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Fumarase deficiency
Classification and external resources

Fumarate is converted to malate by fumarase
OMIM 606812
DiseasesDB 29835

Fumarase deficiency (or fumaric aciduria) is an autosomal recessive metabolic disorder characterized by a deficiency of the enzyme fumarate hydratase, which is indicated by a build up of fumaric acid in the urine.



Fumarase deficiency is caused by a mutation in the fumarate hydratase (FH) gene in humans, which encodes the enzyme that converts fumarate to malate in the mitochondria. Other mutant alleles of the FH gene, located on human Chromosome 1 at position 1q42.1, cause multiple cutaneous and uterine leiomyomata, hereditary leiomyomatosis and renal cell cancer. [1] Fumarase deficiency is one of the few known deficiencies of the Krebs cycle or tricarboxylic acid cycle, the main enzymatic pathway of cellular aerobic respiration.[2]

Fumarase deficiency has an autosomal recessive pattern of inheritance.

The condition is an autosomal recessive disorder,[3] and it is therefore usually necessary for an affected individual to receive the mutant allele from both parents. A number of children diagnosed with the disorder have been born to parents who were first cousins.[4][5] It can also be associated with uniparental isodisomy.[6]


Fumarase deficiency causes encephalopathy,[7] severe mental retardation, unusual facial features, brain malformation, and epileptic seizures[8] due to an abnormally low amount of fumarase in cells.

Emergence in a polygamist settlement

Fumarase deficiency is extremely rare, with only thirteen diagnosed and identified cases worldwide until roughly 1990. Since then an additional twenty cases have been documented in the Arizona/Utah border towns of Colorado City, Arizona (formerly known as Short Creek or the Short Creek Community), and Hildale, Utah, settled in the 1930s by the Fundamentalist Church of Jesus Christ of Latter Day Saints a church that gradually split from The Church of Jesus Christ of Latter-day Saints beginning in 1890.[9] The condition has since been dubbed "Polygamist's Down's."[10]

Theodore Tarby, a pediatric neurologist who has treated some of the community's fumarase deficient residents, has been quoted as estimating the IQ of his patients as around 25.[11]. While treating a child with a developmental disability Tarby sent off a urine sample for testing and learned the child had a disorder so rare that only 13 other current cases were known worldwide.[12] Tarby later learned the child he treated had a sibling who had been diagnosed with cerebral palsy, a disease commonly associated with developmental difficulties. This sibling also turned out to have fumarase deficiency.[9]

According to the Phoenix New Times, the rare disease appeared when Martha Jessop, the daughter of Joseph Smith Jessop, one of the founders of the community, married her second cousin, John Yeates Barlow, in 1923.[9] Tarby and fellow researchers at Barrow Neurological Institute at St. Joseph's Hospital in Phoenix have found that the highest incidence of the disease recorded anywhere appears in the population of polygamists living in these two towns.[9]


  1. ^ OMIM: Fumarase Deficiency at National Center for Biotechnology Information.
  2. ^ Devlin, Thomas M. (2006). Textbook of biochemistry: with clinical correlations. New York: John Wiley. p. 546. ISBN 0-471-67808-2. 
  3. ^ Gellera C, Uziel G, Rimoldi M, et al. (March 1990). "Fumarase deficiency is an autosomal recessive encephalopathy affecting both the mitochondrial and the cytosolic enzymes". Neurology 40 (3 Pt 1): 495–9. PMID 2314594. 
  4. ^ Petrova-Benedict R, Robinson BH, Stacey TE, Mistry J, Chalmers RA (1987). "Deficient fumarase activity in an infant with fumaricacidemia and its distribution between the different forms of the enzyme seen on isoelectric focusing". Am. J. Hum. Genet. 40 (3): 257–66. PMID 3578275. 
  5. ^ Bourgeron T, Chretien D, Poggi-Bach J, et al. (1994). "Mutation of the fumarase gene in two siblings with progressive encephalopathy and fumarase deficiency". J. Clin. Invest. 93 (6): 2514–8. doi:10.1172/JCI117261. PMID 8200987. 
  6. ^ Zeng WQ, Gao H, Brueton L, et al. (2006). "Fumarase deficiency caused by homozygous P131R mutation and paternal partial isodisomy of chromosome 1". Am. J. Med. Genet. A 140 (9): 1004–9. doi:10.1002/ajmg.a.31186. PMID 16575891. 
  7. ^ Bayley JP, Launonen V, Tomlinson IP (2008). "The FH mutation database: an online database of fumarate hydratase mutations involved in the MCUL (HLRCC) tumor syndrome and congenital fumarase deficiency". BMC Med. Genet. 9 (1): 20. doi:10.1186/1471-2350-9-20. PMID 18366737. 
  8. ^ Kerrigan JF, Aleck KA, Tarby TJ, Bird CR, Heidenreich RA (2000). "Fumaric aciduria: clinical and imaging features". Ann. Neurol. 47 (5): 583–8. doi:10.1002/1531-8249(200005)47:5<583::AID-ANA5>3.0.CO;2-Y. PMID 10805328. 
  9. ^ a b c d Forbidden Fruit:Inbreeding among polygamists along the Arizona-Utah border is producing a caste of severely retarded and deformed children, by John Dougherty, The Phoenix New Times News, December 29, 2005, page 2.
  10. ^ Mormon Sect's Polygamy Causes Most Of The World's Fumarase Deficiency Cases, Digital Journal
  11. ^ Birth defect is plaguing children in FLDS towns: Fumarase Deficiency afflicts 20, is linked to marriages of close Kin By John Hollenhorst for Deseret News Published: Wednesday, Feb. 8, 2006 11:36 p.m
  12. ^ Polygamist community faces rare genetic disorder By Jason Szep Thu Jun 14, 2007 11:00am EDT for Reuters

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