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Moon K, McKinnon E, Croft K, Mori TA, Simmer K, Patole S, Rao S. Early versus late parenteral nutrition in term and late preterm infants: a randomised controlled trial. BMJ Paediatr Open 2024; 8:e002579. [PMID: 38735834 DOI: 10.1136/bmjpo-2024-002579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND There is limited evidence regarding the optimal time to commence parenteral nutrition (PN) in term and late preterm infants. DESIGN Single-centre, non-blinded, exploratory randomised controlled trial. SETTING A level-3 neonatal unit in a stand-alone paediatric hospital. PATIENTS Infants born ≥34 weeks of gestation and ≤28 days, who needed PN. Eligible infants were randomised on day 1 or day 2 of admission. INTERVENTIONS Early (day 1 or day 2 of admission, N=30) or late (day 6 of admission, N=30) PN. MAIN OUTCOME MEASURES Plasma phenylalanine and F2-isoprostane levels on day 4 and day 8 of admission. Secondary outcomes were amino-acid and fatty-acid profiles on day 4 and day 8, and clinical outcomes. RESULTS The postnatal age at randomisation was similar between the groups (2.3 (SD 0.8) vs 2.3 (0.7) days, p=0.90). On day 4, phenylalanine levels in early-PN infants were higher than in late-PN (mean (SD) 62.9 (26.7) vs 45.5 (15.3) µmol/L; baseline-adjusted percentage difference 25.8% (95% CI 11.6% to 39.9%), p<0.001). There was no significant difference in phenylalanine levels between the two groups on day 8. There was no significant difference between the groups for F2-isoprostane levels on day 4 (early-PN mean (SD) 389 (176) vs late-PN 419 (291) pg/mL; baseline-adjusted percentage difference: -4.4% (95% CI -21.5% to 12.8%) p=0.62) and day 8 (mean (SD) 305 (125) vs 354 (113) pg/mL; adjusted mean percentage difference -16.1 (95% CI -34.1 to 1.9) p=0.09).Postnatal growth restriction for weight was less severe in the early-PN group (change in weight z-score from baseline to discharge: -0.6 (0.6) vs -1.0 (0.6); p=0.02). The incidence of hyperglycaemia was greater in the early-PN group (20/30 (66.7%) vs 11/30 (36.7%), p=0.02). CONCLUSIONS The timing of the commencement of PN did not seem to affect the degree of oxidative stress in critically ill term and late preterm infants. The effect of transiently high plasma phenylalanine with early PN on clinical outcomes requires further investigation. TRIAL REGISTRATION NUMBER ACTRN12620000324910.
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Affiliation(s)
- Kwi Moon
- Pharmacy Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth McKinnon
- Telethon Institute for Child Health Research, Nedlands, Western Australia, Australia
| | - Kevin Croft
- The University of Western Australia School of Biomedical Sciences, Nedlands, Western Australia, Australia
| | - Trevor A Mori
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Karen Simmer
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Sanjay Patole
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Neonatology, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
| | - Shripada Rao
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Neonatology, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Kang R, Guo D, Wang J, Xie Z. Association of dietary nutrient intake with type 2 diabetes: A Mendelian randomization study. Medicine (Baltimore) 2024; 103:e38090. [PMID: 38728475 PMCID: PMC11081547 DOI: 10.1097/md.0000000000038090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
Observational research suggests that the evidence linking dietary nutrient intake (encompassing minerals, vitamins, amino acids, and unsaturated fatty acids) to type 2 diabetes (T2D) is both inconsistent and limited. This study aims to explore the potential causal relationship between dietary nutrients and T2D. Causal estimation utilized Mendelian randomization techniques. Single nucleotide polymorphisms linked to dietary nutrients were identified from existing genome-wide association studies and used as instrumental variables. Genome-wide association studies data pertinent to T2D were sourced from the DIMANTE consortium and the FinnGen database. Techniques including inverse variance weighting (IVW), weighted mode, weighted median, and Mendelian randomization-Egger were employed for causal inference, complemented by sensitivity analysis. Genetically predicted higher phenylalanine (IVW: odds ratio = 1.10 95% confidence interval 1.04-1.17, P = 1.5 × 10-3, q_pval = 3.4 × 10-2) and dihomo-gamma-linolenic acid (IVW: odds ratio = 1.001 95% confidence interval 1.0006-1.003, P = 3.7 × 10-3, q_pval = 4.1 × 10-2) levels were directly associated with T2D risk. Conversely, no causal relationships between other nutrients and T2D were established. We hypothesize that phenylalanine and dihomo-gamma-linolenic acid contribute to the pathogenesis of T2D. Clinically, the use of foods with high phenylalanine content may pose potential risks for patients with a heightened risk of T2D. Our study provides evidence supporting a causal link between dietary nutrient intake and the development of T2D.
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Affiliation(s)
- Ruixiang Kang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dong Guo
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jiawei Wang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhencong Xie
- Shandong University of Traditional Chinese Medicine, Jinan, China
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3
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Gietl M, Burkert F, Hofer S, Gostner JM, Sonnweber T, Tancevski I, Pizzini A, Sahanic S, Schroll A, Brigo N, Egger A, Bellmann-Weiler R, Löffler-Ragg J, Weiss G, Kurz K. Laboratory parameters related to disease severity and physical performance after reconvalescence of acute COVID-19 infection. Sci Rep 2024; 14:10388. [PMID: 38710760 DOI: 10.1038/s41598-024-57448-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/18/2024] [Indexed: 05/08/2024] Open
Abstract
Research into the molecular basis of disease trajectory and Long-COVID is important to get insights toward underlying pathophysiological processes. The objective of this study was to investigate inflammation-mediated changes of metabolism in patients with acute COVID-19 infection and throughout a one-year follow up period. The study enrolled 34 patients with moderate to severe COVID-19 infection admitted to the University Clinic of Innsbruck in early 2020. The dynamics of multiple laboratory parameters (including inflammatory markers [C-reactive protein (CRP), interleukin-6 (IL-6), neopterin] as well as amino acids [tryptophan (Trp), phenylalanine (Phe) and tyrosine (Tyr)], and parameters of iron and vitamin B metabolism) was related to disease severity and patients' physical performance. Also, symptom load during acute illness and at approximately 60 days (FU1), and one year after symptom onset (FU2) were monitored and related with changes of the investigated laboratory parameters: During acute infection many investigated laboratory parameters were elevated (e.g., inflammatory markers, ferritin, kynurenine, phenylalanine) and enhanced tryptophan catabolism and phenylalanine accumulation were found. At FU2 nearly all laboratory markers had declined back to reference ranges. However, kynurenine/tryptophan ratio (Kyn/Trp) and the phenylalanine/tyrosine ratio (Phe/Tyr) were still exceeding the 95th percentile of healthy controls in about two thirds of our cohort at FU2. Lower tryptophan concentrations were associated with B vitamin availability (during acute infection and at FU1), patients with lower vitamin B12 levels at FU1 had a prolonged and more severe impairment of their physical functioning ability. Patients who had fully recovered (ECOG 0) presented with higher concentrations of iron parameters (ferritin, hepcidin, transferrin) and amino acids (phenylalanine, tyrosine) at FU2 compared to patients with restricted ability to work. Persistent symptoms at FU2 were tendentially associated with IFN-γ related parameters. Women were affected by long-term symptoms more frequently. Conclusively, inflammation-mediated biochemical changes appear to be related to symptoms of patients with acute and Long Covid.
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Affiliation(s)
- Mario Gietl
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Francesco Burkert
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Stefanie Hofer
- Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, Innrain 80, 6020, Innsbruck, Austria
| | - Johanna M Gostner
- Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, Innrain 80, 6020, Innsbruck, Austria
| | - Thomas Sonnweber
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ivan Tancevski
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Alex Pizzini
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sabina Sahanic
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Andrea Schroll
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Natascha Brigo
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Alexander Egger
- Central Institute for Medical and Chemical Laboratory Diagnostics (ZIMCL), Tirol Kliniken GmbH, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Judith Löffler-Ragg
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Katharina Kurz
- Department of Internal Medicine II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Kuypers AM, Vliet KEV, MacDonald A, Ahring K, Abeln D, Ford S, Hildebrandt-Karlsen S, van Spronsen FJ, Heiner-Fokkema MR. Satisfaction with home blood sampling methods and expectations for future point-of-care testing in phenylketonuria: Perspectives from patients and professionals. Mol Genet Metab 2024; 142:108361. [PMID: 38442492 DOI: 10.1016/j.ymgme.2024.108361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Phenylketonuria (PKU) requires regular phenylalanine monitoring to ensure optimal outcome. However, home sampling methods used for monitoring suffer high pre-analytical variability, inter-laboratory variability and turn-around-times, highlighting the need for alternative methods of home sampling or monitoring. METHODS A survey was distributed through email and social media to (parents of) PKU patients and professionals working in inherited metabolic diseases in Denmark, The Netherlands, and United Kingdom regarding satisfaction with current home sampling methods and expectations for future point-of-care testing (POCT). RESULTS 210 parents, 156 patients and 95 professionals completed the survey. Countries, and parents and patients were analysed together, in absence of significant group differences for most questions. Important results are: 1) Many patients take less home samples than advised. 2) The majority of (parents of) PKU patients are (somewhat) dissatisfied with their home sampling method, especially with turn-around-times (3-5 days). 3) 37% of professionals are dissatisfied with their home sampling method and 45% with the turn-around-times. 4) All responders are positive towards developments for POCT: 97% (n = 332) of (parents of) patients is willing to use a POC-device and 76% (n = 61) of professionals would recommend their patients to use a POC-device. 5) Concerns from all participants for future POC-devices are costs/reimbursements and accuracy, and to professionals specifically, accessibility to results, over-testing, patient anxiety, and patients adjusting their diet without consultation. CONCLUSION The PKU community is (somewhat) dissatisfied with current home sampling methods, highlighting the need for alternatives of Phe monitoring. POCT might be such an alternative and the community is eager for its arrival.
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Affiliation(s)
- Allysa M Kuypers
- Section of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Kimber Evers-van Vliet
- Section of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anita MacDonald
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, UK
| | | | | | - Suzanne Ford
- The National Society for Phenylketonuria (NSPKU), Richard House, Lancashire, UK
| | | | - Francjan J van Spronsen
- Section of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M Rebecca Heiner-Fokkema
- Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Trefz F, Frauendienst-Egger G, Dienel G, Cannet C, Schmidt-Mader B, Haas D, Blau N, Himmelreich N, Spraul M, Freisinger P, Dobrowolski S, Berg D, Pilotto A. Does hyperphenylalaninemia induce brain glucose hypometabolism? Cerebral spinal fluid findings in treated adult phenylketonuric patients. Mol Genet Metab 2024; 142:108464. [PMID: 38537426 DOI: 10.1016/j.ymgme.2024.108464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 05/08/2024]
Abstract
Despite numerous studies in human patients and animal models for phenylketonuria (PKU; OMIM#261600), the pathophysiology of PKU and the underlying causes of brain dysfunction and cognitive problems in PKU patients are not well understood. In this study, lumbar cerebral spinal fluid (CSF) was obtained immediately after blood sampling from early-treated adult PKU patients who had fasted overnight. Metabolite and amino acid concentrations in the CSF of PKU patients were compared with those of non-PKU controls. The CSF concentrations and CSF/plasma ratios for glucose and lactate were found to be below normal, similar to what has been reported for glucose transporter1 (GLUT1) deficiency patients who exhibit many of the same clinical symptoms as untreated PKU patients. CSF glucose and lactate levels were negatively correlated with CSF phenylalanine (Phe), while CSF glutamine and glutamate levels were positively correlated with CSF Phe levels. Plasma glucose levels were negatively correlated with plasma Phe concentrations in PKU subjects, which partly explains the reduced CSF glucose concentrations. Although brain glucose concentrations are unlikely to be low enough to impair brain glucose utilization, it is possible that the metabolism of Phe in the brain to produce phenyllactate, which can be transported across the blood-brain barrier to the blood, may consume glucose and/or lactate to generate the carbon backbone for glutamate. This glutamate is then converted to glutamine and carries the Phe-derived ammonia from the brain to the blood. While this mechanism remains to be tested, it may explain the correlations of CSF glutamine, glucose, and lactate concentrations with CSF Phe.
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Affiliation(s)
- Friedrich Trefz
- Heidelberg University, Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic Medicine, Heidelberg, Germany.
| | | | - Gerald Dienel
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Department of Cell Biology and Physiology, University of New Mexico, Albuquerque, NM, United States
| | | | - Brigitte Schmidt-Mader
- Heidelberg University, Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic Medicine, Heidelberg, Germany
| | - Dorothea Haas
- Heidelberg University, Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic Medicine, Heidelberg, Germany
| | - Nenad Blau
- University Children's Hospital Zürich, Zürich, Switzerland
| | | | | | - Peter Freisinger
- Klinikum Reutlingen, Department of Pediatrics, Reutlingen, Germany
| | - Steven Dobrowolski
- Department of Pathology, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15224, United States
| | - Daniela Berg
- Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
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Feldmann R, Och U, Beckmann LS, Weglage J, Rutsch F. Children and Adolescents with Early Treated Phenylketonuria: Cognitive Development and Fluctuations of Blood Phenylalanine Levels. Int J Environ Res Public Health 2024; 21:431. [PMID: 38673342 PMCID: PMC11050632 DOI: 10.3390/ijerph21040431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND We assessed the relationship between the cognitive development of children and adolescents with phenylketonuria (PKU) and fluctuations in peripheral phenylalanine (Phe) levels. METHODS We examined the neurocognitive performance of 33 children and adolescents with early treated PKU, of whom 18 were treated with sapropterin dihydrochloride, and 15 were on a classic diet. For 26 weeks, patients were assessed weekly for their blood phenylalanine (Phe) levels. Phe levels were analyzed for fluctuations indicated by the individual standard deviation. Fluctuations were compared to the standard deviation of 26 Phe level measurements before the study interval. We also assessed the concurrent IQ of the patients. This was repeated at one-, two-, and seven-year intervals. RESULTS Full-scale IQ in patients treated with a classic diet did not change within the follow-up. In patients treated with Sapropterin dihydrochloride, however, there was a considerable gain in full-scale IQ. This was particularly true if blood Phe fluctuations increased in patients of this treatment group. CONCLUSIONS Sapropterin dihydrochloride enhances Phe tolerance in patients with PKU. Increasing blood Phe fluctuations following enhanced Phe tolerance may indicate that the treatment not only allows patients to relax their Phe-restricted diet but also may support cognitive development in patients.
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Affiliation(s)
- Reinhold Feldmann
- Department of General Pediatrics, Münster University Children’s Hospital, 48149 Münster, Germany; (U.O.); (F.R.)
