Cross-sectional multicenter study of patients with urea cycle disorders in the United States.
Inherited urea cycle disorders comprise eight disorders (UCD), each caused by a deficiency of one of the proteins that is essential for ureagenesis. We report on a cross-sectional investigation to determine clinical and laboratory characteristics of patients with UCD in the United States. The data used for the analysis was collected at the time of enrollment of individuals with inherited UCD into a longitudinal observation study. The study has been conducted by the Urea Cycle Disorders Consortium within the Rare Diseases Clinical Research Network (RDCRN) funded by the National Institutes of Health. One-hundred eighty-three patients were enrolled into the study. Ornithine transcarbamylase (OTC) deficiency was the most frequent disorder (55%), followed by argininosuccinic aciduria (16%) and citrullinemia (14%). Seventy-nine percent of the participants were white (16% Latinos), and 6% were African American. Intellectual and developmental disabilities were reported in 39% with learning disabilities (35%) and half had abnormal neurological examination. Sixty-three percent were on a protein restricted diet, 37% were on Na-phenylbutyrate and 5% were on Na-benzoate. Forty-five percent of OTC deficient patients were on L-citrulline, while most patients with citrullinemia (58%) and argininosuccinic aciduria (79%) were on L-arginine. Plasma levels of branched-chain amino acids were reduced in patients treated with ammonia scavenger drugs. Plasma glutamine levels were higher in proximal UCD and in neonatal type disease. The RDCRN allows comprehensive analyses of rare inherited UCD, their frequencies and current medical practices.
Children's National Medical Center, The George Washington University, School of Medicine, 111 Michigan Avenue, N.W., Washington, DC 20010, USA.
Mendel
M
Tuchman
Baylor College of Medicine, Houston, TX, USA.
Brendan
B
Lee
Children's National Medical Center, The George Washington University, School of Medicine, 111 Michigan Avenue, N.W., Washington, DC 20010, USA.
Uta
U
Lichter-Konecki
Vanderbilt University, Nashville, TN, USA.
Marshall L
ML
Summar
Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
Marc
M
Yudkoff
University of California Los Angeles, Los Angeles, CA, USA.
Stephen D
SD
Cederbaum
Case Western Reserve University, Cleveland, OH, USA.
Douglas S
DS
Kerr
Mount Sinai School of Medicine, New York, NY, USA.
George A
GA
Diaz
Yale University, New Haven, CT, USA.
Margaretta R
MR
Seashore
University of South Florida, Tampa, FL, USA.
Hye-Seung
HS
Lee
Children's National Medical Center, The George Washington University, School of Medicine, 111 Michigan Avenue, N.W., Washington, DC 20010, USA.
Robert J
RJ
McCarter
University of South Florida, Tampa, FL, USA.
Jeffrey P
JP
Krischer
Children's National Medical Center, The George Washington University, School of Medicine, 111 Michigan Avenue, N.W., Washington, DC 20010, USA.
Mark L
ML
Batshaw
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000592:Amino Acid Metabolism, Inborn Errors / Q000453:epidemiology* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D000596:Amino Acids / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D020159:Citrullinemia; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020163:Ornithine Carbamoyltransferase Deficiency Disease / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D035583:Rare Diseases / Q000453:epidemiology* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D014481:United States; D014508:Urea / Q000378:metabolism*
D000596:Amino Acids; D014508:Urea