Normoglycemia alone is insufficient to prevent long-term complications of hepatocellular adenoma in glycogen storage disease type Ib mice

• Published in: Journal of hepatology Vol. 51; no. 5; pp. 909 - 917
• Main Authors: Yiu, Wai Han, Pan, Chi-Jiunn, Mead, Paul A, Starost, Matthew F, Mansfield, Brian C, Chou, Janice Y
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.11.2009; Elsevier
• Subjects: Adeno-associated virus; Adenoma, Liver Cell - etiology; Adenoma, Liver Cell - metabolism; Adenoma, Liver Cell - pathology; Adenoma, Liver Cell - prevention & control; Animals; Animals, Newborn; Antiporters - genetics; Antiporters - metabolism; Biological and medical sciences; Blood Glucose - metabolism; Bone Marrow - enzymology; Carbohydrates (enzymatic deficiencies). Glycogenosis; Dependovirus - genetics; Disease Models, Animal; Errors of metabolism; Fatty Liver - etiology; Fatty Liver - prevention & control; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gene therapy; Genetic Therapy; Genetic Vectors; Glucose-6-phosphate transporter; Glycogen Storage Disease Type I - blood; Glycogen Storage Disease Type I - complications; Glycogen Storage Disease Type I - therapy; Glycogen storage disease type Ib; Hepatocellular adenoma; Humans; Liver - enzymology; Liver - metabolism; Liver - pathology; Liver Glycogen - metabolism; Liver Neoplasms - etiology; Liver Neoplasms - metabolism; Liver Neoplasms - pathology; Liver Neoplasms - prevention & control; Malignant transformation; Medical sciences; Metabolic diseases; Mice; Mice, Knockout; Monosaccharide Transport Proteins - genetics; Monosaccharide Transport Proteins - metabolism; Recombinant Proteins - genetics; Recombinant Proteins - metabolism; G6P; glucose-6-phosphate transporter; glycogen storage disease type Ib; HCA; adeno-associated virus; G-CSF; G6PT; G6Pase; hepatocellular adenoma; AAV; Malignant transformation; GSD-Ib; glucose-6-phosphate; Gene therapy; glucose-6-phosphatase; granulocyte colony stimulating factor; Hepatocellular adenoma; Adeno-associated virus; Glycogen storage disease type Ib; Glucose-6-phosphate transporter; Phosphates; Adenoma; Glucose; Enzymopathy; Prevention; Glycogenosis; Gastroenterology; Complication; Carbohydrate; Benign neoplasm; Rodentia; Metabolic diseases; Long term; Genetic disease; Virus; Associated virus; Vertebrata; Mammalia; Treatment; Mouse; Animal
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2008.11.026

Background/Aims Glycogen storage disease type Ib (GSD-Ib) patients deficient in a glucose-6-phosphate transporter (G6PT) manifest disturbed glucose homeostasis, myeloid dysfunctions, and hepatocellular adenoma (HCA). This study was conducted to evaluate whether maintaining normoglycemia in GSD-Ib could prevent HCA. Methods We infused neonatal GSD-Ib mice with adeno-associated virus (AAV) carrying G6PT and examined their metabolic and myeloid phenotypes for the 72-week study. Results The AAV vector delivered the G6PT transgene to the liver and bone marrow. Long-term metabolic correction was achieved alongside a transient myeloid correction. Hepatic G6PT activity was 50% of wild-type levels at 2 weeks post-infusion but declined rapidly thereafter to reach 3% of wild-type levels by age 6 to 72 weeks. Despite this, the infused mice maintained normoglycemia throughout the study, exhibited near normal growth and normalized serum metabolite profiles. However, all five AAV-treated GSD-Ib mice that lived over 50 weeks accumulated excessive hepatic glycogen and fat. Two mice developed steatohepatitis and multiple HCAs with one undergoing malignant transformation. Conclusions Normoglycemia alone cannot prevent hepatic steatosis and glycogen accumulation or the development of HCAs in GSD-Ib, providing one explanation why GSD-Ib patients maintaining normoglycemia under intense dietary therapy continue at risk for this long-term complication.