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Diagnostic and therapeutic implications of medium-chain acylcarnitines in the medium-chain acyl-coA dehydrogenase deficiency.

Publication ,  Journal Article
Roe, CR; Millington, DS; Maltby, DA; Bohan, TP; Kahler, SG; Chalmers, RA
Published in: Pediatr Res
May 1985

The medium-chain acyl-coA dehydrogenase deficiency is one of several metabolic disorders presenting clinically as Reye syndrome. Evidence is presented for a characteristic organic aciduria that distinguishes this disorder from Reye syndrome and other masqueraders characterized by dicarboxylic aciduria. The key metabolites, suberylglycine and hexanoylglycine, are excreted in high concentration only when the patients are acutely ill. More significantly, using novel techniques in mass spectrometry, the medium-chain defect is shown to be characterized by excretion of specific medium-chain acylcarnitines, mostly octanoylcarnitine, without significant excretion of a normal metabolite, acetylcarnitine, in four patients with documented enzyme deficiency. Similar studies on the urine of two patients reported with Reye-like syndromes of unidentified etiology have suggested the retrospective diagnosis of medium-chain acyl-coA dehydrogenase deficiency. Administration of L-carnitine to medium-chain acyl-coA dehydrogenase deficiency patients resulted in the enhanced excretion of medium-chain acylcarnitines. Octanoylcarnitine is prominent in the urine both prior to and following L-carnitine supplementation. The detection of this metabolite as liberated octanoic acid, following ion-exchange chromatographic purification and mild alkaline hydrolysis, provides a straightforward diagnostic procedure for recognition of this disorder without subjecting patients to the significant risk of fasting. In view of the carnitine deficiency and the demonstrated ability to excrete the toxic medium-chain acyl-coA compounds as acylcarnitines, a combined therapy of reduced dietary fat and L-carnitine supplementation (25 mg/kg/6 h) has been devised and applied with positive outcome in two new cases.

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Published In

Pediatr Res

DOI

ISSN

0031-3998

Publication Date

May 1985

Volume

19

Issue

5

Start / End Page

459 / 466

Location

United States

Related Subject Headings

  • Reye Syndrome
  • Pediatrics
  • Male
  • Infant
  • Humans
  • Gas Chromatography-Mass Spectrometry
  • Female
  • Dicarboxylic Acids
  • Carnitine
  • Acyl-CoA Dehydrogenases
 

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Roe, C. R., Millington, D. S., Maltby, D. A., Bohan, T. P., Kahler, S. G., & Chalmers, R. A. (1985). Diagnostic and therapeutic implications of medium-chain acylcarnitines in the medium-chain acyl-coA dehydrogenase deficiency. Pediatr Res, 19(5), 459–466. https://doi.org/10.1203/00006450-198505000-00011
Roe, C. R., D. S. Millington, D. A. Maltby, T. P. Bohan, S. G. Kahler, and R. A. Chalmers. “Diagnostic and therapeutic implications of medium-chain acylcarnitines in the medium-chain acyl-coA dehydrogenase deficiency.Pediatr Res 19, no. 5 (May 1985): 459–66. https://doi.org/10.1203/00006450-198505000-00011.
Roe CR, Millington DS, Maltby DA, Bohan TP, Kahler SG, Chalmers RA. Diagnostic and therapeutic implications of medium-chain acylcarnitines in the medium-chain acyl-coA dehydrogenase deficiency. Pediatr Res. 1985 May;19(5):459–66.
Roe, C. R., et al. “Diagnostic and therapeutic implications of medium-chain acylcarnitines in the medium-chain acyl-coA dehydrogenase deficiency.Pediatr Res, vol. 19, no. 5, May 1985, pp. 459–66. Pubmed, doi:10.1203/00006450-198505000-00011.
Roe CR, Millington DS, Maltby DA, Bohan TP, Kahler SG, Chalmers RA. Diagnostic and therapeutic implications of medium-chain acylcarnitines in the medium-chain acyl-coA dehydrogenase deficiency. Pediatr Res. 1985 May;19(5):459–466.

Published In

Pediatr Res

DOI

ISSN

0031-3998

Publication Date

May 1985

Volume

19

Issue

5

Start / End Page

459 / 466

Location

United States

Related Subject Headings

  • Reye Syndrome
  • Pediatrics
  • Male
  • Infant
  • Humans
  • Gas Chromatography-Mass Spectrometry
  • Female
  • Dicarboxylic Acids
  • Carnitine
  • Acyl-CoA Dehydrogenases