3-hydroxy-3-methylglutaraciduria (case report of a female Turkish sisters with 3-hydroxy-3- methylglutaryl-Coenzyme A lyase deficiency

3-Hydroxy-3-methylglutaric aciduria is a rare inborn error of metabolism, caused by reduced enzyme activity of the intramitochondrial 3-hydroxy-3-methylglutaryl-CoA lyase. We describe two turkish sisters with this disease. In the older sister clinical symptoms with lethargy, convulsions, metabolic acidosis, hypoglycemia and hyperammonemia lead to the diagnosis. The younger sister was diagnosed prenatally. The clinical course of our patients is compared with those reported in the literature with respect to clinical symptoms, differential diagnosis and therapeutic regimens.     

A case of biotin-responsive 3-methylcrotonylglycin- and 3-hydroxyisovaleric aciduria

During selective screening for organic acidurias, a 10-week-old girl with muscular hypotonia and recurrent fits was shown to be excreting 3-methylcrotonylglycin and 3-hydroxyisovaleric acid. Besides these metabolites of leucine the presence of small but pathological amounts of propionic and methylcitric acids were demonstrable in her urine, pointing to a defect in the metabolism of biotin.On treatment with biotin (2×5 mg/day) the convulsions stopped at once, her clinical condition improved gradually, and the abnormal metabolites disappeared from the urine. Within 6 weeks the child was discharged in a good general condition without apparent signs of neurological damage.     

关于脓毒症3.0的争议

感染诱发的脓毒症是ICU最常见的疾病之一.为了统一认识,利于早期诊断和治疗,降低重症感染的病死率,1991年首次提出了脓毒症的概念.近20余年,伴随脓毒症病理生理研究的深入,其定义和诊断标准也不断更新和完善.2016年,欧洲危重病学会指定专家组重新修订了脓毒症的定义和诊断标准,即脓毒症3.0,主要强调感染导致宿主内环境稳态失衡、潜在致命性风险的器官功能障碍.每次更新都融入许多新的理论或观点,同时也充满了争议.本文主要介绍脓毒症的定义和诊断标准,以及脓毒症3.0存在的争议.     

3-HYDROXY-3-METHYLGLUTARYL COENZYME A LYASE DEFICIENCY

ABSTRACT. Shilkin, R., Wilson, G. and Owles, E. (Princess Margaret Hospital for Children, Perth, Western Australia). 3-Hydroxy-3-methylglutaryl Coenzyme A lyase deficiency: follow-up of first described case. Acta Paediatr Scand, 70:265, 1981. –We report the progress of a child with a defect in leucine metabolism due to a deficiency of 3-hydroxy-3-methylglutaryl Coenzyme A lyase activity. This child was reported briefly in 1976 when the abnormality was first suspected at which time he was 7 months old. He is now aged 4 years 7 months and appears to be well and developing satisfactorily. His diet has been difficult to control and the biochemical defect is extremely sensitive to small amounts of leucine in the diet.     

3-Methylglutaconic and 3-methylglutaric aciduria in a patient with suspected 3-methylglutaconyl-CoA hydratase deficiency

A girl suffering from marked muscular hypotonia, severe statomotor and mental retardation, bilateral optic atrophy with chorioretinal degeneration, convulsions and a moderate compensated metabolic acidosis is described. Screening for metabolic disorders revealed massive 3-methylglutaconic with 3-methylglutaric aciduria leading to the tentative diagnosis of 3-methylglutaconyl-CoA hydratase deficiency. Metabolite excretion was correlated with variation of leucine intake. 3-methyl-3-hydroxyglutaryl-CoA lyase activity in cultured fibroblasts was normal. The suspected metabolic defect was not demonstrable in cultured skin fibroblasts, however.Abbreviation MSUD Maple syrup urine disease     

Familial partial trisomy of the long arm of chromosome 3 (3q).

A case of partial trisomy of the long arm of chromosome 3 (3q21 leads to qter) is described. The clinical findings are compared with those in 5 previously reported cases. There is hirsutism and characteristic facial dysmorphism, the common features of which are a square-shaped face, prominent nasal bridge, everted nostrils, hypertelorism, and palate abnormalities; occurring less often are abnormalities of vertebrae, thorax, and digits, or cardiovascular, urinogenital, and central nervous system. New features noted in this present case are absence of right eye from orbit and spina bifida. The spectrum of this syndrome is discussed, with possible relation to the degree of trisomy. The present case is the 6th to be reported with partial trisomy of the long arm of chromosome 3.     

胰岛素样因子3研究进展

胰岛素样因子3属于胰岛素超家族松弛素亚族,是睾丸间质细胞分泌的主要产物,其合成完全依赖睾丸间质细胞的分化状态.胰岛素样因子3除了在睾丸下降方面起重要作用,对于评估睾丸间质细胞功能也很敏感,有很大的临床价值.胰岛素样因子3在生殖细胞存活、骨代谢调控中发挥重要作用.     

