Metabolic insight from genetic diseases Flashcards
in newborn screening what are the inherited metabolic diseases that babies are tested for
- Phenylketonuria (PKU)
- Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
- Maple syrup urine disease (MSUD)
- Isovaleric acidaemia (IVA)
- Glutaric aciduria type 1 (GA1)
- Homocystinuria (pyroxidine unresponsive) (HCU).
what are inherited metabolic diseases caused by (simply)
- they are caused by a gene defects, this results in changed activity of a specific protein
what an inherited metabolic diseases be caused by
- This can be due to reduced synthesis, incorrect transport or altered amino acid composition (changes 3d shape or active site).
- It can be secondary, defects in regeneration of cofactor.
- Sometimes this can lead to the production of a toxic metabolite.
what are metabolic inherited diseases classed by
- often classed by phenotype and not genotype
what is an example of a carbohydrate metabolism disease
example of a carbohydrate metabolism disease is glycogen storage disease.
what is an example of an amino acid metabolism disease
example of amino acid metabolism disease is phenyl-keto urea, maple syrup urine disease, glutaric acidaemia type 1.
what is an example of organic acid metabolism disease
example of organic acid metabolism disease is alkaptonuria.
what is an example of fatty acid metabolism
example of fatty acid metabolism (mitochondrial defects) is medium chain acyl CoA dehydrogenase deficiency
How do you detect an inherited metabolic disorder
neonatal screening is done e.g help prick to test for PKU or MCAD.
- plasma metabolite analysis looks for build-up of abnormal metabolism e.g via mass spectrometry.
- screening of family members looking for specific genotypes, heterozygotes can be detected during screening and given genetic counselling.
these symptoms would signal what metabolic disorder
- hypoglycaemia
- cataracts
- metabolic acidosis
- unusal urine odour
- neurological dysfunction
- HYPOGLYCAEMIA glycogen storage disease
- CATARACTS galactosemia
- METABOLIC ACIDOSIS organic acid defects (PDC deficiency).
- UNSUAL URINE ODOUR amino acid and organic acid defects.
- NEUROLOGICAL DYSFUNCTION urea cycle defects as ammonia builds up in the blood.
how many people does Von Gierkes disease happen in
occurs in 1 in 43000
what is von gierkes disease
- it is a deficiency of glucose-6-phosphatase which reverses glucokinase/hexokinase reaction in the liver.
- this deficiency prevents the liver making its glycogen stores accessible to the rest of the body.
- and glucose cannot be synthesised in the liver from glucogenic amino acids and lactate.
what are the symptoms of Von Gierke’s disease
-hypoglycaemia, lactic acidosis and an enlarged liver are common signs and symptoms.
what is the treatment of von Gierke’s disease
-providing slow release sugar from starch is a treatment.
what causes Her’s disease
- deficiency in liver phosphorylase
- this prevents the liver making its glycogen stores accessible to the rest of the body
what are symptoms of Her’s disease
-signs are hepatomegaly, hypoglycaemia and more lactate and lipids in blood
what are treatments of Her’s disease
-treatment is to provide regular starch
describe what causes McArdle’s disease
- autosomal recessive.
- unable to use muscle glycogen due to deficiency in muscle phosphorylase.
what are the symptoms of McArdle’s disease
- fast exercise results in rhabdomyolysis due to lack of energy, also raised blood creatine kinase and myoglobin (causes dark urine).
- 2nd burst in exercise.
How is McArdle’s diagnosed
-diagnosed with ischaemic forearm test (no lactate produced), biopsy and sequencing
how many people in Galactosameia type 1
-1 in 30-60000 births.
what causes Galactosaemia type 1
- deficiency in galactose-1-phosphate uridyl transferase.
- autosomal recessive disease where baby can’t use galactose portion of lactose.
- galactose and galactose-1-phophate accumulate in tissue and galatcose-1-phosphate in the blood.
