title: Effects of valproic acid on organic acid metabolism in children: a metabolic profiling study.
abstract: Young children are at increased risk for valproic acid (VPA) hepatotoxicity. Urinary organic acid profiles, as a surrogate of mitochondrial function, were obtained in children 1.9 to 17.3 years of age (n = 52) who were undergoing treatment with VPA for seizure disorders. Age-matched patients receiving treatment with carbamazepine (CBZ; n = 50) and healthy children not undergoing treatment (n = 22) served as controls. Age-related changes in organic acid profiles were observed in all three groups. Although the untreated and CBZ control groups were indistinguishable from each other with respect to the principal-component analysis (PCA) score plots of the subjects, a distinct boundary was apparent between the VPA and each of the control groups. Interindividual variability was observed in the VPA-induced alterations in endogenous pathways corresponding to branched-chain amino acid metabolism and oxidative stress. The data suggest that more detailed metabolomic analysis may provide novel insights into biological mechanisms and predictive biomarkers for children at highest risk for serious toxicity.
authors.affiliation: Division of Clinical Pharmacology and Medical Toxicology, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA.
authors.forename: K E
authors.initials: KE
authors.lastname: Price
authors.forename: R E
authors.initials: RE
authors.lastname: Pearce
authors.forename: U C
authors.initials: UC
authors.lastname: Garg
authors.forename: B A
authors.initials: BA
authors.lastname: Heese
authors.forename: L D
authors.initials: LD
authors.lastname: Smith
authors.forename: J E
authors.initials: JE
authors.lastname: Sullivan
authors.forename: M J
authors.initials: MJ
authors.lastname: Kennedy
authors.forename: J F
authors.initials: JF
authors.lastname: Bale
authors.forename: R M
authors.initials: RM
authors.lastname: Ward
authors.forename: T K H
authors.initials: TK
authors.lastname: Chang
authors.forename: F S
authors.initials: FS
authors.lastname: Abbott
authors.forename: J S
authors.initials: JS
authors.lastname: Leeder
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002264:Carboxylic Acids / Q000652:urine*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D019344:Lactic Acid / Q000652:urine; D008297:Male; D055442:Metabolome / Q000187:drug effects* / Q000502:physiology*; D025341:Principal Component Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014635:Valproic Acid / Q000378:metabolism* / Q000494:pharmacology*
chemical_list: D002264:Carboxylic Acids; D019344:Lactic Acid; D014635:Valproic Acid