Medium-chain acyl-CoA dehydrogenase deficiency in children with non-ketotic hypoglycemia and low carnitine levels

Three children in two families presented in early childhood with episodes of illness associated with fasting which resembled Reye's syndrome: coma, hypoglycemia, hyperammonemia, and fatty liver. One child died with cerebral edema during an episode. Clinical studies revealed an absence of ketosis on fasting (plasma beta-hydroxybutyrate less than 0.4 mmole/liter) despite elevated levels of free fatty acids (2.6-4.2 mmole/liter) which suggested that hepatic fatty acid oxidation was impaired. Urinary dicarboxylic acids were elevated during illness or fasting. Total carnitine levels were low in plasma (18-25 mumole/liter), liver (200-500 nmole/g), and muscle (500-800 nmole/g); however, treatment with L-carnitine failed to correct the defect in ketogenesis. Studies on ketone production from fatty acid substrates by liver tissue in vitro showed normal rates from short-chain fatty acids, but very low rates from all medium and long-chain fatty acid substrates. These results suggested that the defect was in the mid-portion of the intramitochondrial beta-oxidation pathway at the medium-chain acyl-CoA dehydrogenase step. A new assay for the electron transfer flavoprotein-linked acyl-CoA dehydrogenases was used to test this hypothesis. This assay follows the decrease in electron transfer flavoprotein fluorescence as it is reduced by acyl-CoA-acyl-CoA dehydrogenase complex. Results with octanoyl-CoA as substrate indicated that patients had less than 2.5% normal activity of medium-chain acyl-CoA dehydrogenase. The activities of short-chain and isovaleryl acyl-CoA dehydrogenases were normal; the activity of long-chain acyl-CoA dehydrogenase was one-third normal. These results define a previously unrecognized inherited metabolic disorder of fatty acid oxidation due to deficiency of medium-chain acyl-CoA dehydrogenase.

Prenatal administration of biotin in biotin responsive multiple carboxylase deficiency

Biotin responsive multiple carboxylase deficiency was suspected in a third trimester conceptus on the basis of enzymatic confirmation in fibroblasts cultured from an earlier sibling who suffered a demise in the immediate neonatal period. Maternal urinary organic acid profile was normal throughout the final 4 wk of pregnancy. Oral administration of biotin, 10 mg/day to the mother resulted in a 100-fold increase in urinary biotin excretion within 7 days. Urinary biotin excretion over the subsequent 2 wk decreased steadily, suggesting either decreased maternal absorption or increased fetal sequestration. After the birth of nonidentical twins, cord blood and urinary organic acid profiles of the infants were normal. However, cord blood biotin concentration was 4 to 7-fold that of normal newborns. Subsequent enzymatic and genetic complementation studies utilizing cultured skin fibroblasts from the infants demonstrated one of them to be affected by the multiple carboxylase defect, although he was clinically and biochemically normal throughout the neonatal period. Thus, prenatal therapy of this inborn enzymatic defect can be safely and effectively accomplished by administration of pharmacologic biotin doses in the last month of pregnancy.

Diet and vitamin nutrition of the high esophageal cancer risk population in Linxian, China

In order to examine the nutritional status of the population of Linxian (in Henan, China) known to be at high risk for esophageal cancer (EC), we analyzed blood samples and conducted 3-day dietary surveys on 3 groups of normal adults, age 40-50, from Henan province. Two groups were from Linxian, where the EC mortality rate is about 138/100,000 (Group C, consisting of volunteers with a family history of EC, and Group NC, consisting of those who did not have a family history of EC). The third group, Group F, was from Fanxian, where the EC mortality rate is about 24/100,000. The average plasma retinol level was found to be about 0.27 micrograms/ml in all 3 groups; about 13%-20% of the individuals had a level less than 0.2 micrograms/ml. The average plasma carotene level of all 3 groups appeared to be adequate, ranging from 0.5-1.0 micrograms/ml. About 23% of the subjects in both Groups C and NC had low (less than 2 micrograms/ml) plasma ascorbate levels; in Group F, 16% had low ascorbate levels. Less than 12% of the individuals in each of the 3 groups had erythrocyte glutathione reductase activation coefficients less than 1.2, indicating a widely occurring riboflavin deficiency. Consumption of alcoholic beverages was not found to be a contributing factor to EC. The results of the present study reveal a deficiency of vitamins in the study populations, but do not indicate that the average nutritional status of the volunteers in Group C was worse than that of Groups NC and F with regard to vitamin A, ascorbate, and riboflavin.

