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Zerjav Tansek M, Groselj U, Angelkova N, Anton D, Baric I, Djordjevic M, Grimci L, Ivanova M, Kadam A, Kotori V, Maksic H, Marginean O, Margineanu O, Miljanovic O, Moldovanu F, Muresan M, Nanu M, Samardzic M, Sarnavka V, Savov A, Stojiljkovic M, Suzic B, Tincheva R, Tahirovic H, Toromanovic A, Usurelu N, Battelino T. Phenylketonuria screening and management in southeastern Europe - survey results from 11 countries. Orphanet J Rare Dis 2015; 10:68. [PMID: 26025111 PMCID: PMC4451731 DOI: 10.1186/s13023-015-0283-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/12/2015] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND We aimed to assess the current state of PKU screening and management in the region of southeastern Europe. METHODS A survey was performed involving all identified professionals responsible for the PKU management in the 11 countries from South-Eastern region of Europe (Albania, Bulgaria, Bosnia and Herzegovina, Croatia, Kosovo, Macedonia, Moldova, Montenegro, Romania, Serbia, Slovenia). The questionnaire was designed to assess the characteristics regarding PKU management in three main areas: nation-wide characteristics, PKU screening, and characteristics of the PKU management in the responding centre. It consisted of 56 questions. The distribution and collection of the questionnaires (via e-mail) was taking place from December 2013 to March 2014. RESULTS Responses from participants from 11 countries were included; the countries cumulative population is approx. 52.5 mio. PKU screening was not yet introduced in 4 of 11 countries. Reported PKU incidences ranged from 1/7325 to 1/39338 (and were not known for 5 countries). National PKU guidelines existed in 5 of 11 countries and 7 of 11 countries had PKU registry (registries included 40 to 194 patients). The number of PKU centers in each country varied from 1 to 6. Routine genetic diagnostics was reported in 4 of 11 countries. Most commonly used laboratory method to assess phenylalanine levels was fluorometric. Tetrahydrobiopterine was used in only 2 of 11 countries. Most frequently, pediatricians were caring for the patients. Dietitian was a member of PKU team in only 4 of 11 countries, while regular psychological assessments were performed in 6 of 11 countries. Patient's PKU society existed in 7 of 11 countries. CONCLUSIONS The region of southeastern Europe was facing certain important challenges of PKU screening and management. Neonatal PKU screening should be introduced throughout the region. Furthermore, PKU management was falling behind internationally established standards-of-care in many aspects.
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Affiliation(s)
- Mojca Zerjav Tansek
- University Children's Hospital Ljubljana, UMC Ljubljana, Ljubljana, Slovenia.
| | - Urh Groselj
- University Children's Hospital Ljubljana, UMC Ljubljana, Ljubljana, Slovenia.
| | | | - Dana Anton
- Clinical Hospital for Children "Sfanta Maria", Iasi, Romania.
| | - Ivo Baric
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia. .,School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Maja Djordjevic
- Mother and Child Health Care Institute of Serbia, Belgrade, Serbia.
| | - Lindita Grimci
- University Hospital Center "Mother Teresa", Tirana, Albania.
| | | | - Adil Kadam
- University Pediatric Hospital Sofia, Sofia, Bulgaria.
| | - Vjosa Kotori
- Pediatric Clinic, University Clinical Center Pristina, Pristina, Kosovo.
| | - Hajrija Maksic
- University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina.
| | | | | | - Olivera Miljanovic
- Institute for Sick Children, Clinical Center of Montenegro, Podgorica, Montenegro.
| | | | - Mariana Muresan
- Clinical Hospital for Children "Iuliu Hateganu", Cluj-Napoca, Romania.
| | - Michaela Nanu
- Mother and Child Health Care Institute "Alfred Rusescu", Bucharest, Romania.
| | - Mira Samardzic
- Institute for Sick Children, Clinical Center of Montenegro, Podgorica, Montenegro.
| | - Vladimir Sarnavka
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia.
| | | | - Maja Stojiljkovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia.
| | - Biljana Suzic
- Children Hospital Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
| | | | - Husref Tahirovic
- Department of Medical Sciences, Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina.
| | - Alma Toromanovic
- Department of Pediatrics, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
| | - Natalia Usurelu
- Institute of Mother and Child, Centre of Reproductive Health and Medical Genetics, Chisinau, Moldova.
