Prefatory material introducing a collection of articles spanning fifty years of research into inborn errors of metabolism. Table of Contents: 1. Introduction -- 2. Background information about inborn errors of metabolism -- 3. Lessons from phenylketonuria [PKU] -- 4. My role in developing new medical foods -- 5. My role in solving an epidemic of benzyl alcohol poisoning in premature infants -- 6. My role in galactosaemia research -- 7. My start in the metabolic world - screening tests in urine -- 8. My experiences in disaster relief -- 9. My first appearance in the medical literature -- 10. A selection of rare and unusual diseases -- 11. Tyrosinaemia type II; tyrosine aminotransferase deficiency -- 12. Iminodipeptiduria due to prolidase deficiency -- 13. Citrullinaemia -- 14. Rippling muscle disease -- 15. A fatal X-linked disorder of diarrhoea, diabetes mellitus and immune dysregulation -- 16. Infantile Refsum disease -- 17. Hereditary hypocalcuric hypercalcaemia -- 18. Carbohydrate deficient glycoprotein disease type IAPKU -- 19. Thiamine-responsive diabetes and deafness -- 20. Folinic acid-responsive seizures: a false alarm -- 21. S-adenosylmethionine hydrolase deficiency -- 22. Deficiency of complex III of the respiratory chain -- 23. Current research: quantitation of infant sucking behaviour -- 24. Discussion and summary.

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Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2641. Advisers: Jan Bressler; Raol Caetano. Includes bibliographical references.

In Chapter 1 a review of the literature concerning aspects of erythrocyte membrane transport and metabolism, and purine and pyrimidine metabolism is presented. The effects of pH, pO₂ and inorganic phosphate (Pi) on the uptake and metabolism of hypoxanthine by erythrocytes has been studied in Chapter 2. Uptake of hypoxanthine and accumulation of inosine 5'-monophosphate (IMP) were markedly increased at acid pH, high external phosphate concentrations, and low pO₂. Release of accumulated IMP as hypoxanthine occurred at alkaline pH values and low external phosphate concentrations. Conditions favouring IMP accumulation gave rise, in the absence of hypoxanthine, to a corresponding increase in 5'-phosphoribosyl-1-pyrophosphate (PRPP). Intracellular phosphate concentrations were markedly pH dependent and a model is presented whereby hypoxanthine uptake and release are controlled by intracellular concentrations of inorganic phosphate and 2,3- bisphosphoglycerate (2,3-DPG). These allosteric effectors influence, in opposing ways, two enzymes governing IMP accumulation, namely PRPP synthetase and 5'-nucleotidase. These metabolic properties suggest that the erythrocyte could play a role in the removal of hypoxanthine from anoxic tissue. In Chapter 3 the kinetics and mechanism of transport of orotate across the human erythrocyte membrane and the effect of pH and inorganic phosphate on its metabolism (in the erythrocyte) have been studied. It has been shown that orotate enters erythrocytes with non-saturable kinetics and with a capacity of 190 μmoles/1 packed cells/min at a concentration of 4-6 mmolar. The presence of competition for transport by a number of anions and the lack of competition by uridine is indicative of transport by a general anion transporter, with the ability for concentrative uptake in the absence of other external anions being compatible with transport via a ping-pong mechanism. Inhibition of transport by the specific band 3 inhibitors DIDS and CHCA confirm that transport is via the band 3 anion transporter. This explains the lack of significant uptake of orotate by most differentiated tissues which lack the intact band 3 protein. However, the demonstration of band 3 in rat hepatocytes (Cheng and Levy, 1980) provides a mechanism for the orotate transport which has been observed in liver (Handschumacher and Coleridge, 1979). Changes in pH and inorganic phosphate (Pi) concentrations have been shown to have marked effects on the relative quantities of metabolic products produced by the erythrocyte from orotate. There was an increase in orotate metabolised with increasing Pi, an effect augmented by lowering the pH, and most easily explained by the allosteric activation of PRPP synthetase by Pi. The increase in UTP levels with decreasing pH may be the consequence of both increased PRPP availability for the formation of uridine nucleotide from