Abstract
The objective of this review is to draw attention to those inherited metabolic traits which are potentially harmful also for the carrier, and to outline preventive measures, at least for obligate heterozygotes, i.e. parents of homozygous children. Concerning carriers of food-dependent abnormalities, early vascular disease in homocystinuria, hyperammonaemic episodes in ornithine transcarbamylase deficiency, presenile cataracts in galactosaemia as well as galactokinase deficiency, spastic paraparesis in X-linked adrenoleukodystrophy, and HELLP syndrome in mothers of babies with long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency have to be mentioned. In the group of food-independent disorders, clinical features in carriers may be paraesthesias and corneal dystrophy in Fabry disease, lens clouding in Lowe syndrome, lung and/or liver diseases in α1-antitrypsin deficiency, and renal stones in cystinuria type II and III. Finally, two monogenic carrier states are known which in pregnant indi-viduals could possibly afflict the developing fetus, i.e. heterozygosity for galactosaemia and for phenylketonuria. Elevated levels of galactose-1-phosphate have been found in red blood cells of infants heterozygous for galactosaemia born to heterozygous mothers. Aspartame in very high doses is reported to increase blood phenylalanine levels in heterozygotes for phenylketonuria, thus being a risk for the fetus of a heterozygous mother. For some of these carrier states preventive measures can be recommended, e.g. restriction of lactose in parents and heterozygous grandparents of children with galactosaemia and galactokinase deficiency as well as transiently in infants heterozygous for galactosaemia, dietary supplementation with monounsaturated fatty acids in symptomatic carriers for X-linked adrenoleukodystrophy, avoidance of smoking and alcohol in heterozygotes for α1-antitrypsin deficiency, avoidance of episodes of dehydration in heterozygotes for cystinuria, and restriction of aspartame in p regnant women.
REFERENCES
Am PH, Hauser ER, Thomas GH, Herman G, Hess D, Brusilow SW (1990) Hyperammonemia in women with a mutation at the ornithine carbamoyltransferase locus, a cause of postpartum coma. N Engl J Med 322:1652–1655.
Aubourg P, Adamsbaum C, Lavallard-Rousseau MC et al (1993) A two-year trial of oleic and erucic acids ('Lorenzo's Oil') as treatment of adrenomyeloneuropathy. N Engl J Med 329:745–752.
Batshaw ML, Roan Y, Jung AL, Rosenberg LA, Brusilow SW (1980) Cerebral dysfunction in asymptomatic carriers of ornithine transcarbamylase deficiency. N Engl J Med 302:482–485.
Batshaw ML, Naylor EW, Thomas GH (1989) False positive alanine tolerance test results in heterozygote detection of urea cycle disorders. J Pediatr 115:595–598.
Becroft DMO, Barry DMJ, Webster DR, Simmonds HA (1984) Failure of protein loading tests to identify heterozygosity for ornithine carbamoyltransferase deficiency. J Inher Metab Dis 7 :157–159.
Bessman SP (1972) Genetic failure of fetal amino acid 'justification': a common basis for many forms of metabolic, nutritional, and 'nonspecific' mental retardation. J Pediatr 81:834–842.
Bessman SP (1979) The justification theory: the essential nature of the non-essential amino acids. Nutr Rev 37: 209–220.
Bessman SP, Williamson ML, Koch R (1978) Diet, genetics, and mental retardation interaction between phenylketonuric heterozygous mother and fetus to produce nonspecific diminution of IQ: evidence in support of the justification hypothesis. Proc Natl Acad Sci 75:1562–1566.
Beutler E, Matsumoto F (1978) Galactokinase and cataracts. Lancet 1:1161.
Beutler E, Matsumoto F. Kuhl W et al (1973) Galactokinase deficiency as a cause of cataracts. N Engl J Med 228:1203–1206.
Boers GHJ, Smals AGH, Trijbels FJM et al (1985) Heterozygosity for homocystinuria in premature peripheral and cerebral occlusive arterial disease. N Engl J Med 313:709–715.
Brattstrom LE, Hardebo JE, Hultberg BL (1984) Moderate homocysteinemia-a possible risk factor for arteriosclerotic cerebrovascular disease. Stroke 15:1012–1016.
Brattstrom L, Israelsson B, Lindgarde F. Hultberg B (1988) Highet total plasma homocysteine in vitamin B,2 deficiency than in heterozygosity for homocystinuria due to cystathionine 3-synthase deficiency. Metabolism 37: 175–178.
Brivet M, Migayron F, Roger J, Cheron G, Lemonnier A (1989) Lens hexitols and cataract formation during lactation in a woman heterozygote for galactosaemia. J Inher Metab Dis 12(supplement 2): 343–345.
