Background: Carnitine-acylcarnitine translocase (CACT) deficiency is a rare autosomal recessive disease in the mitochondrial transport of long-chain fatty acids. Despite early diagnosis and treatment, the disease still has a high mortality rate. Methods: Clinical symptoms, long-term follow-up, and biochemical and molecular results of four cases are described and compared with the reviewed literature data of 55 cases. Results: Two cases with neonatal onset, carrying in homozygosity the novel variant sequences p.Gly20Asp (c.59G>A) and p.Arg179Gly (c.536A>G), died during an intercurrent infectious process in the first year of life despite adequate dietetic treatment (frequent feeding, high-carbohydrate/low-fat diet, MCT, carnitine). The other two cases, one with infantile onset and the other diagnosed in the newborn period after a previous affected sibling, show excellent development at 4 and 16 years of age under treatment. The review shows that the most frequent presenting symptoms of CACT deficiency are hypoketotic hypoglycemia, hyperammonemia, hepatomegaly, cardiomyopathy and/or arrhythmia, and respiratory distress. The onset of symptoms is predominantly neonatal in 82% and infantile in 18%. The mortality rate is high (65%), most in the first year of life due to myocardiopathy or sudden death. Outcomes seem to correlate better with the absence of cardiac disease and with a higher long-chain fatty acid oxidation rate in cultured fibroblasts than with residual enzyme activity. Conclusion: Diagnosis before the occurrence of clinical symptoms by tandem MS–MS and very early therapeutic intervention together with good dietary compliance could lead to a better prognosis, especially in milder clinical cases.
CITATION STYLE
Vitoria, I., Martín-Hernández, E., Peña-Quintana, L., Bueno, M., Quijada-Fraile, P., Dalmau, J., … Merinero, B. (2015). Carnitine-acylcarnitine translocase deficiency: Experience with four cases in spain and review of the literature. In JIMD Reports (Vol. 20, pp. 11–20). Springer. https://doi.org/10.1007/8904_2014_382
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