title: Clinical and molecular heterogeneity in very-long-chain acyl-coenzyme A dehydrogenase deficiency.
abstract: Very-long-chain acyl-coenzyme A dehydrogenase (VLCAD) deficiency is an increasingly recognized defect of mitochondrial fatty acid beta-oxidation manifesting with episodes of metabolic decompensation or isolated recurrent myoglobinuria. In this report the clinical, biochemical, and molecular studies in a series of five patients (four Italian and one Spanish) with this disorder are discussed. Biochemical studies included the determination of fibroblast substrate oxidation rates and enzyme activity and Western blot analysis of VLCAD protein. Molecular analysis was performed by sequencing the VLCAD gene from the genomic DNA. Clinical features were within the spectrum previously reported. Four patients presented in infancy or childhood with episodes of severe metabolic decompensation and dicarboxylic aciduria. Two exhibited cardiomyopathy. The fifth patient presented with isolated recurrent rhabdomyolysis, with no cardiomyopathy or dicarboxylic aciduria. In all patients a significant loss of VLCAD activity associated with a marked reduction of VLCAD protein levels occurred. Molecular analysis disclosed one novel missense mutation (Cys437Tyr) and four previously reported mutations, including two missense substitutions (Phe418Leu and Arg419Trp), a single amino acid deletion (Lys258del), and one splice site mutation (IVS8-C(-2)), which was present in all four Italian patients. All patients exhibited compound heterozygosity. The phenotypic variability and the high genotypic heterogeneity of this hereditary metabolic disorder is reported.
authors.affiliation: Laboratory of Cellular Pathology, Istituto Nazionale Neurologico Carlo Besta, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Pons
authors.forename: P
authors.initials: P
authors.lastname: Cavadini
authors.forename: S
authors.initials: S
authors.lastname: Baratta
authors.forename: F
authors.initials: F
authors.lastname: Invernizzi
authors.forename: E
authors.initials: E
authors.lastname: Lamantea
authors.forename: B
authors.initials: B
authors.lastname: Garavaglia
authors.forename: F
authors.initials: F
authors.lastname: Taroni
mesh_terms: D042964:Acyl-CoA Dehydrogenase; D000328:Adult; D015153:Blotting, Western; D002675:Child, Preschool; D003937:Diagnosis, Differential; D018752:Diet, Fat-Restricted; D017809:Fatal Outcome; D044943:Fatty Acid Desaturases / Q000172:deficiency* / Q000235:genetics*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017240:Mitochondrial Myopathies / Q000175:diagnosis* / Q000178:diet therapy / Q000209:etiology / Q000235:genetics*; D009154:Mutation; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome
chemical_list: D044943:Fatty Acid Desaturases; D042964:Acyl-CoA Dehydrogenase