Background: Pyruvate carboxylase (PC) is a key enzyme for gluconeogenesis. PC deficiency (PCD) is an extremely rare autosomal recessive metabolic disease and is divided into three types. Type B PCD is clinically featured by lactic acidosis, hyperammonemia, hypercitrullinemia, hypotonia, abnormal movement, and seizures. Case presentation: Here, we report the first case of type B PCD in China, presenting with intractable lactic acidosis shortly after birth. A compound heterozygous mutation in the PC gene was identified by whole-exome sequencing, NM_001040716.2: c.1154_1155del and c.152G>A, which were inherited from her asymptomatic parents, respectively. Furthermore, prenatal neuroradiological presentations including widened posterior horns of lateral ventricles, huge subependymal cysts, and increased biparietal diameter and head circumference were concerned. Symptomatic treatment was taken and the infant died at 26 days. Conclusion: To our knowledge, this is the minimum gestational age (22w5d) that's when the prenatal onset of the neuroradiologic phenotype of PCD was observed. PCD has a poor prognosis and lacks an effective treatment, so this paper is shared to highlight the importance of PCD prenatal diagnosis in the absence of family history.
Acidosis, Lactic , Pyruvate Carboxylase Deficiency Disease , Pregnancy , Female , Humans , Pyruvate Carboxylase Deficiency Disease/diagnosis , Pyruvate Carboxylase Deficiency Disease/genetics , Pyruvate Carboxylase/genetics , Seizures , Muscle Hypotonia
OBJECTIVES: Type C pyruvate carboxylase (PC) deficiency is extremely rare, and has been described in only a few patients in literature to date. Herein, we present the case of a four-year-old patient admitted with diabetic ketoacidosis and diagnosed with type C PC deficiency based on clinical and biochemical findings. CASE PRESENTATION: A Turkish girl was referred to the intensive care unit at the age of three-years with a three-day history of vomiting and abdominal pain. Upon physical examination, the patient was found to be experiencing lethargy, dehydration, and Kussmaul breathing. Hyperglycemia, metabolic acidosis, and ketonemia were detected. Clinical and laboratory findings pointed to a prediagnosis of diabetic ketoacidosis. Intravenous fluid, bicarbonate, and insulin treatments were initiated. Elevated alanine and proline levels were recorded in plasma amino acid analysis, while urinary organic acid level analysis revealed increased lactate, pyruvate, 3-OH-butyrate, and acetoacetate levels. Whole exome sequencing revealed homozygous c.584C>T (p.Ala195Val) mutation in the PC gene. CONCLUSIONS: To date, there have been no reports in literature of type C phenotype patients manifesting with DKA. Our case is the first case with the type C phenotype to be admitted with clinical and laboratory findings of DKA.
Diabetic Ketoacidosis/diagnosis , Pyruvate Carboxylase Deficiency Disease/diagnosis , Child, Preschool , Diagnosis, Differential , Female , Genetic Association Studies , Humans , Pyruvate Carboxylase/genetics
In spite of the efforts and interventions by the Government of Pakistan and The World Health Organization, the neonatal mortality in Pakistan has declined by only 0.9% as compared to the global average decline of 2.1% between 2000 and 2010. This has resulted in failure to achieve the global Millennium Development Goal 4. Hypoxic-ischaemic encephalopathy, still birth, sepsis, pneumonia, diarrhoea and birth defects are commonly attributed as leading causes of neonatal mortality in Pakistan. Inherited metabolic disorders often present at the time of birth or the first few days of life. The clinical presentation of the inherited metabolic disorders including hypotonia, seizure and lactic acidosis overlap with clinical features of hypoxic-ischaemic encephalopathy and sepsis. Thus, these disorders are often either missed or wrongly diagnosed as hypoxicischaemic encephalopathy or sepsis unless the physicians actively investigate for the underlying inherited metabolic disorders. We present 4 neonates who had received the diagnosis of hypoxic-ischaemic encephalopathy and eventually were diagnosed to have various inherited metabolic disorders. Neonates with sepsis and hypoxic-ischaemic encephalopathy-like clinical presentation should be evaluated for inherited metabolic disorders.
