Lorenzo's oil

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Bottle of Lorenzo's oil LorenzoOil.png
Bottle of Lorenzo's oil
The two component oils

Lorenzo's oil is a liquid solution made of 4 parts glycerol trioleate and 1 part glycerol trierucate, which are the triacylglycerol forms of oleic acid and erucic acid. [1] It is prepared from olive oil and rapeseed oil. [2] It is used in the investigational treatment of asymptomatic patients with adrenoleukodystrophy (ALD), a nervous system disorder.

Contents

The development of the oil was led by Augusto and Michaela Odone after their son Lorenzo was diagnosed with the disease in 1984, at the age of five. Lorenzo was predicted to die within a few years. His parents sought experimental treatment options, and the initial formulation of the oil was developed by retired British scientist Don Suddaby (formerly of Croda International). [3] Suddaby and his colleague, Keith Coupland, received a U.S. patent (since expired) for invention of the oil. [4] The royalties received by Augusto were paid to The Myelin Project which he and Michaela founded to further research treatments for ALD and similar disorders.[ citation needed ] The Odones and their invention obtained widespread publicity in 1992 because of the film Lorenzo's Oil .

Research on the effectiveness of Lorenzo's oil has seen mixed results, with possible benefit for asymptomatic ALD patients but of unpredictable or no benefit to those with symptoms, suggesting its possible role as a preventative measure in families identified as ALD dominant. Lorenzo Odone died on May 30, 2008, at the age of 30; he was bedridden with paralysis and died from aspiration pneumonia, likely caused by having inhaled food. [5] [6]

Treatment cost

In 2012, Lorenzo's oil cost approximately $400 USD for a month's treatment. [7]

Proposed mechanism of action

The mixture of fatty acids purportedly reduces the levels of very long chain fatty acids (VLCFAs), which are elevated in ALD. It does so by competitively inhibiting the enzyme that forms VLCFAs. [8]

Effectiveness

Lorenzo's oil, in combination with a diet low in VLCFA, has been investigated for its possible effects on the progression of ALD. Clinical results have been mixed and the use of Lorenzo's oil has been controversial due to uncertainties regarding its clinical efficacy and the clinical indications for its use. [9]

Hugo Moser played a prominent role in both the treatment of Lorenzo Odone and the scientific evaluation of Lorenzo's oil. In 2005, Moser published a controlled study concluding that Lorenzo's oil does not alter the course of the illness in symptomatic patients, but asymptomatic patients had a reduced risk of developing ALD while on the dietary therapy. [10] Moser appraised Lorenzo's oil again in a 2007 report. [11]

Moser's findings, that Lorenzo's oil did not help symptomatic ALD patients, are consistent with prior studies published in 2003 [12] and 1999. [9] [13]

A study by Poulos published in 1994 found that Lorenzo's oil is of limited value in correcting the accumulation of saturated VLCFAs in the brain of patients with ALD. [14] Comparative autopsies showed that treatment enriched erucic acid in plasma and tissues, but not in the brain. [15]

Side effects

The oil has been shown to cause a lowered platelet count, [16] which can lead to thrombocytopenia and lymphopenia. [17] :646–657

There are no reports of toxicity from dietary consumption of erucic acid. [17] [18] [19]

Current state

Dietary manipulation using Lorenzo's oil has been shown to lower blood levels of very long chain fatty acids, but it is ineffective in symptomatic ALD. Moser's 2005 study has found "strongly suggestive, albeit not fully definitive, evidence of a preventive effect" of Lorenzo's oil on the onset of symptoms when used by asymptomatic patients. [10]

Related Research Articles

<span class="mw-page-title-main">Fat</span> Esters of fatty acid or triglycerides

In nutrition, biology, and chemistry, fat usually means any ester of fatty acids, or a mixture of such compounds, most commonly those that occur in living beings or in food.

