Analysis of clinical characteristics and ACADM gene variants in four children with Medium chain acyl-CoA dehydrogenase deficiency / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical and genetic characteristics of four patients with medium-chain acyl-CoA dehydrogenase deficiency (MCADD).@*METHODS@#Four children who had presented at the Children's Hospital Affiliated to Zhengzhou University between August 2019 and August 2021 were selected as the study subjects. Clinical data of the children were collected. The children were subjected to whole exome sequencing (WES).@*RESULTS@#All of the four children were diagnosed with MCADD. Blood amino acid and ester acyl carnitine spectrum test showed that the concentration of octanoyl carnitine (C8) was significantly increased. The main clinical manifestations included poor mental response (3 cases), intermittent diarrhea with abdominal pain (1 case), vomiting (1 case), increased transaminase (3 cases), and metabolic acidosis (2 cases). Five variants were identified by genetic testing, among which c.341A>G (p.Y114C) was unreported previously. Three were missense variants, one was frameshift variant and one was splicing variant.@*CONCLUSION@#The clinical heterogeneity of MCADD is obvious, and the severity of the disease may vary. WES can assist with the diagnosis. Delineation of the clinical symptoms and genetic characteristics of the disease can facilitate early diagnosis and treatment of the disease.

Tandem mass spectrometry and genetic variant analysis of four neonates with very long chain acyl-coenzyme A dehydrogenase deficiency / 中华医学遗传学杂志

OBJECTIVE@#To analyze the clinical features and genetic variants in four neonates with very long chain acyl-coenzyme A dehydrogenase (VLCAD) deficiency.@*METHODS@#Neonates with a tetradecenoylcarnitine (C14:1) concentration at above 0.4 μmol/L in newborn screening were recalled for re-testing. Four neonates were diagnosed with VLCAD deficiency by MS-MS and genetic testing, and their clinical features and genotypes were analyzed.@*RESULTS@#All cases had elevated blood C14:1, and the values of first recalls were all lower than the initial test. In 2 cases, the C14:1 had dropped to the normal range. 1 case has remained at above 1 μmol/L after the reduction, and the remainder one case was slightly decreased. In total eight variants of the ADACVL genes were detected among the four neonates, which included 5 missense variants and 3 novel variants (p.Met344Val, p.Ala416Val, c.1077+6T>A). No neonate showed salient clinical manifestations.@*CONCLUSION@#Above findings have enriched the spectrum of ADACVL gene mutations and provided a valuable reference for the screening and diagnosis of VLCAD deficiency.

Tandem mass spectrometry analysis and genetic diagnosis of neonates with fatty acid oxidation disorders in central and northern regions of Guangxi / 中华医学遗传学杂志

OBJECTIVE@#To determine the incidence and mutational types of fatty acid oxidation disorders (FAOD) in central-northern region of Guangxi.@*METHODS@#A total of 62 953 neonates were screened for FAOD during December 2012 and December 2017. Acyl-carnitine profiling of neonatal blood sample was performed by tandem mass spectrometry using dry blood spots on a filter paper. The diagnosis of FAOD was confirmed by organic acid profiling of urea and genetic testing.@*RESULTS@#Eighteen cases of FAOD were diagnosed among the 62 953 neonates. Among these, primary carnitine deficiency (PCD) was the most common type (n=13), which was followed by short-chain acyl-CoA dehydrogenase deficiency (SCADD) (n=2), medium-chain acyl-CoA dehydrogenase deficiency (MCADD) (n=1), multiple acyl-CoA dehydrogenase deficiency (MADD) (n=1), and carnitine palmitoyltransferase II deficiency (CPT II D) (n=1). Genetic testing has revealed two previously unreported variants, i.e., c.337G to A (p.Gly113Arg) of ACADS gene and c.737G TO T (p.Gly246Val) of ETFA gene.@*CONCLUSION@#PCD is the most common FAOD in central-northern Guangxi. Tandem mass spectrometry combined with genetic testing may facilitate early diagnosis of FAOD.

