Amino Acids & Proteins
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Inherited Metabolic Disease
Inherited metabolic disease Dr Neil W Hopper SRH Areas for discussion • Introduction to IEMs • Presentation • Initial treatment and investigation of IEMs • Hypoglycaemia • Hyperammonaemia • Other presentations • Management of intercurrent illness • Chronic management Inherited Metabolic Diseases • Result from a block to an essential pathway in the body's metabolism. • Huge number of conditions • All rare – very rare (except for one – 1:500) • Presentation can be non-specific so index of suspicion important • Mostly AR inheritance – ask about consanguinity Incidence (W. Midlands) • Amino acid disorders (excluding phenylketonuria) — 18.7 per 100,000 • Phenylketonuria — 8.1 per 100,000 • Organic acidemias — 12.6 per 100,000 • Urea cycle diseases — 4.5 per 100,000 • Glycogen storage diseases — 6.8 per 100,000 • Lysosomal storage diseases — 19.3 per 100,000 • Peroxisomal disorders — 7.4 per 100,000 • Mitochondrial diseases — 20.3 per 100,000 Pathophysiological classification • Disorders that result in toxic accumulation – Disorders of protein metabolism (eg, amino acidopathies, organic acidopathies, urea cycle defects) – Disorders of carbohydrate intolerance – Lysosomal storage disorders • Disorders of energy production, utilization – Fatty acid oxidation defects – Disorders of carbohydrate utilization, production (ie, glycogen storage disorders, disorders of gluconeogenesis and glycogenolysis) – Mitochondrial disorders – Peroxisomal disorders IMD presentations • ? IMD presentations • Screening – MCAD, PKU • Progressive unexplained neonatal -
Genes Investigated
BabyNEXTTM EXTENDED Investigated genes and associated diseases Gene Disease OMIM OMIM Condition RUSP gene Disease ABCC8 Familial hyperinsulinism 600509 256450 Metabolic disorder - ABCC8-related Inborn error of amino acid metabolism ABCD1 Adrenoleukodystrophy 300371 300100 Miscellaneous RUSP multisystem (C) * diseases ABCD4 Methylmalonic aciduria and 603214 614857 Metabolic disorder - homocystinuria, cblJ type Inborn error of amino acid metabolism ACAD8 Isobutyryl-CoA 604773 611283 Metabolic Disorder - RUSP dehydrogenase deficiency Inborn error of (S) ** organic acid metabolism ACAD9 acyl-CoA dehydrogenase-9 611103 611126 Metabolic Disorder - (ACAD9) deficiency Inborn error of fatty acid metabolism ACADM Acyl-CoA dehydrogenase, 607008 201450 Metabolic Disorder - RUSP medium chain, deficiency of Inborn error of fatty (C) acid metabolism ACADS Acyl-CoA dehydrogenase, 606885 201470 Metabolic Disorder - RUSP short-chain, deficiency of Inborn error of fatty (S) acid metabolism ACADSB 2-methylbutyrylglycinuria 600301 610006 Metabolic Disorder - RUSP Inborn error of (S) organic acid metabolism ACADVL very long-chain acyl-CoA 609575 201475 Metabolic Disorder - RUSP dehydrogenase deficiency Inborn error of fatty (C) acid metabolism ACAT1 Alpha-methylacetoacetic 607809 203750 Metabolic Disorder - RUSP aciduria Inborn error of (C) organic acid metabolism ACSF3 Combined malonic and 614245 614265 Metabolic Disorder - methylmalonic aciduria Inborn error of organic acid metabolism 1 ADA Severe combined 608958 102700 Primary RUSP immunodeficiency due -
Amino Acid Disorders
471 Review Article on Inborn Errors of Metabolism Page 1 of 10 Amino acid disorders Ermal Aliu1, Shibani Kanungo2, Georgianne L. Arnold1 1Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 2Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA Contributions: (I) Conception and design: S Kanungo, GL Arnold; (II) Administrative support: S Kanungo; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: E Aliu, GL Arnold; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Georgianne L. Arnold, MD. UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Suite 1200, Pittsburgh, PA 15224, USA. Email: [email protected]. Abstract: Amino acids serve as key building blocks and as an energy source for cell repair, survival, regeneration and growth. Each amino acid has an amino group, a carboxylic acid, and a unique carbon structure. Human utilize 21 different amino acids; most of these can be synthesized endogenously, but 9 are “essential” in that they must be ingested in the diet. In addition to