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Bernhardt I, Van Dorp L, Dixon M, McSweeney M, Gan C, Baruteau J, Chakrapani A. Pyruvate carboxylase deficiency type C; variable presentation and beneficial effect of triheptanoin. JIMD Rep 2024; 65:10-16. [PMID: 38186850 PMCID: PMC10764197 DOI: 10.1002/jmd2.12405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Pyruvate carboxylase is a mitochondrial enzyme essential for the tricarboxylic acid cycle (TCA), gluconeogenesis and fatty-acid synthesis. Pyruvate carboxylase deficiency (PCD) mostly presents with life-limiting encephalopathy (types A/B). A milder type C presentation is rare, with a comparatively favourable prognosis. Therapies remain essentially supportive. Triheptanoin is an odd-chain triglyceride, with the potential to replenish TCA intermediates (anaplerosis), and its metabolites cross the blood-brain-barrier. Outcomes of triheptanoin treatment in PCD types A/B have been disappointing, but have not been reported in type C. Here, we present two new patients with PCD type C, and report the response to treatment with triheptanoin in one. Patient 1 (P1) presented with neonatal-onset lactic acidosis and recurrent symptomatic lactic acidosis following exercise and during illnesses, with frequent hospitalisations. Speech development was delayed. MRI-brain showed delayed cerebral myelination. Patient 2 (P2) presented with episodic ketoacidosis, hyperlactataemia and hypoglycaemia at 2 years of age, with gross motor delay and mild global volume loss on MRI brain. Treatment with triheptanoin was commenced in P1 at 3 years of age with up-titration to 35 mL/day (25% of daily energy intake) over 6 months, due to transient diarrhoea. Dietary long-chain triglycerides were restricted, with fat-soluble vitamin supplementation. Subsequently, hospitalisations during intercurrent illnesses decreased, post-exertional hyperlactataemia resolved and exercise tolerance improved. Continued developmental progress was observed, and repeat MRI 18 months after initiation showed improved myelination. Triheptanoin was well-tolerated and appeared efficacious during 2 years' follow-up, and has potential to restore energy homeostasis and myelin synthesis in PCD type C.
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Affiliation(s)
- I. Bernhardt
- Department of Paediatric Metabolic MedicineGreat Ormond Street Hospital for ChildrenLondonUK
| | - L. Van Dorp
- Dietetics DepartmentGreat Ormond Street Hospital for ChildrenLondonUK
| | - M. Dixon
- Dietetics DepartmentGreat Ormond Street Hospital for ChildrenLondonUK
| | - M. McSweeney
- Department of Paediatric Metabolic MedicineGreat Ormond Street Hospital for ChildrenLondonUK
| | - C. Gan
- Department of Paediatric Metabolic MedicineGreat Ormond Street Hospital for ChildrenLondonUK
| | - J. Baruteau
- Department of Paediatric Metabolic MedicineGreat Ormond Street Hospital for ChildrenLondonUK
- Great Ormond Street Institute of Child Health, University College LondonLondonUK
| | - A. Chakrapani
- Department of Paediatric Metabolic MedicineGreat Ormond Street Hospital for ChildrenLondonUK
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Ng J, Karda R, Massaro G, Meyer E, Barrel S, Baruteau J, Hughes M, Perocheau D, Buckley SMK, Kurian M, Rahim A, Waddington S. 392. Evaluating Promoter Regulated Dopaminergic Neuron Targeting with AAV9 Delivered To the Neonatal Mouse. Mol Ther 2015. [DOI: 10.1016/s1525-0016(16)34001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Baruteau J, Hargreaves I, Krywawych S, Chalasani A, Land JM, Davison JE, Kwok MK, Christov G, Karimova A, Ashworth M, Anderson G, Prunty H, Rahman S, Grünewald S. Successful reversal of propionic acidaemia associated cardiomyopathy: evidence for low myocardial coenzyme Q10 status and secondary mitochondrial dysfunction as an underlying pathophysiological mechanism. Mitochondrion 2014; 17:150-6. [PMID: 25010387 DOI: 10.1016/j.mito.2014.07.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/07/2014] [Accepted: 07/01/2014] [Indexed: 12/30/2022]
Abstract
