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Case Reports
. 2014 Mar;173(3):361-6.
doi: 10.1007/s00431-013-2166-5. Epub 2013 Oct 10.

Unsuccessful treatment of severe pyruvate carboxylase deficiency with triheptanoin

C Breen  1 , F J White, C A B Scott, L Heptinstall, J H Walter, S A Jones, A A M Morris
Affiliations
Case Reports

Unsuccessful treatment of severe pyruvate carboxylase deficiency with triheptanoin

C Breen et al. Eur J Pediatr. 2014 Mar.

Abstract

Pyruvate carboxylase (PC) deficiency (OMIM 266150) is an autosomal recessive disorder that usually presents with lactic acidaemia and severe neurological dysfunction, leading to death in infancy. Because the enzyme is involved in gluconeogenesis and anaplerosis of the Krebs cycle, therapeutic strategies have included avoiding fasting and attempts to correct the defect of anaplerosis. Triheptanoin is a triglyceride of C7 fatty acids. The oxidation of odd chain fatty acids leads to the production not only of acetyl-CoA but also of propionyl-CoA, which is an anaplerotic substrate for the Krebs cycle. One infant with PC deficiency has previously been treated with triheptanoin as well as citrate and 2-chloropropionate. We report two further patients with PC deficiency, who were treated with triheptanoin, continuously from 11 and 21 days of age. They were also given citrate, aspartate and dichloroacetate. Triheptanoin did not lead to any clinical or biochemical improvement. The plasma and CSF lactate concentrations remained high with episodes of severe ketoacidosis and lactic acidosis. Both patients had severe hearing loss, roving eye movements, seizures and very limited neurodevelopmental progress; they died at the ages of 7 and 8 months.

Conclusion: Though triheptanoin did not alter the clinical course in our patients, it was well tolerated. It remains possible that less severely affected patients might benefit from this form of therapy.

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