Hyperglycinemia, Nonketotic/diagnosis , Hypoxia-Ischemia, Brain/diagnosis , Metal Metabolism, Inborn Errors/diagnosis , Pyruvate Carboxylase Deficiency Disease/diagnosis , Zellweger Syndrome/diagnosis , Brain/diagnostic imaging , Diagnosis, Differential , Female , Humans , Infant , Infant, Newborn , Magnetic Resonance Imaging , Male , Pakistan , Radiography , Tertiary Care Centers
Pyruvate carboxylase (PC) is a biotin-containing enzyme that is responsible for the adenosine triphosphate-dependent carboxylation of pyruvate to oxaloacetate, a key intermediate in the tricarboxylic acid cycle. PC deficiency (OMIM 266150) is a rare autosomal recessive metabolic disease, causing elevation of pyruvate, lactate, and alanine. Three types of PC deficiency have been described in the literature; A, B, and C. Type A PC deficiency, also called infantile or North American type, is characterized by infantile onset acidosis, failure to thrive, and developmental delay. The second subtype or type B, the neonatal or French form, presents usually in the neonatal period, mostly in the first 72 hours of life with severe lactic acidosis, truncal hypotonia, and seizures. The third type is called type C, is extremely rare with few cases published in the literature. In this case report, we present an 11-month-old girl who presented with acute flaccid paralysis, lethargy, and constipation with elevated ketones and lactate. She was confirmed genetically and biochemically to have PC deficiency type C. The patient's unusual presentation expands the clinical phenotype of this extremely rare disease.
Acidosis, Lactic/diagnosis , Ketosis/diagnosis , Paraplegia/diagnosis , Pyruvate Carboxylase Deficiency Disease/diagnosis , Acidosis, Lactic/etiology , Constipation/diagnosis , Constipation/etiology , Female , Humans , Infant , Ketosis/etiology , Lethargy/diagnosis , Lethargy/etiology , Muscle Hypotonia/diagnosis , Muscle Hypotonia/etiology , Paraplegia/etiology , Phenotype , Pyruvate Carboxylase Deficiency Disease/complications
Astrocytes play crucial roles in maintaining brain homeostasis and in orchestrating neural development, all through tightly coordinated steps that cooperate to maintain the balance needed for normal development. Here, we review the alterations in astrocyte functions that contribute to a variety of developmental neurometabolic disorders and provide additional data on the predominant role of astrocyte dysfunction in the neurometabolic neurodegenerative disease glutaric acidemia type I. Finally, we describe some of the therapeutical approaches directed to neurometabolic diseases and discuss if astrocytes can be possible therapeutic targets for treating these disorders.
Amino Acid Metabolism, Inborn Errors/diagnosis , Amino Acid Metabolism, Inborn Errors/therapy , Astrocytes/pathology , Brain Diseases, Metabolic/diagnosis , Brain Diseases, Metabolic/therapy , Brain/pathology , Glutaryl-CoA Dehydrogenase/deficiency , Alexander Disease/diagnosis , Alexander Disease/metabolism , Alexander Disease/pathology , Alexander Disease/therapy , Amino Acid Metabolism, Inborn Errors/metabolism , Amino Acid Metabolism, Inborn Errors/pathology , Antioxidants/therapeutic use , Astrocytes/drug effects , Astrocytes/metabolism , Brain/drug effects , Brain/metabolism , Brain Diseases, Metabolic/metabolism , Brain Diseases, Metabolic/pathology , Ceruloplasmin/deficiency , Ceruloplasmin/metabolism , Diet/methods , Disease Management , Glucose/therapeutic use , Glutamate-Ammonia Ligase/deficiency , Glutamate-Ammonia Ligase/metabolism , Glutaryl-CoA Dehydrogenase/metabolism , Hepatic Encephalopathy/diagnosis , Hepatic