Acylcarnitine profiles during carnitine loading and fasting tests in a Japanese patient with medium-chain acyl-CoA dehydrogenase deficiency

Kyoko Yokoi, Tetsuya Ito, Yasuhiro Maeda, Yoko Nakajima, Akihito Ueta, Takayasu Nomura, Norihisa Koyama, Ineko Kato, Satoshi Suzuki, Yukihisa Kurono, Naruji Sugiyama, Hajime Togari

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9 Citations (Scopus)

Abstract

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 acylearnitine 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 camitine supplementation. Under hypocarnitinemia, serum level of C8-N vhs 0.16 μmol/1 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 estimination 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.

Original languageEnglish
Pages (from-to)351-359
Number of pages9
JournalTohoku Journal of Experimental Medicine
Volume213
Issue number4
DOIs
Publication statusPublished - 12-12-2007
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)

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    Yokoi, K., Ito, T., Maeda, Y., Nakajima, Y., Ueta, A., Nomura, T., Koyama, N., Kato, I., Suzuki, S., Kurono, Y., Sugiyama, N., & Togari, H. (2007). Acylcarnitine profiles during carnitine loading and fasting tests in a Japanese patient with medium-chain acyl-CoA dehydrogenase deficiency. Tohoku Journal of Experimental Medicine, 213(4), 351-359. https://doi.org/10.1620/tjem.213.351