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  1. Article: Primary carnitine deficiency is a life-long disease.

    Crefcoeur, Loek L / Melles, Mireille C / Bruning, Tobias A / Pereira, Rob Rodrigues / Langendonk, Janneke G

    JIMD reports

    2022  Volume 63, Issue 6, Page(s) 524–528

    Abstract: Primary carnitine deficiency is a rare autosomal recessive disease associated with acute hypoketotic hypoglycaemia, cardiomyopathy and sudden cardiac death. Effective treatment with carnitine supplementation is available. An 18 months old boy, who ... ...

    Abstract Primary carnitine deficiency is a rare autosomal recessive disease associated with acute hypoketotic hypoglycaemia, cardiomyopathy and sudden cardiac death. Effective treatment with carnitine supplementation is available. An 18 months old boy, who presented with cardiomyopathy was diagnosed with primary carnitine deficiency, and carnitine supplementation resulted in a full recovery. At age 13 years, he discontinued his medication and at 20 years, he discontinued clinical monitoring. Nine years later, age 29, he presented with heart failure and atrial fibrillation and was admitted to an intensive care unit, where he was treated with furosemide, enoximone and intravenous carnitine supplementation, this lead to improved cardiac function within 2 weeks, and with continued oral carnitine supplements, his left ventricular ejection fraction normalised. The last 8 years were uneventful and he continued to attend his regular follow-up visits at a specialised metabolic outpatient clinic. We report recurrent reversible severe heart failure in a patient with primary carnitine deficiency; it was directly related to non-compliance to carnitine supplementation (and monitoring). This case report emphasises first, the importance of continued monitoring of metabolic disease patients, second, the potential reversibility of cardiomyopathy in an adult patient, and third, the potential risks in the period of transition from the paediatric to adult care. This is an age where young adults desire to be healthy and ignore the need for ongoing medical treatment, even as simple as oral suppletion. Before they reach this age, adequate disease insight and self-management of the disease should be promoted.
    Language English
    Publishing date 2022-07-27
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2672872-2
    ISSN 2192-8312 ; 2192-8304
    ISSN (online) 2192-8312
    ISSN 2192-8304
    DOI 10.1002/jmd2.12319
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Clinical characteristics of primary carnitine deficiency: A structured review using a case-by-case approach.

    Crefcoeur, Loek L / Visser, Gepke / Ferdinandusse, Sacha / Wijburg, Frits A / Langeveld, Mirjam / Sjouke, Barbara

    Journal of inherited metabolic disease

    2022  Volume 45, Issue 3, Page(s) 386–405

    Abstract: A broad spectrum of signs and symptoms has been attributed to primary carnitine deficiency (PCD) since its first description in 1973. Advances in diagnostic procedures have improved diagnostic accuracy and the introduction of PCD in newborn screening ( ... ...

    Abstract A broad spectrum of signs and symptoms has been attributed to primary carnitine deficiency (PCD) since its first description in 1973. Advances in diagnostic procedures have improved diagnostic accuracy and the introduction of PCD in newborn screening (NBS) programs has led to the identification of an increasing number of PCD patients, including mothers of screened newborns, who may show a different phenotype compared to clinically diagnosed patients. To elucidate the spectrum of signs and symptoms in PCD patients, we performed a structured literature review. Using a case-by-case approach, clinical characteristics, diagnostic data, and mode of patient identification were recorded. Signs and symptoms were categorized by organ involvement. In total, 166 articles were included, reporting data on 757 individual patients. In almost 20% (N = 136) of the cases, the diagnosis was based solely on low carnitine concentration which we considered an uncertain diagnosis of PCD. The remaining 621 cases had a diagnosis based on genetic and/or functional (ie, carnitine transporter activity) test results. In these 621 cases, cardiac symptoms (predominantly cardiomyopathy) were the most prevalent (23.8%). Neurological (7.1%), hepatic (8.4%), and metabolic (9.2%) symptoms occurred mainly in early childhood. Adult onset of symptoms occurred in 16 of 194 adult patients, of whom 6 (3.1%) patients suffered a severe event without any preceding symptom (five cardiac events and one coma). In conclusion, symptoms in PCD predominantly develop in early childhood. Most newborns and mothers of newborns detected through NBS remain asymptomatic. However, though rarely, severe complications do occur in both groups.
    MeSH term(s) Cardiomyopathies/complications ; Cardiomyopathies/diagnosis ; Cardiomyopathies/genetics ; Carnitine/deficiency ; Carnitine/metabolism ; Child, Preschool ; Humans ; Hyperammonemia/complications ; Hyperammonemia/diagnosis ; Hyperammonemia/genetics ; Infant, Newborn ; Muscular Diseases/complications ; Muscular Diseases/diagnosis ; Muscular Diseases/genetics ; Neonatal Screening/methods ; Solute Carrier Family 22 Member 5/genetics
    Chemical Substances Solute Carrier Family 22 Member 5 ; Carnitine (S7UI8SM58A)
    Language English
    Publishing date 2022-02-03
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 438341-2
    ISSN 1573-2665 ; 0141-8955
    ISSN (online) 1573-2665
    ISSN 0141-8955
    DOI 10.1002/jimd.12475
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: A qualitative study on the perspectives of mothers who had been diagnosed with primary carnitine deficiency through newborn screening of their child.

