PROJECT SUMMARY
Devastating human primary mitochondrial disorders are caused by pathogenic mtDNA variants and frequently
evolve into organ failures referred to, as mitochondrial-induced multiple organ dysfunction syndrome
(MIMODS). The underlying pathophysiologic mechanisms are more complex than a mere decrease in ATP pro-
duction and very little is known about these complex processes in a tissue-specific manner. There is thus an
urgent unmet need to assess the impact of the widespread mitochondrial dysfunction in multiple tissues leading
to MIMODS. We have demonstrated deleterious outcomes of widespread mitochondrial dysfunction (lowered
bioenergetics health index, abnormal mitochondrial morphology, elevated putrescine levels) in multiple pediat-
ric PMD dermal fibroblasts carrying unique pathogenic mtDNA variants. Based on our findings, we hypothesize
that elevated putrescine levels cause oxidative stress response and widespread mitochondrial dysfunction that
contributes to MIMODS in cellular models of primary mitochondrial disorders. Our collaborative team will de-
sign experiments and build upon established expertise in mitochondrial genetics and physiology, stem cell biol-
ogy and differentiation, next-generation sequencing analysis and metabolite profiling to address the following
research aims: In Aim 1, we will comprehensively assess mitochondrial dysfunction in twenty pediatric diseased
fibroblasts with a confirmed diagnosis of PMDs, along with five age matched controls. We will assess the oxida-
tive stress markers, NAD/NADH redox biochemistry, metabolomics, mitochondrial respiration and morphology.
In aim 2, we will seek to understand tissue-specific abnormalities associated with mitochondrial dysfunction in
neurons, cardiomyocytes and podocytes. In aim 3, we will assess the effect of targeted interventions of reducing
oxidative stress and improving mitochondrial respiration in multiple differentiated cell types that exhibit ele-
vated putrescine levels; and in multiple tissues from preclinical mouse models of PMD. The completion of these
aims will contribute to a newer understanding of putrescine metabolism in multiple energy-intensive cell types
derived from patients with pediatric PMD and its role in triggering MIMODS. In the long-term, our studies have
the potential to develop strategies for individualized testing of patient cells with candidate therapeutics to drive
rational, personalized therapies.