Clinical aspects of short-chain acyl-CoA dehydrogenase deficiency

Short-chain acyl-CoA dehydrogenase deficiency (SCADD) is an autosomal recessive inborn error of mitochondrial fatty acid oxidation. SCADD is biochemically characterized by increased C4-carnitine in plasma and ethylmalonic acid in urine. The diagnosis of SCADD is confirmed by DNA analysis showing SCAD gene mutations and/or variants. SCAD gene variants are present in homozygous form in approximately 6% of the general population and considered to confer susceptibility to development of clinical disease. Clinically, SCADD generally appears to present early in life and to be most frequently associated with developmental delay, hypotonia, epilepsy, behavioral disorders, and hypoglycemia. However, these symptoms often ameliorate and even disappear spontaneously during follow-up and were found to be unrelated to the SCAD genotype. In addition, in some cases, symptoms initially attributed to SCADD could later be explained by other causes. Finally, SCADD relatives of SCADD patients as well as almost all SCADD individuals diagnosed by neonatal screening remained asymptomatic during follow-up. This potential lack of clinical consequences of SCADD has several implications. First, the diagnosis of SCADD should never preclude extension of the diagnostic workup for other potential causes of the observed symptoms. Second, patients and parents should be clearly informed about the potential lack of relevance of the disorder to avoid unfounded anxiety. Furthermore, to date, SCADD is not an optimal candidate for inclusion in newborn screening programs. More studies are needed to fully establish the relevance of SCADD and solve the question as to whether SCADD is involved in a multifactorial disease or represents a nondisease

The minor C-allele of rs2014355 in ACADS is associated with reduced insulin release following an oral glucose load

<p>Abstract</p> <p>Background</p> <p>A genome-wide association study (GWAS) using metabolite concentrations as proxies for enzymatic activity, suggested that two variants: rs2014355 in the gene encoding short-chain acyl-coenzyme A dehydrogenase (<it>ACADS</it>) and rs11161510 in the gene encoding medium-chain acyl-coenzyme A dehydrogenase (<it>ACADM</it>) impair fatty acid β-oxidation. Chronic exposure to fatty acids due to an impaired β-oxidation may down-regulate the glucose-stimulated insulin release and result in an increased risk of type 2 diabetes (T2D). We aimed to investigate whether the two variants associate with altered insulin release following an oral glucose load or with T2D.</p> <p>Methods</p> <p>The variants were genotyped using KASPar^®PCR SNP genotyping system and investigated for associations with estimates of insulin release and insulin sensitivity following an oral glucose tolerance test (OGTT) in a random sample of middle-aged Danish individuals (<it>n</it>_{<it>ACADS </it>}= 4,324; <it>n</it>_{<it>ACADM </it>}= 4,337). The T2D-case-control study involved a total of ~8,300 Danish individuals (<it>n</it>_{<it>ACADS </it>}= 8,313; <it>n</it>_{<it>ACADM </it>}= 8,344).</p> <p>Results</p> <p>In glucose-tolerant individuals the minor C-allele of rs2014355 of <it>ACADS </it>associated with reduced measures of serum insulin at 30 min following an oral glucose load (per allele effect (β) = -3.8% (-6.3%;-1.3%), <it>P </it>= 0.003), reduced incremental area under the insulin curve (β = -3.6% (-6.3%;-0.9%), <it>P </it>= 0.009), reduced acute insulin response (β = -2.2% (-4.2%;0.2%), <it>P </it>= 0.03), and with increased insulin sensitivity ISI_Matsuda(β = 2.9% (0.5%;5.2%), <it>P </it>= 0.02). The C-allele did not associate with two other measures of insulin sensitivity or with a derived disposition index. The C-allele was not associated with T2D in the case-control analysis (OR 1.07, 95% CI 0.96-1.18, <it>P </it>= 0.21). rs11161510 of <it>ACADM </it>did not associate with any indices of glucose-stimulated insulin release or with T2D.</p> <p>Conclusions</p> <p>In glucose-tolerant individuals the minor C-allele of rs2014355 of <it>ACADS </it>was associated with reduced measures of glucose-stimulated insulin release during an OGTT, a finding which in part may be mediated through an impaired β-oxidation of fatty acids.</p