    van den Heuvel, Lieke M / Kater-Kuipers, Adriana / van Dijk, Tessa / Crefcoeur, Loek L / Visser, Gepke / Langeveld, Mirjam / Henneman, Lidewij

    Orphanet journal of rare diseases

    2023  Volume 18, Issue 1, Page(s) 134

    Abstract: Background: Primary carnitine deficiency is an inborn error of metabolism, which can lead to life-threating complications early in life. Low carnitine levels can be detected by newborn bloodspot screening (NBS). However, NBS can also identify, mostly ... ...

    Abstract Background: Primary carnitine deficiency is an inborn error of metabolism, which can lead to life-threating complications early in life. Low carnitine levels can be detected by newborn bloodspot screening (NBS). However, NBS can also identify, mostly asymptomatic, mothers with primary carnitine deficiency. To identify mothers' needs and areas for improving screening practice, this study explored the experiences with, and opinions on primary carnitine deficiency screening in NBS among women diagnosed through NBS of their newborn.
    Methods: Twelve Dutch women were interviewed, 3-11 years after diagnosis. Data were analysed using a thematic approach.
    Results: Four main themes were derived: 1) psychological impact of primary carnitine deficiency diagnosis, 2) becoming a patient and "patient-in-waiting", 3) information issues and care provision, and 4) primary carnitine deficiency as part of the NBS panel. Mothers shared that they did not experience major psychological distress of the diagnosis. They did experience (recall) various emotions following the initial abnormal NBS result, including fear and anxiety as well as relief, and emotions regarding their own diagnosis, including uncertainty about health risks and treatment effectiveness. Some felt a patient-in-waiting. Many participants experienced a lack of information, especially shortly after receiving the abnormal NBS result. All shared the belief that screening for primary carnitine deficiency in NBS is beneficial for the newborn, and, given the information they received, also considered the knowledge beneficial for their own health.
    Conclusions: Psychological burden following diagnosis was experienced by women as limited, although the experienced lack of information amplified feelings of uncertainty and anxiety. Most mothers believed that benefits of knowing about primary carnitine deficiency outweighed the disadvantages. Mothers' perspectives should be incorporated in policy-making about primary carnitine deficiency in NBS.
    MeSH term(s) Female ; Humans ; Infant, Newborn ; Cardiomyopathies/diagnosis ; Carnitine/metabolism ; Mothers ; Muscular Diseases/diagnosis ; Neonatal Screening
    Chemical Substances Carnitine (S7UI8SM58A)
    Language English
    Publishing date 2023-06-02
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2225857-7
    ISSN 1750-1172 ; 1750-1172
    ISSN (online) 1750-1172
    ISSN 1750-1172
    DOI 10.1186/s13023-023-02735-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Assessment of carnitine excretion and its ratio to plasma free carnitine as a biomarker for primary carnitine deficiency in newborns.

    Crefcoeur, Loek L / Heiner-Fokkema, M Rebecca / Maase, Rose E / Visser, Gepke / de Sain-van der Velden, Monique G M

    JIMD reports

    2022  Volume 64, Issue 1, Page(s) 57–64

    Abstract: In the Netherlands, newborns are referred by the newborn screening (NBS) Program when a low free carnitine (C0) concentration (<5 μmol/l) is detected in their NBS dried blood spot. This leads to ~85% false positive referrals who all need an invasive, ... ...

    Abstract In the Netherlands, newborns are referred by the newborn screening (NBS) Program when a low free carnitine (C0) concentration (<5 μmol/l) is detected in their NBS dried blood spot. This leads to ~85% false positive referrals who all need an invasive, expensive and lengthy evaluation. We investigated whether a ratio of urine C0 / plasma C0 (Ratio
    Language English
    Publishing date 2022-09-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2672872-2
    ISSN 2192-8312 ; 2192-8304
    ISSN (online) 2192-8312
    ISSN 2192-8304
    DOI 10.1002/jmd2.12334
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Neonatal carnitine concentrations in relation to gestational age and weight.

