Published online April 14, 2008
PEDIATRICS (doi:10.1542/peds.2007-2062)
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ARTICLE

Evaluation of Long-term Treatment of Children With Congenital Lactic Acidosis With Dichloroacetate

Peter W. Stacpoole, PhD, MDa,b,c, Lesa R. Gilbert, RNa, Richard E. Neiberger, MD, PhDd, Paul R. Carney, MDd,e,f, Edward Valenstein, MDe, Douglas W. Theriaque, MSc and Jonathan J. Shuster, PhDc,g

a Departments of aMedicine
b Biochemistry and Molecular Biology
d Pediatrics
e Neurology
f Biomedical Engineering
g Epidemiology and Health Policy Research
c General Clinical Research Center, University of Florida, Gainesville, Florida

OBJECTIVE. The purpose of this research was to report results on long-term administration of dichloroacetate in 36 children with congenital lactic acidosis who participated previously in a controlled trial of this drug.

PATIENTS AND METHODS. We conducted a randomized control trial, followed by an open-label study. Data were analyzed for each patient from the time they began treatment through May 2005.

RESULTS. Subject exposure to dichloroacetate totaled 110.42 years. Median height and weight increased over time, but the standardized values declined slightly and remained below the first percentile. There were no significant changes in biochemical metabolic indices, except for a 2% rise in total protein and a 22% increase in 24-hour urinary oxalate. Both the basal and carbohydrate meal-induced rises in lactate were blunted by dichloroacetate. The median cerebrospinal fluid lactate also decreased over time. Conduction velocity decreased and distal latency increased in peroneal nerves. Mean 3-year survival for all of the subjects was 79%.

CONCLUSIONS. Oral dichloroacetate is generally well tolerated in young children with congenital lactic acidosis. Although continued dichloroacetate exposure is associated with evidence of peripheral neuropathy, it cannot be determined whether this is attributable mainly to the drug or to progression of underlying disease.

Key Words: dichloroacetate • lactic acidosis • mitochondria • pyruvate dehydrogenase • respiratory chain

Abbreviations: CLA—congenital lactic acidosis • GCRC—General Clinical Research Center

Accepted Oct 4, 2007.