• Journal of The Korean Society of Inherited Metabolic disease
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• v.22 no.1
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• pp.1-8
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• 2022

Long-chain fatty acid oxidation disorders (LC-FAOD) are an autosomal recessive inherited rare disease group that result in an acute metabolic crisis and chronic energy deficiency owing to the deficiency in an enzyme that converts long-chain fatty acids into energy. LC-FAOD includes carnitine palmitoyltransferase type 1 (CPT1), carnitine-acylcarnitine translocase (CACT), carnitine palmitoyltransferase type 2 (CPT2), very long-chain acyl-CoA dehydrogenase (VLCAD), long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD), and trifunctional protein (TFP) deficiencies. Common symptoms of LC-FAOD are hypoketotic hypoglycemia, cardiomyopathy, and myopathy. Depending on symptom onset, the disease can be divided as neonatal period, late infancy and early childhood, adolescence, or adult onset, but symptoms can appear at any time. The neonatal screening test (NBS) can be used to identify the characteristic plasma acylcarnitine profiles for each disease and confirmed by deficient enzyme analysis or molecular testing. Before introduction of NBS, the mortality rate of LC-FAOD was very high. With NBS implementation as routine neonatal care, the mortality rate was dramatically decreased, but severe symptoms such as rhabdomyolysis recur frequently and affect the quality of life. Triheptanoin (Dojolvi^®), the first drug for pediatric and adult patients with molecularly confirmed LC-FAOD, has recently been approved by the US Food and Drug Administration in 2020. In this review, the diagnosis of LC-FAOD and treatment including triheptanoin are summarized.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.14 no.2
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• pp.174-177
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• 2014

Isolated methylmalonic acidemia (MMA) is a group of autosomal recessive inborn errors of metabolism caused by impaired activity of methylmalonyl-coenzyme A mutase (MCM). Mutations in the gene encoding MCM (MUT ) is the most common cause of isolated MMA. In this report, we identify an asymptomatic 15 days old female who had elevated C3-acylcarnitine (C3) in the newborn screening. Her serum homocysteine was normal and urine methylmalonic acid was increased that suggested isolated MMA. She was maintained on a low-protein diet and carnitine supplementation. At 3 months of age, she was still asymptomatic and had normal growth. We analyzed MUT gene mutations. Two heterozygote mutations in the MUT gene were identified including c.323G>A and c.1672+2T>C (IVS8(+2)T>C. Among these, c.1672+2T>C (IVS8(+2)T>C) have not been described previously.

• Biomolecules & Therapeutics
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• v.17 no.2
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• pp.181-187
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• 2009

Carnitine is known to be involved in lipid metabolism and affects body composition as well as energy metabolism of the whole body. Improvement of obesity by L-carnitine supplement suggests that obesity can be related with the abnormality of carnitine metabolism and therefore, plasma carnitine level in normal and obesity groups was investigated. For the characterization of plasma carnitine level in obese people, 60 plasma samples collected from Korean women subjects were analyzed using LC/MS and plasma fatty acid level was also determined using GC/MS. Additionally, several clinical chemical parameters including fasting glucose, cholesterol, AST, and ALT level were measured. All the data obtained were combined and pattern recognition analysis was carried out with the dataset. Obese group showed a different metabolic pattern compared with normal group. Plasma acylcarnitine level of the obese group was found to be $11.7{\mu}g/ml$, which was higher than that of normal group ($8.0{\mu}g/ml$). Statistically significant differences in plasma fatty acid level were not observed between the two groups. Other clinical parameters for the obese group were within normal ranges but AST and ALT levels were slightly elevated compared to normal group. The obese group showed elevated plasma acylcarnitine level.

• Clinical and Experimental Pediatrics
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• v.55 no.2
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• pp.58-62
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• 2012

Carnitine (${\beta}$-hydroxy-${\gamma}$-trimethylaminobutyric acid) is involved in the transport of long-chain fatty acids into the mitochondrial matrix and the removal of potentially toxic acylcarnitine esters. Transient carnitine transport defect is a rare condition in newborns reported in 1/90,000 live births. In this paper, we describe a case of transient carnitine transport defect found in a premature baby who had prolonged cholestatic jaundice and poor weight gain, and who responded dramatically to oral carnitine supplementation.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.2 no.1
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• pp.12-14
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• 2002

• Journal of the Korean Society of Food Science and Nutrition
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• v.29 no.5
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• pp.762-765
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• 2000

The changes of carnitine levels including nonesterified-carnitine(NEC), acid-soluble acylcarnitine(ASAC) and total carnitine (TC) were investigated in developing soybean sprouts. The concentrations of carnitines were determined in ungerminated and germinated soybean seeds, and in dissected axis segments and cotyledone of the germinated sprouts. Soybean seeds contain 136 nmol of TC per gram dry weight. the contents of NEC, ASAC, and TC were increased during the germination of soybean seeds. The concentrations of NEC and ASAC were highest in cotyledone and inmeristematic tissues, respectively. These data indicate that developmental differences of carnitine levels do exist in plants, and that in delveoping soybean sprouts the levels of NEC and ASAC are highest in the cotyledone and in the youngest meristem, respectively.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.19 no.1
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• pp.20-25
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• 2019

