2-Hydroxyisovaleric Acid

Organic acids are a broad class of organic compounds possessing acidic properties, commonly produced as metabolic byproducts.

2-hydroxyisovaleric acid is an organic acid metabolite derived from the breakdown of the branched-chain amino acid leucine.  This process, primarily occurring in muscle and connective tissues, is catalyzed by the enzyme branched-chain aminotransferase (BCAT), producing α-Ketoisocaproic acid which is then converted into 2-hydroxyisocaproic acid and, finally, 2-hydroxyisovaleric acid.

This acid is not only a key player in normal metabolic functions but also in disease states such as Maple Syrup Urine Disease (MSUD), where its levels can become markedly elevated, leading to serious health issues.  

In clinical contexts, monitoring 2-hydroxyisovaleric acid levels can provide insights into metabolic health and the efficiency of amino acid utilization.

What Are Organic Acids?  [3., 4.]

Organic acids are organic compounds with acidic properties.  They include a variety of functional groups like carboxyl, phenol, enol, and thiol, with carboxylic acids having the strongest acidity.

Organic acids are considered weak acids, with those containing phenol, enol, alcohol, or thiol groups being even weaker.  

Their structures vary in terms of carbon chain types—aromatic, aliphatic, alicyclic, heterocyclic—saturation, substitutions, and the number of functional groups. 

These acids play critical roles in metabolic and catabolic pathways, notably in the tricarboxylic acid cycle inside mitochondria, which is central to energy production in eukaryotes.  They are also pivotal in determining the sensory properties of fruits and vegetables.

Organic Acid Disorders  [2., 13.]

Organic acid disorders are inherited metabolic conditions that affect the enzymes or transport proteins essential for the breakdown of amino acids, lipids, or carbohydrates. They are marked by the excessive excretion of non-amino organic acids in urine, primarily due to defects in specific enzymes involved in amino acid breakdown that cause buildup of organic acids in tissues.

Conditions can manifest as inborn metabolic disorders of organic acids and amino acids, urea cycle anomalies, and mitochondrial respiratory chain deficiencies.

These disorders are typically passed down through autosomal recessive inheritance.  They often present in newborns with symptoms like vomiting and lethargy, progressing to more severe neurological symptoms. 

Early diagnosis and intervention are critical and can improve outcomes. Diagnostic methods include urine organic acid analysis via gas chromatography-mass spectrometry (GC/MS). 

Current treatments focus on managing symptoms and preventing complications, although definitive therapies are still under research.  Treatment focuses may include dietary management, detoxifying harmful metabolites, and in severe cases, organ transplantation. 

Continuous monitoring and management are essential for managing symptoms and preventing complications.

Organic Acids and the Microbiome  [7.]

Increasingly, research highlights new relationships between the microbiome and human health.  Many organisms that comprise the microbiome produce organic acids that can then be tested for additional diagnostic capability.  

Certain organic acids in urine like hippuric acid, benzoic acid, and indoleacetic acid are metabolites produced by gut bacteria from the breakdown of amino acids, dietary polyphenols, and other substances. 

These acids provide insights into gut health and metabolic functions.  For example, elevated levels of certain acids may indicate gut dysbiosis or specific metabolic imbalances, such as phenylketonuria. 

Some organic acids known to be produced by the microbiome include: 

Benzoic Acid (BA): 

Produced from phenylalanine and polyphenol metabolism by intestinal bacteria. High levels in urine can indicate glycine deficiency or liver dysfunction.

Hippuric Acid (HA):

Formed in the liver by conjugation of benzoic acid with glycine. Elevated levels may indicate exposure to environmental toxins like toluene.

Phenylacetic Acid (PAA) and Phenylpropionic Acid (PPA): 

These acids result from phenylalanine metabolism by gut bacteria. High urinary levels can suggest dysbiosis or disorders like phenylketonuria. PAA is also associated with depression markers.