- Children’s Healthcare Center “Haus Walstedde”, 48317 Drensteinfurt, Germany
| | - Ulrike Och
- Department of General Pediatrics, Münster University Children’s Hospital, 48149 Münster, Germany; (U.O.); (F.R.)
| | - Lisa Sophie Beckmann
- Department of General Pediatrics, Münster University Children’s Hospital, 48149 Münster, Germany; (U.O.); (F.R.)
| | - Josef Weglage
- Children’s Healthcare Center “Haus Walstedde”, 48317 Drensteinfurt, Germany
| | - Frank Rutsch
- Department of General Pediatrics, Münster University Children’s Hospital, 48149 Münster, Germany; (U.O.); (F.R.)
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Scott B, Day EA, O'Brien KL, Scanlan J, Cromwell G, Scannail AN, McDonnell ME, Finlay DK, Lynch L. Metformin and feeding increase levels of the appetite-suppressing metabolite Lac-Phe in humans. Nat Metab 2024; 6:651-658. [PMID: 38499765 PMCID: PMC11052712 DOI: 10.1038/s42255-024-01018-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
Metformin, a widely used first-line treatment for type 2 diabetes (T2D), is known to reduce blood glucose levels and suppress appetite. Here we report a significant elevation of the appetite-suppressing metabolite N-lactoyl phenylalanine (Lac-Phe) in the blood of individuals treated with metformin across seven observational and interventional studies. Furthermore, Lac-Phe levels were found to rise in response to acute metformin administration and post-prandially in patients with T2D or in metabolically healthy volunteers.
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Affiliation(s)
- Barry Scott
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Emily A Day
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Katie L O'Brien
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - John Scanlan
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Grace Cromwell
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aine Ni Scannail
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marie E McDonnell
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David K Finlay
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Lydia Lynch
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Bratkovic D, Margvelashvili L, Tchan MC, Nisbet J, Smith N. PTC923 (sepiapterin) lowers elevated blood phenylalanine in subjects with phenylketonuria: a phase 2 randomized, multi-center, three-period crossover, open-label, active controlled, all-comers study. Metabolism 2022; 128:155116. [PMID: 34973284 DOI: 10.1016/j.metabol.2021.155116] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/21/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIM PTC923 (formerly CNSA-001), an oral formulation of sepiapterin, a natural precursor of intracellular tetrahydrobiopterin (BH4), has been shown in humans to induce larger increases in circulating BH4 vs. sapropterin dihydrochloride. Sapropterin reduces blood phenylalanine (Phe) by ≥20-30% in a minority of subjects with PKU. This was a Phase 2 randomized, multicenter, three-period crossover, open-label, active controlled, all-comers [regardless of phenylalanine hydroxylase (PAH) variants] comparison of PTC923 60 mg/kg, PTC923 20 mg/kg and sapropterin 20 mg/kg in 24 adults with phenylketonuria (PKU) and hyperphenylalaninemia. METHODS Eligible subjects were adult men or women (18-60 y) with PKU. Subjects enrolled received 7 days of once-daily oral treatment with PTC923 20 mg/kg/day, PTC923 60 mg/kg/day and sapropterin dihydrochloride 20 mg/kg/day each in a random order. Treatments were separated by a 7-day washout. Subjects maintained their usual pre-study diet, including consumption of amino acid mixtures. Blood Phe was measured on Day 1 (predose baseline), Day 3, Day 5, and Day 7 of each treatment period. RESULTS Least squares mean changes (SE) from baseline in blood Phe were: -206.4 (41.8) μmol/L for PTC923 60 mg/kg (p < 0.0001); -146.9 (41.8) μmol/L for PTC923 20 mg/kg (p = 0.0010); and - 91.5 (41.7) μmol/L for sapropterin (p = 0.0339). Effects of PTC923 60 mg/kg on blood Phe vs. sapropterin were significantly larger (p = 0.0098) and faster in onset with a significantly larger mean reduction in blood Phe at day 3 of treatment, p = 0.0135 (20 mg/kg) and p = 0.0007 (60 mg/kg). Only PTC923 60 mg/kg reduced blood Phe in classical PKU subjects (n = 11, p = 0.0287). The mean blood Phe reduction (PTC923 60 mg/kg) in a cofactor responder analysis (n = 8; baseline Phe ≥300 μmol/L and blood Phe reduction ≥30%) was -463.3 μmol/L (SE 51.5) from baseline. Adverse events were mostly mild to moderate, transient, and similar across treatment groups with no serious adverse events or discontinuations. CONCLUSIONS The substantially significantly better effect of PTC923 60 mg/kg on blood Phe reduction vs. sapropterin supports further clinical development of PTC923 for PKU; ANZCTR number, ACTRN12618001031257.
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Affiliation(s)
- Drago Bratkovic
- PARC Clinical Research, Royal Adelaide Hospital, South Australia, Australia
| | | | - Michel C Tchan
- Department of Genetic Medicine, Westmead Hospital, Australia and University of Sydney, Sydney, New South Wales, Australia
| | - Janelle Nisbet
- Mater Misericordiae Limited, Queensland Diabetes and Endocrine Centre, Brisbane, Queensland, Australia
| | - Neil Smith
- PTC Therapeutics Inc, South Plainfield, NJ, USA.
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Ahring KK, Dagnæs-Hansen F, Brüel A, Christensen M, Jensen E, Jensen TG, Johannsen M, Johansen KS, Lund AM, Madsen JG, Brøndum-Nielsen K, Pedersen M, Sørensen LK, Kjolby M, Møller LB. The effect of casein glycomacropeptide versus free synthetic amino acids for early treatment of phenylketonuria in a mice model. PLoS One 2022; 17:e0261150. [PMID: 35015767 PMCID: PMC8751992 DOI: 10.1371/journal.pone.0261150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Management of phenylketonuria (PKU) is mainly achieved through dietary control with limited intake of phenylalanine (Phe) from food, supplemented with low protein (LP) food and a mixture of free synthetic (FS) amino acids (AA) (FSAA). Casein glycomacropeptide (CGMP) is a natural peptide released in whey during cheese making by the action of the enzyme chymosin. Because CGMP in its pure form does not contain Phe, it is nutritionally suitable as a supplement in the diet for PKU when enriched with specific AAs. Lacprodan® CGMP-20 (= CGMP) used in this study contained only trace amounts of Phe due to minor presence of other proteins/peptides. Objective The aims were to address the following questions in a classical PKU mouse model: Study 1, off diet: Can pure CGMP or CGMP supplemented with Large Neutral Amino Acids (LNAA) as a supplement to normal diet significantly lower the content of Phe in the brain compared to a control group on normal diet, and does supplementation of selected LNAA results in significant lower brain Phe level?. Study 2, on diet: Does a combination of CGMP, essential (non-Phe) EAAs and LP diet, provide similar plasma and brain Phe levels, growth and behavioral skills as a formula which alone consist of FSAA, with a similar composition?. Material and methods 45 female mice homozygous for the Pahenu2 mutation were treated for 12 weeks in five different groups; G1(N-CGMP), fed on Normal (N) casein diet (75%) in combination with CGMP (25%); G2 (N-CGMP-LNAA), fed on Normal (N) casein diet (75%) in combination with CGMP (19,7%) and selected LNAA (5,3% Leu, Tyr and Trp); G3 (N), fed on normal casein diet (100%); G4 (CGMP-EAA-LP), fed on CGMP (70,4%) in combination with essential AA (19,6%) and LP diet; G5 (FSAA-LP), fed on FSAA (100%) and LP diet. The following parameters were measured during the treatment period: Plasma AA profiles including Phe and Tyr, growth, food and water intake and number of teeth cut. At the end of the treatment period, a body scan (fat and lean body mass) and a behavioral test (Barnes Maze) were performed. Finally, the brains were examined for content of Phe, Tyr, Trp, dopamine (DA), 3,4-dihydroxyphenylacetic acid (DOPAC), serotonin (5-HT) and 5-hydroxyindole-acetic acid (5-HIAA), and the bone density and bone mineral content were determined by dual-energy x-ray absorptiometry. Results Study 1: Mice off diet supplemented with CGMP (G1 (N-CGMP)) or supplemented with CGMP in combination with LNAA (G2 (N-CGMP-LNAA)) had significantly lower Phe in plasma and in the brain compared to mice fed only casein (G3 (N)). Extra LNAA (Tyr, Trp and Leu) to CGMP did not have any significant impact on Phe levels in the plasma and brain, but an increase in serotonin was measured in the brain of G2 mice compared to G1. Study 2: PKU mice fed with mixture of CGMP and EAA as supplement to LP diet (G4 (CGMP-EAA-LP)) demonstrated lower plasma-Phe levels but similar brain- Phe levels and growth as mice fed on an almost identical combination of FSAA (G5 (FSAA-LP)). Conclusion CGMP can be a relevant supplement for the treatment of PKU.
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Affiliation(s)
- Kirsten K. Ahring
- Departments of Paediatrics and Clinical Genetics, PKU Clinic, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Denmark
- * E-mail:
| | | | - Annemarie Brüel
- Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark
| | - Mette Christensen
- Departments of Paediatrics and Clinical Genetics, Centre for Inherited Metabolic Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Erik Jensen
- Arla Foods Ingredients Group P/S, Viby J, Denmark
| | - Thomas G. Jensen
- Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark
| | - Mogens Johannsen
- Department of Forensic Medicine, Aarhus University, Skejby, Aarhus, Denmark
| | - Karen S. Johansen
- Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark
| | - Allan M. Lund
- Departments of Paediatrics and Clinical Genetics, Centre for Inherited Metabolic Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jesper G. Madsen
- Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark
| | - Karen Brøndum-Nielsen
- Departments of Paediatrics and Clinical Genetics, PKU Clinic, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Michael Pedersen
- Comparative Medicine Lab, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mads Kjolby
- Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Lisbeth B. Møller
- Department of Clinical Genetics, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Denmark
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10
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Yazdanpanah M, Yuan L. A highly accurate mass spectrometry method for the quantification of phenylalanine and tyrosine on dried blood spots: Combination of liquid chromatography, phenylalanine/tyrosine-free blood calibrators and multi-point/dynamic calibration. Clin Biochem 2021; 101:35-41. [PMID: 34896097 DOI: 10.1016/j.clinbiochem.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/03/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Measurement of quantitative levels of phenylalanine and tyrosine in blood is an essential test for the diagnosis of and monitoring genetic disorders associated with phenylalanine metabolism, such as phenylketonuria (PKU), tyrosinemia, and defects of tetrahydrobiopterin synthesis and recycling. We developed a highly accurate and fast liquid chromatography with tandem mass spectrometry (LC-MS/MS) method for the quantification of phenylalanine and tyrosine on dried blood spot (DBS). We also designed a performance score system to evaluate various calibration methods in matrix matched material. METHODS Phenylalanine/tyrosine-free whole blood was used to make accurate and stable DBS calibrators. Six calibrators cover the range of 0-1000 µmol/L. Underivatized phenylalanine and tyrosine were extracted and measured by LC-MS/MS. Precision, accuracy, limit of quantification, recovery and carryover were validated. External quality assurance materials were also used to evaluate performance of multi-point calibrations and single-point calibrations. RESULTS The run time was 4.5-minute. Accuracy analysis showed good agreement with reference materials. Precision, recovery, and the lower and upper limit of quantification met the criteria. When phenylalanine and tyrosine concentrations were less than 150 µmol/L, the 5-point calibration without the calibrator of 1000 µmol/L had the best performance. When the concentrations were > 250 µmol/L, the single-point calibration of 500 µmol/L had the best performance. CONCLUSION We developed a simple, fast and highly accurate method for the detection of phenylalanine and tyrosine on DBS, with chromatographic separation and underivatized analysis. Based on the calibration performance, a 6-point calibration method is satisfying for this test. An optional dynamic calibration method, which includes 6-point calibration, 5-point calibration and single-point calibration, can further increase test reliability.
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Affiliation(s)
- Mehrdad Yazdanpanah
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Libin Yuan
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
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11
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Manek R, Zhang YV, Berthelette P, Hossain M, Cornell CS, Gans J, Anarat-Cappillino G, Geller S, Jackson R, Yu D, Singh K, Ryan S, Bangari DS, Xu EY, Kyostio-Moore SRM. Blood phenylalanine reduction reverses gene expression changes observed in a mouse model of phenylketonuria. Sci Rep 2021; 11:22886. [PMID: 34819582 PMCID: PMC8613214 DOI: 10.1038/s41598-021-02267-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022] Open
Abstract
Phenylketonuria (PKU) is a genetic deficiency of phenylalanine hydroxylase (PAH) in liver resulting in blood phenylalanine (Phe) elevation and neurotoxicity. A pegylated phenylalanine ammonia lyase (PEG-PAL) metabolizing Phe into cinnamic acid was recently approved as treatment for PKU patients. A potentially one-time rAAV-based delivery of PAH gene into liver to convert Phe into tyrosine (Tyr), a normal way of Phe metabolism, has now also entered the clinic. To understand differences between these two Phe lowering strategies, we evaluated PAH and PAL expression in livers of PAHenu2 mice on brain and liver functions. Both lowered brain Phe and increased neurotransmitter levels and corrected animal behavior. However, PAL delivery required dose optimization, did not elevate brain Tyr levels and resulted in an immune response. The effect of hyperphenylalanemia on liver functions in PKU mice was assessed by transcriptome and proteomic analyses. We observed an elevation in Cyp4a10/14 proteins involved in lipid metabolism and upregulation of genes involved in cholesterol biosynthesis. Majority of the gene expression changes were corrected by PAH and PAL delivery though the role of these changes in PKU pathology is currently unclear. Taken together, here we show that blood Phe lowering strategy using PAH or PAL corrects both brain pathology as well as previously unknown lipid metabolism associated pathway changes in liver.
