Organic Acid Disorders

Glutaric Acidemia Type I (GA I)

background

background

Glutaric acidemia, type I (GA I), was first described in 1975. The disease is caused by a genetic deficiency of the enzyme, glutaryl-CoA dehydrogenase (GCD), which leads to the buildup of glutaric acid in the tissues and its excretion in the urine of affected patients. GCD is involved in the catabolism of the amino acids, lysine, hydroxylysine, and tryptophan.

Over 200 cases of GA I have been reported in the medical literature. GA I is one of the most common organic acidemias and has an estimated incidence of about 1 in 50,000 live births. Because of the initial slow progression of clinical symptoms, GA I is frequently undiagnosed until an acute metabolic crisis occurs.

clinical

clinical

Newborns with GA I may appear normal at birth or have macrocephaly. Development is typically normal during the first year of life until the infant experiences an acute encephalopathic crisis brought on by an intercurrent illness. Symptoms are characterized by metabolic acidosis, dystonia, athetosis, and seizures. The patient is often left with permanent dystonia and long-term loss of motor function. Neurologic recovery is rare and incomplete. As an alternate presentation, an affected infant may be delayed in achieving early motor milestones and appear irritable, jittery, hypotonic, and have impaired voluntary movements. This may progress as a gradual neurological disorder with preservation of mental abilities. Both presentations involve destruction of the caudate and putamen resulting in the movement disorder typical of GA I. Affected patients have a very high risk for neurologic problems before age five.

testing

testing

Newborn screening using tandem mass spectrometry of the heel stick dried blood spot identifies patients with GA I by the presence of glutaric acid covalently bound to carnitine (C5-dicarboxylic acylcarnitine, C5-DC). Also the C5DC/C5-OH, C5DC/C8 and C5DC/C16 ratios have been found informative for GA I. This permits the earliest possible diagnosis and initiation of treatment for presymptomatic patients. In acutely ill patients, large amounts of glutaric acid can be detected in blood and urine by organic acid analysis. Analysis of the urine for abnormal organic acids in a suspected patient may reveal glutaric acid, 3-hydroxyglutaric acid (which is pathognomonic for GA I), and possibly glutaconic acid. These organic acids may be missing, however, in patients who are not acutely ill, in which case acylcarnitine analysis or enzymatic testing is preferred. GCD enzyme activity can be assayed in cultured fibroblasts, cultured amniocytes and chorionic villus (direct or cultured). Prenatal diagnosis has also been accomplished by finding elevated glutaric acid in amniotic fluid. DNA mutation analysis for prenatal diagnosis requires knowing the mutation(s) in the parents prior to testing. Free carnitine levels are often low and acylated carnitine levels are high at diagnosis. Plasma amino acids are usually normal and not helpful in diagnosis. 

Several different gene mutations have been found to cause GA I. There has been no correlation of the DNA mutation with the clinical severity of the disorder for a given patient.

treatment

treatment

Early, aggressive treatment prior to onset of clinical symptoms may prevent development of neurological damage. At the onset of any sickness or metabolic decompensation, prompt, vigorous initiation of IV fluids, including glucose and carnitine, with monitored administration of insulin, is recommended. Restriction of protein, i.e. Lysine and Tryptophan restriction, has not produced clear clinical benefits.

Because the diagnosis and therapy of GA I is complex, the pediatrician is advised to manage the patient in close collaboration with a consulting pediatric metabolic disease specialist. It is suggested that parents travel with a letter of treatment guidelines from the patient’s physician.

inheritance

inheritance

This disorder most often follows an autosomal recessive inheritance pattern. With recessive disorders affected patients usually have two copies of a disease gene (or mutation) in order to show symptoms. People with only one copy of the disease gene (called carriers) generally do not show signs or symptoms of the condition but can pass the disease gene to their children. When both parents are carriers of the disease gene for a particular disorder, there is a 25% chance with each pregnancy that they will have a child affected with the disorder.

Source: Newborn Screening Today (2011), PerkinElmer Inc., Waltham MA
This website stores cookies on your computer. These cookies are used to improve our website and provide more personalised services to you.
Close

Cookies

To make this site work properly, we sometimes place small data files called cookies on your device. Most big websites do this too.

1. What are cookies?

A cookie is a small text file that a website saves on your computer or mobile device when you visit the site. It enables the website to remember your actions and preferences (such as login, language, font size and other display preferences) over a period of time, so you don’t have to keep re-entering them whenever you come back to the site or browse from one page to another.

2. How do we use cookies?

A number of our pages use cookies to remember your actions and preferences (such as login, language, font size and other display preferences.)

Also, some videos embedded in our pages use a cookie to anonymously gather statistics on how you got there and what videos you visited.

Enabling these cookies is not strictly necessary for the website to work but it will provide you with a better browsing experience. You can delete or block these cookies, but if you do that some features of this site may not work as intended.

The cookie-related information is not used to identify you personally and the pattern data is fully under our control. These cookies are not used for any purpose other than those described here.

3. How to control cookies

You can control and/or delete cookies as you wish – for details, see aboutcookies.org. You can delete all cookies that are already on your computer and you can set most browsers to prevent them from being placed. If you do this, however, you may have to manually adjust some preferences every time you visit a site and some services and functionalities may not work.

Close