title: A case of holocarboxylase synthetase deficiency with insufficient response to prenatal biotin therapy.
abstract: Holocarboxylase synthetase (HCS) deficiency is an inborn error of biotin metabolism, leading to a multiple carboxylases deficiency. As the affected fetus sometimes presents with enlargement of the cerebral ventricles and intrauterine growth retardation (IUGR), prenatal administration of biotin has been attempted in some pregnancies. We present herein the case of a Japanese neonate with HCS deficiency who received maternal administration of biotin (10mg/day) from 33 weeks' gestation. After biotin administration, the fetal body weight increased and gestation was continued to full term. However, lactic acidemia and metabolic acidosis were observed after birth. To evaluate the effects of prenatal therapy, we collected serum samples and measured the acylcarnitine profiles using high-performance liquid chromatography electrospray ionization tandem mass spectrometry. At birth, levels of propionylcarnitine and 3-hydroxyisovalerylcarnitine had already increased. At 2h after birth, these levels of acylcarnitines were further increased. At 3.5h after the start of biotin, these chemical findings were slightly improved. In conclusion, we considered that prenatal biotin therapy at 10mg/day may have been inadequate to avoid neonatal acidotic crisis in this case.
authors.affiliation: Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Yokoi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ito
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Maeda
authors.forename: Yoko
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Yukihisa
authors.initials: Y
authors.lastname: Kurono
authors.forename: Naruji
authors.initials: N
authors.lastname: Sugiyama
authors.forename: Hajime
authors.initials: H
authors.lastname: Togari
mesh_terms: D000108:Acetylcarnitine / Q000097:blood; D001710:Biotin / Q000627:therapeutic use*; D002331:Carnitine / Q000097:blood; D005260:Female; D028922:Holocarboxylase Synthetase Deficiency / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D006801:Humans; D007231:Infant, Newborn; D007564:Japan; D009100:Multiple Carboxylase Deficiency / Q000235:genetics; D009154:Mutation; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011297:Prenatal Exposure Delayed Effects / Q000235:genetics
chemical_list: D000108:Acetylcarnitine; D001710:Biotin; D002331:Carnitine