Acylcarnitine Profiles during Carnitine Loading and Fasting Tests in a Japanese Patient with Medium-Chain Acyl-CoA Dehydrogenase Deficiency

DOI Web Site 被引用文献2件 参考文献27件
  • Yokoi Kyoko
    Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Science
  • Ito Tetsuya
    Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Science
  • Maeda Yasuhiro
    Laboratory of Hospital Pharmacy, Graduate School of Pharmaceutical Science, Nagoya City University
  • Nakajima Yoko
    Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Science
  • Ueta Akihito
    Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Science
  • Nomura Takayasu
    Department of Pediatrics, Toyohashi Municipal Hospital
  • Koyama Norihisa
    Department of Pediatrics, Toyohashi Municipal Hospital
  • Kato Ineko
    Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Science
  • Suzuki Satoshi
    Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Science
  • Kurono Yukihisa
    Laboratory of Hospital Pharmacy, Graduate School of Pharmaceutical Science, Nagoya City University
  • Sugiyama Naruji
    Department of Pediatrics, Aichi-Gakuin University, School of Dentistry
  • Togari Hajime
    Department of Pediatrics and Neonatology, Nagoya City University, Graduate School of Medical Science

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Medium-chain acyl-CoA dehydrogenase deficiency (MCADD) is rare among Asian individuals, and the clinical course and biochemical findings remain unclear. We report herein a 3-year-old Japanese girl with MCADD. The diagnosis was suggested by acylcarnitine profiles and confirmed by enzyme activity and genetic analysis after clinical presentation. Our described method with high-performance liquid chromatography/tandem mass spectrometry allows quantification of levels of n-octanoylcarnitine (C8-N) and other isomers (e.g. valproylcarnitine). We examined the patient's acylcarnitine profiles in serum and urine samples during carnitine loading and 14-hr fasting tests with/without carnitine supplementation. Under hypocarnitinemia, serum level of C8-N was 0.16 μmol/l and C8-N/decanoylcarnitine (C10) ratio was 1.8, which did not correspond to the diagnostic criteria for MCADD. However, intravenous carnitine loading test (100 mg/kg/day for 3 days and 50 mg/kg/day for 1 day) led to increased serum C8-N levels and urinary excretion was obvious, strongly suggesting MCADD. In the fasting test with carnitine supplementation, marked production of acylcarnitines (C8-N > C2 >> C6 > C10) was found, compared to the fasting test without carnitine supplementation. These results indicate that carnitine supplementation may be useful for detoxification of accumulated acylcarnitines even in an asymptomatic state. Moreover, the one-point examination for serum C8-N level and/or C8-N/C10 ratio may make the diagnosis of MCADD difficult, particularly in the presence of significant hypocarnitinemia. To avoid this pitfall, attention should be given to serum levels of free carnitine, and carnitine loading may be demanded in hypocarnitinemia.

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