Cell-permeable succinate rescues mitochondrial respiration in cellular models of statin toxicity

VF Avram, I Chamkha, E Åsander-Frostner… - International journal of …, 2021 - mdpi.com
VF Avram, I Chamkha, E Åsander-Frostner, JK Ehinger, RZ Timar, MJ Hansson…
International journal of molecular sciences, 2021mdpi.com
Statins are the cornerstone of lipid-lowering therapy. Although generally well tolerated, statin-
associated muscle symptoms (SAMS) represent the main reason for treatment
discontinuation. Mitochondrial dysfunction of complex I has been implicated in the
pathophysiology of SAMS. The present study proposed to assess the concentration-
dependent ex vivo effects of three statins on mitochondrial respiration in viable human
platelets and to investigate whether a cell-permeable prodrug of succinate (complex II …
Statins are the cornerstone of lipid-lowering therapy. Although generally well tolerated, statin-associated muscle symptoms (SAMS) represent the main reason for treatment discontinuation. Mitochondrial dysfunction of complex I has been implicated in the pathophysiology of SAMS. The present study proposed to assess the concentration-dependent ex vivo effects of three statins on mitochondrial respiration in viable human platelets and to investigate whether a cell-permeable prodrug of succinate (complex II substrate) can compensate for statin-induced mitochondrial dysfunction. Mitochondrial respiration was assessed by high-resolution respirometry in human platelets, acutely exposed to statins in the presence/absence of the prodrug NV118. Statins concentration-dependently inhibited mitochondrial respiration in both intact and permeabilized cells. Further, statins caused an increase in non-ATP generating oxygen consumption (uncoupling), severely limiting the OXPHOS coupling efficiency, a measure of the ATP generating capacity. Cerivastatin (commercially withdrawn due to muscle toxicity) displayed a similar inhibitory capacity compared with the widely prescribed and tolerable atorvastatin, but did not elicit direct complex I inhibition. NV118 increased succinate-supported mitochondrial oxygen consumption in atorvastatin/cerivastatin-exposed platelets leading to normalization of coupled (ATP generating) respiration. The results acquired in isolated human platelets were validated in a limited set of experiments using atorvastatin in HepG2 cells, reinforcing the generalizability of the findings.
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