Friedreich ataxia (FRDA) is an autosomal recessive neurodegenerative disorder characterized by early onset and progressive limb and gait ataxia, dysarthria, deep tendon areflexia especially of the lower extremities, and presence of a sensory axonal neuropathy with motor conduction velocities greater than 40 m/s. In addition, most patients show hypertrophic cardiomyopathy. Additional non-neurological features are skeletal deformities and glucose intolerance or diabetes mellitus
[1],
[2]. The disease is caused by GAA triplet expansions
[3] and point mutations
[4],
[5] in the
FXN gene mapped to human chromosome 9q13.
FXN encodes frataxin, a small protein of 210 amino acids expressed in the mitochondrial matrix
[6]–
[8]. Frataxin seems to act as a iron donor to other proteins for their utilization in different biochemical pathways, such as biogenesis of iron-sulfur clusters (ISC)
[9]–
[11] and activation of aconitase
[12]. Thus, the pathogenic consequences of frataxin deficiency have been related with defects of ISC biogenesis but also with iron deposits
[13], oxidative stress
[8] and regulation of the mitochondrial respiratory chain
[14],
[15].
Based on cell and mitochondrial effects of the lack of frataxin, several pharmacological approaches have been proposed. These include the use of antioxidants to reduce radical oxidative species. Idebenone is a synthetic analogue of ubiquinone or coenzyme Q
10 (CoQ), which has antioxidant activity and is able to act in situations of low concentrations of oxygen. It has the ability to inhibit the lipidic peroxidation, protecting the cellular membranes and the mitochondria from oxidative damage. It is able to stimulate the mitochondrial functions and increase the energetic contribution to the myocardium. A number of clinical trials have been conducted, suggesting a protecting effect on the cardiac hypertrophy
[16]–
[21]. More recently, some beneficial effects of idebenone on the neurological symptoms have also been described
[22],
[23]. Mitoquinone (MitoQ) is another proposed CoQ derivative with antioxidant activity selectively directed to the mitochondria
[24],
[25].
Alternative pharmacological strategies have been used. Iron chelators mobilize the iron deposits observed in patients
[26]. Chelator treatment with deferiprone causes no apparent hematologic or neurologic side effects while reducing neuropathy and ataxic gait in the youngest patients
[27].
Expansion of the GAA trinucleotide reduces transcription of
FXN gene, which in turn leads to frataxin deficiency. To reverse
FXN silencing, a class of histone deacetylase (HDAC) inhibitors have been proposed as an alternative therapy
[28]–
[30]. Recently, treatment of a FRDA mouse model by an HDAC inhibitor compound has shown correction of biological parameters of frataxin deficiency
[31].
Some data suggest that frataxin may be involved in the energetic metabolism. Clinical studies applying magnetic resonance show a failure in the production of ATP in the patients' muscles
[32]. Overexpression of human frataxin in human adipocytes increases the activity of the electron transport chain, mitochondrial membrane potential and ATP production
[14]. By genetic and biochemical analyses in
Saccharomyces cerevisiae we have demonstrated a physical and functional interaction among the yeast frataxin, Yfh1p, and succinate dehydrogenase subunits Sdh1p and Sdh2p of complex II of the respiratory chain
[15]. We have also confirmed the interaction among frataxin and both SDHA and SDHB human proteins. Additionally, we also demonstrated genetic interaction between frataxin and SDHC subunit in
Caenorhabditis elegans [33]. All these data point to a direct role of frataxin on the complex II of the electronic transport chain (ETC); thus, lack of frataxin may induce a failure in the oxidative phosphorylation (OXPHOS) by means of abnormal function of the electron transport at complex II.
Transport of electrons through the ETC is needed to correct reduction of CoQ. In mammalian cells electrons are provided to CoQ not just by reduction of complex I and complex II but also by the electron transfer flavoprotein (ETF) complex, a system composed by the ETF-dehydrogenase (ETF-QO) and ETF, a heterodimer composed by two subunits (ETFα and ETFβ), that delivers electrons coming from β-oxidation of fatty acids and amino acid catabolism to CoQ
[34]. In
S. cerevisiae β-oxidation occurs mainly in peroxisomes but not in mitochondria; however, homologous genes for ETF complex genes have been reported in yeast:
ypr004c as the
ETFα homologue and
ygr207c as the homologue of
ETFβ. We have also demonstrated that Yfh1p interacts with two of these components of the electron transfer flavoprotein complex
[15].
Human complex II is a multimeric enzyme composed of four subunits: a flavoprotein (SDHA), an iron-sulphur subunit (SDHB), and two proteins (SDHC and SDHD) that is anchored to the inner mitochondrial membrane. Complex II carries electrons to the ubiquinone pool and constitutes the second essential oxidation–reduction reaction of the respiratory chain. Moreover, SDHA and SDHB subunits compose the active enzyme succinate dehydrogenase that oxidizes succinate to fumarate in the Krebs cycle
[35]. Complex II has flavin adenine dinucleotide (FAD) as a prosthetic group that is covalently anchored to the SDHA subunit. FAD also acts as a cofactor to the ETF complex. FAD and flavin mononucleotide (FMN) are cofactors derived from riboflavin, a water-soluble vitamin that have been used in the treatment of several mitochondrial disorders such as complex I deficiency
[36], short-chain acyl coenzyme A dehydrogenase (SCAD)
[37], mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome
[38], L-2-hydroxyglutaric aciduria
[39], and in complex II deficiency
[40].
Based on our finding that frataxin interacts with subunits of the complex II and with components of the electron transfer flavoprotein complex we wonder whether riboflavin could be useful in the treatment of FRDA as well. To address this question we investigated the effect of riboflavin and riboflavin-derived cofactors on frataxin-deficient strains of S. cerevisiae and C. elegans. Our results show that the flavin adenin dinucleotide is able to rescue the phenotype of both mutant organisms but, this improvement is not dependent of complex II activity.