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Affiliation(s)
- Rachna Manek
- Genomic Medicine Unit, Sanofi, Framingham, MA, USA.
| | - Yao V Zhang
- Genomic Medicine Unit, Sanofi, Framingham, MA, USA
| | | | | | | | - Joseph Gans
- Translational Sciences, Sanofi, Framingham, MA, USA
| | | | - Sarah Geller
- Pre-Development Sciences NA, Analytical R&D, Sanofi, Framingham, MA, USA
| | | | - Dan Yu
- Genomic Medicine Unit, Sanofi, Framingham, MA, USA
| | - Kuldeep Singh
- Global Discovery Pathology, Sanofi, Framingham, MA, USA
| | - Sue Ryan
- Global Discovery Pathology, Sanofi, Framingham, MA, USA
| | | | - Ethan Y Xu
- Translational Sciences, Sanofi, Framingham, MA, USA
- Excision BioTherapeutics, Cambridge, MA, USA
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12
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Scala I, Concolino D, Nastasi A, Esposito G, Crisci D, Sestito S, Ferraro S, Albano L, Ruoppolo M, Parenti G, Strisciuglio P. Beneficial Effects of Slow-Release Large Neutral Amino Acids after a Phenylalanine Oral Load in Patients with Phenylketonuria. Nutrients 2021; 13:nu13114012. [PMID: 34836270 PMCID: PMC8618154 DOI: 10.3390/nu13114012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
The mainstay of phenylketonuria treatment is a low protein diet, supplemented with phenylalanine (Phe)-free protein substitutes and micronutrients. Adhering to this diet is challenging, and even patients with good metabolic control who follow the dietary prescriptions in everyday life ignore the recommendations occasionally. The present study explores the ability of slow-release large neutral amino acids (srLNAAs) to prevent Phe increase following a Phe dietary load. Fourteen phenylketonuric patients aged ≥13 years were enrolled in a 6-week protocol. Oral acute Phe loads of 250 and 500 mg were added to the evening meal together with srLNAAs (0.5 gr/kg). Phe and tyrosine were dosed before dinner, 2h-after dinner, and after the overnight fast. After oral Phe loads, mean plasma Phe remained stable and below 600 µmol/L. No Phe peaks were registered. Tyrosine levels significantly increased, and Phe/Tyrosine ratio decreased. No adverse events were registered. In conclusion, a single oral administration of srLNAAs at the dose of 0.5 gr/kg is effective in maintaining stable plasma Phe during acute oral loads with Phe-containing food and may be added to the dietetic scheme in situations in which patients with generally good adherence to diet foresee a higher than prescribed Phe intake due to their commitments.
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Affiliation(s)
- Iris Scala
- Department of Maternal and Child Health, Federico II University Hospital, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-7463348; +39-081-7463769
| | - Daniela Concolino
- Pediatric Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (D.C.); (S.S.); (S.F.)
| | - Anna Nastasi
- Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy;
| | - Giulia Esposito
- Department of Translational Medical Science, Section of Pediatrics, Federico II University, 80131 Naples, Italy; (G.E.); (G.P.); (P.S.)
| | - Daniela Crisci
- CEINGE Biotecnologie Avanzate Scarl, 80131 Naples, Italy; (D.C.); (L.A.); (M.R.)
| | - Simona Sestito
- Pediatric Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (D.C.); (S.S.); (S.F.)
| | - Stefania Ferraro
- Pediatric Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (D.C.); (S.S.); (S.F.)
| | - Lucia Albano
- CEINGE Biotecnologie Avanzate Scarl, 80131 Naples, Italy; (D.C.); (L.A.); (M.R.)
| | - Margherita Ruoppolo
- CEINGE Biotecnologie Avanzate Scarl, 80131 Naples, Italy; (D.C.); (L.A.); (M.R.)
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, 80131 Naples, Italy
| | - Giancarlo Parenti
- Department of Translational Medical Science, Section of Pediatrics, Federico II University, 80131 Naples, Italy; (G.E.); (G.P.); (P.S.)
- Telethon Institute of Genetics and Medicine, 80078 Pozzuoli, Italy
| | - Pietro Strisciuglio
- Department of Translational Medical Science, Section of Pediatrics, Federico II University, 80131 Naples, Italy; (G.E.); (G.P.); (P.S.)
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13
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Aitkenhead L, Krishna G, Ellerton C, Moinuddin M, Matcham J, Shiel L, Hossain S, Kiffin M, Foley J, Skeath R, Cleary M, Lachmann R, Murphy E. Long-term cognitive and psychosocial outcomes in adults with phenylketonuria. J Inherit Metab Dis 2021; 44:1353-1368. [PMID: 34145605 DOI: 10.1002/jimd.12413] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 05/31/2021] [Accepted: 06/16/2021] [Indexed: 12/22/2022]
Abstract
Previous studies have suggested that cognitive and psychosocial underfunctioning in early-treated adults with phenylketonuria (PKU) may be explained by suboptimal adherence to dietary treatments, however, these studies often employ small samples, with different outcome measures, definitions and cut-offs. Samples have also tended to comprise participants with a limited range of blood phenylalanine concentrations, and often individuals who may not have been treated early enough to avoid neurological damage. In this study, we explore the impact of lifetime dietary control, as indicated by blood phenylalanine concentrations in childhood, adolescence and adulthood, on long-term cognitive and psychosocial outcomes in a large sample of adults with PKU who were diagnosed by neonatal screening and commenced on dietary treatment within the first month of life. One hundred and fifty-four participants underwent cognitive testing, assessing attention, learning, working memory, language, executive functioning and processing speed. One hundred and forty-nine completed measures of psychosocial functioning, documenting educational, occupational, quality of life, emotional and social outcomes which were compared with a group of healthy controls. Many adults with PKU demonstrated cognitive impairments, most frequently affecting processing speed (23%), executive function (20%) and learning (12%). Cognitive outcomes were related to measures of historic metabolic control, but only processing speed was significantly related to phenylalanine concentration at the time of testing after controlling for historic levels. Adults with PKU did not, however, differ from controls in educational, occupational, quality of life or emotional outcomes, or on a measure of family functioning, and showed only minor differences in relationship style. These findings have implications for patient counselling and decisions regarding the management of PKU in adulthood.
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Affiliation(s)
- Lynne Aitkenhead
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
- UCL Institute of Neurology, London, UK
| | - Gauri Krishna
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Charlotte Ellerton
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Md Moinuddin
- UCL Institute of Child Health, London, UK
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Jessica Matcham
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Lisha Shiel
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Shasoty Hossain
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Marianne Kiffin
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jennifer Foley
- UCL Institute of Neurology, London, UK
- Department of Neuropsychology, National Hospital of Neurology & Neurosurgery, London, UK
| | - Rachel Skeath
- Department of Metabolic Medicine, Great Ormond Street Hospital, London, UK
| | - Maureen Cleary
- Department of Metabolic Medicine, Great Ormond Street Hospital, London, UK
- Great Ormond Street Hospital NIHR Biomedical Research Centre, London, UK
| | - Robin Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
- UCL Institute of Neurology, London, UK
| | - Elaine Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
- UCL Institute of Neurology, London, UK
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14
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Aryal M, Lau K, Boyer R, Zhou H, Abend J, Gu K, Olbertz J, Gupta S, Zoog S, Larimore K. Achieving efficacy in subjects with sustained pegvaliase-neutralizing antibody responses. Mol Genet Metab 2021; 134:235-242. [PMID: 34716085 DOI: 10.1016/j.ymgme.2021.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/04/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
Pegvaliase (Palynziq®) is an enzyme substitution therapy using PEGylated recombinant Anabaena variabilis phenylalanine ammonia lyase (PAL) to reduce blood phenylalanine (Phe) levels in adults with phenylketonuria (PKU). In Phase 3 clinical studies, all subjects treated with pegvaliase developed anti-drug antibodies. To specifically evaluate pegvaliase-neutralizing antibodies (NAbs) and assess impact on pegvaliase efficacy, a novel hybrid ligand-binding/tandem mass spectrometry NAb assay was developed. Analysis of Phase 3 study samples revealed that pegvaliase NAb titers developed during early treatment (≤6 months after treatment initiation), and then plateaued and persisted in the majority of subjects during late treatment (>6 months). Subjects with the lowest/undetectable NAb titers had relatively high plasma pegvaliase concentrations and experienced the most rapid decline in blood Phe concentrations at relatively low pegvaliase dose concentrations. In contrast, subjects with higher NAb titers generally had lower plasma pegvaliase concentrations on similar low doses, with little change in blood Phe concentrations. However, with additional time on treatment and individualized dose titration, the majority of subjects achieved substantial and sustained blood Phe reduction, including those with higher NAb titers. Moreover, after maturation of the anti-pegvaliase immune response, NAb titers were stable over time and did not rise in response to dose increases; thus, subjects did not require additional dose increases to maintain reduction in blood Phe.
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Affiliation(s)
- Madhukar Aryal
- BioMarin Pharmaceutical Inc., 105 Digital Drive, Novato, CA 94949, USA
| | - Kelly Lau
- BioMarin Pharmaceutical Inc., 105 Digital Drive, Novato, CA 94949, USA
| | - Ryan Boyer
- BioMarin Pharmaceutical Inc., 105 Digital Drive, Novato, CA 94949, USA
| | - Huiyu Zhou
- BioMarin Pharmaceutical Inc., 105 Digital Drive, Novato, CA 94949, USA
| | - Johanna Abend
- BioMarin Pharmaceutical Inc., 105 Digital Drive, Novato, CA 94949, USA
| | - Karen Gu
- BioMarin Pharmaceutical Inc., 105 Digital Drive, Novato, CA 94949, USA
| | - Joy Olbertz
- BioMarin Pharmaceutical Inc., 105 Digital Drive, Novato, CA 94949, USA
| | - Soumi Gupta
- BioMarin Pharmaceutical Inc., 105 Digital Drive, Novato, CA 94949, USA
| | - Stephen Zoog
- BioMarin Pharmaceutical Inc., 105 Digital Drive, Novato, CA 94949, USA
| | - Kevin Larimore
- BioMarin Pharmaceutical Inc., 105 Digital Drive, Novato, CA 94949, USA.
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15
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Kenneson A, Singh RH. Natural history of children and adults with phenylketonuria in the NBS-PKU Connect registry. Mol Genet Metab 2021; 134:243-249. [PMID: 34654619 DOI: 10.1016/j.ymgme.2021.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/01/2021] [Accepted: 10/02/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Phenylalanine hydroxylase deficiency, or phenylketonuria (PKU), is a rare autosomal recessive metabolic disorder. Early diagnosis via newborn screening (NBS) and initiation of treatment prevent the development of cognitive impairment and other co-morbidities. The purpose of this study is to describe the natural history of PKU in the United States, including prevalence of co-morbidities and predictors of outcomes. METHODS We analyzed data from a self-report survey in the NBS-PKU Connect online registry. We describe the participants' nutrition management strategies, barriers to management, outcomes of bone disorders, skin, and psychological co-morbidities, and the use of special education or other special services. Predictors of outcomes were identified and assessed, including the impact of sex, age, age at diagnosis, blood phenylalanine concentration, use of sapropterin, use of medical food, adherence to prescribed diet, use of low protein modified foods, whether they had ever been off-diet, and use of tyrosine supplementation. RESULTS The 219 respondents included individuals with PKU or hyperphenylalanemia (n = 78), or their caregivers (n = 141). Most (84.3%) started treatment before the age of two weeks. About one-third indicated that they had been off-diet at some point in their lives, and 81.4% reported that they currently adhered to their prescribed diet, with adherence to prescribed diet decreasing with age. Blood phenylalanine concentration was under the recommended threshold of 360 μmol/L for 68.5% of participants. One-quarter of respondents reported psychological co-morbidities, with anxiety and ADD/ADHD being the most common. The incidence of psychological co-morbidities increased with age and with ever having been off diet. Special education or other special services were more likely to be reported by individuals who were diagnosed after one week of age. Skin disorders such as acne and eczema were more common in females than males, and a minority of participants reported bone disorders. CONCLUSIONS Despite recommendations to maintain blood phenylalanine concentrations in the therapeutic range throughout life, it is not uncommon for adults with PKU to discontinue dietary management of their disorder. Early diagnosis was associated with reduced need for special education or other special services, and continuous treatment was associated with decreased psychological co-morbidities.
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Affiliation(s)
- Aileen Kenneson
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States of America.
| | - Rani H Singh
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States of America; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America.
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16
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Kaiser RA, Weber ND, Trigueros‐Motos L, Allen KL, Martinez M, Cao W, VanLith CJ, Hillin LG, Douar A, González‐Aseguinolaza G, Aldabe R, Lillegard JB. Use of an adeno-associated virus serotype Anc80 to provide durable cure of phenylketonuria in a mouse model. J Inherit Metab Dis 2021; 44:1369-1381. [PMID: 33896013 PMCID: PMC9291745 DOI: 10.1002/jimd.12392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/02/2022]
Abstract
Phenylketonuria (PKU) is the most common inborn error of metabolism of the liver, and results from mutations of both alleles of the phenylalanine hydroxylase gene (PAH). As such, it is a suitable target for gene therapy via gene delivery with a recombinant adeno-associated virus (AAV) vector. Here we use the synthetic AAV vector Anc80 via systemic administration to deliver a functional copy of a codon-optimized human PAH gene, with or without an intron spacer, to the Pahenu2 mouse model of PKU. Dose-dependent transduction of the liver and expression of PAH mRNA were present with both vectors, resulting in significant and durable reduction of circulating phenylalanine, reaching near control levels in males. Coat color of treated Pahenu2 mice reflected an increase in pigmentation from brown to the black color of control animals, further indicating functional restoration of phenylalanine metabolism and its byproduct melanin. There were no adverse effects associated with administration of AAV up to 5 × 1012 VG/kg, the highest dose tested. Only minor and/or transient variations in some liver enzymes were observed in some of the AAV-dosed animals which were not associated with pathology findings in the liver. Finally, there was no impact on cell turnover or apoptosis as evaluated by Ki-67 and TUNEL staining, further supporting the safety of this approach. This study demonstrates the therapeutic potential of AAV Anc80 to safely and durably cure PKU in a mouse model, supporting development for clinical consideration.
