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Doença da urina xarope de bordo intermediária
ORPHA:268162CID-10 · E71.0CID-11 · 5C50.D0DOENÇA RARA

A doença da urina do xarope de bordo intermediária (MSUD intermediária) é uma forma mais leve da MSUD. Ela é caracterizada por níveis que estão sempre altos de aminoácidos de cadeia ramificada (BCAAs) e de cetoácidos, mas com menos ou nenhuma crise aguda de piora grave da condição.

Mantido por Agente Raras·Colaborar como especialista →

Introdução

O que você precisa saber de cara

📋

A doença da urina do xarope de bordo intermediária (MSUD intermediária) é uma forma mais leve da MSUD. Ela é caracterizada por níveis que estão sempre altos de aminoácidos de cadeia ramificada (BCAAs) e de cetoácidos, mas com menos ou nenhuma crise aguda de piora grave da condição.

Publicações científicas
11 artigos
Último publicado: 2024 Nov 1

Escala de raridade

CLASSIFICAÇÃO ORPHANET · BRASIL 2024
1-9 / 1 000 000
Ultra-rara
<1/50k
Muito rara
1/20k
Rara
1/10k
Pouco freq.
1/5k
Incomum
1/2k
Prevalência
0.0
Europe
Início
Infancy
+ neonatal
🏥
SUS: Cobertura mínimaScore: 20%
Triagem neonatal (Fase 2)CID-10: E71.0
🇧🇷Dados SUS / DATASUS
PROCEDIMENTOS SIGTAP (7)
0202010279
Dosagem de aminoácidos (erros inatos)metabolic_test
0202010295
Dosagem de ácidos orgânicos na urinagenetic_test
0202010490
Teste de triagem para erros inatos do metabolismonewborn_screening
0202010694
Sequenciamento completo do exoma (WES)rehabilitation
0202080013
Teste do pezinho (triagem neonatal)nutritional
0301070040
Atendimento em reabilitação — doenças raras
+1 outros procedimentos
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Sinais e sintomas

O que aparece no corpo e com que frequência cada sintoma acontece

Linha do tempo da pesquisa

Publicações por ano — veja quando o interesse científico cresceu
Anos de pesquisa2desde 2024
Total histórico11PubMed
Últimos 10 anos2publicações
Pico20211 papers
Linha do tempo
2024Hoje · 2026
Publicações por ano (últimos 10 anos)

Triagem neonatal (Teste do Pezinho)

👶
Teste: MS/MS (espectrometria de massas em tandem)
Fase 2 do PNTNin_rollout
Incidência no Brasil: 1:10.000 (coletivo)

A triagem neonatal permite diagnóstico precoce e início imediato do tratamento.

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Genética e causas

O que está alterado no DNA e como passa nas famílias

Genes associados

4 genes identificados com associação a esta condição. Padrão de herança: Autosomal recessive.

PPM1KProtein phosphatase Mn(2+)-dependent 1KDisease-causing germline mutation(s) inTolerante
FUNÇÃO

Serine/threonine-protein phosphatase component of macronutrients metabolism. Forms a functional kinase and phosphatase pair with BCKDK, serving as a metabolic regulatory node that coordinates branched-chain amino acids (BCAAs) with glucose and lipid metabolism via two distinct phosphoprotein targets: mitochondrial BCKDHA subunit of the branched-chain alpha-ketoacid dehydrogenase (BCKDH) complex and cytosolic ACLY, a lipogenic enzyme of Krebs cycle (PubMed:17336929, PubMed:17374715, PubMed:194117

LOCALIZAÇÃO

Mitochondrion matrix

VIAS BIOLÓGICAS (1)
Branched-chain amino acid catabolism
MECANISMO DE DOENÇA

Maple syrup urine disease, mild variant

A mild form of maple syrup urine disease, a metabolic disorder due to an enzyme defect in the catabolic pathway of the branched-chain amino acids leucine, isoleucine, and valine. Accumulation of these 3 amino acids and their corresponding keto acids leads to encephalopathy and progressive neurodegeneration. Clinical features include mental and physical retardation, feeding problems, and a maple syrup odor to the urine. The keto acids of the branched-chain amino acids are present in the urine. If untreated, maple syrup urine disease can lead to seizures, coma, and death. The disease is often classified by its pattern of signs and symptoms. The most common and severe form of the disease is the classic type, which becomes apparent soon after birth. Variant forms of the disorder become apparent later in infancy or childhood and are typically milder, but they still involve developmental delay and other medical problems if not treated. MSUDMV is characterized by increased plasma levels of branched-chain amino acids (BCAA) apparent at birth. Treatment with a low-protein diet free of BCAA can result in normal psychomotor development and lack of metabolic episodes.