<span class="mw-page-title-main">Adrenoleukodystrophy</span> Medical condition

Adrenoleukodystrophy (ALD) is a disease linked to the X chromosome. It is a result of fatty acid buildup caused by failure of peroxisomal fatty acid beta oxidation which results in the accumulation of very long chain fatty acids in tissues throughout the body. The most severely affected tissues are the myelin in the central nervous system, the adrenal cortex, and the Leydig cells in the testes. The long chain fatty acid buildup causes damage to the myelin sheath of the neurons of the brain, resulting in seizures and hyperactivity. Other symptoms include problems in speaking, listening, and understanding verbal instructions.

Erucic acid is a monounsaturated omega-9 fatty acid, denoted 22:1ω9. It has the chemical formula :CH3(CH2)7CH=CH(CH2)11CO2H. It is prevalent in wallflower seed and other plants in the family Brassicaceae, with a reported content of 20 to 54% in high erucic acid rapeseed oil and 42% in mustard oil. Erucic acid is also known as cis-13-docosenoic acid and the trans isomer is known as brassidic acid.

<i>Lorenzos Oil</i> 1992 drama film directed by George Miller

Lorenzo's Oil is a 1992 American drama film directed and co-written by George Miller. It is based on the true story of Augusto and Michaela Odone, parents who search for a cure for their son Lorenzo's adrenoleukodystrophy (ALD), leading to the development of Lorenzo's oil. The film was shot in Pittsburgh, Pennsylvania, primarily from September 1991 to February 1992. It had a limited release in North America on December 30, 1992, with a nationwide release two weeks later, on January 15, 1993. Though it was a box office disappointment, grossing $7.2 million against its $30 million budget, the film was generally well received by the critics and garnered two nominations at the 65th Academy Awards.

<span class="mw-page-title-main">Zellweger syndrome</span> Congenital disorder of nervous system

Zellweger syndrome is a rare congenital disorder characterized by the reduction or absence of functional peroxisomes in the cells of an individual. It is one of a family of disorders called Zellweger spectrum disorders which are leukodystrophies. Zellweger syndrome is named after Hans Zellweger (1909–1990), a Swiss-American pediatrician, a professor of pediatrics and genetics at the University of Iowa who researched this disorder.

<span class="mw-page-title-main">Leukodystrophy</span> Group of disorders characterised by degeneration of white matter in the brain

Leukodystrophies are a group of, usually, inherited disorders, characterized by degeneration of the white matter in the brain. The word leukodystrophy comes from the Greek roots leuko, "white", dys, "abnormal" and troph, "growth". The leukodystrophies are caused by imperfect growth or development of the glial cells which produce the myelin sheath, the fatty insulating covering around nerve fibers. Leukodystrophies may be classified as hypomyelinating or demyelinating diseases, respectively, depending on whether the damage is present before birth or occurs after. Other demyelinating diseases are usually not congenital and have a toxic or autoimmune cause.

Omega-9 fatty acids are a family of unsaturated fatty acids which have in common a final carbon–carbon double bond in the omega−9 position; that is, the ninth bond from the methyl end of the fatty acid.

Augusto Daniel Odone and Michaela Teresa Murphy Odone were the parents of Lorenzo Michael Murphy Odone, a boy with the illness adrenoleukodystrophy (ALD). They became famous for developing a controversial treatment using Lorenzo's oil for their son's incurable illness. This quest was recounted in the film Lorenzo's Oil (1992). Augusto had previously been an economist for the World Bank.

The Myelin Project was a 501(c)(3) nonprofit organization established in 1989 by Augusto Odone and his wife, Michaela and their friend Patti Chapman. Their son, Lorenzo, suffered from adrenoleukodystrophy (ALD), the most common of the leukodystrophies. The story of the Odones' struggle was dramatized in the 1992 Hollywood film Lorenzo's Oil, starring the well-known actors Nick Nolte, Susan Sarandon and Peter Ustinov. After 20 years, the Myelin Project was merged into another organization called ALD Connect in July 2019.

<span class="mw-page-title-main">Triolein</span> Chemical compound

Triolein is a symmetrical triglyceride derived from glycerol and three units of the unsaturated fatty acid oleic acid. Most triglycerides are unsymmetrical, being derived from mixtures of fatty acids. Triolein represents 4–30% of olive oil.

<span class="mw-page-title-main">ABCD1</span> Protein-coding gene in humans

ABCD1 is a protein that transfers fatty acids into peroxisomes.