their role as building blocks of protein, amino acids are key energy source (ketogenic, glucogenic or both), are building blocks of Kreb’s (aka TCA) cycle intermediates and other metabolites, and recycled as needed. A metabolic defect in the metabolism of tyrosine (homogentisic acid oxidase deficiency) historically defined Archibald Garrod as key architect in linking biochemistry, genetics and medicine and creation of the term ‘Inborn Error of Metabolism’ (IEM). The key concept of a single gene defect leading to a single enzyme dysfunction, leading to “intoxication” with a precursor in the metabolic pathway was vital to linking genetics and metabolic disorders and developing screening and treatment approaches as described in other chapters in this issue. -
Annual Symposium of the Society for the Study of Inborn Errors of Metabolism Birmingham, UK, 4 – 7 September 2012
J Inherit Metab Dis (2012) 35 (Suppl 1):S1–S182 DOI 10.1007/s10545-012-9512-z ABSTRACTS Annual Symposium of the Society for the Study of Inborn Errors of Metabolism Birmingham, UK, 4 – 7 September 2012 This supplement was not sponsored by outside commercial interests. It was funded entirely by the SSIEM. 01. Amino Acids and PKU O-002 NATURAL INHIBITORS OF CARNOSINASE (CN1) O-001 Peters V1 ,AdelmannK2 ,YardB2 , Klingbeil K1 ,SchmittCP1 , Zschocke J3 3-HYDROXYISOBUTYRIC ACID DEHYDROGENASE DEFICIENCY: 1Zentrum für Kinder- und Jugendmedizin de, Heidelberg, Germany IDENTIFICATION OF A NEW INBORN ERROR OF VALINE 2Universitätsklinik, Mannheim, Germany METABOLISM 3Humangenetik, Innsbruck, Austria Wanders RJA1 , Ruiter JPN1 , Loupatty F.1 , Ferdinandusse S.1 , Waterham HR1 , Pasquini E.1 Background: Carnosinase degrades histidine-containing dipeptides 1Div Metab Dis, Univ Child Hosp, Amsterdam, Netherlands such as carnosine and anserine which are known to have several protective functions, especially as antioxidant agents. We recently Background, Objectives: Until now only few patients with an established showed that low carnosinase activities protect from diabetic nephrop- defect in the valine degradation pathway have been identified. Known athy, probably due to higher histidine-dipeptide concentrations. We deficiencies include 3-hydroxyisobutyryl-CoA hydrolase deficiency and now characterized the carnosinase metabolism in children and identi- methylmalonic semialdehyde dehydrogenase (MMSADH) deficiency. On fied natural inhibitors of carnosinase. the other hand many patients with 3-hydroxyisobutyric aciduria have been Results: Whereas serum carnosinase activity and protein concentrations described with a presumed defect in the valine degradation pathway. To correlate in adults, children have lower carnosinase activity although pro- identify the enzymatic and molecular defect in a group of patients with 3- tein concentrations were within the same level as for adults. -
Omics Knowledgebase for Mammalian Cellular Signaling Pathways
bioRxiv preprint doi: https://doi.org/10.1101/401729; this version posted August 27, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. The Signaling Pathways Project: an integrated ‘omics knowledgebase for mammalian cellular signaling pathways Scott Ochsner, David Abraham*, Kirt Martin*, Wei Ding, Apollo McOwiti, Zichen Wang, Kaitlyn Andreano, Ross A. Hamilton, Yue Chen, Angelica Hamilton, Marin L. Gantner, Michael Dehart, Shijing Qu, Susan G. Hilsenbeck, Lauren B. Becnel, Dave Bridges, Avi Ma’ayan, Janice M. Huss, Fabio Stossi, Charles E. Foulds, Anastasia Kralli, Donald P. McDonnell and Neil J. McKenna Address Correspondence To: Neil J. McKenna Department of Molecular and Cellular Biology Baylor College of Medicine Houston, TX 77030 USA e: [email protected] t: 713-798-8568 *These authors contributed equally to this study 1 bioRxiv preprint doi: https://doi.org/10.1101/401729; this version posted August 27, 2018. The copyright holder for this preprint (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. Summary Public transcriptomic and ChIP-Seq datasets have the potential to illuminate facets of transcriptional regulation by mammalian cellular signaling pathways not yet explored in the research literature. Unfortunately, a variety of obstacles prevent routine re-use of these datasets by bench biologists for hypothesis generation and data validation. Here, we designed a web knowledgebase, the Signaling Pathways Project (SPP), which incorporates stable community classifications of three major categories of cellular signaling pathway node (receptors, enzymes and transcription factors) and the bioactive small molecules (BSMs) known to modulate their functions. -
