Hypophosphatemia and sudden infant death syndrome (SIDS)--is ATP the link?

Abstract

In their recent letter Van Kempen and co-workers presented an intriguing hypothesis linking hypophosphatemia and sudden infant death syndrome (SIDS) (1), founded on the work by Siren and Siren on the critical diaphragm failure being the cause of SIDS incidences (2,3). Van Kempen and co-workers argued that both etiology and symptoms of SIDS can be explained by low concentrations in erythrocytes of phosphate metabolites, mainly 2,3-biphosphoglycerate (2,3-BPG, also known as 2,3-diphosphoglycerate, 2,3-DPG), which in effect would impair muscle function (especially diaphragm) and lead to respiratory failure as Siren and Siren originally stated. We find the hypothesis interesting and definitely worth further investigation; however, we would assign the main role to ATP, not to 2,3-BPG.