EXPRESSÃO TECIDUAL(Ubíquo)
Cérebro - Hemisfério cerebelar
42.9 TPM
Cervix Ectocervix
41.0 TPM
Útero
41.0 TPM
Fallopian Tube
40.8 TPM
Ovário
37.6 TPM
OUTRAS DOENÇAS (2)
maple syrup urine disease, mild variantintermediate maple syrup urine disease
HGNC:25415UniProt:Q8N3J5
BCKDHA2-oxoisovalerate dehydrogenase subunit alpha, mitochondrialDisease-causing germline mutation(s) inTolerante
FUNÇÃO

Together with BCKDHB forms the heterotetrameric E1 subunit of the mitochondrial branched-chain alpha-ketoacid dehydrogenase (BCKD) complex. The BCKD complex catalyzes the multi-step oxidative decarboxylation of alpha-ketoacids derived from the branched-chain amino-acids valine, leucine and isoleucine producing CO2 and acyl-CoA which is subsequently utilized to produce energy. The E1 subunit catalyzes the first step with the decarboxylation of the alpha-ketoacid forming an enzyme-product intermed

LOCALIZAÇÃO

Mitochondrion matrix

VIAS BIOLÓGICAS (7)
BCKDH synthesizes BCAA-CoA from KIC, KMVA, KIVBranched-chain amino acid catabolismBranched-chain ketoacid dehydrogenase kinase deficiencyLoss-of-function mutations in DLD cause MSUD3/DLDDLoss-of-function mutations in DBT cause MSUD2
MECANISMO DE DOENÇA

Maple syrup urine disease 1A

A form of maple syrup urine disease, an autosomal recessive metabolic disorder due to an enzyme defect in the catabolic pathway of the branched-chain amino acids leucine, isoleucine, and valine. Accumulation of these 3 amino acids and their corresponding keto acids leads to encephalopathy and progressive neurodegeneration. Clinical features include mental and physical retardation, feeding problems, and a maple syrup odor to the urine. The keto acids of the branched-chain amino acids are present in the urine. If untreated, maple syrup urine disease can lead to seizures, coma, and death. The disease is often classified by its pattern of signs and symptoms. The most common and severe form of the disease is the classic type, which becomes apparent soon after birth. Variant forms of the disorder become apparent later in infancy or childhood and are typically milder, but they still involve developmental delay and other medical problems if not treated.

OUTRAS DOENÇAS (4)
maple syrup urine disease type 1Aclassic maple syrup urine diseaseintermediate maple syrup urine diseaseintermittent maple syrup urine disease
HGNC:986UniProt:P12694
BCKDHB2-oxoisovalerate dehydrogenase subunit beta, mitochondrialDisease-causing germline mutation(s) (loss of function) inTolerante
FUNÇÃO

Together with BCKDHA forms the heterotetrameric E1 subunit of the mitochondrial branched-chain alpha-ketoacid dehydrogenase (BCKD) complex. The BCKD complex catalyzes the multi-step oxidative decarboxylation of alpha-ketoacids derived from the branched-chain amino-acids valine, leucine and isoleucine producing CO2 and acyl-CoA which is subsequently utilized to produce energy. The E1 subunit catalyzes the first step with the decarboxylation of the alpha-ketoacid forming an enzyme-product intermed

LOCALIZAÇÃO

Mitochondrion matrix

VIAS BIOLÓGICAS (6)
BCKDH synthesizes BCAA-CoA from KIC, KMVA, KIVBranched-chain amino acid catabolismBranched-chain ketoacid dehydrogenase kinase deficiencyLoss-of-function mutations in DLD cause MSUD3/DLDDLoss-of-function mutations in DBT cause MSUD2
MECANISMO DE DOENÇA