Medium-chain acyl-CoA dehydrogenase deficiency: neonatal screening and follow-uP / 中国当代儿科杂志

OBJECTIVE@#To investigate the epidemiological characteristics, phenotype, genotype, and prognosis of medium-chain acyl-CoA dehydrogenase deficiency (MCADD) in the Chinese population.@*METHODS@#A retrospective analysis was performed for the clinical data of the neonates who underwent screening with high-performance liquid chromatography-tandem mass spectrometry from January 2009 to June 2018 and were diagnosed with MCADD by gene detection.@*RESULTS@#A total of 2 674 835 neonates underwent neonatal screening, among whom 12 were diagnosed with MCADD. Gene detection was performed for 10 neonates with MCADD and found 13 mutation types at 16 mutation sites of the ACADM gene, among which there were 7 reported mutations (p.T150Rfs*4, p.M1V, p.R206C, p.R294T, p.G310R, p.M328V, and p.G362E), 5 novel mutations (p.N194D, p.A324P, p.N366S, c.118+3A>G, and c.387+1del G), and 1 exon 11 deletion; p.T150Rfs*4 was the most common mutation (4/16). The detection rate of mutation sites in the ACADM gene was 80%. No phenotype-genotype correlation was observed. Dietary guidance and symptomatic treatment were given after confirmed diagnosis. No acute metabolic imbalance was observed within 4-82 months of follow-up. All neonates had good prognosis except one who had brain dysplasia.@*CONCLUSIONS@#MCADD is relatively rare in southern China, and p.T150Rfs*4 is a common mutation in the Chinese population. Cases with positive screening results should be evaluated by octanoylcarnitine C8 value and gene detection.

Medium-chain acyl-CoA dehydrogenase enhances invasion and metastasis ability of breast cancer cells / 南方医科大学学报

OBJECTIVE@#To investigate the effect of medium-chain acyl-CoA dehydrogenase (ACADM) on invasion and metastasis of breast cancer cells and explore the underlying mechanism.@*METHODS@#A large cancer genome database was used to analyze the expression of ACADM in breast cancer tissues and normal tissues. The proliferation, migration and invasion of cultured breast cancer MCF-7 and T47D cells with ACADM overexpression or ACADM silencing were evaluated using MTT proliferation assay, EdU assay, Transwell chamber assay, and Boyden invasion assay; Western blotting was used to detect the protein expressions of the related pathway in the cells. In nude mouse models of tail vein metastasis of MCF-7 cells with or without ACADM overexpression, the tumor growth and tumor histopathology were observed using HE staining.@*RESULTS@#Analysis of the Oncomine sample set showed a significantly higher expression level of ACADM in breast cancer tissues than in normal breast tissues ( < 0.05). Overexpression of ACADM obviously enhanced the migration and invasion abilities and promoted the epithelial-mesenchymal transition (EMT) of cultured MCF-7 and T47D cells; conversely, silencing of ACADM significantly suppressed the migration and invasion of the breast cancer cells. In the nude mouse models, ACADM overexpression in MCF-7 cells significantly enhanced their migration and invasion abilities.@*CONCLUSIONS@#ACADM can promote the EMT process of breast cancer cells and improve the migration and invasion ability. ACADM is an oncogene in breast cancer.

