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  • 1
    ISSN: 1432-1076
    Keywords: Methylmalonic acidaemia ; Propionic acidaemia ; Metronidazole ; Gut bacteria ; Propionate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gut bacteria have been implicated as an important source of propionate in children with inborn errors of propionate metabolism. We have investigated the value of oral metronidazole (10–20 mg/kg per day) in five children with methylmalonic acidaemia (MMA) and four with propionic acidaemia (PA). Urinary excretion of propionate metabolites fell significantly during the treatment in all subjects, the mean decrease being 41% (range 12–76,P〈0.01), while mean plasma propionate was reduced from 45.0 μmol/l to 25.1 μmol/l (P〈0.05). Substantial reduction of the gut bacterial population was confirmed by lactulose breath hydrogen tests and by stool culture, and stool propionate concentration was reduced in most subjects. Clinical improvement was noted in three children. These results suggest that long-term antimicrobial therapy may offer significant clinical benefit to children with inborn errors of propionate metabolism.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1076
    Keywords: Propionate ; Stable isotope ; Oxidation ; Methylmalonic acidaemia ; Propionic acidaemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Biochemical markers such as plasma and urinary metabolite concentrations and in vitro enzyme activity are of limited prognostic value in the most common disorders of propionate metabolism, methylmalonic acidaemia (MMA) and propionic acidaemia (PA). In vivo propionate oxidation was compared with conventional prognostic measures as predictors of clinical severity in seven children with MMA and six with PA. Propionate oxidation was measured using a continuous infusion of [1-13C]propionate and was expressed as the rate of appearance of13CO2 as a percentage of the propionate infusion rate. Children with MMA (mean oxidation 51.2%, range 17.5–91.6,P〈0.05) and with PA (mean oxidation 36.3%, range 3.0–91.1,P=NS) oxidised substantially less propionate than controls (mean oxidation 81.9%, range 69.4–101.0,n=5). Percentage oxidation was a better predictor of the clinical severity score (r=0.75,P〈0.01) than was in vitro enzyme activity, plasma propionate or methylmalonate concentration or urinary metabolite excretion. Studies were repeated after an interval of 1–3 weeks in six of the subjects; the percentage oxidation in each subject was virtually unchanged between studies (coefficient of variation 8.6%). These results suggest that in vivo oxidation measurements using [13C]propionate are both reproducible and prognostically useful in disorders of propionate metabolism.
    Type of Medium: Electronic Resource
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