title: Biochemical, clinical and molecular findings in LCHAD and general mitochondrial trifunctional protein deficiency.
abstract: General mitochondrial trifunctional protein (TFP) deficiency leads to a wide clinical spectrum of disease ranging from severe neonatal/infantile cardiomyopathy and early death to mild chronic progressive sensorimotor poly-neuropathy with episodic rhabdomyolysis. Isolated long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency resulting from the common Glu510Gln mutation usually gives rise to a moderately severe phenotype with multiorgan involvement with high morbidity and mortality. However, isolated LCHAD deficiency can also be consistent with long-term survival in patients identified and treated from an early age. We present biochemical, clinical and mutation data in 9 patients spanning the full spectrum of disease. Fibroblast acylcarnitine profiling shows good correlation with clinical phenotype using the ratio C18(OH)/(C14(OH)+C12(OH)). This ratio shows a gradation of values, from high in four patients with severe neonatal disease (2.5+/-0.8), to low in two neuromyopathic patients (0.35, 0.2). Fibroblast fatty acid oxidation flux assays also show correlation with the patient phenotype, when expressed either as percentage residual activity with palmitate or as a ratio of percentage activity of myristate/oleate (M/O ratio). Fibroblasts from four patients with severe neonatal disease gave an M/O ratio of 4.0+/-0.6 compared to 1.97 and 1.62 in two neuromyopathic patients. Specific enzyme assay of LCHAD and long-chain 3-ketothiolase activity in patient cells shows lack of correlation with phenotype. These results show that measurements in intact cells, which allow all determinative and modifying cellular factors to be present, better reflect patient phenotype. Mutation analysis reveals a number of alpha- and beta-subunit mutations. Peripheral sensorimotor polyneuropathy, often as the initial major presenting feature but usually later accompanied by episodic rhabdomyolysis, is a manifestation of mild TFP protein deficiency. The mild clinical presentation and relative difficulty in diagnosis suggest that this form of TFP is probably underdiagnosed.
authors.affiliation: Department of Clinical Chemistry, Sheffield Children's Hospital, Sheffield, UK. simon.olpin@sch.nhs.uk
authors.forename: S E
authors.initials: SE
authors.lastname: Olpin
authors.forename: S
authors.initials: S
authors.lastname: Clark
authors.forename: B S
authors.initials: BS
authors.lastname: Andresen
authors.forename: C
authors.initials: C
authors.lastname: Bischoff
authors.forename: R K J
authors.initials: RK
authors.lastname: Olsen
authors.forename: N
authors.initials: N
authors.lastname: Gregersen
authors.forename: A
authors.initials: A
authors.lastname: Chakrapani
authors.forename: M
authors.initials: M
authors.lastname: Downing
authors.forename: N J
authors.initials: NJ
authors.lastname: Manning
authors.forename: M
authors.initials: M
authors.lastname: Sharrard
authors.forename: J R
authors.initials: JR
authors.lastname: Bonham
authors.forename: F
authors.initials: F
authors.lastname: Muntoni
authors.forename: D N
authors.initials: DN
authors.lastname: Turnbull
authors.forename: M
authors.initials: M
authors.lastname: Pourfarzam
mesh_terms: D044942:Acyl-CoA Dehydrogenase, Long-Chain / Q000172:deficiency*; D009202:Cardiomyopathies / Q000175:diagnosis / Q000235:genetics; D002331:Carnitine / Q000031:analogs & derivatives / Q000378:metabolism; D005091:Exons; D005227:Fatty Acids / Q000378:metabolism; D005347:Fibroblasts / Q000378:metabolism; D006720:Homozygote; D006801:Humans; D008052:Lipid Metabolism, Inborn Errors / Q000175:diagnosis* / Q000235:genetics*; D008297:Male; D008928:Mitochondria / Q000473:pathology*; D063991:Mitochondrial Trifunctional Protein; D009097:Multienzyme Complexes / Q000172:deficiency*; D009154:Mutation; D010641:Phenotype; D011115:Polyneuropathies / Q000175:diagnosis / Q000235:genetics; D011379:Prognosis; D012206:Rhabdomyolysis / Q000175:diagnosis / Q000235:genetics
chemical_list: D005227:Fatty Acids; D009097:Multienzyme Complexes; C116917:acylcarnitine; D044942:Acyl-CoA Dehydrogenase, Long-Chain; D063991:Mitochondrial Trifunctional Protein; D002331:Carnitine