Very-long-chain acyl-CoA dehydrogenase (VLCAD) deficiency (OMIM#201475) is an autosomal recessively inherited metabolic disorder of mitochondrial long-chain fatty acid oxidation. The clinical features of VLCAD deficiency is classified by three clinical forms according to the severity. Here, we report a case of later-onset episodic myopathic form of VLCAD deficiency whose diagnosis was confirmed by plasma acylcarnitine analysis and" multigene panel multigene panel sequencing. A 34-year old female patient visited genetics clinic for genetic evaluation for history of recurrent myopathy with intermittent rhabdomyolysis. She suffered first episode of rhabdomyolysis with acute renal failure requiring hemodialysis at twelve years old. After then, she suffered several times of recurrent rhabdomyolysis provoked by prolonged exercise or fasting. Physical and neurologic exam was normal. Serum AST/ALT and creatinine kinase (CK) levels were mildly elevated. However, according to her previous medical records, her AST/ALT, CK were highly elevated when she had rhabdomyolysis. In suspicion of fatty acid oxidation disorder, multigene panel sequencing and plasma acylcarnitine analysis were performed in non-fasting, asymptomatic condition for the differential diagnosis. Plasma acylcarnitine analysis revealed elevated levels of C14:1 ($1.453{\mu}mol/L$; reference, 0.044-0.285), and C14:2 ($0.323{\mu}mol/L$; 0.032-0.301) and upper normal level of C14 ($0.841{\mu}mol/L$; 0.065 -0.920). Two heterozygous mutation in ACADVL were detected by multigene panel sequencing and confirmed by Sanger sequencing: c.[1202G>A(;) 1349G>A] (p.[(Ser 401Asn)(;)(Arg450His)]). Diagnosis of VLCAD deficiency was confirmed and frequent meal with low-fat diet was educated for preventing acute metabolic derangement. Fatty acid oxidation disorders have diagnostic challenges due to their intermittent clinical and laboratorial presentations, especially in milder late-onset forms. We suggest that multigene panel sequencing could be a useful diagnostic tool for the genetically and clinically heterogeneous fatty acid oxidation disorders.

• Journal of Nutrition and Health
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• v.28 no.5
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• pp.397-405
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• 1995

The present study examined the effects of swimming on some plasma parameters of lipid metabolism in the middle-aged women. The control group(C) was the women who lived without any intentional physical exercise, and the first experimental group(S I) and the second experimental group(S II) had gone swimming everyday at least one hour for 3-6 months, and more than one year, respectively. The results obtained were summarized as follows: 1) Energy and nutrient intakes of the three groups were not different, but the body fat(%) of two experimental groups(S I, S II) was significantly lower than that of control. 2) Total cholesterol and HDL-cholesterol in plasma were not significantly changed by swimming and swimming period. However, total lipids and LDL-cholesterol were significantly lower in the two experimental groups than in control. 3) The level of plasma triglycerides of SI was not different from the control, but SII showed significantly lower triglycerides. 4) Acid-soluble acylcarnitine and $\beta$-hydroxybutyrate concentration in plasma were significantly greater in SII than in control. There results suggest that regular swimming in a longer period might help to protect the risk of obesity and cardiovascular disease by modulating lipid metabolism.

• BMB Reports
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• v.39 no.4
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• pp.400-405
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• 2006

A 16-month old boy was referred to our hospital for evaluation of recurrent generalized tonic clonic seizures. Metabolic evaluation revealed significant hyperammonemia ($1,112\;{\mu}g/dl$). Amino acid/acylcarnitine screening using tandem mass spectrometry showed markedly increased plasma levels of citrulline ($1,350\;{\mu}M/l$) with undetectable levels of arginine and arginosuccinic acid. Urinary excretion of citrulline was markedly increased ($38,617\;{\mu}M/g$ creatinine). Brain MRI findings showed diffuse high-signal intensity lesions, that involved gray and white matter in both frontal lobes and insula with edematous changes; these findings were consistent with the acute stage of citrullinemia (CTLN). Mutation analysis of the argininosuccinate synthetase (ASS) gene, in this patient, showed a Gly324Ser mutation in exon 13, and a 67-bp duplication mutation in exon 15 (c.1128-6_1188dup67). The patient was confirmed as having late-onset CTLN1 and treated with anticonvulsants, lactulose enema, protein restricted diet and arginine. Here we describe a case of late-onset CTLN1 in a patient by biochemical analyses and ASS gene mutation confirmation. This is the first report of a Korean patient with late-onset CTLN1 confirmed by ASS gene mutation identification.

• Analytical Science and Technology
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• v.14 no.5
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• pp.384-391
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• 2001

In this study, a new quantitative analytical method has been developed for the rapid determination of acylcarnitines and amino acids in human blood using electrospray ionization / tandem mass spectrometry (ESI-MS/MS). Acylarmitines and amino acids were analyzed by tandem mass spectrometry after conversion to their butylesters through treatment with 3N butanolic hydrogen chloride. Acylcrnitines were analyzed using precursor 85 ion scan and alanine, valine, leucine/isoleucine, methionine, phenylalanine, tyrosine, aspartic acid and glutamic acid were analyzed using neutral loss 102 scan, ornitine and citrulline were analyzed neutral loss 119 scan, glycine was analyzed using neutral loss 56 scan, arginine was analyzed using neutral loss 161 scan and argininosuccinic acid was analyzed product ion 459 scan. This method reduced sample preparation time compared to that with conventional amino acid analyzer and liquid chromatography, with high sensitivity and good reproducibility.