Dilated cardiomyopathy is a rare complication in propionic acidaemia (PA). Underlying pathophysiological mechanisms are poorly understood. We present a child of Pakistani consanguineous parents, diagnosed with late-onset PA at 18months of age. He presented a mild phenotype, showed no severe further decompensations, normal growth and psychomotor development on a low protein diet and carnitine supplementation. At 15years, a mildly dilated left ventricle was noticed. At 17years he presented after a 2-3month history of lethargy and weight loss with severe decompensated dilated cardiomyopathy. He was stabilised on inotropic support and continuous haemofiltration; a Berlin Heart biventricular assist device was implanted. He received d,l-hydroxybutyrate 200mg/kg/day, riboflavin and thiamine 200mg/day each and coenzyme Q10 (CoQ10). Myocardial biopsy showed endocardial fibrosis, enlarged mitochondria, with atypical cristae and slightly low respiratory chain (RC) complex IV activity relative to citrate synthase (0.012, reference range 0.014-0.034). Myocardial CoQ10 was markedly decreased (224pmol/mg, reference range 942-2738), with a marginally decreased white blood cell level (34pmol/mg reference range 37-133). The dose of CoQ10 was increased from 1.5 to 25mg/kg/day. Cardiomyopathy slowly improved allowing removal of the external mechanical cardiac support after 67days. We demonstrate for the first time low myocardial CoQ10 in cardiomyopathy in PA, highlighting secondary mitochondrial impairment as a relevant causative mechanism. According to these findings, a high-dose CoQ10 supplementation could be a potential adjuvant therapeutic to be considered in PA-related cardiomyopathy.
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Affiliation(s)
- J Baruteau
- Metabolic Medicine Department, Great Ormond Street Hospital, London, UK.
| | - I Hargreaves
- Neurometabolic Laboratory, National Hospital for Neurology and Neurosurgery, London, UK
| | - S Krywawych
- Chemical Pathology, Great Ormond Street Hospital, London, UK
| | - A Chalasani
- Neurometabolic Laboratory, National Hospital for Neurology and Neurosurgery, London, UK
| | - J M Land
- Neurometabolic Laboratory, National Hospital for Neurology and Neurosurgery, London, UK
| | - J E Davison
- Metabolic Medicine Department, Great Ormond Street Hospital, London, UK
| | - M K Kwok
- Metabolic Medicine Department, Great Ormond Street Hospital, London, UK
| | - G Christov
- Cardiothoracic Unit, Great Ormond Street Hospital, London, UK
| | - A Karimova
- Cardiothoracic Unit, Great Ormond Street Hospital, London, UK
| | - M Ashworth
- Pathology Laboratory, Great Ormond Street Hospital, London, UK
| | - G Anderson
- Pathology Laboratory, Great Ormond Street Hospital, London, UK
| | - H Prunty
- Chemical Pathology, Great Ormond Street Hospital, London, UK
| | - S Rahman
- Metabolic Medicine Department, Great Ormond Street Hospital, London, UK; Clinical and Molecular Genetics Unit, UCL Institute of Child Health, London, UK
| | - S Grünewald
- Metabolic Medicine Department, Great Ormond Street Hospital, London, UK; Clinical and Molecular Genetics Unit, UCL Institute of Child Health, London, UK
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Adam S, Almeida MF, Assoun M, Baruteau J, Bernabei SM, Bigot S, Champion H, Daly A, Dassy M, Dawson S, Dixon M, Dokoupil K, Dubois S, Dunlop C, Evans S, Eyskens F, Faria A, Favre E, Ferguson C, Goncalves C, Gribben J, Heddrich-Ellerbrok M, Jankowski C, Janssen-Regelink R, Jouault C, Laguerre C, Le Verge S, Link R, Lowry S, Luyten K, Macdonald A, Maritz C, McDowell S, Meyer U, Micciche A, Robert M, Robertson LV, Rocha JC, Rohde C, Saruggia I, Sjoqvist E, Stafford J, Terry A, Thom R, Vande Kerckhove K, van Rijn M, van Teeffelen-Heithoff A, Wegberg AV, van Wyk K, Vasconcelos C, Vestergaard H, Webster D, White FJ, Wildgoose J, Zweers H. Dietary management of urea cycle disorders: European practice. Mol Genet Metab 2013; 110:439-45. [PMID: 24113687 DOI: 10.1016/j.ymgme.2013.