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Disorders of carnitine cycle in ChineseDisorders of carnitine cycle in Chinese
(Nelson Tang)(Nelson Tang)
MD, FRCPAMD, FRCPA
香港中文大学 邓亮生邓亮生
••
••
香港中文大学 邓亮生邓亮生
&& --
(CH3)3-N-CH2-CH-CH2-COOH
OH
Low affinity transport
乙酰-辅酶A
乙酰卡尼丁
卡尼丁
乙酰卡尼丁
LCAD
MCAD
SCAD
乙酰-辅酶A
Acyl-CoA
EH
HAD
KAT
Acetyl-CoA
FADETFETF-DH
CoQ
Electron
transport chain
CPT 1
CPT 2
CACT
(Carnitine transporter defect)
(CPT1 def.)
(Carnitine translocase deficiency)
(CPT2 def.)
香港中文大学 邓亮生邓亮生
••
•• ATPATP
(1)(1)
•• (2)(2)
––
香港中文大学 邓亮生邓亮生
β-
• ( )
• ( )
• : ( URTI)
•
•
香港中文大学 邓亮生邓亮生
Primary Carnitine deficiencyPrimary Carnitine deficiency
(Carnitine transporter defect)(Carnitine transporter defect)
••卡尼丁吸收障卡尼丁吸收障碍碍
香港中文大学 邓亮生邓亮生
PrimaryPrimary CarnitineCarnitine DeficiencyDeficiency
••
••
••
–– Acute presentation in infancyAcute presentation in infancy
••
–– CardiomyopathyCardiomyopathy
香港中文大学 邓亮生邓亮生
••
•• ::
••
香港中文大学 邓亮生邓亮生
( L( L-- ))
•• : 9 umol (22: 9 umol (22--50 umol )50 umol )
•• : 12 umol: 12 umol
::
––
香港中文大学 邓亮生邓亮生
OCTN2OCTN2 (1)(1)
•• ,, 5050 (1999(1999 ))
Autosomal recessive inheritance, less thanAutosomal recessive inheritance, less than
50 cases (up to 1999)50 cases (up to 1999)
•• 19751975 ,,
–– Researches are searching for theResearches are searching for the
causative gene since 1975causative gene since 1975
••
–– Patient inherits one defective carnitinePatient inherits one defective carnitine
transporter gene from each of the parenttransporter gene from each of the parent
香港中文大学 邓亮生邓亮生
香港中文大学 邓亮生邓亮生
--
0 10 2 0 3 0 4 0 50 6 0 7 0 8 0 90 1 0 0
0
1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
1 0 0
F ilte red lo ad
C O N T R O L
M O T H E R
F A T H E R
肾脏排泄游离肉碱肾脏排泄游离肉碱(umol/LGFR)(umol/LGFR)
(umol/L)
Renal
excretion
threshold
正常对照
香港中文大学 邓亮生邓亮生
OCTN2OCTN2 (2)(2)
•• ,,
OCTN2OCTN2
–– Among the first in identifying the carnitine transporterAmong the first in identifying the carnitine transporter
gene, OCTN2gene, OCTN2
Named Outstanding Research in
Annual Report of CUHK
香港中文大学 邓亮生邓亮生
OCTN2OCTN2
•• (( ).).
•• ..
••
香港中文大学 邓亮生邓亮生
香港中文大学 邓亮生邓亮生
••
香港中文大学 邓亮生邓亮生
••
•• 1010
•• 50,00050,000
•• : 1: 1 //60,00060,000
•• (Tang, 2002)(Tang, 2002)
香港中文大学 邓亮生邓亮生
•• (R254X:(R254X: 50%50%
))
•• 11 //40,00040,000 11 //
60,00060,000
Beijing
香港中文大学 邓亮生邓亮生
••
•• (R254X:(R254X: 50%50%
))
••
香港中文大学 邓亮生邓亮生
•• 11//40,00040,000
11//60,00060,000
••
•• 1010
•• 50%50% R254XR254X
香港中文大学 邓亮生邓亮生
•• ? Recurrent mutation events, happened? Recurrent mutation events, happened
independentlyindependently
•• Same founder mutation but traveledSame founder mutation but traveled
across Continentsacross Continents
香港中文大学 邓亮生邓亮生
••
••
香港中文大学 邓亮生邓亮生
香港中文大学 邓亮生邓亮生
••
•• 50%50%
••
•• 50%50%
••
香港中文大学 邓亮生邓亮生
•• //
•• (( ))
••
••
•• (( ))
香港中文大学 邓亮生邓亮生
••
•• i. e genuine deficiencyi. e genuine deficiency
••
––
香港中文大学 邓亮生邓亮生
香港中文大学 邓亮生邓亮生
::
•• 携带携带S467CS467C突变的母亲。突变的母亲。
•• 此突变在日本人中第一次被报道此突变在日本人中第一次被报道(1999)(1999)
香港中文大学 邓亮生邓亮生
S467CS467C
•• Koizumi et al 1999Koizumi et al 1999
香港中文大学 邓亮生邓亮生
::
44
香港中文大学 邓亮生邓亮生
Dx
1. ↓↓ ↓↓
2. CPT1 ↑↑ ↓↓
3. CACT ↓↓ ↑↑ ↑ (i.e. C16,
C18, C18:1 and C18:2)
4. CPT2 ↓↓ ↑↑ ↑ (i.e. C16,
C18, C18:1 and C18:2)
香港中文大学 邓亮生邓亮生
:: ββ--
1.1. Primary Carnitine deficiencyPrimary Carnitine deficiency
2.2. Carnitine translocase deficiencyCarnitine translocase deficiency
3.3. Glutaric aciduria type 2 (ETF chain)Glutaric aciduria type 2 (ETF chain)
defectsdefects 22
4.4. VLCADVLCAD ΑΑ
5.5. SCADSCAD ΑΑ
香港中文大学 邓亮生邓亮生
(CH3)3-N-CH2-CH-CH2-COOH
OH
Long-Chain - FA
Plasma membrane
inner mitochondria
membrance
High affinity transport Low affinity transport
Acyl-CoA
Acyl-Carnitine
Carnitine
Acyl-Carnitine
LCAD
MCAD
SCAD
Acyl-CoA
Acyl-CoA
EH
HAD
KAT
Acetyl-CoA
FADETFETF-DH
CoQ
Electron
transport chain
CPT 1
CPT 2
Outer mitochondrial
membrance
Translocase
香港中文大学 邓亮生邓亮生
??
•• 19991999
••
..
香港中文大学 邓亮生邓亮生
香港中文大学 邓亮生邓亮生
香港中文大学 邓亮生邓亮生
Prof. D. Applegarth (Canada)
Prof. F. Choy (Canada)
Prof. V. Ganapathy (USA)
Prof. G Grabowski (USA)
Prof. KJ Hsiao (Taiwan)
Dr. W.L. Hwu (Taiwan)
Prof. R. Wanders (The Netherlands)

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Carnitine chinese 1中國人 肉鹼(卡尼丁)循環相關的代谢遺傳病