Serum and urinary biotin levels during treatment of holocarboxylase synthetase deficiency

Measurements of blood and urine biotin levels have been performed during treatment of a patient with holocarboxylase synthetase deficiency. During the first 24 hours of therapy, the infant progressed from a moribund, shock-like state to a clinically normal baby. Urinary biotin concentration increased more that 100-fold after 12 hours of treatment. Within 48 hours of treatment, blood biotin levels were greater than 10 times control levels. On the basis of the data presented, it is suggested that therapeutic blood levels of biotin can be achieved by enteral administration of 10 mg of biotin per day.

Rapid gas chromatographic-mass spectrometric analysis of [15N]urea: application to human metabolic studies

A rapid gas chromatographic-mass spectrometric method for [15N]urea analysis is described which is based on the formation of a TFA-urea derivative. The method is extremely sensitive, being capable of detecting less than 0.2 atom % excess [15N]urea in as little as 50 microliter of plasma and 10 microliter of urine with a coefficient of variation of 11%. The method was used to measure in vivo the disappearance of [15N]urea from plasma and the incorporation of [15N]ammonium acetate into [15N]urea. The values obtained for urea pool size and flux are 4.5 +/- 0.30 g nitrogen/total body weight and 16.2 +/- 1.34 g nitrogen per 24 h per 1.73 m2. Following the ingestion of [15N]ammonium acetate nearly 90% of the 15N label was incorporated into [15N]urea by 30 min.

Holocarboxylase synthetase deficiency: a biotin-responsive organic acidemia

The clinical and biochemical features of an infant affected by holocarboxylase synthetase deficiency are presented. The patient was the sibling of the deceased child in whose cultured skin fibroblasts the precise enzymatic disorder was first determined. This fact permitted administration of specific therapy in the form of oral biotin, resulting in immediate improvement from impending respiratory failure and shock. The clinical response to biotin was accompanied by recovery of the biochemical mechanisms known to be biotin-dependent, as manifested by disappearance of intermediates in urine and blood. The variability of biotin responsiveness and the diversity of clinical presentation in the patients originally thought to have a deficiency of beta methylcrotonylCoA carboxylase, a biotin-dependent enzyme, raises the question of a separate, specific apocarboxylase defect.

Heteropolypeptides from poly-alpha-cyanoglycine and hydrogen cyanide: a model for the origin of proteins

Poly-alpha-cyanoglycine, a homopolymer synthesized from the N-carboxyanhydride of alpha-cyanoglycine, is converted by cumulative reaction of hydrogen cyanide to heteropolypeptides that can be hydrolyzed to protein amino acids, including glycine, alanine, valine, aspartic acid, and glutamic acid. These results are consistent with the hypothesis that the original heteropolypeptides on the earth arose spontaneously from hydrogen cyanide and water without the intervening formation of alpha-amino acids.

Reciprocal inhibition of mouse leukemia virus infection by Fv-1 allele cell extracts

Soluble extracts of mouse cells with Fv-1(n) or Fv-1(b) gene alleles specifically and reciprocally inhibit infection of B- or N-tropic mouse leukemia viruses in permissive cell cultures. NB-tropic virus infection was not inhibited by either cell extract. Extracts from Fv-1(-) cells did not inhibit infection by the three virus host-range types, but N- or B-tropic virus infection of Fv-1(-) cells was inhibited by extracts of the nonpermissive cells, and Fv-1(nb) cell extracts inhibited both viruses. The maximum degree of inhibition was 50-80% as determined by immunofluorescent or plaque assays, with extracts containing up to 500 mug/ml of nonpermissive cell protein. The inhibitor(s) is relatively unstable since activity is lost after 2 hr at 37 degrees or 30 min at 56 degrees . The inhibitor(s) was most effective if added 2 hr before or within 2 hr after infection, did not react with the virus directly, inhibit virus attachment, or inhibit the normal cell functions tested. These results indicate that nonpermissive mouse cells contain a product, possibly determined by the Fv-1 gene, which inhibits some early postpenetration event(s) in leukemia virus infection.

The redox potentials of the two-iron plant and algal ferredoxins. An electrostatic model

The two-iron-sulphur co-ordination centre in plant and algal ferredoxins is considered as a collection of charged ions whose net negative charge is twice that of the one-iron-sulphur protein rubredoxin. Calculation of the electrostatic free-energy changes for reduction of the two types of proteins indicates that the redox potential of the two-iron-sulphur proteins should be more negative than that of the one-iron-sulphur protein and that in biological systems the ferredoxins should function as one-electron transfer proteins.