Encephalopathy/metabolism , Hepatic Encephalopathy/pathology , Hepatic Encephalopathy/therapy , Homeostasis , Humans , Iron Metabolism Disorders/diagnosis , Iron Metabolism Disorders/metabolism , Iron Metabolism Disorders/pathology , Iron Metabolism Disorders/therapy , Neurodegenerative Diseases/diagnosis , Neurodegenerative Diseases/metabolism , Neurodegenerative Diseases/pathology , Neurodegenerative Diseases/therapy , Neurogenesis/drug effects , Niemann-Pick Disease, Type C/diagnosis , Niemann-Pick Disease, Type C/metabolism , Niemann-Pick Disease, Type C/pathology , Niemann-Pick Disease, Type C/therapy , Pyruvate Carboxylase Deficiency Disease/diagnosis , Pyruvate Carboxylase Deficiency Disease/metabolism , Pyruvate Carboxylase Deficiency Disease/pathology , Pyruvate Carboxylase Deficiency Disease/therapy , Sorption Detoxification
Pyruvate carboxylase deficiency is a rare metabolic disorder, with three different phenotypes. We aim to report the case of a newborn presenting the severe neonatal form of this deficiency (the B or "French" phenotype, hypokinesia and rigidity being the main features) and the results of the study of classic neurotransmitters involved in movement control. Hyperdopaminergic transmission (both in the cerebrospinal fluid and in the substantia nigra) and hypoGABAergic transmission (in the substantia nigra) were found. Both gamma-aminobutyric acid and dopamine markers were found coexisting in individual neurons of the substantia nigra. This is the first time this phenomenon has been reported in the literature. We discuss the possible role of GABAergic deficiency, its interaction with other neurotransmitters and its implication in neurotransmitter homeostasis. A better comprehension of that field would increase understanding of the pathophysiology of neurological symptoms and neurotransmitter plasticity.
Parkinsonian Disorders/diagnosis , Pyruvate Carboxylase Deficiency Disease/diagnosis , Brain/metabolism , Brain/pathology , Fatal Outcome , Female , GABAergic Neurons/physiology , Humans , Parkinsonian Disorders/enzymology , Parkinsonian Disorders/physiopathology , Pyruvate Carboxylase Deficiency Disease/physiopathology , Synaptic Transmission , Tyrosine 3-Monooxygenase/metabolism
Pyruvate dehydrogenase and pyruvate carboxylase deficiency are the most common disorders in pyruvate metabolism. Diagnosis is made by enzymatic and DNA analysis after basic biochemical tests in plasma, urine, and CSF. Pyruvate dehydrogenase has three main subunits, an additional E3-binding protein and two complex regulatory enzymes. Most frequent are deficiencies in PDH-E1α. There is a spectrum of clinical presentations in E1α deficiency, ranging in boys from severe neonatal lactic acidosis, Leigh encephalopathy, to later onset of neurological disease such as intermittent ataxia or dystonia. Females tend to have a more uniform presentation resembling nonprogressive cerebral palsy. Neuroradiological abnormalities such as corpus callosum agenesis are seen more frequently in girls, basal ganglia and midbrain disturbances in boys. Deficiencies in the other subunits have also been described, but in a smaller number of patients. Pyruvate carboxylase deficiency has three clinical phenotypes. The infantile type is characterized mainly by severe developmental delay, failure to thrive, and seizures. The second type is characterized by neonatal onset of severe lactic acidosis with rigidity and hypokinesia. A third form is rarer with intermittent episodes of lactic acidosis and ketoacidosis. Neuroradiological findings such as cystic periventricular leukomalacia have been described.
