Inborn Errors of Metabolism Flashcards

1
Q

What did Garrod propose

A
Garrod proposed that:
Alkaptonuria
Cystinuria
Albinism
Pentosuria
Congenital (present at birth)
Inborn (transmitted through the gametes)
Had the discontinuous distribution of a Mendelian trait
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2
Q

Alkaptonuria - define

A

Black ochrontic pigmentation of cartilage & collagenous tissue

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3
Q

Alkaptonuria - characteristics

A
Autosmal recessive
Urine turns black
on standing (and 
alkalinisation)
Arthritis
Homogentisic acid oxidase deficiency
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4
Q

Cystinuria - define

A

Defective transport of cystine and dibasic aa’s through epithelial cells of renal tubule and intestinal tract

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5
Q

Cystinuria - cause

A

Mutations of SLC3A1 aa transporter gene (Chr 2p) & SLC7A9 (Chr 19)

AR

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6
Q

What 4 things did Beadle and Tatum propose

A

All biochemical processes in all organisms are under genetic control

These biochemical processes are resolvable into a series of stepwise reactions

Each biochemical reaction is under the ultimate control of a different single gene

Mutation of a single gene results in an alteration in the ability of the cell to carry out a single primary chemical reaction

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7
Q

Inborn errors of metabolism are caused by

A

Inborn errors of metabolism are caused by mutations in genes which then produce abnormal proteins whose functional activities are altered

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8
Q

Mechanisms of inheritance - list 5

A
Autosomal recessive
Autosomal dominant
X-linked
Codominant
Mitochondrial
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9
Q

Autosomal recessive - describe action, effect and examples

A

Both parents carry a mutation affecting the same gene
1 in 4 risk each pregnancy
Consanguinity increases risk of autosomal recessive conditions
Examples: Cystic fibrosis, sickle cell disease

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10
Q

Autosomal dominant - in IEMs and examples

A

Rare in IEMs

Examples: Huntingdon disease, Marfan’s, Familial hypercholesterolaemia

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11
Q

Describe passing of recessive X linked conditions - explain

A

Recessive X linked conditions passed through the maternal line

condition appears in males

condition carried in females, but not usually expressed. Female carriers may manifest condition –Lyonisation (random inactivation of one of the X chromosomes)

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12
Q

Describe passing of dominant X linked conditions - explain

A

Dominant X-linked conditions passed on from either affected parent

Affected father will only pass the condition to his daughters

Affected mother can pass the condition to sons and daughters

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13
Q

X-linked dominant: examples

A

X-linked dominant: Fragile X, Ornithine carbamoyl transferase deficiency

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14
Q

X-linked recessive: examples

A

X-linked recessive: Haemophilia A, Duchenne muscular dystrophy, Fabry’s disease

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15
Q

Codominant - describe w/examples

A

Codominant

two different versions (alleles) of a gene are expressed, and each version makes a slightly different protein. Both alleles influence the genetic trait or determine the characteristics of the genetic condition.

Example: ABO Blood group, α1AT

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16
Q

Mitochondrial inheritance - describe and explain

A

Inherited exclusively from mother

only the egg contributes mitochondria to the developing embryo

only females can pass on mitochondrial mutations to their children

Fathers do not pass these disorders to their daughters or sons

17
Q

Heteroplasmy - define

A

Heteroplasmy - Cell contains varying amounts of normal mt DNA and also mutated mt DNA

18
Q

Presentation of IEM - neonate to adult

A

Neonate to adult

Neonatal presentation often acute

Often caused by defects in energy metabolism:
Maple syrup urine disease
Tyrosinaemia
OTC (urea cycle defect)

Adult
Wilson’s
Haemochromatosis

19
Q

Neonates with IEM - weight significance

A

Most are born at term with normal birthweight and no abnormal features

20
Q

Neonates with IEM - symptoms

A

Symptoms present frequently in the first week of life when starting full milk feeds