orotate, and decreased conversion of UMP to uridine by pyrimidine 5'-nucleotidase, which is known to be inhibited by phosphate. The accumulation of UDP sugars is optimal at a phosphate concentration of 10 mmolar, which is unexplained but would be compatible with an inhibitory effect of Pi on CTP synthetase. A PRPP wasting cycle at alkaline pH values is proposed to explain the apparent paradox where no PRPP was observed to accumulate in erythrocytes (Chapter 2) at pH values of 7.6 and above in the presence of 10 mmolar phosphate and no added hypoxanthine, yet the metabolism of orotate, which is a PRPP utilising reaction, at alkaline pH values was readily demonstrable here. This (apparent paradox) can be resolved if one assumes that even in the absence of added hypoxanthine and demonstrable intracellular IMP there are sufficient quantities of hypoxanthine and/or IMP to maintain a PRPP wasting cycle at alkaline pH values. The cycle is interrupted at acidic pH values as phosphate levels rise and inhibit 5'-nucleotidase, an effect augmented by the decreasing levels of 2,3-DPG which accompany decreasing pH. This wasting cycle has recently been confirmed by P. Berman (unpublished). The kinetics of orotate uptake by erythrocytes and its eventual release as uridine provides a role for the erythrocyte in the transport and distribution of pyrimidines to peripheral tissues. A model is proposed and involves the de novo production of orotate in the liver. In the next step erythrocytes take up the orotate secreted by the liver into the circulation, convert it into an intermediate buffer store of uridine nucleotides, whose distribution is a function of pH and phosphate concentration, and eventually release it as uridine, which is a readily available form of pyrimidine for utilisation by peripheral nucleated cells. The enhancement of uptake of labelled orotate into nucleic acids of cultured cells is demonstrated here. The degradative half of the cycle proposes that uracil and palanine are the predominant degradative forms of pyrimidines produced by peripheral cells, and their ultimate metabolic fate is complete catabolism in the liver to CO₂ and water. In the final chapter the possible role of the human erythrocyte in the prevention of reperfusion injury has been investigated. The development of a model of renal ischaemia in the rat is described. The ability of human erythrocytes, "primed" by preincubating in acid medium of high Pi concentration and low pO₂, to take up hypoxanthine in a concentrative manner when perfused through ischaemic rat kidney is demonstrated. Attempts to demonstrate improved survival and renal function in rats with "primed" human erythrocytes prior to reperfusion were, however, unsuccessful. It is further demonstrated that "unprimed" human erythrocytes, resident in ischaemic rat kidney for 3 hours, take up hypoxanthine and convert it to IMP. that erythrocytes could play a physiological prevention of reperfusion injury.

Lai Ching Ha. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 225-243). / Title --- p.1 / Abstract --- p.2 / Acknowledgments --- p.4 / Contents --- p.5 / Abbreviations --- p.10 / List of Figures --- p.12 / List of Tables --- p.15 / Chapter Chapter 1 --- Review on Inherited Metabolic Diseases --- p.18 / Chapter 1.1 --- Development of the concept of inherited metabolic diseases (IMD) --- p.18 / Chapter 1.2 --- Frequency of inherited metabolic diseases --- p.20 / Chapter 1.3 --- Molecular basis of mutations in inherited metabolic diseases --- p.22 / Chapter 1.3.1 --- Point mutations --- p.22 / Chapter 1.3.2 --- Small deletions and insertions --- p.25 / Chapter 1.3.3 --- large deletions or duplications --- p.26 / Chapter 1.4 --- Pathological consequences of protein defect resultingin IMD --- p.27 / Chapter 1.4.1 --- End product --- p.28 / Chapter 1.4.2 --- Precursor accumulation --- p.28 / Chapter 1.4.3 --- Unusual metabolites --- p.29 / Chapter 1.5 --- Heterogeneity of inherited metabolic diseases --- p.29 / Chapter 1.5.1 --- Genetic heterogeneity --- p.29 / Chapter 1.5.2 --- Variations of expression in different cells --- p.31 / Chapter 1.6 --- Diagnosis of inherited metabolic diseases --- p.32 / Chapter 1.6.1. --- Biochemical investigations --- p.32 / Chapter 1.6.2 --- Identification of accumulated or missing metabolites --- p.33 / Chapter 1.6.3 --- Direct analysis of enzymes and proteins --- p.34 / Chapter 1.6.4 --- Molecular