Reviewed May 2013
What is mitochondrial trifunctional protein deficiency?
Mitochondrial trifunctional protein deficiency is a rare condition that prevents the body from converting certain fats to energy, particularly during periods without food (fasting).
Signs and symptoms of mitochondrial trifunctional protein deficiency may begin during infancy or later in life. Features that occur during infancy include feeding difficulties, lack of energy (lethargy), low blood sugar (hypoglycemia), weak muscle tone (hypotonia), and liver problems. Infants with this disorder are also at high risk for serious heart problems, breathing difficulties, coma, and sudden death. Signs and symptoms of mitochondrial trifunctional protein deficiency that may begin after infancy include hypotonia, muscle pain, a breakdown of muscle tissue, and a loss of sensation in the extremities (peripheral neuropathy).
Problems related to mitochondrial trifunctional protein deficiency can be triggered by periods of fasting or by illnesses such as viral infections. This disorder is sometimes mistaken for Reye syndrome, a severe disorder that may develop in children while they appear to be recovering from viral infections such as chicken pox or flu. Most cases of Reye syndrome are associated with the use of aspirin during these viral infections.
How common is mitochondrial trifunctional protein deficiency?
Mitochondrial trifunctional protein deficiency is a rare disorder; its incidence is unknown.
What genes are related to mitochondrial trifunctional protein deficiency?
Mutations in the HADHA and HADHB genes cause mitochondrial trifunctional protein deficiency. These genes each provide instructions for making part of an enzyme complex called mitochondrial trifunctional protein. This enzyme complex functions in mitochondria, the energy-producing centers within cells. As the name suggests, mitochondrial trifunctional protein contains three enzymes that each perform a different function. This enzyme complex is required to break down (metabolize) a group of fats called long-chain fatty acids. Long-chain fatty acids are found in foods such as milk and certain oils. These fatty acids are stored in the body's fat tissues. Fatty acids are a major source of energy for the heart and muscles. During periods of fasting, fatty acids are also an important energy source for the liver and other tissues.
Mutations in the HADHA or HADHB genes that cause mitochondrial trifunctional protein deficiency disrupt all three functions of this enzyme complex. Without enough of this enzyme complex, long-chain fatty acids from food and body fat cannot be metabolized and processed. As a result, these fatty acids are not converted to energy, which can lead to some features of this disorder, such as lethargy and hypoglycemia. Long-chain fatty acids or partially metabolized fatty acids may also build up and damage the liver, heart, and muscles. This abnormal buildup causes the other signs and symptoms of mitochondrial trifunctional protein deficiency.
Changes in these genes are associated with mitochondrial trifunctional protein deficiency.
How do people inherit mitochondrial trifunctional protein deficiency?
This condition is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition.
Where can I find information about diagnosis or management of mitochondrial trifunctional protein deficiency?
These resources address the diagnosis or management of mitochondrial trifunctional protein deficiency and may include treatment providers.
- Baby's First Test (http://www.babysfirsttest.org/newborn-screening/conditions/trifunctional-protein-deficiency)
- Genetic Testing Registry: Mitochondrial trifunctional protein deficiency (http://www.ncbi.nlm.nih.gov/gtr/conditions/C0342786)
- MedlinePlus Encyclopedia: Hypoglycemia (https://www.nlm.nih.gov/medlineplus/ency/article/000386.htm)
- MedlinePlus Encyclopedia: Peripheral Neuropathy (https://www.nlm.nih.gov/medlineplus/ency/article/000593.htm)
You might also find information on the diagnosis or management of mitochondrial trifunctional protein deficiency in
Educational resources and Patient support.
General information about the diagnosis (http://ghr.nlm.nih.gov/handbook/consult/diagnosis) and management (http://ghr.nlm.nih.gov/handbook/consult/treatment) of genetic conditions is available in the Handbook.
Read more about genetic testing (http://ghr.nlm.nih.gov/handbook/testing), particularly the difference between clinical tests and research tests (http://ghr.nlm.nih.gov/handbook/testing/researchtesting).
To locate a healthcare provider, see How can I find a genetics professional in my area? (http://ghr.nlm.nih.gov/handbook/consult/findingprofessional) in the Handbook.
Where can I find additional information about mitochondrial trifunctional protein deficiency?
You may find the following resources about mitochondrial trifunctional protein deficiency helpful. These materials are written for the general public.