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Affiliation(s)
- Robert A. Kaiser
- Children's Hospitals and Clinics of MinnesotaMinneapolisMinnesotaUSA
- Department of SurgeryMayo ClinicRochesterMinnesotaUSA
| | | | | | - Kari L. Allen
- Department of SurgeryMayo ClinicRochesterMinnesotaUSA
| | - Michael Martinez
- Department of Molecular and Medical GeneticsOregon Health & Science UniversityPortlandOregonUSA
| | - William Cao
- Department of SurgeryMayo ClinicRochesterMinnesotaUSA
| | | | | | | | - Gloria González‐Aseguinolaza
- Vivet Therapeutics S.L.PamplonaSpain
- Division of Gene Therapy and Regulation of Gene ExpressionCIMA Universidad de NavarraPamplonaSpain
- Instituto de Investigación Sanitaria de Navarra (IdISNA)PamplonaSpain
| | - Rafael Aldabe
- Division of Gene Therapy and Regulation of Gene ExpressionCIMA Universidad de NavarraPamplonaSpain
| | - Joseph B. Lillegard
- Children's Hospitals and Clinics of MinnesotaMinneapolisMinnesotaUSA
- Department of SurgeryMayo ClinicRochesterMinnesotaUSA
- Pediatric Surgical AssociatesMinneapolisMinnesotaUSA
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Kanufre V, Almeida MF, Barbosa CS, Carmona C, Bandeira A, Martins E, Rocha S, Guimas A, Ribeiro R, MacDonald A, Pinto A, Rocha JC. Metabolic Control of Patients with Phenylketonuria in a Portuguese Metabolic Centre Comparing Three Different Recommendations. Nutrients 2021; 13:3118. [PMID: 34578995 PMCID: PMC8469656 DOI: 10.3390/nu13093118] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/28/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Blood phenylalanine (Phe) is used as the primary marker to evaluate metabolic control. Our study aimed to describe the metabolic control of patients with phenylketonuria (PKU) comparing three different treatment recommendations (European guidelines/US guidelines/Portuguese consensus). This was a retrospective, observational, single centre study in patients with PKU collecting data on blood Phe levels from 2017. Nutritional intake data and sapropterin (BH4) prescription were collected at the last appointment of 2017. The final sample studied included 87 patients (48% females) [13 hyperphenylalaninemia; 47 mild PKU; 27 classical PKU] with a median age of 18 y (range: 1-36 y). The median number of blood Phe measurements for patients was 21 (range: 6-89). In patients aged < 12 y, the median blood Phe level was 300 μmol/L (range 168-480) and 474 μmol/L (range 156-1194) for patients ≥ 12 y. Overall, a median of 83% of blood Phe levels were within the European PKU guidelines target range. In patients aged ≥ 12 years, there was a higher median % of blood Phe levels within the European PKU guidelines target range (≥12 y: 84% vs. <12 y: 56%). In children < 12 y with classical PKU (n = 2), only 34% of blood Phe levels were within target range for all 3 guidelines and 49% with mild PKU (n = 11). Girls had better control than boys (89% vs. 66% median Phe levels within European Guidelines). Although it is clear that 50% or more patients were unable to achieve acceptable metabolic control on current treatment options, a globally agreed upper Phe target associated with optimal outcomes for age groups is necessary. More studies need to examine how clinics with dissimilar resources, different therapeutic Phe targets and frequency of monitoring relate to metabolic control.
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Affiliation(s)
- Viviane Kanufre
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-028 Porto, Portugal; (V.K.); (M.F.A.); catarina-s-@hotmail.com (C.S.B.); (C.C.)
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
- Núcleo de Ações e Pesquisa em Apoio Diagnóstico (NUPAD), School of Medicine, Federal University of Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190, Belo Horizonte 30130-100, Brazil
- Hospital das Clínicas, UFMG, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte 30130-100, Brazil
| | - Manuela Ferreira Almeida
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-028 Porto, Portugal; (V.K.); (M.F.A.); catarina-s-@hotmail.com (C.S.B.); (C.C.)
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, 4050-313 Porto, Portugal
| | - Catarina Sousa Barbosa
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-028 Porto, Portugal; (V.K.); (M.F.A.); catarina-s-@hotmail.com (C.S.B.); (C.C.)
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
| | - Carla Carmona
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-028 Porto, Portugal; (V.K.); (M.F.A.); catarina-s-@hotmail.com (C.S.B.); (C.C.)
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, 4050-313 Porto, Portugal
| | - Anabela Bandeira
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
| | - Esmeralda Martins
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto-UMIB/ICBAS/UP, 4050-313 Porto, Portugal
| | - Sara Rocha
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
| | - Arlindo Guimas
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
| | - Rosa Ribeiro
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
| | - Anita MacDonald
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (A.M.); (A.P.)
| | - Alex Pinto
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (A.M.); (A.P.)
| | - Júlio César Rocha
- Centro de Genética Médica, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-028 Porto, Portugal; (V.K.); (M.F.A.); catarina-s-@hotmail.com (C.S.B.); (C.C.)
- Centro de Referência na Área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto-CHUPorto, 4099-001 Porto, Portugal; (A.B.); (E.M.); (S.R.); (A.G.); (R.R.)
- Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056 Lisbon, Portugal
- Centre for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal
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Czibik G, Mezdari Z, Murat Altintas D, Bréhat J, Pini M, d'Humières T, Delmont T, Radu C, Breau M, Liang H, Martel C, Abatan A, Sarwar R, Marion O, Naushad S, Zhang Y, Halfaoui M, Suffee N, Morin D, Adnot S, Hatem S, Yavari A, Sawaki D, Derumeaux G. Dysregulated Phenylalanine Catabolism Plays a Key Role in the Trajectory of Cardiac Aging. Circulation 2021; 144:559-574. [PMID: 34162223 DOI: 10.1161/circulationaha.121.054204] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aging myocardium undergoes progressive cardiac hypertrophy and interstitial fibrosis with diastolic and systolic dysfunction. Recent metabolomics studies shed light on amino acids in aging. The present study aimed to dissect how aging leads to elevated plasma levels of the essential amino acid phenylalanine and how it may promote age-related cardiac dysfunction. METHODS We studied cardiac structure and function, together with phenylalanine catabolism in wild-type (WT) and p21-/- mice (male; 2-24 months), with the latter known to be protected from cellular senescence. To explore phenylalanine's effects on cellular senescence and ectopic phenylalanine catabolism, we treated cardiomyocytes (primary adult rat or human AC-16) with phenylalanine. To establish a role for phenylalanine in driving cardiac aging, WT male mice were treated twice a day with phenylalanine (200 mg/kg) for a month. We also treated aged WT mice with tetrahydrobiopterin (10 mg/kg), the essential cofactor for the phenylalanine-degrading enzyme PAH (phenylalanine hydroxylase), or restricted dietary phenylalanine intake. The impact of senescence on hepatic phenylalanine catabolism was explored in vitro in AML12 hepatocytes treated with Nutlin3a (a p53 activator), with or without p21-targeting small interfering RNA or tetrahydrobiopterin, with quantification of PAH and tyrosine levels. RESULTS Natural aging is associated with a progressive increase in plasma phenylalanine levels concomitant with cardiac dysfunction, whereas p21 deletion delayed these changes. Phenylalanine treatment induced premature cardiac deterioration in young WT mice, strikingly akin to that occurring with aging, while triggering cellular senescence, redox, and epigenetic changes. Pharmacological restoration of phenylalanine catabolism with tetrahydrobiopterin administration or dietary phenylalanine restriction abrogated the rise in plasma phenylalanine and reversed cardiac senescent alterations in aged WT mice. Observations from aged mice and human samples implicated age-related decline in hepatic phenylalanine catabolism as a key driver of elevated plasma phenylalanine levels and showed increased myocardial PAH-mediated phenylalanine catabolism, a novel signature of cardiac aging. CONCLUSIONS Our findings establish a pathogenic role for increased phenylalanine levels in cardiac aging, linking plasma phenylalanine levels to cardiac senescence via dysregulated phenylalanine catabolism along a hepatic-cardiac axis. They highlight phenylalanine/PAH modulation as a potential therapeutic strategy for age-associated cardiac impairment.
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Affiliation(s)
- Gabor Czibik
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
- Department of Physiology (G.C., T.d'H., S.A., G.D.), AP-HP, Henri Mondor Hospital, FHU-SENEC, Créteil, France
| | - Zaineb Mezdari
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Dogus Murat Altintas
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Juliette Bréhat
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Maria Pini
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Thomas d'Humières
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
- Department of Physiology (G.C., T.d'H., S.A., G.D.), AP-HP, Henri Mondor Hospital, FHU-SENEC, Créteil, France
| | - Thaïs Delmont
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Costin Radu
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
- Department of Cardiac Surgery (C.R.), AP-HP, Henri Mondor Hospital, FHU-SENEC, Créteil, France
| | - Marielle Breau
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Hao Liang
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Cecile Martel
- Mitologics SAS (C.M.), Université Paris-Est Créteil, France
| | - Azania Abatan
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Rizwan Sarwar
- Experimental Therapeutics, Radcliffe Department of Medicine (R.S., A.Y.), University of Oxford, United Kingdom
| | - Ophélie Marion
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Suzain Naushad
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Yanyan Zhang
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Maissa Halfaoui
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Nadine Suffee
- Sorbonne Universités, INSERM UMR_S1166, Faculté de Médecine UPMC, Paris, France (N.S., S.H.)
- Institute of Cardiometabolism and Nutrition, ICAN, Paris, France (N.S., S.H.)
| | - Didier Morin
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Serge Adnot
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
- Department of Physiology (G.C., T.d'H., S.A., G.D.), AP-HP, Henri Mondor Hospital, FHU-SENEC, Créteil, France
| | - Stéphane Hatem
- Sorbonne Universités, INSERM UMR_S1166, Faculté de Médecine UPMC, Paris, France (N.S., S.H.)
- Institute of Cardiometabolism and Nutrition, ICAN, Paris, France (N.S., S.H.)
| | - Arash Yavari
- Experimental Therapeutics, Radcliffe Department of Medicine (R.S., A.Y.), University of Oxford, United Kingdom
- Wellcome Centre for Human Genetics (A.Y.), University of Oxford, United Kingdom
| | - Daigo Sawaki
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
| | - Geneviève Derumeaux
- INSERM (L'Institut National de la Santé et de la Recherche Médicale) U955 (G.C., Z.M., D.M.A., J.B., M.P., T.d'H., T.D., C.R., M.B., H.L., A.A., O.M., S.N., Y.Z., M.H., D.M., S.A., D.S., G.D.), Université Paris-Est Créteil, France
- Department of Physiology (G.C., T.d'H., S.A., G.D.), AP-HP, Henri Mondor Hospital, FHU-SENEC, Créteil, France
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Çıkı K, Yıldız Y, Yücel Yılmaz D, Pektaş E, Tokatlı A, Özgül RK, Sivri HS, Dursun A. DNACJ12 deficiency in patients with unexplained hyperphenylalaninemia: two new patients and a novel variant. Metab Brain Dis 2021; 36:1405-1410. [PMID: 34014443 DOI: 10.1007/s11011-021-00753-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
In addition to tetrahydrobiopterin deficiencies and phenylalanine hydroxylase deficiency (phenylketonuria) due to PAH variants, the deficiency of the co-chaperone protein DNAJC12 was identified in 2017 as a novel cause of inherited hyperphenylalaninemia, revealing the genetic etiology in previously unresolved cases. In this study, we aimed to investigate DNAJC12 deficiency in non-tetrahydrobiopterin-deficient persistent hyperphenylalaninemia cases without biallelic PAH variants in a single pediatric metabolic center. It was determined retrospectively that 471 patients with non-tetrahydrobiopterin deficiency-hyperphenylalaninemia had undergone PAH gene sequencing and 451 patients had biallelic variants in PAH. DNAJC12 sequencing was performed in the remaining 20 patients, identifying a previously reported homozygous splice-site variant (c.158-2A > T) in one patient with axial hypotonia and developmental delay, and a novel, homozygous c.404del (p.Arg135Lysfs*21) frameshift variant in an asymptomatic patient. In segregation analysis, the asymptomatic patient's both parents were also found to be homozygous for this variant and hyperphenylalaninemic. The parents may have had academic difficulties but intellectual disability could not be confirmed due to lack of cooperation. The symptomatic patient significantly benefited from treatment with sapropterin dihydrochloride and neurotransmitter precursors. DNAJC12 deficiency might be responsible for approximately 10% or more of cases with unexplained hyperphenylalaninemia. The phenotypic spectrum is broad, ranging from early infantile hypotonia to incidental diagnosis in adulthood. Similar to tetrahydrobiopterin deficiencies, early diagnosis and treatment with sapropterin dihydrochloride and neurotransmitter precursors can be beneficial, supporting the analysis of DNACJ12 gene in patients with unexplained hyperphenylalaninemia.
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Affiliation(s)
- Kısmet Çıkı
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Yılmaz Yıldız
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Didem Yücel Yılmaz
- Department of Pediatric Metabolism, Institute of Child Health, Hacettepe University, Ankara, Turkey
| | - Emine Pektaş
- Pediatric Metabolic Diseases Unit, Gaziantep Cengiz Gökçek Maternity and Pediatrics Hospital, Gaziantep, Turkey
| | - Ayşegül Tokatlı
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - R Köksal Özgül
- Department of Pediatric Metabolism, Institute of Child Health, Hacettepe University, Ankara, Turkey
| | - H Serap Sivri
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Dursun
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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20
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Viau K, Wessel A, Martell L, Sacharow S, Rohr F. Nutrition status of adults with phenylketonuria treated with pegvaliase. Mol Genet Metab 2021; 133:345-351. [PMID: 34116943 DOI: 10.1016/j.ymgme.2021.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pegvaliase is an enzyme substitution therapy that reduces blood phenylalanine (Phe) in adults with phenylketonuria (PKU), and often allows normalization of protein intake (≥0.8 g protein/kg). Here we examine the nutrition status of adults with PKU consuming a normal protein intake without medical food after being treated with pegvaliase for ≥1 year. METHODS A cross-sectional study evaluating nutritional intake (3-day food record and food frequency questionnaire), anthropometrics, laboratory indices of protein, micronutrient, and essential fatty acid (EFA) status, and questionnaires evaluating food neophobia and Epicurean eating pleasure. RESULTS Participants (n = 18, 61% female) started pegvaliase 4.9 ± 2.1 years prior to enrollment and were aged 38.2 ± 8.8 years with a mean BMI of 29.2 ± 4.1 kg/m2. Participants consumed a mean of 73.2 ± 17.6 g protein/d (1.0 ± 0.3 g/kg/d). Eleven participants had low blood Phe (<30 μmol/L) with adequate protein intake and normal indices of protein status. Micronutrient and EFA concentrations were normal except for mildly low vitamin D (<30 ng/mL, n = 12). Intakes of sodium, saturated fat, and added sugars exceeded recommendations for healthy adults, though mean diet quality was comparable to a US adult reference population. Lower food neophobia scores correlated with an increased aesthetic appreciation of food. However, 53% of participants self-reported having moderate (n = 6) to high (n = 3) food neophobia. DISCUSSION Participants treated with pegvaliase consumed an unrestricted diet with adequate dietary protein and, overall, had normal protein, micronutrient, and fatty acid status. Despite low blood Phe, protein nutriture was not compromised. While nutritional deficiencies were not identified, diet quality was suboptimal and some participants reported food neophobia. Nutrition education remains an important component of care as patients adapt to a normal diet.
