Abstract
Aromatic L-amino acid decarboxylase (AADC - E.C. 4.1.1.28) converts L-dopa to dopamine
and 5-hydroxytryptophan to serotonin. Inherited deficiency of this enzyme leads to
decreased brain levels of these neurotransmitters. Clinically this results in the
development of a progressive neurometabolic disorder characterized by severe hypotonia,
dystonic and choreoathetoid movements, oculogyric crises, and hypothermia from infancy.
Here we describe the clinical, biochemical and molecular details of two affected brothers,
one of whom, despite the lack of AADC, presented with hyperdopaminuria. In addition,
we detail his reactions to treatment with dopaminergic agonists, monoamine oxidase
inhibitors and pyridoxine.
Key words
Aromatic L-Amino Acid Decarboxylase Deficiency - Neurotransmitters - Hyperdopaminuria
- L-Dopa
References
- 1
Abeling N GGM, Van Gennip A H, Barth P G, van Cruchten A, Westra M, Wijburg F A.
Aromatic amino acid decarboxylase deficiency: a new case with a mild clinical presentation
and unexpected laboratory findings.
J Inher Metab Dis.
1998;
21
240-242
- 2
Abeling N GGM, Bräutigam C, Hoffmann G F, Barth P G, Wevers R A, Jaeken J, Fiumara A,
Knust A, Van Gennip A H.
Pathobiochemical implications of hyperdopaminuria in patients with aromatic amino
acid decarboxylase deficiency.
J Inher Metab Dis.
2000;
23
325-328
- 3
Bräutigam C, Wevers R A, Jansen R JT. et al .
Biochemical hallmarks of tyrosine hydroxylase deficiency.
Clin Chem.
1998;
44
1897-1904
- 4
Bräutigam C, Wevers R A, Hyland K, Sharma R K, Knust A, Hoffmann G F.
The influence of L-Dopa on methylation capacity in aromatic L-amino acid decarboxylase
deficiency: Biochemical findings in two patients.
J Inher Metab Dis.
2000;
23
321-324
- 5
Fiumara A, Wevers R, Barone R, Lagae L, Stoltenborg B, Nigro F, Jaeken J.
Aromatic L-amino acid decarboxylase deficiency: the first Italian case.
J Inher Metab Dis.
1998;
21 (Suppl 2)
5
- 6
Hyland K, Clayton P T.
Aromatic amino acid decarboxylase deficiency in twins.
J Inher Metab Dis.
1990;
13
301-304
- 7
Hyland K, Surtees R AH, Rodeck C, Clayton P T.
Aromatic amino acid decarboxylase deficiency: Clinical features, diagnosis and treatment
of a new inborn error of neurotransmitter amine synthesis.
Neurology.
1992;
42
1980-1988
- 8
Hyland K, Clayton P T.
Aromatic L-amino acid decarboxylase deficiency: Diagnostic methodology.
Clin Chem.
1992;
38
2405
- 9
Korenke G C, Christen H J, Hyland K, Hunneman D H, Hanefeld F.
Aromatic L-amino acid decarboxylase deficiency. An extrapyramidal movement disorder
with oculogyric crises.
Eur J Paed Neurol.
1997;
2/3
67-71
- 10
Maller A, Hyland K, Milstien S, Biaggioni I, Butler I J.
Aromatic L-amino acid decarboxylase deficiency: Clinical features, diagnosis and treatment
of a second family.
J Child Neurol.
1997;
12
349-354
- 11
Nagatsu T.
Genes for human catecholamine-synthesizing enzymes.
Neurosci Res.
1991;
12
315-345
- 12
Swoboda K J, Hyland K.
Clinical and therapeutic observation in aromatic amino-acid decarboxylase deficiency.
Neurology.
1999;
53
1205-1211
M.D. Agata Fiumara
Department of Pediatrics, Università di Catania
Via S. Sofia, 78
95123 Catania
Italy
Email: afiumara@katamail.com