SummaryThe effects of 18 normally occurring and 11 patalogical metabolites of the branched-chain amino acids on the glycine cleavage system were investigated on intact rat liver mitochondria. It was demonstrated, that 2-0x0-isovaleric acid, 2-methyl-butyric acid, and isobutyric acid significantly inhibited the glycine cleavage system in intact mitochondria.Further studies on the solubilized glycine cleavage system demonstrated that the inhibitory effect was due to 2-methyl-butyrylCoA (linear noncompetitive inhibition, ki: 0.1-0.15 mM) and isobutyryl-CoA (S-hyperbolic, I-linear noncompetitive inhibition, ki: 0.2-0.3 mM). Both 2-methyl-butyric acid and isobutyric acid exhibited less inhibition (2-methyl-butyric acid: competitive inhibition, ki: 5.5 mM, isobutyric acid: competitive inhibition, ki: 16 mM), while 2-0x0-isovaleric acid was without inhibitory effect, and probably affects intact mitochondria through transformation to isobutyryl-CoA.It is suggested that the inhibitory action of 2-methyl-butyrylCoA and isobutyryl-CoA may explain the hyperglycinemia seen in propionyl-CoA carboxylase deficiency, methyl-malonyl-CoA mutase deficiency and P-ketothiolase deficiency.
SpeculationIn patients not suffering from any known inborn error of metabolism, hyperglycinemia has been described in connection with two circumstances, namely, severe generalized illness and medication with dipropylacetic acid. Because both these conditions might cause some derangement of the branched-chain amino acid metabolism, it is speculated that this hyperglycinemia might be due to inhibition of the glycine cleavage system by 2-methyl-butyryl-CoA and isobutyryl-CoA, and that these conditions thus might serve as n~odels for ketotic hyperglycinemia.In 1961, Childs and Nyhan (4) described a syndrome, named the hyperglycinemia syndrome, presenting as a severe neonatal illness in a child with elevated glycine concentrations in both serum and urine. In a following paper (23), they showed that administration of branched-chain amino acids resulted in deterioration of the clinical symptoms and further elevation of the glycine concentrations.During the following years, several new cases of hyperglycinemia were reported, and it became obvious that symptoms and signs associated with this condition varied considerably. It was, therefore, proposed that the syndrome covered several ethiologic entities (9).It is now firmly documented that the condition exists in connection with at least five different enzymatic defects. Three are in the metabolism of branched-chain amino acids (propionyl-CoA carboxylase deficiency (2). methylmalonyl-CoA mutase deficiency (la), and P-ketothiolase deficiency (I I), and one in the metabolism of glycine itself, namely, deficiency of the glycine cleavage system (24). The fifth has recently been described in a child with deficient D-glycerate dehydrogenase activity (16).Whereas it is not surprising that a primary defect in the glycine cleavage system results in hyperglycinemia. it is still not clear why elevated glycine concentrat...