Yoghurt: an unlikely source of Campylobacter jejuni/coli

Knowledge of the relative insensitivity of Campylobacter jejuni to moderately acid environments prompted us to study its survival in different batches of yoghurt of pH range 4.2–5.3 and the role of organic or inorganic acid in the die-off of this pathogen. None of the 11 strains of C. jejuni or C. coli survived more than 25 min in yoghurt. Suspecting that this rapid die-off cannot be accounted for by the pH of the yoghurt we compared the survival rates of C. jejuni in milk, whose pH had been adjusted by lactic, propionic and hydrochloric acid respectively, with that of yoghurt. Even for an inoculum of 10⁵–10⁸ cfu/ml propionic acid was bactericidal in minutes. Lactic acid reduced the bacterial populations by 3–5 logs in 30 min. Strong inorganic acid HC1, by contrast, had little or no effect on the populations. Although lactic acid is quite bactericidal for C. jejuni , it is apparently not the only factor to which the prompt elimination of this pathogen from yoghurt could be attributed.     

Protective effect of casein toward Salmonella typhimurium in acid-milk

Lactic acid is the inhibitory agent in yoghurt responsible for the inhibition of Salmonella typhimurium. Casein, however, may exert a protective effect toward the survival of the salmonella in acid-milk products. Salmonella typhimurium was found to die-off 21.2% more rapidly in 18-h yoghurt-whey than in 18-h yoghurt at 37 degrees C with a pH of 3.85 and 1.42% lactic acid. When casein was added to yoghurt-whey, the die-off rate of the salmonellas was reduced to that found in yoghurt. The rate remained unchanged when 4.8% sodium caseinate was added to the whey. When 0 to 14% casein was added to the acid-whey the die-off rate changed from 9.7 to 24.0 min/log reduction of cells, respectively. There was a direct correlation between the increase in casein concentration and length of survival of the salmonellas. At a pH of 3.85, 4.2 or 4.5, the die-off rate was 6.5, 13.0 or 40 min/log reduction of cells in milk containing 1.42% lactic acid, and was 4.0, 10.0 or 33.3 min/log reduction, respectively, in whey with 1.42% lactic acid. Thus, the protective effect of casein toward Salm. typhimurium increased as the pH increased. This indicated that casein exerts a protective effect on Salm. typhimurium in acid dairy products and the degree of protection depends on the casein concentration, the form of the casein molecule and the pH.     

Protective effect of casein toward Salmonella typhimurium in acid-milk

Lactic acid is the inhibitory agent in yoghurt responsible for the inhibition of Salmonella typhimurium. Casein, however, may exert a protective effect toward the survival of the salmonella in acid-milk products. Salmonella typhimurium was found to die-off 21.2% more rapidly in 18-h yoghurt-whey than in 18-h yoghurt at 37 C with a pH of 3.85 and 1.42% lactic acid. When casein was added to yoghurt-whey, the die-off rate of the salmonellas was reduced to that found in yoghurt. The rate remained unchanged when 4.8% sodium caseinate was added to the whey. When 0 to 14% casein was added to the acid-whey the die-off rate changed from 9.7 to 24.0 min/log reduction of cells, respectively. There was a direct correlation between the increase in casein concentration and length of survival of the salmonellas. At a pH of 3.85, 4.2 or 4.5, the die-off rate was 6.5, 13.0 or 40 min/log reduction of cells in milk containing 1.42% lactic acid, and was 4.0, 10.0 or 33.3 min/log reduction, respectively, in whey with 1.42% lactic acid. Thus, the protective effect of casein toward Salm. typhimurium incieased as the pH increased. This indicated that casein exerts a protective effect on Salm. typhimurium in acid dairy products and the degree of protection depends on the casein concentration, the form of the casein molecule and the pH.     