Reye syndrome and sudden death symptoms after oral administration of nimesulide due to upper respiratory tract infection in a boy / 中国当代儿科杂志

A boy aged 6 years and 3 months developed upper respiratory tract infection and pyrexia 2 months ago and was given oral administration of nimesulide by his parents according to directions. Half an hour later, the boy experienced convulsions and cardiopulmonary arrest, and emergency examination found hypoketotic hypoglycemia, metabolic acidosis, significant increases in serum aminotransferases and creatine kinase, and renal damage. Recovery of consciousness and vital signs was achieved after cardiopulmonary resuscitation, but severe mental and movement regression was observed. The boy had a significant reduction in free carnitine in blood and significant increases in medium- and long-chain fatty acyl carnitine, urinary glutaric acid, 3-hydroxy glutaric acid, isovalerylglycine, and ethylmalonic acid, suggesting the possibility of multiple acyl-CoA dehydrogenase deficiency. After the treatment with vitamin B2, L-carnitine, and bezafibrate, the boy gradually improved, and reexamination after 3 months showed normal biochemical parameters. The boy had compound heterozygous mutations in the ETFDH gene, i.e., a known mutation, c.341G>A (p.R114H), from his mother and a novel mutation, c.1484C>G (p.P495R), from his father. Finally, he was diagnosed with multiple acyl-CoA dehydrogenase deficiency. Reye syndrome and sudden death symptoms were caused by nimesulide-induced acute metabolic crisis. It is concluded that inherited metabolic diseases may be main causes of Reye syndrome and sudden death, and biochemical and genetic analyses are the key to identifying underlying diseases.

Methionine Adenosyltransferase 1: A Proteomic Surrogate Marker of Early Hepatocellular Carcinoma in Cirrhotic Patients

BACKGROUND/AIMS: Because there is a lack of effective biomarkers, we aimed to discover proteomic candidate markers for hepatocellular carcinoma (HCC) in cirrhotic patients at the highest-risk of HCC, and to validate the markers. METHODS: We collected tumor tissue from 5 cirrhotics with HCC, and from 5 cirrhotics without HCC, who underwent liver resection or transplantation. These tissue samples were analyzed by 2-dimensional difference gel electrophoresis coupled with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and potential markers were validated at the transcriptional and translational levels. We also performed western blot assays using other blood samples from 10 cirrhotics with HCC and 10 without HCC. RESULTS: Among the 66 distinguishable spots on 2-D gel images, we identified 15 proteins overexpressed more than 1.5 fold in terms of volume ratio in the tumors. Ten of the over-expressed proteins were identified by MALDI-TOF MS; of those, only methionine adenosyltransferase 1 (MAT1), a protein specific for liver, and acyl-CoA dehydrogenase were significantly up-regulated in tumors in further immunoblotting analyses (Ps<0.05). There was no between-pair difference in MAT1 mRNA measured by real-time polymerase chain reaction (P=0.96). However, in western blots of serum samples, distinct MAT1 bands were observed in all 10 HCC patients, but in only 2 of the non-HCC patients. CONCLUSIONS: MAT1 is a potential marker for surveillance in cirrhotic patients with and without prior HCC.

An analysis of clinical characteristics and gene mutation in two patients with medium- and short-chain acyl-CoA dehydrogenase deficiency / 中国当代儿科杂志

Medium- and short-chain acyl-CoA dehydrogenase deficiency is a disorder of fatty acid β-oxidation. Gene mutation prevents medium- and short-chain fatty acids from entry into mitochondria for oxidation, which leads to multiple organ dysfunction. In this study, serum acylcarnitines and the organic acid profile in urea were analyzed in two children whose clinical symptoms were hypoglycemia and metabolic acidosis. Moreover, gene mutations in the two children and their parents were evaluated. One of the patients was a 3-day-old male who was admitted to the hospital due to neonatal asphyxia, sucking weakness, and sleepiness. The serum acylcarnitine profile showed increases in medium-chain acylcarnitines (C6-C10), particularly in C8, which showed a concentration of 3.52 μmol/L (reference value: 0.02-0.2 μmol/L). The analysis of organic acids in urea gave a normal result. Sanger sequencing revealed a reported c.580A>G (p.Asn194Asp) homozygous mutation at exon 7 of the ACADM gene. The other patient was a 3-month-old female who was admitted to the hospital due to cough and recurrent fever for around 10 days. The serum acylcarnitine profile showed an increase in serum C4 level, which was 1.66 μmol/L (reference value: 0.06-0.6 μmol/L). The analysis of organic acids in urea showed an increase in the level of ethyl malonic acid, which was 55.9 (reference value: 0-6.2). Sanger sequencing revealed a reported c.625G>A (p.Gly209Ser) homozygous mutation in the ACADS gene. This study indicates that screening tests for genetic metabolic diseases are recommended for children who have unexplained metabolic acidosis and hypoglycemia. Genetic analyses of the ACADM and ACADS genes are helpful for the diagnosis of medium- and short-chain acyl-CoA dehydrogenase deficiency.

