Biotinidase deficiency

General Information (adopted from Orphanet):

Synonyms, Signs: MULTIPLE CARBOXYLASE DEFICIENCY, JUVENILE-ONSET
Late-onset multiple carboxylase deficiency
Juvenile-onset multiple carboxylase deficiency
btd deficiency
Number of Symptoms 50
OrphanetNr: 79241
OMIM Id: 253260
ICD-10: E53.8
UMLs:
MeSH:
MedDRA:
Snomed:

Prevalence, inheritance and age of onset:

Prevalence: No data available.
Inheritance: Autosomal recessive
[Orphanet]
Age of onset: Neonatal
Infancy
[Orphanet]

Disease classification (adopted from Orphanet):

Parent Diseases: Disorder of other vitamins and cofactors metabolism and transport
 -Rare genetic disease
Multiple carboxylase deficiency
 -Rare genetic disease
 -Rare skin disease
Rare hereditary metabolic disease with peripheral neuropathy
 -Rare genetic disease
 -Rare neurologic disease

Symptom Information: Sort by abundance 

1
(HPO:0001992) Organic aciduria 28 / 7739
2
(HPO:0000648) Optic atrophy 238 / 7739
3
(HPO:0001123) Visual field defect Occasional [Orphanet] 30 / 7739
4
(HPO:0000509) Conjunctivitis 47 / 7739
5
(HPO:0000618) Blindness 124 / 7739
6
(HPO:0000545) Myopia Occasional [Orphanet] 286 / 7739
7
(HPO:0000572) Visual loss 272 / 7739
8
(HPO:0000510) Rod-cone dystrophy Occasional [Orphanet] 266 / 7739
9
(HPO:0100533) Inflammatory abnormality of the eye Frequent [Orphanet] 70 / 7739
10
(HPO:0000407) Sensorineural hearing impairment 524 / 7739
11
(HPO:0000365) Hearing impairment Frequent [Orphanet] 539 / 7739
12
(HPO:0001254) Lethargy 104 / 7739
13
(HPO:0001276) Hypertonia Occasional [Orphanet] 317 / 7739
14
(HPO:0001263) Global developmental delay 853 / 7739
15
(HPO:0001251) Ataxia 413 / 7739
16
(HPO:0002066) Gait ataxia Frequent [Orphanet] 327 / 7739
17
(HPO:0001250) Seizures Very frequent [Orphanet] 1245 / 7739
18
(HPO:0004372) Reduced consciousness/confusion Occasional [Orphanet] 73 / 7739
19
(HPO:0002014) Diarrhea 225 / 7739
20
(HPO:0002013) Vomiting 191 / 7739
21
(HPO:0008872) Feeding difficulties in infancy 153 / 7739
22
(HPO:0011968) Feeding difficulties 240 / 7739
23
(HPO:0002240) Hepatomegaly 467 / 7739
24
(HPO:0001744) Splenomegaly 337 / 7739
25
(HPO:0004325) Decreased body weight Occasional [Orphanet] 492 / 7739
26
(HPO:0001581) Recurrent skin infections 9 / 7739
27
(HPO:0001051) Seborrheic dermatitis 25 / 7739
28
(HPO:0010783) Erythema Frequent [Orphanet] 138 / 7739
29
(HPO:0001006) Hypotrichosis Very frequent [Orphanet] 219 / 7739
30
(HPO:0000988) Skin rash Frequent [Orphanet] 98 / 7739
31
(HPO:0000958) Dry skin Frequent [Orphanet] 152 / 7739
32
(HPO:0200042) Skin ulcer Occasional [Orphanet] 138 / 7739
33
(HPO:0001596) Alopecia Frequent [Orphanet] 162 / 7739
34
(HPO:0001987) Hyperammonemia 50 / 7739
35
(HPO:0005979) Metabolic ketoacidosis 4 / 7739
36
(HPO:0002093) Respiratory insufficiency Occasional [Orphanet] 410 / 7739
37
(HPO:0002104) Apnea 106 / 7739
38
(HPO:0002789) Tachypnea 48 / 7739
39
(HPO:0010547) Muscle flaccidity 466 / 7739
40
(HPO:0001252) Muscular hypotonia Occasional [Orphanet] 990 / 7739
41
(HPO:0008947) Infantile muscular hypotonia 482 / 7739
42
(HPO:0001324) Muscle weakness Occasional [Orphanet] 859 / 7739
43
(HPO:0000007) Autosomal recessive inheritance 2538 / 7739
44
(OMIM) Mild hyperammonemia 1 / 7739
45
(HPO:0002506) Diffuse cerebral atrophy 9 / 7739
46
(HPO:0100275) Diffuse cerebellar atrophy 2 / 7739
47
(HPO:0002334) Abnormality of the cerebellar vermis Occasional [Orphanet] 137 / 7739
48
(MedDRA:10071434) Biotinidase deficiency 1 / 7739
49
(OMIM) Breathing problems 1 / 7739
50
(HPO:0012795) Abnormality of the optic disc Frequent [Orphanet] 187 / 7739