Survival of a Salmonella typhimurium poultry isolate in the presence of propionic acid under aerobic and anaerobic conditions

Propionic acid is commonly found as a fermentation product in the gastrointestinal tracts of food animals and has also been used to limit the microbial contaminants in animal feeds. Because propionic acid is known to have antibacterial activity, the propionic acid encountered by foodborne pathogens during their life cycles may play an important role in inhibiting the survival of the pathogens. The survival patterns of Salmonella typhimurium poultry isolate were determined both in aerobic and anaerobic tryptic soy broth (TSB; pH 5.0 or 7.0) containing various concentrations of propionic acid (0-200 mM). The levels of recovered cells were consistently greater at pH 7.0 compared to those at pH 5.0. For the first 4 days, the levels were significantly decreased by incubation under anaerobic conditions as compared to aerobic condition at pH 7.0 (P<0.05). However, there were fluctuations of cell populations with different patterns depending on both concentrations and growth conditions. To characterize the nature of the capability which allowed the cell multiplication following decreases in cell population during incubation at pH 7.0, the cells isolated from the outgrowth cultures were tested for survival in aerobic or anaerobic TSB (pH 5.0 or pH 7.0) containing propionic acid (50 mM). The outgrowth isolates did not show significant differences in the level of recovered cells in the presence of propionic acid when compared to the wild type strain (P>0.05), suggesting that the cells in the outgrowth cultures did not harbour mutation(s) conferring increased resistance to propionic acid. In addition, the level of recovered cells of isogenic rpoS mutant strain of S. typhimurium was not significantly different from that of the wild type strain in the same assay conditions (P<0.05). The results of this study show that the bactericidal activity of propionic acid on S. typhimurium can be affected by environmental conditions such as acidic pH levels and anaerobiosis in food materials and gastrointestinal tracts. However, S. typhimurium is also able to multiply in the presence of sublethal concentrations of propionic acid at neutral pH during prolonged incubation under both aerobic and anaerobic conditions.     

The immediate bactericidal effect of lactic acid on meat-borne pathogens

P. VAN NETTEN, J.H.J. HUIS IN'T VELD AND D.A.A. MOSSEL. 1994. The kinetics of the bactericidal effect of lactic acid decontamination (LAD) on meat-borne pathogens ( Salmonella spp., Campylobacter jejuni and Listeria monocytogenes ) was studied in an in-vitro model. The bactericidal effect was greatest on organisms in the lactic acid film that replaced the natural fluid on the meat surface during LAD. A stepwise increase in pH from 2.6 to 3.5 and 4.0 progressively reduced the bactericidal effect of decontamination. For treatment with 2% lactic acid for 30–90 s at 21C, the immediate death of Salmonella spp. decreased from about 0.5–2 log₁₀ cfu at pH 2.6 to an insignificant level at pH 4.0. The immediate death for Camp. jejuni decreased from 2.6 to >5.3 at pH 2.6 to 0.3–1.0 at pH 4.0. The decrease in bactericidal effect with increasing pH could, however, be countered by an increase in the temperature from 21C to 37C. It is suggested that 2% LAD at 37C for 30–90 s is suitable for elimination of salmonellas on meat but not for L. monocytogenes. Decontamination with 1% lactic acid at pH 3.0 and 21C for at least 30 s was effective for Camp. jejuni. Mesophilic Enterobacteriaceae were reliable indicators of the LAD-induced bactericidal effect on Salmonella spp. and Camp. jejuni.     

The survival of Staphylococcus aureus during the fermentation and storage of yoghurt

The effect of yoghurt culture R _x on the survival of Staphylococcus aureus CCM 5984 added to milk in various concentrations was observed during the fermentation and storage of yoghurt. The end of the fermentation process (3.5 h) was only accompanied by a slight reduction. During the storage of yoghurt at 4°C a 1-2 log reduction was observed. No Staph. aureus was detected in yoghurt produced from milk contaminated by 10³ Staph. aureus cells 1^-1 after 48 h of cold storage. When a concentration of 10² Staph. aureus cells was used for milk contamination, the pathogen was not recovered from yoghurt during the fermentation and storage. The fermentation and storage of yoghurt was accompanied by increases in lactic acid and titrimetric acidity, as well as by a decrease in pH value.     

