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Methylmalonic acidemia without homocystinuria

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Disease definition

Methylmalonic acidemia is an inborn error of vitamin B12 metabolism characterized by gastrointestinal and neurometabolic manifestations resulting from decreased function of the mitochondrial enzyme methylmalonyl-CoA mutase.

ORPHA:293355

Classification level: Group of disorders

Synonym(s):
  • Methylmalonic aciduria without homocystinuria

Prevalence: 1-9 / 100 000

Inheritance: Autosomal dominant, Autosomal recessive, X-linked dominant

Age of onset: All ages

UMLS: C5848400

Summary
Epidemiology

Prevalence of methylmalonic acidemia has been estimated at 1/48,000 to 1/61,000 in North America, and at 1/26,000 in China (these values may include patients with methylmalonic acidemia with homocystinuria).

Clinical description

Clinical signs include lethargy, failure to thrive, recurrent vomiting, dehydration, respiratory distress, and muscle hypotonia, as well as developmental delay, intellectual deficit, hepatomegaly and coma. Long-term consequences of the disorder include neurological damage due to metabolic stroke affecting the brain stem, and end stage renal failure. The disease can either be responsive or unresponsive to treatment with vitamin B12 (vitamin B12-responsive or unresponsive methylmalonic acidemia). Patients with mut0 or cblB tend to be more severely affected than patients with cblA, cblDv2 or mut-.

Etiology

Vitamin B12-responsive methylmalonic acidemia is caused by defects in the synthesis of adenosylcobalamin (AdoCbl) that result from genetic defects in cobalamin metabolism (cblA, cblB or cblD variant 2 [cblDv2]). Vitamin B12-unresponsive methylmalonic acidemia is caused by complete (mut0) or partial (mut-) deficiency in the activity of the mitochondrial enzyme methylmalonyl-CoA mutase. cblA is caused by mutations in the MMAA gene (4q31.1-2), cblB by mutations in the MMAB gene (12q24.1), cblDv2 by mutations in the MMADHC gene (2q23.2), and mut0 and mut- by mutations in the MUT gene (6p21), and all are transmitted in an autosomal recessive manner. The previously reported cblH disorder is now known to be cblDv2.

Last update: March 2012 - Expert reviewer(s): Dr David ROSENBLATT
A summary on this disease is available in Français, Español, Deutsch, Italiano, Português, Nederlands
Detailed information

Logo ERN: produced/endorsed by ERN(s) Logo FSMR: produced/endorsed by FSMR(s)

Guidelines
Emergency guidelines
English (2012.pdf) - Brit Inher Metab Dis Group
Anesthesia guidelines
English (2017) - Orphananesthesia
Čeština (2017) - Orphananesthesia
Clinical practice guidelines
English (2024) - Kidney Int Rep
English (2025) - Kidney Int Rep
English (2021) - J Inherit Metab Dis Logo ERN
English (2014) - Orphanet J Rare Dis
Disease review articles
Clinical genetics review
English (2022) - GeneReviews
The documents contained in this website are presented for information purposes only. The material is in no way intended to replace professional medical care by a qualified specialist and should not be used as a basis for diagnosis or treatment.