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      Diagnóstico de la deficiencia de hidroxi-acil CoA deshidrogenasa de cadena larga, mediante la incubación de fibroblastos con ácido [9,10)(n)-³h] palmítico y ácido [9,10)(n)-³h] mirístico Translated title: Diagnosis Long-chain hydroxy acyl-CoA dehydrogenase deficiency, by fibroblasts incubation with [9, 10)(N)-³H] palmitic and [9,10)(N)-³H] miristic acids Translated title: Diagnóstico da deficiência de hidroxi-acil CoA deshidrogenasa de longa cadeia, mediante incubação de fibroblastos com ácido [9,10)(n)-³h] palmítico e ácido [9,10)(n)-³h] mirístico

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          Abstract

          Introducción: la deficiencia de hidroxi-acil CoA deshidrogenasa de cadena larga, es una enfermedad metabólica autosómica recesiva, caracterizada por acidosis, hipoglicemia, cardiomiopatía, daño hepático y rabdomiólisis. Objetivo: analizar las tasas de oxidación de sustratos tritiados por fibroblastos de pacientes con deficiencia de hidroxi-acil-CoA deshidrogensa y controles. Métodos: fibroblastos de pacientes y controles se incubaron con [³H]-palmitato y [³H]-miristato y se determinó la oxidación de los mismos en nmol/h/mg proteína. Resultados: se encontró deficiente la oxidación de sustratos tritiados por parte de los fibroblastos procedentes de los pacientes que presentaban la deficiencia, con una tasa de oxidación de 43 y 48% para palmitato y miristato respectivamente. Conclusión: esta técnica modificada permite el diagnóstico in vitro de la deficiencia de hidroxi-acil-CoA de cadena larga.

          Translated abstract

          Introduction: long-chain hydroxy acyl-CoA dehydrogenase (LCHAD) deficiency, is an autosomal recessive metabolic disease, characterised by acidosis, hypoglycaemia, cardiomyopathy, liver damage, and rhabdomyolysis. Objective: to analyse the oxidation rate of tritiated substrates in fibroblasts of patients suffering the deficiency and controls. Methods: fibroblasts from patients and controls were incubated with [³H]-palmitate and [³H]-miristate and the oxidation of these substrates were measured in nmol/ hour/mg protein. Results: it was found depressed oxidation of tritiated substrates in fibroblasts from patients suffering the deficiency, with a oxidation rate of 43% and 48% for palmitate and miristate respectively. Conclusion: this modified technique enables us the in vitro diagnosis or long-chain hydroxy acyl-CoA dehydrogenase.

          Translated abstract

          Introdução: a deficiência de hidroxi-acil CoA deshidrogenasa de longa cadeia, é uma doença metabólica autossômica recessiva, caracterizada por acidose, hipoglicemia, cardiomiopatia, dano hepático e rabdomiólise. Objetivo: analisar as taxas de oxidação de substratos tritiados por fibroblastos de pacientes com deficiência de hidroxi-acil-CoA desidrogenas e controles. Métodos: fibroblastos de pacientes e controles se incubaram com [³H]-palmitato e [³H]-miristato e se determinou a oxidação dos mesmos em nmol/h/mg proteína. Resultados: encontrou-se deficiente a oxidação de substratos tritiados por parte dos fibroblastos procedentes dos pacientes que apresentavam a deficiência, com taxa de oxidação de 43 e 48% para palmitato e miristato respectivamente. Conclusão: esta técnica modificada permite o diagnóstico in vitro da deficiência de hidroxi-acil-CoA de longa cadeia.

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          Mitochondrial fatty acid oxidation disorders: clinical presentation of long-chain fatty acid oxidation defects before and after newborn screening.

