DLD

At least 17 mutations in the DLD gene have been found to cause dihydrolipoamide dehydrogenase deficiency. The signs and symptoms of this severe condition vary widely, but they most commonly include a potentially life-threatening buildup of lactic acid in the tissues (lactic acidosis), neurological problems, and liver disease.

Most DLD mutations change single amino acids in dihydrolipoamide dehydrogenase, which prevents the BCKD, PDH, and αKGDH enzyme complexes from functioning normally. Impairment of BCKD function leads to a buildup of valine, isoleucine, and leucine and their byproducts in the body. This accumulation is toxic to cells and tissues, particularly in the nervous system, and contributes to neurological problems in people with dihydrolipoamide dehydrogenase deficiency. A reduction in pyruvate dehydrogenase function results in buildup of pyruvate, which is converted in another chemical reaction to lactic acid, contributing to lactic acidosis in affected individuals. Impairment of αKGDH leads to the accumulation of alpha-ketoglutarate and likely also contributes to lactic acidosis. Reduced function of these three enzyme complexes also diminishes the production of cellular energy. The brain, which requires especially large amounts of energy, is severely affected, resulting in the neurological problems associated with dihydrolipoamide dehydrogenase deficiency. Liver problems are likely also related to decreased energy production in cells. The degree of impairment of each complex contributes to the variability in the features of this condition.

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