Clinical, biochemical, and molecular spectrum of hyperargininemia due to arginase I deficiency

Abstract

The urea cycle consists of six consecutive enzymatic reactions that convert waste nitrogen into urea. Urea cycle disorders are a group of inborn errors of hepatic metabolism that often result in life threatening hyperammonemia and hyperglutaminemia. Deficiencies of all of the enzymes of the cycle have been described and although each specific disorder results in the accumulation of different precursors, hyperammonemia and hyperglutaminemia are common biochemical hallmarks of these disorders. Arginase is the enzyme involved in the last step of the urea cycle. It catalyzes the conversion of arginine to urea and ornithine. The latter reenters the mitochondrion to continue the cycle. Hyperargininemia is an autosomal recessive disorder caused by a defect in the arginase I enzyme. Unlike other urea cycle disorders, this condition is not generally associated with a hyperammonemic encephalopathy in the neonatal period. It typically presents later in childhood between 2 and 4 years of age with predominantly neurological features. If untreated, it progresses with gradual developmental regression. A favorable outcome can be achieved if dietary treatment and alternative pathway therapy are instituted early in the disease course. With this approach, further neurological deterioration is prevented and partial recovery of skills ensues. Early diagnosis of this disorder through newborn screening programs may lead to a better outcome. This review article summarizes the clinical characterization of this disorder; as well as its biochemical, enzymatic, and molecular features. Treatment, prenatal diagnosis and diagnosis through newborn screening are also discussed.

Figure 1. The Urea Cycle

The urea cycle (UC) converts nitrogen, derived from dietary protein intake and the catabolic breakdown of endogenous protein into urea, which is readily excreted from the body. “Reprinted from Trends in Molecular Medicine, Vol. 8, A. Mian and B. Lee, Urea cycle disorders as a paradigm for inborn errors of hepatocyte metabolism, 538-589, Copyright (2002), with permission from Elsevier.

Figure 2

Alternative Pathway Therapy for Urea Cycle Disorders (UCD)