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2-Methylbutyryl-CoA Dehydrogenase Deficiency

2-Methylbutyric Aciduria

2-methylbutyryl-CoA dehydrogenase deficiency is an autosomal recessive disease characterized by an impairment in the degradation of isoleucine. Most people with this rare enzymatic deficiency are asymptomatic and are identified by elevated plasma levels of C5-carnitine found on routine newborn screening. Urine organic acid analysis, measurement of enzymatic activity, and genetic testing are employed for confirmation.


Presentation

2-methylbutyryl-CoA dehydrogenase deficiency, also referred to as short/branched chain acyl-CoA dehydrogenase (SBCAD) deficiency, is a rare genetic disease in which insufficient levels of this enzyme result in impaired metabolism of L-isoleucine [1] [2] [3]. This autosomal recessive disorder is attributed to mutations in the SBCAD gene [3] [4]. Overall, it is more predominant in the Hmong community in China [3], in whom there is a recurrence of a known SBCAD mutation [5]. The prevalence of the disease is 1:250 to 1:500 in the Hmong population.

Affected individuals are diagnosed either due to increased C5-carnitine levels discovered during newborn screening [6] [7] [8], or secondary to clinical features and 2-methylbutyrylglycinuria [8] [9] [10]. The majority of cases, whether of Hmong descent or not, remain asymptomatic [3] [5]. However, those with manifestations present as neonates or young children with an onset characterized by poor feeding, lethargy, irritability, and emesis. Moreover, newborns may exhibit acute metabolic acidosis accompanied by seizures, weak muscle tone, vomiting, as well as delays in development and motor skills [2] [7] [8].

Complications

2-methylbutyryl-CoA dehydrogenase deficiency does not confer the same impact on all patients. Most are asymptomatic, hence, complications are very rare.

Physical exam

Hypotonia [1] [3], inadequate growth, psychomotor difficulties, and possibly respiratory trouble are remarkable signs observed on the physical exam.

Asymptomatic
  • Most people with this rare enzymatic deficiency are asymptomatic and are identified by elevated plasma levels of C5-carnitine found on routine newborn screening.[symptoma.com]
  • A sibling of the first patient is asymptomatic after prenatal diagnosis and early treatment. Family investigations in the second family revealed that the patient's mother was also affected but asymptomatic.[ncbi.nlm.nih.gov]
  • Initial case reports identified individuals with developmental delay and epilepsy, however most cases identified through newborn screening have been asymptomatic.[en.wikipedia.org]
  • A sibling of the first patient is asymptomatic after prenatal diagnosis and early treatment. Family investigations in the second family revealed that the patient's mother was also affected but asymptomatic. Methods.[experts.umn.edu]
  • A sibling of the first patient is asymptomatic after prenatal diagnosis and early treatment. Family investigations in the second family revealed that the patient’s mother was also affected but asymptomatic. Methods.[pediatrics.aappublications.org]
Macula
  • . , 1986: The role of the macula densa in renin release: studies by microperfusion .[wwe.geoscience.net]
Muscular Atrophy
  • Spinal Muscular Atrophy (SMA): SMA status is assessed via copy number analysis using the data generated via the NGS panel described above. Normalized coverage of exons 7-8 are compared against healthy cohort data to determine copy status.[babygenes.net]
Abnormal Behavior
  • Our patient exhibited clinical signs of brain dysfunction including mental retardation, abnormal behavior, and a history of infantile seizures.[doi.org]
Withdrawn
  • […] symbols: ACAD7, SBCAD ) Mouse Orthologs Acadsb (Withdrawn symbols: 1300003O09Rik, BB066609 ) Source OMIM:610006 (names, synonyms, disease associated genes) , Orphanet (disease classes) , HGNC, Ensembl, MGI (gene symbols, gene orthology) HPO (phenotypes[mousephenotype.org]
Dystonia
  • However, a defect in a neighbouring enzyme step in the degradation pathway of isoleucine, 3-hydroxy-2-methylbutyryl-CoA dehydrogenase deficiency (OMIM 300438), was characterised by progressive dystonia, seizures and blindness [ 9, 10 ].[doi.org]

Workup

All babies and children suspected to have 2-methylbutyryl-CoA dehydrogenase deficiency, whether due to abnormal newborn screening or clinical manifestations, warrant a personal and family history, physical exam, and follow-up studies. In addition to plasma and urine tests, fibroblast cultures and genetic testing are also used to confirm the diagnosis.

Laboratory tests

2-methylbutyryl-CoA dehydrogenase deficiency is one of the disorders tested for in routine newborn screening [6] [9], which is how most patients are identified. Specifically, this disease is associated with elevated plasma levels of C5-carnitine [3], which can be demonstrated through blood spot tandem mass spectrometry [6]. Note that C5-carnitine may be normal in affected individuals. Another marker, 2-ethylhydracrylic acid, is sensitive for this disease [7].

In patients with abnormal C5-carnitine levels, a further assessment with urine organic acid analysis and urine acylglycine detection is required [3] [11]. Consequently, a urine organic acid profile may reveal increased amounts of 2-methylbutyrylglycine and possibly 2-methylbutyrylcarnitine [7] [12].

Finally, fibroblast assays should reflect a profound reduction in 2-methylbutyryl-CoA activity in these patients [1] [3].

Genetic testing

Molecular analysis for mutations in SBCAD genes is performed for diagnostic confirmation [3]. Moreover, genetic counseling should be offered to parents with personal or family history.

