STUDIES ON TYROSINOSIS: 2, ACTIVITY OF THE TRANSAMINASE, PARAHYDROXY-PHENYL-PYRUVATE OXIDASE, AND HOMOGENTISIC-ACID OXIDASE

Hepatorenal tyrosinemia

In 1957 Sakai and Kitagawa in Japan reported the clinical and biochemical findings in a patient with tyrosinemia, tyrosyluria, liver cirrhosis, and renal rickets. Subsequently, reports were published from various countries of other patients with hepatorenal tyrosinemia (HRT). 4-Hydroxyphenylpyruvate dioxygenase deficiency was originally proposed as the cause of HRT. However, in 1977 Lindblad et al. found that succinylacetone, which accumulates in the serum and urine from patients with HRT, inhibits delta-aminolevulinic acid (ALA) dehydratase in vitro. They suggested that the primary enzyme deficiency in patients with HRT was fumarylacetoacetate hydrolase, and this was soon confirmed. Thus, the elucidation of the pathogenesis of this disease has led to the possibility that, if a reliable newborn screening method could be developed, the prognosis of these patients would be improved. Early treatment would require a diet low in phenylalanine and tyrosine, administration of 2-(2-nitoro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione (NTBC), and liver transplantation.

Chemical Oxidation of p-Hydroxyphenylpyruvic Acid in Aqueous Solution by Capillary Electrophoresis with an Electrochemiluminescence Detection System

A system of capillary electrophoresis with electrochemiluminescence detection (CE-ECL) together with UV spectroscopic and electrochemical methods were used to study the chemical oxidation of p-hydroxyphenylpyruvic acid (pHPP) by dissolved oxygen in aqueous solution. The pHPP was observed to be readily oxidized by dissolved oxygen in alkaline solution and yielded a compound that strongly enhanced the electrochemiluminescence of Ru(bpy)23+. This compound was separated and detected by a new CE-ECL system and revealed to be oxalate by being compared with an authentic sample of oxalate. The chemical oxidation mechanism of pHPP by dissolved oxygen was discussed in this paper.

Biochemical studies on the enzymatic deficiencies in hereditary tyrosinemia

Experiments are described on the effects of succinylacetone and fumarylacetoacetate on delta-aminolevulinic acid dehydratase, methionine adenosyltransferase and p-OH-phenylpyruvate dioxygenase. delta-Aminolevulinic acid dehydratase from human erythrocytes is inhibited non-competitively by succinylacetone (Ki 0.03 mumol/l) and by fumarylacetoacetate (Ki 0.06 mumol/l). The inhibition by succinylacetone is not prevented by dithiothreitol, but the inhibition by fumarylacetoacetate is not observed if dithiothreitol is present. Methionine adenosyltransferase, partially purified from rabbit liver, is not inhibited by succinylacetone but is inhibited by fumarylacetoacetate: 69% inhibition is observed at 1 mmol/l. Human liver p-OH-phenylpyruvate dioxygenase is not inhibited by succinylacetone or fumarylacetoacetate. It is concluded that secondary enzyme deficiencies observed in hereditary tyrosinemia (delta-aminolevulinic acid dehydratase, methionine adenosyl transferase) are the result of inhibition by succinylacetone and fumarylacetoacetate, accumulating as a result of a primary deficiency of fumarylacetoacetase.

Evidence for liver disease preceding amino acid abnormalities in hereditary tyrosinemia

In hereditary tyrosinemia, an autosomal recessive disorder of infants, it has been postulated that hepatic toxicity arising from defective degradation of tyrosine accounts for the severe liver disease that is a feature of this condition. We measured the concentration of alpha-fetoprotein, a marker for liver disease, and of amino acid in cord blood from three infants with hereditary tyrosinemia and found that the concentration of alpha-fetoprotein was greatly increased at birth, whereas the level of tyrosine was normal or not specifically elevated, and that hypertyrosinemia developed only postnatally. These results indicate that liver disease is prenatal in hereditary tyrosinemia and that therapy aimed at reduction of the elevated tyrosine level is unlikely to be of fundamental value.

Urinary excretion of succinylacetone and delta-aminolevulinic acid in patients with hereditary tyrosinemia

Succinylacetone was excreted in the urine from four patients, with hereditary tyrosinemia i.e., two patients with the severe infantile type with fatal outcome and two patients with less severe juvenile form. In the urine from two patients with neonatal transient tyrosinemia and from normal individuals succinylacetone was not detectable. The urinary excretion of delta-aminolevulinic acid was also increased in all patients with hereditary tyrosinemia compared to patients with neonatal transient tyrosinemia and to normal individuals. The results presented support the hypothesis of a deficiency of fumarylacetoacetase in hereditary tyrosinemia. Furthermore an analytical method for the quantitative determination of succinylacetone in urine using GC-MS is described.

On the renal tubular damage in hereditary tyrosinemia and on the formation of succinylacetoacetate and succinylacetone

Phenylalanine and homogentisate increase the concentration of succinylacetoacetate and succinylacetone both in serum and urine in patients with hereditary tyrosinemia and therefore increase the excretion of 5-aminolevulinate. Both phenylalanine and homogentisate cause a tubular proteinuria which is in agreement with our hypothesis that their metabolites maleylacetoacetate and fumarylacetoacetate are the toxic compounds in hereditary tyrosinemia. The patient with the highest excretion of succinylacetoacetate and succinylacetone has the slightest tubular proteinuria whereas the one with the lowest excretion of these compounds has the more pronounced tubular proteinuria. It is suggested that this is caused by a difference in the ability to reduce the presumed toxic compounds fumarylacetoacetate and maleylacetoacetate, i.e. the precursors of succinylacetoacetate.

The genetics of diabetes mellitus in man

The genetics of diabetes mellitus in man has been reviewed. The evidence for genetic heterogeneity on clinical, biochemical and HLA (histocompatibility leukocyte antigens) data is presented. An attempt is made to interpret the meaning of the associations of the disease and certain HLA antigens and the complement factor, properdin in populations and in families. The population data can be best explained by the linkage disequilibrium hypothesis requiring tight linkage between the DS (diabetes susceptibility) locus and those in the MHC (major histocompatibility complex). Linkage between the DS locus and MHC from family data is estimated to be about 14%, which is not likely tight enough to be compatible with the population data; and a one locus or one allele hypothesis and genetic heterogeneity is postulated as the best explanation of the incompatibility between population and family data. It is still impossible to precisely define the exact genetic hypothesis for diabetes in man.

The occurrence of hepatoma in the chronic form of hereditary tyrosinemia

A 5 1/2-year-old child with hepatocarcinoma complicating hereditary tyrosinemia is presented. A review of the literature and an attempted follow-up of previously reported patients with the chronic form of hereditary tyrosinemia have disclosed 16 cases of hepatocarcinoma occurring in 43 patients surviving beyond 2 years of age (37%). This incidence is considerably higher than that generally given for the occurrence of hepatoma in adults with macronodular cirrhosis. Females and males are equally at risk. Additional factors beyond the development of cirrhosis are likely operative in the induction of hepatocarcinoma in patients with this metabolic disorder; those surviving beyond infancy are at considerable risk for the development of fatal hepatic neoplasms.

Tyrosinosis. A study of 6 cases

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