M. Wajner et al., Reduction of large neutral amino acid concentrations in plasma and CSF of patients with maple syrup urine disease during crises, J INH MET D, 23(5), 2000, pp. 505-512
Neurological dysfunction is common in patients with maple syrup urine disea
se (MSUD). However, the mechanisms underlying the neuropathology of this di
sorder are poorly understood. We determined the concentrations of all amino
acids in plasma of patients with MSUD during crises (with severe CNS sympt
oms) and after recovery in the hope of detecting possible alterations of th
ese levels during metabolic decompensation. Blood samples obtained from 11
children with MSUD aged 1 month to 7 years and from 10 age-matched controls
(5 months to 6 years) with no evidence of metabolic disease were examined
for their amino acid content by high-performance liquid chromatography. We
observed that leucine, isoleucine and valine concentrations were respective
ly 30, 9 and 3 times higher than normal values, whereas the concentrations
of the large neutral amino acids (LNAA) phenylalanine, tyrosine, tryptophan
and methionine were significantly lower during metabolic decompensation as
compared to the controls. In addition, concentrations of leucine, but not
of valine or isoleucine, were inversely related to the LNAA concentrations
in plasma. The concentrations of these amino acids in plasma returned to no
rmal values when patients were clinically well. CSF amino acid concentratio
ns also showed decreased amounts of LNAA and increased concentrations of br
anched-chain amino acids. It is possible that the decrease in plasma concen
trations of LNAA may lead to a deficit of these essential amino acids in th
e brain as well as of their products such as proteins and neurotransmitters
, a fact that might be related to the neurological dysfunction of MSUD.