The Effect of Lactic Acid Sprays on Campylobacter jejuni Inoculated onto Poultry Carcasses

Spraying poultry carcasses with 1 % lactic acid 10 min after inoculation with Campylobacter jejuni, resulted in a significant reduction in the number of the bacteria after 4 h at 4°C. Some of the inoculated cells, however, survived for at least 144 h. Spraying 10 min after inoculation with 2% lactic acid, totally eliminated all inoculated C. jejuni within 24 h. On the other hand, spraying 24 h after inoculation, with either 1 % or 2 % lactic acid did not eliminate all the bacteria. Inoculated C. jejuni on poultry carcasses not sprayed with lactic acid, survived at 4°C throughout the sampling period (up to 144 h) and showed little tendency to decrease in number even when the carcasses started to deteriorate. Resident Campylobacters on poultry carcasses were significantly reduced by the lactic acid treatment. Frozen and thawed chickens appeared to show a graying of the skins immediately after spraying with lactic acid, slightly stronger with 2 % lactic acid, but the colour reverted to normal after 24 h. We were not able to observe any colour change on the fresh broiler chickens after lactic acid treatment. Our results indicated that lactic acid had a significant bactericidal effect on C. jejuni on both naturally and artificially contaminated poultry carcasses. This effect, however, became manifest only several hours after acid treatment.     

Effects of disinfectants on Campylobacter jejuni

Because of the increasing recognition that Campylobacter jejuni is an important enteric pathogen of humans, we studied the effects of widely used disinfectants on the viability of this organism. At an inoculum size of 10(3) to 10(4) CFU/ml, 1.25 mg of hypochlorite per liter killed three strains within 1 min. At an inoculum size of 10(6) to 10(7) CFU/ml, 5 mg of hypochlorite per liter killed three strains within 15 min. Killing of similar concentrations of C. jejuni and Escherichia coli by hypochlorite was approximately the same. At the high inoculum, 0.15% phenolic compound, 10 mg of iodophor per liter, 1:50,000 quaternary ammonium compound, 70% ethyl alcohol, and 0.125% glutaraldehyde killed all three strains within 1 min. These studies demonstrate that, under the conditions we tested (pH 7.0; 24 to 26 degrees C), the recommended standard concentrations of disinfecting agents are adequate to destroy C. jejuni.     

Comparison of survival of Campylobacter jejuni in the phyllosphere with that in the rhizosphere of spinach and radish plants

Campylobacter jejuni has been isolated previously from market produce and has caused gastroenteritis outbreaks linked to produce. We have tested the ability of this human pathogen to utilize organic compounds that are present in leaf and root exudates and to survive in the plant environment under various conditions. Carbon utilization profiles revealed that C. jejuni can utilize many organic acids and amino acids available on leaves and roots. Despite the presence of suitable substrates in the phyllosphere and the rhizosphere, C. jejuni was unable to grow on lettuce and spinach leaves and on spinach and radish roots of plants incubated at 33 degrees C, a temperature that is conducive to its growth in vitro. However, C. jejuni was cultured from radish roots and from the spinach rhizosphere for at least 23 and 28 days, respectively, at 10 degrees C. This enteric pathogen also persisted in the rhizosphere of spinach for prolonged periods of time at 16 degrees C, a temperature at which many cool-season crops are grown. The decline rate constants of C. jejuni populations in the spinach and radish rhizosphere were 10- and 6-fold lower, respectively, than on healthy spinach leaves at 10 degrees C. The enhanced survival of C. jejuni in soil and in the rhizosphere may be a significant factor in its contamination cycle in the environment and may be associated with the sporadic C. jejuni incidence and campylobacteriosis outbreaks linked to produce.     

Effects of disinfectants on Campylobacter jejuni.

Because of the increasing recognition that Campylobacter jejuni is an important enteric pathogen of humans, we studied the effects of widely used disinfectants on the viability of this organism. At an inoculum size of 10(3) to 10(4) CFU/ml, 1.25 mg of hypochlorite per liter killed three strains within 1 min. At an inoculum size of 10(6) to 10(7) CFU/ml, 5 mg of hypochlorite per liter killed three strains within 15 min. Killing of similar concentrations of C. jejuni and Escherichia coli by hypochlorite was approximately the same. At the high inoculum, 0.15% phenolic compound, 10 mg of iodophor per liter, 1:50,000 quaternary ammonium compound, 70% ethyl alcohol, and 0.125% glutaraldehyde killed all three strains within 1 min. These studies demonstrate that, under the conditions we tested (pH 7.0; 24 to 26 degrees C), the recommended standard concentrations of disinfecting agents are adequate to destroy C. jejuni.     

Growth and survival of Escherichia coli O157:H7 under acidic conditions.

