Prenatal diagnosis of pyruvate carboxylase deficiency.
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Biomedical subjects
Publications and source records attributed to G Feldman.
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Multiple carboxylase deficiency is characterized by deficient activities of three biotin-dependent enzymes, propionyl coenzyme A carboxylase, pyruvate carboxylase, and beta-methylcrotonyl coenzyme A carboxylase. A newborn infant was seen with metabolic ketoacidosis, hyperammonemia, organic aciduria, seizures, and coma. Multiple carboxylase deficiency was subsequently confirmed by enzyme activity determinations in his peripheral blood leukocytes and cultured skin fibroblasts. The infant's neurologic and metabolic status improved markedly within a few days of administration of pharmacologic doses of oral biotin. His EEG, which was distinctly abnormal, became normal; his extensive computed tomography scan changes resolved, with the exception of ventricular dilation, over the next two months. After two weeks of biotin treatment the excretion of abnormal organic acid metabolites was reduced and his carboxylase activities increased to the normal range. However, the activities of these enzymes increased only to 30% to 55% of normal in fibroblasts incubated in supplemental biotin. This partial correction of enzyme activity differs from that observed in other individuals with multiple carboxylase deficiency and suggests biochemical heterogeneity in this disorder. Prompt diagnosis and intervention can avert some of the pathologic complications of this biotin-responsive condition.
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Foreign protein injections (hyposensitization) given for one year to human asymptomatic asthmatics did not increase their serum total lipids or lipoprotein levels, as they apparently did in rabbits fed a lipid-rich, cholesterol-poor diet. Serum total protein and immunoglobulin levels for IgA, IgM and IgG for the asthmatics and controls were no different.
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In 1963, Rosen and Bougas reported the case of a woman with recurrent infection, marked elevation of 19S, and virtual absence of 7S gamma globulin. Recently, members of her family were found to have similar abnormalities: Ten of the 37 family members tested had elevated levels of serum IgM accompanied by a combined deficiency of IgG and IgA in three, and by a deficiency of either IgG or IgA in two. In five, an increase in IgM was the sole abnormality. Two children had deficiencies of IgG and IgA with normal serum levels of IgM. Ten of the 12 affected individuals had no IgD detectable by radial immunodiffusion and six had a low percentage of IgG-bearing B lymphocytes. A lack of correlation between the immunochemical abnormalities and either the presence or severity of clinical illness was observed. The presence of immunodeficiency in three generations and in both sexes of this family suggests an autosomal dominant mode of inheritance with variable penetrance of the defect.
Hypersensitivity pneumonitis, a disease caused by repetitive inhalation of nonviable organic dust, is increasingly recognized as a cause of acute and chronic lung disease in both children and adults. Twenty-one of 32 children and adults who went on a hay ride in Arkansas developed this disease. These cases are reported. The clinical manifestations, pathology, differential diagnosis, treatment, and immunologic aspects of the disease are reviewed.
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