectomy were used as the controls. RESULTS: CD(3)(+) and CD(4)(+) cells in peripheral blood were reduced in patients with HCC. After hepatectomy, they declined further with decrease in CD(4)(+)/CD(8)(+) ratio. The results returned to pre-operative level at the end of 4th week after surgery. The CD(3)(+), CD(4)(+) cells and the CD(4)(+)/CD(8)(+) ratio increased remarkably following the use of Roferon-A. The 1-, 2- and 3-year recurrence rates of patients treated with HACE, PVC and Roferon-A in combination were 0%, 6.2% and 15.6%, respectively, while those treated with HACE and PVC were 5.0%, 12.5% and 27.5%, respectively. CONCLUSION: Patients with HCC suffer from marked immuno-suppression which became ever more severe after hepatectomy, combined use of HACE, PVC and Roferon-A is superior to only HACE and PVC by decreasing the recurrence rate.