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Hertzog A, Selvanathan A, Pandithan D, Kim W, Kava MP, Boneh A, Coman D, Tolun AA, Bhattacharya K. 3‐Methylglutaconyl‐CoA
hydratase deficiency: When ascertainment bias confounds a biochemical diagnosis. JIMD Rep 2022; 63:568-574. [DOI: 10.1002/jmd2.12332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ashley Hertzog
- NSW Biochemical Genetics Service, Western Sydney Genetics Program The Children's Hospital at Westmead Westmead New South Wales Australia
- Disciplines of Genetic Medicine and Child and Adolescent Health The University of Sydney Sydney New South Wales Australia
| | - Arthavan Selvanathan
- Genetic Metabolic Disorders Service Sydney Children's Hospital Network Sydney New South Wales Australia
- Queensland Lifespan Metabolic Medicine Service Queensland Children's Hospital Brisbane Queensland Australia
| | - Dinusha Pandithan
- Department of Metabolic Medicine The Royal Children's Hospital Parkville Victoria Australia
| | - Won‐Tae Kim
- NSW Newborn Screening Programme The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Maina P. Kava
- Metabolic Unit, Department of Rheumatology and Metabolic Medicine Perth Children's Hospital Perth Western Australia Australia
- School of Paediatrics and Child Health University of Western Australia Perth Western Australia Australia
| | - Avihu Boneh
- Department of Paediatrics University of Melbourne Parkville Victoria Australia
| | - David Coman
- Queensland Lifespan Metabolic Medicine Service Queensland Children's Hospital Brisbane Queensland Australia
- School of Medicine University of Queensland Brisbane Queensland Australia
| | - Adviye Ayper Tolun
- NSW Biochemical Genetics Service, Western Sydney Genetics Program The Children's Hospital at Westmead Westmead New South Wales Australia
- Disciplines of Genetic Medicine and Child and Adolescent Health The University of Sydney Sydney New South Wales Australia
| | - Kaustuv Bhattacharya
- Disciplines of Genetic Medicine and Child and Adolescent Health The University of Sydney Sydney New South Wales Australia
- Genetic Metabolic Disorders Service Sydney Children's Hospital Network Sydney New South Wales Australia
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2
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3-Methylglutaconic Aciduria Type I Due to AUH Defect: The Case Report of a Diagnostic Odyssey and a Review of the Literature. Int J Mol Sci 2022; 23:ijms23084422. [PMID: 35457240 PMCID: PMC9029672 DOI: 10.3390/ijms23084422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/10/2022] [Accepted: 04/15/2022] [Indexed: 01/29/2023] Open
Abstract
3-Methylglutaconic aciduria type I (MGCA1) is an inborn error of the leucine degradation pathway caused by pathogenic variants in the AUH gene, which encodes 3-methylglutaconyl-coenzyme A hydratase (MGH). To date, MGCA1 has been diagnosed in 19 subjects and has been associated with a variable clinical picture, ranging from no symptoms to severe encephalopathy with basal ganglia involvement. We report the case of a 31-month-old female child referred to our center after the detection of increased 3-hydroxyisovalerylcarnitine levels at newborn screening, which were associated with increased urinary excretion of 3-methylglutaconic acid, 3-hydroxyisovaleric acid, and 3-methylglutaric acid. A next-generation sequencing (NGS) panel for 3-methylglutaconic aciduria failed to establish a definitive diagnosis. To further investigate the strong biochemical indication, we measured MGH activity, which was markedly decreased. Finally, single nucleotide polymorphism array analysis disclosed the presence of two microdeletions in compound heterozygosity encompassing the AUH gene, which confirmed the diagnosis. The patient was then supplemented with levocarnitine and protein intake was slowly decreased. At the last examination, the patient showed mild clumsiness and an expressive language disorder. This case exemplifies the importance of the biochemical phenotype in the differential diagnosis of metabolic diseases and the importance of collaboration between clinicians, biochemists, and geneticists for an accurate diagnosis.
