Ornithine transcarbamoylase deficiency

Tuchman M et al The biochemical and molecular spectrum of ornithine transcarbamoylase deficiency. J Inherit Metab Dis 1998 21 40. 

The two conditions can be distinguished by an increase in orotic add and uracil, which occurs in ornithine transcarbamoylase deficiency, but not in the defldency of carbamoyl phosphate synthetase. Orotic acid and uracil are intermediates in pyrimidine synthrais (see Chapter 18). This pathway is stimulated by the accumulation of carbamoyl phosphate, the substrate for ornithine transcarbamoylase in the urea cycle and for aspartate transcarbamoylase in pyrimidine synthesis. 

B-9) Ornithine transcarbamoylase deficiency, another cause of hyperammonemia the most common of the urea cycle metabolic disorders. It is X-Iinked. 

Figure 23.20. Treatment of Carbamoyl Phosphate Synthetase and Ornithine Transcarbamoylase Deficiencies.

Deficiency of folate or vitamin Bn can cause hematological changes similar to hereditary orotic aciduria. Folate is directly involved in thymidylic acid synthesis and indirectly involved in vitamin Bn synthesis. Orotic aciduria without the characteristic hematological abnormalities occurs in disorders of the urea cycle that lead to accumulation of carbamoyl phosphate in mitochondria (e.g., ornithine transcarbamoylase deficiency see Chapter 17). The carbamoyl phosphate exits from the mitochondria and augments cytosolic pyrimidine biosynthesis. Treatment with allopurinol or 6-azauridine also produces orotic aciduria as a result of inhibition of orotidine-5 phosphate decarboxylase by their metabolic products. 

Figure 23.21 Treatment of carbamoyl phosphate synthetase and ornithine transcarbamoylase deficiencies,...

In an attempt to treat ornithine transcarbamoylase deficiency (a disorder of nitrogen metabolism) using adenoviral vectors, a volunteer died of a severe immune response to the vector. This unfortunate result has led to a reevaluation of the safety of viral vectors for gene therapy. 

The second delivery method, called in mvo, means that the virus is used to directly infect the patient s tissues. The most common vector for this delivery is the adenoviras (which is a DNA virus). A particular vector can be chosen based on specific receptors on the target tissue. Adenovirus has receptors in lung and liver cells, and it has been used in clinical trials for gene therapy of cystic fibrosis and ornithine transcarbamoylase deficiency. 

Mustafa, A. and J.T. Clarke, 2006. Ornithine transcarbamoylase deficiency presenting with acute liver failure. J Inherit Metab Dis, 29(4) p. 586... 

Hyperammonemia Type 2. A deficiency of ornithine transcarbamoylase (reaction 2, Figure 29-9) produces this X chromosome-linked deficiency. The mothers also exhibit hyperammonemia and an aversion to high-protein foods. Levels of glutamine are elevated in blood, cerebrospinal fluid, and urine, probably due to enhanced glutamine synthesis in response to elevated levels of tissue ammonia. 

Answer E. Given these symptoms, the defect is in the urea cycle and the elevated orotate suggests deficiency of ornithine transcarbamoylase. 

In view of the toxicity of ammonia, complete absence of any one of the enzymes of the cycle is fatal. Nonetheless, disorders of the cycle do occur, which are caused by a low activity of one of the enzymes or carbamoyl phosphate synthetase. In addition, defects in N-acetylglutamate synthase have been reported, but they are very rare. With the exception of ornithine transcarbamoylase, the deficiencies have an autosomal recessive mode of inheritance. The transcarbamoylase deficiency is inherited as an X-linked dominant trait, usually lethal in male patients. A deficiency of carbamoyl phosphate synthetase, ornithine transcarbamoylase or argininosuccinate synthetase results in accumulation and excretion of citrulline. A deficiency of argininosuccinate lyase results in the accumulation and excretion of argininosuccinate and arginine (Table 10.5). The abbreviations CPSD, OTCD, ASD, ALD and AD stand, respectively, for the deficiencies of these enzymes, where D stands for deficiency. 

Supplementing the diet with arginine is useful in treating deficiencies of ornithine transcarbamoylase, argini-nosuccinate synthetase, and argininosuccinase. Many... 

Ornithine transcarbamoylase OTC deficiency OTC Xp21.1 Liver Citrulline i Orotic acid TT... 

A number of inherited diseases are associated with the urea cycle. The mutations result in changes in either Vm or Km as defective proteins are produced. These include disruptions of N- acety 1 gl utam ate synthase, carbamoyl phosphate synthetase, ornithine transcarbamoylase (the most prevalent of the urea cycle deficiencies), argininosuccinate synthetase, argininosuccinate lyase, and arginase. In these diseases, when applicable, treatments are low-protein diets, to put less strain on urea cycle flux and, when appropriate, addition of amino acids as required, such as ornithine and/or arginine. 

When ornithine transcarbamoylase (OTC) is deficient, the carbamoyl phosphate that normally would enter the urea cycle accumulates and floods the pathway for pyrimidine biosynthesis. Under these conditions, excess orotic acid (orotate), an intermediate in pyrimidine biosynthesis, is excreted in the urine. It produces no ill effects but is indicative of a problem in the urea cycle. 

When ornithine transcarbamoylase is deficient (urea cycle disorder), excess carbamoyl phosphate from the mitochondria leaks into the cytoplasm. The elevated levels of cytoplasmic carbamoyl phosphate lead to pyrimidine production, as the regulated step of the pathway, the reaction catalyzed by carbamoyl synthetase II, is being bypassed. Thus, orotic aciduria results. 

Hyperammonemia is a finding in biotin deficiency. Maeda and colleges have reported that ornithine transcarbamoylase (an enzyme in the urea cycle) is significantly reduced in biotin-deficient rats. 

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