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2.1
Severe Infantile Carnitine Palmitoyl Transferase II Deficiency
CPT2

Presentation

Abstract Antenatal presentation of carnitine palmitoyltransferase type II deficiency due to mutations in the CPT2 gene has been rarely reported. [journals.sagepub.com]

Clinical description Presentation can be in the newborn period but most cases have an age of onset between 6 and 24 months. [orpha.net]

CPT II deficiency has several clinical presentations: the adult form is characterized by episodes of rhabdomyolysis, usually triggered by extensive exercice, cold, fever or prolonged fasting and the infantile-type CPT II hepatocardiomuscular form presents [repositorio.insa.pt]

This text brings together leading authorities presenting state-of-the-art clinical reviews covering the science, recognition, and treatment of the inherited metabolic epilepsies and related disorders. [books.google.com]

Thus, mitochondrial myopathies are frequently misdiagnosed as inflammatory myositis upon presentation. [the-rheumatologist.org]

Entire Body System

  • Fatigue

    Cancer-related fatigue. Some cancer patients have low blood levels of L-carnitine, which might reduce energy and lead to fatigue. Some early research suggests that taking L-carnitine might improve fatigue in advanced cancer patients. [webmd.com]

    The clinical picture is characterized by recurrent attacks of rhabdomyolysis, muscular pains and fatigue, secondary to a prolonged physical exercise and sometimes aggravated by intercurrent events. [ncbi.nlm.nih.gov]

    Fatigue and sleep disturbance are frequently associated with EDS hypermobility type and affected individuals are often diagnosed with chronic fatigue syndrome, fibromyalgia, depression, hypochondriasis, and/or malingering prior to recognition of joint [bredagenetics.com]

    […] competitors FOR PHARMACEUTICAL COMPANIES Get data-driven insights on drug usage patterns and safety profiles BENEFITS THAT CONVINCE Detection of true patient risk by considering patient characteristics and all medications in combination Avoidance of alert fatigue [epha.health]

    Late-onset mitochondrial myopathies feature proximal muscle weakness, easy fatigueability, and variably elevated CK levels. Lactic acidemia is often absent. [the-rheumatologist.org]

Cardiovascular

  • Cardiomegaly

    Clinical features include hypoketotic hypoglycemia, lethargy, seizures, hepatomegaly, liver dysfunction, cardiomegaly and dilated cardiomyopathy. [uniprot.org]

    More common in males Carnitine palmitoyl-transferase II deficiency (INFANTILE) LCFA accumulated in mitochondria Seizures, loss of consciousness, hypokinetic hypoglycemia, cardiomegaly, hepatomegaly Carnitine palmitoyl-transferase II deficiency (NEONATE [quizlet.com]

    The neonatal form presents shortly after birth with respiratory distress, seizures, altered mental status, hepatomegaly, cardiomegaly, cardiac arrhythmia, and, in many cases, dysmorphic features, renal dysgenesis, and migration defects. [mendelian.co]

    Reduced muscle carnitine uptake 1 Onset: Infantile Respiratory insufficiency Chronic central alveolar hypoventilation Nocturnal respiratory disorder (Ondine syndrome): Sleep apnea Acidosis Motor dysfunction: Hypotonia; Feeding disorder Cardiomyopathy: Cardiomegaly [neuromuscular.wustl.edu]

Onset

  • Onset in Infancy

    Disease description An autosomal recessive disorder of mitochondrial long-chain fatty acid oxidation, characterized by hepatic or hepato-cardio-muscular manifestations with onset in infancy. [uniprot.org]

    […] age: Infancy to 1st decade; Intrafamilial variation General: Fatigability; Vomiting; Abdominal pain; Low height & weight Hypoglycemia: May occur in infants Encephalopathy: Episodic; r/o Reyes syndrome Myopathy: Generalized weakness Cardiomyopathy Dilated [neuromuscular.wustl.edu]