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3
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Bizjak N, Zerjav Tansek M, Avbelj Stefanija M, Repic Lampret B, Mezek A, Drole Torkar A, Battelino T, Groselj U. Precocious puberty in a girl with 3-methylglutaconic aciduria type 1 (3-MGA-I) due to a novel AUH gene mutation. Mol Genet Metab Rep 2020; 25:100691. [PMID: 33304818 PMCID: PMC7718479 DOI: 10.1016/j.ymgmr.2020.100691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/22/2022] Open
Abstract
3-methylglutaconic aciduria type 1 (3-MGA-I) (MIM ID #250950) is an ultra-rare, autosomal recessive organic aciduria, resulting from mutated AUH gene, leading to the deficient 3-methylglutaconyl-CoA hydratase (3-MGH). Only around 40 cases are previously reported, caused by a spectrum of 10 mutations. The clinical spectrum of 3-MGA-I in children is heterogeneous, varying from asymptomatic individuals to mild neurological impairment, speech delay, quadriplegia, dystonia, choreoathetoid movements, severe encephalopathy, psychomotor retardation, basal ganglia involvement. Early dietary treatment with leucine restriction and carnitine supplementation may be effective in improving neurological state in pediatric patients with 3-MGA-I. We presented a girl with 3-MGA-I due to novel AUH gene mutation (homozygous variant c.330 + 5G > A) and confirmed by almost undetectable 3-MGH-enzyme activity, who initially presented with central precocious puberty at an early age of 4.5 years. Precocious puberty might be associated with the 3-MGA-I, as is reported previously in some other metabolic disorders that result in pathologic accumulation of metabolites or toxic brain damage. Therapy with GnRH agonist triptorelin effectively arrested pubertal development. Girl with 3-MGA-I presented with central precocious puberty. Novel AUH gene mutation and almost undetectable 3-MGH-enzyme activity were detected. GnRH agonist triptorelin effectively arrested pubertal development. Precocious puberty is reported in some other metabolic disorders.
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Key Words
- 3-HIVA, 3-hydroxyisovaleric acid
- 3-MG, 3-methylglutaric acid
- 3-MGA-I
- 3-MGA-I, 3-methylglutaconic aciduria type I
- 3-MGH, 3-methylglutaconyl-CoA hydratase
- 3-methylglutaconic aciduria type 1
- AUH gene
- C5-OH, 3-hydroxyisovaleryl-carnitine
- GnRH agonist
- GnRH, Gonadotropin-releasing hormone
- IEM, inborn errors of metabolism
- LC-MS/MS, Tandem mass spectrometry
- LH, luteinizing hormone
- MRI, Magnetic resonance imaging
- NBS, newborn screening
- Precocious puberty
- ToL, The Tower of London test
- Triptorelin
- UCHL, University Children's Hospital Ljubljana
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Affiliation(s)
- Neli Bizjak
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Centre Ljubljana, Bohoriceva 20, Ljubljana, Slovenia
| | - Mojca Zerjav Tansek
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Magdalena Avbelj Stefanija
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Barbka Repic Lampret
- Clinical Institute for Special Laboratory Diagnostics, University Children's Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Ajda Mezek
- Unit for Clinical Dietetics, University Children's Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Ana Drole Torkar
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Urh Groselj
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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4
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Neugeborenenscreening als eine Form der prädiktiven genetischen Testung: Prinzipien und Herausforderungen. Wien Med Wochenschr 2012; 162:168-75. [DOI: 10.1007/s10354-012-0062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 01/26/2012] [Indexed: 10/28/2022]
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Mercimek-Mahmutoglu S, Tucker T, Casey B. Phenotypic heterogeneity in two siblings with 3-methylglutaconic aciduria type I caused by a novel intragenic deletion. Mol Genet Metab 2011; 104:410-3. [PMID: 21840233 DOI: 10.1016/j.ymgme.2011.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 07/20/2011] [Accepted: 07/20/2011] [Indexed: 11/18/2022]
Abstract
We describe two siblings with 3-methylglutaconic aciduria type I with phenotypic heterogeneity. The index case was a 14-year-old female with learning disability, attention deficit-hyperactivity and early onset subclinical leukoencephalopathy. Her 9-year-old brother had severe expressive speech delay and delay in speech sound development with normal cognitive functions. The diagnosis was confirmed by a demonstration of 3-methylglutaconyl-CoA hydratase enzyme deficiency in the cultured skin fibroblasts and homozygous deletion of exons 1-3 within the AUH gene.
