A case of holocarboxylase synthetase deficiency with insufficient response to prenatal biotin therapy.
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.
Yokoi
Kyoko
K
Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
Ito
Tetsuya
T
Maeda
Yasuhiro
Y
Nakajima
Yoko
Y
Kurono
Yukihisa
Y
Sugiyama
Naruji
N
Togari
Hajime
H
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
D000108:Acetylcarnitine; D001710:Biotin; D002331:Carnitine