Very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency

About the condition VLCAD deficiency is a long-chain fatty acid oxidation disorder. It is a hereditary disease that is caused by a missing enzyme complex needed to convert fat into energy.
Inheritance Autosomal recessive
Year screening started in WA 2005
Incidence in Australia Currently unknown
Enzyme defect Deficiency of very long-chain acyl-CoA dehydrogenase, an enzyme that participates in fatty acid oxidation
Symptoms if untreated
  • Hypoketotic hypoglycaemia
  • Cardiomyopathy
  • Hepatomegaly
  • Rhabdomyolysis
  • Sudden death possible
  • Adult-onset myopathy
Metabolites on bloodspot screening
  • Increased long-chain acylcarnitines (C14:1 and C14)
  • Increased C14:1/C2 ratio
Diagnostic tests
  • Plasma acylcarnitine profile
  • Urine organic acids
  • Lymphocyte VLCAD enzymology
  • ACADVL gene analysis
Treatment
  • High-carbohydrate, low-fat diet
  • Avoidance of long-chain fatty acids
  • Medium-chain triglyceride supplementation
  • Cornstarch supplementation
  • Possible carnitine supplementation
  • Avoidance of fasting
  • IV glucose during illness
Screening issues Later-onset and milder variants occur.