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Severe Infantile Carnitine Palmitoyl Transferase II Deficiency

CPT2


Presentation

  • Antenatal presentation of carnitine palmitoyltransferase II deficiency. Am J Med Genet 2001 ;102: 183 – 187. Google Scholar ISI 8. Land, JM, Mistry, S, Squier, M. Neonatal carnitine palmitoyltransferase-2 deficiency: a case presenting with myopathy.[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]
  • 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]
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]
  • Late-onset mitochondrial myopathies feature proximal muscle weakness, easy fatigueability, and variably elevated CK levels. Lactic acidemia is often absent.[the-rheumatologist.org]
  • Accumulate Leu, Ile, Val Symptoms:SWEET SMELLING URINE (from Sotolone), metabolic acidosis, optic atrophy , AHDS, axial hypotonia, exertional fatigue, mental retardation, ataxia, hypoglycemia, liver enz & br-chain AA in serum, abdominal pain Deficient[quizlet.com]
Pathologist
  • The target audience is a wide variety of clinicians, including pediatricians, neonatologists, obstetricians, maternal-fetal specialists, internists, pathologists, geneticists, and laboratorians engaged in prenatal and/or neonatal screening.[books.google.com]
Multiple Organ Dysfunction Syndrome
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]
Excitement
  • It is our hope that the 2nd Edition will open new avenues and vistas for our readers and that they will share with us the interest, excitement and passion of the research into all these challenging disorders.[books.google.com]
  • excitation : 470 40 nm band pass filter, λ detection : 535 50 nm band pass filter) [ 20, 21 ].[journals.plos.org]
  • ECG may reveal a pre-excitation syndrome in individuals harboring a mtDNA LHON-causing pathogenic variant; referral to cardiology can be considered and treatment for symptomatic individuals is the same as that in the general population.[mitoaction.org]
  • Genetic testing - Pre-excitation ventricular arrhythmia (See Wolff-Parkinson-White syndrome ...). Genetic Testing - Preeclampsia (Preeclampsia) - Genes Corin EPHXI and STOX1 .[ivami.com]
Febrile Convulsions
  • In affected children, high-grade fever is accompanied within 12 to 48 hours by febrile convulsions, often leading to coma, multiple-organ failure, brain edema, and high morbidity and mortality.[uniprot.org]
  • It is characterized by a high-grade fever accompanied within 12 to 48 hours by febrile convulsions, often leading to coma, multiple-organ failure, brain edema, and high morbidity and mortality.[mendelian.co]
  • To date, more than 70 different mutations of CPT2 have recently been reported, and studies have demonstrated the relationships between the CPT II deficiency genotypes and their clinical phenotypes characterized by febrile convulsions and multiple-organ[journals.plos.org]
Altered Mental Status
  • It is characterized by respiratory distress, seizures, altered mental status, hepatomegaly, cardiomegaly, cardiac arrhythmia, and, in many cases, dysmorphic features, renal dysgenesis, and migration defects. recessive.[uniprot.org]
  • 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]
Neonatal Seizures
  • Genetic Testing - benign familial neonatal epilepsy (Benign familial neonatal seizures -BFNS-) - Genes KCNQ2 and KCNQ3. Genetic Testing - benign hereditary chorea (Bening Chorea hereditary) - Gen NKX2-1.[ivami.com]

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]
Hypoketotic Hypoglycemia
  • 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]
  • hypoglycemia, severe cardiac involvement, renal malformations, arrhythmias, sudden death.[newbornscreening.info]
  • . • 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]
  • Clinical features include hypoketotic hypoglycemia, lethargy, seizures, hepatomegaly, liver dysfunction, cardiomegaly and dilated cardiomyopathy.[uniprot.org]
  • This form involves recurring episodes of hypoketotic hypoglycemia, seizures, an enlarged liver (hepatomegaly), cardiomyopathy, and arrhythmia.[ghr.nlm.nih.gov]
Brain Edema
  • In affected children, high-grade fever is accompanied within 12 to 48 hours by febrile convulsions, often leading to coma, multiple-organ failure, brain edema, and high morbidity and mortality.[uniprot.org]
  • It is characterized by a high-grade fever accompanied within 12 to 48 hours by febrile convulsions, often leading to coma, multiple-organ failure, brain edema, and high morbidity and mortality.[mendelian.co]
  • The sudden-onset brain edema with clinical manifestation in patients supports the ATP threshold hypothesis in the etiology of this kind edema.[journals.plos.org]
  • Japanese patients Genetics: Missense mutations, Phe352Cys & Val368Ile CPT2 protein : Mutation causes thermolability Clinical Fever Seizures Coma Multiorgan failure Brain edema Laboratory Acylcarnitine ratios: High Carnitine-acylcarnitine translocase deficiency[neuromuscular.wustl.edu]

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]

Prognosis

  • Prognosis The severe infantile form may lead to sudden death during infancy due, in general, to paroxysmal cardiac arrhythmias. This is particularly true for undiagnosed cases.[orpha.net]
  • 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]
  • 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]

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]
  • 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]
  • For example, metabolic myopathies, which comprise a clinically and etiologically diverse group of disorders caused by defects in cellular energy metabolism, including the breakdown of carbohydrates and fatty acids and the disruption of mitochondrial metabolism[bredagenetics.com]

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]
Sex distribution
Age distribution

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

  • 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]
  • This DNA vaccine has the potential to be a safe and effective therapy to prevent Alzheimer disease. He described Machado-Joseph disease (MJD), an autosomal dominant ataxia, with William Nyhan, M.D. Ph.D, in 1976, for the first time.[books.google.com]
  • 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]
  • 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]
  • 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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