investigations --- p.34 / Chapter 1.7 --- Treatment of inherited metabolic diseases --- p.40 / Chapter 1.7.1 --- Treatment at the clinical phenotype level --- p.41 / Chapter 1.7.2 --- Treatment at the metabolite level --- p.41 / Chapter 1.7.3 --- Treatment at the dysfunctional protein level --- p.43 / Chapter 1.7.4 --- Transplantation --- p.44 / Chapter 1.7.5 --- Gene therapy --- p.45 / Chapter 1.8 --- Inherited metabolic diseases in Hong Kong --- p.47 / Chapter 1.9 --- General Aim --- p.48 / Chapter Chapter 2 --- Study of Inherited Metabolic Diseases in Mentally Retarded Patients --- p.49 / Chapter 2.1 --- Introduction --- p.49 / Chapter 2.2 --- Aim --- p.52 / Chapter 2.3 --- Materials --- p.53 / Chapter 2.3.1 --- Standards --- p.53 / Chapter 2.3.2 --- Chemical reagents --- p.53 / Chapter 2.3.3 --- Derivatization reagents --- p.54 / Chapter 2.3.4 --- Major equipment --- p.54 / Chapter 2.4 --- Clinical materials --- p.56 / Chapter 2.4.1 --- Subjects --- p.55 / Chapter 2.4.2 --- Blood and urine samples --- p.56 / Chapter 2.5 --- Methods --- p.57 / Chapter 2.5.1 --- General biochemistry tests --- p.57 / Chapter 2.5.2 --- Metabolic screening tests --- p.57 / Chapter 2.5.3 --- Two-dimensional thin layer chromatography --- p.53 / Chapter 2.5.4 --- Identification of urinary organic acids by gas chromatography mass spectroscopy --- p.59 / Chapter 2.5.5 --- Amino acid analysis by high performance liquid chromatography --- p.66 / Chapter 2.6 --- Results --- p.71 / Chapter (A) --- Methodological Aspects / Chapter 2.6.1 --- Identification of urinary organic acids by gas chromatography-mass spectroscopy (GC-MS) --- p.71 / Chapter 2.6.2 --- Amino acid analysis by high performance liquid chromatography (HPLC) --- p.86 / Chapter (B) --- Patient Investigations / Chapter 2.6.3 --- General biochemistry tests --- p.107 / Chapter 2.6.4 --- Serum amino acid profiles --- p.113 / Chapter 2.6.5 --- Urinary organic acid analysis --- p.115 / Chapter 2.6.6 --- Case reports --- p.119 / Chapter 2.7 --- Discussion --- p.123 / Chapter 2.7.1 --- Identification of urinary organic acids by gas chromatography-mass spectroscopy (GC-MS) --- p.123 / Chapter 2.7.2. --- Amino acid analysis by high performance liquid chromatography (HPLC) --- p.130 / Chapter 2.7.3 --- Identification of inherited metabolic diseases (IMD)in an institutionalized mentally retarded patients --- p.136 / Chapter Chapter 3 --- Molecular Investigation of Maple Syrup Urine Disease --- p.140 / Chapter 3.1 --- Introduction --- p.140 / Chapter 3.1.1 --- Branched chain amino acids (BCAA) --- p.140 / Chapter 3.1.2 --- Metabolism of branched chain amino acids --- p.142 / Chapter 3.1.3 --- Maple syrup urine disease (MSUD) --- p.144 / Chapter 3.1.4 --- Classification of maple syrup urine disease --- p.146 / Chapter 3.1.5 --- Screening and diagnosis of maple syrup urine disease --- p.148 / Chapter 3.1.6 --- Treatment of maple syrup urine disease --- p.150 / Chapter 3.1.7. --- Branched chain a-ketoacid dehydrogenase complex (BCKDH) --- p.151 / Chapter 3.1.8 --- "Gene features of human E1α,E1β and E2 subunitsin branched chain α-ketoacid dehydrogenase complex" --- p.153 / Chapter 3.1.9 --- Molecular defects of the BCKDH gene complex --- p.156 / Chapter 3.1.10 --- MSUD in Hong Kong --- p.161 / Chapter 3.2 --- Aim --- p.163 / Chapter 3.3 --- Materials --- p.164 / Chapter 3.3.1 --- Source of skin fibroblasts --- p.164 / Chapter 3.3.2 --- Enzymes --- p.164 / Chapter 3.3.3 --- DNA markers --- p.164 / Chapter 3.3.4 --- Reagent Kits --- p.165 / Chapter 3.3.5 --- Primers --- p.165 / Chapter 3.3.6 --- Chemical reagents --- p.165 / Chapter 3.3.7 --- Nitrocellulose membrane --- p.166 / Chapter 3.3.8 --- Antiserum for Western blotting --- p.166 / Chapter 3.3.9 --- Radioisotopes --- p.166 / Chapter 3.4 --- Methods --- p.168 / Chapter 3.4.1 --- Preparation of buffers and solutions --- p.168 / Chapter 3.4.2 --- Agarose gel electrophoresis --- p.170 / Chapter 3.4.3 --- Preparation of native polyacrylamide gel --- p.171 / Chapter 3.4.4 --- Preparation of sodium dodecyl sulfate (SDS) polyacrylamide gel --- p.172 / Chapter 3.4.5 --- Preparation of denaturing polyacrylamide gel --- p.173 / Chapter 3.4.6 --- Branched chain α-ketoacid dehydrogenase complex enzyme assay --- p.173 / Chapter 3.4.7. --- Identification of the affected subunits in BCKDH complex of MSUD patient and her family members --- p.176 / Chapter 3.4.8 --- Screening of mutation in the