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/04/2013] [Accepted: 09/06/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is no published data comparing dietary management of urea cycle disorders (UCD) in different countries. METHODS Cross-sectional data from 41 European Inherited Metabolic Disorder (IMD) centres (17 UK, 6 France, 5 Germany, 4 Belgium, 4 Portugal, 2 Netherlands, 1 Denmark, 1 Italy, 1 Sweden) was collected by questionnaire describing management of patients with UCD on prescribed protein restricted diets. RESULTS Data for 464 patients: N-acetylglutamate synthase (NAGS) deficiency, n=10; carbamoyl phosphate synthetase (CPS1) deficiency, n=29; ornithine transcarbamoylase (OTC) deficiency, n=214; citrullinaemia, n=108; argininosuccinic aciduria (ASA), n=80; arginase deficiency, n=23 was reported. The majority of patients (70%; n=327) were aged 0-16y and 30% (n=137) >16y. Prescribed median protein intake/kg body weight decreased with age with little variation between disorders. The UK tended to give more total protein than other European countries particularly in infancy. Supplements of essential amino acids (EAA) were prescribed for 38% [n=174] of the patients overall, but were given more commonly in arginase deficiency (74%), CPS (48%) and citrullinaemia (46%). Patients in Germany (64%), Portugal (67%) and Sweden (100%) were the most frequent users of EAA. Only 18% [n=84] of patients were prescribed tube feeds, most commonly for CPS (41%); and 21% [n=97] were prescribed oral energy supplements. CONCLUSIONS Dietary treatment for UCD varies significantly between different conditions, and between and within European IMD centres. Further studies examining the outcome of treatment compared with the type of dietary therapy and nutritional support received are required.
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Affiliation(s)
- S Adam
- Royal Hospital for Sick Children, Glasgow Royal Infirmary, Glasgow, UK
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Baruteau J, Heissat S, Collardeau-Frachon S, Debray D, Broué P, Guigonis V. Nouveaux concepts dans l’hémochromatose périnatale. Arch Pediatr 2012; 19:755-61. [DOI: 10.1016/j.arcped.2012.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/13/2012] [Accepted: 04/11/2012] [Indexed: 11/28/2022]
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Galoin-Bertail C, Ogier de Baulny H, Wanders R, Schiff M, Bellavoine V, Mlika A, Benoist G, Baruteau J. Le syndrôme de Sjögren-Larsson : à propos de 2 cas. Arch Pediatr 2012; 19:135-41. [DOI: 10.1016/j.arcped.2011.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 07/05/2011] [Accepted: 11/07/2011] [Indexed: 10/14/2022]
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Feillet F, Ogier H, Cheillan D, Aquaviva C, Labarthe F, Baruteau J, Chabrol B, de Lonlay P, Valayanopoulos V, Garnotel R, Dobbelaere D, Briand G, Jeannesson E, Vassault A, Vianey-Saban C. [Medium-chain acyl-CoA-dehydrogenase (MCAD) deficiency: French consensus for neonatal screening, diagnosis, and management]. Arch Pediatr 2012; 19:184-93. [PMID: 22244319 DOI: 10.1016/j.arcped.2011.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 10/28/2011] [Indexed: 12/30/2022]
Abstract
MCAD deficiency is the most common fatty acid oxidation disorder, with the prevalence varying from 1/10,000 to 1/27,000 in the countries adjacent to France. As the High Authority for Health has recently proposed including MCAD deficiency in the panel of diseases neonatally screened for in France, a consensus was written for the management of MCAD deficiency diagnosed either clinically or by neonatal screening. Patients may present acutely with hyperammonemia, hypoglycemia, encephalopathy, and hepatomegaly, mainly after a prolonged fast of intercurrent infection. Sudden death related to heartbeat disorders may also occur. The diagnosis of MCAD deficiency is suspected on the plasma acylcarnitine and/or the urinary organic acid profile. The diagnosis is confirmed by molecular biology and the enzymatic activity for patients who are not homozygous for the main mutation c.985A>G. However, some MCAD-deficient individuals may remain asymptomatic throughout life. The mainstay of treatment consists in avoiding prolonged fast and prescribing l-carnitine for patients who exhibit a deficiency in plasma carnitine. This management has radically modified the natural history of MCAD deficiency. This consensus will allow homogeneous management of these patients once the neonatal screening of MCAD deficiency has been introduced in France.