Workup

Marked symmetrical weakness of both arms and legs was confirmed during the neurological workup. She was unable to raise her legs and had difficulties abducting her shoulders. [medicalbag.com]

Appropriate blood, urine, and radiographic workups are required to rule out a secondary cause of hyperlipidemia. Lipoprotein profiles are primarily used to assess cardiac risk and to aid in the diagnosis of lipid metabolism disorders. [namrata.co]

Diagnostic workup and expected values for newborns with elevated C3-carnitine ( 1 ). On further review of the history, we learned that the mother was diagnosed with anemia during the pregnancy. [clinchem.aaccjnls.org]

The question remains of whether the male predominance is due to sex-related differences in exercise activities, an X-chromosomal modifier gene, or hormonal factors such as estrogen that seem to be a regulator of CPT. 17, 18 Diagnostic workup of exercise-induced [jamanetwork.com]

Workup of such patients includes measuring plasma amino acids and looking for succinylacetone on urine organic acid analysis. [genico.ch]

Serum

  • Hypoketotic Hypoglycemia

    Affected individuals also have low blood sugar (hypoglycemia) and a low level of ketones, which are produced during the breakdown of fats and used for energy. Together these signs are called hypoketotic hypoglycemia. [medlineplus.gov]

    The disease is characterized by a severe fasting intolerance leading to metabolic derangements of hypoketotic hypoglycemia, resulting in coma and seizures, and hepatic encephalopathy leading to liver failure. [orpha.net]

    • A severe infantile form with liver failure and hypoketotic hypoglycemia and a lethal neonatal form represent other rarer manifestations. • Analysis of acylcarnitine profile in blood by tandem mass spectrometry that is used in newborn screening is [medlink.com]

    hypoglycemia, severe cardiac involvement, renal malformations, arrhythmias, sudden death. [newbornscreening.info]

Treatment

Natural history without treatment Severe infantile form is often fatal. Natural history with treatment Even with treatment, the severe infantile form of CPT2 may be fatal. [newbornscreening.info]

Management and treatment Treatment is based on prevention of the fasting intolerance by providing carbohydrate calories during periods of febrile or gastrointestinal illness. [orpha.net]

Make informed clinical choices for each patient, from diagnosis and treatment selection through post-treatment strategies and management of complications, with new evidence-based criteria throughout. [books.google.com]

The Connecticut AIDS Drugs Assistance Program The CT AIDS Drug Assistance Program provides eligible low-income residents with medications and health insurance premium assistance for the treatment of HIV and HIV-related conditions. [ct.gov]

Managed early in life with treatment Chronic and requires lifelong management Life-threatening with no curative treatments Carnitine Palmitoyltransferase II Deficiency is a genetic disorder that affects many body systems including the nervous, muscular [evolvegene.com]

Prognosis

Prognosis The myopathic form of CPT II has a good prognosis. The severe infantile form may lead to sudden death during infancy due, in general, to paroxysmal cardiac arrhythmias. [orpha.net]

In some of the more severe infantile forms, there is a very poor prognosis. [idph.state.il.us]

Coma – Muscle pain and weakness – Weak heart muscle – Irregular heart beat – Enlarged liver – Liver failure Myopathic Form – Muscle pain and weakness – Muscle tissue breakdown – Discolored urine (e.g. red/brown) – Kidney issues( e.g. kidney failure) PROGNOSIS [evolvegene.com]

What is the prognosis? If the enzyme is completely lost there is rapid progression of the condition leading to death in infancy. If some enzyme activity remains, little or no progression with normal strength between episodes. [mda.org.au]

Etiology

Etiology Missense mutations in the CPT2 gene result in the infantile form of CPT II deficiency. Contrary to the adult myopathic form (see this term), no S113L mutations have ever been detected in the infantile form. [orpha.net]

Diagnostic approaches to pediatric cardiomyopathy of metabolic genetic etiologies and their relation to therapy. Prog Pediatr Cardiol 2007; 24(1): 15–25. CrossRef PubMed Google Scholar Kollberg et al. [link.springer.com]