鞘氨醇激酶基因在3T3-L1脂肪细胞诱导分化中的表达水平

目的 探讨鞘氨醇激酶基因(SPHK）在3T3-L1脂肪细胞诱导分化中表达水平的变化。方法采用细胞培养和RT-PCR技术检测细胞分化不同阶段脂肪细胞中SPHK基因表达水平。结果1．SPHK基因在3T3-L1脂肪前体细胞诱导分化初期表达呈明显上调趋势；2．随着脂肪前体细胞分化成熟，该基因表达水平明显低于诱导分化初期的基因表达水平。结论 SPHK基因可能参与脂肪细胞分化的调控过程，与肥胖发生有一定联系。     

PRNP基因在3T3-L1脂肪前体细胞分化过程中的表达及肿瘤坏死因子-α对其调节作用

目的 探讨3T3-L1脂肪前体细胞诱导分化过程中PRNP基因表达水平的变化及TNF-α对其调节作用.方法 体外培养3T3-L1前体脂肪细胞,胰岛素加地塞米松加1-甲基-3-异丁基黄嘌呤(MDI)方案诱导3T3-L1细胞分化成熟,并收集分化前、分化0～10 d各时段细胞,采用RT-PCR技术检测诱导分化不同时段3T3-L1细胞PRNP基因表达水平;同时在成功诱导3T3-L1细胞分化成熟的基础上,应用不同水平TNF-α(0.1、1.0、10.0 μg/L)干预分化后的成熟脂肪细胞(第10天),收集TNF-α刺激前(0 h)及刺激后0.5、2.0、6.0、12.0、24.0 h的脂肪细胞,通过RT-PCR测定TNF-α干预前后不同时间点脂肪细胞中PRNP基因表达水平.采用Excel软件进行统计学分析.结果 1.PRNP基因低表达于3T3-L1脂肪前体细胞中,随细胞分化成熟该基因表达水平逐渐上调,至分化第10天其表达水平最高.PRNP基因表达水平除在诱导分化前(第-1天)至第4天、第2～5天、第6～10天时段内无显著性差异外(Pa＞0.05),其余各时段间表达水平均有显著性差异(Pa＜0.05);2.在分化前的3T3-L1脂肪细胞和成熟脂肪细胞中,不同水平TNF-α(0.1、1.0、10.0 μg/L)均能在短时间内明显抑制PRNP基因mRNA的表达,且呈时间依赖性.结论 PRNP基因可能参与3T3-L1脂肪细胞分化及脂质积聚过程;不同水平重组TNF-α对成熟脂肪细胞的PRNP基因表达具有抑制作用,其抑制效应总体趋势上呈时间依赖性.     

3-hydroxy-3-methylglutaryl-coenzyme A lyase deficiency: review of 18 reported patients

3-Hydroxy-3-methylglutaryl-coenzyme A lyase deficiency (HMG-CoA lyase) is an inborn error of leucine catabolism which often leads to life-threatening illness in the neonatal period. The cardinal clinical features include severe infantile hypoglycemia, metabolic acidosis, hepatomegaly, lethargy or coma and apnea. Hyperammonemia is variable. There is a characteristic absence of ketosis. Considerable heterogeneity has been observed in clinical and biochemical presentation. Acute episodes of illness have been mistaken for Reye syndrome. The pattern of organic acids in the urine includes large amounts of 3-hydroxy-3-methylglutaric, 3-methylglutaconic, 3-methylglutaric and 3-hydroxyisovaleric acids. Smaller, but appreciable levels of glutaric, adipic and other dicarboxylic acids may also be excreted in the urine. Lactic acid may be present in sizable amounts at times of acute illness. The primary defect is a deficiency of 3-hydroxy-3-methylglutaryl-coenzyme A lyase, a key enzyme in the cycle of ketogenesis.Abbreviation HMG-CoA lyase 3-hydroxy-3-methylglutaryl-coenzyme A lyase     

Partial trisomy of chromosome 3 (3q12 leads to qter) owing to 3q/18p translocation. A trisomy 3q syndrome.

In four previously reported patients with partial 3q trisomy, only a small portion of 3q was trisomic (3q21 leads to qter or 3q25 leads to qter). Clinical features in these cases have included the following: low-set ears, mongoloid slant of eyes, hypertelorism, cleft palate, webbed neck, simian creases, short finger, clinodactyly, hypotonia, and low-set hairline. Cytogenetic studies of a premature, 1,680-g female infant with with these clinical features showed this extra material to be part of the long arm of chromosome 3 (3q12 leads qter), which resulted in partial trisomy for this segment, ie, 46,XX,-18, +t (3;18) (q12;p11). Although a larger portion of 3q was involved in this case, the clinical picture was similar to other cases of 3q duplication with or without 3p deletion.