MedlinePlus - Health information
- Encyclopedia: Hypoglycemia (https://www.nlm.nih.gov/medlineplus/ency/article/000386.htm)
- Encyclopedia: Peripheral Neuropathy (https://www.nlm.nih.gov/medlineplus/ency/article/000593.htm)
- Health Topic: Metabolic Disorders (https://www.nlm.nih.gov/medlineplus/metabolicdisorders.html)
- Health Topic: Newborn Screening (https://www.nlm.nih.gov/medlineplus/newbornscreening.html)
Educational resources - Information pages
- Illinois Department of Public Health (http://www.idph.state.il.us/HealthWellness/fs/mcad.htm)
- Orphanet: Mitochondrial trifunctional protein deficiency (http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=EN&Expert=746)
- Screening, Technology, and Research in Genetics (http://www.newbornscreening.info/Parents/fattyaciddisorders/TFP.html)
- Virginia Department of Health (http://www.vdh.virginia.gov/livewell/programs/dbsns/documents/Parent%20Fact%20Sheet_TFP_English.pdf)
Patient support - For patients and families
- Children's Mitochondrial Disease Network (UK) (http://www.emdn-mitonet.co.uk/)
- Children Living with Inherited Metabolic Diseases (CLIMB) (http://www.climb.org.uk/)
- FOD (Fatty Oxidation Disorders) Family Support Group (http://www.fodsupport.org/)
- United Mitochondrial Disease Foundation (http://www.umdf.org/site/c.8qKOJ0MvF7LUG/b.7929671/k.BDF0/Home.htm)
You may also be interested in these resources, which are designed for healthcare professionals and researchers.
Genetic Testing Registry - Repository of genetic test information
- Genetic Testing Registry: Mitochondrial trifunctional protein deficiency (http://www.ncbi.nlm.nih.gov/gtr/conditions/C0342786)
ACT Sheets - Newborn screening follow up
- Elevated C16-OH +/- C18:1-OH and Other Long Chain Acylcarnitines (http://www.ncbi.nlm.nih.gov/books/NBK55827/bin/C16-OH.pdf)
- ClinicalTrials.gov - Linking patients to medical research (https://clinicaltrials.gov/ct2/results?cond=%22mitochondrial%20trifunctional%20protein%20deficiency%22)
- PubMed - Recent literature (http://www.ncbi.nlm.nih.gov/pubmed?term=%28%28mitochondrial%20trifunctional%20protein%20deficiency%5BTIAB%5D%29%20OR%20%28TFP%20deficiency%5BTIAB%5D%29%29%20AND%20english%5Bla%5D%20AND%20human%5Bmh%5D%20AND%20%22last%203600%20days%22%5Bdp%5D)
- OMIM - Genetic disorder catalog (http://omim.org/entry/609015)
What other names do people use for mitochondrial trifunctional protein deficiency?
- MTP deficiency
- TFP deficiency
- TPA deficiency
- trifunctional protein deficiency, type 2
For more information about naming genetic conditions, see the Genetics Home Reference
Condition Naming Guidelines (http://ghr.nlm.nih.gov/ConditionNameGuide)
How are genetic conditions and genes named? (http://ghr.nlm.nih.gov/handbook/mutationsanddisorders/naming) in the Handbook.
What if I still have specific questions about mitochondrial trifunctional protein deficiency?
Ask the Genetic and Rare Diseases Information Center (https://rarediseases.info.nih.gov/gard).
What glossary definitions help with understanding mitochondrial trifunctional protein deficiency?
autosomal recessive ;
fatty acids ;
muscle tone ;
newborn screening ;
peripheral neuropathy ;
You may find definitions for these and many other terms in the Genetics Home Reference
- Angdisen J, Moore VD, Cline JM, Payne RM, Ibdah JA. Mitochondrial trifunctional protein defects: molecular basis and novel therapeutic approaches. Curr Drug Targets Immune Endocr Metabol Disord. 2005 Mar;5(1):27-40. Review. (http://www.ncbi.nlm.nih.gov/pubmed/15777202?dopt=Abstract)
- Boutron A, Acquaviva C, Vianey-Saban C, de Lonlay P, de Baulny HO, Guffon N, Dobbelaere D, Feillet F, Labarthe F, Lamireau D, Cano A, de Villemeur TB, Munnich A, Saudubray JM, Rabier D, Rigal O, Brivet M. Comprehensive cDNA study and quantitative analysis of mutant HADHA and HADHB transcripts in a French cohort of 52 patients with mitochondrial trifunctional protein deficiency. Mol Genet Metab. 2011 Aug;103(4):341-8. doi: 10.1016/j.ymgme.2011.04.006. Epub 2011 Apr 19. (http://www.ncbi.nlm.nih.gov/pubmed/21549624?dopt=Abstract)