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Affiliation(s)
- Krista Viau
- Division of Genetics and Genomics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States.
| | - Ann Wessel
- Division of Genetics and Genomics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States
| | - Leslie Martell
- Division of Genetics and Genomics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States
| | - Stephanie Sacharow
- Division of Genetics and Genomics, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, United States; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, United States
| | - Fran Rohr
- Met Ed, Boulder, CO 80302, United States
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21
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Poloni S, dos Santos BB, Chiesa A, Specola N, Pereyra M, Saborío-Rocafort M, Salazar MF, Leal-Witt MJ, Castro G, Peñaloza F, Wong SP, Porras RB, Paranza LO, Sanabria MC, Amieva MV, Morales M, Naranjo ARC, Mahfoud A, Colmenares AR, Lemes A, Sotillo-Lindo JF, Perez C, Rey LM, Torriente GMZ, Refosco LF, Schwartz IVD, Cornejo V. Current Practices and Challenges in the Diagnosis and Management of PKU in Latin America: A Multicenter Survey. Nutrients 2021; 13:2566. [PMID: 34444728 PMCID: PMC8399454 DOI: 10.3390/nu13082566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/08/2021] [Indexed: 01/09/2023] Open
Abstract
This study aimed to describe the current practices in the diagnosis and dietary management of phenylketonuria (PKU) in Latin America, as well as the main barriers to treatment. We developed a 44-item online survey aimed at health professionals. After a pilot test, the final version was sent to 25 practitioners working with inborn errors of metabolism (IEM) in 14 countries. Our results include 22 centers in 13 countries. Most countries (12/13) screened newborns for PKU. Phenylalanine (Phe) targets at different ages were very heterogeneous among centers, with greater consistency at the 0-1 year age group (14/22 sought 120-240 µmol/L) and the lowest at >12 years (10 targets reported). Most countries had only unflavored powdered amino acid substitutes (10/13) and did not have low-protein foods (8/13). Only 3/13 countries had regional databases of the Phe content of foods, and only 4/22 centers had nutrient analysis software. The perceived obstacles to treatment were: low purchasing power (62%), limited/insufficient availability of low-protein foods (60%), poor adherence, and lack of technical resources to manage the diet (50% each). We observed a heterogeneous scenario in the dietary management of PKU, and most countries experienced a lack of dietary resources for both patients and health professionals.
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Affiliation(s)
- Soraia Poloni
- Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil; (B.B.d.S.); (L.F.R.); (I.V.D.S.)
| | - Bruna Bento dos Santos
- Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil; (B.B.d.S.); (L.F.R.); (I.V.D.S.)
- Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre 91501-970, Brazil
| | - Ana Chiesa
- Centro de Investigaciones Endocrinologicas DR Cesar Bergadá, CEDIE-CONICET-Fundación de Endocrinologia Infantil-Division de Endocrinologia Hospital de Niños R Gutierrez, Gallo 1330, Buenos Aires C1425EFD, Argentina;
| | - Norma Specola
- Unidad de Metabolismo, Hospital de Niños de La Plata, La Plata B1904, Argentina;
| | - Marcela Pereyra
- Servicio de Crecimiento y Desarrollo del Hospital Pediátrico Dr. H. Notti, 2603, Mendoza M5519, Argentina;
| | - Manuel Saborío-Rocafort
- Hospital Nacional de Niños, Caja Costarricense de Seguro Social & Sistema de Estudios de Posgrado, Universidad de Costa Rica, San José 11501, Costa Rica;
| | - María Florencia Salazar
- Instituto de Nutrición y Tecnología de los Alimentos (INTA) Universidad de Chile, Santiago de Chile 1058, Chile; (M.F.S.); (M.J.L.-W.); (G.C.); (F.P.); (V.C.)
| | - María Jesús Leal-Witt
- Instituto de Nutrición y Tecnología de los Alimentos (INTA) Universidad de Chile, Santiago de Chile 1058, Chile; (M.F.S.); (M.J.L.-W.); (G.C.); (F.P.); (V.C.)
| | - Gabriela Castro
- Instituto de Nutrición y Tecnología de los Alimentos (INTA) Universidad de Chile, Santiago de Chile 1058, Chile; (M.F.S.); (M.J.L.-W.); (G.C.); (F.P.); (V.C.)
| | - Felipe Peñaloza
- Instituto de Nutrición y Tecnología de los Alimentos (INTA) Universidad de Chile, Santiago de Chile 1058, Chile; (M.F.S.); (M.J.L.-W.); (G.C.); (F.P.); (V.C.)
| | - Sunling Palma Wong
- Programa Nacional de Tamizaje, Hospital Nacional de Niños, San José 267-1005, Costa Rica;
| | - Ramsés Badilla Porras
- FCCMG Servicio de Genética Médica y Metabolismo, Hospital Nacional de Niños, San José 267-1005, Costa Rica;
| | | | - Marta Cristina Sanabria
- Pediatric Department and Department of the Hospital de Clínicas, Universidad Nacional de Asunciòn, Asunción 1102, Paraguay;
| | - Marcela Vela Amieva
- Laboratorio de Errores Innatos del Metabolismo y Tamiz-Instituto Nacional de Pediatría, Ciudad de México 04530, Mexico;
| | | | - Amanda Rocío Caro Naranjo
- Instituto de Errores Innatos del Metabolismo de la Pontificia Universidad Javeriana, Bogota 110231, Colombia;
| | | | - Ana Rosa Colmenares
- Hospital Clinica Caracas-Materno Infantil de Caricuao, Caracas 1000, Venezuela;
| | - Aida Lemes
- Instituto de la Seguridad Social, Montevideo 11000, Uruguay;
| | | | - Ceila Perez
- Robert Reid Cabral Children’s Hospital, Santo Domingo 10101, Dominican Republic;
| | | | - Georgina María Zayas Torriente
- Centro de Nutrición e Higiene de los Alimentos del Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), La Habana 10300, Cuba;
| | - Lilia Farret Refosco
- Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil; (B.B.d.S.); (L.F.R.); (I.V.D.S.)
| | - Ida Vanessa Doederlein Schwartz
- Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil; (B.B.d.S.); (L.F.R.); (I.V.D.S.)
- Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre 91501-970, Brazil
| | - Veronica Cornejo
- Instituto de Nutrición y Tecnología de los Alimentos (INTA) Universidad de Chile, Santiago de Chile 1058, Chile; (M.F.S.); (M.J.L.-W.); (G.C.); (F.P.); (V.C.)
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22
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Abstract
Pegvaliase-pqpz (Palynziq) is an enzyme substitution therapy FDA approved May 2018 to treat phenylketonuria in adults with blood phenylalanine levels greater than 600 μmol/L (10 mg/dL). Pegvaliase is administered via subcutaneous injection and carries a high risk of side effects including anaphylaxis. A consensus statement on its use recommends careful education and monitoring of patients. We established a dedicated Palynziq Clinic in October 2018 with detailed protocols to minimize these risks. In the first year, we evaluated 43 patients, initiated Palynziq in 37 and transitioned two trial patients to commercial drug. 13/37 patients (35.1%) have sustained blood phenylalanine levels <360 μmol/L (6 mg/dL) without adjunct sapropterin dihydrochloride treatment or medical food. The timing and dosage needed to achieve a response did not correlate with patient weight, starting phenylalanine level, starting diet, or co-treatment with sapropterin dihydrochloride. Some patients had consistently low phenylalanine levels <30 μmol/L (0.5 mg/dL) and required doses as low as 20 mg weekly. Anaphylactic episodes were reported by 21.6% (8/37 patients) versus 10% seen in the clinical trial. Rates of other side effects were similar to or less than those in the trial. Adverse reactions commonly occurred shortly after dosage increases. We provide a model for safely introducing and managing pegvaliase in adult patients with PKU.
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Affiliation(s)
- Melissa Lah
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Molly McPheron
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States of America
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23
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van Wegberg A, Evers R, Burgerhof J, van Dam E, Heiner-Fokkema MR, Janssen M, de Vries MC, van Spronsen FJ. Effect of BH4 on blood phenylalanine and tyrosine variations in patients with phenylketonuria. Mol Genet Metab 2021; 133:49-55. [PMID: 33766497 DOI: 10.1016/j.ymgme.2021.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND In patients with phenylketonuria, stability of blood phenylalanine and tyrosine concentrations might influence brain chemistry and therefore patient outcome. This study prospectively investigated the effects of tetrahydrobiopterin (BH4), as a chaperone of phenylalanine hydroxylase on diurnal and day-to-day variations of blood phenylalanine and tyrosine concentrations. METHODS Blood phenylalanine and tyrosine were measured in dried blood spots (DBS) four times daily for 2 days (fasting, before lunch, before dinner, evening) and once daily (fasting) for 6 days in a randomized cross-over design with a period with BH4 and a period without BH4. The sequence was randomized. Eleven proven BH4 responsive PKU patients participated, 5 of them used protein substitutes during BH4 treatment. Natural protein intake and protein substitute dosing was adjusted during the period without BH4 in order to keep DBS phenylalanine levels within target range. Patients filled out a 3-day food diary during both study periods. Variations of DBS phenylalanine and Tyr were expressed in standard deviations (SD) and coefficient of variation (CV). RESULTS BH4 treatment did not significantly influence day-to-day phenylalanine and tyrosine variations nor diurnal phenylalanine variations, but decreased diurnal tyrosine variations (median SD 17.6 μmol/l, median CV 21.3%, p = 0.01) compared to diet only (median SD 34.2 μmol/l, median CV 43.2%). Consequently, during BH4 treatment diurnal phenylalanine/tyrosine ratio variation was smaller, while fasting tyrosine levels tended to be higher. CONCLUSION BH4 did not impact phenylalanine variation but decreased diurnal tyrosine and phenylalanine/tyrosine ratio variations, possibly explained by less use of protein substitute and increased tyrosine synthesis.
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Affiliation(s)
- Amj van Wegberg
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Raf Evers
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Jgm Burgerhof
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - E van Dam
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - M R Heiner-Fokkema
- Department of Laboratory Medicine, Laboratory of Metabolic Diseases, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - McH Janssen
- Department of Internal Medicine, Radboudumc, Nijmegen, the Netherlands
| | - M C de Vries
- Department of Pediatrics, Radboudumc Nijmegen, the Netherlands
| | - F J van Spronsen
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.
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24
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Evers RAF, van Wegberg AMJ, Ahring K, Beblo S, Bélanger-Quintana A, Bosch AM, Burlina A, Campistol J, Coskun T, Feillet F, Giżewska M, Huijbregts SCJ, Kearney S, Langeveld M, Leuzzi V, Maillot F, Muntau AC, Rocha JC, Romani C, Trefz FK, MacDonald A, van Spronsen FJ. Defining tetrahydrobiopterin responsiveness in phenylketonuria: Survey results from 38 countries. Mol Genet Metab 2021; 132:215-219. [PMID: 33610470 DOI: 10.1016/j.ymgme.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND A subset of patients with phenylketonuria benefit from treatment with tetrahydrobiopterin (BH4), although there is no consensus on the definition of BH4 responsiveness. The aim of this study therefore was to gain insight into the definitions of long-term BH4 responsiveness being used around the world. METHODS We performed a web-based survey targeting healthcare professionals involved in the treatment of PKU patients. Data were analysed according to geographical region (Europe, USA/Canada, other). RESULTS We analysed 166 responses. Long-term BH4 responsiveness was commonly defined using natural protein tolerance (95.6%), improvement of metabolic control (73.5%) and increase in quality of life (48.2%). When a specific value for a reduction in phenylalanine concentrations was reported (n = 89), 30% and 20% were most frequently used as cut-off values (76% and 19% of respondents, respectively). When a specific relative increase in natural protein tolerance was used to define long-term BH4 responsiveness (n = 71), respondents most commonly reported cut-off values of 30% and 100% (28% of respondents in both cases). Respondents from USA/Canada (n = 50) generally used less strict cut-off values compared to Europe (n = 96). Furthermore, respondents working within the same center answered differently. CONCLUSION The results of this study suggest a very heterogeneous situation on the topic of defining long-term BH4 responsiveness, not only at a worldwide level but also within centers. Developing a strong evidence- and consensus-based definition would improve the quality of BH4 treatment.
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Affiliation(s)
- R A F Evers
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Metabolic Diseases, the Netherlands
| | - A M J van Wegberg
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Metabolic Diseases, the Netherlands
| | - K Ahring
- Department of PKU, Copenhagen University Hospital, Denmark
| | - S Beblo
- Center for Pediatric Research Leipzig, Department of Women and Child Health, Hospital for Children and Adolescents, University Hospitals, Germany
| | - A Bélanger-Quintana
- Metabolic Diseases Unit, Department of Pediatrics, Hospital Ramon y Cajal, Madrid, Spain
| | - A M Bosch
- Department of Pediatrics, Division of Metabolic Disorders, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - A Burlina
- Division of Inherited Metabolic Diseases, Department of Integrated Diagnostics, University Hospital of Padova, Padova, Italy
| | - J Campistol
- Neuropaediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - T Coskun
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nutrition & Metabolism, Hacettepe, Ankara, Turkey
| | - F Feillet
- Inborn Errors of Metabolism, Pediatric unit, University Hospital of Nancy, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Nancy, France
| | - M Giżewska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - S C J Huijbregts
- Department of Clinical Child and Adolescent Studies-Neurodevelopmental Disorders, Faculty of Social Sciences, Leiden University, Leiden, Netherlands
| | - S Kearney
- Clinical Psychology Department, Birmingham Children's Hospital, Birmingham, UK
| | - M Langeveld
- Department of Endocrinology and Metabolism, Amterdam UMC, University of Amsterdam, AZ, Amsterdam, the Netherlands
| | - V Leuzzi
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - F Maillot
- Department of Internal Medicine, CHRU de Tours, Université de Tours, Tours, France
| | - A C Muntau
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J C Rocha
- Centro de Referência na área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto - CHUP, Porto, Portugal; Centre for Health Technology and Services Research (CINTESIS), Portugal; Nutrition & Metabolism, Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - C Romani
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - F K Trefz
- University Children's Hospital, Dietmar-Hoppe Metabolic Centre, Heidelberg, Germany
| | - A MacDonald
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - F J van Spronsen
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Metabolic Diseases, the Netherlands.
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25
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Nogueira ZD, Boa-Sorte N, Leite MEDQ, Toralles MBP, Amorim T. METABOLIC CONTROL AND BODY COMPOSITION OF CHILDREN AND ADOLESCENTS WITH PHENYLKETONURIA. Rev Paul Pediatr 2021; 39:e2020095. [PMID: 33656145 PMCID: PMC7903412 DOI: 10.1590/1984-0462/2021/39/2020095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/25/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To characterize metabolic control and verify whether it has any relation with socioeconomic, demographic, and body composition variables in children and adolescents with phenylketonuria (PKU) diagnosed in the neonatal period. METHODS This cohort study collected retrospective data of 53 phenylketonuric children and adolescents. Data on family income, housing, and mother's age and schooling level were collected, and anthropometric measures of body composition and distribution were taken. All dosages of phenylalanine (Phe) from the last five years (2015-2019) were evaluated and classified regarding their adequacy (cutoffs: 0-12 years: 2-6 mg/dL; 12-19 years: 2-10 mg/dL). Adequate metabolic control was considered if ≥7%) of the dosages were within desired ranges. RESULTS The mean (±standard deviation) age in the last year was 10.1±4.6 years. Most of them were under 12 years old (33/53; 62.3%) and had the classic form of the disease (39/53; 73.6%). Better metabolic control was observed among adolescents (68.4 versus 51.4%; p=0.019). Overweight was found in 9/53 (17%) and higher serum Phe levels (p<0.001) were found in this group of patients. Metabolic control with 70% or more Phe level adequacy decreased along with the arm muscle area (AMA) (ptendency=0.042), being 70.0% among those with low reserve (low AMA), and 18.5% among those with excessive reserve (high AMA). CONCLUSIONS Adequate metabolic control was observed in most patients. The findings suggest that, in this sample, the levels of phenylalanine may be related to changes in body composition.