Amino Acid Disorders Detected by Quantitative Amino Acid HPLC Analysis in Thailand: an Eight-Year Experience
ارا ه ت ه از $&% #ت "! Clinica Chimica Acta 413 (2012) 1141–1144 Contents lists available at SciVerse ScienceDirect Clinica Chimica Acta journal homepage: www.elsevier.com/locate/clinchim Amino acid disorders detected by quantitative amino acid HPLC analysis in Thailand: An eight-year experience Nithiwat Vatanavicharn ⁎, Pisanu Ratanarak, Somporn Liammongkolkul, Achara Sathienkijkanchai, Pornswan Wasant Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand article info abstract Article history: Background: Amino acid disorders are a major group of inborn errors of metabolism (IEM) with variable clin- Received 13 October 2011 ical presentations. This study was aimed to provide the data of amino acid disorders detected in high-risk Received in revised form 16 March 2012 Thai patients referred to our metabolic lab from all over the country. Accepted 20 March 2012 Methods: From 2001 to 2009, we analyzed amino acids by HPLC in 1214 plasma and cerebrospinal fluid spec- Available online 23 March 2012 imens. These specimens were obtained from patients with clinical suspicion of IEM or with positive newborn screening. The clinical data of the patients with confirmed diagnoses of amino acid disorders were also ana- Keywords: lyzed. Amino acid disorders HPLC Results: Fifty-eight patients were diagnosed with amino acid disorders, including 20 cases (34.5%) with maple Thailand syrup urine disease, 13 (22.4%) with phenylketonuria and hyperphenylalaninemia, 13 (22.4%) with nonke- totic hyperglycinemia, 9 (15.5%) with urea cycle defects, 2 (3.4%) with classical homocystinuria, and 1 (1.7%) with ornithine aminotransferase deficiency. There was considerable delay in diagnoses which led to poor outcomes in most patients. -
Enteral Nutrition
UnitedHealthcare® Commercial Coverage Determination Guideline Enteral Nutrition Guideline Number: CDG.027.03 Effective Date: July 1, 2021 Instructions for Use Table of Contents Page Related Commercial Policies Coverage Rationale ........................................................................... 1 • Durable Medical Equipment, Orthotics, Medical Definitions ........................................................................................... 2 Supplies and Repairs/ Replacements Applicable Codes .............................................................................. 3 References .......................................................................................10 Community Plan Policy Guideline History/Revision Information .......................................10 • Oral and Enteral Nutrition Instructions for Use .........................................................................10 Coverage Rationale Indications for Coverage Certain plans may include coverage for enteral nutrition (enteral formulas and low protein modified food products). Refer to the member specific benefit plan document to determine if this coverage applies. For Plans with Language that Cover Enteral Nutrition For plans that cover enteral nutrition, if there is a difference between a member specific benefit plan document and the information below, the member specific benefit plan document should be used for making benefit determinations. Note: Check state mandate applicability before proceeding with the following. Benefits are provided -
Catabolism of the Carbon Skeletons of Amino Acids
