Diagnostic work-up and management of patients with isolated methylmalonic acidurias in European metabolic centres

T. Zwickler, M. Lindner, H. I. Aydin, M. R. Baumgartner, O. A. Bodamer, A. B. Burlina, A. M. Das, J. B C deKlerk, G. Gökcay, S. Grünewald, N. Guffon, E. M. Maier, E. Morava, S. Geb, B. Schwahn, J. H. Walter, U. Wendel, F. A. Wijburg, E. Müller, S. KölkerFriederike Hörster

Research output: Contribution to journalArticle

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Abstract

The long-term outcome of patients with methylmalonic aciduria (MMA) is still uncertain due to a high frequency of complications such as chronic renal failure and metabolic stroke. The understanding of this disease is hampered by a huge variation in the management of these patients. The major aim of this study was to evaluate the current practice in different European metabolic centres. A standardized questionnaire was sent to 20 metabolic centres asking for standard procedures for confirmation of diagnosis, testing cobalamin responsiveness, dietary treatment, pharmacotherapy, and biochemical and clinical monitoring. Sixteen of 20 metabolic centres (80%) returned questionnaires on 183 patients: 89 of the patients were classified as mut0, 36 as mut-, 13 as cblA, 7 as cblB, and 38 as cblA/B. (1) Confirmation of diagnosis: All centres investigate enzyme activity by propionate fixation in fibroblasts; six centres also perform mutation analysis. (2) Cobalamin response: Ten centres follow standardized protocols showing large variations. A reliable exclusion of nonspecific effects has not yet been achieved by these protocols. (3) Long-term treatment: In cobalamin-responsive patients, most centres use hydroxocobalamin (1-14 mg/week i.m. or 5-20 mg/week orally), while two centres use cyanocobalamin. All cobalamin-nonresponsive patients and most cobalamin-responsive patients are supplemented with l-carnitine (50-100 mg/kg per day). Fourteen centres use intestinal decontamination by antibiotic therapy. Most centres follow D-A-CH (n = 6) or Dewey (n = 4) recommendations for protein requirements. Fourteen centres regularly use precursor-free amino acid supplements. Standardized monitoring protocols are available in seven centres, again showing high variability.

Original languageEnglish
Pages (from-to)361-367
Number of pages7
JournalJournal of Inherited Metabolic Disease
Volume31
Issue number3
DOIs
StatePublished - Jun 1 2008

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Vitamin B 12
Hydroxocobalamin
Decontamination
Carnitine
Propionates
Methylmalonic acidemia
Chronic Kidney Failure
Therapeutics
Fibroblasts
Stroke
Anti-Bacterial Agents
Amino Acids
Drug Therapy
Mutation
Enzymes
Proteins

ASJC Scopus subject areas

  • Genetics(clinical)
  • Genetics
  • Endocrinology

Cite this

Zwickler, T., Lindner, M., Aydin, H. I., Baumgartner, M. R., Bodamer, O. A., Burlina, A. B., ... Hörster, F. (2008). Diagnostic work-up and management of patients with isolated methylmalonic acidurias in European metabolic centres. Journal of Inherited Metabolic Disease, 31(3), 361-367. https://doi.org/10.1007/s10545-008-0804-2

Diagnostic work-up and management of patients with isolated methylmalonic acidurias in European metabolic centres. / Zwickler, T.; Lindner, M.; Aydin, H. I.; Baumgartner, M. R.; Bodamer, O. A.; Burlina, A. B.; Das, A. M.; deKlerk, J. B C; Gökcay, G.; Grünewald, S.; Guffon, N.; Maier, E. M.; Morava, E.; Geb, S.; Schwahn, B.; Walter, J. H.; Wendel, U.; Wijburg, F. A.; Müller, E.; Kölker, S.; Hörster, Friederike.

In: Journal of Inherited Metabolic Disease, Vol. 31, No. 3, 01.06.2008, p. 361-367.

Research output: Contribution to journalArticle

Zwickler, T, Lindner, M, Aydin, HI, Baumgartner, MR, Bodamer, OA, Burlina, AB, Das, AM, deKlerk, JBC, Gökcay, G, Grünewald, S, Guffon, N, Maier, EM, Morava, E, Geb, S, Schwahn, B, Walter, JH, Wendel, U, Wijburg, FA, Müller, E, Kölker, S & Hörster, F 2008, 'Diagnostic work-up and management of patients with isolated methylmalonic acidurias in European metabolic centres', Journal of Inherited Metabolic Disease, vol. 31, no. 3, pp. 361-367. https://doi.org/10.1007/s10545-008-0804-2
Zwickler, T. ; Lindner, M. ; Aydin, H. I. ; Baumgartner, M. R. ; Bodamer, O. A. ; Burlina, A. B. ; Das, A. M. ; deKlerk, J. B C ; Gökcay, G. ; Grünewald, S. ; Guffon, N. ; Maier, E. M. ; Morava, E. ; Geb, S. ; Schwahn, B. ; Walter, J. H. ; Wendel, U. ; Wijburg, F. A. ; Müller, E. ; Kölker, S. ; Hörster, Friederike. / Diagnostic work-up and management of patients with isolated methylmalonic acidurias in European metabolic centres. In: Journal of Inherited Metabolic Disease. 2008 ; Vol. 31, No. 3. pp. 361-367.
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