The effect of pH reduction with acetic (pH 5.2), citric (pH 4.0), lactic (pH 4.7), malic (pH 4.0), mandelic (pH 5.0), or tartaric (pH 4.1) acid on growth and survival of Escherichia coli O157:H7 in tryptic soy broth with 0.6% yeast extract held at 25, 10, or 4 degrees C for 56 days was determined. Triplicate flasks were prepared for each acid treatment at each temperature. At 25 degrees C, populations increased 2 to 4 log10 CFU/ml in all treatments except that with mandelic acid, whereas no growth occurred at 10 or 4 degrees C in any treatments except the control. However, at all sampling times, higher (P < 0.05) populations were recovered from treatments held at 4 degrees C than from those held at 10 degrees C. At 10 degrees C, E. coli O157:H7 was inactivated at higher rates in citric, malic, and mandelic acid treatments than in the other treatments. At the pH values tested, the presence of the organic acids enhanced survival of the pathogen at 4 degrees C compared with the unacidified control. E. coli O157:H7 has the ability to survive in acidic conditions (pH, > or = 4.0) for up to 56 days, but survival is affected by type of acidulant and temperature.     

Combinations of intervention treatments resulting in 5-log10-unit reductions in numbers of Escherichia coli O157:H7 and Salmonella typhimurium DT104 organisms in apple cider

The U.S. Food and Drug Administration (FDA) recently mandated a warning statement on packaged fruit juices not treated to reduce target pathogen populations by 5 log10 units. This study describes combinations of intervention treatments that reduced concentrations of mixtures of Escherichia coli O157:H7 (strains ATCC 43895, C7927, and USDA-FSIS-380-94) or Salmonella typhimurium DT104 (DT104b, U302, and DT104) by 5 log10 units in apple cider with a pH of 3.3, 3.7, and 4.1. Treatments used were short-term storage at 4, 25, or 35 degrees C and/or freeze-thawing (48 h at -20 degrees C; 4 h at 4 degrees C) of cider with or without added organic acids (0.1% lactic acid, sorbic acid [SA], or propionic acid). Treatments more severe than those for S. typhimurium DT104 were always required to destroy E. coli O157:H7. In pH 3.3 apple cider, a 5-log10-unit reduction in E. coli O157:H7 cell numbers was achieved by freeze-thawing or 6-h 35 degrees C treatments. In pH 3.7 cider the 5-log10-unit reduction followed freeze-thawing combined with either 6 h at 4 degrees C, 2 h at 25 degrees C, or 1 h at 35 degrees C or 6 h at 35 degrees C alone. A 5-log10-unit reduction occurred in pH 4.1 cider after the following treatments: 6 h at 35 degrees C plus freeze-thawing, SA plus 12 h at 25 degrees C plus freeze-thawing, SA plus 6 h at 35 degrees C, and SA plus 4 h at 35 degrees C plus freeze-thawing. Yeast and mold counts did not increase significantly (P < 0.05) during the 6-h storage at 35 degrees C. Cider with no added organic acids treated with either 6 h at 35 degrees C, freeze-thawing or their combination was always preferred by consumers over pasteurized cider (P < 0.05). The simple, inexpensive intervention treatments described in the present work could produce safe apple cider without pasteurization and would not require the FDA-mandated warning statement.     

Survival and growth of Campylobacter fetus subsp. jejuni on meat and in cooked foods.

Twelve strains of Campylobacter fetus subsp. jejuni isolated from humans and animals grew at temperatures ranging from 34 to 45 degrees C and pH minima between 5.7 and 5.9. Only one strain grew at pH 5.8 with lactic acid present at a concentration similar to that in meat. All strains had decimal reduction times of less than 1 min at 60 degrees C. Further examination of a typical strain showed that it grew at 37 degrees C on high-pH meat but not at 37 degrees C on normal-pH meat. Bacterial numbers on both high (6.4)-pH and normal (5.8)-pH inoculated meat declined at a similar rate when the meat was stored at 25 degrees C. At -1 degree C, the rate of die-off was somewhat slower on normal-pH meat but was very much slower on high-pH meat. The initial fall in bacterial numbers that occurred when meat was frozen was also greater for normal-pH meat than for high-pH meat. The organism exhibited a long lag phase (1 to 2 days) when grown in cooked-meat medium at 37 degrees C and died in meat pies stored at 37 or 43 degrees C. Evaluation of the risk of Campylobacter contamination of red-meat carcasses to human health must take into account the limited potential of the organism to grow or even survive on fresh meats and in warm prepared foods.     

