Glutaric aciduria type I (GA-I) is an autosomal recessive inborn error of lysine, hydroxylysine, and tryptophan metabolism caused by deficiency of the enzyme glutaryl-CoA dehydrogenase . Frequent laboratory findings include hypoglycemia, ketonuria, and metabolic acidosis. Urinary 3-hydroxyglutaric acid is the diagnostic metabolite with glutaric acid and glutarylcarnitine frequently but not always elevated . The buildup of metabolites may lead to basal ganglia injury.
The clinical manifestations of GA-1 can vary considerably between individual patients, but most have macrocephaly at birth or shortly thereafter. Affected individuals may experience motor difficulty, abnormal gait, spasms, jerking, rigidity, hypotonia, and seizures. Some individuals with glutaric acidemia have developed subdural or retinal hemorrhage. MRI or CT of the brain may show an underdeveloped neocortex with fronto-operculo-temporal hypoplasia and communicating hydrocephalus, creating a distinct radiologic appearance that characterizes GA-I. The presentation of distinctive acute striatal necrosis is a major cause of morbidity and mortality. Acute neurological deterioration usually occurs between 6 and 18 months of age and can be triggered by a febrile illness or dehydration.
GA-1 is caused by mutations in the glutaryl-CoA dehydrogenase gene (GCDH) located on 19p13 . Gene sequence analysis is available to test for mutations in the GCDH gene (FX). For patients with mutations not identified by full gene sequencing, a separate deletion/duplication assay is available using a targeted CGH array (NL).
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- Goodman et al. Glutaryl-CoA dehydrogenase mutations in glutaric acidemia (type I): Review and report of thirty novel mutations. Hum Mutat 1998, 12:141-144.
- Korman et al. Glutaric aciduria type 1: Clinical, biochemical and molecular findings in patients from Israel. Eur J Ped Neurol 2007, 11:81-89.
- Schwarz et al. The human glutaryl-CoA dehydrogenase gene: report of intronic sequences and of 13 novel mutations causing glutaric aciduria type 1. Hum Genet 1998;102:452-8.
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- Confirmation of a clinical/biochemical diagnosis of GA-I
- Carrier testing in adults with a family history of GA-I
Clinical Sensitivity: 24/24 mutations identified in 12 patients , 38/40 mutations identified in 20 patients .
Analytical Sensitivity: ~99%
Results of molecular analysis must be interpreted in the context of the patient's clinical and/or biochemical phenotype.
Prevalence: The incidence of GA-I is estimated to be 1:83,300 . It is inherited in an autosomal recessive manner, therefore the recurrence risk for carrier parents of an affected child is 25%.
Isolation using the Perkin Elmer™Chemagen™ Chemagen™ Automated Extraction method or Qiagen™ Puregene kit for DNA extraction is recommended.
Orangene™ Saliva Collection Kit used according to manufacturer instructions. Please contact EGL for a Saliva Collection Kit for patients that cannot provide a blood sample.
Infants and Young Children (<2 years of age): 2-3 ml
Children > 2 years of age to 10 years old: 3-5 ml
Older Children & Adults: 5-10 ml
Autopsy: 2-3 ml unclotted cord or cardiac blood
- Urine Organic Acid Analysis (OA) showing elevation of glutaric and 3-hydroxyglutaric acids
- Plasma/Urine Acylcarnitine Profile showing increased concentration of glutarylcarnitine.
- Custom diagnostic mutation analysis (KM) is available to family members if mutations are identified by sequencing.
- For comprehensive testing, a Deletion/Duplication Assay is available separately. This test is indicated for individuals where mutations are not identified by sequence analysis. Refer to the test requisition or contact the laboratory for more information.
- Prenatal testing is available to couples who are confirmed carriers of mutations. Please contact the laboratory genetic counselor to discuss appropriate testing prior to collecting a prenatal specimen.