Maple Branched amino acids

The branched fatty acids the oxidation of which will be considered now are carbon compounds derived from amino acid metabolism. Isovalerate, methylbu-tyrate, and isobutyrate are related to the metabolism of leucine, isoleucine, and valine, respectively. The interest in the metabolism of branched fatty acids stems partly from the fact that the branched amino acids from which they are derived are precisely those that accumulate in maple syrup disease. 

Patients with maple syrup urine disease are mentally retarded, have seizures, and show abnormal electroen-cephalographic patterns. The disease is probably hereditary, but the exact mechanism of transmission is not established. Although the pathogenesis of maple syrup urine disease is still unknown, the metabolism of the branched amino acids provides the key to understanding the proposed mechanism [97]. 

Multiple deletion cannot be excluded as a possible cause of maple syrup urine disease because a deficiency in a specific decarboxylase does not adequately explain the accumulation of indole derivatives and methionine. Of course, the branched amino acids or the corresponding keto acids could inhibit other metabolic pathways. 

In the case of hyperphenylalaninaemia, which occurs ia phenylketonuria because of a congenital absence of phenylalanine hydroxylase, the observed phenylalanine inhibition of proteia synthesis may result from competition between T.-phenylalanine and L-methionine for methionyl-/RNA. Patients sufferiag from maple symp urine disease, an inborn lack of branched chain oxo acid decarboxylase, are mentally retarded unless the condition is treated early enough. It is possible that the high level of branched-chain amino acids inhibits uptake of L-tryptophan and L-tyrosiae iato the brain. Brain iajury of mice within ten days after thek bkth was reported as a result of hypodermic kijections of monosodium glutamate (MSG) (0.5—4 g/kg). However, the FDA concluded that MSG is a safe kigredient, because mice are bom with underdeveloped brains regardless of MSG kijections (106). 

The catabolism of leucine, valine, and isoleucine presents many analogies to fatty acid catabolism. Metabolic disorders of branched-chain amino acid catabolism include hypervalinemia, maple syrup urine disease, intermittent branched-chain ketonuria, isovaleric acidemia, and methylmalonic aciduria. 

DISORDERS OF BRANCHED-CHAIN AMINO ACIDS MAPLE SYRUP URINE DISEASE 671... 

Maple syrup urine disease involves a congenital failure to oxidize the three branched-chain amino acids 671... 

Effective treatment of maple syrup urine disease involves the restriction of dietary branched-chain amino acids 672... 

Effective treatment of maple syrup urine disease involves the restriction of dietary branched-chain amino acids. Long-term treatment entails the dietary restriction of the BCAAs. This is accomplished by administration of a special formula from which these amino acids are removed. The outlook for intellectual development is favorable in youngsters in whom diagnosis is made early and who do not suffer recurrent, severe episodes of metabolic decompensation [17]. 

Answer C. Maple syrup urine disease substrates are branched chain a-ketoacids derived from the branched chain amino acids. 

T There is a relatively rare genetic disease in which the three branched-chain a-lceto acids (as well as their precursor amino acids, especially leucine) accumulate in the blood and spill over into the urine. This condition, called maple syrup urine disease because of the characteristic odor imparted to the urine by the a-lceto acids, results from a defective branched-chain a-lceto acid dehydrogenase complex. Untreated, the disease results in abnormal development of the brain, mental retardation, and death in early infancy. Treatment entails rigid control of the diet, limiting the intake of valine, isoleucine, and leucine to the minimum required to permit normal growth. ... 

Maple syrup urine disease (MSUD) is a recessive disorder in which there is a partial or complete deficiency in branched-chain o-ketoacid dehydrogenase, an enzyme that decarboxylates leucine, isoleucine, and valine (see Figure 20.10). These amino acids and their corre sponding a-keto acids accumulate in the blood, causing a toxic effect that interferes with brain functions. The disease is characterized by feeding problems, vomiting, dehydration, severe metabolic acidosis, and a characteristic maple syrup odor to the urine. If untreated, the disease leads to mental retardation, physical disabilities, and death. 

In a rare autosomal recessive condition (discovered in 1954) the urine and perspiration has a maple syrup odor/ High concentrations of the branched-chain 2-oxoacids formed by transamination of valine, leucine, and isoleucine are present, and the odor arises from decomposition products of these acids. The branched-chain amino acids as well as the related alcohols also accumulate in the blood and are found in the urine. The biochemical defect lies in the enzyme catalyzing oxidative decarboxylation of the oxoacids, as is indicated in Fig. 24-18. Insertions, deletions, and substitutions may be present in any of the subunits (Figs. 15-14,15-15). The disease which may affect one person in 200,000, is usually fatal in early childhood if untreated. Children suffer seizures, mental retardation, and coma. They may survive on a low-protein (gelatin) diet supplemented with essential amino acids, but treatment is difficult and a sudden relapse is apt to prove fatal. Some patients respond to administration of thiamin at 20 times the normal daily requirement. The branched-chain oxoacid dehydrogenase from some of these children shows a reduced affinity for the essential coenzyme thiamin diphosphate.d... 