Associated genes:

ClinVar (via SNiPA)

Gene symbol Variation Clinical significance Reference

Additional Information:

Description: (OMIM) Multiple carboxylase deficiency (MCD) is an autosomal recessive metabolic disorder characterized primarily by cutaneous and neurologic abnormalities. Symptoms result from the patient's inability to reutilize biotin, a necessary nutrient. Sweetman (1981) recognized that multiple carboxylase deficiency could be ...
Clinical Description OMIM Gompertz et al. (1971) reported a patient with biotin-responsive beta-methylcrotonylglycinuria who had a deficiency of 3-methylcrotonyl-CoA carboxylase (Gompertz et al., 1973). On restudy of this patient, Sweetman et al. (1977) found that the patient was severely ketoacidotic, responded ...
Genotype-Phenotype Correlations OMIM Sivri et al. (2007) reported 20 Turkish patients with biotinidase deficiency. All except 1 were born of consanguineous parents. Variable hearing loss was present in 11 (55%) children. There were no significant differences in mean age of onset ...
Molecular genetics OMIM In 10 of 25 patients with biotinidase deficiency, Pomponio et al. (1995) identified an allele with a 7-bp deletion and a 3-bp insertion in the BTD gene (609019.0001). In 37 symptomatic children (30 index cases and 7 sibs) ...
Population genetics OMIM - Newborn Screening

Newborn screening for biotinidase deficiency identifies children with profound biotinidase deficiency (less than 10% of mean normal serum activity) and those with partial biotinidase deficiency (10 to 30% of mean normal serum activity). ...

Diagnosis GeneReviews Biotinidase deficiency is suspected in the presence of the following characteristic symptoms and is confirmed by enzymatic testing. Clinical issues and frequently asked questions about biotinidase deficiency have been addressed in a recent review [Wolf 2010]. ...
Clinical Description GeneReviews Individuals with biotinidase deficiency who are diagnosed before they have developed symptoms (e.g., by newborn screening) and who are treated with biotin have normal development. Neurologic problems occur only in those individuals with biotinidase deficiency who have recurrent symptoms and metabolic compromise prior to biotin treatment....
Genotype-Phenotype Correlations GeneReviews Genotype/phenotype correlations are not well established. Deletions, insertions, or nonsense mutations usually result in complete absence of biotinidase enzyme activity, whereas missense mutations may or may not result in complete loss of biotinidase enzyme activity. Those with absence of all biotinidase enzyme activity are likely to be at increased risk for earlier onset of symptoms. Regardless of their molecular genetic test results, all individuals with deficient biotinidase enzyme activity require biotin treatment....
Differential Diagnosis GeneReviews Clinical features, such as vomiting, hypotonia, and seizures accompanied by metabolic ketolactic acidosis or mild hyperammonemia, are often observed in inherited metabolic diseases. Individuals with biotinidase deficiency may exhibit clinical features that are misdiagnosed as other disorders, such as isolated carboxylase deficiency, before they are correctly identified [Suormala et al 1985, Wolf 1992]. Other symptoms that are more characteristic of biotinidase deficiency (e.g., skin rash, alopecia) can also occur in children with nutritional biotin deficiency, holocarboxylase synthetase deficiency, zinc deficiency, or essential fatty acid deficiency....
Management GeneReviews To establish the extent of disease in an individual diagnosed with biotinidase deficiency, the following evaluations are recommended:...
Molecular genetics GeneReviews Information in the Molecular Genetics and OMIM tables may differ from that elsewhere in the GeneReview: tables may contain more recent information. —ED....