Treatment

  • Dietary treatment was initiated in the neonatal period. Except for 1 patient who developed mild muscle hypotonia, all patients remain asymptomatic at ages ranging from 3 to 14 months of age.[ncbi.nlm.nih.gov]
  • Dietary treatment was initiated in the neonatal period. Except for 1 patient who developed mild muscle hypotonia, all patients remain asymptomatic at ages ranging from 3 to 14 months of age. Conclusions.[experts.umn.edu]
  • Currently, there is no accepted treatment, as most affected individuals do not require any. Some recommend avoidance of valproic acid, as it can be a substrate for 2-methylbutyryl-CoA dehydrogenase.[en.wikipedia.org]
  • Many of these conditions have specific implications for the presenting phenotype and for treatment, management, and intervention.[books.google.de]

Prognosis

  • Chardot C, Carton M, Spire-Bendelac N, et al: Prognosis of biliary atresia in the era of liver transplantation: French national study from 1986 to 1996. Hepatology 1999;30:606–611.[karger.com]
  • Early diagnosis and prompt treatment is essential for an improved prognosis. Individuals with GSD require prompt correction of any metabolic acidosis and/or hyperbilirubinemia to help prevent brain damage.[dnadvent.com]

Etiology

  • In addition, new technologies have brought three major challenges to newborn screening: 1) expanding knowledge base of the etiology and therefore the treatment or potential treatment of genetic diseases; 2) rapid expansion of diverse technologies such[doi.org]

Epidemiology

  • […] shows that the notion of a single condition known as 'autism' is no longer tenable, and challenges current trends in the diagnosis and management of these behaviours as a homogenous group by drawing on recent research into brain function, genetics, epidemiology[books.google.de]
  • Relevant External Links for ACADSB Genetic Association Database (GAD) ACADSB Human Genome Epidemiology (HuGE) Navigator ACADSB Atlas of Genetics and Cytogenetics in Oncology and Haematology: ACADSB No data available for Genatlas for ACADSB Gene Short[genecards.org]
  • Chardot C, Carton M, Spire-Bendelac N, et al: Epidemiology of biliary atresia in France: a national study. J Hepatol 1999;31:1006–1013.[karger.com]
Sex distribution
Age distribution

Prevention

  • Websitei Glutaric acidemia type II (GA-II) An inherited disorder that prevents to the breakdown of proteins and fats to produce energy.[savebabies.org]
  • Detecting TFP early and beginning treatment can often prevent some of the severe outcomes of TFP.[dnadvent.com]
  • Dietary Treatment The best way to prevent the symptoms of 2MBG is to have a very restricted diet for your child.[babysfirsttest.org]
  • Early treatment may prevent serious health problems.[newbornscreening.info]
  • The Newborn Screening Expert Group was as follows: Newborn Screening Steering Committee: Jose Cordero, MD, MPH, Centers for Disease Control and Prevention; E. Steven Edwards, MD, Past President, AAP; R.[doi.org]

References

Article

  1. Andresen B, Christensen E, Corydon T, et al. Isolated 2-methylbutyrylglycinuria caused short/branched-chain acyl-CoA dehydrogenase deficiency: Identification of a new enzyme defect, resolution of its molecular basis, and evidence for distinct acyl-CoA dehydrogenases in isoleucine and valine metabolism. Am J Hum Genet. 2000;67(5):1095–1103.
  2. Gibson KM, Burlingame TG, Hogema B, et al. 2-Methylbutyryl-coenzyme A dehydrogenase deficiency: A new inborn error of L-isoleucine metabolism. Pediatr Res. 2000;47(6):830–833.
  3. Alfardan J, Mohsen A-W, Copeland S, et al. Characterization of New ACADSB Gene Sequence Mutations and Clinical Implications in Patients with 2-Methylbutyrylglycinuria Identified by Newborn Screening. Molec Gen Metab. 2010;100(4):333-338.
  4. Rozen R, Vockley J, Zhou L, et al. Isolation and expression of a cDNA encoding the precursor for a novel member (ACADSB) of the acyl-CoA dehydrogenase gene family. Genomics. 1994;24(2):280–287.
  5. van Calcar SC, Gleason LA, Lindh H, et al. 2-methylbutyryl-CoA dehydrogenase deficiency in Hmong infants identified by expanded newborn screen. WMJ. 2007;106(1):12-15.
  6. Matern D, He M, Berry SA, Rinaldo P, Whitley CB, Madsen PP, van Calcar SC, Lussky RC, Andresen BS, Wolff JA, Vockley J. Prospective diagnosis of 2-methylbutyryl-CoA dehydrogenase deficiency in the Hmong population by newborn screening using tandem mass spectrometry. Pediatrics. 2003;112:74–78.
  7. Korman SH, Andresen BS, Zeharia A, et al. 2-ethylhydracrylic aciduria in short/branched-chain acyl-CoA dehydrogenase deficiency: application to diagnosis and implications for the R-pathway of isoleucine oxidation. Clin Chem. 2005;51(3):610-617.
  8. Korman SH. Inborn errors of isoleucine degradation: a review. Mol Genet Metab. 2006;89(4):289-299.
  9. Kanavin OJ, Woldseth B, Jellum E, et al. 2-methylbutyryl-CoA dehydrogenase deficiency associated with autism and mental retardation: a case report. J Med Case Reports. 2007;1:98.
  10. Madsen PP, Kibaek M, Roca X, et al. Short/branched-chain acyl-CoA dehydrogenase deficiency due to an IVS3+3A>G mutation that causes exon skipping. Hum Genet. 2006;118(6):680–690.
  11. American College of Medical Genetics. ACT SHEET. https://www.ncbi.nlm.nih.gov/books/NBK55827/. Accesed October 23, 2017.
  12. Rinaldo P, Tortorelli S, Matern D. Recent developments and new applications of tandem mass spectrometry in newborn screening. Curr Opin Pediatr. 2004;16(4):427–433.

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Last updated: 2019-07-11 19:55