Aminoaciduria
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Aminoaciduria. Overview of Amino Acid Catabolism. 1st phase R emoval of the α-amino groups 2 nd phase C arbon skeletons of the α- ketoacids are converted to common intermediates of energy producing and other metabolic pathways. 1st phase of catabolism of amino acids:

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Aminoaciduria

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Aminoaciduria

Aminoaciduria


Overview of amino acid catabolism

Overview of Amino Acid Catabolism

1st phase

Removal of the α-amino groups

2ndphase

Carbon skeletons of the α-ketoacidsare converted to common intermediates of energy producing and other metabolic pathways


Aminoaciduria

1st phase of catabolism of amino acids:

Removal of the α-amino groups

With production of

Free Ammonia

In Liver

Small amount excreted in urine

Urea


Aminoaciduria

2ndphase of A. A. catabolism

Breakdown of the resulting carbon skeletons of amino acids

Giving 7 intermediates

Oxalacetate, a-ketoglutarate, Pyruvate, Fumarate, Succinyl CoA

Acetyl CoA & Acetoacetyl CoA

  • ATP, CO2 & H2O: by Citric acid cycle intermediates)

  • Glucose: from Gluconeogenesis intermediates)

  • Fatty Acids: from acetyl CoA & Acetoacetyl CoA)

  • Ketone Bodies : from acetyl CoA & Acetoacetyl CoA)


Aminoaciduria

Amino Acids

Metabolism


Glucogenic ketogenic amino acids

Glucogenic & Ketogenic Amino Acids

Glucogenic Amino Acids

Amino acids whose catabolism

yields pyruvate or one of the

intermediates of citric acid cycle

i.e. substrates of gluconeogenesis

& therefore can give rise to GLUCOSE

Ketogenic Amino Acids

Amino Acids whose catabolism

Yields acetyl CoA or acetoactyl CoA

i.e. finally give rise to ketone bodies

Leucine& lysine are the only

exclusively ketogenic amino acids

& therefore cannot give rise to glucose


Aminoaciduria

Inborn Errors of Amino Acid Metabolism


Inborn errors of metabolism

Inborn Errors of Metabolism

also called,

Inherited metabolic diseases

or Congenital metabolic diseases

They are a large group of genetic disorders, resulting in metabolicdefects due to

a genetically determined specificdefects in a protein.

Defects in proteins result from a single gene mutationwhich leads to reduced or

absent gene product or production of a different protein with abnormal

function.


Aminoaciduria

General effects of

inborn errors of metabolism

  • Accumulation of a substrate or its metabolic derivatives that are harmful or may interfere with normal function of cells.

  • Accumulation of intermediates from alternative metabolic pathways

  • Decreased ability to synthesize essential compounds

  • Defects in energy production


Aminoaciduria

Inheritance of

inborn errors of metabolism

  • Most of the inborn errors of metabolism are inherited as autosomal recessive or

    X-linked disorders in nuclear DNA.

  • Few are inherited as autosomal dominant.

  • Some may involve mitochondrial functions as they are linked to mitochondrial DNA

  • The incidence of these diseases within different racial & ethnic groups varies with predominance of certain inborn errors of metabolism within particular groups.

  • Some of these diseases occur in large numbers in communities in which consanguinityis common.


Aminoaciduria

Detection of inborn errors of metabolism

Inherited disorders may be detected in different stages during life

  • Heterozygote carriers of a disease

    may be found during screening (as such performed on family members of a patient with muscular dystrophy).

  • Before birth (intrauterine)

    some inherited disorders can be detected before birth (as cystic fibrosis).

  • Neonatal screening (in first days of life)

    As for phenylketonuria

  • In neonates (in first weeks of life)

    Many disorders involving single gene defects become apparent clinically (give symptoms & signs).

  • Some disorders such as familial hypercholesterolemia may not be recognized until adult life.


Neonatal screening

Neonatal Screening

  • Programs for screening all newborns for certain metabolic disordersare performed with the following criteria:

    1- The disease should not be clinically apparent at the time of screening

    2- The disease should have a relatively high incidence in the population screened.

    3- The disease should be treatable & so results of screening test must be obtained before

    irreversible damage is likely to have occurred.

    4- Screening test should be simple & reliable.

  • Examples of screening programs:

    Phenylketonuria

    Galactossemia

    Congenital hypothyroidism

    Cystic fibrosis

  • A positive result of a screening test should be confirmed by quantitative analysis or identifying the enzyme defect..

  • In a second positive test, the individual might be required to be reassessed after a period of time in some cases.


Aminoaciduria

Inborn Errors of Amino Acid Metabolism

1- Phenylketonuria (PKU)

Phenylketonuria

  • is the commonest cause of inborn errors of amino acid metabolism

  • is the commonest inherited cause of mental retardation

  • It is mainly caused by deficiency of phenylalanine hydroxylase of liver (which converts phenylalanine to tyrosine).


Aminoaciduria

Causes of Phenylketonuria (PKU)

1- Deficiency of phenylalanine hydroxylase


Causes of phenylketonuria pku cont

Causes of Phenylketonuria (PKU) cont.

2- Deficiency in enzymes that synthesize or reduce the coenzyme dihydrobiobterin

(DHBP synthetase & DHBP reductase)

In this case, simply restricting dietary phenylalanine will not reverse CNS defects due to deficiency of neurotransmitters


Aminoaciduria

Metabolic & clinical effects of phenylketonuria

  • Elevated blood phenylalanine & its metabolites

    Phenylalanine & its metabolites phenylpyruvic, phenylacetate &

    phenyllactate accumulates resulting in their rise in blood

    & excretion in urine (phenylketonuria).