What are the symptoms of galactosaemia type 1
hypoglycaemic, acidosis and will later develop cataracts and mental retardation
what is the treatments for galactosaemia type 1
treatment is via a galactose free diet, if untreated, patients will die.
what causes a fructose tolerance
caused by fructose aldolase deficiency.
- fructose accumulates in the liver and kidneys as fructose-1-phosphate.
- this inhibits glycogenolysis and gluconeogenesis and causes hypoglycaemia and can lead to hepatic and renal failure.
- they have a distaste for sweet food.
- can be from mild to severe
what causes pyruvate dehydrogenase deficiency
- caused by mutations in any genes coding for pyruvate dehydrogenase (PDHA1, PDHB, DLAT, PDP1).
- x-linked (PDHA1) or autosomal recessive
what are symptoms of pyruvate dehydrogenase deficiency
- Mental retardation
- Seizures
- Hypotonia
- Brain wasting
- Lactic acidosis
- Vomiting
- Breathing problems
- Abnormal heartbeat
- Can be fatal if untreated.
How do you treat pyruvate dehydrogenase deficiency
treated with thiamine, lipoic acid and ketogenic diet.
-a spectrum disorder
what are inherited disorders of carbohydrate metabolism
VON GIERKE’S DISEASE HERS DISEASE MCARDLES DISEASE GALACOTSAEMIA TYPE 1 FRUCTOSE INTLOERANCE PYRUVATE DEHYDROGENASE DEFICIENCY
what are inherited disorders of Amino acid metabolism
Phenylketonuria
Alakaptonuria
Maple syrup urine
what are inherited disorders of lipid metabolism
MCADD
Familial hypercholesterolameia
what causes phenylketonuria
- impaired conversion of phenylalanine to tyrosine due to defect in phenylalanine hydroxylase.
- a rarer condition is a defect in dihydrobiopterin reductase which recycle the cofactor for the main reaction
what are the side effects of high phenylalanine concentrations
- A side reaction creates phenylpyruvate and phenylethylamine.
- Phenylalanine and the side reaction products are excreted in the urine causes aminoaciduria
when does phenylketonuria develop
3-6 months
what are the symptoms of phenylketonuria
- Developmental delay
- Eczema
- Hyperactivity
- Mental retardation
- Irritability
- Vomiting
- Reduce melanin formation in skin
how do you treat phenylketouria
-treated by phenylalanine restricted diet and supplemented by tyrosine and vitmains such as iron
what causes alkaptouria
deficiency in homogentisate-1,2-dioxygenase
what is the treatment of alkaptouria
-diet restrictions and lots of vitamin C to treat. Only restricted as phenylalanine is an essential amino acid.
what are the symptoms of alkaptouria
-causes black urine (alkapton) and joint and cardiac problems due to deposits of homogentisate.
what causes maple syrup urine
- deficiency in branched chain alpha-ketoacid dehydrogenase.
- affects valine, leucine and isoleucine breakdown.
- cannot break down branched amino acids so their ketoacids build-up and are excreted.
what is the treatment of maple syrup urine
-control amounts of intake, not restricted completely.
what are the symptoms of maple syrup urine
urine produced has a very distinctive smell of maple syrup
what cause MCADD
-medium-chain acyl-CoA dehydrogenase deficiency. Can partially metabolise fat from long chain to medium but cannot continue on further is the beta-oxidation spiral.
what is the symptoms of MCADD
-ketoacidosis, low blood glucose and presence of fats occur
What is the treatment of MCADD
treated by regular food to prevent beta oxidation occurring.
what is the cause of FAMILIAL HYPERCHOLESTEROLAEMIA
- genetic defect reducing the number of functional LDL receptors; mainly in the liver.
- levels of LDL in the blood rise.
- SNP’s in SREBP2 can also change LDL receptor levels. Defect in feedback loop.
what are the symptoms of FAMILIAL HYPERCHOLESTEROLAEMIA
-symptoms include high blood cholesterol, tendon xanthomas (yellow, cholesterol build-up) and premature CHD.
what are the treatments of FAMILIAL HYPERCHOLESTEROLAEMIA
treated by diet modifications, statins and bile acid binding resins