Bio. 2. ASPU. Lectu.3. Prof. Dr. F. ALQuobaili Catabolism of the Carbon Skeletons of Amino Acids • Biomedical Importance ‐ The metabolic diseases or "inborn errors of metabolism" associated with conversion of the carbon skeletons of the common L ‐‐amino acids to amphibolic intermediates can result in irreversible brain damage and .(ﺍﻟﻭﻓﺎﺓ) early mortality ‐ Prenatal or early postnatal detection and timely initiation of treatment thus are essential. Almost all states conduct screening tests for up to as many as 30 metabolic diseases. ‐ The best screening tests use tandem mass spectrometry to detect, in a few drops of neonate blood, catabolites suggestive of a metabolic defect. ‐ Treatment consists primarily of feeding diets low in the amino acids whose catabolism is impaired. • Transamination Typically Initiates Amino Acid Catabolism Removal of ‐amino nitrogen by transamination is the first catabolic reaction of amino acids except for proline, hydroxyproline, threonine, and lysine. The hydrocarbon skeleton that remains is then degraded to amphibolic intermediates. • Asparagine, Aspartate, Glutamine, and Glutamate All four carbons of asparagine and aspartate form oxaloacetate. Analogous reactions convert glutamine and glutamate to ‐ ketoglutarate. No metabolic defects are associated with the catabolism of these four amino acids. • Proline The catabolism of proline takes place in mitochodria. Since proline does not participate in transamination, the nitrogen of this imino acid is retained throughout its oxidation to 1‐ pyrolline‐5‐carboxylate, ring opening to glutamate‐‐ semialdehyde, and oxidation to glutamate, and is only removed during transamination of glutamate to ‐ketoglutarate. There are two metabolic disorders of proline catabolism. Both types are inherited as autosomal recessive traits, and are consistent with a normal adult life. -
Attachment a Rare and Expensive Disease List As of December 27, 2010 ICD-9 Age Disease Guidelines Code Group 042
Attachment A Rare and Expensive Disease List as of December 27, 2010 ICD-9 Age Disease Guidelines Code Group 042. Symptomatic HIV disease/AIDS 0-20 (A) A child <18 mos. who is known to be HIV (pediatric) seropositive or born to an HIV-infected mother and: * Has positive results on two separate specimens (excluding cord blood) from any of the following HIV detection tests: --HIV culture (2 separate cultures) --HIV polymerase chain reaction (PCR) --HIV antigen (p24) N.B. Repeated testing in first 6 mos. of life; optimal timing is age 1 month and age 4-6 mos. or * Meets criteria for Acquired Immunodeficiency Syndrome (AIDS) diagnosis based on the 1987 AIDS surveillance case definition V08 Asymptomatic HIV status 0-20 (B) A child >18 mos. born to an HIV-infected (pediatric) mother or any child infected by blood, blood products, or other known modes of transmission (e.g., sexual contact) who: * Is HIV-antibody positive by confirmatory Western blot or immunofluorescense assay (IFA) or * Meets any of the criteria in (A) above 795.71 Infant with inconclusive HIV result 0-12 (E) A child who does not meet the criteria above months who: * Is HIV seropositive by ELISA and confirmatory Western blot or IFA and is 18 mos. or less in age at the time of the test or * Has unknown antibody status, but was born to a mother known to be infected with HIV 270.0 Disturbances of amino-acid 0-20 Clinical history and physical exam; laboratory transport studies supporting diagnosis. Subspecialist Cystinosis consultation note may be required. -
Diseases Catalogue
Diseases catalogue AA Disorders of amino acid metabolism OMIM Group of disorders affecting genes that codify proteins involved in the catabolism of amino acids or in the functional maintenance of the different coenzymes. AA Alkaptonuria: homogentisate dioxygenase deficiency 203500 AA Phenylketonuria: phenylalanine hydroxylase (PAH) 261600 AA Defects of tetrahydrobiopterine (BH 4) metabolism: AA 6-Piruvoyl-tetrahydropterin synthase deficiency (PTS) 261640 AA Dihydropteridine reductase deficiency (DHPR) 261630 AA Pterin-carbinolamine dehydratase 126090 AA GTP cyclohydrolase I deficiency (GCH1) (autosomal recessive) 233910 AA GTP cyclohydrolase I deficiency (GCH1) (autosomal dominant): Segawa syndrome 600225 AA Sepiapterin reductase deficiency (SPR) 182125 AA Defects of sulfur amino acid metabolism: AA N(5,10)-methylene-tetrahydrofolate reductase deficiency (MTHFR) 236250 AA Homocystinuria due to cystathionine beta-synthase deficiency (CBS) 236200 AA Methionine adenosyltransferase deficiency 250850 AA Methionine synthase deficiency (MTR, cblG) 250940 AA Methionine synthase reductase deficiency; (MTRR, CblE) 236270 AA Sulfite oxidase deficiency 272300 AA Molybdenum cofactor deficiency: combined deficiency of sulfite oxidase and xanthine oxidase 252150 AA S-adenosylhomocysteine hydrolase deficiency 180960 AA Cystathioninuria 219500 AA Hyperhomocysteinemia 603174 AA Defects of gamma-glutathione cycle: glutathione synthetase deficiency (5-oxo-prolinuria) 266130 AA Defects of histidine metabolism: Histidinemia 235800 AA Defects of lysine and -