  • CNS symptoms:

    Persistent postnatal hyperphenylalaninemia causes irreversible brain

    damage ending in mental retardation (by age of one year) & convulsions.

    Most untreated patients show IQ below 50

  • Hypopigmentation:

    Tyrosinelevels are reduced ending in deficiency of melanin formation resulting in

    decreased pigmentation (hypopigmentation) in hair & eyes.

    Also, the hydroxylation of tyrosine by tyrosinase (the first step in melanin

    pigment formation) is competitively inhibited by high levels phenylalanine.


Diagnosis of phenylketonuria

Diagnosis of Phenylketonuria

Neonatal diagnosis

Early diagnosis of PKU is important because the disease is treatable by dietary means.

Newborn with PKU frequently has normal blood levels of phenylalanine (PA) at birth

As the mother clears increased blood PA in her fetus through placenta. So, test performed at birth may show false –ve results.

PA begins to be elevated when newborn takes milk (containing proteins) for at least 24 hours

Accordingly, feeding with milk for 48 hours is sufficient to raise the newborn blood PA to levels that can be used for diagnosis.


Aminoaciduria

Diagnosis of Phenylketonuria cont.

Neonatal Screening Program for PKU

  • Must be made within one month of birth, if mental retardation is to be prevented.

  • Screening program for neonate (6 –14 days of life) using Guthrie testis performed:

    - A disk of a filter paper containing blood from a heel

    prick is placed on plates impregnated with a microorganism, Bacillus subtilis,

    which requires phenylalanine for growth, the only source being the

    blood spot.

    - The growth of the organism is a positive test.

  • Test has to be confirmed by measuring blood phenylalanine


Treatment of phenylketonuria

Treatment of phenylketonuria

Principles of treatment of PKU

  • Treatment must begin during first 7-10 days of life to prevent mental retardation.

    .

  • Treatment aims at maintaining blood phenylalanine levels close to normal range.

  • Treatment should be continued for many years (at least till age of 8) as high blood levels of

    phenylalanine between 4 – 8 years leads to mental retardation.

    However, life-long treatment by diet restriction of phenylalanine is preferred

  • Avoiding low levels of phenylalanine in blood as it is an essential amino acid and therefore is essential for physical & mental growth.

  • Tyrosine is must be supplied in diet as it cannot be synthesized from phenylalanine in cases of PKU

    Protocol of treatment:

  • By feeding synthetic amino acid preparations low in phenylalanine

  • Supplemented with some natural foods such as vegetables, fruits & certain cereals selectedfor their low phenylalanine content & rich in tyrosine.


Maternal pku

Maternal PKU

  • Pregnant women with PKU & are not on low PA diet, the offspring are affected with maternal PKU syndrome.

  • High blood PA levels in the mother cause microcephaly, mental retardation & congenital heart abnormalities in the fetus

  • Accordingly, dietary control of PA must begin prior to pregnancy & must be maintained throughout pregnancy.


Aminoaciduria

Inborn Errors of Amino Acid Metabolism

2- Maple Syrup Urine Disease (MSUD)

  • Due to deficiency of the branched chain a-ketoacid dehydrogenase enzymewhich decarboxylates the branched-chain amino acids leucine, isoleucine & valine.

  • Metabolic & clinical effects :

    1- Accumulation of these amino acids & their metabolites (a-ketoacids) in

    blood lead to toxic CNS effects.

    2- Characteristic maple syrup odor in urine (due to the amino acid isoleucine)

  • Diagnosis:

    Elevated branched-chain amino acids & their metabolites in blood & urine

    Newborns suspected to have MSUD should be tested within 24 hours of birth to start treatment early (to avoid toxic effects)

  • Treatment:

    Synthetic formula that contains limited amounts of leucine, isoleucine & valine

    sufficient to provide amino acids necessary for normal growth & development

    without producing toxic effects.


Aminoaciduria

Inborn Errors of Amino Acid Metabolism

3- Disorders of tyrosine amino acid metabolism

Disorders of tyrosine amino acid metabolism lead to the following consequences:

1- Deficiency of melanin pigments (Albinism)

Tyrosine is the precursor of melanin (by tyrosinase enzyme)

Deficiency of tyrosine leads to albinism.

Albinism refers to a group of conditions in which a defect in tyrosine metabolism

(deficiency of tyrosinase) results in deficiency in the production of melanin resulting in the

partial or full absence of pigment from the skin, hair & eyes.

2- Deficiency of neurotransmitters:

Tyrosine is the precursor of DOPA

DOPA is converted to dopamine & catecholamine(neurotransmitters)

Disturbance of these neurotransmitters may cause Parkinson’s disease.


Aminoaciduria

Inborn Errors of Amino Acid Metabolism

4- Disorders of tyrosine amino acid metabolism Alkaptonuria

  • Caused by deficiency of homgentisic acid oxidase

    ( enzyme in tyrosine metabolism)

  • Homgentisicacid (metabolite of tyrosine metabolism)

    cannot be further metabolized & thus accumulates resulting in:

    1- Excretion of homogentisic acid in urine in excessive amounts

    (homogentisic aciduria) which is oxidized to dark pigments

    on standing.

    2- Homogentisic acid is deposited in connective tissue ending in

    degenerative changes in large joints (arthritis).


Aminoaciduria

Inborn Errors of Amino Acid Metabolism

5- Homocystinuria

  • Deficiency of the enzyme cytathioninesynthetase (for methionine amino acid

    metabolism)resulting in inability to metabolize amino acid methionine & homocysteine

  • Elevated methionine & homocysteine may cause:

    - CNS manifestations: mental retardation, seizures, etc

    - Vascularthrombosis (complicated by CHD & strokes)

  • Treated by diet deficient in methionine & giving large dose of vitamin B6,B12 & folate


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