Effect of Short-Chain Fatty Acids and Soil Atmosphere on Tylenchorhynchus spp.

Short-chain fatty acids can be produced under anaerobic conditions by fermentative soil microbes and have nematicidal properties. We evaluated the effects of butyric and propionic acids on death and recovery of stunt nematodes (Tylenchorhynchus spp.), a common parasite of turfgrass. Nematodes in a sand-soil mix (80:20) were treated with butyric or propionic acid and incubated under air or N₂ for 7 days at 25 °C. Amendment of soil with 0.1 and 1.0 µmol (8.8 and 88 µg) butyric acid/g soil or 1.0 µmol (74 µg) propionic acid/g soil resulted in the death of all nematodes. The composition of the soil atmosphere had no effect on the nematicidal activity of the acids. Addition of hydrochloric acid to adjust soil pH to 4.4 and 3.5 resulted in nematode mortality relative to controls (41% to 86%) but to a lesser degree than short-chain fatty acids at the same pH. Nematodes did not recover after a 28-day period following addition of 10 µmol butyric acid/g soil under air or N₂. Carbon mineralization decreased during this period, whereas levels of inorganic N and microbial biomass-N remained constant. Short-chain fatty acids appear to be effective in killing Tylenchorhynchus spp. independent of atmospheric composition. Nematode mortality appears to be a function of the type and concentration of fatty acid and soil pH.     

Factors influencing potent antagonistic effects of Escherichia coli and Bacteroides ovatus on Staphylococcus aureus in anaerobic continuous flow cultures

We examined factors related to the potent antagonistic effect of Escherichia coli and Bacteroides ovatus on Staphylococcus aureus in anaerobic continuous flow cultures. In the presence of sugars fermentable by E. coli alone or both E. coli and S. aureus, motile E. coli strains exerted a potent antagonistic effect and S. aureus was expelled from the culture vessel within a few days. Conversely, in the presence of a sugar fermentable by S. aureus alone, the antagonistic effect of E. coli was diminished and S. aureus persisted at ca. 5 x 10(5) cfu/mL. B. ovatus alone exerted only a weak antagonistic effect on S. aureus in any culture conditions; however, when B. ovatus was cocultivated with E. coli and S. aureus, even in the presence of a sugar fermentable by S. aureus but not by E. coli, the potent antagonistic effect was restored. Escherichia coli showed the same level of antagonistic effect either in the presence of acetic acid (ca. 32 mM), propionic acid (4 mM), butyric acid (17 mM) and hydrogen sulfide (5 x 10(-1) mM) or when these metabolic products, except for a small amount of acetic acid (1.2 mM) were not present. In these culture conditions, S. aureus populations were lost at rates much higher than theoretical wash out rates of resting cells. These results indicate the presence of some bactericidal factors other than the volatile fatty acids and hydrogen sulfide. The bactericidal factors were not found in cultures of E. coli heated in boiling water for 10 min and in cell-free culture filtrates. Thus, the bactericidal factors seem to be associated with live E. coli cells. The nature of the bactericidal factors is not clear at present.     

Effect of ascorbic, isoascorbic and dehydroascorbic acids on the growth and survival of Campylobacter jejuni

Ascorbic acid (AsA), added to nutrient broth at a concentration of 5 mmol/l, was bactericidal towards Campylobacter jejuni grown at 42°C in a micro-aerobic atmosphere. Specific enzymes, radical scavengers, metal chelators and reducing agents were tested as possible antagonists to the cytotoxicity of AsA. The addition of catalase or of the metal chelators ceruloplasmin or Desferal did not prevent the cytotoxic effect of AsA. The addition of the hydroxyl radical scavengers mannitol. formate, histidine or DMSO also failed to counteract the toxicity of AsA. On the other hand, thiourea or cysteamine and the reducing agents cysteine or dithionite significantly increased the recovery of C. jejuni in the presence of AsA. Although the possibility of the involvement of hydroxyl radicals in AsA cytotoxicity cannot be ruled out, it appears that the toxic effect of AsA is due mostly to the formation of products of oxidation of AsA and particularly to dehydroascorbic acid (DHA). Dehydroascorbic acid was also bactericidal to C. jejuni at a concentration of 5 mmol/l. Of all the compounds tested, only cysteamine was effective in preventing (partially) the toxic effect of DHA. The growth of C. jejuni was not inhibited by the addition of 5 mmol/l of isoascorbic acid or sodium isoascorbate.     

