Oxaloacetate pyruvate carboxylase deficiency

Pyruvate carboxylase (also called PC) is an enzyme that converts pyruvate to oxaloacetate (shown as oxaloacetic acid in the citric acid cycle diagram). Pyruvate carboxylase deficiency is a genetic disorder that is characterized by insufficient quantities of pyruvate carboxylate in the body. How do you think this disorder affects the citric acid cycle Use print and electronic resources to research pyruvate carboxylase deficiency. Find out what its symptoms are, and how it affects the body at the molecular level. Also find out what percent of the population is affected, and how the deficiency can be relieved. Present your findings as an informative pamphlet. If possible, conduct an e-mail interview with an expert on the disorder. 

The answer is C. Pyruvate kinase deficiency is ruled out by the elevated serum lactate levels. The coma is associated with a fasting hypoglycemia, which is indicative of pyruvate carboxylase deficiency. The elevated citrulline and lysine in the serum are due to a reduction of aspartic acid levels, which are caused by the reduced levels of oxaloacetate, the product of the pymvate carboxylase reaction. 

Pyruvate carboxylase deficiency is a usually fatal disease caused by a missing or defective enzyme that converts pyruvate to oxaloacetate. It is characterized by varying degrees of mental retardation and disturbances in several metabolic QUESTION 9.6... 

This reaction is important because it provides oxaloacetate for the citric acid cycle when the supplies have run low because of the demands of biosynthesis. It is also the enzyme that catalyzes the first step in gluconeogenesis, the pathway that provides the body with needed glucose in times of starvation or periods of exercise that deplete glycogen stores. But somehow these descriptions don t fill us with a sense of the importance of this enzyme and its jobs. It is not until we investigate a case study of a child born with pyruvate carboxylase deficiency that we see the full impact of this enzyme. 

Pyruvate carboxylase deficiency is one of the genetic diseases grouped together under the clinical manifestations of Leigh s disease (subacute necrotizing encephalopathy). In the mild form, the patient presents early in life with delayed development and a mild-to-moderate lactic acidemia. Patients who survive are severely mentally retarded, and there is a loss of cerebral neurons. In the brain, pyruvate carboxylase is present in the astrocytes, which use TCA cycle intermediates to synthesize glutamine. This pathway is essential for neuronal survival. The major cause of the lactic acidemia is that cells dependent on pyruvate carboxylase for an anaplerotic supply of oxaloacetate cannot oxidize pyruvate in the TCA cycle (because of low oxaloacetate levels), and the liver cannot convert pyruvate to glucose (because the pyruvate carboxylase reaction is required for this pathway to occur), so the excess pyruvate is converted to lactate. 

Rapid p-oxidation of fatty acids in perfused liver (DeBeer et a/., 1974) and in isolated mitochondria (Lopes-Cardozo and Van den Bergh, 1972) has been shown to suppress the operation of citric acid cycle apparently from the elevation of mitochondrial NADH/NAD ratio which restricts oxaloaceta-te availability for citrate synthase and simultaneously inhibits isocitrate oxidation (Lenartowicz et a/., 1976). Considerable support for an earlier postulate that oxaloacetate availability normally determines the rate of citrate synthesis has become available. Thus, because of marked protein binding, the concentration of free, as opposed to total, oxaloacetate in matrix of liver mitochondria is now estimated to be near the of citrate synthase (Siess et al., 1976 Brocks eta ., 1980). The antiketogenic effect of alanine (Nosadini et a/., 1980) and of 3-mercaptopicolinate, an inhibitor of phosphoenolpy-ruvate carboxykinase (Blackshear et a/., 1975), is believed to be exerted, at least in part, from their ability to raise hepatic oxaloacetate concentration. And, in pyruvate carboxylase deficiency, expected to impair oxaloacetate supply, concentration of ketone bodies is elevated (Saudubray et a/., 1976). 

Table 16-2 shows the most common anaplerotic reactions, all of which, in various tissues and organisms, convert either pyruvate or phosphoenolpyruvate to ox-aloacetate or malate. The most important anaplerotic reaction in mammalian liver and kidney is the reversible carboxylation of pyruvate by C02 to form oxaloacetate, catalyzed by pyruvate carboxylase. When the citric acid cycle is deficient in oxaloacetate or any other intermediates, pyruvate is carboxylated to produce more oxaloacetate. The enzymatic addition of a carboxyl group to pyruvate requires energy, which is supplied by ATP—the free energy required to attach a carboxyl group to pyruvate is about equal to the free energy available from ATP. 

Genetic deficiency of pyruvate carboxylase does not cause the expected hypoglycemia. Rather, it seems that depletion of tissue pools of oxaloacetate results in impaired activity of citrate synthase, and a slowing of citric acid cycle activity, leading to accumulation of lactate, pyruvate, and alanine, and also increased accumulation of acetyl CoA, resulting in ketosis. Affected infants have serious neurological problems and rarely survive. A less severe variant of the disease is associated with low residual activity of pyruvate carboxylase. 

D. The increased concentrations of pyruvate, lactate, and alanine indicate that there is a block in the pathway leading from pyruvate toward the TCA cycle. A deficiency in pyruvate dehydrogenase would lead to a buildup of pyruvate. Pyruvate has three fates other than conversion to acetyl-CoA by pyruvate dehydrogenase conversion to oxaloacetate by pyruvate carboxylase, reduction to lactate by lactate dehydrogenase, and transamination to the amino acid alanine. Thus, because pyruvate builds up, an increase in lactate and alanine would be expected if pyruvate dehydrogenase was deficient. 

B. A deficiency in pyruvate carboxylase results in a diminution of oxaloacetate, the acid that acts as the acceptor for an acetyl group from acetyl-CoA. In order for the TCA cycle to continue efficiently, C4 acids must be replenished. Amino acids whose carbon skeletons feed into the TCA cycle and increase the C4 pool will accomplish this. Glutamine, which is converted to a-ketoglutarate, will lead to an increase in all of the C acids (succinate, fumarate, malate, and oxaloacetate). Alanine and serine are converted to pyruvate, which as a result of the deficiency in pyruvate carboxylase will not increase the C4 pool. Lysine and leucine are ketogenic amino acids and thus also do not increase the C pool. 

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