Biotinidase deficiency is an inherited disorder in which the body is unable to recycle the vitamin biotin. If this condition is not recognized and treated, its signs and symptoms typically appear within the first few months of life, although it can also become apparent later in childhood.

Profound biotinidase deficiency, the more severe form of the condition, can cause seizures, weak muscle tone (hypotonia), breathing problems, hearing and vision loss, problems with movement and balance (ataxia), skin rashes, hair loss (alopecia), and a fungal infection called candidiasis. Affected children also have delayed development. Lifelong treatment can prevent these complications from occurring or improve them if they have already developed.

Partial biotinidase deficiency is a milder form of this condition. Without treatment, affected children may experience hypotonia, skin rashes, and hair loss, but these problems may appear only during illness, infection, or other times of stress.

Mutations in the BTD gene cause biotinidase deficiency. The BTD gene provides instructions for making an enzyme called biotinidase. This enzyme recycles biotin, a B vitamin found in foods such as liver, egg yolks, and milk. Biotinidase removes biotin that is bound to proteins in food, leaving the vitamin in its free (unbound) state. Free biotin is needed by enzymes called biotin-dependent carboxylases to break down fats, proteins, and carbohydrates. Because several of these enzymes are impaired in biotinidase deficiency, the condition is considered a form of multiple carboxylase deficiency.

Mutations in the BTD gene reduce or eliminate the activity of biotinidase. Profound biotinidase deficiency results when the activity of biotinidase is reduced to less than 10 percent of normal. Partial biotinidase deficiency occurs when biotinidase activity is reduced to between 10 percent and 30 percent of normal. Without enough of this enzyme, biotin cannot be recycled. The resulting shortage of free biotin impairs the activity of biotin-dependent carboxylases, leading to a buildup of potentially toxic compounds in the body. If the condition is not treated promptly, this buildup damages various cells and tissues, causing the signs and symptoms described above.

Normal Function

The BTD gene provides instructions for making an enzyme called biotinidase. This enzyme recycles biotin, a B vitamin found in foods such as liver, egg yolks, and milk. Biotinidase removes biotin that is bound to proteins in food, leaving the vitamin in its free (unbound) state. The body needs free biotin to activate enzymes called biotin-dependent carboxylases. These carboxylases are involved in many critical cellular functions, including the breakdown of proteins, fats, and carbohydrates.

In addition to processing biotin obtained from the diet, biotinidase recycles biotin within the body. As biotin-dependent carboxylases are broken down, they release a molecule called biocytin. Biocytin is a complex made of up biotin and a protein building block (amino acid) called lysine. Biotinidase splits this complex, making free biotin available for reuse by other carboxylase enzymes.

Researchers suspect that biotinidase may have several additional functions. This enzyme may transport free biotin through the bloodstream. It might also have the ability to attach biotin to certain proteins through a process called biotinylation. Within the nucleus, biotinylation of DNA-associated proteins called histones may help determine whether certain genes are turned on or off. It is unclear, however, whether biotinidase plays a role in regulating gene activity.

Health Conditions Related to Genetic Changes

Biotinidase deficiency

More than 150 mutations in the BTD gene have been identified in people with biotinidase deficiency. This disorder, if untreated, can affect many parts of the body and cause delayed development. Most of the mutations that cause biotinidase deficiency change single amino acids in the biotinidase enzyme. These changes occur in critical regions of the enzyme and reduce or eliminate the enzyme's activity.

Most BTD gene mutations cause profound biotinidase deficiency. This severe form of the disorder results when the activity of biotinidase is reduced to less than 10 percent of normal. Other mutations cause a milder form of the condition called partial biotinidase deficiency. These mutations reduce biotinidase activity to between 10 percent and 30 percent of normal. Without enough of this enzyme, biotin cannot be recycled. The resulting shortage of free biotin impairs the activity of biotin-dependent carboxylases, leading to a buildup of potentially toxic compounds in the body. If the condition is not treated promptly, this buildup damages various cells and tissues, causing the signs and symptoms associated with biotinidase deficiency.

Leigh syndrome

MedlinePlus Genetics provides information about Leigh syndrome

Other Names for This Gene

• Biocytin Hydrolase

Genomic Location

Biotinidase deficiency is a genetic condition. Babies inherit it from their biological (birth) parents.

• Biotinidase deficiency is an autosomal recessive condition. Babies inherit the condition when each parent passes down a nonworking BTD gene to their baby. Only babies with two nonworking BTD genes—one from the mom and one from the dad—have this condition.
  • People with one working copy and one nonworking copy of the BTD gene are called carriers.
  • Carriers do not have or develop the condition. However, they may pass down a nonworking copy of the gene to their children.
  • If two parents are carriers of a nonworking copy of the BTD gene, they have a 1 in 4 chance of having a child with biotinidase deficiency.
  • Carriers for biotinidase deficiency often do not know they are carriers before having a child with the condition. In most cases, families have no history of the condition until the birth of a child with biotinidase deficiency.
  • Parents who already have a child with biotinidase deficiency still have a 1 in 4 chance of having another child with biotinidase deficiency. This 1 in 4 chance stays the same for all future children.
• Genetic counselors and medical geneticists can help families learn about this condition and the chance of having children with it.

Signs of biotinidase deficiency often appear within the first few months of life but may also appear later in childhood. Common illnesses, like cold or flu, or stress can trigger symptoms.

Signs of the condition may include the following:

• Seizures
• Weak muscle tone (hypotonia)
• Breathing problems
• Hearing and vision loss
• Unusual movements (ataxia)
• Skin rashes
• Hair loss (alopecia)
• Fungal infection (candidiasis)
• Delayed development

Newborn screening for biotinidase deficiency is done using a small amount of blood collected from your baby’s heel. During screening, a special machine measures the activity of the enzyme biotinidase. Babies that do not have enough biotinidase enzyme activity might have biotinidase deficiency.

What Happens After an Out-of-Range Screening Result?

If your baby’s blood spot screening result for biotinidase deficiency is out-of-range, your baby’s health care provider will contact you. Together, you will discuss next steps and follow-up plans.

An out-of-range screening result does not mean that your baby definitely has the condition. It does mean that your baby needs more follow-up testing.

Your baby may need the following tests after an out-of-range screening result:

• Blood and/or urine tests
• Genetic testing using a blood sample

You should complete any recommended follow-up testing as soon as possible. Babies with this condition can have serious health problems in the months after birth if they are not diagnosed and treated quickly.

False-positive newborn screening results for this condition can happen. Babies born early (premature) may have out-of-range results. Screening samples that are exposed to high heat or humidity or that take a long time to get to the testing lab may have false positive results.

Newborn screening helps babies lead healthier lives. If your baby has an out-of-range result, follow up with your health care provider quickly. It is important to follow their instructions. Your baby may need to get treatment right away, even if they are not showing signs or symptoms. In some cases, your baby’s health care provider may decide it is best to watch (monitor) your baby to decide next steps. Careful monitoring and early treatment will help your baby stay as healthy as possible.

It is important to talk to your health care provider about which treatment(s) are best for your baby. The goal of treatment is to prevent the health problems caused by this condition.

Treatment may include biotin supplements to help the body break down food.

Children who receive early and ongoing treatment for biotinidase deficiency can have healthy growth and development.