Brain Diseases, Metabolic, Inborn/diagnosis , Pyruvate Carboxylase Deficiency Disease/diagnosis , Pyruvate Carboxylase/genetics , Pyruvate Dehydrogenase (Lipoamide)/genetics , Pyruvic Acid/metabolism , Brain Diseases, Metabolic, Inborn/genetics , Brain Diseases, Metabolic, Inborn/metabolism , Humans , Pyruvate Carboxylase/metabolism , Pyruvate Carboxylase Deficiency Disease/genetics , Pyruvate Carboxylase Deficiency Disease/metabolism , Pyruvate Dehydrogenase (Lipoamide)/metabolism
Introducción. La deficiencia de piruvato deshidrogenasa(PDH) constituye la base metabólica más frecuente de las acidosislácticas congénitas y también es responsable de una forma menoshabitual, exclusiva del sexo femenino, que cursa con un síndromedismórfico asociado a graves malformaciones cerebrales. El defectomás común afecta a la fracción E1α (gen Xp22.1-22.2). Objetivo.Presentar el caso de una niña con deficiencia de PDH, síndromedismórfico, malformaciones cerebrales y una mutación no descritaen el gen correspondiente. Caso clínico. Niña de 8 meses deedad con microcefalia, frente estrecha, hipoplasia nasal, narinasantevertidas, labios finos, hipotonía axial, crisis epilépticas y herniaumbilical. La resonancia magnética cerebral evidenció unaatrofia corticosubcortical intensa supra e infratentorial, dilataciónventricular y agenesia del cuerpo calloso. Las concentraciones deácido láctico y pirúvico estaban elevadas en la sangre y el líquidocefalorraquídeo (LCR), y la de alanina estaba elevada en el LCR.La histología muscular fue normal. La actividad del complejo de laPDH en los fibroblastos y en el músculo, así como la de los complejosde la cadena respiratoria mitocondrial en homogenado muscular,fueron normales. El estudio genético molecular del gen parala PDH E1α, tanto en elementos formes de la sangre como en fibroblastos,demostró un cambio C > T en el nucleótido 515 (C515T)del exón 6, que causa un cambio P172L en la proteína. El estudio de108 controles descartó que se tratase de un polimorfismo. Los padresno presentaban la mutación. Conclusiones. Se describe la mutaciónC515T en el exón 6 del gen para la PDH E1α. La actividadnormal del complejo de la PDH en los fibroblastos y en el músculono excluye esta entidad
Introduction. Pyruvate dehydrogenase (PDH) deficiency constitutes the most frequent metabolic origin of congenitallactic acidosis and is also responsible for a less usual form, found exclusively in females, which leads to a dysmorphicsyndrome accompanied by severe cerebral malformations. The most common defect affects fraction E1α (gene Xp22.1-22.2).Aim. To report the case of a young female with PDH deficiency, dysmorphic syndrome, cerebral deformations and anunidentified mutation in the corresponding gene. Case report. An 8-month-old female with microcephaly, a narrow forehead,nasal hypoplasia, anteverted nostrils, thin lips, axial hypotonia, epileptic seizures and an umbilical hernia. Magneticresonance imaging of the brain revealed intense supra- and infratentorial cortico-subcortical atrophy, ventricular dilatationand agenesis of the corpus callosum. Lactic and pyruvic acid concentrations were high both in blood and in cerebrospinalfluid (CSF), and the level of alanine was high in CSF. Muscular histology results were normal. PDH complex activity infibroblasts and in muscle tissue, as well as that of the mitochondrial respiratory chain complexes in muscle homogenate, werefound to be normal. A molecular genetic study of the gene for PDH E1α, both in formed elements in the blood and infibroblasts, showed a C > T change in nucleotide 515 (C515T) of exon 6, which causes a P172L change in the protein. A studyof 108 controls ruled out the possibility of a polymorphism. The parents did not have the mutation. Conclusions. The C515Tmutation of exon 6 of the gene for PDH E1α is described. Normal activity of the PDH complex in fibroblasts and in muscletissue does not exclude this condition
Female , Infant , Child , Humans , Pyruvate Carboxylase Deficiency Disease/genetics , Pyruvate Carboxylase Deficiency Disease/complications , Mutation , Telencephalon/abnormalities , Pyruvate Carboxylase Deficiency Disease/diagnosis , Pyruvate Carboxylase Deficiency Disease/drug therapy , Pyruvate Dehydrogenase (Lipoamide) , Microcephaly/genetics , Sex Factors , Magnetic Resonance Imaging , Telencephalon/pathology , Lactic Acid/cerebrospinal fluid , Pyruvic Acid/cerebrospinal fluid
Pyruvate carboxylase (PC) is a key enzyme for gluconeogenesis and anaplerotic pathways in brain. PC deficiency is a rare autosomal recessive neurometabolic disorder with three described characteristic presentations. We report a patient with atypical clinical and neuroradiological aspects. He survived from neonatal lactic acidemia and is alive at 9 years of age with a mild developmental delay. A brain MRI performed by the age of 18 months disclosed an unusual subcortical leucodystrophic process.
