Author:
Gan Yi,Yu Fei,Fang Haining
Abstract
Abstract
Background
Carnitine palmitoyltransferase 1A (CPT1A) deficiency is a rare mitochondrial fatty acid oxidation (FAO) disorder that results in hypoketotic hypoglycemia and hepatic encephalopathy. It is caused by mutation in CPT1A. To date, only two symptomatic cases of CPT1A deficiency have been reported in China.
Case presentation
A newborn male, without any disease-related clinical manifestations, was diagnosed with CPT1A deficiency through newborn screening. Increased free carnitine levels and a significantly increased C0/(C16 + C18) ratio were detected by tandem mass spectrometry, and subsequently, mutations in CPT1A were found by gene sequence analysis. The patient was advised a low-fat, high-protein diet and followed up regularly. During three-years of follow-up since, the patient showed normal growth velocity and developmental milestones. Whole-exome sequence identified two mutations, c.2201 T > C (p.F734S) and c.1318G > A (p.A440T), in the patient. The c.2201 T > C mutation, which has been reported previously, was inherited from his father, while the c.1318G > A, a novel mutation, was inherited from his mother. The amino acid residues encoded by original sequences are highly conserved across different species. These mutations slightly altered the three-dimensional structure of the protein, as analyzed by molecular modeling, suggesting that they may be pathogenic.
Conclusion
This is the first case of CPT1A deficiency detected through newborn screening based on diagnostic levels of free carnitine, in China. Three years follow-up suggested that early diagnosis and diet management may improve the prognosis in CPT1A patient. In addition, we identified a novel mutation c.1318G > A in CPT1A,and a possible unique to Chinese lineage mutation c.2201 T > C. Our findings have expanded the gene spectrum of this rare condition and provided a basis for family genetic counseling and prenatal diagnosis.
Publisher
Springer Science and Business Media LLC
Reference28 articles.
1. Bennett MJ, Boriack RL, Narayan S, Rutledge SL, Raff ML. Novel mutations in CPT 1A define molecular heterogeneity of hepatic carnitine palmitoyltransferase I deficiency. Mol Genet Metab. 2004;82(1):59–63. https://doi.org/10.1016/j.ymgme.2004.02.004.
2. University of Washington, Seattle. Bennett MJ, Santani AB. Carnitine palmitoyltransferase1A deficiency. In: Pagon RA, Adam MP, Ardinger HH, Wallace SE, Amemiya A, Bean LJH, et al, eds. GeneReviews(R). Seattle: Seattle University of Washington, 2005. https://www.ncbi.nlm.nih.gov/books/NBK1527/
3. Dykema DM. Carnitine palmitoyltransferase-1A deficiency: a look at classic and arctic variants. Adv Neonatal Care. 2012;12(1):23–7. https://doi.org/10.1097/ANC.0b013e318242df6d.
4. Dong C, Hu Y, Shen D, et al. Clinical features and genetic analysis of a case with carnitine palmitoyltransferase 1A deficiency. Chin J Med Genet. 2017;34(2):228–31.(in chinese). https://doi.org/10.3760/cma.j.issn.1003-9406.2017.02.017.
5. Lee BH, Kim YM, Kim JH, Kim GH, Kim JM, Kim JH, et al. Atypical manifestation of carnitine palmitoyltransferase 1A deficiency: hepatosplenomegaly and nephromegaly. J Pediatr Gastroenterol Nutr. 2015;60(3):e19–22. https://doi.org/10.1097/MPG.0b013e3182a95a42.