home *** CD-ROM | disk | FTP | other *** search
- $Unique_ID{BRK04035}
- $Pretitle{}
- $Title{N-Acetyl Glutamate Synthetase Deficiency}
- $Subject{N-Acetyl Glutamate Synthetase Deficiency NAGS Deficiency Urea Cycle
- Disorders Inborn Errors of Urea Synthesis }
- $Volume{}
- $Log{}
-
- Copyright (C) 1986, 1987, 1990, 1992 National Organization for Rare
- Disorders, Inc.
-
- 313:
- N-Acetyl Glutamate Synthetase Deficiency
-
- ** IMPORTANT **
- It is possible the main title of the article (N-Acetyl Glutamate
- Synthetase Deficiency) is not the name you expected. Please check the
- SYNONYMS listing to find the alternate names and disorder subdivisions
- covered by this article.
-
- Synonyms
-
- NAGS Deficiency
- Urea Cycle Disorders
- Inborn Errors of Urea Synthesis
-
- General Discussion
-
- ** REMINDER **
- The information contained in the Rare Disease Database is provided for
- educational purposes only. It should not be used for diagnostic or treatment
- purposes. If you wish to obtain more information about this disorder, please
- contact your personal physician and/or the agencies listed in the "Resources"
- section of this report.
-
-
- N-Acetyl Glutamate Synthetase (NAGS) Deficiency is one of several
- hereditary urea cycle disorders. These disorders are caused by a deficiency
- of one of the enzymes needed for the breakdown of ammonia into urea, which is
- normally excreted in the urine. The deficiencies cause an excess of ammonia
- in the blood (hyperammonemia). (For more information on the other Urea Cycle
- Disorders, choose "urea cycle disorder" as your search term in the Rare
- Disease Database.)
-
- In NAGS Deficiency the deficient enzyme is N-acetyl glutamate synthetase.
- If left untreated, NAGS deficiency manifests itself by an elevated level of
- toxic ammonia in the blood (hyperammonemia). Untreated this imbalance may
- lead to brain damage, coma, and eventually death.
-
- Symptoms
-
- NAGS Deficiency is characterized in infants by an excess of ammonia in the
- blood (hyperammonemia). Differential diagnosis is based on the absence of
- citrulline and a low level of arginine in blood plasma and a low level of
- orotic acid in the urine. Immediate treatment after diagnosis in newborn
- babies is imperative. If left untreated, brain damage and coma usually
- occur, which may lead to death.
-
- Causes
-
- NAGS Deficiency is an autosomal recessive hereditary disorder in which the
- activity of the enzyme N-acetyl glutamate synthetase is deficient. This
- deficiency causes an accumulation of excess ammonia in blood and body
- tissues. (Human traits including the classic genetic diseases, are the
- product of the interaction of two genes for that condition, one received from
- the father and one from the mother. In recessive disorders, the condition
- does not appear unless a person inherits the same defective gene from each
- parent. If one receives one normal gene and one gene for the disease, the
- person will be a carrier for the disease, but usually will show no symptoms.
- The risk of transmitting the disease to the children of a couple, both of
- whom are carriers for a recessive disorder, is twenty-five percent. Fifty
- percent of their children will be carriers, but healthy as described above.
- Twenty-five percent of their children will receive both normal genes, one
- from each parent and will be genetically normal.)
-
- Affected Population
-
- NAGS Deficiency is a very rare disorder affecting less than a thousand people
- in the United States. Males and females are affected equally. Onset of the
- symptoms occurs at birth.
-
- Related Disorders
-
- Organic Acidemias are characterized by hyperammonemia associated with
- metabolic acidosis, with an anion gap, and sometimes ketonuria. These
- disorders are also of genetic origin and affect the Urea Cycle as a secondary
- phenomenon.
-
- Reye Syndrome is a combination of acute brain disease (encephalopathy),
- and fatty degeneration of the abdominal organs (viscera), which tends to
- follow some acute virus infections (such as flu and chickenpox) combined with
- certain toxins (usually aspirin). (For more information, choose "Reye" as
- your search term in the Rare Disease Database.)
-
- The following Urea Cycle Disorders can also be found in the Rare Disease
- Database. They are all characterized by deficiencies of enzymes that are
- needed for different steps in the incorporation of ammonium into urea. The
- symptoms of all Urea Cycle Disorders result from hyperammonemia, in different
- degrees of severity.