21
Q

Neonates with IEM - clues

A

Clues for IEMs:
Consanguinity
FH of similar illness in siblings or unexplained deaths
Infant who was well at birth but starts to deteriorate for no obvious reason

22
Q

IEM - presentation (specific vs unspecific)

A

Symptoms - can be very non-specific
Poor feeding, lethargy, vomiting, hypotonia, fits

Or specific
Abnormal smell (sweet, musty, cabbage-like)
Cataracts
Hyperventilation 2° to metabolic acidosis
Hyponatraemia and ambiguous genitalia
Neurological dysfunction with respiratory alkalosis

23
Q

IEM clinical scenarios - Biochemical abnormalities list

A

Biochemical abnormalities:

Hypoglycaemia
Hyperammonaemia
Unexplained metabolic acidosis / ketoacidosis
Lactic acidosis

24
Q

IEM clinical scenarios - clinical list = 8

A

Clinical:

Cognitive decline
Epileptic encephalopathy
Floppy baby
Exercise intolerant
Cardiomyopathy
Dysmorphic features
Sudden unexpected death in infancy (SUDI)
Fetal hydrops
25
Q

Routine laboratory investigations (IEM) - list 3

A

Blood gas analysis
Blood glucose
Plasma ammonia

26
Q

Specialist investigations for IEM - list 6

A

Specialist investigations:

Plasma amino acids
Urinary organic acids + orotic acid
Blood acyl carnitines
Blood lactate and pyruvate
Urinary glycosaminoglycans
Plasma very long chain fatty acids
27
Q

Confirmatory investigations - list 4

A

Enzymology
- Red cell galactose-1-phosphate uridyl
transferase
- Lysosomal enzyme screening

Biopsy (muscle, liver)

Fibroblast studies

Mutation analysis – whole genome sequencing

28
Q

Neonatal Screening - benefits

A

Early identification of life-threatening disease in pre-symptomatic babies
Earlier initiation of medical treatment
Reduction of morbidity and mortality

29
Q

Criteria for screening

(Wilson and Jungner) - neonatal

A

Condition should be an important health problem

Must know incidence/prevelence in screening population

Natural history of the condition should be understood
- there should be a recognisable latent or early symptomatic stage

Availability of a screening test that is easy to perform and interpret
- acceptable, accurate, reliable, sensitive and specific

Availability of an accepted treatment for the condition
- more effective if treated earlier

Diagnosis and treatment of the condition should be cost-effective

30
Q

Criteria for a good screening test, neonatal

A

Accurate and reproducible
Cheap and produces rapid result
Ethical
Good statistical performance
- How well the diagnosis influences the test result (sensitivity and specificity)
- How well the test result predicts the diagnosis (positive and negative predictive values)

31
Q

Newborn blood spot screening - Initial National programme included:

A

PKU

Congenital hypothyroidism

32
Q

Newborn blood spot screening - extended to include

A

Extended to include:

Cystic fibrosis
Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
Haemoglobinopathies

33
Q

Newborn blood spot screening - From 2015, the screening in England expanded to include four additional conditions

A
Maple syrup urine disease (MSUD)
Homocystinuria (pyridoxine unresponsive) (HCU)
Isovaleric acidaemia (IVA)
Glutaric aciduria type 1 (GA1)
34
Q

Taking blood spots for screening (neonates) - requirements

A

Samples should be taken on day 5 (day of birth is day 0)

All four circles on card need to be completely filled with a single drop of blood which soaks through to the back of the Guthrie card

35
Q

Acute liver failure - treatment

A

Treatment:

iv dextrose, bicarbonate, antibiotics and FFP

36
Q

Possible metabolic causes for acute liver disease in neonate

A

Classical galactosaemia
Hereditary fructose intolerance
An organic acidaemia
Tyrosinemia type 1

37
Q

Tyrosinaemia type1 - define + cause

A

Most severe form of tyrosinemia, a buildup of too much of the amino acid tyrosine in the blood and tissues due to an inability to metabolize it.

It is caused by a deficiency of the enzyme fumarylacetoacetate hydrolase.