BOOK REVIEWS 567 Prenatal Diagnosis and Selective Abortion
BOOK REVIEWS 567 Prenatal Diagnosis and Selective Abortion. By H. HARRIS. London: Nuffield Provincial Hospitals Trust, 1974. Pp. 101. 11.75. U.S. publisher, Harvard University Press. The recent introduction of prenatal detection of genetic disorders has raised a variety of ethical and biological questions. This book not only reviews a number of problems with intrauterine diagnosis, including the scope of the procedure and its effects on the incidence of genetic diseases, but it also raises a number of ethical questions which have generated considerable discussion in both professional and nonprofessional fields. The text is authored by an acknowledged expert in the field of human genetics. Harris has divided his thesis into three major chapters. The first presents an overview of the present state of knowledge of intrauterine diagnosis as it relates to chromosomal abnor- malities, X-linked disorders, metabolic diseases, and congenital malformations. This section does not contain an extensive review of the literature but does highlight many of the more important aspects. The second section deals with effects on the incidence of genetic disease. It outlines both the potential short- and long-term effects that are expected to follow from selective abortion whether the abnormality is a single gene or classical Mendelian condition, a gross chromosomal defect, or a disorder regarded as multifactorial in origin. The last section, which is the most interesting in my opinion, deals with the question of ethics. Harris not only clearly points out the ethical and moral questions of selective abortion, including the undesirable aspects, but he also describes the visible benefits which, in his opinion, make intrauterine detection a valuable advance in medicine. -
Hematologic Aberrations in Metabolic Diseases
ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 10, No. 6 Copyright © 1980, Institute for Clinical Science, Inc. Hematologic Aberrations in Metabolic Diseases BRUCE A. BUEHLER, M.D. Department of Pediatric Metabolism University of Utah College of Medicine Salt Lake City, UT 84132 ABSTRACT This study of enzyme deficiencies and hematologic aberrations in meta bolic diseases includes disorders of amino acidopathies, lipid disease, al binism, carbohydrates, and mucopolysaccharidosis. Introduction clinical evidence of marked hematologi cal aberrations. This list is divided into The definition of metabolic disease has problems of amino acid metabolism, lipid changed markedly during this century. disease, albinism, carbohydrate disorders When Sir Archibald Garrod gave the orig and, finally, the mucopolysaccharidoses. inal Croonian lectures in 1902, metabolic disease was synonomous with the term Amino Acidopathies “inborn errors of metabolism,” but pres ent concepts have expanded to include all A c id e m i a s diseases that affect availability of biologi In 1971, Hsia6 described the enzyme cal substrates or energy production. It deficiency that accounted for ketotic would be impossible to summarize all the hyperglycinemia. Fibroblasts from pa metabolic diseases that may have a pri tients with this disease were found to be mary or secondary effect on hemato- deficient in propionyl CoA carboxylase poiesis; therefore, this study has been ar activity, and the toxic product responsible bitrarily limited to diseases which have a for the clinical symptoms was propionic known or postulated genetic enzyme de acid. Since this discovery, the disease is ficiency as the primary aberration. now referred to as propionic acidemia. Pathological states such as chronic liver The dietary precursors of propionyl disease, ingestion of toxins, or dietary de CoA and propionic acid are valine, ficiency states have not been considered leucine, isoleucine, methionine, within the scope of this text.