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Affiliation(s)
- Saadet Mercimek-Mahmutoglu
- Division of Biochemical Diseases, Department of Pediatrics, University of British Columbia, Vancouver, Canada.
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6
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Ribeiro CAJ, Hickmann FH, Wajner M. Neurochemical evidence that 3‐methylglutaric acid inhibits synaptic Na
+
,K
+
‐ATPase activity probably through oxidative damage in brain cortex of young rats. Int J Dev Neurosci 2010; 29:1-7. [DOI: 10.1016/j.ijdevneu.2010.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 10/26/2010] [Accepted: 10/26/2010] [Indexed: 01/05/2023] Open
Affiliation(s)
- César Augusto João Ribeiro
- Departamento de BioquímicaInstituto de Ciências Básicas da SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazil
| | - Fernanda Hermes Hickmann
- Departamento de BioquímicaInstituto de Ciências Básicas da SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazil
| | - Moacir Wajner
- Departamento de BioquímicaInstituto de Ciências Básicas da SaúdeUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazil
- Serviço de Genética MédicaHospital de Clínicas de Porto AlegrePorto AlegreRSBrazil
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7
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Leipnitz G, Seminotti B, Amaral AU, de Bortoli G, Solano A, Schuck PF, Wyse ATS, Wannmacher CMD, Latini A, Wajner M. Induction of oxidative stress by the metabolites accumulating in 3-methylglutaconic aciduria in cerebral cortex of young rats. Life Sci 2008; 82:652-62. [PMID: 18261750 DOI: 10.1016/j.lfs.2007.12.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 12/14/2007] [Accepted: 12/18/2007] [Indexed: 02/07/2023]
Abstract
3-methylglutaconic (MGT), 3-methylglutaric (MGA) and occasionally 3-hydroxyisovaleric (OHIVA) acids accumulate in a group of diseases known as 3-methylglutaconic aciduria (MGTA). Although the clinical presentation of MGTA is mainly characterized by neurological symptoms, the mechanisms of brain damage in this disease are poorly known. In the present study we investigated the in vitro effect of MGT, MGA and OHIVA on various parameters of oxidative stress in cerebral cortex from young rats. Thiobarbituric acid-reactive substances (TBA-RS) and chemiluminescence were significantly increased by MGT, MGA and OHIVA, indicating that these metabolites induce lipid oxidative damage. Furthermore, the addition of melatonin, alpha-tocopherol and superoxide dismutase plus catalase fully prevented MGT-induced increase on TBA-RS, suggesting that free radicals were involved in this effect. These metabolites also provoked protein oxidative damage determined by increased carbonyl formation and sulfhydryl oxidation, but did not induce superoxide generation in submitochondrial particles. It was also verified that MGA and MGT significantly decreased the non-enzymatic antioxidant defenses in cerebral cortex supernatants and that melatonin and alpha-tocopherol totally blocked MGA-induced GSH reduction. The data indicate that the metabolites accumulating in MGTA elicit oxidative stress in vitro in the cerebral cortex. It is therefore presumed that this pathomechanism may be involved in the brain damage observed in patients affected by MGTA.
