RARE DISEASE
Carnitine palmitoyltransferase II deficiency
Carnitine palmitoyltransferase II deficiency
Carnitine palmitoyltransferase II deficiency
Synonyms: CPT2, CPTII, Carnitine palmitoyltransferase deficiency type 2
Synonyms: CPT2, CPTII, Carnitine palmitoyltransferase deficiency type 2
Synonyms: CPT2, CPTII, Carnitine palmitoyltransferase deficiency type 2
Drug discovery
1
drug
With orphan designation
Overview
Carnitine palmitoyltransferase II (CPT II) deficiency is an autosomal recessive disorder impairing mitochondrial long-chain fatty acid oxidation. It manifests in three forms: lethal neonatal (multiorgan failure), severe infantile (hepatocardiomuscular involvement), and myopathic (recurrent rhabdomyolysis). Symptoms include hypoketotic hypoglycemia, cardiomyopathy, muscle pain, and myoglobinuria. Diagnosis involves acylcarnitine profiling, genetic testing, and enzyme assays. Management focuses on dietary modifications, avoidance of metabolic stressors, and emergency glucose support during crises [1][2][6][11].
Burden
Neonatal/infantile forms: High mortality (~100% neonatal mortality within months) [1][6][16].
Myopathic form: Recurrent hospitalizations for rhabdomyolysis-induced acute kidney injury [4][9].
Chronic comorbidities: Cardiomyopathy, liver failure, and reduced quality of life due to activity restrictions [2][4][6].
Categories: rare genetic diseases, rare inborn errors of metabolism, rare neurological diseases
Research Papers
157 drug discovery papers about Carnitine palmitoyltransferase II deficiency, with 3 next-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
157 drug discovery papers about Carnitine palmitoyltransferase II deficiency, with 3 next-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
2026-08-06 | A covalent PFKL activator suppresses tumor growth.
Glycolysis fuels vital cellular functions, and its dysregulation has been implicated in cancer, neurodegeneration, antibiotic resistance and diabetes. The glycolytic dependency of cancer, known as the Warburg effect, represents a key vulnerability for development of targeted anticancer agents; however, the development of such agents remains challenging owing to metabolic heterogeneity and resistance. Here we developed a covalent phosphofructokinase-1 liver type (PFKL) activator that couples glycolytic activation with delivery of a cytotoxic carnitine palmitoyltransferase 2 (CPT2)-targeting payload to cancer cells in vitro and in vivo. The electrophile-drug conjugate site-specifically and proteome-wide selectively modifies K677 in the allosteric effector site to stabilize the R-state tetramer of PFKL, while concomitantly releasing a CPT2-selective inhibitor to destabilize cell metabolism. The delivery mechanism of electrophile-drug conjugates is analogous to that of antibody-drug conjugates, but differentiated by their selective covalent targeting of intracellular proteins.
2026-07-19 | CPT2 as a Convergent Node Linking Age-Associated Neuronal H3K27me3 Remodeling to Nicotinamide Mononucleotide (NMN)-Induced Expression Rescue in Metabolic Tissues.
