Propionic acidaemia is a genetic, metabolic condition and a type of organic acid disorder. People with propionic acidaemia cannot properly break down certain amino acids (which are building blocks of protein) and some types of fats.¹ This happens because they do not have enough of a functional (working) enzyme (a type of protein) called propionyl-CoA carboxylase (PCC) and their bodies cannot fully process these amino acids and fats, causing build-up of propionyl-CoA and its by-products that are harmful to the body.²

Symptoms often appear in the first few weeks of life and include low muscle tone (hypotonia), extreme tiredness and lack of energy (lethargy), not feeding well, dehydration and vomiting. If left untreated, this can lead to seizures, coma and death. In rare cases, symptoms may only present later in life and may also include intellectual disability, heart issues and other complications.

In Australia, propionic acidaemia is often detected shortly after birth via newborn bloodspot screening (NBS) programs. Additional testing is required for diagnosis. For individuals who are not screened at birth, propionic acidaemia is often diagnosed after symptoms develop.

Synonyms:³ Propionic aciduria; Propionyl-CoA carboxylase deficiency; Ketotic hyperglycinemia

Universal rare disease classifications provide a common language for recording, reporting and monitoring diseases. Please visit the Rare Disease Classifications page for more information about these internationally recognised classifications.

ORPHA:35 Propionic acidemia

ICD-11: 5C50.E0 Classical organic aciduria

Symptoms of propionic acidaemia usually present during the newborn (neonatal) period, often in the first few days of life, and are often severe and life-threatening.^1-6 Symptoms tend to present as severe metabolic crisis with metabolic acidosis (high levels of acid in blood), hypoglycaemia (low blood sugar), lactic acidosis (build-up of lactic acid in the blood) and hyperammonaemia (toxic build-up of ammonia in blood). Babies may have low muscle tone (hypotonia), poor feeding, extreme tiredness and lack of energy (lethargy), nausea and vomiting. If left untreated, this can progress to encephalopathy (where brain function is affected), seizures, coma and early death. 

For some people, the symptoms may present later and may be brought upon by an illness, fasting or surgery.^2,3

Long-term complications of propionic acidaemia may include affected growth, intellectual disability, inflammation of pancreas (pancreatitis), cardiomyopathy (condition that affects the heart muscle, preventing it from pumping blood effectively), kidney disease, neurological issues as well as other complications related to the liver, immune systems, eyes, hearing, musculoskeletal system, skin and others.^2-6 

Please speak to your medical team to learn more about the symptoms of this condition.

Rare diseases are often serious and progressive, exhibiting a high degree of symptom complexity, leading to significant disability. Majority of the estimated two million Australians living with a rare disease meet the Australian Government’s definition for disability (in accordance to the Australian Public Service Commission and Australian Bureau of Statistics), and many experience severe and permanent disability impacts. If you or someone you care for is experiencing disability-related impacts from a rare condition, please speak with a health or disability professional for advice. Information about relevant disability support can be found at the RARE Portal’s Disability Support Information page.

Orphanet: Disability – Propionic acidemia has information about the activity limitations that people with propionic acidaemia may face; please note that this was last updated in 2019 and may not reflect the most current information.

Propionic acidaemia is a genetic condition. It is caused by disease-causing genetic changes (variants) in either the PCCA (on Chromosome 13) or PCCB (on Chromosome 3) genes.^2,3 These genes are responsible for producing the α- and β-subunits of the propionyl CoA carboxylase protein.

All individuals have two copies (alleles) of the PCCA and PCCB genes – one copy inherited from each parent. Propionic acidaemia is an autosomal recessive condition, which means both copies of the PCCA or PCCB gene must have the disease-causing genetic variants. More information on autosomal recessive inheritance pattern can be found at Centre for Genetics Education: Autosomal recessive inheritance.

