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It is characterized by life\u2010threatening episodes of ketoacidosis, chronic kidney disease, and other multiorgan complications. Liver transplantation can improve patient stability and survival and thus provides clinical and biochemical benchmarks for the development of hepatocyte\u2010targeted genomic therapies. Data are presented from a US natural history protocol that evaluated subjects with different types of MMA including\n                    <jats:italic>mut<\/jats:italic>\n                    \u2010type (\n                    <jats:italic>N\u2009=\u200991<\/jats:italic>\n                    ),\n                    <jats:italic>cblB<\/jats:italic>\n                    \u2010type (15), and\n                    <jats:italic>cblA\u2010<\/jats:italic>\n                    type MMA (17), as well as from an Italian cohort of\n                    <jats:italic>mut<\/jats:italic>\n                    \u2010type (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u200919) and\n                    <jats:italic>cblB<\/jats:italic>\n                    \u2010type MMA (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u20092) subjects, including data before and after organ transplantation in both cohorts. Canonical metabolic markers, such as serum methylmalonic acid and propionylcarnitine, are variable and affected by dietary intake and renal function. We have therefore explored the use of the 1\u2010\n                    <jats:sup>13<\/jats:sup>\n                    C\u2010propionate oxidation breath test (POBT) to measure metabolic capacity and the changes in circulating proteins to assess mitochondrial dysfunction (fibroblast growth factor 21 [FGF21] and growth differentiation factor 15 [GDF15]) and kidney injury (lipocalin\u20102 [LCN2]). Biomarker concentrations are higher in patients with the severe\n                    <jats:italic>mut<\/jats:italic>\n                    <jats:sup>\n                      <jats:italic>0<\/jats:italic>\n                    <\/jats:sup>\n                    \u2010type and\n                    <jats:italic>cblB<\/jats:italic>\n                    \u2010type MMA, correlate with a decreased POBT, and show a significant response postliver transplant. Additional circulating and imaging markers to assess disease burden are necessary to monitor disease progression. A combination of biomarkers reflecting disease severity and multisystem involvement will be needed to help stratify patients for clinical trials and assess the efficacy of new therapies for MMA.\n                  <\/jats:p>","DOI":"10.1002\/jimd.12636","type":"journal-article","created":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T04:14:23Z","timestamp":1685160863000},"page":"554-572","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Biomarkers to predict disease progression and therapeutic response in isolated methylmalonic acidemia"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1543-2941","authenticated-orcid":false,"given":"Irini","family":"Manoli","sequence":"first","affiliation":[{"name":"Metabolic Medicine Branch, National Human Genome Research Institute National Institutes of Health (NIH)  Bethesda Maryland 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