| | - Tadej Battelino
- University Children's Hospital Ljubljana, UMC Ljubljana, Ljubljana, Slovenia. .,Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Abstract
Phenylketonuria (PKU) is heterogeneous. More than 400 different mutations in the phenylalanine hydroxylase (PAH) gene have been identified. In a systematic review of the molecular genetics of PKU in Europe we identified 29 mutations that may be regarded as prevalent in European populations. Comprehensive regional data for these mutations were collated from all available studies. The spectrum of mutations found in individual regions results from a combination of factors including founder effect, range expansion and migration, genetic drift, and probably heterozygote advantage. Common mutations include R408W on a haplotype 2 background in Eastern Europe, IVS10-11G>A in the Mediterranean, IVS12+1G>A in Denmark and England, Y414C in Scandinavia, I65T in Western Europe, and R408W on haplotype 1 in the British Isles. Molecular data from mild hyperphenylalaninemia (MHP) patients are available from a number of countries, but it is currently not possible to calculate relative allele frequencies. The available data on PAH mutations are useful for the understanding of both the clinical features and the population genetics of PAH deficiency in Europe.
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Affiliation(s)
- Johannes Zschocke
- Institut für Humangenetik, Ruprecht-Karls-Universität, Heidelberg, Germany.
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Kidd JR, Pakstis AJ, Zhao H, Lu RB, Okonofua FE, Odunsi A, Grigorenko E, Tamir BB, Friedlaender J, Schulz LO, Parnas J, Kidd KK. Haplotypes and linkage disequilibrium at the phenylalanine hydroxylase locus, PAH, in a global representation of populations. Am J Hum Genet 2000; 66:1882-99. [PMID: 10788337 PMCID: PMC1378054 DOI: 10.1086/302952] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/1999] [Accepted: 03/14/2000] [Indexed: 11/04/2022] Open
Abstract
Because defects in the phenylalanine hydroxylase gene (PAH) cause phenylketonuria (PKU), PAH was studied for normal polymorphisms and linkage disequilibrium soon after the gene was cloned. Studies in the 1980s concentrated on European populations in which PKU was common and showed that haplotype-frequency variation exists between some regions of the world. In European populations, linkage disequilibrium generally was found not to exist between RFLPs at opposite ends of the gene but was found to exist among the RFLPs clustered at each end. We have now undertaken the first global survey of normal variation and disequilibrium across the PAH gene. Four well-mapped single-nucleotide polymorphisms (SNPs) spanning approximately 75 kb, two near each end of the gene, were selected to allow linkage disequilibrium across most of the gene to be examined. These SNPs were studied as PCR-RFLP markers in samples of, on average, 50 individuals for each of 29 populations, including, for the first time, multiple populations from Africa and from the Americas. All four sites are polymorphic in all 29 populations. Although all but 5 of the 16 possible haplotypes reach frequencies >5% somewhere in the world, no haplotype was seen in all populations. Overall linkage disequilibrium is highly significant in all populations, but disequilibrium between the opposite ends is significant only in Native American populations and in one African population. This study demonstrates that the physical extent of linkage disequilibrium can differ substantially among populations from different regions of the world, because of both ancient genetic drift in the ancestor common to a large regional group of modern populations and recent genetic drift affecting individual populations.
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Affiliation(s)
- J R Kidd
- Department of Genetics, Yale University School of Medicine, New Haven, CT 06520, USA.
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Kádasi L, Poláková H, Feráková E, Hudecová S, Bohusová T, Szomolayová I, Strnová J, Hruskovic I, Moschonas NK, Ferák V. PKU in Slovakia: mutation screening and haplotype analysis. Hum Genet 1995; 95:112-4. [PMID: 7814013 DOI: 10.1007/bf00225087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The restriction fragment length polymorphism haplotypes and seven common mutations in the phenylalanine hydroxylase gene were analysed in 49 unrelated Slovak phenylketonuria (PKU) families of Caucasian origin. The predominant mutation in this population sample is R408W, with a frequency of 45.9%. In addition, four other mutations have been identified at relatively high frequencies: IVS12nt1, 10.2%; R158Q, 7.1%; R261Q, 7.1%; R252W, 2.0%. The mutation-haplotype associations correspond to those described in other European populations. The high proportion of mutations (72.4%) amenable to simple rapid detection based on the polymerase chain reaction provides a good basis for direct DNA-diagnosis of PKU in the Slovak population.
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Affiliation(s)
- L Kádasi
- Institute of Molecular Physiology and Genetics, Slovak Academy of Sciences, Bratislava
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