Brusilow SW, Horwich AL (1995) Urea cycle enzymes. In Scriver CR, Beaudet AL, Sly WS, Valle D, eds. The Metabolic and Molecular Bases of Inherited Disease,7th edn. New York: McGraw-Hill, 1187–1232.
Burke JP, O'Keefe M, Bowell R, Naughten ER (1988) Cataracts in children with classical galacto-saemia and in their parents. J Inher Metab Dis 11(supplement 2): 246–248.
Caballero B, Mahon BE, Rohr FJ, Levy HL, Wurtman RJ (1986) Plasma amino acid levels after single-dose aspartame consumption in phenylketonuria, mild hyperphenylalaninemia, and hetero-zygous state for phenylketonuria. J Pediatr 109:668–671.
Carlson, Eriksson S (1985) Chronic cryptogenic liver disease in malignant hepatoma in inter-mediate alpha 1-antitrypsin deficiency identified by a PI Z-specific monoclonal antibody. Scand J Gastroenterol 20:835–842.
Christomanou H, Martinius J, Jaffé S, Betke K, Förster C (1980) Biochemical, psychometric, and neuropsychological studies in heterozygotes for various lipidoses. Hum Genet 55 :103–110.
Christomanou H, Jaffé S, Martinius J, Cáp C, Betke K (1981) Biochemical, genetic, psychometric, and neuropsychological studies in heterozygotes of a family with globoid cell leucodystrophy (Krabbe's disease). Hum Genet 58:179–183.
Clarke R, Daly L, Robinson K et al (1991) Hyperhomocysteinemia: an independent risk factor for vascular disease. N Engl J Med 324:1149–1155.
Cox TM, Camilleri M, O'Donnell MW, Chadwick VS (1982) Pseudodominant transmission of fructose intolerance in an adult and three offsprings. Heterozygote detection by intestinal biopsy. N Engl J Med 307: 537–540.
Curtius H-Ch, Endres W, Blau N (1994) Effect of high-protein meal plus aspartame ingestion on serum phenylalanine concentrations in obligate heterozygotes for phenylketonuria. Metabolism 43:413–416.
Desnick RJ, Ioannou YA, Eng CM (1995) Alpha-galactosidase A deficiency: Fabry disease. In: Scriver CR, Beaudet AL, Sly WS, Valle D, eds. The Metabolic and Molecular Bases of Inherited Disease,7th edn. New York: McGraw-Hill, 2741–2784.
Endres W, Shin YS (1990) Cataract and metabolic disease. J Inher Metab Dis 13:509–516.
Endres W, Schaub J, Stefani FH, Wirtz A, Zahn V (1977) Cataract in a fetus at risk for oculo-cerebro-renal syndrome (Lowe). Klin Wochenschr 55 :141–144.
Eriksson S, Lindell SE, Wiberg R (1985) Effects of smoking and intermediate alpha,-antitrypsin deficiency (Pi MZ) on lung function. Eur J Respir Dis 67: 279–285.
Fisch RO, Chang P-N, Sines L, Weisberg S, Bessman SP (1985) Relationship between phenylalanine tolerance and psychological characteristics of phenylketonuric families. Biochem Med 33:236–245.
Ford RC, Berman JL (1977) Phenylalanine metabolism and intellectual functioning among carriers of phenylketonuria and hyperphenylalaninaemia. Lancet 1:767–771.
Fujimoto A, Crawford R, Bessman SP (1979) Relative inability of mother and child to convert phenylalanine to tyrosine-a possible cause of nonspecific mental retardation. Biochem Med 21 :271–276.
Gardner RJM, Brown N (1976) Lowe's syndrome: identification of carriers by lens examination. J Med Genet 13:449–454.
Giugliani R, Ferrari I, Greene LJ (1985) Heterozygous cystinuria and urinary lithiasis. Am J Med Genet 22:703–715.
Hanley WB, Clarke JTR, Schoonheyt W (1987) Maternal phenylketonuria (PKU)-a review. Clin Biochem 20:149–156.
Harley JD, Irvine S, Mutton P, Gupta JD (1974) Maternal enzymes of galactose metabolism and the 'inexplicable' infantile cataract. Lancet 2: 259–261.
Hauser ER, Finkelstein JE, Valle D, Brusilow SW (1990) Alldpurinol-induced orotidinuria. A test for mutations at the ornithine carbamoyltransferase locus in women. N Engl J Med 322:1641–1645.
Hittner HM, Carroll AJ, Prchal JT (1982) Linkage studies in carriers of Lowe oculo-cerebro-renal syndrome. Am J Hum Genet 34:966–971.