BCKDH subunits by RT-PCR-SSCP --- p.178 / Chapter 3.4.9 --- Mutation analysis of whole cDNA fragments of Elα， Elβ and E2 subunits by ds DNA cycle sequencing --- p.184 / Chapter 3.5 --- Results --- p.188 / Chapter 3.5.1 --- Branched chain α-ketoacid dehydrogenase complex enzyme assay --- p.188 / Chapter 3.5.2 --- Identification of the affected subunits in BCKDH complex ofMSUD patient and her family members --- p.188 / Chapter 3.5.3 --- Screening of mutation in the BCKDH subunits by RT-PCR-SSCP --- p.192 / Chapter 3.5.4 --- "Mutation analysis of whole cDNA fragments of Ela, Elβ and E2 subunits by ds DNA cycle sequencing" --- p.204 / Chapter 3.6 --- Discussion --- p.210 / Chapter 3.6.1 --- BCKDH activity in the MSUD patient and her family members --- p.210 / Chapter 3.6.2 --- Investigation of the mutation sites --- p.212 / General Conclusion --- p.222 / Appendix --- p.224 / References --- p.225

Genetics is concerned with inheritance, genomics with the study of genomes. Bioinformatics provides the tools to study the interface between the two. If a particular locus in the human genome could have 100 discrete alleles, then the genome (comprising an estimated 80,000 genes), could harbor 8 million different alleles. To record information about each of these alleles in a meaningful and systematic fashion is a task for the Mutation Database domain of bioinformatics. The HUGO Mutation Database Initiative is an international effort to capture, record and distribute information about variation in genomes. This initiative comprises a growing number of Locus-Specific Mutation databases, and a few large Federated Genomic databases [Cotton et al., 1998]. / Here I present work on a well recognized prototypical Locus-Specific database: PAHdb. PAHdb is a relatively large curated relational database. / This graduate project has had two major aims: to improve PAHdb , by careful analysis of version 1.0 and revision of its design, resulting in PAHdb version 2.0; to document the redesign process and share the experience by the conception of guidelines for content and structure of mutation databases in general. (Abstract shortened by UMI.)

Several of the inborn errors of vitamin B$ sb{12}$ (cobalamin, Cbl) metabolism (cblC, cblD, cblE, cblF, cblG) are associated with homocystinuria and hypomethioninemia due to a functional deficiency of the cytoplasmic enzyme methionine synthase which requires methylcobalamin (MeCbl) as a cofactor. We compared the growth of cultured fibroblasts from controls with those from patients with a selective deficiency of MeCbl (cblE and cblG) and with those from patients with a defect in both MeCbl and adenosylcobalamin (AdoCbl) (cblC, cblD and cblF). Cells were grown in methionine and folic acid free media and in fully supplemented medium. Control cells were able to grow in the deficient medium supplied with homocysteine, cobalamin and folate, while mutant cells were not, due to their inability to synthesize methionine from its immediate metabolic precursor, homocysteine. This differential growth is useful for screening for genetic defects of methionine biosynthesis. Moreover, by correcting methionine auxotrophy in these cells, it may be possible to isolate genes which code for the products that are deficient in these disorders.

Methionine synthase (MS) is a vitamin B12(cobalamin;cbl) dependent enzyme that catalyses the methylation of homocysteine to methionine. It uses methyl-cbl as coenzyme and in ethyl tetrahydrofolate as the methyl donor. Methionine sythase reductase (MSR) maintains MS in it active state using S-adenosyl methionine as the methyl donor. Functional MS deficiency may occur as a result of a defect in either enzyme. Patients with this disorder have been classified into two complemetation groups according to which protein is defective: cblG patients are deficient in MS and cblE patients in MSR. A subset of cblG, known as cblG variant, is unique in showing barely detectable MS activity and failure of cbl incorporation into MS in patient fibroblasts. I report the mutations responsible for three cblG variant patients, two of them siblings, and connect their phenotype to lack of protein expression. I also report the cloning of the MSR cDNA, aided by confirming the identity of the cDNA through the discovery of two deleterious mutations in three cblE patients. These findings contribute to the overall understanding of functional MS deficiency.