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Affiliation(s)
- Guilhian Leipnitz
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal de Rio Grande do Sul, Porto Alegre-RS, Brazil
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8
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Mack M, Schniegler-Mattox U, Peters V, Hoffmann GF, Liesert M, Buckel W, Zschocke J. Biochemical characterization of human 3-methylglutaconyl-CoA hydratase and its role in leucine metabolism. FEBS J 2006; 273:2012-22. [PMID: 16640564 DOI: 10.1111/j.1742-4658.2006.05218.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The metabolic disease 3-methylglutaconic aciduria type I (MGA1) is characterized by an abnormal organic acid profile in which there is excessive urinary excretion of 3-methylglutaconic acid, 3-methylglutaric acid and 3-hydroxyisovaleric acid. Affected individuals display variable clinical manifestations ranging from mildly delayed speech development to severe psychomotor retardation with neurological handicap. MGA1 is caused by reduced or absent 3-methylglutaconyl-coenzyme A (3-MG-CoA) hydratase activity within the leucine degradation pathway. The human AUH gene has been reported to encode for a bifunctional enzyme with both RNA-binding and enoyl-CoA-hydratase activity. In addition, it was shown that mutations in the AUH gene are linked to MGA1. Here we present kinetic data of the purified gene product of AUH using different CoA-substrates. The best substrates were (E)-3-MG-CoA (V(max) = 3.9 U.mg(-1), K(m) = 8.3 microM, k(cat) = 5.1 s(-1)) and (E)-glutaconyl-CoA (V(max) = 1.1 U.mg(-1), K(m) = 2.4 microM, k(cat) = 1.4 s(-1)) giving strong evidence that the AUH gene encodes for the major human 3-MG-CoA hydratase in leucine degradation. Based on these results, a new assay for AUH activity in fibroblast homogenates was developed. The only missense mutation found in MGA1 phenotypes, c.719C>T, leading to the amino acid exchange A240V, produces an enzyme with only 9% of the wild-type 3-MG-CoA hydratase activity.
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Affiliation(s)
- Matthias Mack
- Institut für Technische Mikrobiologie der Hochschule Mannheim, Germany.
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Matsumori M, Shoji Y, Takahashi T, Shoji Y, Takada G. A molecular lesion in a Japanese patient with severe phenotype of 3-methylglutaconic aciduria type I. Pediatr Int 2005; 47:684-6. [PMID: 16354225 DOI: 10.1111/j.1442-200x.2005.02130.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mika Matsumori
- Department of Pediatrics, Akita University School of Medicine, Akita, Japan.
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10
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Illsinger S, Lücke T, Zschocke J, Gibson KM, Das AM. 3-methylglutaconic aciduria type I in a boy with fever-associated seizures. Pediatr Neurol 2004; 30:213-5. [PMID: 15033206 DOI: 10.1016/j.pediatrneurol.2003.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2003] [Accepted: 09/09/2003] [Indexed: 11/27/2022]
Abstract
3-Methylglutaconic-aciduria type I (MGA1, OMIM 250950) resulting from 3-Methylglutaconyl-coenzyme A hydratase deficiency is a rare inherited metabolic disorder of l-leucine catabolism. We diagnosed this condition in a 4-year-old German male with generalized fever-associated seizures from the age of 12 months and normal psychomotor development. First he was considered to suffer from uncomplicated febrile seizures. After his eighth seizure, laboratory investigations were performed to exclude inborn errors of metabolism. Analysis of organic acids in urine indicated highly elevated concentrations of 3-methylglutaconic and 3-hydroxyisovaleric acids. 3-Methylglutaconyl-coenzyme A hydratase activity was markedly decreased in skin fibroblasts. Mutation analysis in the AUH gene revealed homozygosity for a novel splice site mutation IVS9-2A>G. We conclude that MGA1 may be associated with fever-associated seizures even in children without delayed psychomotor development.
