Maple syrup urine disease

Maple syrup urine disease is a rare genetic metabolic disorder where the body cannot break down branched chain amino acids like valine, leucine, and isoleucine completely, causing buildup of these amino acids and their toxic metabolic byproducts.

It was named maple syrup urine disease since the urine that contain these metabolites smell like maple syrup.

Other names for this disease include branched- chain ketoacid dehydrogenase deficiency, or BCKD deficiency, and branched- chain ketoaciduria.

Now, amino acids are the basic building blocks that make up proteins.

There are 20 amino acids used in the human body and they all contain a carboxyl group (-COOH) and an amine (-NH2) group.

The branched chain amino acids have a side chain containing 3 or more carbons, and they include valine, leucine, and isoleucine.

These 3 are essential amino acids, meaning our bodies can’t create them, so they must be acquired through protein rich foods like meat, eggs, dairy, avocados, beans, etc.

So the proteins you eat are broken down into amino acids in the gastrointestinal tract by gastric acid and digestive enzymes.

The amino acids are then absorbed by the small intestine into the bloodstream, which then travel to the cells of the body, where they are used for protein synthesis.

Since the body can’t store these amino acids, any extra amino acids are converted into glucose or ketones and used for energy.

Branched chain amino acids: valine, leucine and isoleucine, require special steps during their catabolism.

First, the enzyme branched- chain amino transferase, or BCAT, strip off their alpha amino group and transfers it to an alpha ketoglutarate to form glutamate.

This also converts the branched- chain amino acids into branched- chain keto acids.

Valine into alpha-ketoisovalerate, or KIV, leucine is converted into alpha-ketoisocaproate, or KIC, and isoleucine into alpha-keto-beta-methylvalerate, or KMV.

In the second step, branched-chain alpha-keto acid dehydrogenase complex, or BCKD, removes the carboxyl group from these keto acids and turns them into the intermediates isobutyryl-CoA, isovaleryl-CoA, and alpha-methylbutyryl-CoA respectively.

These intermediates will eventually be converted into acetyl-CoA and succinyl-CoA, which are used by other metabolic processes like the kreb cycle, ketogenesis, or gluconeogenesis.