Maple syrup urine disease 1B

A form of maple syrup urine disease, an autosomal recessive metabolic disorder due to an enzyme defect in the catabolic pathway of the branched-chain amino acids leucine, isoleucine, and valine. Accumulation of these 3 amino acids and their corresponding keto acids leads to encephalopathy and progressive neurodegeneration. Clinical features include mental and physical retardation, feeding problems, and a maple syrup odor to the urine. The keto acids of the branched-chain amino acids are present in the urine. If untreated, maple syrup urine disease can lead to seizures, coma, and death. The disease is often classified by its pattern of signs and symptoms. The most common and severe form of the disease is the classic type, which becomes apparent soon after birth. Variant forms of the disorder become apparent later in infancy or childhood and are typically milder, but they still involve developmental delay and other medical problems if not treated.

OUTRAS DOENÇAS (4)
maple syrup urine disease type 1Bclassic maple syrup urine diseaseintermittent maple syrup urine diseaseintermediate maple syrup urine disease
HGNC:987UniProt:P21953
DBTLipoamide acyltransferase component of branched-chain alpha-keto acid dehydrogenase complex, mitochondrialDisease-causing germline mutation(s) (loss of function) inTolerante
FUNÇÃO

The branched-chain alpha-keto dehydrogenase complex catalyzes the overall conversion of alpha-keto acids to acyl-CoA and CO(2). It contains multiple copies of three enzymatic components: branched-chain alpha-keto acid decarboxylase (E1), lipoamide acyltransferase (E2) and lipoamide dehydrogenase (E3). Within this complex, the catalytic function of this enzyme is to accept, and to transfer to coenzyme A, acyl groups that are generated by the branched-chain alpha-keto acid decarboxylase component

LOCALIZAÇÃO

Mitochondrion matrix

VIAS BIOLÓGICAS (2)
Protein lipoylationMitochondrial protein degradation
EXPRESSÃO TECIDUAL(Ubíquo)
Bladder
10.2 TPM
Nervo tibial
8.9 TPM
Glândula adrenal
8.7 TPM
Artéria tibial
8.4 TPM
Fallopian Tube
8.3 TPM
OUTRAS DOENÇAS (5)
maple syrup urine disease type 2intermediate maple syrup urine diseasethiamine-responsive maple syrup urine diseaseintermittent maple syrup urine disease
HGNC:2698UniProt:P11182

Variantes genéticas (ClinVar)

535 variantes patogênicas registradas no ClinVar.

🧬 PPM1K: NM_152542.5(PPM1K):c.586C>T (p.Arg196Ter) ()
🧬 PPM1K: NM_152542.5(PPM1K):c.*3330G>T ()
🧬 PPM1K: NM_152542.5(PPM1K):c.1A>G (p.Met1Val) ()
🧬 PPM1K: GRCh37/hg19 4q21.21-22.3(chr4:81558759-95965995)x1 ()
🧬 PPM1K: GRCh37/hg19 4q21.23-22.3(chr4:85139670-96295033)x3 ()
Ver todas no ClinVar

Diagnóstico

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Onde tratar no SUS

Hospitais de referência no Brasil e o protocolo oficial do SUS (PCDT)

🇧🇷 Atendimento SUS — Doença da urina xarope de bordo intermediária

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Ensaios clínicos abertos e novidades científicas recentes

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Publicações mais relevantes

Timeline de publicações
2 papers (10 anos)
#1

Two Novel Mutations in the BCKDHB Gene Cause Intermediate Maple Syrup Urine Disease.

Annals of Indian Academy of Neurology2024 Nov 01
#2

Challenges in Diagnosing Intermediate Maple Syrup Urine Disease by Newborn Screening and Functional Validation of Genomic Results Imperative for Reproductive Family Planning.