For example, alkaponuria is characterized by homogentisic acid in urine phenylketonuria, which results in mental retardation, is characterized by quantities of phenylpyruvic acid in the urine. It is diagnosed in a suspected patient by determining the amount of this acid in the urine and the increased levels of phenylalanine in the plasma. Maple sugar disease is diagnosed the presence of large amounts of the branched chain amino acids, such as valine, leucine, and isoleucine in the blood and urine. 

Maple Syrup Urine Disease Figure 18-28 shows the pathway for the degradation of branched-chain amino acids and the site of the biochemical defect that causes maple syrup urine disease. The initial findings that eventually led to the discovery of the defect in this disease were presented in three papers published in the late 1950s and early 1960s. This problem traces the history of the findings from initial clinical observations to proposal of a biochemical mechanism. 

Figure 20.20 Pathways of branched-chain amino acid metabolism. A, B, C, D, E, and F indicate defects in valinemia, maple syrup urine disease, isovaleric acidemia, /3-hydroxyisovaleric aciduria, a-methyl-j3-hydroxybutyric aciduria, and methylmalonic aciduria, respectively.

Various mutations affecting either the El or the E2 subunit of the dehydrogenase are involved in different forms of maple symp urine disease. Acute infantile disease is caused by near complete lack of activity of the enzyme. The intermittent form of the disease is associated with marginally adequate residual activity of the enzyme that is able to cope with the branched-chain oxo-acids arising from the metabolism of modest amounts of branched-chain amino acids, but not relatively large amounts. 

Branched-Chain Oxo-acid Decarboxylase and Maple Syrup Urine Disease The third oxo-add dehydrogenase catalyzes the oxidative decarboxylation of the branched-chain oxo-acids that arise from the transamination of the branched-chain amino acids, leucine, isoleuctne, emd vtdine. It has a similEU subunit composition to pyruvate and 2-oxoglutarate dehydrogenases, and the E3 subunit (dihydrolipoyl dehydrogenase) is the stune protein as in the other two multienzyme complexes. Genetic lack of this enzyme causes maple syrup urine disease, so-called because the bremched-chain oxo-acids that are excreted in the urine have a smell reminiscent of maple syrup. 

C-11) (1-9) Maple Syrup Urine Disease. There is a block in the degradation of the branched chain amino acids. Leucine, isoleucine, valine, and their ketoic acids are elevated in the blood and urine. Assays for these chemicals can be done in the laboratory. The urine acquires a maple syrup aroma. Infants with the condition have a variety of neurologic problems, including mental retardation. The condition is treated by dietary restriction of the affected amino acids. 

Although alcaptonuria is a relatively harmless condition, such is not the case with other errors in amino acid metabolism. In maple syrup urine disease, the oxidative decarboxylation of a-ketoacids derived from valine, isoleucine, and leucine is blocked because the branched-chain dehydrogenase is missing or defective. Hence, the levels of these a-ketoacids and the branched-chain amino acids that give rise to them are markedly elevated in both blood and urine. Indeed, the urine of patients has the odor of maple syrup—hence the name of the disease (also called branched-chain ketoaciduria). Maple syrup urine disease usually leads to mental and physical retardation unless the patient is placed on a diet low in valine. 

In maple syrup urine disease, the enzyme complex that decarboxy-lates the transamination products of the branched-chain amino acids is defective (see Figure 7-11). Valine, isoleucine, and leucine accumulate. Urine has the odor of maple syrup. Mental retardation occurs. 

C. In maple syrup urine disease, the branched-chain amino acids (valine, leucine, and isoleucine) can be transaminated but not oxidatively decarboxylated because the a-keto acid dehydrogenase is defective. 

These branched-chain aliphatic amino acids contain bulky nonpolar R-groups and participate in hydrophobic interactions. All three are essential amino acids. A defect in their catabolism leads to maple syrup urine disease (Chapter 17). Isoleucine has asymmetrical centers at both the a- and 8-carbons and four stereoisomers, only one of which occurs in protein. The bulky side chains tend to associate in the interior of water-soluble globular proteins. Thus, the hydrophobic amino acid residues stabilize the three-dimensional structure of the polymer. 

A similar success was observed for studies of branched-chain ketoaciduria in which the second stage of the catabolism of leucine, valine and isoleucine involves an oxidative decarboxylation. In patients with branched-chain ketoaciduria, this step is blocked for all three of these amino acids. The urine of these patients takes on the odour of maple syrup and hence this condition... 

E. The correct response is very low levels of phoiylalanine hydroxylase, a key oizyme in the metabolic sequelae of phenylketonuria, that is, elevated phenylalanine, phoiylpyruvale, and para-hydroxyphenylpyruvate in blood. Homogentisic acid is an intermediate in the breakdown of tyrosine to fumarate and acetoacetate. Vitamin is required in the metabolism of branched-chain amino acids not phenylalanine. The a-keto acids of the branched chain amino acids produce the maple-syrup odor. 

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