Alternative methionine degradation via the transamination pathway: an option for therapy for homocystinuria due to cystathionine synthase deficiency

Retrospective evaluation of methionine intoxication associated with urinary acidifying products in dogs: 1,525 cases (2001-2012)

OBJECTIVE

To describe the signalment, clinical findings, timing of signs, outcome, and prognosis in a population of dogs exposed to methionine through the ingestion of urine acidifying products.

DESIGN

Retrospective observational study from January 1, 2001 to December 31, 2012.

SETTING

Animal Poison Control Center.

ANIMALS

A total of 1,197 case calls yielding 1,525 dogs identified with presumed methionine ingestion.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Records of dogs with presumptive methionine ingestion were reviewed from the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center database. Ingested methionine doses ranged from 3.9 mg/kg to 23,462 mg/kg. Clinical signs developed in 47% of dogs. The most common clinical signs were gastrointestinal (GI) and neurologic. The mean onset of GI signs was 2.8 hours following ingestion. The mean onset of neurologic signs was 6.8 hours following ingestion. GI signs were identified with ingested doses ≥22.5 mg/kg. Vomiting was the most common GI sign. Neurologic signs were identified with ingested doses ≥94.6 mg/kg. Ataxia was the most common neurologic sign. Resolution of clinical signs occurred within 48 hours of ingestion, and no fatalities were reported.

CONCLUSIONS

Prognosis for dogs with methionine intoxication is excellent. Vomiting and ataxia were the most common clinical signs associated with methionine toxicosis.

Thiamine (vitamin B1) supplementation does not reduce fasting blood homocysteine concentration in most homozygotes for homocystinuria

Homozygotes for homocystinuria due to cystathionine synthase (CS) deficiency accumulate homocysteine and methionine in their blood and tissues. High-dose pyridoxin, folic acid, vitamin B12, or betaine are therapeutical options to lower the elevated homocysteine concentration. These compounds stimulate the transsulfuration or remethylation of homocysteine. Despite such treatment, elevated blood homocysteine concentrations may persist in many homocystinurics. Therefore, it is warranted to study alternative regimen to reduce the blood homocysteine concentration in homocystinurics. Apart from entering the transsulfuration pathway, methionine can be catabolized via the transamination pathway, by conversion into 4-methylthio-2-oxobutyrate (MTOB), followed by oxidative decarboxylation of MTOB to 3-methylthiopropionate. Thiamine pyrophosphate, the active form of thiamine, is a cofactor of the supposed rate-limiting oxidative decarboxylation in the transamination of methionine. The effect of thiamine administered in 2 or 3 daily doses of 25 mg orally, was studied in nine homozygote CS deficient patients. Methionine levels decreased in 6 out of 9 patients. In 8 out of 9 patients, however, the levels of plasma homocysteine remained virtually unchanged, as did the serum transamination metabolites in all patients. We conclude that vitamin B1 cannot be used as an additional homocysteine-lowering treatment in most homozygotes for homocystinuria.

Methionine transamination--metabolic function and subcellular compartmentation

Enzymatic activities catalysing the inter-conversion of L-methionine and its oxy analogue 4-methylthio-2-oxobutyric acid (2,4-KMB) were detected in the liver, skeletal muscle and heart of the laboratory rat and of sheep. In both species the highest activity of methionine transamination was found in the liver and was located in the cytoplasm and mitochondria. We propose that physiological and nutritional role of the cytoplasmic methionine transamination is amination of 2,4 KMB and formation of L-methionine while in mitochondria the activity is responsible for disposal of excess methionine is oxidised through oxidative decarboxylation of 2,4 KMB.