Brain/abnormalities , Psychomotor Disorders/diagnosis , Psychomotor Disorders/genetics , Pyruvate Carboxylase Deficiency Disease/diagnosis , Pyruvate Carboxylase Deficiency Disease/genetics , Pyruvate Carboxylase/genetics , Child , Child, Preschool , Diagnosis, Differential , Humans , Infant , Infant, Newborn , Magnetic Resonance Imaging , Male , Psychomotor Disorders/physiopathology , Pyruvate Carboxylase Deficiency Disease/enzymology
Pyruvate Carboxylase Deficiency Disease , Acidosis, Lactic/etiology , Child, Preschool , Citrullinemia/etiology , Diagnosis, Differential , Humans , Hyperammonemia/etiology , Infant , Infant, Newborn , Mutation , Prognosis , Pyruvate Carboxylase/genetics , Pyruvate Carboxylase Deficiency Disease/diagnosis , Pyruvate Carboxylase Deficiency Disease/etiology , Pyruvate Carboxylase Deficiency Disease/therapy
Seizures and metabolic disease are frequently associated, either indirectly as a consequence of the metabolically caused brain dysgenesis or directly by the metabolic derangement. This article describes defects in pyruvate metabolism (pyruvate carboxylase deficiency, pyruvate dehydrogenase deficiency) and Krebs cycle defects such as fumarase deficiency. Clinical characterizations and diagnostic strategies have been developed for each of these diseases. In contrast, very little is known about the specific epileptic features in these disorders. In females with a pyruvate dehydrogenase deficiency E1alpha owing to the mutation in the subunit E1alpha of the pyruvate dehydrogenase complex West's syndrome associated with large ventricles and corpus callosum agenesis on magnetic resonance imaging can be the main feature of the disease. In fumarase deficiency, prenatal brain dysgenesis is the most prominent feature of the disease. Diagnosis of these disorders requires measurements of lactate and pyruvate in plasma and cerebrospinal fluid, analysis of amino acids in plasma and organic acids in urine, and neuroradiologic investigations. Further biochemical and molecular analysis leads to a definitive diagnosis and opens the way to adequate treatment, genetic counseling, and prenatal diagnosis.
Brain/abnormalities , Citric Acid Cycle/physiology , Fumarate Hydratase/deficiency , Pyruvate Carboxylase Deficiency Disease/diagnosis , Pyruvate Dehydrogenase Complex Deficiency Disease/diagnosis , Pyruvic Acid/metabolism , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Pyruvate Carboxylase Deficiency Disease/complications , Pyruvate Dehydrogenase Complex Deficiency Disease/complications , Pyruvate Dehydrogenase Complex Deficiency Disease/diet therapy , Seizures/etiology , Sex Factors
Pyruvate carboxylase (PC) is a key enzyme in the gluconeogenesis and anaplerotic metabolic pathways. PC deficiency is a rare autosomal recessive disorder with three clinical presentations: an infantile form, a severe neonatal form, and a benign form. We report brother and sister sibs with the severe form of PC deficiency. Both had macrocephaly and severe ischemia-like brain lesions at birth and died in the first week of life with intractable lactic acidemia. In the girl, increased head circumference and periventricular leukomalacia (PVL) were detected on fetal ultrasonography at 29.4 weeks of gestation. PC activity in cultured skin fibroblasts was <2% of control. This is the first reported case of ischemia-like brain lesions documented prenatally in PC deficiency. The lesions were detected at a time of maximal periventricular metabolic demand. We postulate that energy deprivation induced by PC deficiency impairs astrocytic buffering capacity against excitotoxic insult and compromises normal microvascular morphogenesis and autoregulation, both mechanisms leading to cystic degeneration of the periventricular white matter. Discovery of cystic PVL on cerebral ultrasound at birth in a newborn infant presenting with primary lactic acidemia is highly suggestive of PC deficiency. Moreover, PC deficiency should also be considered when ischemia-like brain lesions are documented by fetal ultrasonography.