- Choi JH, Yoon HR, Kim GH, Park SJ, Shin YL, Yoo HW. Identification of novel mutations of the HADHA and HADHB genes in patients with mitochondrial trifunctional protein deficiency. Int J Mol Med. 2007 Jan;19(1):81-7. (http://www.ncbi.nlm.nih.gov/pubmed/17143551?dopt=Abstract)
- den Boer ME, Dionisi-Vici C, Chakrapani A, van Thuijl AO, Wanders RJ, Wijburg FA. Mitochondrial trifunctional protein deficiency: a severe fatty acid oxidation disorder with cardiac and neurologic involvement. J Pediatr. 2003 Jun;142(6):684-9. (http://www.ncbi.nlm.nih.gov/pubmed/12838198?dopt=Abstract)
- Gillingham MB, Purnell JQ, Jordan J, Stadler D, Haqq AM, Harding CO. Effects of higher dietary protein intake on energy balance and metabolic control in children with long-chain 3-hydroxy acyl-CoA dehydrogenase (LCHAD) or trifunctional protein (TFP) deficiency. Mol Genet Metab. 2007 Jan;90(1):64-9. Epub 2006 Sep 22. (http://www.ncbi.nlm.nih.gov/pubmed/16996288?dopt=Abstract)
- Oey NA, den Boer ME, Wijburg FA, Vekemans M, Augé J, Steiner C, Wanders RJ, Waterham HR, Ruiter JP, Attié-Bitach T. Long-chain fatty acid oxidation during early human development. Pediatr Res. 2005 Jun;57(6):755-9. Epub 2005 Apr 21. (http://www.ncbi.nlm.nih.gov/pubmed/15845636?dopt=Abstract)
- Sperk A, Mueller M, Spiekerkoetter U. Outcome in six patients with mitochondrial trifunctional protein disorders identified by newborn screening. Mol Genet Metab. 2010 Oct-Nov;101(2-3):205-7. doi: 10.1016/j.ymgme.2010.07.003. Epub 2010 Jul 24. (http://www.ncbi.nlm.nih.gov/pubmed/20659813?dopt=Abstract)
- Spiekerkoetter U, Khuchua Z, Yue Z, Bennett MJ, Strauss AW. General mitochondrial trifunctional protein (TFP) deficiency as a result of either alpha- or beta-subunit mutations exhibits similar phenotypes because mutations in either subunit alter TFP complex expression and subunit turnover. Pediatr Res. 2004 Feb;55(2):190-6. Epub 2003 Nov 19. (http://www.ncbi.nlm.nih.gov/pubmed/14630990?dopt=Abstract)
- Spiekerkoetter U, Lindner M, Santer R, Grotzke M, Baumgartner MR, Boehles H, Das A, Haase C, Hennermann JB, Karall D, de Klerk H, Knerr I, Koch HG, Plecko B, Röschinger W, Schwab KO, Scheible D, Wijburg FA, Zschocke J, Mayatepek E, Wendel U. Management and outcome in 75 individuals with long-chain fatty acid oxidation defects: results from a workshop. J Inherit Metab Dis. 2009 Aug;32(4):488-97. doi: 10.1007/s10545-009-1125-9. Epub 2009 Apr 29. (http://www.ncbi.nlm.nih.gov/pubmed/19399638?dopt=Abstract)
- Spiekerkoetter U, Mueller M, Cloppenburg E, Motz R, Mayatepek E, Bueltmann B, Korenke C. Intrauterine cardiomyopathy and cardiac mitochondrial proliferation in mitochondrial trifunctional protein (TFP) deficiency. Mol Genet Metab. 2008 Aug;94(4):428-30. doi: 10.1016/j.ymgme.2008.04.002. Epub 2008 May 15. (http://www.ncbi.nlm.nih.gov/pubmed/18485779?dopt=Abstract)
- Spiekerkoetter U, Sun B, Khuchua Z, Bennett MJ, Strauss AW. Molecular and phenotypic heterogeneity in mitochondrial trifunctional protein deficiency due to beta-subunit mutations. Hum Mutat. 2003 Jun;21(6):598-607. (http://www.ncbi.nlm.nih.gov/pubmed/12754706?dopt=Abstract)
- Spierkerkoetter U, Khuchua Z, Yue Z, Strauss AW. The early-onset phenotype of mitochondrial trifunctional protein deficiency: a lethal disorder with multiple tissue involvement. J Inherit Metab Dis. 2004;27(2):294-6. (http://www.ncbi.nlm.nih.gov/pubmed/15243991?dopt=Abstract)
The resources on this site should not be used as a substitute for
professional medical care or advice. Users seeking information about
a personal genetic disease, syndrome, or condition should consult with a qualified
See How can I find a genetics professional in my area? (http://ghr.nlm.nih.gov/handbook/consult/findingprofessional) in the Handbook.