ABSTRAm. Isovaleric acidemia is a disorder of leucine metabolism caused by a deficiency of isovaleryl-CoA dehydrogenase. At least two clinical subgroups of patients exist: a severe form, in which symptoms occur within the 1st wk of life, and a milder variant in which manifestations develop later in life. We developed a modified version of the tritium release assay to accurately measure residual isovaleryl-CoA dehydrogenase activity in fibroblasts from patients with both forms of isovaleric acidemia. In the modified assay, specific isovaleryl-CoA dehydrogenasecatalyzed tritium release from [2,3-3H]isovaleryl-CoA was determined by including an inhibitor of isovaleryl-CoA dehydrogenase, (methylenecyclopropy1)acetyl-CoA, in one of the tubes in paired assays, to determine the nonspecifically released 3H20. Residual activities of the nine isovaleric acidemia lines tested ranged from 0 to 0.67 pmol Isovaleric acidemia is an inherited disorder of leucine metabolism caused by a deficiency of the activity of isovaleryl-CoA dehydrogenase (EC. 1.3.99.10) (1, 2). Isovaleric acidemia has generally been considered to have two clinical phenotypes (3). One form (severe type) manifests as severe vomiting, lethargy, and coma, which commences within the first 2 wk of life and often causes death in the neonatal period. The other form (mild type) is characterized by recurrent milder episodes of vomiting, lethargy, and ketoacidosis. These episodes tend to begin later in life, and they are often triggered by viral or bacterial infection.