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Affiliation(s)
| | - Ney Boa-Sorte
- Universidade do Estado da Bahia, Salvador, BA, Brazil
| | | | | | - Tatiana Amorim
- Association of Parents and Friends of Intelectually Disabled Individuals (Associação de Pais e Amigos dos Excepcionais de Salvador - APAE), BA, Brazil
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26
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Jeanjean LC, Duval F, Foucher JR, Gendrault C. Neuroendocrine Response to Apomorphine After Tetrahydrobiopterin Use in a Depressed Teenager With Mild Hyperphenylalaninemia: A Case Report. J Clin Psychopharmacol 2021; 40:414-416. [PMID: 32639296 DOI: 10.1097/jcp.0000000000001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Daly A, Evans S, Pinto A, Ashmore C, MacDonald A. Protein Substitutes in PKU; Their Historical Evolution. Nutrients 2021; 13:484. [PMID: 33540516 PMCID: PMC7912909 DOI: 10.3390/nu13020484] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/29/2022] Open
Abstract
Protein substitutes developed for phenylketonuria (PKU) are a synthetic source of protein commonly based on L-amino acids. They are essential in the treatment of phenylketonuria (PKU) and other amino acid disorders, allowing the antagonistic amino acid to be removed but with the safe provision of all other amino acids necessary for maintaining normal physiological function. They were first formulated by a chemist and used experimentally on a 2-year-old girl with PKU and their nutritional formulations and design have improved over time. Since 2008, a bioactive macropeptide has been used as a base for protein substitutes in PKU, with potential benefits of improved bone and gut health, nitrogen retention, and blood phenylalanine control. In 2018, animal studies showed that physiomimic technology coating the amino acids with a polymer allows a slow release of amino acids with an improved physiological profile. History has shown that in PKU, the protein substitute's efficacy is determined by its nutritional profile, amino acid composition, dose, timing, distribution, and an adequate energy intake. Protein substitutes are often given little importance, yet their pharmacological actions and clinical benefit are pivotal when managing PKU.
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Affiliation(s)
- Anne Daly
- Birmingham Women’s and Children’s Hospital, NHS Foundation Trust, Birmingham B4 6NH, UK; (S.E.); (A.P.); (C.A.); (A.M.)
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28
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Waisbren S, Burton BK, Feigenbaum A, Konczal LL, Lilienstein J, McCandless SE, Rowell R, Sanchez-Valle A, Whitehall KB, Longo N. Long-term preservation of intellectual functioning in sapropterin-treated infants and young children with phenylketonuria: A seven-year analysis. Mol Genet Metab 2021; 132:119-127. [PMID: 33485801 PMCID: PMC8684368 DOI: 10.1016/j.ymgme.2021.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/19/2022]
Abstract
Sapropterin dihydrochloride has been approved for the treatment of hyperphenylalaninemia in infants and young children with phenylketonuria (PKU). Sapropterin can reduce phenylalanine (Phe) levels in tetrahydrobiopterin (BH4)-responsive patients, potentially preventing the intellectual impairment caused by elevated Phe levels. The long-term effect of sapropterin on intellectual functioning was assessed using the Full-Scale Intelligence Quotient (FSIQ) in 62 children who began treatment before the age of 6 years. Over each 2-year interval, the estimate of mean change in FSIQ was -0.5768 with a lower limit of the 95% confidence interval (CI) of -1.60. At the end of the follow-up period (Year 7), the least squares mean estimate of the change in FSIQ from baseline was 1.14 with a lower limit of the 95% CI of -3.53. These lower limits were both within the clinically expected variation of 5 points. During the whole study period, mean blood Phe levels remained within the American College of Medical Genetics (ACMG) target range of 120-360 μmol/L. In addition, height, weight, and head circumference were maintained within normal ranges throughout follow-up, as defined by growth charts from the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) for children below and above the age of 24 months, respectively. All patients (n = 65) enrolled in this study experienced at least one adverse event, as expected from previous studies. In conclusion, long-term use of sapropterin in individuals with PKU helps to control blood Phe, preserve intellectual functioning, and maintain normal growth in BH4-responsive children who initiated treatment between the ages of 0 to 6 years.
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Affiliation(s)
- Susan Waisbren
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Barbara K Burton
- Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annette Feigenbaum
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Laura L Konczal
- Center for Human Genetics, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | | | - Shawn E McCandless
- Section of Genetics and Metabolism, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
| | | | | | | | - Nicola Longo
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
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29
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Hiraiwa H, Okumura T, Kondo T, Kato T, Kazama S, Kimura Y, Ishihara T, Iwata E, Shimojo M, Kondo S, Aoki S, Kanzaki Y, Tanimura D, Sano H, Awaji Y, Yamada S, Murohara T. Prognostic value of leucine/phenylalanine ratio as an amino acid profile of heart failure. Heart Vessels 2021; 36:965-977. [PMID: 33481086 DOI: 10.1007/s00380-020-01765-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/25/2020] [Indexed: 12/16/2022]
Abstract
Heart failure (HF) causes a hypercatabolic state that enhances the catabolic activity of branched-chain amino acids (BCAA; leucine, isoleucine, and valine) in the heart and skeletal muscles and reduces protein synthesis in the liver. Consequently, free plasma aromatic amino acids (AAA, tyrosine and phenylalanine) are increased. To date, we have reported the prognostic value of the BCAA/AAA ratio (Fischer's ratio) in patients with HF. However, the leucine/phenylalanine ratio, which is a simpler index than the Fischer's ratio, has not been examined. Therefore, the prognostic value of the leucine/phenylalanine ratio in patients with HF was investigated. Overall 157 consecutive patients hospitalized for worsening HF (81 men, median age 78 years) were enrolled in the study. Plasma amino acid levels were measured when the patients were stabilized at discharge. Cardiac events were defined as a composite of cardiac death and hospitalization for worsening HF. A total of 46 cardiac events occurred during the median follow-up period of 238 (interquartile range 93-365) days. The median leucine/phenylalanine ratio was significantly lower in patients with cardiac events than in those without cardiac events (1.4 vs. 1.8, P < 0.001). The best cutoff value of the leucine/phenylalanine ratio was determined as 1.7 in the receiver operating characteristic (ROC) curve for cardiac events. Following a Kaplan-Meier survival analysis, the low group (leucine/phenylalanine ratio < 1.7, n = 72) had more cardiac events than the high group (leucine/phenylalanine ratio ≥ 1.7, n = 85) (log-rank, P < 0.001). Multivariate Cox proportional hazards regression analysis showed that the leucine/phenylalanine ratio was an independent predictor of cardiac events. Furthermore, on comparing the prognostic values for cardiac events based on ROC curves of leucine levels, BCAA levels, Fischer's ratio, and leucine/phenylalanine ratio, the leucine/phenylalanine ratio was the most accurate in predicting future cardiac events (area under the curve 0.763,; sensitivity 0.783,; specificity 0.676,; P < 0.001). The leucine/phenylalanine ratio could be a useful predictor of future cardiac events in patients with HF, reflecting an imbalance in amino acid metabolism.
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Affiliation(s)
- Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan.
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Toshiaki Kato
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Shingo Kazama
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Yuki Kimura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Toshikazu Ishihara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Etsuo Iwata
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Masafumi Shimojo
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Sayano Kondo
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Soichiro Aoki
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Yasunori Kanzaki
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Daisuke Tanimura
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Hiroaki Sano
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Yoshifumi Awaji
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Sumio Yamada
- Department of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
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Abstract
BACKGROUND Phenylketonuria is an inherited disease for which the main treatment is the dietary restriction of the amino acid phenylalanine. The diet has to be initiated in the neonatal period to prevent or reduce mental handicap. However, the diet is very restrictive and unpalatable and can be difficult to follow. A deficiency of the amino acid tyrosine has been suggested as a cause of some of the neuropsychological problems exhibited in phenylketonuria. Therefore, this review aims to assess the efficacy of tyrosine supplementation for phenylketonuria. This is an update of previously published versions of this review. OBJECTIVES To assess the effects of tyrosine supplementation alongside or instead of a phenylalanine-restricted diet for people with phenylketonuria, who commenced on diet at diagnosis and either continued on the diet or relaxed the diet later in life. To assess the evidence that tyrosine supplementation alongside, or instead of a phenylalanine-restricted diet improves intelligence, neuropsychological performance, growth and nutritional status, mortality rate and quality of life. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Trials Register which is comprised of references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. Additional studies were identified from handsearches of the Journal of Inherited Metabolic Disease (from inception in 1978 to 1998). The manufacturers of prescribable dietary products used in the treatment of phenylketonuria were also contacted for further references. Date of the most recent search of the Group's Inborn Errors of Metabolism Trials Register: 07 December 2020. SELECTION CRITERIA All randomised or quasi-randomised trials investigating the use of tyrosine supplementation versus placebo in people with phenylketonuria in addition to, or instead of, a phenylalanine-restricted diet. People treated for maternal phenylketonuria were excluded. DATA COLLECTION AND ANALYSIS Two authors independently assessed the trial eligibility, methodological quality and extracted the data. MAIN RESULTS Six trials were found, of which three trials reporting the results of a total of 56 participants, were suitable for inclusion in the review. The blood tyrosine concentrations were significantly higher in the participants receiving tyrosine supplements than those in the placebo group, mean difference 23.46 (95% confidence interval 12.87 to 34.05). No significant differences were found between any of the other outcomes measured. The trials were assessed as having a low to moderate risk of bias across several domains. AUTHORS' CONCLUSIONS From the available evidence no recommendations can be made about whether tyrosine supplementation should be introduced into routine clinical practice. Further randomised controlled studies are required to provide more evidence. However, given this is not an active area of research, we have no plans to update this review in the future.
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Affiliation(s)
- Tracey Remmington
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Sherie Smith
- Division of Child Health, Obstetrics & Gynaecology (COG), School of Medicine, University of Nottingham, Nottingham, UK
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Bärhold F, Meyer U, Neugebauer AK, Thimm EM, Lier D, Rosenbaum-Fabian S, Och U, Fekete A, Möslinger D, Rohde C, Beblo S, Hochuli M, Bogovic N, Korpel V, vom Dahl S, Mayorandan S, Fischer A, Freisinger P, Dokoupil K, Heddrich-Ellerbrok M, Jörg-Streller M, van Teeffelen-Heithoff A, Lahl J, Das AM. Hepatorenal Tyrosinaemia: Impact of a Simplified Diet on Metabolic Control and Clinical Outcome. Nutrients 2020; 13:nu13010134. [PMID: 33396520 PMCID: PMC7824011 DOI: 10.3390/nu13010134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Tyrosinaemia type 1 is a rare inherited metabolic disease caused by an enzyme defect in the tyrosine degradation pathway. It is treated using nitisinone and a low-protein diet. In a workshop in 2013, a group of nutritional specialists from Germany, Switzerland and Austria agreed to advocate a simplified low-protein diet and to allow more natural protein intake in patients with tyrosinaemia type 1. This retrospective study evaluates the recommendations made at different treatment centers and their impact on clinical symptoms and metabolic control. Methods: For this multicenter study, questionnaires were sent to nine participating treatment centers to collect data on the general therapeutic approach and data of 47 individual patients treated by those centers. Results: Dietary simplification allocating food to 3 categories led to increased tyrosine and phenylalanine blood concentrations without weighing food. Phenylalanine levels were significantly higher in comparison to a strict dietary regimen whereas tyrosine levels in plasma did not change. Non-inferiority was shown for the simplification and liberalization of the diet. Compliance with dietary recommendations was higher using the simplified diet in comparison to the stricter approach. Age correlates negatively with compliance. Conclusions: Simplification of the diet with increased natural protein intake based on three categories of food may be implemented in the diet of patients with tyrosinaemia type 1 without significantly altering metabolic control. Patient compliance is strongly influencing tyrosine blood concentrations. A subsequent prospective study with a larger sample size is necessary to get a better insight into the effect of dietary recommendations on metabolic control.
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Affiliation(s)
- Friederike Bärhold
- Department of Paediatrics, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (F.B.); (U.M.); (S.M.)
| | - Uta Meyer
- Department of Paediatrics, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (F.B.); (U.M.); (S.M.)
| | - Anne-Kathrin Neugebauer
- Klinik für Allgemeine Pädiatrie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany; (A.-K.N.); (E.M.T.)
| | - Eva Maria Thimm
- Klinik für Allgemeine Pädiatrie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany; (A.-K.N.); (E.M.T.)
| | - Dinah Lier
- Klinik für Kinder- und Jugendmedizin, Stoffwechselzentrum, Klinikum am Steinenberg, Steinenbergstraße 31, 72764 Reutlingen, Germany; (D.L.); (A.F.); (P.F.)
| | - Stefanie Rosenbaum-Fabian
- Zentrum für Kinder- u. Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany;
| | - Ulrike Och
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany; (U.O.); (A.v.T.-H.)
| | - Anna Fekete
- Kinder- und Jugendheilkunde, AKH Universitätsklinikum Wien, Währinger Gürtel 18-20, 1090 Wien, Austria; (A.F.); (D.M.)
| | - Dorothea Möslinger
- Kinder- und Jugendheilkunde, AKH Universitätsklinikum Wien, Währinger Gürtel 18-20, 1090 Wien, Austria; (A.F.); (D.M.)
| | - Carmen Rohde
- Universitätsklinik für Kinder und Jugendliche, Universitätsklinikum Leipzig, Liebigstraße 20 a, 04103 Leipzig, Germany; (C.R.); (S.B.)
| | - Skadi Beblo
- Universitätsklinik für Kinder und Jugendliche, Universitätsklinikum Leipzig, Liebigstraße 20 a, 04103 Leipzig, Germany; (C.R.); (S.B.)
| | - Michel Hochuli
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Rämistraße 100, 8091 Zürich, Switzerland;
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism Inselspital Bern, University Hospital and University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Nina Bogovic
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany; (N.B.); (V.K.); (S.v.D.)
| | - Vanessa Korpel
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany; (N.B.); (V.K.); (S.v.D.)
| | - Stephan vom Dahl
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany; (N.B.); (V.K.); (S.v.D.)
| | - Sebene Mayorandan
- Department of Paediatrics, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (F.B.); (U.M.); (S.M.)
