title: Inborn errors of metabolism diagnosed in sudden death cases by acylcarnitine analysis of postmortem bile.
abstract: Fatty acid oxidation (FAO) disorders represent a frequently misdiagnosed group of inborn errors of metabolism. Some patients die at the first episode of fasting intolerance and, if appropriate investigations are not undertaken, often meet the criteria of sudden infant death syndrome (SIDS). To expand existing protocols for the postmortem diagnosis of FAO and other metabolic disorders, we tested the hypothesis that analysis for acylcarnitine in bile, a specimen readily available at autopsy, may be utilized for diagnostic purposes. Using electrospray/tandem mass spectrometry, we analyzed for acylcarnitine postmortem bile specimens from two infants with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, one infant with glutaryl-CoA dehydrogenase deficiency, and 17 uninformative SIDS cases as controls. The affected cases, and none of the controls, showed marked accumulation of C10-C18 acylcarnitines or glutarylcarnitine (acyl/free carnitine ratio: 5.2, 2.7, and 1.9, respectively; controls 0.2 +/- 0.1). In one patient, all other diagnostic methods were uninformative, suggesting that bile acylcarnitine profiling could lead to identification of previously overlooked cases.
authors.affiliation: King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: M S
authors.initials: MS
authors.lastname: Rashed
authors.forename: P T
authors.initials: PT
authors.lastname: Ozand
authors.forename: M J
authors.initials: MJ
authors.lastname: Bennett
authors.forename: J J
authors.initials: JJ
authors.lastname: Barnard
authors.forename: D R
authors.initials: DR
authors.lastname: Govindaraju
authors.forename: P
authors.initials: P
authors.lastname: Rinaldo
mesh_terms: D015094:3-Hydroxyacyl CoA Dehydrogenases / Q000172:deficiency; D000215:Acylation; D001646:Bile / Q000737:chemistry*; D002331:Carnitine / Q000032:analysis*; D002648:Child; D005227:Fatty Acids / Q000378:metabolism*; D050770:Glutaryl-CoA Dehydrogenase; D006801:Humans; D007231:Infant, Newborn; D008052:Lipid Metabolism, Inborn Errors / Q000175:diagnosis*; D063989:Long-Chain-3-Hydroxyacyl-CoA Dehydrogenase; D008297:Male; D013058:Mass Spectrometry; D010084:Oxidation-Reduction; D010088:Oxidoreductases / Q000172:deficiency; D044925:Oxidoreductases Acting on CH-CH Group Donors; D011180:Postmortem Changes; D013398:Sudden Infant Death
chemical_list: D005227:Fatty Acids; D010088:Oxidoreductases; D015094:3-Hydroxyacyl CoA Dehydrogenases; D063989:Long-Chain-3-Hydroxyacyl-CoA Dehydrogenase; D044925:Oxidoreductases Acting on CH-CH Group Donors; D050770:Glutaryl-CoA Dehydrogenase; D002331:Carnitine