Infantile Refsum disease (IRD) is a rare autosomal recessive congenital peroxisomal biogenesis disorder within the Zellweger spectrum. These are disorders of the peroxisomes that are clinically similar to Zellweger syndrome and associated with mutations in the PEX family of genes. IRD is associated with deficient phytanic acid catabolism, as is adult Refsum disease, but they are different disorders that should not be confused.

<span class="mw-page-title-main">Nervonic acid</span> Chemical compound

Nervonic acid is a fatty acid. It is a monounsaturated analog of lignoceric acid (24:0). It is also known as selacholeic acid and cis-15-tetracosenoic acid. Its name derives from the Latin word nervus, meaning nerve or sinew.

Hugo Wolfgang Moser (1924–2007) was a Swiss-born American research scientist and director of the Neurogenetics Research Center at the Kennedy Krieger Institute. Moser was also University Professor of Neurology and Pediatrics at Johns Hopkins University. His research on peroxisomal disorders achieved international recognition.

A very-long-chain fatty acid (VLCFA) is a fatty acid with 22 or more carbons. Their biosynthesis occurs in the endoplasmic reticulum. VLCFA's can represent up to a few percent of the total fatty acid content of a cell.

Odone is a surname and given name. Notable people with the name include:

<span class="mw-page-title-main">Kennedy Krieger Institute</span> Hospital in Maryland, United States

The Kennedy Krieger Institute is a nonprofit, 501(c)(3) tax-exempt, Johns Hopkins affiliate located in Baltimore, Maryland, that provides in-patient and out-patient medical care, community services, and school-based programs for children and adolescents with learning disabilities, as well as disorders of the brain, spinal cord, and musculoskeletal system. The Institute provides services for children with developmental concerns mild to severe and is involved in research of various disorders, including new interventions and earlier diagnosis.

<span class="mw-page-title-main">Acyl-CoA oxidase deficiency</span> Medical condition

Acyl-CoA oxidase deficiency is a rare disorder that leads to significant damage and deterioration of nervous system functions (neurodegeneration). It is caused by pathogenic variants in ACOX1, which codes for the production of an enzyme called peroxisomal straight-chain acyl-CoA oxidase (ACOX1). This specific enzyme is responsible for the breakdown of very long chain fatty acids (VLCFAs).

Elivaldogene autotemcel, sold under the brand name Skysona, is a gene therapy used to treat cerebral adrenoleukodystrophy (CALD). It was developed by Bluebird bio and was given breakthrough therapy designation by the U.S. Food and Drug Administration in May 2018.

<span class="mw-page-title-main">Rapeseed oil</span> Vegetable oil

Rapeseed oil is one of the oldest known vegetable oils. There are both edible and industrial forms produced from rapeseed, the seed of several cultivars of the plant family Brassicaceae. Historically, it was restricted as a food oil due to its content of erucic acid, which in laboratory studies was shown to be damaging to the cardiac muscle of laboratory animals in high quantities and which imparts a bitter taste, and glucosinolates, which made it less nutritious in animal feed. Rapeseed oil from standard cultivars can contain up to 54% erucic acid.

