Metabolism of branched-chain amino acids in fibroblasts from patients with maple syrup urine disease and other abnormalities of branched-chain ketoacid dehydrogenase activity.

The metabolism of branched-chain amino acids was studied in cultured fibroblasts from patients with branched-chain ketoacid dehydrogenase deficiency using 1-14C- and UL-14C-leucine and valine. The formation of 14CO2 from 1-14C-valine or 1-14C-leucine was 1-3% of normal. In fibroblasts of patients with associated lactic acidemia the values were 4-29% of control. Analysis of organic acid products revealed that in both patients and controls the amount of labeled alpha-ketoisovalerate recovered after incubation with 1-14C-valine was one-third of the amount of alpha-ketoisocaproate recovered after incubation with 1-14C-leucine. Very little alpha-hydroxyisocaproate was produced, while the amount of alpha-hydroxyisovalerate was about 10% of the alpha-ketoisovalerate. Unexpectedly beta-hydroxyisobutyrate was found to be the major metabolic product of UL-14C-valine in normal fibroblasts. Large accumulations of beta-hydroxyisovalerate were found in normal fibroblasts using UL-14C-leucine. There were little or no conversions to these compounds in fibroblasts of patients with branched-chain ketoacid dehydrogenase deficiency. There were substantial conversions in the patients in whom dehydrogenase deficiency was associated with lactic acidemia.