Peroxisome biogenesis defect/disorder

In disorders which affect cholesterol synthesis (e.g, mevalonic aciduria, 7-dehydrocholesterol reductase deficiency [Smith-Lemli-Opitz syndrome]) there may be markedly reduced bile acid synthesis - these disorders are beyond the scope of his chapter. As indicated in section 3, the synthesis of bile acids involves conversion of C27 bile acids (cholestanoic acids) to their C24 analogues (cholanic acids) and this occurs by a process of )5-oxidation in the peroxisomes. Thus defective bile acid synthesis occurs in disorders of peroxisomal yff-oxidation and in disorders of peroxisome biogenesis. These disorders affect pathways other than the bile acid synthesis pathway and are discussed in Chap. 23. 

Disorders of peroxisome biogenesis 689 Defects of single peroxisomal enzymes 691... 

Zellweger syndrome Is a llpid storage disorder caused by impaired peroxisome biogenesis due to deficiency or functional defect of one of eleven proteins involved in the complex mechanism of peroxisomal matrix protein import and assembly of the organelle. 

Peroxisomal disorders (Zellweger syndrome, Refsum s disease, neonatal adre-noleukodystrophy) are characterised by defective peroxisome biogenesis, or, being present, peroxisomes lacking / -oxidative enzymes. In the BA biosynthetic pathway, dihydroxycoprostanic acid (DHCA) and trihydroxycoprostanic acid (THCA) are /1-oxidised in peroxisomes to produce CA and CDCA, respectively, whereas peroxisomal disorders cause a defective oxidation of the BA precursor side chain, which leads to an accumulation of C27 bile acids, notably 3 ,7 -dihydroxy-5/3-cholesta-noic acid (DHCA) and 3a,7a,12a-trihydroxy-5/l-cholestanoic acid (THCA), in the plasma and urine of affected patients. 

The growing list of disorders of peroxisomal function, divided into peroxisome biogenesis disorders (PBD) and defects of isolated peroxisomal enzymes, requires selective markers for their biochemical detection. One of the functions of the peroxisomes is the -oxidation of substances that cannot be handled by the mitochondria such as very long-chain (C24-C26)... 

Fig. 32.1. The classical ( neutral ) pathway for the synthesis of bile acids from cholesterol, where the modification of the steroid nucleus occurs prior to side-chain modification. Also illustrated are the inborn errors of bile acid synthesis and the resulting abnormal metabolites. 32.1, 3) -hydroxy-A -C27-steroid dehydrogenase (3) -HSDH) deficiency 32.2, A -3-oxosteroid 5 -reductase deficiency 32.3, sterol 27-hydroxylase deficiency (cerebrotendinous xanthomatosis, CTX) PD, peroxisomal disorders (defects of peroxisome biogenesis and peroxisomal j -oxidation). The abnormal metabolites that are readily detected by analysis of urine by LSI-MS are shown in boxes. Cholic acid can also be synthesised from 5 -cholestane-3a,7a,12a,25-tetrol this is the so-called microsomal or 25-hydroxylase pathway of cholic acid synthesis, which provides an alternative route for side-chain modification other than peroxisomal j -oxidation...

A few disorders have been identified causing secondary disturbances in LT elimination and degradation, e.g. defective hepatobiliary elimination of cysteinyl leukotrienes as seen in the Dubin-Johnson syndrome [3], impaired co-oxidation of LTB4 in the Sjogren-Larsson syndrome [4] or altered jff-oxidation in disorders of peroxisome biogenesis such as the Zellweger syndrome [5]. The metabolic changes seen in these disorders are characterised by altered urinary excretion patterns of leukotrienes. However, in these conditions LT synthesis itself is not affected. 

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