Augmenting effect of acetic acid for acidification on bactericidal activity of hypochlorite solution

AIMS: Bactericidal activity of chlorine solution is enhanced by weak acidification. We compared the effects of various acids on the bactericidal activity of hypochlorite solution to establish a method for safe and effective use of an acidic hypochlorite solution. METHODS AND RESULTS: The bactericidal activities of acidic hypochlorite solutions that had been adjusted to pH 5.0 with hydrochloric acid, acetic acid, citric acid, lactic acid, formic acid, phosphoric acid or sulphuric acid against Bacillus subtilis spores were compared. The acidic solutions prepared with hydrochloric acid and acetic acid showed the highest bactericidal activity, and all of the spores (5 x 106 cfu ml(-1)) were killed within 10 min. On the other hand, the solutions prepared with citric acid and lactic acid showed no bactericidal activity against any bacterial strains tested in this study despite the low pH. The amount of chlorine gas produced by the preparation using acetic acid was sixfold less than that produced from the preparation using hydrochloric acid. CONCLUSIONS: Acetic acid is the most suitable and safe acid for the preparation of an acidic hypochlorite solution. SIGNIFICANCE AND IMPACT OF THE STUDY: The results of this study provide useful information for establishing a method for safe and effective use of an acidic hypochlorite solution.     

Effect of short-chain organic acids on macromolecular synthesis in Escherichia coli

Incubating cultures of Escherichia coli with propionic acid (5 mmol/l) or formic acid (10 mmol/l) at pH 5.0 produced bacteriostasis lasting 30 and 120 min respectively. During this time rates of RNA, DNA, protein, lipid and cell wall synthesis were reduced. Growth resumed after continued incubation in the presence of acid, but cells from acid-treated cultures were larger than controls. DNA synthesis was particularly sensitive to the presence of the propionic or formic acid.     

Effect of short-chain organic acids on macromolecular synthesis in Escherichia coli.

Incubating cultures of Escherichia coli with propionic acid (5 mmol/l) or formic acid (10 mmol/l) at pH 5.0 produced bacteriostasis lasting 30 and 120 min respectively. During this time rates of RNA, DNA, protein, lipid and cell wall synthesis were reduced. Growth resumed after continued incubation in the presence of acid, but cells from acid-treated cultures were larger than controls. DNA synthesis was particularly sensitive to the presence of the propionic or formic acid.     

Inhibition of oxidative metabolism by propionic acid and its reversal by carnitine in isolated rat hepatocytes.

The present study was designed to study the interaction of propionic acid and carnitine on oxidative metabolism by isolated rat hepatocytes. Propionic acid (10 mM) inhibited hepatocyte oxidation of [1-14C]-pyruvate (10 mM) by 60%. This inhibition was not the result of substrate competition, as butyric acid had minimal effects on pyruvate oxidation. Carnitine had a small inhibitory effect on pyruvate oxidation in the hepatocyte system (210 +/- 19 and 184 +/- 18 nmol of pyruvate/60 min per mg of protein in the absence and presence of 10 mM-carnitine respectively; means +/- S.E.M., n = 10). However, in the presence of propionic acid (10 mM), carnitine (10 mM) increased the rate of pyruvate oxidation by 19%. Under conditions where carnitine partially reversed the inhibitory effect of propionic acid on pyruvate oxidation, formation of propionylcarnitine was documented by using fast-atom-bombardment mass spectroscopy. Propionic acid also inhibited oxidation of [1-14C]palmitic acid (0.8 mM) by hepatocytes isolated from fed rats. The degree of inhibition caused by propionic acid was decreased in the presence of 10 mM-carnitine (41% inhibition in the absence of carnitine, 22% inhibition in the presence of carnitine). Propionic acid did not inhibit [1-14C]palmitic acid oxidation by hepatocytes isolated from 48 h-starved rats. These results demonstrate that propionic acid interferes with oxidative metabolism in intact hepatocytes. Carnitine partially reverses the inhibition of pyruvate and palmitic acid oxidation by propionic acid, and this reversal is associated with increased propionylcarnitine formation. The present study provides a metabolic basis for the efficacy of carnitine in patients with abnormal organic acid accumulation, and the observation that such patients appear to have increased carnitine requirements ('carnitine insufficiency').