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany; (U.O.); (A.v.T.-H.)
| | - Aleksandra Fischer
- Klinik für Kinder- und Jugendmedizin, Stoffwechselzentrum, Klinikum am Steinenberg, Steinenbergstraße 31, 72764 Reutlingen, Germany; (D.L.); (A.F.); (P.F.)
| | - Peter Freisinger
- Klinik für Kinder- und Jugendmedizin, Stoffwechselzentrum, Klinikum am Steinenberg, Steinenbergstraße 31, 72764 Reutlingen, Germany; (D.L.); (A.F.); (P.F.)
| | - Katharina Dokoupil
- Dr. von Haunersches Kinderspital, Lindwurmstraße 4, 80337 München, Germany;
| | - Margret Heddrich-Ellerbrok
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Monika Jörg-Streller
- Department für Kinder- und Jugendheilkunde, Medizinische Universität Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria;
| | - Agnes van Teeffelen-Heithoff
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany; (U.O.); (A.v.T.-H.)
| | - Janina Lahl
- Nutricia GmbH, Metabolics Expert Centre, Am Hauptbahnhof 18, 60329 Frankfurt, Germany;
| | - Anibh Martin Das
- Department of Paediatrics, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; (F.B.); (U.M.); (S.M.)
- Correspondence: ; Tel.: +49-511-532-3220; Fax: +49-511-532-18516
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Hartmann H, Pauli LK, Janssen LK, Huhn S, Ceglarek U, Horstmann A. Preliminary evidence for an association between intake of high-fat high-sugar diet, variations in peripheral dopamine precursor availability and dopamine-dependent cognition in humans. J Neuroendocrinol 2020; 32:e12917. [PMID: 33270945 DOI: 10.1111/jne.12917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 09/30/2020] [Accepted: 10/30/2020] [Indexed: 12/16/2022]
Abstract
Obesity is associated with alterations in dopaminergic transmission and cognitive function. Rodent studies suggest that diets rich in saturated fat and refined sugars (HFS), as opposed to diets diets low in saturated fat and refined sugars (LFS), change the dopamine system independent of excessive body weight. However, the impact of HFS on the human brain has not been investigated. Here, we compared the effect of dietary dopamine depletion on dopamine-dependent cognitive task performance between two groups differing in habitual intake of dietary fat and sugar. Specifically, we used a double-blind within-subject cross-over design to compare the effect of acute phenylalanine/tyrosine depletion on a reinforcement learning and a working memory task, in two groups that are on opposite ends of the spectrum of self-reported HFS intake (low vs high intake: LFS vs HFS group). We tested 31 healthy young women matched for body mass index (mostly normal weight to overweight) and IQ. Depletion of peripheral precursors of dopamine reduced the working memory specific performance on the operation span task in the LFS, but not in the HFS group (P = 0.016). Learning from positive- and negative-reinforcement (probabilistic selection task) was increased in both diet groups after dopamine depletion (P = 0.049). As a secondary exploratory research question, we measured peripheral dopamine precursor availability (pDAP) at baseline as an estimate for central dopamine levels. The HFS group had a significantly higher pDAP at baseline compared to the LFS group (P = 0.025). Our data provide the first evidence indicating that the intake of HFS is associated with changes in dopamine precursor availability, which is suggestive of changes in central dopamine levels in humans. The observed associations are present in a sample of normal to overweight participants (ie, in the absence of obesity), suggesting that the consumption of a HFS might already be associated with altered behaviours. Alternatively, the effects of HFS diet and obesity might be independent.
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Affiliation(s)
- Hendrik Hartmann
- Collaborative Research Centre 1052 'Obesity Mechanisms', Leipzig University Medical Center, Leipzig, Germany
- Department of Neurology, MaxPlanck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Larissa K Pauli
- Department of Neurology, MaxPlanck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Lieneke K Janssen
- Department of Neurology, MaxPlanck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Sebastian Huhn
- Department of Neurology, MaxPlanck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Molecular Systems Biology, Helmholtz Centre for Environmental Research - UFZ, Leipzig, Germany
| | - Uta Ceglarek
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
| | - Annette Horstmann
- Collaborative Research Centre 1052 'Obesity Mechanisms', Leipzig University Medical Center, Leipzig, Germany
- Department of Neurology, MaxPlanck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Lee J, Lee JY, Meade CS, Cohn M, Chahine A, Dilworth SE, Magidson JF, Gouse H, Fuchs D, Carrico AW. Tryptophan degradation is associated with risk-taking propensity in methamphetamine users with treated HIV infection. J Neurovirol 2020; 26:779-784. [PMID: 32728896 PMCID: PMC7541781 DOI: 10.1007/s13365-020-00841-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/11/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
Abstract
Few studies have examined neuroimmune pathways that could contribute to impulsivity in people living with HIV who use substances. Eighty-four methamphetamine-using, sexual minority men with an undetectable HIV viral load were administered the Balloon Analogue Risk Task (BART), a behavioral measure of risk-taking propensity. We examined the associations between kynurenine/tryptophan ratio and phenylalanine/tyrosine ratio with BART scores using multiple linear regression. A higher kynurenine/tryptophan ratio was independently associated with greater BART scores (beta = 0.25; 95% CI = 0.05-1.23; p = 0.034). The phenylalanine/tyrosine ratio was not significantly associated with BART scores. Findings support the need for further research to elucidate the neuroimmune mechanisms linking tryptophan degradation with impulsivity to catalyze the development novel pharmacologic treatments for people living with HIV who use methamphetamine.
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Affiliation(s)
- Jared Lee
- Public Health Sciences and Psychology, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120NW 14th St. Office 1005, Miami, FL, 33136, USA
| | - Ji-Young Lee
- Public Health Sciences and Psychology, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120NW 14th St. Office 1005, Miami, FL, 33136, USA
| | | | - Michael Cohn
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Antonio Chahine
- Public Health Sciences and Psychology, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120NW 14th St. Office 1005, Miami, FL, 33136, USA
| | - Samantha E Dilworth
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Hetta Gouse
- Unviversity of Cape Town Department of Psychiatry and Mental Health, Cape Town, South Africa
| | | | - Adam W Carrico
- Public Health Sciences and Psychology, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120NW 14th St. Office 1005, Miami, FL, 33136, USA.
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Abstract
Phenylketonuria (PKU) is the most common inborn error of amino acids metabolism. PKU management aims to keep as soon as possible blood phenylalanine (Phe), a non-acutely neurotoxic metabolite, within safe ranges through a dietary Phe restriction tailored to individual dietary Phe tolerance. Information on initial neonatal management of PKU, when Phe tolerance is still unknown, is scanty. We reviewed the metabolic data from 304 patients with PAH deficiency detected at newborn screening within the last 37 years. In keeping with the general neonatal management of intoxication-type inborn errors of metabolism, initial management consisted in a Phe wash-out through the exclusive administration of normocaloric Phe-free formulas until normalization of blood Phe. Based on genotype and Phe tolerance assessed at follow-up, 55 patients had classic PKU (18%), 50 mild PKU (17%), and 199 non-PKU hyperphenylalaninemia (HPA) (65%). The duration of Phe wash-out amounted to 7 ± 2 days in classic PKU, 4 ± 2 days in mild PKU, and < 24 h in non-PKU HPA (p < 0.001). After the wash-out, dietary Phe re-introduction and its upwardly titration allowed the assessment of individual metabolic phenotype. During the first 6 years of life, Phe tolerance was stable in classic PKU (~ 200 mg/day) but increased in milder forms, allowing unrestricted diet in non-PKU HPA. Neonatal Phe wash-out in PKU ensures the earliest correction of HPA. This metabolic reset also facilitates the prompt definition of individual Phe tolerance, allowing anticipation of dietary personalization and optimization of longitudinal metabolic control.
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Affiliation(s)
- Francesco Porta
- Department of Pediatrics, AOU Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.
- Department of Pediatrics, University of Torino, Piazza Polonia 94, Turin, 10126, Italy.
| | - Alberto Ponzone
- Department of Pediatrics, AOU Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Marco Spada
- Department of Pediatrics, AOU Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
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Sumanszki C, Kovacs K, Karvaly GB, Kiss E, Simon E, Patocs A, Toth M, Komka Z, Reismann P. Metabolic and catecholamine response to sympathetic stimulation in early-treated adult male patients with phenylketonuria. Hormones (Athens) 2020; 19:395-402. [PMID: 31993977 PMCID: PMC7426284 DOI: 10.1007/s42000-020-00176-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/22/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Defective function of phenylalanine hydroxylase in phenylketonuria (PKU) results in the accumulation of phenylalanine (Phe) and the reduction of tyrosine (Tyr) in the blood, interfering in the normal development and function of organs and tissues in the body. Tyr is the precursor of catecholamines, secreted in response to stress by the adrenal medulla and paraganglia. The aim of this study was to evaluate plasma catecholamine and amino acid response to an escalating series of sympathetic stress tests in PKU patients. METHODS Twelve males with classical PKU (aged 18-41 years) and ten healthy male controls were included in this study. The subjects were exposed to three different sympathetic stress stimulations: cold pressor, isometric handgrip, and peak treadmill tests to exhaustion. Physiological, metabolic, and hormonal changes were determined. RESULTS Aerobic capacity (VO2max) was significantly lower in the PKU group (p = 0.018); however, relative VO2max was similar in the two groups during the spiroergometric test. No significant differences in norepinephrine or in epinephrine response were found between the two groups during the different stimulation tests. Blood Phe increased significantly in the PKU group compared with controls (p = 0.027) during the spiroergometric test, while Tyr levels remained stable in both groups. CONCLUSION PKU itself might not influence stress-induced catecholamine changes. Only strenuous exercise increased blood Phe levels in PKU subjects.
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Affiliation(s)
- Csaba Sumanszki
- 2nd Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi u. 46, Budapest, 1088 Hungary
| | - Krisztian Kovacs
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | | | - Erika Kiss
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Erika Simon
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Attila Patocs
- Molecular Medicine Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
- “Lendület” Hereditary Endocrine Tumours Research Group, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Miklos Toth
- Department of Health Sciences and Sport Medicine, University of Physical Education, Budapest, Hungary
| | - Zsolt Komka
- Department of Health Sciences and Sport Medicine, University of Physical Education, Budapest, Hungary
| | - Peter Reismann
- 2nd Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Szentkirályi u. 46, Budapest, 1088 Hungary
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Hillert A, Anikster Y, Belanger-Quintana A, Burlina A, Burton BK, Carducci C, Chiesa AE, Christodoulou J, Đorđević M, Desviat LR, Eliyahu A, Evers RAF, Fajkusova L, Feillet F, Bonfim-Freitas PE, Giżewska M, Gundorova P, Karall D, Kneller K, Kutsev SI, Leuzzi V, Levy HL, Lichter-Konecki U, Muntau AC, Namour F, Oltarzewski M, Paras A, Perez B, Polak E, Polyakov AV, Porta F, Rohrbach M, Scholl-Bürgi S, Spécola N, Stojiljković M, Shen N, Santana-da Silva LC, Skouma A, van Spronsen F, Stoppioni V, Thöny B, Trefz FK, Vockley J, Yu Y, Zschocke J, Hoffmann GF, Garbade SF, Blau N. The Genetic Landscape and Epidemiology of Phenylketonuria. Am J Hum Genet 2020; 107:234-250. [PMID: 32668217 PMCID: PMC7413859 DOI: 10.1016/j.ajhg.2020.06.006] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/05/2020] [Indexed: 11/22/2022] Open
Abstract
Phenylketonuria (PKU), caused by variants in the phenylalanine hydroxylase (PAH) gene, is the most common autosomal-recessive Mendelian phenotype of amino acid metabolism. We estimated that globally 0.45 million individuals have PKU, with global prevalence 1:23,930 live births (range 1:4,500 [Italy]-1:125,000 [Japan]). Comparing genotypes and metabolic phenotypes from 16,092 affected subjects revealed differences in disease severity in 51 countries from 17 world regions, with the global phenotype distribution of 62% classic PKU, 22% mild PKU, and 16% mild hyperphenylalaninemia. A gradient in genotype and phenotype distribution exists across Europe, from classic PKU in the east to mild PKU in the southwest and mild hyperphenylalaninemia in the south. The c.1241A>G (p.Tyr414Cys)-associated genotype can be traced from Northern to Western Europe, from Sweden via Norway, to Denmark, to the Netherlands. The frequency of classic PKU increases from Europe (56%) via Middle East (71%) to Australia (80%). Of 758 PAH variants, c.1222C>T (p.Arg408Trp) (22.2%), c.1066-11G>A (IVS10-11G>A) (6.4%), and c.782G>A (p.Arg261Gln) (5.5%) were most common and responsible for two prevalent genotypes: p.[Arg408Trp];[Arg408Trp] (11.4%) and c.[1066-11G>A];[1066-11G>A] (2.6%). Most genotypes (73%) were compound heterozygous, 27% were homozygous, and 55% of 3,659 different genotypes occurred in only a single individual. PAH variants were scored using an allelic phenotype value and correlated with pre-treatment blood phenylalanine concentrations (n = 6,115) and tetrahydrobiopterin loading test results (n = 4,381), enabling prediction of both a genotype-based phenotype (88%) and tetrahydrobiopterin responsiveness (83%). This study shows that large genotype databases enable accurate phenotype prediction, allowing appropriate targeting of therapies to optimize clinical outcome.