Compound heterozygous mutations of ACADS gene in newborn with short chain acyl-CoA dehydrogenase deficiency: case report and literatures review / 소아과

Short-chain acyl-CoA dehydrogenase deficiency (SCADD) is a rare autosomal recessive mitochondrial disorder of fatty acid β-oxidation, and is associated with mutations in the acyl-CoA dehydrogenase (ACADS) gene. Recent advances in spectrometric screening for inborn errors of metabolism have helped detect several metabolic disorders, including SCADD, without symptoms in the neonate period. This allows immediate initiation of treatment and monitoring, so they remain largely symptomless metabolic disease. Here, we report a 15-month-old asymptomatic male, who was diagnosed with SCADD by newborn screening. Spectrometric screening for inborn errors of metabolism 72 hours after birth revealed an elevated butyrylcarnitine (C4) concentration of 2.25 µmol/L (normal, T (p.Pro55Leu) and c.1031A>G (p.Glu344Gly) on exons 2 and 9, respectively. The patient is now growing up, unretarded by symptoms such as seizure and developmental delay.

Evidencia del polimorfismo 511C>T en el gen de la acil-CoA deshidrogenasade cadena corta en Colombia / Evidence of 511C>T polymorphism in the short chain acyl-CoA dehydrogenase gene in Colombia / Evidência do polimorfismo 511C>T no gene da acil-CoA desidrogenase de cadeia curta na Colômbia

La acil-CoA deshidrogenasa de cadena corta (SCAD) cataliza la reacción inicial de la ß-oxidación de los ácidos grasos de cadena corta. La deficiencia hereditaria de SCAD ha sido reportada y han sido descritos pocos casos de la misma. El presente estudio pretendió determinar la posible presencia del polimorfismo 511C>T en Caldas (Colombia), debido a que las variantes 625G>A y 511C>T en el gen de la acil-CoA deshidrogenasa de cadena corta están presentes en el 14% de algunas poblaciones estudiadas, causando algunas veces su deficiencia. El presente estudio es descriptivo. Muestras de sangre de 300 voluntarios fueron estudiadas para el polimorfismo 511C>T mediante la técnica de polimorfismo de conformación de la cadena simple, utilizando ADN amplificado por reacción en cadena de la polimerasa. Los resultados fueron confirmados por secuenciación. El polimorfismo fue identificado en tres personas aparentemente sanas. Existe evidencia de la presencia del polimorfismo 511C>T en el gen de la acil-CoA en Colombia, lo que significa que algunas personas de esta población pueden tener riesgo de sufrir su deficiencia.

Short-chain acyl-CoA dehydrogenase (SCAD) catalyzes the initial reaction in short-chain fatty acid ß-oxidation. Hereditary SCAD deficiency has been reported and only few cases of this disorder have been described. The present study was conducted to determine the possible presence of the 511C>T variation in the short-chain acyl-CoA dehydrogenase gene in Caldas (Colombia), as the 625G>A and 511C>T variations are present in 14% of some studied populations causing its deficiency on some occasions. The present study is descriptive, blood samples of three hundred adult volunteers were tested for 511C>T polymorphism, analysing the polymerase chain reaction amplified cDNA, using a single-stranded conformation polymorphism assay. The results were confirmed by direct bidirectional cycle sequencing using DNA from the positive patients. The polymorphism was identified and confirmed in three healthy persons. This is evidence of the presence of 511C>T polymorphism in the short chain acyl-coA dehydrogenase gene in Colombia, which means that some people in these populations can be at risk of suffering SCAD deficiency.

