Mitochondrial trifunctional protein deficiency explained

Mitochondrial trifunctional protein deficiency
Synonyms:TFP deficiency[1]
Symptoms:Cardiomyopathy, skeletal myopathy
Types:Mutations in the HADHA and HADHB gene
Diagnosis:CBC, Urine test
Treatment:Low fat diet, Limited exercise

Mitochondrial trifunctional protein deficiency (MTP deficiency or MTPD) is an autosomal recessive fatty acid oxidation disorder[2] that prevents the body from converting certain fats to energy, particularly during periods without food.[3] [4] People with this disorder have inadequate levels of an enzyme that breaks down a certain group of fats called long-chain fatty acids.[4]

Signs and symptoms

The presentation of mitochondrial trifunctional protein deficiency may begin during infancy, features that occur are: low blood sugar, weak muscle tone, and liver problems. Infants with this disorder are at risk for heart problems, breathing difficulties, and pigmentary retinopathy. Signs and symptoms of mitochondrial trifunctional protein deficiency that may begin after infancy include hypotonia, muscle pain, a breakdown of muscle tissue, and a loss of sensation in the extremities called peripheral neuropathy. Some who have MTP deficiency show a progressive course associated with myopathy, and recurrent rhabdomyolysis.[5] [4] [6]

Genetics

The genetics of mitochondrial trifunctional protein deficiency is based on mutations in the HADHA[7] and HADHB[8] genes which cause this disorder. These genes each provide instructions for making part of an enzyme complex called mitochondrial trifunctional protein. This enzyme complex functions in mitochondria, the energy-producing centers within cells: mitochondrial trifunctional protein contains three enzymes that each perform a different function. This enzyme complex is required to metabolize a group of fats called long-chain fatty acids. These fatty acids are stored in the body's fat tissues and are a major source of energy for the heart and muscles. During periods of fasting, fatty acids are also an important energy source for the liver and other tissues.[9] [10] [11]

Mutations in the HADHA or HADHB genes that cause mitochondrial trifunctional protein deficiency disrupt all functions of this enzyme complex.[12] Without enough of this enzyme complex, long-chain fatty acids cannot be metabolized. As a result, these fatty acids are not converted to energy, which can lead to some features of this disorder. Long-chain fatty acids may also build up and damage the liver, heart, and muscles. This abnormal buildup causes other symptoms of mitochondrial trifunctional protein deficiency.

The mechanism of this condition indicates that the mitochondrial trifunction protein catalyzes 3 steps in mitochondrial beta-oxidation of fatty acids: long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD), long-chain enoyl-CoA hydratase, and long-chain thiolase activities. Trifunctional protein deficiency is characterized by decreased activity of all 3 enzymes. Clinically, trifunctional protein deficiency usually results in sudden unexplained infant death, cardiomyopathy, or skeletal myopathy.[13] [10] [11]

Diagnosis

Diagnosis of mitochondrial trifunctional protein deficiency is often confirmed using tandem mass spectrometry.[2] Genetic counseling is available for this condition. Additionally the following exams are available:

Treatment

Management for mitochondrial trifunctional protein deficiency entails the following:[6]

See also

Further reading

Notes and References

  1. Web site: Mitochondrial trifunctional protein deficiency Genetic and Rare Diseases Information Center (GARD) – an NCATS Program . rarediseases.info.nih.gov . 31 July 2019 . 31 July 2019 . https://web.archive.org/web/20190731153426/https://rarediseases.info.nih.gov/diseases/3684/index . dead .
  2. Solish JO, Singh RH . Management of fatty acid oxidation disorders: a survey of current treatment strategies . J Am Diet Assoc . 102 . 12 . 1800–1803 . 2002 . 12487544 . 10.1016/S0002-8223(02)90386-X. subscription needed
  3. Web site: OMIM Entry - # 609015 - MITOCHONDRIAL TRIFUNCTIONAL PROTEIN DEFICIENCY; MTPD. omim.org. 2016-11-05. 2017-05-10. https://web.archive.org/web/20170510093254/https://omim.org/entry/609015. live.
  4. Web site: mitochondrial trifunctional protein deficiency. Reference. Genetics Home. Genetics Home Reference. 2016-10-28. 2020-04-04. https://web.archive.org/web/20200404101131/https://ghr.nlm.nih.gov/condition/mitochondrial-trifunctional-protein-deficiency. live.
  5. Web site: Mitochondrial trifunctional protein deficiency Genetic and Rare Diseases Information Center(GARD) – an NCATS Program. rarediseases.info.nih.gov. 12 November 2016. 9 January 2019. https://web.archive.org/web/20190109063929/https://rarediseases.info.nih.gov/diseases/3684/mitochondrial-trifunctional-protein-deficiency. live.
  6. Book: Swaiman . Kenneth F. . Swaiman's Pediatric Neurology: Principles and Practice . Ashwal . Stephen . Ferriero . Donna M. . Donna Ferriero . Schor . Nina F. . 2014 . Elsevier Health Sciences . 978-0323089111 . 461, 1638 . en . 12 November 2016.
  7. Web site: HADHA gene. Reference. Genetics Home. Genetics Home Reference. 2016-11-05. 2019-10-17. https://web.archive.org/web/20191017205033/https://ghr.nlm.nih.gov/gene/HADHA#conditions. live.
  8. Web site: HADHB gene. Reference. Genetics Home. Genetics Home Reference. 2016-11-05. 2016-11-05. https://web.archive.org/web/20161105160942/https://ghr.nlm.nih.gov/gene/HADHB. live.
  9. Web site: Long-Chain Acyl CoA Dehydrogenase Deficiency: Background, Pathophysiology, Epidemiology. eMedicine. 12 November 2016. 24 March 2016. 13 March 2020. https://web.archive.org/web/20200313085833/https://emedicine.medscape.com/article/945857-overview#showall. live.
  10. Web site: HADHA hydroxyacyl-CoA dehydrogenase/3-ketoacyl-CoA thiolase/enoyl-CoA hydratase (trifunctional protein), alpha subunit [Homo sapiens (human)] - Gene - NCBI]. www.ncbi.nlm.nih.gov. 12 November 2016. 25 August 2018. https://web.archive.org/web/20180825041331/https://www.ncbi.nlm.nih.gov/gene/3030. live.
  11. Web site: Home - Gene - NCBI. www.ncbi.nlm.nih.gov. 12 November 2016. 13 November 2016. https://web.archive.org/web/20161113060727/https://www.ncbi.nlm.nih.gov/gene?Db=gene&Cmd=ShowDetailView&TermToSearch=3032. live.
  12. Web site: OMIM Entry - * 600890 - HYDROXYACYL-CoA DEHYDROGENASE/3-KETOACYL-CoA THIOLASE/ENOYL-CoA HYDRATASE, ALPHA SUBUNIT; HADHA. omim.org. 5 November 2016. 31 July 2015. https://web.archive.org/web/20150731124948/http://omim.org/entry/600890. live.
  13. Rector. R. Scott. Payne. R. Mark. Ibdah. Jamal A.. Mitochondrial Trifunctional Protein Defects: Clinical Implications and Therapeutic Approaches. Adv Drug Deliv Rev. 1 January 2008. 60. 13–14. 1488–1496. 10.1016/j.addr.2008.04.014. 0169-409X. 18652860. 2848452.
  14. Web site: Orphanet: Mitochondrial trifunctional protein deficiency. RESERVED. INSERM US14 -- ALL RIGHTS. www.orpha.net. 2016-11-12. 2016-11-13. https://web.archive.org/web/20161113114117/http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Expert=746. live.

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