L-alloisoleucine (2S, 3R), a diastereomer of L-isoleucine (2S, 3S), is a normal constituent of human plasma. It was shown, that the plasma L-alloisoleucine above the cutoff value of 5 micromol/L is the most specific and most sensitive diagnostic marker for all forms of maple syrup urine disease (MSUD). The precise mechanism of L-alloisoleucine formation is unclear, but existed suggestions, that R-3-methyl-2-oxopentanoate is an immediate and inevitable byproduct of L-isoleucine transamination and that alloisoleucine is primarily formed via transamination of 3-methyl-2-oxopenanoate in vivo.