Age-related decline in mitochondrial function and disruption of epigenetic regulation are two closely connected features of biological aging. In neurons, age-associated remodeling of repressive H3K27me3 chromatin may constrain genes needed for metabolic, synaptic, and stress-adaptive maintenance. In parallel, nicotinamide mononucleotide (NMN), an NAD+ precursor, has been reported to mitigate age-associated physiological and transcriptional changes in peripheral metabolic tissues. However, direct links between neuronal epigenetic aging programs and NMN-responsive transcriptional rescue remain unclear. Here, we performed a secondary integrative analysis of two public datasets: GSE190102, focused on age-associated neuronal H3K27me3 targets mapped through an activity-by-contact-style region-gene framework, and GSE85718, a long-term NMN transcriptomic dataset from skeletal muscle, liver, and white adipose tissue in mice. The analysis identified 23 genes shared between 21,155 aging H3K27me3-associated targets and 35 robust NMN-rescue genes. Because the aging target set was extremely broad, gene-level overlap was not statistically persuasive, and pathway-level convergence was absent. Under repressive-mark direction logic, 14 of the 23 shared genes were concordant, meaning that the NMN expression effect opposed the expected consequence of age-associated H3K27me3 remodeling. Objectives were to quantify overlap between neuronal age-associated H3K27me3 targets and robust NMN-responsive genes in peripheral metabolic tissues, classify shared genes by directional concordance under repressive chromatin logic, and identify high-priority mechanistic candidates. The analysis supports limited global convergence and nominates CPT2 as the leading convergent node for targeted validation. CPT2 emerged as the leading candidate. It showed age-associated H3K27me3 gain, a large K27me3 log-fold change of +3.504, NMN-induced expression increase in old animals, a positive NMN interaction coefficient of +0.201, and membership in the mitochondrial fatty-acid oxidation pathway. Within the downstream shared-gene mitochondrial analysis, CPT2 was the only mitochondrial-core gene, with nominal enrichment only. These findings do not support a broad reversal of neuronal epigenetic aging by NMN. Instead, they identify CPT2 as a biologically coherent and experimentally tractable candidate linking age-related repressive chromatin remodeling to NMN-responsive mitochondrial metabolism.
2026-07-01 | CPT2 as a Convergent Node Linking Age-Associated Neuronal H3K27me3 Remodeling to NMN-Induced Expression Rescue in Metabolic Tissues
Age-related decline in mitochondrial function and disruption of epigenetic regulation are two closely connected features of biological aging. In neurons, age-associated remodeling of repressive H3K27me3 chromatin may constrain genes needed for metabolic, synaptic, and stress-adaptive maintenance. In parallel, nicotinamide mononucleotide (NMN), an NAD+ precursor, has been reported to mitigate age-associated physiological and transcriptional changes in peripheral metabolic tissues. However, direct links between neuronal epigenetic aging programs and NMN-responsive transcriptional rescue remain unclear.Here, we performed a secondary integrative analysis of two public datasets: GSE190102, focused on age-associated neuronal H3K27me3 targets mapped through an activity-by-contact-style region–gene framework, and GSE85718, a long-term NMN transcriptomic dataset from skeletal muscle, liver, and white adipose tissue in mice. The analysis identified 23 genes shared between 21,155 aging H3K27me3-associated targets and 35 robust NMN-rescue genes. Because the aging target set was extremely broad, gene-level overlap was not statistically persuasive, and pathway-level convergence was absent. Under repressive-mark direction logic, 14 of the 23 shared genes were concordant, meaning that the NMN expression effect opposed the expected consequence of age-associated H3K27me3 remodeling.CPT2 emerged as the leading candidate. It showed age-associated H3K27me3 gain, a large K27me3 log-fold change of +3.504, NMN-induced expression increase in old animals, a positive NMN interaction coefficient of +0.201, and membership in the mitochondrial fatty-acid oxidation pathway. Within the downstream shared-gene mitochondrial analysis, CPT2 was the only mitochondrial-core gene, with nominal enrichment only. These findings do not support broad reversal of neuronal epigenetic aging by NMN. Instead, they identify CPT2 as a biologically coherent and experimentally tractable candidate linking age-related repressive chromatin remodeling to NMN-responsive mitochondrial metabolism.
2025-11-12 | Long-Chain Fatty Acid Beta-Oxidation Defects: A Case Series and Literature Review.