References

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  2. Shankar Vedantam. "A Real-Life Sequel to 'Lorenzo's Oil' – washingtonpost.com". Washington Post 2007-01-28. pp. A01. Retrieved 2007-12-10.
  3. "Lorenzo Odone". 1 June 2008 via www.telegraph.co.uk.
  4. U.S. Patent 5,331,009: Pharmaceutical compositions for treating adrenoleukodystrophy.[ dead link ] Issued July 19, 1994.
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  6. "Subject of 'Lorenzo's Oil' dies at 30". CNN . Associated Press. 2008-05-30. Archived from the original on July 17, 2008. Retrieved 2008-07-12.
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  8. "Archived copy". www.myelin.org. Archived from the original on 4 November 2013. Retrieved 17 January 2022.{{cite web}}: CS1 maint: archived copy as title (link)
  9. 1 2 Berger J, Pujol A, Aubourg P, Forss-Petter S (July 2010). "Current and Future Pharmacological Treatment Strategies in X-Linked Adrenoleukodystrophy". Brain Pathol. 20 (4): 845–56. doi:10.1111/j.1750-3639.2010.00393.x. PMC   2967711 . PMID   20626746.
  10. 1 2 Moser HW, Raymond GV, Lu SE, Muenz LR, Moser AB, Xu J, Jones RO, Loes DJ, Melhem ER, Dubey P, Bezman L, Brereton NH, Odone A (July 2005). "Follow-up of 89 asymptomatic patients with adrenoleukodystrophy treated with Lorenzo's Oil". Archives of Neurology. 62 (7): 1073–80. doi: 10.1001/archneur.62.7.1073 . PMID   16009761.
  11. Moser HW, Moser AB, Hollandsworth K, Brereton NH, Raymond GV (September 2007). ""Lorenzo's oil" therapy for X-linked adrenoleukodystrophy: rationale and current assessment of efficacy". J. Mol. Neurosci. 33 (1): 105–13. doi:10.1007/s12031-007-0041-4. PMID   17901554. S2CID   21333247.
  12. Aubourg P, Adamsbaum C, Lavallard-Rousseau MC, Rocchiccioli F, Cartier N, Jambaqué I, Jakobezak C, Lemaitre A, Boureau F, Wolf C (September 1993). "A two-year trial of oleic and erucic acids ("Lorenzo's oil") as treatment for adrenomyeloneuropathy". N. Engl. J. Med. 329 (11): 745–52. doi: 10.1056/NEJM199309093291101 . PMID   8350883.
  13. van Geel BM, Assies J, Haverkort EB, Koelman JH, Verbeeten B, Wanders RJ, Barth PG (September 1999). "Progression of abnormalities in adrenomyeloneuropathy and neurologically asymptomatic X-linked adrenoleukodystrophy despite treatment with "Lorenzo's oil"". J. Neurol. Neurosurg. Psychiatry. 67 (3): 290–9. doi:10.1136/jnnp.67.3.290. PMC   1736534 . PMID   10449548.
  14. Poulos A, Gibson R, Sharp P, Beckman K, Grattan-Smith P (1994). "Very long chain fatty acids in X-linked adrenoleukodystrophy brain after treatment with Lorenzo's oil". Ann. Neurol. 36 (5): 741–6. doi:10.1002/ana.410360509. PMID   7979219. S2CID   41340913.
  15. Magnhild Rasmussen; Ann B. Moser; Janet Borel; Surinder Khangoora; Hugo W. Moser (Aug 1994). "Brain, liver, and adipose tissue erucic and very long chain fatty acid levels in adrenoleukodystrophy patients treated with glyceryl trierucate and trioleate oils (Lorenzo's Oil)". Neurochemical Research. Springer Netherlands. 19 (8): 1073–1082. doi:10.1007/BF00968719. PMID   7800117. S2CID   11658824.
  16. Crowther MA, Barr RD, Kelton J, Whelan D, Greenwald M (February 1995). "Profound thrombocytopenia complicating dietary erucic acid therapy for adrenoleukodystrophy". American Journal of Hematology . 48 (2): 132–3. doi:10.1002/ajh.2830480217. PMID   7847331. S2CID   29556389.
  17. 1 2 Luger CL et al. Food Safety and Foodborne Toxicants. Chapter 14 in Hayes' Principles and Methods of Toxicology, Sixth Edition. Eds A. Wallace Hayes, Claire L. Kruger. CRC Press, 2014 ISBN   9781842145371. Quote: "In humans. however. although the long-term use of Lorenzo's oil (oleic acid and erucic acid) in the treatment of adrenoleukodystrophy or adrenomyeloneuropathy leads to thrombocytopenia and lymphopenia (Unkrig et al. 1994), adverse effects from dietary consumption of erucic acid have not been reported."
  18. Food Standards Australia New Zealand (June 2003) Erucic acid in food Archived 2008-12-03 at the Wayback Machine  : A Toxicological Review and Risk Assessment . Technical report series No. 21; Page 4 paragraph 1; ISBN   0-642-34526-0, ISSN 1448-3017
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