Presence or absence of an anion gap (AG) can help to distinguish the underlying etiology. In general, with a pure or uncompensated metabolic acidosis, every 10 mEq/L fall in bicarbonate (HCO 3 ) results in an average pH fall of 0.15. [mhmedical.com]

The molecular etiologies of these syndromes have not been determined. In this investigation, we considered the hypothesis that these syndromes result from defective transport of carnitine into tissues, particularly skeletal muscle. [osti.gov]

Epidemiology

Summary Epidemiology It has been identified in approximately 30 families. Clinical description Presentation can be in the newborn period but most cases have an age of onset between 6 and 24 months. [orpha.net]

Cerevisiae, homolog of (FLAD1; FADS) ; Chromosome 1q21.3; Recessive Epidemiology: 9 patients Genetics Mutations: Biallelic, Frameshift, Missense or 1 amino acid deletion Mutation locations Molybdopterin binding (MPTb) domain, upstream of FADS domain: [neuromuscular.wustl.edu]

[…] osseous dysplasia - pigmentary defects Synonym(s): - ANEC - Isolated ANE - Isolated acute necrotizing encephalopathy Classification (Orphanet): - Rare infectious disease - Rare neurologic disease Classification (ICD10): - Diseases of the nervous system - Epidemiological [csbg.cnb.csic.es]

Epidemiology The incidence of CDSP varies depending on ethnicity. In Japan, the incidence of CDSP is approximately 1 in 40,000 [ 3 ], whereas the frequency in Australia is approximately 1 in 120,000 [ 4 ]. [ojrd.biomedcentral.com]

Pathophysiology

The syndrome of rhabdomyolysis: Pathophysiology and diagnosis. Eur. J. Intern. Med. 2007, 18, 90–100. [ Google Scholar ] [ CrossRef ] [ PubMed ] Zutt, R.; van der Kooi, A.J.; Linthorst, G.E.; Wanders, R.J.; de Visser, M. [mdpi.com]

Pathophysiologic findings The CPT system mediates the transport of long-chain fatty acids into the mitochondrial matrix. [jamanetwork.com]

[…] compared to the adult group. [17] This group concluded that both the type and location of CPT2 mutation in combination with at least one secondary genetic factor modulate the long-chain fatty acid flux and, therefore, the severity of the disease. [17] Pathophysiology [en.wikipedia.org]

The mechanism of this destabilizing effect and its pathophysiologic impact remain enigmatic. Acyl- l -carnitines with more than 10 carbons in the acyl side-chain stabilized the variant S113L against the temperature-induced inactivation. [ng.neurology.org]

The pathophysiology and molecular biology vary among different forms of SCID, however, the lack of T-cell and B-cell function is the common endpoint in all forms of SCID. [genico.ch]

Prevention

This can prevent low blood sugar. It can also prevent the body using fats for energy. And you should stay away from things that may trigger symptoms. These may include skipping meals, exposure to cold, stress, and a lot of exercise. [cedars-sinai.org]

Top Problem Sustainability Solution Customers Benefits Team Digital AI-powered assistant to prevent harm from medication NO ONE SHOULD BE HARMED IN HEALTHCARE Medication errors are still the 6th leading cause of death Every 2nd adverse event is preventable [epha.health]

2018 at 15:52 Last Updated: September 10, 2018 at 15:52 PW122088 View Pathway disease Long-Chain-3-Hydroxyacyl-CoA Dehydrogenase Deficiency (LCHAD) Rattus norvegicus Long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency is a rare condition that prevents [smpdb.ca]

Management and treatment Treatment is based on prevention of the fasting intolerance by providing carbohydrate calories during periods of febrile or gastrointestinal illness. [orpha.net]

As a preventative measure, glucose infusion may be necessary to prevent catabolism during infections, and frequent meals may help avoid low glucose levels and lipolysis. Reference Ameele J, Landegem W, Wuyts W, Bleeecker J. [medicalbag.com]

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