European Journal of Pediatrics

, Volume 144, Issue 5, pp 451–456

The response to l-carnitine and glycine therapy in isovaleric acidaemia

  • C. de Sousa
  • R. A. Chalmers
  • T. E. Stacey
  • B. M. Tracey
  • C. M. Weaver
  • D. Bradley
Original Investigations

DOI: 10.1007/BF00441737

Cite this article as:
de Sousa, C., Chalmers, R.A., Stacey, T.E. et al. Eur J Pediatr (1986) 144: 451. doi:10.1007/BF00441737

Abstract

The profound metabolic disturbances which occur in isovaleric acidaemia are due to the intramitochondrial accumulation of isovaleryl coenzyme A (CoA) with a consequent reduction in the availability of free CoA. Secondary carnitine insufficiency is also a feature of this and other disorders of organic acid metabolism. A patient who presented at 2.5 years of age was diagnosed using capillary GC-MS as having isovaleric acidaemia. She showed the full spectrum of abnormal organic acids previously associated with the ‘neonatal’ form of the disease despite her late presentation, indicating that it is inappropriate to refer to acute early and late onset forms of isovaleric acidaemia. Instead, a spectrum of disease exists, determined by environmental factors, residual enzyme activities and modifying effects of different phenotypes in different individuals. She also showed evidence of carnitine insufficiency. An oral challenge with l-carnitine resulted in the excretion of large amounts of urinary acylcarnitines which were shown by use of fast atom bombardment mass spectrometry to be primarily isovalerylcarnitine. Regular glycine supplementation caused no significant increase in urinary isovaleryglycine and had to be stopped because of side-effects after 5 days. An oral l-carnitine challenge during glycine supplementation resulted in a marked increase in isovalerylglycine excretion, again associated with the excretion of large amounts of isovalerylcarnitine. Carnitine acts by removing (detoxifying) intramitochondrial isovaleryl groups and, in the presence of glycine, it promotes the formation of isovalerylglycine. We believe l-carnitine supplementation is of value in the treatment of isovaleric acidaemia and that, in the present case, l-carnitine together with a moderate dietary restriction has proved to be the optimum form of therapy.

Key words

Isovaleric acidaemia Carnitine Isovalerylcarnitine Glycine therapy Carnitine therapy 

Abbreviations

CoA

Coenzyme A

TMS

trimethylsilyl

S.D.

standard deviation

DEAE

diethylaminoethyl

FAB

fast atom bombardment

Copyright information

© Springer-Verlag 1986

Authors and Affiliations

  • C. de Sousa
    • 2
    • 1
  • R. A. Chalmers
    • 2
    • 1
  • T. E. Stacey
    • 2
    • 1
  • B. M. Tracey
    • 2
    • 1
  • C. M. Weaver
    • 2
    • 1
  • D. Bradley
    • 2
    • 1
  1. 1.Departments of Child Health and MedicineUniversity of WalesCardiffUK
  2. 2.Section of Perinatal and Child HealthMRC Clinical Research CentreHarrowEngland

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