Fatty acid beta-oxidation defects (FAOD) are a subgroup of lipid myopathies with heterogeneous presentations. Clinical presentation may manifest as muscular weakness, cramps, postexercise myalgias, and episodic rhabdomyolysis in children or adults. Our objective was to describe the clinical manifestations, biochemical, anatomopathological, and molecular results in a series of adult patients diagnosed with FAOD during adolescence or adulthood at five centers in Argentina. A total of seven patients with carnitine palmitoyltransferase-2 (CPT II), very-long-chain acyl-CoA dehydrogenase (VLCAD), and long-chain 3-hydroxyacyl-CoA dehydrogenase LCHAD deficiency were reported. The definite diagnosis of metabolic myopathies due to FAOD requires an understanding of clinical, biochemical, neurophysiological, and muscular imaging/biopsy patterns. All patients in this series consulted pediatricians, general practitioners, rheumatologists, and orthopedists for years, underscoring the need to disseminate these presentation patterns across various medical specialties. Early diagnosis and treatment using traditional diets and new pharmacological strategies not only enhance the quality of life, but also improve survival in these patients.
2025-07-17 | SIRT3 mediates CPT2 delactylation to enhance mitochondrial function and proliferation in goat granulosa cells.
Reproductive efficiency in goats is closely linked to the healthy development of follicles, with the proliferation of ovarian granulosa cells (GCs) playing a crucial role in this process. Sirtuin 3 (SIRT3), an enzyme that catalyzes post-translational modifications (PTMs) of proteins, is known to regulate a variety of mitochondrial metabolic pathways, thereby affecting cell fate. However, the specific effect of SIRT3 on the follicular development process remains unclear. Therefore, this study aimed to investigate the regulatory role of SIRT3 in the mitochondrial function and proliferation of goat GCs, as well as the underlying mechanisms involved. In this study, GCs from small follicles in goat ovaries presented increased proliferative potential and elevated SIRT3 expression levels compared with those from large follicles. In vitro, SIRT3 overexpression enhanced mitochondrial function, promoted proliferation and inhibited apoptosis in GCs. Correspondingly, the inhibition of SIRT3 led to the opposite effects. Notably, SIRT3 interacted with carnitine palmitoyl transferase 2 (CPT2) and stabilized the CPT2 protein by mediating delactylation, which prolonged the half-life of CPT2 and prevented its degradation. Further investigation revealed that CPT2 overexpression enhanced fatty acid β-oxidation and mitochondrial function in GCs. Additionally, CPT2 promoted the proliferation of GCs by increasing the protein levels of β-catenin and its downstream target, cyclin D1 (CCND1). However, this effect was reversed by 3-TYP (a SIRT3 inhibitor). SIRT3 stabilizes CPT2 protein expression through delactylation, thereby enhancing mitochondrial function and the proliferative capacity of GCs in goats. This study provides novel insights into the molecular mechanisms and regulatory pathways involved in mammalian follicular development.
2026-08-06 | A covalent PFKL activator suppresses tumor growth.
Glycolysis fuels vital cellular functions, and its dysregulation has been implicated in cancer, neurodegeneration, antibiotic resistance and diabetes. The glycolytic dependency of cancer, known as the Warburg effect, represents a key vulnerability for development of targeted anticancer agents; however, the development of such agents remains challenging owing to metabolic heterogeneity and resistance. Here we developed a covalent phosphofructokinase-1 liver type (PFKL) activator that couples glycolytic activation with delivery of a cytotoxic carnitine palmitoyltransferase 2 (CPT2)-targeting payload to cancer cells in vitro and in vivo. The electrophile-drug conjugate site-specifically and proteome-wide selectively modifies K677 in the allosteric effector site to stabilize the R-state tetramer of PFKL, while concomitantly releasing a CPT2-selective inhibitor to destabilize cell metabolism. The delivery mechanism of electrophile-drug conjugates is analogous to that of antibody-drug conjugates, but differentiated by their selective covalent targeting of intracellular proteins.
2026-07-19 | CPT2 as a Convergent Node Linking Age-Associated Neuronal H3K27me3 Remodeling to Nicotinamide Mononucleotide (NMN)-Induced Expression Rescue in Metabolic Tissues.