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Affiliation(s)
- Sabine Illsinger
- Department of Paediatrics, Medical School Hanover, Hanover, Germany
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11
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Ly TBN, Peters V, Gibson KM, Liesert M, Buckel W, Wilcken B, Carpenter K, Ensenauer R, Hoffmann GF, Mack M, Zschocke J. Mutations in the AUH gene cause 3-methylglutaconic aciduria type I. Hum Mutat 2003; 21:401-7. [PMID: 12655555 DOI: 10.1002/humu.10202] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The conversion of 3-methylglutaconyl-CoA to 3-hydroxy-3-methylglutaryl-CoA is the only step in leucine catametabolism yet to be characterized at enzyme and DNA levels. The deficiency of the putative mitochondrial enzyme 3-methylglutaconyl-CoA hydratase associates with the rare organic aciduria 3-methylglutaconic aciduria type I (MGA1), but neither the enzyme nor its gene have been described in any organism. Here we report that human 3-methylglutaconyl-CoA hydratase is identical with a previously described RNA-binding protein (designated AUH) possessing enoyl-CoA hydratase activity. Molecular analyses in five patients from four independent families revealed homozygosity or compound heterozygosity for mutations in the AUH gene; most mutations are predicted to completely abolish protein function. Mutations identified include c.80delG, R197X, IVS8-1G>A, A240V, and c.613_614insA. Clinical severity of MGA1 in published patients has been quite variable. Included in the present study is an additional patient with MGA1 who was detected by neonatal screening and has remained asymptomatic up to his present age of 2 years. The boy is homozygous for an N-terminal frameshift mutation in the AUH gene. Complete absence of 3-methylglutaconyl-CoA hydratase/AUH appears to be compatible with normal development in some cases. Further work is required to identify external or genetic factors associated with development of clinical problems in patients with MGA1.
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Affiliation(s)
- T B Nga Ly
- Department of General Paediatrics, Ruprecht-Karls-University, Heidelberg, Germany
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12
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IJlst L, Loupatty FJ, Ruiter JPN, Duran M, Lehnert W, Wanders RJA. 3-Methylglutaconic aciduria type I is caused by mutations in AUH. Am J Hum Genet 2002; 71:1463-6. [PMID: 12434311 PMCID: PMC378594 DOI: 10.1086/344712] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2002] [Accepted: 09/11/2002] [Indexed: 11/03/2022] Open
Abstract
3-Methylglutaconic aciduria type I is an autosomal recessive disorder clinically characterized by various symptoms ranging from delayed speech development to severe neurological handicap. This disorder is caused by a deficiency of 3-methylglutaconyl-CoA hydratase, one of the key enzymes of leucine degradation. This results in elevated urinary levels of 3-methylglutaconic acid, 3-methylglutaric acid, and 3-hydroxyisovaleric acid. By heterologous expression in Escherichia coli, we show that 3-methylglutaconyl-CoA hydratase is encoded by the AUH gene, whose product had been reported elsewhere as an AU-specific RNA-binding protein. Mutation analysis of AUH in two patients revealed a nonsense mutation (R197X) and a splice-site mutation (IVS8-1G-->A), demonstrating that mutations in AUH cause 3-methylglutaconic aciduria type I.
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Affiliation(s)
- Lodewijk IJlst
- Departments of Clinical Chemistry and Pediatrics, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam; and University Children’s Hospital, Freiburg, Germany
| | - Ference J. Loupatty
- Departments of Clinical Chemistry and Pediatrics, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam; and University Children’s Hospital, Freiburg, Germany
| | - Jos P. N. Ruiter
- Departments of Clinical Chemistry and Pediatrics, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam; and University Children’s Hospital, Freiburg, Germany
| | - Marinus Duran
- Departments of Clinical Chemistry and Pediatrics, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam; and University Children’s Hospital, Freiburg, Germany
| | - Willy Lehnert
- Departments of Clinical Chemistry and Pediatrics, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam; and University Children’s Hospital, Freiburg, Germany
| | - Ronald J. A. Wanders
- Departments of Clinical Chemistry and Pediatrics, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam; and University Children’s Hospital, Freiburg, Germany
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13
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Ensenauer R, Müller CB, Schwab KO, Gibson KM, Brandis M, Lehnert W. 3-Methylglutaconyl-CoA hydratase deficiency: a new patient with speech retardation as the leading sign. J Inherit Metab Dis 2000; 23:341-4. [PMID: 10896289 DOI: 10.1023/a:1005670911799] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R Ensenauer
- University Children's Hospital Freiburg, Germany
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