International journal of neonatal screening2021 May 14

Maple syrup urine disease is caused by a deficiency of branched-chain alpha-ketoacid dehydrogenase, responsible for degradation of leucine, isoleucine, and valine. Biallelic pathogenic variants in BCKDHA, BCKDHB, or DBT genes result in enzyme deficiency. We report the case of a female infant who presented with mild gross motor delay at 4 months, and seizures with hypoglycaemia at 5 months. Newborn screening returned total leucine/isoleucine at the 99.5th centile of the population; however, as second-tier testing reported minimal alloisoleucine, the results were considered inconsistent with MSUD. Plasma amino acid and urine organic acid analyses at 5 months were, however, consistent with a diagnosis of MSUD. A brain MRI showed bilateral symmetrical T2 hyperintense signal abnormalities involving white matter, globus pallidus, thalamus, brainstem, and dentate nuclei with restricted diffusion. A repeat MRI 10 months post-dietary-intervention showed the resolution of these changes and progression in myelination. Her clinical phenotype, including protein tolerance, correlated with intermediate MSUD. Molecular analysis of all three genes identified two variants of uncertain significance, c.434-15_434-4del and c.365A>G (p. Tyr122Cys) in the DBT gene. The rate of leucine decarboxylation in fibroblasts was reduced, but not to the extent observed in classical MSUD patients, supporting an intermediate form of MSUD. Previously reported mRNA splicing studies supported a deleterious effect of the c.434-15_434-4del variant. This functional evidence and confirmation that the variants were in trans, permitted their reclassification as pathogenic and likely pathogenic, respectively, facilitating subsequent prenatal testing. This report highlights the challenges in identifying intermediate MSUD by newborn screening, reinforcing the importance of functional studies to confirm variant pathogenicity in this era of molecular diagnostics.

Publicações recentes

Ver todas no PubMed

Associações

Organizações que acompanham esta doença — pra ter apoio e orientação

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Comunidades

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Doenças relacionadas

Doenças com sintomas parecidos — ajudam quem ainda está buscando diagnóstico

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Referências e fontes

Bases de dados externas citadas neste artigo

Publicações científicas

Artigos indexados no PubMed ligados a esta doença no grafo RarasNet — título, periódico e PMID direto da fonte, sem intermediação de IA.

  1. Two Novel Mutations in the BCKDHB Gene Cause Intermediate Maple Syrup Urine Disease.
    Annals of Indian Academy of Neurology· 2024· PMID 39363617mais citado
  2. Challenges in Diagnosing Intermediate Maple Syrup Urine Disease by Newborn Screening and Functional Validation of Genomic Results Imperative for Reproductive Family Planning.
    International journal of neonatal screening· 2021· PMID 34069211mais citado
  3. Improved amino acid, bioenergetic metabolite and neurotransmitter profiles following human amnion epithelial cell transplant in intermediate maple syrup urine disease mice.
    Mol Genet Metab· 2013· PMID 23566440recente
  4. Placental stem cell correction of murine intermediate maple syrup urine disease.
    Hepatology· 2013· PMID 23175463recente
  5. Hepatocyte transplantation (HTx) corrects selected neurometabolic abnormalities in murine intermediate maple syrup urine disease (iMSUD).
    Biochim Biophys Acta· 2009· PMID 19699299recente

Bases de dados e fontes oficiais

Identificadores e referências canônicas usadas para montar este verbete.

  1. ORPHA:268162(Orphanet)
  2. MONDO:0017052(MONDO)
  3. GARD:17264(GARD (NIH))
  4. Variantes catalogadas(ClinVar)
  5. Busca completa no PubMed(PubMed)
  6. Q56013922(Wikidata)

Dados compilados pelo RarasNet a partir de fontes abertas (Orphanet, OMIM, MONDO, PubMed/EuropePMC, ClinicalTrials.gov, DATASUS, PCDT/MS). Este conteúdo é informativo e não substitui avaliação médica.

Conteúdo mantido por Agente Raras · Médicos e pesquisadores podem colaborar

Doença da urina xarope de bordo intermediária
Compêndio · Raras BR

Doença da urina xarope de bordo intermediária

ORPHA:268162 · MONDO:0017052
🇧🇷 Brasil SUS
Triagem
MS/MS (espectrometria de massas em tandem)
PNTN
Fase 2
Incidência BR
1:10.000 (coletivo)
Geral
Prevalência
1-9 / 1 000 000
Herança
Autosomal recessive
CID-10
E71.0 · Doença da urina em xarope de ácer (ou bordo) (Maple-syrup urine disease)
CID-11
Início
Infancy, Neonatal
Prevalência
0.0 (Europe)
MedGen
UMLS
C1621920
EuropePMC
Wikidata
Papers 10a
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