    Crefcoeur, Loek L / de Sain-van der Velden, Monique G M / Ferdinandusse, Sacha / Langeveld, Mirjam / Maase, Rose / Vaz, Frédéric M / Visser, Gepke / Wanders, Ronald J A / Wijburg, Frits A / Verschoof-Puite, Rendelien K / Schielen, Peter C J I

    JIMD reports

    2020  Volume 56, Issue 1, Page(s) 95–104

    Abstract: Background: Free carnitine has been measured in the Dutch newborn screening (NBS) program since 2007 with a referral threshold of ≤5 μmol/L, regardless of gestational age or birthweight. However, several studies suggest that carnitine concentrations may ...

    Abstract Background: Free carnitine has been measured in the Dutch newborn screening (NBS) program since 2007 with a referral threshold of ≤5 μmol/L, regardless of gestational age or birthweight. However, several studies suggest that carnitine concentrations may depend on gestational age and birthweight. We evaluated differences in postnatal day-to-day carnitine concentrations in newborns based on gestational age (GA) and/or weight for GA (WfGA).
    Methods: A retrospective study was performed using data from the Dutch NBS. Dried blood spot (DBS) carnitine concentrations, collected between the 3rd and 10th day of life, of nearly 2 million newborns were included. Individuals were grouped based on GA and WfGA. Median carnitine concentrations were calculated for each group. Mann-Whitney
    Results: Preterm, postterm, and small for GA (SGA) newborns have higher carnitine concentrations at the third day of life compared to term newborns. The median carnitine concentration of preterm newborns declines from day 3 onwards, and approximates that of term newborns at the sixth day of life, while median concentrations of postterm and SGA newborns remain elevated at least throughout the first 10 days of life. Carnitine concentrations ≤5 μmol/L were found less frequently in SGA newborns and newborns born between 32 and 37 weeks of gestation, compared to term newborns.
    Conclusions: Median carnitine concentrations in NBS DBS vary with day of sampling, GA, and WfGA. It is important to take these variables into account when interpreting NBS results..
    Language English
    Publishing date 2020-09-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2672872-2
    ISSN 2192-8312 ; 2192-8304
    ISSN (online) 2192-8312
    ISSN 2192-8304
    DOI 10.1002/jmd2.12162
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Exploring the metabolic fate of medium-chain triglycerides in healthy individuals using a stable isotope tracer.

    Knottnerus, Suzan J G / van Harskamp, Dewi / Schierbeek, Henk / Bleeker, Jeannette C / Crefcoeur, Loek L / Ferdinandusse, Sacha / van Goudoever, Johannes B / Houtkooper, Riekelt H / IJlst, Lodewijk / Langeveld, Mirjam / Wanders, Ronald J A / Vaz, Frédéric M / Wijburg, Frits A / Visser, Gepke

    Clinical nutrition (Edinburgh, Scotland)

    2020  Volume 40, Issue 3, Page(s) 1396–1404

    Abstract: Background & aims: Medium chain triglyceride (MCT) supplementation is often recommended as treatment for patients with long-chain fatty acid β-oxidation (lcFAO) disorders, since they can be utilized as an energy source without the use of the defective ... ...

