Non-ketotic hyperglycinemia (NKH): an inborn error of metabolism affecting brain function exclusively

Glycine causes increased excitability and neurotoxicity by activation of NMDA receptors in the hippocampus

Glycine is an inhibitory neurotransmitter in the spinal cord and also acts as a permissive cofactor required for activation of the N-methyl-D-aspartate (NMDA) receptor. We have found that high concentrations of glycine (10 mM) cause marked hyperexcitability and neurotoxicity in organotypic hippocampal slice cultures. The hyperexcitability, measured using intracellular recording in CA1 pyramidal neurons was completely blocked by the NMDA receptor antagonist MK-801 (10 microM), but not by the AMPA receptor antagonist DNQX (100 microM). The neurotoxicity caused by glycine occurred in all regions of hippocampal cultures but was most marked in area CA1. There was significant CA1 neuronal damage in cultures exposed to 10 mM glycine for 30 min or longer (P < 0.01) or those exposed to 4 mM glycine for 24 h compared to control cultures (P < 0.01). The NMDA antagonists MK-801 (10 microM) and APV (100 microM) significantly reduced glycine-induced neuronal damage in all hippocampal subfields (P < 0.01). The AMPA antagonists CNQX, DNQX, and NBQX (100 microM) had no effect on glycine-induced neuronal damage. High concentrations of glycine therefore appear to enhance the excitability of hippocampal slices in an NMDA receptor-dependent manner. The neurotoxic actions of glycine are also blocked by NMDA receptor antagonists.

Effect of threonine on the behavioural development of the rat

Rats received different levels of threonine (Thr), one, 1.7 and four times the normal dietary intake, from conception to adulthood. The mothers were fed the experimental diets before and during pregnancy. Their offspring received a daily oral load of Thr or placebo until weaning. Thereafter, the juveniles were fed the same diet as their mothers. Morphologic development, ingestive behaviour, homing, and locomotion were observed before weaning. Exploration and spontaneous alternation were studied thereafter. Animals exposed during gestation to 1.7 times the normal Thr intake consumed more food during the test of independent ingestion. Grooming showed inconsistent variations between days 12 and 29 in pups fed 1.7 times the normal Thr intake. Rats performed equally well on the other behavioural tasks independently of the dietary treatment. We conclude that Thr intake as much as four times higher than the levels found in normal diets does not impair the behavioural ontogenesis of the rat.

Non-ketotic hyperglycinaemia: clinical and biochemical aspects

Non-ketotic hyperglycinaemia is an autosomal recessive disorder of glycine metabolism characterized by elevated concentrations of glycine in plasma, urine and cerebrospinal fluid. The fundamental defect was found to lie in the glycine cleavage system. It is of significance that the major pathway for the catabolism of glycine was elucidated through the studies of hyperglycinaemia. The present knowledge about non-ketotic hyperglycinaemia is described in clinical and biochemical aspects.

The effect of hyperphenylalaninaemia on glycine metabolism in developing rat brain

The brains of 3--16-day-old rats that were rendered hyperphenylalaninaemic by daily injections of alpha-methylphenylalanine plus phenylalanine were subjected to biochemical analysis. Fluctuations throughout the treatment period in the concentrations of branched-chain amino acids, methionine and serotonin were in agreement with the known interference of excess plasma phenylalanine with transport. The glycine content, however, became abnormal only by day 5, remained so through the treatment, and the elevation was equally apparent at 4, 8 or 24 h after the last daily injections. On the last day of treatment there were small increases in the taurine, glutamate, aspartate and 4-aminobutyrate concentrations, attributable mainly to the diencephalon or brain stem. After day 3 of treatment there were persistent elevations in the specific activity of phosphoserine phosphatase and glycine synthase (but not serine hydroxymethyltransferase) of the brain in each of the regions analysed. The observations indicate that chronic hyperphenylalaninaemia interferes with the normal regulation of intracerebral glycine metabolism during a critical period of early postnatal development, and suggest that the resulting excess in this amino acid (particularly marked in the cortex) contributes to the behavioural abnormalities that these animals exhibit in later life.

Iatrogenic and transient hyperglycinemia in patients with phenylketonuria

Two patients with phenylketonuria detected by newborn screening for inborn errors of metabolism were treated with low phenylanine formulae. Serum phenylalanine levels were well controlled, but serum glycine levels were elevated until 4 or 5 months of age. This was probable due to the high content of glycine in the formulae. Glycine level returned to be normal in these patients, even though they were kept on the same formula, suggesting, immature metabolism of glycine during this period. No clinical problems were encountered in either patient.