Acyl-CoA oxidase 1 (ACOX1) is the rate-limiting enzyme of the peroxisomal fatty acid β-oxidation pathway of very-long-chain fatty acid (VLCFAs). In humans, ACOX1 deficiency, also called pseudo-neonatal adrenoleukodystrophy, is an autosomal recessive and a severe form of the peroxisomal β-oxidation deficiency. Patients suffer from severe delayed motor development followed by a progressive neurological regression including progressive hypodensity of cerebral white matter, hepatomegaly and deafness and die during late-infantile period. Elevated plasma and tissues VLCFAs levels are detected in these patients. Mice lacking ACOX1 develop severe microvesicular steatohepatitis with increased intrahepatic H2O2 levels and hepatocellular regeneration. Liver cell proliferation in Acox1-/- mice leads to complete replacement of steatotic hepatocytes with hepatocytes that exhibit massive spontaneous peroxisome proliferation. Older mice develop hepatocellular carcinomas due to the sustained activation of peroxisome proliferator-activated receptor-alpha (PPARα). Contrary to humans, mice lacking ACOX1 have no apparent neurological disorder. Based on fibroblasts cell model from P-NALD patients, we show that ACOX1 deficiency lead to abolition of peroxysomal β-oxidation of cerotic acid (C26:0) and modification of peroxysomal morphology which appear reduced in number and enlarged in size. Moreover, accumulation of VLCFAs in ACOX1 deficiency in human fibroblasts interferes at the transcription level with cholesterol synthesis pathway. Furthermore, these cells show activation of interleukin-1b pathway with elevated production of interleukin-6 and interleukin-8 as an inflammatory response to metabolic disturbance due to VLCFAs accumulation. Furthermore, we show in this study that the ACOX1 deficiency in human fibroblasts and in mice liver leads to alteration of the mitochondrial ultra structure, changes in the expression and activity of mitochondrial chain complexes. These alterations of mitochondrial functions are accompanied by reduction in mitochondrial ATP levels in human fibroblasts and decreased mitochondrial respiration in ACOX1 deficient mice. Interestingly, the mitochondrial changes observed in Acox1-/- mice are restored by expression of human ACOX1 in liver suggesting an essential role of human and murine Acyl-CoA oxidase 1 activity in preventing mitochondrial and lipid disturbance.Together, the results presented in this work underscore the important role of ACOX1 in humans and mice to ensure peroxisomal β-oxidation, VLCFAs catabolism and to preserve peroxisomal morphology. Given mitochondrial perturbation in ACOX1 deficiency, it is clear that this enzyme plays a pivotal role in preventing VLCFAs accumulation and their cellular toxicity and guarantees mitochondrial normal morphology and function in response to energy demand
