4.4 Article

Novel metabolic and molecular findings in hepatic carnitine palmitoyltransferase I deficiency

Journal

MOLECULAR GENETICS AND METABOLISM
Volume 86, Issue 3, Pages 337-343

Publisher

ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.ymgme.2005.07.022

Keywords

carnitine palmitoyltransferase I deficiency; CPT1A gene mutation; mitochondrial fatty acid oxidation; urine organic acids; dicarboxylic aciduria; 3-hydroxyglutaric acid; glutaric acid; dodecanedioic; tandem MS; acylcarnitines

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Detection of hepatic carnitine palmitoyltransferase I (CPT IA) deficiency by metabolite screening may be problematic. The urine organic acid profile is generally said to be normal and no abnormal or increased acylcarnitine species are evident on bloodspot tandem MS examination. We diagnosed CPT IA deficiency presenting with acute encephalopathy +/- hypoglycemia and hepatomegaly in one Bukharan Jewish and two Palestinian Arab infants from consanguineous families. CPTIA mutation analysis identified two novel nonsense mutations, c.1737C > A (Y579X) and c.1600delC (L534fsX), extending the known genetic heterogeneity in this disorder. A distinctive organic aciduria was observed in all three patients, even several days after initiation of treatment and resolution of symptoms. Abnormal findings included a hypoketotic dicarboxylic aciduria with prominence of the C, dicarboxylic (dodecanedioic) acid. This C-12 dicarboxylic aciduria suggests that CPT I may play a role in uptake of long-chain dicarboxylic acids by mitochondria after their initial shortening by beta-oxidation in peroxisomes. In addition, increased excretion of 3-hydroxyglutaric acid was detected in all three patients, a finding previously observed only in glutaric aciduria type 1, ketosis, and short-chain hydroxyacyl-CoA dehydrogenase deficiency. Examination of urine organic acids with awareness of these metabolic findings may lead to improved diagnosis of this seemingly rare disorder. (c) 2005 Elsevier Inc. All rights reserved.

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