A acil-CoA desidrogenase de cadeia curta (SCAD) catalisa a reação inicial da b-oxidação dos ácidos graxos de cadeia curta. Foi reportada a deficiência hereditária de SCAD e poucos casos da deficiência foram descritos. O presente trabalho quis determinar a possível presença do polimorfismo 511C>T em Caldas (Colômbia), devido a que as variantes 625G>A e 511C>T no gene da acil-CoA desidrogenase de cadeia curta estão presentes em 14% de algumas populações estudadas, produzindo algumas vezes sua deficiência. O presente estudo é descritivo. Amostras de sangue de 300 voluntários foram analisadas para o polimorfismo 511C>T através da técnica de polimorfismo de conformação da cadeia simples, utilizando DNA amplificado por reação em cadeia da polimerase. Os resultados foram confirmados por sequenciamento. O polimorfismo foi identificado em três pessoas aparentemente saudáveis. Existe evidência da presença do polimorfismo 511C>T no gene da acil-CoA na Colômbia, o que significa que algumas pessoas desta população correm o risco de sofrer sua deficiência.

Identification of Novel Compound Heterozygous Mutations in the ACADS Gene of an Asymptomatic Korean Newborn with Short Chain Acyl-CoA Dehydrogenase Deficiency by Tandem Mass Spectrometry

Short-chain acyl-CoA dehydrogenase deficiency (SCADD; OMIM # 201470) is an autosomal recessive inborn error of mitochondrial fatty acid beta-oxidation, presenting with a variety of clinical signs and symptoms. Developmental delay, hypertonia or hypotonia, ketotic hypoglycemia, and epilepsy are most frequently reported. In general, patients diagnosed through newborn screening have shown normal growth and development in contrast to those diagnosed as a result of clinically initiated evaluations. Here, the case of an asymptomatic Korean newborn with SCADD identified by tandem mass spectrometry is reported. The patient showed an elevated concentration of butyrylcarnitine detected on newborn screening. Urinary excretion of ethylmalonic acid was elevated by urine organic acid analysis. To confirm the diagnosis of SCADD, a direct sequencing analysis of 10 coding exons and the exon-intron boundaries of the ACADS gene were performed. Genetic analysis of ACADS showed the following novel compound heterozygous missense mutations: c.277C>A (p.Leu93Ile) on exon3 and c.682G>A (p.Glu288Lys) on exon6. These results will provide further evidence of mutational heterogeneity for SCADD.

Clinical, Biochemical and Genetic Analyses in Two Korean Patients with Medium-chain Acyl-CoA Dehydrogenase Deficiency / 대한진단검사의학회지

Medium-chain acyl-CoA dehydrogenase deficiency (MCADD) is an autosomal recessive hereditary metabolic disorder of mitochondrial fatty acid beta-oxidation. It is characterized by hypoketotic hypoglycemia, hyperammonemia, seizure, coma, and sudden infant death syndrome-like illness. The most frequently isolated mutation in the acyl-CoA dehydrogenase, medium-chain (ACADM) gene of Caucasian patients with MCADD is c.985A>G, but ethnic variations exist in the frequency of this mutation. Here, we describe 2 Korean pediatric cases of MCADD, which was detected during newborn screening by tandem mass spectrometry and confirmed by molecular analysis. The levels of medium-chain acylcarnitines, including octanoylcarnitine (C8), hexanoylcarnitine (C6), and decanoylcarnitine (C10), were typically elevated. Molecular studies revealed that Patient 1 was a compound heterozygote for c.449_452delCTGA (p.Thr150ArgfsX4) and c.461T>G (p.L154W) mutations, and Patient 2 was a compound heterozygote for c.449_452delCTGA (p.Thr150ArgfsX4) and c.1189T>A (p.Y397N) mutations. We detected asymptomatic patients with MCADD by using a newborn screening test and confirmed it by ACADM mutation analysis. This report presents evidence of the biochemical and molecular features of MCADD in Korean patients and, to the best of our knowledge, this is the first report of the c.461T>G mutation in the ACADM gene.

