MSUD, or maple syrup urine disease, is a rare autosomal recessive genetic disorder that prevents the breakdown of the branched-chain amino acids leucine, isoleucine, and valine. It can be life-threatening if not treated early through a very restricted diet that avoids these amino acids and intravenous therapy if amino acid levels rise too high. The disease causes a sweet-smelling urine due to high amino acid levels and, if untreated, can cause rapid brain damage in infants. Diagnosis is through newborn screening and treatment must begin immediately to prevent health issues.

1. MAPLE SYRUP
DISEASE
”Branched-chain
ketoaciduria”
By: PANGAN, DMD2D

2. What is MSUD?
 is an autosomal recessive, metabolic
disorder affecting branched-chain amino
acids.
 It is one type of ”organic acidemia” the
disease is named for the presence of
sweet-smelling urine, with an odor similar to
that of maple syrup.
 is a potentially deadly disorder that
affects the way the body breaks down
three amino acids, leucine, isoleucine, and
valine. (used as supplements for body
(muscle) building.)

3. What is MSUD?
 People with MSUD have a mutation that
results in a deficiency for one of the 6
proteins that make up this complex.
Therefore, they can't break down
leucine, isoleucine, and valine.
 They end up with dangerously high levels of
these amino acids in their blood, causing
the rapid degeneration of brain cells and
death if left untreated.

4.  Defects in any of the six
subunits that make up the
BCKD protein complex
can cause the
development of MSUD.
 The most common defect
is caused by a mutation in
a gene on chromosome
19 that encodes the alpha
subunit of the BCKD
complex (BCKDHA).

5. How do people get MSUD?
 MSUD is inherited in
an autosomal
recessive pattern.
 For a child to get the
disease, he or she
must inherit a
defective copy of the
gene from each
parent.
 If both parents carry
the MSUD
gene, each of their
children has a 25 %
chance of getting
the disorder, and a 50
% chance of being a
carrier.

6. A young boy with MSUD at 5 months

7. What are the symptoms of MSUD?
 A baby who has the disorder may appear
normal at birth. But within three to four
days, the symptoms appear. These may
include:
• loss of appetite
• fussiness
• sweet-smelling urine
The elevated levels of amino acids in the
urine generate the smell, which is
reminiscent of maple syrup.

8. How do doctors diagnose MSUD?
 In some states, all babies are screened for
MSUD within 24 hours after birth.
 A blood sample taken from the baby's
heel is analyzed for high leucine levels.

9. How is MSUD treated?
 Treatment involved dietary restriction of the
amino acids leucine, isoleucine, and valine.
 This treatment must begin very early to
prevent brain damage.
 Babies with the disease must eat a special
formula that does not contain the amino
acids leucine, isoleucine, and valine.
 As the person grows to adulthood, he or she
must always watch their diet, avoiding high
protein foods such as meat, eggs, and nuts.

10. How is MSUD treated?
 Iflevels of the three amino acids still get too
high, patients can be treated with an
intravenous (given through a vein) solution
that helps the body use up excess
leucine, isoleucine, and valine for protein
synthesis.
 Gene therapy is also a potential future
treatment for patients with MSUD.
 This would involve replacing the mutated
gene with a good copy, allowing the
patient's cells to generate a functional BCKD
protein complex and break down the excess
amino acids