Holmes LB, McGowan BL, Efron ML (1969) Lowe's syndrome: a search for the carrier state. Pediatrics 44:359–364.
Hu FL, Gu Z, Kozich V, Kraus JP, Ramesh V, Shih VE (1993) Molecular basis of cystathionine ,Bsynthase deficiency in pyridoxine responsive and nonresponsive homocystinuria.Hum Mol Genet 2:1857–1860.
Jakobs C, Douwes AC, Brockstedt M, Stellaard F, Endres W, Shin YS (1990) Plasma polyol levels in patients with cataract.J Inher Metab Dis 13:517–522.
Kang S-S, Wong PWK, Zhou J et al (1988a) Thermolabile methylene-tetrahydrofolate reductase in patients with coronary artery disease. Metabolism 37: 611–613.
Kang S-S, Zhou J, Wong PWK, Kowalisyn J, Strokosch G (1988b) Intermediate homocysteinemia: a thermolabile variant of methylenetetrahydrofolate reductase. Am J Hum Genet 43:414–421.
Kang S-S, Wong PWK, Bock H-GO, Horwitz A, Grix A (1991) Intermediate hyperhomocysteinemia resulting from compound heterozygosity of methylenetetrahydrofolate reductase mutations. Am J Hum Genet 48:546–551.
Kohn H, Manowitz P, Miller M, Kling A (1988) Neuropsychological deficits in obligatory hetero-zygotes for metachromatic leukodystrophy. Hum Genet 79: 8–12.
Kozich V, Kraus JP (1992) Screening for mutations by expressing patient cDNA segments in E. coli:homocystinuria due to cystathionine β-synthase deficiency. Hum Mutat 1:113–123.
Kudo Y, Boyd CAR (1990) Transport of amino acids by the human placenta: predicted effects thereon of maternal hyperphenylalaninaemia. J Inher Metab Dis 13:617–626.
Larsson C, Eriksson S., Dirksen H (1977) Smoking and intermediate alpha,-antitrypsin deficiency and lung function in middle-aged men. Br Med J 2: 922–925.
Lutz P, Schmidt H, Batzler U (1990) Collaborative study of children treated for phenylketonuria (PKU) in the Federal Republic of Germany. Study design and description of patients. Eur J Pediatr 149(supplement 1):S5–S12.
MacKenzie AE, MacLeod HL, Heick HMC, Korneluk RG (1989) False positive results from the alanine loading test for ornithine carbamoyl-transferase deficiency heterozygosity. J Pediatr 115:605–608.
McDonald L, Bray C, Field C, Love F. Davies B (1964) Homocystinuria, thrombosis, and the blood-platelets. Lancet 1:745–746.
McGill JJ, Mettler G, Rosenblatt DS, Scriver CR (1990) Detection of heterozygotes for recessive alleles. Homocyst(e)inemia: paradigm of pitfalls in phenotypes. Am J Med Genet 36:45–52.
Monteleone JA, Beutler E, Monteleone PL, Utz CL, Casey EC (1971) Cataracts, galactosuria and hypergalactosaemia due to galactokinase deficiency in a child. Am J Med 50 :403–407.
Morin T Feldmann G, Martin J-P. Rueff B, Benhamou J-P, Ropartz C (1975) Heterozygous alpha,-antitrypsin deficiency and cirrhosis in adults, a fortuitous association. Lancet 1:250–251.
Moser HW, Moser AB, Smith KD et al (1992) Adrenoleukodystrophy: phenotypic variability and implications for therapy. J Inher Metab Dis 15:645–664.
Moser HW, Smith KD, Moser AB (1995) X-linked adrenoleukodystrophy. In Scriver CR, Beaudet AL, Sly WS, Valle D, eds. The Metabolic and Molecular Bases ofInherited Disease,7th edn. New York: McGraw-Hill, 2325–2349.
Mudd SH (1985) Vascular disease and homocysteine metabolism. N EnglJ Med 313:751–753.
Mudd SH, Levy HL, Abeles RH (1969) A derangement in B 1 2 metabolism leading to homocystinemia, cystathioninemia and methylmalonic aciduria. Biochem Biophys Res Commun 35 :121–126.
Mudd SH, Havlik R, Levy HL, McKusick VA, Feinleib M (1981) A study of cardiovascular risk in heterozygotes for homocystinuria. Am J Hum Genet 33:883–893.
Mudd SH, Skovby F, Levy HL et al (1985) The natural history of homocystinuria due to cystathione /-synthase deficiency. Am J Hum Genet 37:1–3 1.