Evidence in Colombia of 625G>A polymorphism in the short chain acyl-CoA dehydrogenase gene, a variation which could cause glutaric aciduria in our populations / Evidencia del polimorfismo 625G>A en el gen de la acil-CoA deshidrogenasa de cadena corta en Colombia, una variación que podría causar aciduria glutárica en algunas poblaciones del país

Introduction: Short-chain acyl-CoA dehydrogenase (SCAD) is a homotetrameric mitochondrial flavoenzyme that catalyzes the initial reaction in short-chain fatty acid b-oxidation. The SCAD gene is located on chromosome 12q22 and is approximately 13 kb long with 10 exons and 1236 nucleotides of coding sequence. Hereditary SCAD deficiency has been reported and only a few cases of this disorder have been described. Objective: The present study was conducted to determine the possible presence of the 625G>A variation in the short-chain acyl-CoA dehydrogenase gene in Caldas (Colombia), given that variations 625G>A and 511C>T are present in 14% of some studied populations; thereby sometimes causing its deficiency. Methods: This is a descriptive study; blood samples from three-hundred adult volunteers were tested for 625G>A polymorphism, analysing the polymerase chain reaction amplified cDNA, using a single-stranded conformation polymorphism assay. The results were confirmed by direct bidirectional cycle sequencing using DNA from the positive persons. Results: The polymorphism was identified and confirmed in four healthy persons. Conclusion: This is evidence of the presence of 625G>A polymorphism in the short-chain acyl-CoA dehydrogenase gene in Colombia, meaning that some people in our populations can be at risk of suffering SCAD deficiency and its main complication: the ethylmalonic aciduria.

Introducción: La acil-CoA deshidrogenasa de cadena corta (SCAD) es una flavoenzima homotetramérica mitocondrial que cataliza la reacción inicial de la â-oxidación de los ácidos grasos de cadena corta. El gen SCAD se ubica en el cromosoma 12q22, con una longitud de 13 kb, con 10 exones y 1236 nucleótidos de secuencia codificadora. Se ha informado la deficiencia hereditaria de SCAD y se han descrito pocos casos de la deficiencia. Objetivo: El presente estudio buscó determinar la posible presencia del polimorfismo 625G>A en Caldas, Colombia, debido a que las variantes 625G>A y 511C>T en el gen de la acil-CoA deshidrogenasa de cadena corta están presentes en 14% de algunas poblaciones estudiadas, causando algunas veces su deficiencia. Métodos: El presente estudio es descriptivo; se estudiaron muestras de sangre de 300 voluntarios para el polimorfismo 625G>A mediante la técnica de polimorfismo de conformación de la cadena simple, con ADN amplificado por reacción en cadena de la polimerasa. Los resultados se confirmaron por secuenciación. Resultados: El polimorfismo se identificó en cuatro personas aparentemente sanas. Conclusión: Existe evidencia de la presencia del polimorfismo 625 G>A en el gen de la acil-CoA en Colombia, lo que significa que algunas personas en la  poblaciones del país pueden estar en riesgo de sufrir deficiencia de SCAD y su principal complicación, la aciduria etilmalónica.