Brain/blood supply , Ischemia/diagnosis , Pyruvate Carboxylase Deficiency Disease/diagnosis , Ultrasonography, Prenatal , Female , Humans , Infant, Newborn , Liver/abnormalities , Liver/pathology , Male , Muscle, Skeletal/abnormalities , Muscle, Skeletal/anatomy & histology , Pregnancy , Pyruvate Carboxylase Deficiency Disease/genetics
Pyruvate carboxylase (PC) deficiency is a rare metabolic disorder in infants and children, most frequently with fatal outcome. Its prenatal diagnosis by radiometric assay in cultured amniocytes has previously been reported. We present and discuss the prenatal diagnosis of PC deficiency by direct measurement of PC activity in chorionic villi, in two subsequent pregnancies in a family who previously lost a child affected by PC deficiency. In the next pregnancy PC was unmeasurably low in chorionic villi whereas in control samples its activity was between 0.8 and 3.3 nmol min-1 mg protein-1. Following elective termination of the pregnancy PC was shown to be totally inactive in post-mortem fetal liver. In the most recent pregnancy of the proband's mother PC was normally active in the chorionic villi. The product of this pregnancy was a normal boy.
Chorionic Villi Sampling , Chorionic Villi/enzymology , Pyruvate Carboxylase Deficiency Disease/diagnosis , Pyruvate Carboxylase/metabolism , Fatal Outcome , Female , Gestational Age , Humans , Infant, Newborn , Liver/enzymology , Male , Pregnancy
Pyruvate carboxylase [EC 6.4.1.1] is a member of the family of biotin-dependent carboxylases and is found widely among eukaryotic tissues and in many prokaryotic species. It catalyses the ATP-dependent carboxylation of pyruvate to form oxaloacetate which may be utilised in the synthesis of glucose, fat, some amino acids or their derivatives and several neurotransmitters. Diabetes and hyperthyroidism increase the level of expression of pyruvate carboxylase in the long term, while its activity in the short term is controlled by the intramitochondrial concentrations of acetyl-CoA and pyruvate. Many details of this enzyme's regulation are yet to be described in molecular terms. However, progress towards this goal and towards understanding the relationship of pyruvate carboxylase structure to its catalytic reaction mechanism, has been enormously enhanced recently by the cloning and sequencing of genes and cDNAs encoding the approximately 130 kDa subunit of this homotetramer. Defects in the expression or biotinylation of pyruvate carboxylase in humans almost invariably results in early death or at best a severely debilitating psychomotor retardation, clearly reflecting the vital role it plays in intermediary metabolism in many tissues including the brain.
