Blunted fat oxidation upon submaximal exercise is partially compensated by enhanced glucose metabolism in children, adolescents, and young adults with Barth syndrome

Abstract

Barth syndrome (BTHS) is a rare X-linked condition resulting in abnormal mitochondria, cardioskeletal myopathy, and growth delay; however, the effects of BTHS on substrate metabolism regulation and their relationships with tissue function in humans are unknown. We sought to characterize glucose and fat metabolism during rest, submaximal exercise, and postexercise rest in children, adolescents, and young adults with BTHS and unaffected controls and examine their relationships with cardioskeletal energetics and function. Children/adolescents and young adults with BTHS (n = 29) and children/adolescent and young adult control participants (n = 28, total n = 57) underwent an infusion of 6'6'H2 glucose and U-¹³ C palmitate and indirect calorimetry during rest, 30-minutes of moderate exercise (50% $\dot{V}{O}_{2\text{peak}}$ ), and recovery. Cardiac function, cardioskeletal mitochondrial energetics, and exercise capacity were examined via echocardiography, ³¹ P magnetic resonance spectroscopy, and peak exercise testing, respectively. The glucose turnover rate was significantly higher in individuals with BTHS during rest (33.2 ± 9.8 vs 27.2 ± 8.1 μmol/kgFFM/min, P < .01) and exercise (34.7 ± 11.2 vs 29.5 ± 8.8 μmol/kgFFM/min, P < .05) and tended to be higher postexercise (33.7 ± 10.2 vs 28.8 ± 8.0 μmol/kgFFM/min, P < .06) compared to controls. Increases in total fat (-3.9 ± 7.5 vs 10.5 ± 8.4 μmol/kgFFM/min, P < .0001) and plasma fatty acid oxidation rates (0.0 ± 1.8 vs 5.1 ± 3.9 μmol/kgFFM/min, P < .0001) from rest to exercise were severely blunted in BTHS compared to controls. Conclusion: An inability to upregulate fat metabolism during moderate intensity exercise appears to be partially compensated by elevations in glucose metabolism. Derangements in fat and glucose metabolism are characteristic of the pathophysiology of BTHS. A severely blunted ability to upregulate fat metabolism during a modest level of physical activity is a defining pathophysiologic characteristic in children, adolescents, and young adults with BTHS.

Trial registration: ClinicalTrials.gov NCT01625663.

Keywords: Barth syndrome; exercise; fatty acid; mitochondria.

Figure 1:. Study Schematic for Substrate Kinetics Study.

IC: indirect calorimetry.

Figure 2:. Glucose Metabolism during Rest, Exercise, and Post-Exercise.

A. Glucose turnover rate, B. Glucose oxidation rate. BTHS: Barth syndrome, μmol: micromole, FFM: fat free mass, Exs: exercise, PostExs: post-exercise.

Figure 3:. Lipid Metabolism during Rest, Exercise and Post-Exercise.

A. Total lipid oxidation rate, B. Plasma FA oxidation rate, C. Non-plasma FA oxidation rate, D. Change in plasma FA oxidation rate from rest to exercise. BTHS: Barth syndrome, μmol: micromole, FFM: fat free mass, Exs: exercise, PostExs: post-exercise.