Patricia Stallings was wrongly convicted of murdering her son Ryan in 1989 after tests indicated elevated levels of ethylene glycol in his blood. She was imprisoned until 1991 when her newborn son was diagnosed with Methylmalonic Acidemia (MMA), a condition that can mimic antifreeze poisoning. Experts then testified that Ryan had died of MMA as well. Stallings was released and prosecutors dropped the case. She later won a lawsuit related to Ryan's incorrect medical care.

1. Case History
Patricia Stallings is an
American woman who was
wrongfully convicted of murder
after the death of her son Ryan
on September 7, 1989. Because
testing seemed to indicate an
elevated level of Ethylene
Glycol in Ryan's blood,
authorities suspected
antifreeze poisoning and they
arrested Patricia Stallings the
next day. She was convicted of
murder in early 1991 and
sentenced to life in prison.
Patricia Stallings

2. After she went to prison, Stallings
gave birth to another child; he was
diagnosed from Methylmalonic
Acidemia , a medical condition that
can mimic antifreeze poisoning.
Prosecutors initially did not believe
that the sibling's diagnosis had
anything to do with Ryan's case, but
ultimately experts testified that
Ryan had also died of MMA. Stallings
was released from prison in July
1991 and prosecutors decided to
close the case two months later.
Stallings later won a lawsuit against
the hospital and laboratories that
were involved in Ryan's care.
Biochemistry Make Justice
Ryan
David Stallings Jr.
With his parents

3. Methylmalonic Acidemia(MMA)
Methylmalonic Acidemia(MMA) is
an autosomal recessive
metabolic disorder. It is a classical
type of organic acidemia.The result
of this condition is the inability to
properly digest specific fats and
proteins, which in turn leads to a
buildup of a toxic level of
methylmalonic acid in the blood.
Methylmalonic acidemia stems from
several genotypes, all forms of the
disorder usually diagnosed in the
early neonatal period. The disorder
can result in death if undiagnosed
or left untreated. It is estimated that
this disorder has a frequency of 1 in
48,000 births, though the high
mortality rate in diagnosed cases
make exact determination difficult.
Methylmalonic acid
Piero Rinaldo, a metabolic disease expert at Yale University
School of Medicine
Discovered the mystery of MMA

4. Stroke Kidney Failure
Respirator Distress
Progressive Encephalopathy Dehydration and Vomiting

5. GENETIC CAUSE DIETARY CAUSE

6. MMA is caused by a defect in
the vitamin B12­dependent
enzyme methylmalonyl CoA
mutase. The inherited forms of
methylmalonic acidemia cause
defects in the metabolic
pathway where methylmalonyl
coenzyme A (CoA) is converted
into succinyl­ CoA by the
enzyme methylmalonyl­CoA
mutase.
This disorder has an autosomal recessive inheritance
pattern, which means the defective gene is located on an
autosome, and two copies of the gene one from each
parent must be inherited to be affected by the disorder.

7. Vitamin B12 is also needed
for the conversion of
methylmalonyl­CoA to
Succinyl­CoA. Mutations
leading to defects in
vitamin B12 metabolism or
in its transport
frequently result in the
development of
methylmalonic acidemia.

8. In Methylmalonic Acidemia, the body
is unable to break down the amino
acids methionine, threonine, isoleucine
and valine; as a result methylmalonic
acid builds up in the blood and tissues.
Those afflicted with this disorder are
either lacking functional copies or
adequate levels of one or more of the
following enzymes: methylmalonyl CoA
mutase, methylmalonyl CoA epimerase,
or those involved in
adenosylcobalamin synthesis.

10. It is estimated that as many as 60%
of cases are the result of a mutated
MUT gene which encodes the
protein methylmalonyl CoA mutase.
This enzyme is responsible converts
methylmalonyl­CoA into succinyl­
CoA.The action of this enzyme can
also be crippled by mutations in the
MMAA, MMAB, and MMADHC genes,
each of which encodes a protein
required for normal functioning of
methylmalonyl CoA Mutase
Mutations in the MCEE gene, which
encodes the methylmalonyl CoA
epimerase gene, also referred to as
methylmalonyl racemase.
Mutation of MMAA gene

11. Because of the inability to properly break down amino acids
completely, the byproduct of protein digestion, the compound
methylmalonic acid, is found in a disproportionate concentration
in the blood and urine of those afflicted.
 Urine analysis
 Blood panel
 CT Scan
 Percentage of Ammonia and Glycine in blood
 Ketone Bodies in blood serum
Diagnosis report of an affected person

12. Dietary Surgery
Treatment for all forms of this
condition primarily relies on a
low­protein diet, And various
dietary supplements like..
 Levo isomer of carnitine
 Cyanocobalamin supplements
A more extreme treatment
includes kidney or liver
transplant from a donor
without the condition. The
foreign organs will produce a
functional version of
the defective enzymes and
digest the methylmalonic acid

13. ● We are presenting this
project to creat a social
awarness on the disorder
MMA , to avoid
misdiagnosis as mentioned
in Patricia Stalling’s case.
● Awaring the symptoms of
MMA it can be diagnosed
at the earlier phase .

14. ● lehninger principles of
biochemistry
● http://flipper.diff.org/apptagsaccount/items/5453
● https://en.m.wikipedia.org/wiki/Methylmalonic_acidemia
● https://ghr.nlm.nih.gov/condition/methylmalonic­acidemia#genes
● http://www.justicedenied.org/patriciastallings.htm