Tráfico de acyl- CoA de membrana y niveles remanentes en glóbulos rojos, plasma y suero, analizados por espectrometría de masas en tandemso de la espectrometría de masas en tándem / Membrane ACYL-CoA traffic and remaning levels in red blood cells, plasma and serum analysed

Existe un cuestionamiento permanente acerca del fluido ideal para el análisis de carnitina y acilcarnitina por medio de la espectrometría de masas en tándem. El presente estudio evalúa el porcentaje de carnitina y acilcarnitinas en glóbulos rojos y la relación con el contenido de carnitina y acilcarnitina en la sangre, plasma y suero. Se centrifugaron muestras de sangre humana, se extrajeron plasma y suero, y se lavaron los glóbulos rojos con diferentes soluciones isotónicas. Se resuspendió el pellet en PBS para la preparación de tarjetas y análisis por espectrometría de masas en tandem. Se encontró que la carnitina y las acilcarnitinas de cadenas corta, media y larga, permanecen en los glóbulos rojos en porcentajes promedio de 43,4; 48;49; y 70% respectivamente. Se encontró una diferencia significativa entre los niveles de carnitina y acilcarnitina en la sangre comparado con sus niveles en plasma o suero (p<0,05). Dada la asociación de la carnitina y las acilcarnitinas con los glóbulos rojos, parece ser que ni la plasma ni el suero son el material ideal para el análisis de carnitina y acilcarnitinas.

There has been a permanent question about the ideal fluid for carnitine and acylcarnitine analysis by tandem mass spectrometry. The present study evaluates the percentage of carnitine and acylcarnitines in red blood cells and the relationship with the carnitine and acylcarnitines content in whole blood, plasma, and serum. Human blood samples were centrifuged, plasma or serum extracted, and blood cells were washed with different isotonic solutions. The final pellet was resuspended in PBS for card preparation and tandem mass spectrometry analysis. It was found that carnitine, short-chain, medium-chain and longchain acylcarnitines remain in red blood cells at average percentages of 43.4; 48; 49; and 70% respectively. A significant difference was found between carnitine and acylcarnitine levels in whole blood compare to its levels in plasma or serum (p<0.05). As carnitine and acylcarnitines remained associated with the blood cells, it seems therefore that plasma (or serum) is not the ideal material for the analysis of carnitine and acylcarnitines.

Diagnóstico "in vitro" de la deficiencia de ACIL-CoA deshidrogenasa de cadena corta / \"In vitro\" diagnosis of short chain acyl-CoA dehydrogenase deficiency

La acil-CoA deshidrogenasa de cadena corta (SCAD) cataliza la primera reacción de la degradación de ácidos grasos de 4 a 6 átomos de carbono. Su deficiencia debe ser siempre confirmada por estudios de laboratorio. En el presente trabajo, fueron incubados fibroblastos de pacientes que presentaban la deficiencia de SCAD, en presencia de sustratos tritiados. Fue encontrada diferencia significativa (p<0,05) al comparar la degradación de palmitato y miristato tritiado entre controles y pacientes con deficiencia de SCAD.

Short-chain acyl-CoA dehydrogenase (SCAD) is the key enzyme for degrading fatty acids with a 4-6 atoms carbon chain. It is necessary to always confirm this deficiency using laboratory methods. Fibroblasts of patients suffering SCAD deficiency were incubated with tritiated palmitate and miristatesubstrates. A significant difference (p<0.05) was found when comparing tritiated palmitate and miristate degradation between controls and patients suffering SCAD deficiency.

Inherited metabolic diseases in the urine organic acid analysis of complex febrile seizure patients / 소아과