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Affiliation(s)
- F Feillet
- Inserm U 954, centre de référence des maladies héréditaires du métabolisme, hôpital de Brabois-Enfants, rue du Morvan, 54511 Vandœuvre, France.
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Baruteau J, Schiff M, Sachs P, Rigal O, Benoist J, Durand P, Debray D, Ogier De Baulny H. CL145 - Insuffisance hépatocellulaire aiguë et hyperammoniémie : quand évoquer un déficit du cycle de l’urée ? Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baruteau J, Joomye R, Muller JB, Vinceslas C, Baraton L, Joubert M, Paumier A, Roze JC. La chorioangiomatose : une cause rare d’anasarque fœtoplacentaire non immune. Implications pratiques obstétrico-pédiatriques. Arch Pediatr 2009; 16:1341-5. [DOI: 10.1016/j.arcped.2009.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 10/04/2008] [Accepted: 07/05/2009] [Indexed: 10/20/2022]
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Baruteau J, Cartault A, Chanot A, Sevely A, Casper C. Neonatal Escherichia coli meningitis can be complicated by central permanent diabetes insipidus. J Pediatr Endocrinol Metab 2009; 22:213. [PMID: 19492576 DOI: 10.1515/jpem.2009.22.3.213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J Baruteau
- Neonatology Unit, Children's Hospital and Neuroradiology, Purpan Hospital, Toulouse, France.
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Baruteau AE, Baruteau J, Baruteau R, Schleich JM, Roussey M, Daubert JC, Mabo P. [Long QT syndrome: an underestimated cause of sudden infant death]. Arch Pediatr 2009; 16:373-80. [PMID: 19217761 DOI: 10.1016/j.arcped.2008.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 09/03/2008] [Accepted: 12/24/2008] [Indexed: 10/21/2022]
Abstract
Congenital long QT syndrome (LQTS) is an inherited arrhythmia that can be sporadic or familial. It predisposes to sudden cardiac death by ventricular fibrillation, which can occur at any age, particularly in neonates. Recent postmortem molecular screening surveys have shown that 10 to 12% of sudden infant death syndrome (SIDS) cases were potentially related to congenital long QT syndrome. Current SIDS etiological surveys fail to diagnose LQTS. Specific questioning and electrocardiographic screening of first-degree relatives could greatly facilitate LQTS diagnosis. We propose adding these to screening modalities after a SIDS incident. Neonatal electrocardiographic screening could allow early identification of LQTS and adapted treatment and follow-up.
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Affiliation(s)
- A-E Baruteau
- Département de cardiologie et maladies vasculaires, hôpital de Pontchaillou, centre hospitalier universitaire de Rennes, 35033 Rennes cedex, France.
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Humbert J, Muller JB, Baruteau J, Roze JC, Vianey-Saban C, Sevin C, Aubourg P, Kuster A. SFP-P119 – Métabolisme – Un syndrome de Zellweger chez une enfant prématurée. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)72249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Baruteau J, Devilliers A, François I, Blettery B. [End-of-life and euthanasia, an intensive care team's experience]. Presse Med 2002; 31:683-91. [PMID: 12148130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVES The improvement in the medical techniques used in intensive care units over the last 30 years has led to a different approach towards the end of life and death. Our study has underlined the feelings of all the staff of an intensive care unit towards the various difficulties engendered by death and the question of euthanasia. RESULTS Conducted in the particular context of an intensive care unit, this work is a survey on the staff's feelings and factual experiences, in order to promote discussions on this painful subject. Sixty-one percent of the persons surveyed declared that euthanasia was ethically acceptable. The patients take the initiative of the request (92%) and the cohesion of the team is unanimously required. Pain and corporeal deterioration are the first motivations. DISCUSSION Euthanasia is a difficult question, sometimes impassionate, and the care units have to consider whether they are concerned by the quality of their patients' care. The press regularly issues reports on this. But beyond these quantified questions, the staff who care for these ill patients are often very discreet. The regular confrontation with this situation changes the medical team's view of the profession.
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Affiliation(s)
- J Baruteau
- Service de Réanimation Médicale, Hôpital Général, 3, Rue du Faubourg Raines, 21003 Dijon
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