Gene Expression Regulation, Enzymologic/genetics , Pyruvate Carboxylase/chemistry , Pyruvate Carboxylase/metabolism , Amino Acid Sequence , Animals , Brain/metabolism , Catalysis , DNA, Complementary/genetics , Diabetes Mellitus/enzymology , Humans , Hyperthyroidism/enzymology , Molecular Sequence Data , Molecular Weight , Pancreas/metabolism , Pyruvate Carboxylase/genetics , Pyruvate Carboxylase Deficiency Disease/diagnosis , Pyruvate Carboxylase Deficiency Disease/physiopathology , RNA, Messenger/genetics , Up-Regulation
OBJECTIVE: To report the clinical history and laboratory evaluation of a patient presenting with lactic acidosis secondary to pyruvate carboxylase deficiency. METHODS AND RESULTS: Enzyme analysis of cultured skin fibroblasts revealed 2-5% of normal pyruvate carboxylase activity. Although most patients with this condition die in early infancy, this child has survived to age 8-1/2 years, with only occasional episodes of metabolic acidosis, usually responding rapidly to intravenous hydration and bicarbonate. Despite having a seizure disorder and moderate mental retardation, he continues to thrive and make progress in his acquisition of motor and language skills. Of the 35 patients described in the literature with pyruvate carboxylase deficiency, only two other patients have lived beyond 5 years of age. CONCLUSION: There does not seem to be a correlation of prolonged survival with residual pyruvate carboxylase activity on assay of cultured fibroblasts. Possible explanations for this patient's prolonged survival include tissue heterogeneity, increased residual enzyme activity in vivo, or partial stabilization of the enzyme by supplemental biotin.
Fibroblasts/enzymology , Pyruvate Carboxylase Deficiency Disease/enzymology , Acidosis, Lactic/complications , Adult , Alanine/blood , Cells, Cultured , Child , Child, Preschool , Female , Fibroblasts/pathology , Humans , Lactates/analysis , Lactic Acid , Male , Pyruvate Carboxylase Deficiency Disease/complications , Pyruvate Carboxylase Deficiency Disease/diagnosis
We report a boy with a partial deficiency of pyruvate carboxylase as documented in enzyme assays of skin fibroblasts, lymphocytes, and hepatic tissue. Magnetic resonance imaging at age 20 months demonstrated a leukodystrophic process involving the brain stem and subcortical white matter, which, except for the brain stem, improved after biotin treatment. The lymphocyte pyruvate carboxylase activity of both heterozygous parents slightly increased after receiving oral biotin for 1 month, but a definitive enzymatic response to biotin was not confirmed in our patient. At age 6 years, he is dysarthric with a spastic quadriparesis despite improvements in development and myelination. This is the first demonstration of magnetic resonance imaging changes in this disease.
Brain Diseases, Metabolic/genetics , Brain/pathology , Lymphocytes/enzymology , Magnetic Resonance Imaging , Pyruvate Carboxylase Deficiency Disease/genetics , Pyruvate Carboxylase/blood , Biotin/therapeutic use , Brain Diseases, Metabolic/diagnosis , Brain Diseases, Metabolic/drug therapy , Child , Child, Preschool , Consanguinity , Fibroblasts/enzymology , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Neurologic Examination , Phenotype , Pyruvate Carboxylase/genetics , Pyruvate Carboxylase Deficiency Disease/diagnosis , Pyruvate Carboxylase Deficiency Disease/drug therapy
Pyruvate carboxylase deficiency results in congenital lactic acidosis. We report the significant finding in a child with infantile spasms controlled with adrenocorticotrophin hormone (ACTH) but who then developed severe lactic acidosis; pyruvate carboxylase deficiency was subsequently diagnosed. Blood lactate, pyruvate, and alanine levels were elevated, as well as cerebrospinal fluid alanine. Plasma alanine concentration was doubled by ACTH therapy. Fibroblasts contained extremely low pyruvate carboxylase activity. The patient died at 12 weeks of age after recurrent episodes of profound acidosis. At autopsy, the brain manifested cystic degeneration and demyelination. Pyruvate carboxylase deficiency is associated with neonatal onset of acidosis, delayed development, seizures, hypotonia, recurrent profound acidosis, and early death. The dramatic rise in plasma alanine content coincident with ACTH therapy suggest that ACTH played a role in precipitating the catastrophic metabolic acidosis.
Acidosis, Lactic/metabolism , Adrenocorticotropic Hormone/adverse effects , Pyruvate Carboxylase Deficiency Disease/complications , Spasms, Infantile/drug therapy , Acidosis, Lactic/etiology , Female , Humans , Infant, Newborn , Pyruvate Carboxylase Deficiency Disease/diagnosis , Pyruvate Metabolism, Inborn Errors , Spasms, Infantile/etiology