4-Hydroxybenzoic Acid (4-HBA) and 4-Hydroxyphenylacetic Acid (4-HPAA): 

Derivatives of tyrosine metabolism. 4-HBA is linked to catechin (green tea) metabolism, and 4-HPAA is useful in diagnosing small bowel diseases related to bacterial overgrowth.

3-Hydroxyphenylpropionic Acid (3-HPPA): 

A metabolite from dietary polyphenols like proanthocyanidins, indicative of robust bacterial metabolism in the intestines.

3,4-Dihydroxyphenyl Propionic Acid (3,4-DHPPA): 

Produced from dietary quinolones by clostridial species, with high levels suggesting an overgrowth.

3-Indoleacetic Acid (IAA): A breakdown product of tryptophan by gut bacteria such as Bifidobacterium and Bacteroides. Elevated levels are seen in conditions like phenylketonuria or dietary changes.

These organic acids are important markers in clinical diagnostics, helping to monitor metabolic disturbances, gut microbiota balance, and exposure to environmental toxins.

Their presence and concentration are influenced by diet, gut microbiota composition, and overall metabolic health, making them valuable indicators in clinical settings for assessing both metabolic and gastrointestinal conditions.

Understanding 2-Hydroxyisovaleric Acid

2-hydroxyisovaleric acid is a metabolite of leucine, a branched-chain amino acid.  

Leucine is converted to α-Ketoisocaproic acid by the enzyme branched-chain aminotransferase, which is then converted to 2-hydroxyisovaleric acid (HICA), also known as leucic acid, by the cytosolic enzyme α-ketoisocaproate oxygenase.  [12.]

In the final step, HICA is further metabolized to 2-hydroxyisovaleric acid.

2-Hydroxyisovaleric Acid in Health and Disease  

2-Hydroxyisovaleric Acid in Healthy Individuals

In people with healthy protein metabolism, 2-hydroxyisovaleric acid is produced as a normal metabolite of the branched-chain amino acid leucine.  2-hydroxyvaleric acid is an end product of leucine metabolism in human tissues such as muscle and connective tissue. 

Moderate increases in 2-hydroxyisovaleric acid may occur in situations like lactic acidosis or episodic ketosis, but significant elevations are more commonly associated with inherited metabolic disorders affecting branched-chain amino acid metabolism, particularly maple syrup urine disease (MSUD). 

In healthy individuals, 2-hydroxyisovaleric acid levels are expected to be low and not cause any clinical symptoms.

2-Hydroxyisovaleric Acid in Maple Syrup Urine Disease  [10.]

In maple syrup urine disease (MSUD), a genetic disorder affecting branched-chain amino acid metabolism, 2-hydroxyisovaleric acid levels can be significantly elevated in blood and urine.  [1.]

MSUD results from deficiencies in the branched-chain α-ketoacid dehydrogenase complex, which metabolizes leucine, isoleucine and valine.

Newborns with classical MSUD present within days of birth with metabolic ketoacidosis and progressive neurological decline.  Diagnosis requires quantitative amino acid analysis, which shows elevated branched-chain amino acids and the presence of alloisoleucine, a non-proteinogenic amino acid pathognomonic for MSUD. 

Urine organic acid analysis can detect elevated 2-hydroxyisovaleric acid and other keto and hydroxyacids of branched-chain amino acid metabolites.

Management aims to maintain leucine levels below 200 μM and isoleucine/valine below 400 μM. Leucine and its metabolites like 2-ketoisocaproic acid are thought to be primarily neurotoxic in MSUD.  [1.]

Cachexia and Leucine Supplementation  [5.]

Cachexia, often seen in severe illnesses like cancer, is characterized by muscle wasting due to an imbalance between protein synthesis and degradation.  

In this state, protein synthesis is suppressed, largely due to the activation of pathways that hinder the formation of necessary protein complexes required for the initiation and elongation phases of protein assembly.  

Specifically, there is a decreased activity in the mTOR pathway, which leads to reduced phosphorylation of several key proteins, such as 4E-BP1 and p70S6k, that facilitate protein synthesis. 

