Biochemical, clinical and molecular findings in LCHAD and general mitochondrial trifunctional protein deficiency

Title

Biochemical, clinical and molecular findings in LCHAD and general mitochondrial trifunctional protein deficiency

Creator

Olpin SE; Clark S; Andresen BS; Bischoff C; Olsen RK; Gregersen N; Chakrapani A; Downing M; Manning NJ; Sharrard M; Bonham JR; Muntoni F; Turnbull DN; Pourfarzam M

Publisher

Journal Of Inherited Metabolic Disease

Date

2005

Subject

Humans; Male; Prognosis; Mutation; Longitudinal Studies; Phenotype; Fibroblasts/metabolism; Lipid Metabolism; Multienzyme Complexes/deficiency; Mitochondria/pathology; Acyl-CoA Dehydrogenase; Cardiomyopathies/diagnosis/genetics; Carnitine/analogs & derivatives/metabolism; Exons; Fatty Acids/metabolism; Homozygote; Inborn Errors/diagnosis/genetics; Long-Chain/deficiency; Polyneuropathies/diagnosis/genetics; Rhabdomyolysis/diagnosis/genetics

Description

General mitochondrial trifunctional protein (TFP) deficiency leads to a wide clinical spectrum of disease ranging from severe neonatal/infantile cardiomyopathy and early death to mild chronic progressive sensorimotor poly-neuropathy with episodic rhabdomyolysis. Isolated long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency resulting from the common Glu510Gln mutation usually gives rise to a moderately severe phenotype with multiorgan involvement with high morbidity and mortality. However, isolated LCHAD deficiency can also be consistent with long-term survival in patients identified and treated from an early age. We present biochemical, clinical and mutation data in 9 patients spanning the full spectrum of disease. Fibroblast acylcarnitine profiling shows good correlation with clinical phenotype using the ratio C18(OH)/(C14(OH)+C12(OH)). This ratio shows a gradation of values, from high in four patients with severe neonatal disease (2.5+/-0.8), to low in two neuromyopathic patients (0.35, 0.2). Fibroblast fatty acid oxidation flux assays also show correlation with the patient phenotype, when expressed either as percentage residual activity with palmitate or as a ratio of percentage activity of myristate/oleate (M/O ratio). Fibroblasts from four patients with severe neonatal disease gave an M/O ratio of 4.0+/-0.6 compared to 1.97 and 1.62 in two neuromyopathic patients. Specific enzyme assay of LCHAD and long-chain 3-ketothiolase activity in patient cells shows lack of correlation with phenotype. These results show that measurements in intact cells, which allow all determinative and modifying cellular factors to be present, better reflect patient phenotype. Mutation analysis reveals a number of alpha- and beta-subunit mutations. Peripheral sensorimotor polyneuropathy, often as the initial major presenting feature but usually later accompanied by episodic rhabdomyolysis, is a manifestation of mild TFP protein deficiency. The mild clinical presentation and relative difficulty in diagnosis suggest that this form of TFP is probably underdiagnosed.
2005

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

533-544

Issue

4

Volume

28

Citation

Olpin SE; Clark S; Andresen BS; Bischoff C; Olsen RK; Gregersen N; Chakrapani A; Downing M; Manning NJ; Sharrard M; Bonham JR; Muntoni F; Turnbull DN; Pourfarzam M, “Biochemical, clinical and molecular findings in LCHAD and general mitochondrial trifunctional protein deficiency,” Pediatric Palliative Care Library, accessed October 23, 2021, https://pedpalascnetlibrary.omeka.net/items/show/13778.

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