If you would like to learn more about the inheritance and impact of this condition, please ask your doctor for a referral to a genetic counsellor. Genetic counsellors are qualified allied health professionals who can provide information and support regarding genetic conditions and testing. More information about genetic counselling can be found at:

• Information on Genetic Services
• The National and State Services pages underneath the ‘Genetic Counselling’ sections listed

Newborn screening

In Australia, propionic acidaemia is usually detected via the newborn bloodspot screening (NBS) programs.  Shortly after birth and with parental consent, a nurse or midwife will collect the baby’s blood via a heel prick blood test. The healthcare provider will then send it to a specific laboratory to test for a range of rare conditions, including propionic acidaemia. If the test results suggest that there is a risk of the baby having one of the screened conditions, laboratory staff will promptly get in touch with healthcare providers. The healthcare providers will then arrange for the baby to have further testing to confirm if the baby actually has the condition. The healthcare providers will also organise for the baby to receive urgent care if required. Depending on your state or territory, parents may or may not receive a notification if the test results are clear. You can find out more about NBS in your state or territory at Australian Government Department of Health, Disability and Ageing: Delivering newborn bloodspot screening programs.

Newborn bloodspot screening is a reliable way to check for certain rare conditions early in life. Although it’s extremely rare, cases can sometimes be missed. If you are concerned your baby may have a condition that they have already been screened for, you should contact a medical professional.

Diagnosis

A diagnosis of propionic acidaemia may be suspected based on an abnormal result from NBS but additional tests or a clinical examination will be required to confirm a diagnosis. For individuals who are not screened at birth, propionic acidaemia is often diagnosed after symptoms develop.

Diagnosis of propionic acidaemia may be made based on clinical evaluation of symptoms, laboratory tests on blood and urine samples to detect for levels or pattern of specific metabolites, measurement of enzyme activity and genetic testing.^2,3

As part of the diagnostic process, doctors may do a differential diagnosis, which is to rule out other conditions that have similar symptoms, such as neonatal sepsis, other organic acid disorders, urea cycle disorders,  biotinidase deficiency, pyruvate dehydrogenase complex deficiency and pyruvate carboxylase deficiency.⁴

Please speak to your medical team to learn more about the available pathways for diagnosis of this condition.

There is currently no curative treatment for propionic acidaemia; however, early diagnosis and appropriate management can reduce or prevent the risk of early death and enable better outcomes.^2-4,7

Metabolic crises in propionic acidaemia can include metabolic acidosis (high levels of acid in blood), hypoglycaemia (low blood sugar), lactic acidosis (build-up of lactic acid in the blood) and hyperammonaemia (toxic build-up of ammonia in blood), which are medical emergencies and require immediate treatment.

Long-term management of propionic acidaemia may involve a low-protein diet and a special nutritional supplement, with monitoring and regular attendance at a metabolic clinic.^2-4,7 The recommended amount of protein from food and supplement varies between individuals and may also change over time with age. Prolonged fasting should be avoided. Carnitine supplementation may be considered for some individuals to help the body remove the toxic byproducts that build up. 

Liver transplantation may be considered for some individuals with severe symptoms and frequent metabolic crises, but it may not be beneficial for all individuals.^2,4,7

Additional management of symptoms may include tube feeding, physiotherapy, occupational therapy, speech therapy, as well as management of issues and complications related to pancreas, heart, kidney, liver, immune system, eyes, hearing, musculoskeletal system, skin and others.^2,7

Please speak to your medical team to learn more about the possible treatment or management options for your condition. Treatment will depend on an individual’s specific condition and symptoms. It is also important to stay connected to your medical team so that you can be made aware of any upcoming clinical trial opportunities. For many rare diseases, treatment options may be limited. Participation in a clinical trial may provide access to new or emerging therapies.

Healthcare professionals involved in the clinical care of individuals with propionic acidaemia may include general practitioners (GP), paediatricians, geneticists, metabolic physicians, genetic counsellors, metabolic dietitians, neurologists, cardiologists, nephrologists, ophthalmologists, audiologists, physiotherapists, occupational therapists, speech therapists and others. The need for different healthcare professionals may change over a person’s lifetime and extend beyond those listed here. It is recommended that care be managed by a metabolic specialist team.²

Clinical care for rare diseases often involves a multidisciplinary team of medical, care and support professionals. Please note that the information provided here is as a guide and that RVA does not necessarily monitor or endorse specific clinics or health experts.

