S-220 Chapter 18 Amino Acid Oxidation and the Production of Urea
Answer
Data Analysis Problem
20. Maple Syrup Urine Disease Figure 18–28 shows the pathway for the degradation of branched-chain
amino acids and the site of the biochemical defect that causes maple syrup urine disease. The initial
findings that eventually led to the discovery of the defect in this disease were presented in three pa-
pers published in the late 1950s and early 1960s. This problem traces the history of the findings from
initial clinical observations to proposal of a biochemical mechanism.
Menkes, Hurst, and Craig (1954) presented the cases of four siblings, all of whom died following a
similar course of symptoms. In all four cases, the mother’s pregnancy and the birth had been normal.
The first 3 to 5 days of each child’s life were also normal. But soon thereafter each child began having
convulsions, and the children died between the ages of 11 days and 3 months. Autopsy showed consid-
erable swelling of the brain in all cases. The children’s urine had a strong, unusual “maple syrup” odor,
starting from about the third day of life.
Menkes (1959) reported data collected from six more children. All showed symptoms similar
to those described above, and died within 15 days to 20 months of birth. In one case, Menkes was able
to obtain urine samples during the last months of the infant’s life. When he treated the urine with
2,4-dinitrophenylhydrazone, which forms colored precipitates with keto compounds, he found three
␣-keto acids in unusually large amounts:
(a) These ␣-keto acids are produced by the deamination of amino acids. For each of the ␣-keto acids
above, draw and name the amino acid from which it was derived.
Dancis, Levitz, and Westall (1960) collected further data that led them to propose the biochemical
defect shown in Figure 18–28. In one case, they examined a patient whose urine first showed the
maple syrup odor when he was 4 months old. At the age of 10 months (March 1956), the child was
admitted to the hospital because he had a fever, and he showed grossly retarded motor development.