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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1977 Apr;40(4):313–322. doi: 10.1136/jnnp.40.4.313

Carnitine deficiency: clinical, morphological, and biochemical observations in a fatal case.

A G Engel, B Q Banker, R M Eiben
PMCID: PMC492697  PMID: 874508

Abstract

A fatal case of carnitine deficiency is described. The patient had intermittent metabolic acidosis, fluctuating hepatomegaly, and progressive muscle weakness since 22 months of age. One of two liver biopsies revealed lipid accumulation in the hepatocytes, and a muscle biopsy at age 5 years showed a lipid storage myopathy. Type 1 fibres were the most severely affected. Satellite and vascular endothelial cells also contained abnormal lipid deposits. Quantitative electron microscopy demonstrated an approximately 50-fold increase in lipid material, and a twofold increase in mitochondria in myofibres. The muscle carnitine level was less than one-seventh of the lowest value encountered in 74 biopsies from non-weak or neuromuscular disease controls. The basic abnormality in this patient is assumed to be a defect in carnitine biosynthesis.

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Selected References

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  1. Angelini C., Lücke S., Cantarutti F. Carnitine deficiency of skeletal muscle: report of a treated case. Neurology. 1976 Jul;26(7):633–637. doi: 10.1212/wnl.26.7.633. [DOI] [PubMed] [Google Scholar]
  2. Boudin G., Mikol J., Guillard A., Engel A. G. Fatal systemic carnitine deficiency with lipid storage in skeletal muscle, heart, liver and kidney. J Neurol Sci. 1976 Dec;30(2-3):313–325. doi: 10.1016/0022-510x(76)90137-4. [DOI] [PubMed] [Google Scholar]
  3. Buse M. G., Biggers J. F., Friderici K. H., Buse J. F. Oxidation of branched chain amino acids by isolated hearts and diaphragms of the rat. The effect of fatty acids, glucose, and pyruvate respiration. J Biol Chem. 1972 Dec 25;247(24):8085–8096. [PubMed] [Google Scholar]
  4. Cederblad G., Lindstedt S. A method for the determination of carnitine in the picomole range. Clin Chim Acta. 1972 Mar;37:235–243. doi: 10.1016/0009-8981(72)90438-x. [DOI] [PubMed] [Google Scholar]
  5. Chalmers R. A., Johnson M., Pallis C., Watts R. W. Xanthinuria with myopathy (with some observations on the renal handling of oxypurines in the disease). Q J Med. 1969 Oct;38(152):493–512. [PubMed] [Google Scholar]
  6. DiMauro S., DiMauro P. M. Muscle carnitine palmityltransferase deficiency and myoglobinuria. Science. 1973 Nov 20;182(4115):929–931. doi: 10.1126/science.182.4115.929. [DOI] [PubMed] [Google Scholar]
  7. Engel A. G., Angelini C. Carnitine deficiency of human skeletal muscle with associated lipid storage myopathy: a new syndrome. Science. 1973 Mar 2;179(4076):899–902. doi: 10.1126/science.179.4076.899. [DOI] [PubMed] [Google Scholar]
  8. Felig P. Amino acid metabolism in man. Annu Rev Biochem. 1975;44:933–955. doi: 10.1146/annurev.bi.44.070175.004441. [DOI] [PubMed] [Google Scholar]
  9. Goldstein L., Newsholme E. A. The formation of alanine from amino acids in diaphragm muscle of the rat. Biochem J. 1976 Feb 15;154(2):555–558. doi: 10.1042/bj1540555. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gullotta F., Payk T. R., Solbach A. Sudanophile (mitochondriale) myopathie. Z Neurol. 1974 Apr 4;206(4):309–326. [PubMed] [Google Scholar]
  11. Jerusalem F., Engel A. G., Peterson H. A. Human muscle fiber fine structure: morphometric data on controls. Neurology. 1975 Feb;25(2):127–134. doi: 10.1212/wnl.25.2.127. [DOI] [PubMed] [Google Scholar]
  12. Jerusalem F., Spiess H., Baumgartner G. Lipid storage myopathy with normal carnitine levels. J Neurol Sci. 1975 Mar;24(3):273–282. doi: 10.1016/0022-510x(75)90247-6. [DOI] [PubMed] [Google Scholar]
  13. Karpati G., Carpenter S., Engel A. G., Watters G., Allen J., Rothman S., Klassen G., Mamer O. A. The syndrome of systemic carnitine deficiency. Clinical, morphologic, biochemical, and pathophysiologic features. Neurology. 1975 Jan;25(1):16–24. doi: 10.1212/wnl.25.1.16. [DOI] [PubMed] [Google Scholar]
  14. Lindstedt G. Hydroxylation of gamma-butyrobetaine to carnitine in rat liver. Biochemistry. 1967 May;6(5):1271–1282. doi: 10.1021/bi00857a007. [DOI] [PubMed] [Google Scholar]
  15. MARQUIS N. R., FRITZ I. B. ENZYMOLOGICAL DETERMINATION OF FREE CARNITINE CONCENTRATIONS IN RAT TISSUES. J Lipid Res. 1964 Apr;5:184–187. [PubMed] [Google Scholar]
  16. Markesbery W. R., McQuillen M. P., Procopis P. G., Harrison A. R., Engel A. G. Muscle carnitine deficiency. Association with lipid myopathy, vacuolar neuropathy, and vacuolated leukocytes. Arch Neurol. 1974 Nov;31(5):320–324. doi: 10.1001/archneur.1974.00490410068007. [DOI] [PubMed] [Google Scholar]
  17. Odessey R., Khairallah E. A., Goldberg A. L. Origin and possible significance of alanine production by skeletal muscle. J Biol Chem. 1974 Dec 10;249(23):7623–7629. [PubMed] [Google Scholar]
  18. Smyth D. P., Lake B. D., MacDermot J., Wilson J. Letter: Inborn error of carnitine metabolism ("carnitine deficiency") in man. Lancet. 1975 May 24;1(7917):1198–1199. doi: 10.1016/s0140-6736(75)93191-8. [DOI] [PubMed] [Google Scholar]
  19. Sutton H. E., Wagner R. P. Mutation and enzyme function in humans. Annu Rev Genet. 1975;9:187–212. doi: 10.1146/annurev.ge.09.120175.001155. [DOI] [PubMed] [Google Scholar]
  20. VanDyke D. H., Griggs R. C., Markesbery W., Dimauro S. Hereditary carnitine deficiency of muscle. Neurology. 1975 Feb;25(2):154–159. doi: 10.1212/wnl.25.2.154. [DOI] [PubMed] [Google Scholar]

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