    Abstract Background & aims: Medium chain triglyceride (MCT) supplementation is often recommended as treatment for patients with long-chain fatty acid β-oxidation (lcFAO) disorders, since they can be utilized as an energy source without the use of the defective enzyme. However, studies in mice and preterm infants suggest that not all medium-chain fatty acids (MCFA) are oxidized and may undergo elongation to long-chain fatty acids (LCFA). In this single blinded study, we explored the metabolic fates of MCT in healthy individuals using a
    Method: Three healthy males in rest received on two test days a primed continuous infusion of glyceryl tri[1,2,3,4-
    Results: When provided as single energy source, an estimated 42% of administered MCT was converted to CO
    Conclusions: Although the relative MCT oxidation rate was higher when combined with carbohydrates and protein, quantitatively more MCT was oxidized when given an isocaloric meal with solely MCT. As these results were obtained in the resting state opposed to during exercise, it is too early to give a recommendation concerning the use of MCT in lcFAO disorders. The data show that in resting healthy individuals only a very small part of the MCT is traced back as LCFA in plasma, suggesting that MCT treatment does not result in a large LCFA burden, however further research on storage of MCT in tissues is warranted.
    Registration: The study was registered in the Nederlands Trialregister. Protocol ID: Trial NL7417 (NTR7650).
    MeSH term(s) Adult ; Breath Tests ; Caprylates ; Carbon Dioxide/metabolism ; Carbon Isotopes ; Diet ; Fatty Acids/blood ; Humans ; Isotope Labeling ; Male ; Oxidation-Reduction ; Triglycerides/administration & dosage ; Triglycerides/metabolism
    Chemical Substances Caprylates ; Carbon Isotopes ; Fatty Acids ; Triglycerides ; Carbon Dioxide (142M471B3J) ; tricaprylin (6P92858988)
    Language English
    Publishing date 2020-09-04
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 604812-2
    ISSN 1532-1983 ; 0261-5614
    ISSN (online) 1532-1983
    ISSN 0261-5614
    DOI 10.1016/j.clnu.2020.08.032
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Exploring the metabolic fate of medium-chain triglycerides in healthy individuals using a stable isotope tracer

    Knottnerus, Suzan J.G / van Harskamp, Dewi / Schierbeek, Henk / Bleeker, Jeannette C / Crefcoeur, Loek L / Ferdinandusse, Sacha / van Goudoever, Johannes B / Houtkooper, Riekelt H / IJlst, Lodewijk / Langeveld, Mirjam / Wanders, Ronald J.A / Vaz, Frédéric M / Wijburg, Frits A / Visser, Gepke

    Clinical nutrition. 2020 Aug. 27,

    2020  

    Abstract: Medium chain triglyceride (MCT) supplementation is often recommended as treatment for patients with long-chain fatty acid β-oxidation (lcFAO) disorders, since they can be utilized as an energy source without the use of the defective enzyme. However, ... ...

    Abstract Medium chain triglyceride (MCT) supplementation is often recommended as treatment for patients with long-chain fatty acid β-oxidation (lcFAO) disorders, since they can be utilized as an energy source without the use of the defective enzyme. However, studies in mice and preterm infants suggest that not all medium-chain fatty acids (MCFA) are oxidized and may undergo elongation to long-chain fatty acids (LCFA). In this single blinded study, we explored the metabolic fates of MCT in healthy individuals using a ¹³C-labeled MCT tracer.Three healthy males in rest received on two test days a primed continuous infusion of glyceryl tri[1,2,3,4–¹³C₄]-octanoate with either an isocaloric supplementation of 1) exclusively MCT (MCT-only) or 2) a mixture of MCT, proteins and carbohydrates (MCT-mix). Gas chromatography - combustion - isotope ratio mass spectrometry (GC-C-IRMS) was used to determine ¹³C-enrichment of long-chain fatty acids in plasma and of ¹³CO₂ in exhaled air.When provided as single energy source, an estimated 42% of administered MCT was converted to CO₂. In combination with carbohydrates and proteins in the diet, oxidation of MCT was higher (62%). In both diets <1% of ¹³C-label was incorporated in LCFA in plasma, indicating that administered MCT underwent chain-elongation to LCT.Although the relative MCT oxidation rate was higher when combined with carbohydrates and protein, quantitatively more MCT was oxidized when given an isocaloric meal with solely MCT. As these results were obtained in the resting state opposed to during exercise, it is too early to give a recommendation concerning the use of MCT in lcFAO disorders. The data show that in resting healthy individuals only a very small part of the MCT is traced back as LCFA in plasma, suggesting that MCT treatment does not result in a large LCFA burden, however further research on storage of MCT in tissues is warranted.The study was registered in the Nederlands Trialregister. Protocol ID: Trial NL7417 (NTR7650).
    Keywords carbohydrates ; carbon dioxide ; clinical nutrition ; combustion ; diet ; energy ; enzymes ; exercise ; gas chromatography ; long chain fatty acids ; males ; mass spectrometry ; medium chain fatty acids ; medium chain triacylglycerols ; mice ; patients ; premature birth ; proteins ; protocols ; research ; stable isotopes ; storage ; tissues
    Language English
    Dates of publication 2020-0827
    Publishing place Elsevier Ltd
    Document type Article
    Note NAL-light ; Pre-press version
    ZDB-ID 604812-2
    ISSN 1532-1983 ; 0261-5614
    ISSN (online) 1532-1983
    ISSN 0261-5614
    DOI 10.1016/j.clnu.2020.08.032
    Database NAL-Catalogue (AGRICOLA)

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