Age-related decline in mitochondrial function and disruption of epigenetic regulation are two closely connected features of biological aging. In neurons, age-associated remodeling of repressive H3K27me3 chromatin may constrain genes needed for metabolic, synaptic, and stress-adaptive maintenance. In parallel, nicotinamide mononucleotide (NMN), an NAD+ precursor, has been reported to mitigate age-associated physiological and transcriptional changes in peripheral metabolic tissues. However, direct links between neuronal epigenetic aging programs and NMN-responsive transcriptional rescue remain unclear. Here, we performed a secondary integrative analysis of two public datasets: GSE190102, focused on age-associated neuronal H3K27me3 targets mapped through an activity-by-contact-style region-gene framework, and GSE85718, a long-term NMN transcriptomic dataset from skeletal muscle, liver, and white adipose tissue in mice. The analysis identified 23 genes shared between 21,155 aging H3K27me3-associated targets and 35 robust NMN-rescue genes. Because the aging target set was extremely broad, gene-level overlap was not statistically persuasive, and pathway-level convergence was absent. Under repressive-mark direction logic, 14 of the 23 shared genes were concordant, meaning that the NMN expression effect opposed the expected consequence of age-associated H3K27me3 remodeling. Objectives were to quantify overlap between neuronal age-associated H3K27me3 targets and robust NMN-responsive genes in peripheral metabolic tissues, classify shared genes by directional concordance under repressive chromatin logic, and identify high-priority mechanistic candidates. The analysis supports limited global convergence and nominates CPT2 as the leading convergent node for targeted validation. CPT2 emerged as the leading candidate. It showed age-associated H3K27me3 gain, a large K27me3 log-fold change of +3.504, NMN-induced expression increase in old animals, a positive NMN interaction coefficient of +0.201, and membership in the mitochondrial fatty-acid oxidation pathway. Within the downstream shared-gene mitochondrial analysis, CPT2 was the only mitochondrial-core gene, with nominal enrichment only. These findings do not support a broad reversal of neuronal epigenetic aging by NMN. Instead, they identify CPT2 as a biologically coherent and experimentally tractable candidate linking age-related repressive chromatin remodeling to NMN-responsive mitochondrial metabolism.
2026-07-01 | CPT2 as a Convergent Node Linking Age-Associated Neuronal H3K27me3 Remodeling to NMN-Induced Expression Rescue in Metabolic Tissues
Age-related decline in mitochondrial function and disruption of epigenetic regulation are two closely connected features of biological aging. In neurons, age-associated remodeling of repressive H3K27me3 chromatin may constrain genes needed for metabolic, synaptic, and stress-adaptive maintenance. In parallel, nicotinamide mononucleotide (NMN), an NAD+ precursor, has been reported to mitigate age-associated physiological and transcriptional changes in peripheral metabolic tissues. However, direct links between neuronal epigenetic aging programs and NMN-responsive transcriptional rescue remain unclear.Here, we performed a secondary integrative analysis of two public datasets: GSE190102, focused on age-associated neuronal H3K27me3 targets mapped through an activity-by-contact-style region–gene framework, and GSE85718, a long-term NMN transcriptomic dataset from skeletal muscle, liver, and white adipose tissue in mice. The analysis identified 23 genes shared between 21,155 aging H3K27me3-associated targets and 35 robust NMN-rescue genes. Because the aging target set was extremely broad, gene-level overlap was not statistically persuasive, and pathway-level convergence was absent. Under repressive-mark direction logic, 14 of the 23 shared genes were concordant, meaning that the NMN expression effect opposed the expected consequence of age-associated H3K27me3 remodeling.CPT2 emerged as the leading candidate. It showed age-associated H3K27me3 gain, a large K27me3 log-fold change of +3.504, NMN-induced expression increase in old animals, a positive NMN interaction coefficient of +0.201, and membership in the mitochondrial fatty-acid oxidation pathway. Within the downstream shared-gene mitochondrial analysis, CPT2 was the only mitochondrial-core gene, with nominal enrichment only. These findings do not support broad reversal of neuronal epigenetic aging by NMN. Instead, they identify CPT2 as a biologically coherent and experimentally tractable candidate linking age-related repressive chromatin remodeling to NMN-responsive mitochondrial metabolism.