This may not be applicable to all rare diseases but for many, palliative care services may be relevant and useful. Palliative care services are available for people (adults, children and their families) living with a life-limiting illness and is not only for end-of-life care. It can also help at any stage of illness from diagnosis onwards, and will look different for different people. Palliative care services provide assistance, support, resources and tools to help people manage their illness and the symptoms, ease pain, and improve comfort and quality of life. If this is relevant to you and you wish to find out more information about palliative care and how it can help you, please visit:

• Australian Institute of Health and Welfare: Palliative care Overview
• Australian Government Department of Health, Disability and Ageing: Palliative care
• Palliative Care Australia

Guidelines for the diagnosis and management of methylmalonic acidaemia and propionic acidaemia: First revision was produced by a panel of 21 international healthcare professionals who work in the field of metabolic medicine; published in 2021 and is an update of the following:

Proposed guidelines for the diagnosis and management of methylmalonic and propionic acidemia published in 2014 and intended for metabolic specialists, pediatricians, dietitians, neonatologists, intensive care specialists, adult physicians, obstetricians, nurses and psychologists involved in the care of MMA/PA patients.

Individuals living with rare diseases may have complex medical issues and disabilities, which are not always visible. It is often useful to refer to their medical history as well as personal information such as a medical card, doctor’s letter, or if available, a rare disease passport, for relevant information.

In addition, individuals, their parents, families and carers often develop extensive expertise on their specific rare disease. It is important to recognise that they can contribute valuable knowledge about their rare condition. Rare diseases often impact individuals differently, so it’s important to consider a person’s lived experience.

Below are some considerations for the emergency management of individuals living with propionic acidaemia, including when presenting to emergency departments:²

• Prolonged fasting, catabolic stressors, and excessive protein intake should be avoided.
• Individuals are at risk of metabolic crises, particularly during times of illness, dehydration, vomiting and fasting. Emergency treatment will be required.
• Metabolic specialist team or specialists with expertise in inherited metabolic disorders to be consulted for emergency surgeries and procedures in respect to perioperative fluid and nutritional management.

Metabolic Dietary Disorders Association (MDDA): Latest Research Updates has information about key areas of ongoing research for various inborn errors of metabolism conditions, including organic acidaemias.

Australian Organisation:

Metabolic Dietary Disorders Association (MDDA)
Website: https://mdda.org.au/

Metabolic Dietary Disorders Association Inc (MDDA) is the national peak consumer body dedicated to supporting, educating, connecting, and representing all individuals their families and carers living with Inborn Errors of protein Metabolism (IEpM).

Please note that RVA does not monitor or endorse each group/organisation’s operational governance and activities. When engaging with a group, please consider the information on the RARE Portal’s Finding Helpful Peer and Community Supports page.

Propionic acidaemia varies between individuals, and each person’s experience is unique.

If you would like to share your personal story with RVA, please visit the Rare Voices Australia: Share Your Story page. RVA will consider your story for publishing on our website and inclusion on the RARE Portal.

The ASIEM Low Protein Handbook for Organic acid disorders

Organic Aciduria Fruit and Veg Counting Lists

Organic Aciduria General Protein Counting Lists

For information on available government and social services that provide support for individuals with a rare disease, please visit the National and State Services pages.

People living with a rare disease often face unique challenges such as diagnostic delays, misdiagnoses, limited treatment options, and limited access to rare disease specialists and support. These challenges may impact people’s emotional wellbeing and quality of life. Many find it helpful to seek mental health and wellbeing support to cope with ongoing stress and uncertainty. Connecting with people who have shared experiences through a support group may also be helpful. Information about relevant mental health and wellbeing support can be found at:

• Mental Health and Wellbeing Support for Australians Living with a Rare Disease
• The National and State Services pages underneath the ‘Mental Health’ sections listed

Further information relevant to propionic acidaemia can be found at:

• Government of Western Australia Department of Health – Propionic acidaemia (PA)
• Metabolic Dietary Disorders Association (MDDA): Propionic Acidaemia (PA)
• Genetic and Rare Diseases (GARD) Information Center: Propionic acidemia
• National Organization for Rare Disorders (NORD): Propionic Acidemia

Orphanet: Propionic acidemia

Online Mendelian Inheritance in Man, OMIM^®: #606054 – Propionic acidemia

GeneReviews^®: Propionic Acidemia

This page has been developed by Rare Voices Australia (RVA)’s RARE Portal team.

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