-
- Carbamyl Phosphate Synthetase (CPS) Deficiency
- Ornithine Transcarbamylase (OTC) Deficiency
- Citrullinemia
- Arginino Succinic Aciduria
- Arginase Deficiency
-
- Therapies: Standard
-
- As soon as a urea cycle disorder is suspected, a number of diagnostic tests
- should be performed, including measurement of pH to assess the acidity of
- blood and body tissues, plasma levels of ammonia, amino acids, and
- bicarbonate. However, before the results of these tests are in, treatment of
- hyperammonemia should be started to prevent coma and/or brain damage.
-
- As soon as CPS Deficiency is diagnosed in a newborn baby, dialysis or
- exchange transfusion should be started. If hyperammoniac coma is present
- shortly after birth, a combined treatment needs to be started as soon as
- possible, which may include hemodialysis.
-
- Genetic counseling is imperative for the family of children with CPS
- Deficiency.
-
- Enzyme replacement therapy shows potential promise for treatment of urea
- cycle disorders including CPS Deficiency. Research on this type of therapy
- is in a preliminary stage. A regimen consisting of acute hemodialysis
- followed by a restricted intake of protein, plus sodium benzoate, sodium
- phenylacetate, and orginine or citrulline is being used on an experimental
- basis.
-
- Two new investigational drugs, sodium (or calcium) benzoate, and sodium
- (or calcium) phenylacetate, are used to enhance waste nitrogen excretion.
- Thus they prevent toxic ammonia buildup in the blood. These orphan drugs
- have been developed by Dr. Saul Brusilow (see Resources section of this
- entry) who is also developing sodium (or calcium) phenylbutyrate which does
- not have an offensive smell.
-
- The drug benzoate/phenylacetate (Ucephan) was approved in 1988 for use in
- the prevention and treatment of hyperammonemia in patients with urea cycle
- enzymopathy (UCE) due to enzyme deficiencies. The drug is manufactured by:
-
- Kendall McGaw Laboratories, Inc.
- P.O. Box 25080
- Santa Ana, CA 92799-5080
-
- For information on additional therapies that have been designated as
- Orphan Drugs in the last few months, please return to the main menu of NORD
- Services and access the Orphan Drug Database.
-
- Therapies: Investigational
-
- Clinical trials are underway to study L-Carnitine in amino acid and fat
- metabolism. Interested persons may wish to contact:
-
- Charles R. Roe, M.D.
- Box 3028
- Duke University Medical Center
- Durham, NC 27710
- (919) 684-2036
-
- to see if further patients are needed for this research.
-
- This disease entry is based upon medical information available through
- January 1992. Since NORD's resources are limited, it is not possible to keep
- every entry in the Rare Disease Database completely current and accurate.
- Please check with the agencies listed in the Resources section for the most
- current information about this disorder.
-
- Resources
-
- For more information on N-Acetyl Glutamate Synthetase Deficiency, please
- contact:
-
- National Organization for Rare Disorders (NORD)
- P.O. Box 8923
- New Fairfield, CT 06812-1783
- (203) 746-6518
-
- National Urea Cycle Disorders Foundation
- 4559 Vauxhall Rd.
- Richmond, VA 23234-3556
-
- National Digestive Diseases Information Clearinghouse
- Box NDDIC
- Bethesda, MD 20892
- (301) 468-6344
-
- Saul Brusilow, M.D.
- 301 Children's Medical and Surgical Center
- Johns Hopkins Hospital
- 600 N. Wolfe St.
- Baltimore, MD 21205
- (310) 955-0885
-
- The National Kidney Foundation
- 2 Park Ave.
- New York, NY 10016
- (212) 8689-2210
- (800) 622-9010
-
- American Kidney Fund
- 6110 Executive Blvd., Suite 1010
- Rockville, MD 20852
- (301) 881-3052
- (800) 638-8299
- (800) 492-8361 (MD)
-
- Research Trust for Metabolic Diseases in Children
- Golden Gates Lodge, Weston Rd.
- Crewe CW1 1XN, England
- Telephone: (0270) 250244
-
- For information on genetics and genetic counseling referrals, please
- contact:
-
- March of Dimes Birth Defects Foundation
- 1275 Mamaroneck Avenue
- White Plains, NY 10605
- (914) 428-7100
-
- Alliance of Genetic Support Groups
- 35 Wisconsin Circle, Suite 440
- Chevy Chase, MD 20815
- (800) 336-GENE
- (301) 652-5553
-
- References
-
- DISORDERS OF THE UREA CYCLE: Saul W. Brusilow; Hospital Practice (October
- 15, 1985; issue 305). Pp. 65-72.
-
- SYMPTOMATIC INBORN ERRORS OF METABOLISM IN THE NEONATE: Saul W. Brusilow
- and David L. Vallee; In: Current Therapy in Neonatal-Perinatal Medicine.
- Marcel Decker, 1985. Pp. 207-212.
-
-