2025-11-12 | Long-Chain Fatty Acid Beta-Oxidation Defects: A Case Series and Literature Review.
Fatty acid beta-oxidation defects (FAOD) are a subgroup of lipid myopathies with heterogeneous presentations. Clinical presentation may manifest as muscular weakness, cramps, postexercise myalgias, and episodic rhabdomyolysis in children or adults. Our objective was to describe the clinical manifestations, biochemical, anatomopathological, and molecular results in a series of adult patients diagnosed with FAOD during adolescence or adulthood at five centers in Argentina. A total of seven patients with carnitine palmitoyltransferase-2 (CPT II), very-long-chain acyl-CoA dehydrogenase (VLCAD), and long-chain 3-hydroxyacyl-CoA dehydrogenase LCHAD deficiency were reported. The definite diagnosis of metabolic myopathies due to FAOD requires an understanding of clinical, biochemical, neurophysiological, and muscular imaging/biopsy patterns. All patients in this series consulted pediatricians, general practitioners, rheumatologists, and orthopedists for years, underscoring the need to disseminate these presentation patterns across various medical specialties. Early diagnosis and treatment using traditional diets and new pharmacological strategies not only enhance the quality of life, but also improve survival in these patients.
2025-07-17 | SIRT3 mediates CPT2 delactylation to enhance mitochondrial function and proliferation in goat granulosa cells.
Reproductive efficiency in goats is closely linked to the healthy development of follicles, with the proliferation of ovarian granulosa cells (GCs) playing a crucial role in this process. Sirtuin 3 (SIRT3), an enzyme that catalyzes post-translational modifications (PTMs) of proteins, is known to regulate a variety of mitochondrial metabolic pathways, thereby affecting cell fate. However, the specific effect of SIRT3 on the follicular development process remains unclear. Therefore, this study aimed to investigate the regulatory role of SIRT3 in the mitochondrial function and proliferation of goat GCs, as well as the underlying mechanisms involved. In this study, GCs from small follicles in goat ovaries presented increased proliferative potential and elevated SIRT3 expression levels compared with those from large follicles. In vitro, SIRT3 overexpression enhanced mitochondrial function, promoted proliferation and inhibited apoptosis in GCs. Correspondingly, the inhibition of SIRT3 led to the opposite effects. Notably, SIRT3 interacted with carnitine palmitoyl transferase 2 (CPT2) and stabilized the CPT2 protein by mediating delactylation, which prolonged the half-life of CPT2 and prevented its degradation. Further investigation revealed that CPT2 overexpression enhanced fatty acid β-oxidation and mitochondrial function in GCs. Additionally, CPT2 promoted the proliferation of GCs by increasing the protein levels of β-catenin and its downstream target, cyclin D1 (CCND1). However, this effect was reversed by 3-TYP (a SIRT3 inhibitor). SIRT3 stabilizes CPT2 protein expression through delactylation, thereby enhancing mitochondrial function and the proliferative capacity of GCs in goats. This study provides novel insights into the molecular mechanisms and regulatory pathways involved in mammalian follicular development.
Access all drug discovery papers and probability of success in trials forecasts:
Access all drug discovery papers and probability of success in trials forecasts:
Drug Discovery Landscape
1 orphan drug designation for Carnitine palmitoyltransferase II deficiency.
1 orphan drug designation for Carnitine palmitoyltransferase II deficiency.
Drug | Therapy type | Regulator | Orphan designation | Approval | Sponsor |
|---|---|---|---|---|---|
Triheptanoin | small molecules | EMA | 2015-07-28 | — | Ultragenyx Netherlands B.V. |
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