PURPOSE: Seizure associated with fever may indicate the presence of underlying inherited metabolic diseases. The present study was performed to investigate the presence of underlying metabolic diseases in patients with complex febrile seizures, using analyses of urine organic acids. METHODS: We retrospectively analyzed and compared the results of urine organic acid analysis with routine laboratory findings in 278 patients referred for complex febrile seizure. RESULTS: Of 278 patients, 132 had no abnormal laboratory findings, and 146 patients had at least one of the following abnormal laboratory findings: acidosis (n=58), hyperammonemia (n=55), hypoglycemia (n=21), ketosis (n=12). Twenty-six (19.7%) of the 132 patients with no abnormal findings and 104 (71.2%) of the 146 patients with statistically significant abnormalities showed abnormalities on the organic acid analysis (P<0.05). Mitochondrial respiratory chain disorders (n=23) were the most common diseases found in the normal routine laboratory group, followed by PDH deficiency (n=2 ) and ketolytic defect (n=1). In the abnormal routine laboratory group, mitochondrial respiratory chain disorder (n=29) was the most common disease, followed by ketolytic defects (n=27), PDH deficiency (n=9), glutaric aciduria type II (n=9), 3-methylglutaconic aciduria type III (n=6), biotinidase deficiency (n=5), propionic acidemia (n=4), methylmalonic acidemia (n=2), 3-hydroxyisobutyric aciduria (n=2), orotic aciduria (n=2), fatty acid oxidation disorders (n=2), 2-methylbranched chain acyl CoA dehydrogenase deficiency (n=2), 3-methylglutaconic aciduria type I (n=1), maple syrup urine disease (n=1), isovaleric acidemia (n=1), HMG-CoA lyase deficiency (n=1), L-2-hydroxyglutaric aciduria (n=1), and pyruvate carboxylase deficiency (n=1). CONCLUSION: These findings suggest that urine organic acid analysis should be performed in all patients with complex febrile seizure and other risk factors for early detection of inherited metabolic diseases.

What is the Key Step in Muscle Fatty Acid Oxidation after Change of Plasma Free Fatty Acids Level in Rats?

The purpose of this study was to discern the critical point in skeletal muscle fatty acid oxidation by changing plasma free fatty acids (FFA) level in rat. In the study, 3 key steps in lipid oxidation were examined after changing plasma FFA level by acipimox. The rates of both palmitate and palmitoyl- carnitine oxidation were decreased by decrease of plasma FFA level, however, carnitine palmitoyl transferase (CPT) 1 activity was not changed, suggesting CPT1 activity may not be involved in the fatty acid oxidation at the early phase of plasma FFA change. In the fasted rats, beta-hydroxy acyl-CoA dehydrogenase (beta-HAD) activity was depressed to a similar extent as palmitate oxidation by a decrease of plasma FFA level. This suggested that beta-oxidation might be an important process to regulate fatty acid oxidation at the early period of plasma FFA change. Citrate synthase activity was not altered by the change of plasma FFA level. In conclusion, the critical step in fatty acids oxidation of skeletal muscles by the change of plasma FFA level by acipimox in fasting rats might be the beta-oxidation step rather than CPT1 and TCA cycle pathways.

Hypoglycemic coma in a young girl: first case of medium chain Acyl-Co Dehydrogenase [MCAD] deficiency identified in Kuwait

Medium-chain acyl CoA dehydrogenase [MCAD] deficiency is the commonest inborn error of fatty acid oxidation. Affected children usually present within the first two years of life with re c u r rent episodes of hypoketotic hypoglycemia and lethargy with high risk of mortality and morbidity. We describe a two-year old girl who presented with hypoglycemic hypoketotic coma due to MCAD and we describe the investigative work-up that led to the diagnosis. Our aim is to increase awareness of this disorder and to emphasize the need for prompt diagnosis and management. This is the first case of MCAD deficiency identified in Kuwait and we believe that this condition may be under-diagnosed

A Suspect Case of Medium Chanin Acyl-Coenzyme A Dehydrogenase Deficiency with Iron Deficiency Anemia / 대한소아혈액종양학회지

Iron deficiency anemia is a common disorder during infancy and childhood. Medium chain acyl-CoA dehydrogenase (MCAD) deficiency is the most common disorder of mitochondrial fatty acid oxidation. However, this metabolic disorder is extremely rare among Asians. Generally MCAD deficiency patients are healthy until initial presentation of hypoketogenic hypoglycemia and encephalopathy which is predisposed by an intercurrent illness and/or a period of poor oral intake. The first attack causes a high risk of mortality or permanent neurologic sequelae. The authors report a suspect case of MCAD deficiency with iron deficiency anemia, with a brief review of related literatures.