Concurrently, there's an increase in protein degradation through pathways activated by PKR (double-stranded-RNA-dependent protein kinase), which exacerbates muscle loss. 

Supplementation with branched-chain amino acids (BCAAs), particularly leucine, has shown potential in counteracting these effects.

Leucine not only enhances protein synthesis by stimulating mTOR and associated pathways, thereby promoting the formation of protein synthesis complexes but also mitigates the activation of degradation pathways, presenting a dual mechanism by which muscle mass can be preserved or potentially increased in cachectic conditions.

Organic Acid Testing in Functional Medicine

Organic Acid Testing in Functional Medicine

In functional medicine, organic acid testing is utilized to evaluate a patient's metabolic function through a simple urine test. This testing can identify metabolic imbalances that may affect a patient’s mood, energy, and overall health. 

Testing provides insights into nutrient deficiencies, dietary habits, toxic exposures, and gut microbiome activity. 

The results assist practitioners in customizing treatment plans to address specific metabolic dysfunctions and improve health outcomes. 

Additionally, it helps in assessing the impact of microbial metabolism and the efficiency of the Krebs Cycle, aiding in personalized healthcare.

Lab Testing for 2-Hydroxyisovaleric Acid

Test Information, Sampling Methods and Preparation

Laboratory testing for organic acids including 2-hydroxyisovaleric acid is typically done in urine, although it can also be tested in blood.  Testing may be ordered to diagnose an inborn metabolic disorder, or to assess metabolic function and gastrointestinal health in a functional medicine setting.  

Urine samples may be collected in a clinical setting; they can also be collected at home.  Some labs recommend or require a first morning void sample, to provide a concentrated sample.  

Interpreting 2-Hydroxyisovaleric acid Results

Optimal Range for 2-Hydroxyisovaleric acid Testing

Generally, falling within reference ranges for organic acids is recommended, although for many of these organic acids, a level towards the lower end of the reference range is considered optimal.  

It is essential to consult with the laboratory company used for their recommended reference range for 2-hydroxyisovaleric acid.  

One company reports the following reference range for 2-hydroxyisovaleric acid:  <2 mmol/mol creatinine  [11.]

Clinical Significance of Elevated Levels of 2-Hydroxyisovaleric acid

Elevated levels of 2-hydroxyisovaleric acid in the body may indicate the presence of a  metabolic disorder like Maple Syrup Urine Disease (MSUD).

MSUD leads to the accumulation of branched-chain amino acids and their metabolites, which can result in severe neurological damage if untreated. 

More commonly, mild elevations in the organic acid 2-hydroxyisovaleric acid may indicate altered metabolic states or inefficiencies in protein metabolism. 

Monitoring 2-hydroxyisovaleric acid levels can therefore provide crucial insights into metabolic health and the effectiveness of dietary or therapeutic interventions, particularly in individuals with inherited metabolic disorders or those undergoing metabolic stress.  Elevated levels may indicate an increased need for thiamin supplementation.  

Clinical Significance of Low Levels of 2-Hydroxyisovaleric acid

Low levels of 2-hydroxyisovaleric acid are not considered clinically relevant.  

2-Hydroxyisovaleric Acid-Related Biomarkers and Comparative Analysis

2-hydroxyisovaleric acid is typically tested along with other organic acids to gain deeper insights into metabolic pathways and physiological processes.

Organic acids that may be tested as part of a panel include: 

2-Hydroxybutyric acid: this acid is a marker for insulin resistance and increased oxidative stress.

2-Hydroxyphenylacetic Acid: derived from phenylalanine metabolism, this acid is used as a biomarker in various metabolic assessments.

3-Hydroxybutyric Acid: a ketone body produced during fat metabolism, indicative of carbohydrate deprivation or ketogenic conditions.

3-Hydroxyisovaleric Acid: an organic acid that accumulates in leucine catabolism disorders, often elevated in maple syrup urine disease.