Mudd SH, Levy HL, Skovby F (1995) Disorders of transsulfuration. In Scriver CR, Beaudet AL, Sly WS, Valle D, eds. The Metabolic and Molecular Bases of Inherited Disease,7th edn. New York: McGraw-Hill, 1279–1327.
Ostrer H, Hejtmancik JF (1988) Prenatal diagnosis and carrier detection of genetic diseases by analysis of deoxyribonucleic acid. J Pediatr 112:679–687.
Pittschieler K (1991) Liver disease and heterozygous alpha-l-antitrypsin deficiency. Acta Paediatr Scand 80 :323–327.
Prchal JT, Conrad ME, Skalka HW (1978) Association of presenile cataracts with heterozygosity for galactosaemic states and with riboflavin deficiency. Lancet 1:12–13.
Rinaldi E, Albini L, Costagliola C et al (1984) High frequency of lactose absorbers among adults with idiopathic senile and presenile cataract in a population with a high prevalence of primary adult lactose malabsorption. Lancet 1:355–357.
Rizzo WB, Watkins PA, Phillips MW, Cranin D, Campbell B, Avigan J (1986) Adrenoleukodystrophy: oleic acid lowers fibroblast saturated C22-C26 fatty acids. Neurology 36: 357–361.
Rizzo WB, Leshner RT, Odone A et al (1989) Dietary erucic acid therapy for X-linked adrenoleuko-dystrophy. Neurology 39:1415–1422.
Ruecker A von, Endres W, Shin YS, Butenandt I, Steinmann B, Gitzelmann R (1981) A case of fatal hereditary fructose intolerance. Misleading information on formula composition. Helv Paediatr Acta 36:599–600.
Sartorio R, Greco L, Carrozzo R, Budillon C, Andria G (1988) A simplified test to detect PKU heterozygotes by discriminant analysis in mentally retarded children and their mothers. Clin Genet 33:241–245.
Schmidt B, Servidei S., Gabbai AA, Silva AC, De Sousa Bulle de Oliveira A, DiMauro S (1987) McArdle's disease in two generations: autosomal recessive transmission with manifesting hetero-zygote. Neurology 37: 1558–1561.
Shin YS, Rieth M, Endres W, Haas K (1984) Sorbitol dehydrogenase deficiency in a family with congenital cataracts. J Inher Metab Dis 7(supplement 2): 151–152.
Shin YS, Endres W, Schmid K-M, Volcker HE, Jakobs C (1985) Elevated plasma sorbitol levels in cataract patients with sorbitol dehydrogenase deficiency. Pediatr Res 19:1082.
Stegink LD, Filer LJ, Baker GL, McDonnell JE (1980) Effect of an abuse dose of aspartame upon plasma and erythrocyte levels of amino acids in phenylketonuric, heterozygous and normal adults. J Nutr 110: 2216–2224.
Stegink LD, Koch R, Blaskovic ME, Filer LJ Jr, Baker GL, McDonnell JE (1981) Plasma phenyl-alanine levels in phenylketonuric heterozygous and normal adults administered aspartame at 34mg/kg body weight. Toxicology 20: 81–90.
Stegink LD, Filer LJ Jr, Baker GL et al (1989) Repeated ingestion of aspartame-sweetened beverage: effect on plasma amino acid concentrations in individuals heterozygous for phenylketonuria. Metabolism 38:78–84.
Thalhammer O, Havelec L, Knoll E, Wehle E (1977) Intellectual level (IQ) in heterozygotes for phenylketonuria (PKU). Hum Genet 38:285–288.
Vaca G, Ibarra B, Bracamontes M et al (1982) Red blood cell sorbitol dehydrogenase deficiency i a family with cataracts. Hum Genet 61:338–341.
Wilcken B, Leung K-C, Hammond J., Kamath R, Leonard JV (1993) Pregnancy and fetal long-chain 3-hydroxyacyl coenzyme A dehydrogenase deficiency. Lancet 341:407–408.
Wilcken DEL, Reddy SG, Gupta VJ (1983) Homocysteinemia, ischemic heart disease, and the carrier state for homocystinuria. Metabolism 32:363–370.
Williamson M, Koch R, Bessman SP, Layne EC (1976) The relation between heterozygosity and IQ in phenylketonuria (Abstract). Pediatr Res 10:373.
Winder AF, Fielder AR, Mount JN et al (1985) Direct and maternal aspects of the risk of cataract with partial disorders of galactose metabolism. Clin Genet 28:199–206.
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Endres, W. Inherited metabolic diseases affecting the carrier. J Inherit Metab Dis 20, 9–20 (1997). https://doi.org/10.1023/A:1005397120726
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DOI: https://doi.org/10.1023/A:1005397120726