title: Treatment of arginase deficiency revisited: guanidinoacetate as a therapeutic target and biomarker for therapeutic monitoring.
abstract: Hyperargininaemia is a disorder of the last step of the urea cycle. It is an autosomal recessive disease caused by deficiency of liver arginase-1 and usually presents later in childhood with progressive neurological symptoms including marked spasticity. In contrast with other urea cycle disorders, hyperammonaemia is not usually present but can be a feature. A number of guanidine compounds may accumulate in the blood and cerebrospinal fluid of these patients, which could play an important pathophysiological role. Guanidinoacetate is of particular interest as a well-known potent epileptogenic compound in guanidinoacetate methyltransferase deficiency. We found markedly elevated guanidinoacetate levels in a patient with arginase deficiency, which dropped significantly in response to dietary and medical treatment. Measurement of guanidinoacetate and other guanidino compounds may, therefore, be important for therapeutic monitoring in arginase deficiency.
authors.affiliation: Department of Paediatrics, Clinic for Paediatric Kidney-, Liver- and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
authors.forename: Wajdi
authors.initials: W
authors.lastname: Amayreh
authors.forename: Uta
authors.initials: U
authors.lastname: Meyer
authors.forename: Anibh M
authors.initials: AM
authors.lastname: Das
mesh_terms: D001565:Benzoates / Q000008:administration & dosage / Q000494:pharmacology*; D015415:Biomarkers; D002648:Child; D003401:Creatine / Q000008:administration & dosage / Q000494:pharmacology*; D005998:Glycine / Q000031:analogs & derivatives* / Q000097:blood; D006801:Humans; D020162:Hyperargininemia / Q000178:diet therapy / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D009952:Ornithine / Q000008:administration & dosage / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D001565:Benzoates; D015415:Biomarkers; D009952:Ornithine; C004946:glycocyamine; D003401:Creatine; D005998:Glycine