3-Indoleacetic Acid: a metabolite of tryptophan, it is significant in the study of serotonin pathways and plant growth regulation.

4-Hydroxybenzoic Acid: a derivative of tyrosine metabolism, it is linked to catechin (green tea) metabolism and may be produced by some intestinal bacteria.

4-Hydroxyphenyllactic Acid: a metabolite associated with disorders of tyrosine metabolism.

4-Hydroxyphenylacetic Acid: a breakdown product of tyrosine, used in diagnosing disorders involving the degradation of aromatic amino acids.

5-Hydroxyindoleacetic Acid: the main metabolite of serotonin, used as a marker in the diagnosis of carcinoid syndrome.

Adipic Acid: a dicarboxylic acid that can also be formed metabolically in humans through the oxidation of certain fatty acids.

a-Keto-b-Methylvaleric Acid: an intermediate in isoleucine metabolism, which can accumulate in certain metabolic disorders.

a-Ketoisocaproic Acid: an intermediate in the metabolism of leucine, elevated in maple syrup urine disease.

a-Ketoisovaleric Acid: a breakdown product of valine metabolism, also linked to maple syrup urine disease.

a-Ketoglutaric Acid: a key intermediate in the citric acid cycle, essential for energy production and nitrogen transport.

Benzoic Acid: produced from phenylalanine and polyphenol metabolism by intestinal bacteria. High levels in urine can indicate glycine deficiency or liver dysfunction.

‍Cis-Aconitic Acid: an intermediate in the tricarboxylic acid cycle, formed by the dehydration of citric acid.

Citric Acid: a central compound in the citric acid cycle, crucial for energy production in cells.

‍Ethylmalonic Acid: this acid accumulates in ethylmalonic encephalopathy and is involved in fatty acid metabolism.

Fumaric Acid: an intermediate in the tricarboxylic acid (TCA) cycle, participating in energy production through its conversion to malate and subsequent participation in the generation of ATP.

Homovanillic Acid: a major metabolite of dopamine, used as a marker to monitor dopamine levels.

Hippuric Acid: formed from the conjugation of benzoic acid and glycine; elevated levels can indicate exposure to certain environmental toxins.

Hydroxymethylglutarate: an intermediate in leucine metabolism, also associated with disorders of ketogenesis and ketolysis.

Isocitric Acid: an isomer of citric acid and an important part of the citric acid cycle, pivotal in cellular energy production.

Kynurenic Acid: a product of tryptophan metabolism, known for its role as a neuroprotective agent.

Lactic Acid: produced from pyruvate via anaerobic metabolism, an indicator of hypoxia and strenuous exercise.

Malic Acid: a dicarboxylic acid found in fruits, and involved  in the citric acid cycle.

Methylmalonic Acid: an indicator of Vitamin B12 deficiency, it accumulates when the vitamin is deficient.

Methylsuccinic Acid: a dicarboxylic acid often involved in alternative pathways of fatty acid metabolism.

Orotic Acid: involved in the metabolism of pyrimidines, abnormalities in its levels can indicate metabolic disorders.

‍Pyroglutamic Acid: an uncommon amino acid derivative that can accumulate in glutathione synthesis disorders.

‍Pyruvic Acid: a key intersection in several metabolic pathways; its levels are crucial for assessing cellular respiration and metabolic function.

Quinolinic Acid: a neuroactive metabolite of the kynurenine pathway, elevated levels are associated with neurodegenerative diseases.

Suberic Acid: a dicarboxylic acid that is a biomarker in adipic aciduria, often studied in relation to fatty acid oxidation disorders.

Succinic Acid: a four-carbon dicarboxylic acid that plays a central role in the Krebs cycle, crucial for energy production.

Tricarballylic Acid: an organic acid that can inhibit aconitase in the citric acid cycle and is sometimes associated with glyphosate exposure.

Vanillylmandelic Acid: a metabolite of epinephrine and norepinephrine, used as a marker for neuroblastoma and other catecholamine-secreting tumors.

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