O balanço redox em mitocôndrias de mamíferos é realizado pelo transportador de aspartato-glutamato (AGC), o qual é o principal mecanismo para o movimento de equivalentes redutores na forma de NADH. A citrulinemia do tipo II (CTLN2) é uma doença autossômica recessiva de início tardio, causada por mutações no gene SLC25A13 que codifica a citrina. A citrina é uma isoforma do transportador AGC e catalisa o transporte de glutamato citosólico através da troca com o aspartato mitocondrial, o qual será utilizado no ciclo da ureia. A CTLN2 promove uma deficiência no ciclo da ureia e consequente hiperamonemia. A deficiência da citrina promove um aumento da razão NADH/NAD+ citosólica. O aumento dessa razão inibe a glicólise e a gliconeogênese. O desenvolvimento de modelo in vitro da CTLN2 é importante para estudos do mecanismo da doença e de novas terapias. A expressão heteróloga de proteínas entre diferentes reinos tem sido utilizado como uma forma de corrigir algumas doenças mitocondriais. Estudos bioquímicos e moleculares em nosso laboratório demonstraram a presença de um transportador mitocondrial de nicotinamida adenina dinucleotídeo (Ndt1) em Aspergillus fumigatus. Ndt1 realiza o transporte de NAD+ citosólico para a matriz mitocondrial, sendo dessa forma uma proteína importante para manter o balanço redox em A. fumigatus. Assim, o objetivo deste trabalho foi obter uma linhagem de células de mamífero HEK293 com knockdown para o gene SLC25A13, ou seja, um modelo in vitro de CTLN2 e a expressão heteróloga da proteína Ndt1 como uma forma de recuperação do metabolismo. As células com knockdown para o gene SLC25A13 apresentaram um aumento da razão NADH/NAD+ citosólico, redução da glicólise, redução da concentração da ureia e aumento da concentração de amônia. A expressão de Ndt1 foi capaz de reduzir a razão NADH/NAD+ citosólico e recuperou a atividade glicolítica. Entretanto, a expressão de Ndt1 não foi capaz de aumentar a concentração de ureia e reduzir a concentração de amônia causadas pela CTLN2. Dessa forma, nossos resultados sugerem que a expressão da proteína Ndt1 em células de mamíferos recupera o metabolismo mitocondrial e atividade glicolítica das células com CTLN2, mas não melhora o ciclo da ureia e o aumento da concentração de amônia. / Redox balance in mammalian mitochondria is performed by the aspartate-glutamate carrier (AGC), which is the main mechanism for the movement of reducing equivalents in the form of NADH.Type II citrullinemia (CTLN2) is an adult-onset autosomal recessive disease caused by mutations in SLC25A13 gene, and that coding citrin. Citrin is an isoform of AGC and catalyzes the transport of cytosolic glutamate through exchange with mitochondrial aspartate. It will be used in the urea cycle. CTLN2 causes urea cycle deficiency and hyperammonemia. Citrin deficiency cause an increase in the cytosolic NADH/NAD+ ratio. The increase in this ratio inhibits glycolysis and gluconeogenesis. The development an in vitro CTLN2 model is important for new studies about the disease mechanism and new therapies. Heterologous expression of proteins from different organisms has been used to recover some mitochondrial diseases. Biochemical and molecular studies in our laboratory demonstrated the presence of a mitochondrial nicotinamide adenine dinucleotide transporter (Ndt1) in Aspergillus fumigatus. Ndt1 protein performs cytosolic NAD+ transport to the mitochondria matrix, thus being an important protein to keep the redox balance in A. fumigatus. Thus, the aim of this work was to obtain a line of HEK293 mammalian cells with knockdown for the SLC25A13 gene, an in vitro CTLN2 model and the heterologous expression of the Ndt1 protein as a form of metabolism recovery. Cells with citrin knockdown showed an increase of cytosolic NADH/NAD+ ratio, reduction of glycolysis, reduction of urea concentration, and increase of ammonia concentration. Expression of Ndt1 protein was able to reduce cytosolic NADH/NAD+ ratio and recovered the glycolytic activity. However, Ndt1 protein was not able to increase the urea concentration and reduce of ammonia concentration caused by CTLN2. Thus, our results suggest that expression of Ndt1 protein in mammal cells recovers the mitochondrial metabolism and glycolytic activity in CTLN2 cells but does not improve urea cycle and reduce ammonia concentration.

Themitochondrialmalate aspartate shuttle system(MAS)maintains the cytosolicNAD+/NADH redox balance, thereby sustaining cytosolic redox-dependent pathways, such as glycolysis and serine biosynthesis. Human disease has been associated with defects in four MAS-proteins (encoded by MDH1, MDH2, GOT2, SLC25A12) sharing a neurological/epileptic phenotype, as well as citrin deficiency (SLC25A13) with a complex hepatopathic-neuropsychiatric phenotype. Ketogenic diets (KD) are high-fat/low-carbohydrate diets, which decrease glycolysis thus bypassing the mentioned defects. The same holds for mitochondrial pyruvate carrier (MPC) 1 deficiency, which also presents neurological deficits. We here describe 40 (18 previously unreported) subjects with MAS-/MPC1-defects (32 neurological phenotypes, eight citrin deficiency), describe and discuss their phenotypes and genotypes (presenting 12 novel variants), and the efficacy of KD. Of 13 MAS/MPC1- individuals with a neurological phenotype treated with KD, 11 experienced benefits—mainly a striking effect against seizures. Two individuals with citrin deficiency deceased before the correct diagnosis was established, presumably due to high-carbohydrate treatment. Six citrin-deficient individuals received a carbohydrate-restricted/fat-enriched diet and showed normalisation of laboratory values/hepatopathy as well as age-adequate thriving. We conclude that patients with MAS-/MPC1- defects are amenable to dietary intervention and that early (genetic) diagnosis is key for initiation of proper treatment and can even be lifesaving.