          The different long-chain fatty acid oxidation defects present with similar heterogeneous clinical phenotypes of different severity. Organs mainly affected comprise the heart, liver, and skeletal muscles. All symptoms are reversible with sufficient energy supply. In some long-chain fatty acid oxidation defects, disease-specific symptoms occur. Only in disorders of the mitochondrial trifunctional protein (TFP) complex, including long-chain 3-hydroxyacyl-coenzyme A (CoA) dehydrogenase (LCHAD) deficiency, neuropathy and retinopathy develop that are progressive and irreversible despite current treatment measures. In most long-chain fatty acid oxidation defects, no clear genotype-phenotype correlation exists due to molecular heterogeneity. However, some isolated mutations have been identified to be associated with only mild phenotypes, e.g., the V243A mutation in very-long-chain acyl-CoA dehydrogenase (VLCAD) deficiency. LCHAD deficiency is due to the prevalent homozygous 1528G>C mutation and presents with heterogeneous clinical phenotypes, suggesting the importance of other environmental and genetic factors. For some disorders, it was shown that residual enzyme activity measured in fibroblasts or lymphocytes correlated with severity of clinical phenotype. Implementation of newborn screening has significantly reduced morbidity and mortality of long-chain fatty acid oxidation defects. However, the severest forms of TFP deficiency are still highly associated with neonatal death. Newborn screening also identifies a great number of mildly affected patients who may never develop clinical symptoms throughout life. However, later-onset exercise-induced myopathic symptoms remain characteristic clinical features of long-chain fatty acid oxidation defects. Disease prevalence has increased with newborn screening.
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            Acute fatty liver of pregnancy: an update on pathogenesis and clinical implications.

            Acute fatty liver of pregnancy (AFLP) is a serious maternal illness occurring in the third trimester of pregnancy with significant perinatal and maternal mortality. Till recently, it has been considered a mysterious illness. In this editorial, we review the recent advances in understanding the pathogenesis of AFLP and discuss the studies documenting a fetal-maternal interaction with a causative association between carrying a fetus with a defect in mitochondrial fatty acid oxidation and development of AFLP. Further, we discuss the impact of these recent advances on the offspring born to women who develop AFLP, such that screening for a genetic defect can be life saving to the newborn and would allow genetic counseling in subsequent pregnancies. The molecular basis and underlying mechanism for this unique fetal-maternal interaction causing maternal liver disease is discussed.
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              Dietary management of long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD). A case report and survey.

              Current dietary management of long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD; long-chain-(S)-3-hydroxyacyl-CoA:NAD+ oxido-reductase, EC 1.1.1.211) deficiency (LCHADD) is based on avoiding fasting, and minimizing energy production from long-chain fatty acids. We report the effects of various dietary manipulations on plasma and urinary laboratory values in a child with LCHADD. In our patient, a diet restricted to 9% of total energy from long-chain fatty acids and administration of 1.5 g medium-chain triglyceride oil per kg body weight normalized plasma acylcarnitine and lactate levels, but dicarboxylic acid excretion remained approximately ten times normal. Plasma docosahexaenoic acid (DHA, 22:6n-3) was consistently low over a 2-year period; DHA deficiency may be related to the development of pigmentary retinopathy seen in this patient population. We also conducted a survey of metabolic physicians who treat children with LCHADD to determine current dietary interventions employed and the effects of these interventions on symptoms of this disease. Survey results indicate that a diet low in long-chain fatty acids, supplemented with medium-chain triclyceride oil, decreased the incidence of hypoketotic hypoglycaemia, and improved hypotonia, hepatomegaly, cardiomyopathy, and lactic acidosis. However, dietary treatment did not appear to effect peripheral neuropathy, pigmentary retinopathy or myoglobinuria.
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                Author and article information

                Contributors
                Role: ND
                Journal
                inan
                Investigaciones Andina
                Investig. andina
                Fundación Universitaria del Área Andina (Pereira )
                0124-8146
                April 2013
                : 15
                : 26
                : 693-699
                Affiliations
                [1 ] Universidad de Caldas Colombia
                Article
                S0124-81462013000100007
                a224ff0b-93f1-4554-831e-073cde7e82b4

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Colombia

                Self URI (journal page): http://www.scielo.org.co/scielo.php?script=sci_serial&pid=0124-8146&lng=en
                Categories
                PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

                Public health
                ß-Oxidation,Fatty Acids,Metabolism,ß-Oxidacäo,Ácidos Gordurosos,Metabolismo,ß-Oxidacion,Ácidos Grasos

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