title: Successful treatment of severe cardiomyopathy in glycogen storage disease type III With D,L-3-hydroxybutyrate, ketogenic and high-protein diet.
abstract: Glycogen storage disease type III (GSD III) due to debranching enzyme deficiency presenting usually with hepatomegaly and hypoglycemia may be responsible for severe cardiomyopathy which is often fatal. Current treatment of GSD III is based on frequent high-carbohydrate meals that have no effect on the cardiomyopathy. We describe a 2-mo-old infant presenting with a familial form of GSD III complicated with cardiomyopathy. As conventional treatment was unable to improve his sister's cardiomyopathy who was deceased at age 11 mo, we proposed an experimental treatment combining the use of synthetic ketone bodies (D,L-3-OH butyrate) as an alternative energy source, 2:1 ketogenic diet to reduce glucose intake and high-protein diet to enhance gluconeogenesis. Twenty-four months after the onset of this treatment, echocardiography showed an improvement of cardiomyopathy. Growth and liver size remained normal, and no side effects were observed. Blood glucose levels remained within the normal range and insulin levels decreased. These findings show that synthetic ketone bodies as well as low-carbohydrate, high-lipid, and high-protein diet may be a more beneficial therapeutic choice therapeutic choice for GSD III patients with cardiomyopathy. These encouraging data need to be confirmed in more GSD III patients presenting with cardiac or muscular symptoms.
authors.affiliation: Reference Center for Inherited Metabolic Disorders, Necker-Enfants Malades Hospital and Paris Descartes University, 75015 Paris, France. vassili.valaya@nck.aphp.fr
authors.forename: Vassili
authors.initials: V
authors.lastname: Valayannopoulos
authors.forename: Fanny
authors.initials: F
authors.lastname: Bajolle
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Arnoux
authors.forename: Sandrine
authors.initials: S
authors.lastname: Dubois
authors.forename: Nathalie
authors.initials: N
authors.lastname: Sannier
authors.forename: Christiane
authors.initials: C
authors.lastname: Baussan
authors.forename: François
authors.initials: F
authors.lastname: Petit
authors.forename: Philippe
authors.initials: P
authors.lastname: Labrune
authors.forename: Daniel
authors.initials: D
authors.lastname: Rabier
authors.forename: Chris
authors.initials: C
authors.lastname: Ottolenghi
authors.forename: Anne
authors.initials: A
authors.lastname: Vassault
authors.forename: Christine
authors.initials: C
authors.lastname: Broissand
authors.forename: Damien
authors.initials: D
authors.lastname: Bonnet
authors.forename: Pascale
authors.initials: P
authors.lastname: de Lonlay
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000494:pharmacology* / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D009202:Cardiomyopathies / Q000178:diet therapy* / Q000188:drug therapy* / Q000209:etiology; D003402:Creatine Kinase / Q000097:blood; D055423:Diet, Ketogenic; D004044:Dietary Proteins / Q000494:pharmacology*; D006010:Glycogen Storage Disease Type III / Q000150:complications*; D006801:Humans; D007223:Infant; D007328:Insulin / Q000097:blood; D007657:Ketone Bodies / Q000097:blood; D008099:Liver / Q000473:pathology; D008297:Male; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D004044:Dietary Proteins; D007328:Insulin; D007657:Ketone Bodies; D014280:Triglycerides; D003402:Creatine Kinase; D020155:3-Hydroxybutyric Acid