Bacterial lipoate protein ligases rescue lipoylation and respiration deficiency in mammals

Human lipoylation pathway deficiencies caused by LIPT2/LIAS/LIPT1 gene mutations lead to inherited metabolic disorders characterized by severe defects of mitochondrial energy and amino acids metabolism. Patients with such mutations suffer from hyperlactic acidemia, encephalopathy, hypotonia and early death. So far there is no effective treatment. Here we introduced the bacteria salvage lipoylation pathway, which is absent in eukaryotes, into lipoylation defective human cells and mouse models. Both E. coli-derived LplA and B. subtilis-derived LplJ restored the phenotypes of LIPT2/LIAS/LIPT1 gene knockout cells to those of wildtype cells with lipoic acid supplementation. Biochemical and isotope tracing analysis demonstrated LplA and LplJ function through direct lipoylation of the H protein of glycine cleavage system and the E2 subunits of 2-oxoacid dehydrogenases, thereby reactivating the short-circuited TCA cycle and amino acids metabolism. This strategy is further extended to treat lipoyl precursor supply defects caused by MECR and FDX1 mutations and its efficacy and safety are validated in Lipt1-/- and LplAOE/+ mouse models. This study provides systematic characterization of lipoylation deficiency and paves the way to gene therapy for treatment of lipoylation-deficient patients.