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Affiliation(s)
- Alicia Hillert
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, Clinic I, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Yair Anikster
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Aviv University, 52621 Tel-Aviv, Israel
| | - Amaya Belanger-Quintana
- Unidad de Enfermedades Metabolicas, Servicio de Pediatria, Hospital Ramon y Cajal, 28034 Madrid, Spain
| | - Alberto Burlina
- Division of Inherited Metabolic Diseases, Department of Woman's and Child's Health, University Hospital, 35129 Padua, Italy
| | - Barbara K Burton
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Carla Carducci
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Ana E Chiesa
- Fundación de Endocrinología Infantil (FEI), C1425 Buenos Aires, Argentina
| | - John Christodoulou
- Murdoch Children's Research Institute and Department of Pediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Maja Đorđević
- Institute of Mother and Child Healthcare "Dr. Vukan Čupić," 11000 Belgrade, Serbia
| | - Lourdes R Desviat
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular CSIC-UAM, Universidad Autónoma de Madrid. CIBERER, IdiPAz, 28049 Madrid, Spain
| | - Aviva Eliyahu
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Aviv University, 52621 Tel-Aviv, Israel
| | - Roeland A F Evers
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Section of Metabolic Diseases, 9712 CP Groningen, the Netherlands
| | - Lena Fajkusova
- Centre of Molecular Biology and Gene Therapy, University Hospital Brno, 62500 Brno, Czech Republic
| | - François Feillet
- Reference Center for Inherited Metabolic Diseases, University Hospital of Nancy, 54511 Vandoeuvre-lès-Nancy, France
| | - Pedro E Bonfim-Freitas
- Laboratory of Inborn Errors of Metabolism, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, Brazil
| | - Maria Giżewska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University, 71-252 Szczecin, Poland
| | | | - Daniela Karall
- Clinic of Pediatrics, Division of Inherited Metabolic Disorders, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Katya Kneller
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Aviv University, 52621 Tel-Aviv, Israel
| | | | - Vincenzo Leuzzi
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Harvey L Levy
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | - Ania C Muntau
- University Children's Hospital, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany
| | - Fares Namour
- Reference Center for Inherited Metabolic Diseases, University Hospital of Nancy, 54511 Vandoeuvre-lès-Nancy, France
| | - Mariusz Oltarzewski
- Department of Screening and Metabolic Diagnostics, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Andrea Paras
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Belen Perez
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular CSIC-UAM, Universidad Autónoma de Madrid. CIBERER, IdiPAz, 28049 Madrid, Spain
| | - Emil Polak
- Comenius University, Faculty of Natural Sciences, Department of Molecular Biology, 84215 Bratislava 4, Slovak Republic
| | | | - Francesco Porta
- Department of Pediatrics, AOU Citta' della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Marianne Rohrbach
- Division of Metabolism, University Children's Hospital, 8032 Zürich, Switzerland
| | - Sabine Scholl-Bürgi
- Clinic of Pediatrics, Division of Inherited Metabolic Disorders, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Norma Spécola
- Unidad de Metabolismo. Hospital de Niños "Sor Ludovica" de La Plata, 1904 Buenos Aires, Argentina
| | - Maja Stojiljković
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11000 Belgrade, Serbia
| | - Nan Shen
- Department of Infectious Diseases, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 2000025 Shanghai, China
| | - Luiz C Santana-da Silva
- Laboratory of Inborn Errors of Metabolism, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, Brazil
| | | | - Francjan van Spronsen
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Section of Metabolic Diseases, 9712 CP Groningen, the Netherlands
| | - Vera Stoppioni
- Centro Screening Neonatale Regione Marche, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61032 Fano, Italy
| | - Beat Thöny
- Division of Metabolism, University Children's Hospital, 8032 Zürich, Switzerland
| | - Friedrich K Trefz
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, Clinic I, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Jerry Vockley
- UPMC, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Youngguo Yu
- Department of Pediatric Endocrinology/Genetics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute for Pediatric Research, 2000025 Shanghai, China
| | - Johannes Zschocke
- Institute of Human Genetics, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Georg F Hoffmann
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, Clinic I, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Sven F Garbade
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, Clinic I, University Hospital Heidelberg, 69120 Heidelberg, Germany.
| | - Nenad Blau
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, Clinic I, University Hospital Heidelberg, 69120 Heidelberg, Germany; Division of Metabolism, University Children's Hospital, 8032 Zürich, Switzerland.
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Ellul S, Marx W, Collier F, Saffery R, Tang M, Burgner D, Carlin J, Vuillermin P, Ponsonby AL. Plasma metabolomic profiles associated with infant food allergy with further consideration of other early life factors. Prostaglandins Leukot Essent Fatty Acids 2020; 159:102099. [PMID: 32505120 DOI: 10.1016/j.plefa.2020.102099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/03/2020] [Accepted: 03/26/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Fatty acids have been implicated in early life immune development. Food allergy provides a clear phenotype of early allergic disease. Fish oil and vitamin D have immune-modulating properties. We aimed to identify the metabolomic profile of (i) infant food allergy and (ii) factors linked to food allergy in past studies such as fish oil supplementation and serum 25OHD3 levels in early life. METHODS NMR was used to quantify 73 metabolites in plasma of 1 year old infants from the Barwon Infant Study (n=485). Logistic regression models were used to examine associations between infant metabolome and food allergy in infants. Linear regression models were used to describe associations between maternal fish oil supplementation and 25OHD3 levels with infant metabolites. RESULTS A higher linoleic acid: total fatty acid (FA) ratio and phenylalanine level were associated with higher odds of food allergy. Antenatal fish oil supplementation was positively associated with docosahexaenoic acid (DHA) and omega-3 related metabolite levels. Postnatal 25OHD3 levels at 1 year of age were positively associated with several FA measures and creatinine and inversely with the saturated FA: total FA ratio. Only the postnatal 25OHD3 patterns persisted after adjustment for multiple comparisons. CONCLUSIONS Infants with food allergy had altered fatty acid profiles at one year. Fish oil supplementation in pregnancy was associated with higher DHA and omega-3 related metabolites at 1 year of age. Associations were modest and the most robustly altered metabolomic profiles were with postnatal 25OHD3 levels.
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Affiliation(s)
- Susan Ellul
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Wolfgang Marx
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia; Deakin University, Geelong, VIC, Australia; Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Fiona Collier
- Deakin University, Geelong, VIC, Australia; Child Health Research Unit, Barwon Health. Geelong, VIC, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Mimi Tang
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia; Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - John Carlin
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Peter Vuillermin
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia; Deakin University, Geelong, VIC, Australia; Child Health Research Unit, Barwon Health. Geelong, VIC, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia; Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia.
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Abstract
BACKGROUND Phenylketonuria is an inherited disease treated with dietary restriction of the amino acid phenylalanine. The diet is initiated in the neonatal period to prevent learning disability; however, it is restrictive and can be difficult to follow. Whether the diet can be relaxed or discontinued during adolescence or should be continued for life remains a controversial issue, which we aim to address in this review. This is an updated version of a previously published review. OBJECTIVES To assess the effects of a low-phenylalanine diet commenced early in life for people with phenylketonuria. To assess the possible effects of relaxation or termination of the diet on intelligence, neuropsychological outcomes and mortality, growth, nutritional status, eating behaviour and quality of life. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. Most recent search of the Inborn Errors of Metabolism Trials Register: 30 April 2020. SELECTION CRITERIA All randomised or quasi-randomised controlled trials comparing a low-phenylalanine diet to relaxation or termination of dietary restrictions in people with phenylketonuria. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility and methodological quality, and subsequently extracted the data. MAIN RESULTS We included four studies in this review (251 participants), and found few significant differences between treatment and comparison groups for the outcomes of interest. Blood phenylalanine levels were significantly lower in participants with phenylketonuria following a low-phenylalanine diet compared to those on a less restricted diet, mean difference (MD) at three months -698.67 (95% confidence interval (CI) -869.44 to -527.89). Intelligence quotient was significantly higher in participants who continued the diet than in those who stopped the diet, MD after 12 months 5.00 (95% CI 0.40 to 9.60). However, these results came from a single study. AUTHORS' CONCLUSIONS The results of non-randomised studies have concluded that a low-phenylalanine diet is effective in reducing blood phenylalanine levels and improving intelligence quotient and neuropsychological outcomes. We were unable to find any randomised controlled studies that have assessed the effect of a low-phenylalanine diet versus no diet from diagnosis. In view of evidence from non-randomised studies, such a study would be unethical and it is recommended that low-phenylalanine diet should be commenced at the time of diagnosis. There is uncertainty about the precise level of phenylalanine restriction and when, if ever, the diet should be relaxed. This should be addressed by randomised controlled studies; however, no new studies are expected in this area so we do not plan to update this review.
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Affiliation(s)
- Elisabeth Jameson
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Tracey Remmington
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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Mozrzymas R, Walkowiak D, Drzymała-Czyż S, Krzyżanowska-Jankowska P, Duś-Żuchowska M, Kałużny Ł, Walkowiak J. Vitamin K Status in Adherent and Non-Adherent Patients with Phenylketonuria: A Cross-Sectional Study. Nutrients 2020; 12:nu12061772. [PMID: 32545860 PMCID: PMC7353192 DOI: 10.3390/nu12061772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/04/2020] [Accepted: 06/12/2020] [Indexed: 01/09/2023] Open
Abstract
This is the first study to evaluate vitamin K status in relation to dietary intake and phenylalanine dietary compliance in patients with phenylketonuria (PKU). The dietary and PKU formula intake of vitamin K was calculated in 34 PKU patients, with vitamin K status determined by the measurement of prothrombin induced by vitamin K absence (PIVKA-II). Blood phenylalanine concentrations in the preceding 12 months were considered. There were significantly more phenylalanine results exceeding 6 mg/dL in patients with normal PIVKA-II concentrations than in those with abnormal PIVKA-II levels (p = 0.035). Similarly, a higher total intake of vitamin K and dietary vitamin intake expressed as μg/day (p = 0.033 for both) and %RDA (p = 0.0002 and p = 0.003, respectively) was observed in patients with normal PIVKA-II levels. Abnormal PIVKA-II concentrations were associated with a lower OR (0.1607; 95%CI: 0.0273–0.9445, p = 0.043) of having a median phenylalanine concentration higher than 6 mg/dL. In conclusion, vitamin K deficiency is not uncommon in phenylketonuria and may also occur in patients with adequate vitamin K intake. PKU patients with better dietary compliance have a higher risk of vitamin K deficiency. The present findings highlight the need for further studies to re-evaluate dietary recommendations regarding vitamin K intake, both concerning formula-based and dietary consumption of natural products.
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Affiliation(s)
- Renata Mozrzymas
- Research and Development Center, Regional Specialist Hospital in Wrocław, H. M. Kamieńskiego Street 73a, 51-124 Wrocław, Poland;
| | - Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Przybyszewskiego Street 39, 60-356 Poznan, Poland;
| | - Sławomira Drzymała-Czyż
- Department of Bromatology, Poznan University of Medical Sciences, Marcelinska Street 42, 60-354 Poznan, Poland;
| | - Patrycja Krzyżanowska-Jankowska
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572 Poznan, Poland; (P.K.-J.); (M.D.-Ż.); (Ł.K.)
| | - Monika Duś-Żuchowska
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572 Poznan, Poland; (P.K.-J.); (M.D.-Ż.); (Ł.K.)
| | - Łukasz Kałużny
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572 Poznan, Poland; (P.K.-J.); (M.D.-Ż.); (Ł.K.)
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572 Poznan, Poland; (P.K.-J.); (M.D.-Ż.); (Ł.K.)
- Correspondence: ; Tel.: +48-61-849-1432
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Leskanicova A, Chovancova O, Babincak M, Verboova L, Benetinova Z, Macekova D, Kostolny J, Smajda B, Kiskova T. Sexual Dimorphism in Energy Metabolism of Wistar Rats Using Data Analysis. Molecules 2020; 25:molecules25102353. [PMID: 32443550 PMCID: PMC7287681 DOI: 10.3390/molecules25102353] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/25/2022] Open
Abstract
The prevalence of some chronic diseases, such as cancer or neurodegenerative disorders, differs between sexes. Animal models provide an important tool to adopt potential therapies from preclinical studies to humans. Laboratory rats are the most popular animals in toxicology, neurobehavioral, or cancer research. Our study aimed to reveal the basic differences in blood metabolome (amino acids, biogenic amines, and acylcarnitines) of the adult male (n = 10) and female (n = 10) Wistar rats. Partial least square-discrimination analysis (PLS-DA) and a variance im portance in projection (VIP) score was used to identify the key sex-specific metabolites. All groups of metabolites, as the main markers of energy metabolism, showed a significant sex-dependent pattern. The most important features calculated in PLS-DA according to VIP score were free carnitine (C0), tyrosine (Tyr), and acylcarnitine C5-OH. While aromatic amino acids, such as Tyr and phenylalanine (Phe), were significantly elevated in the blood plasma of males, tryptophan (Trp) was found in higher levels in the blood plasma of females. Besides, significant sex-related changes in urea cycle were found. Our study provides an important insight into sex-specific differences in energy metabolism in rats and indicates that further studies should consider sex as the main aspect in design and data interpretation.
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Affiliation(s)
- Andrea Leskanicova
- Institute of Biology and Ecology, Faculty of Sciences, University of Pavol Jozef Šafárik in Košice, Šrobárova 2, 041 80 Košice, Slovakia; (A.L.); (M.B.)
| | - Olga Chovancova
- Department of Informatics, Faculty of Management Sciences and Informatics, University of Žilina, Univerzitná 8215/1, 010 26 Žilina, Slovakia; (O.C.); (D.M.); (J.K.)
| | - Marian Babincak
- Institute of Biology and Ecology, Faculty of Sciences, University of Pavol Jozef Šafárik in Košice, Šrobárova 2, 041 80 Košice, Slovakia; (A.L.); (M.B.)
| | - Ludmila Verboova
- Department of Pathology, Faculty of Medicine, University of Pavol Jozef Šafárik in Košice, Rastislavova 43, 040 01 Košice, Slovakia; (L.V.); (Z.B.)
| | - Zuzana Benetinova
- Department of Pathology, Faculty of Medicine, University of Pavol Jozef Šafárik in Košice, Rastislavova 43, 040 01 Košice, Slovakia; (L.V.); (Z.B.)
| | - Denisa Macekova
- Department of Informatics, Faculty of Management Sciences and Informatics, University of Žilina, Univerzitná 8215/1, 010 26 Žilina, Slovakia; (O.C.); (D.M.); (J.K.)
| | - Jozef Kostolny
- Department of Informatics, Faculty of Management Sciences and Informatics, University of Žilina, Univerzitná 8215/1, 010 26 Žilina, Slovakia; (O.C.); (D.M.); (J.K.)
| | - Benadik Smajda
- Institute of Biology and Ecology, Faculty of Sciences, University of Pavol Jozef Šafárik in Košice, Šrobárova 2, 041 80 Košice, Slovakia; (A.L.); (M.B.)
- Correspondence: (B.S.); (T.K.); Tel.: +421-55-234-1216 (T.K.); Fax: +421-55-622-2124 (T.K.)
| | - Terezia Kiskova
- Institute of Biology and Ecology, Faculty of Sciences, University of Pavol Jozef Šafárik in Košice, Šrobárova 2, 041 80 Košice, Slovakia; (A.L.); (M.B.)
- Correspondence: (B.S.); (T.K.); Tel.: +421-55-234-1216 (T.K.); Fax: +421-55-622-2124 (T.K.)
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Wang L, Ye F, Zou H, Wang K, Chen Z, Hui Q, Han B, He C, Li X, Shen M. The first study of successful pregnancies in Chinese patients with Phenylketonuria. BMC Pregnancy Childbirth 2020; 20:253. [PMID: 32345238 PMCID: PMC7189601 DOI: 10.1186/s12884-020-02941-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the inception of newborn screening programs in China in the 1990s, pregnancy among patients with inherited, metabolic disorders has become more common. This study explores the management and outcomes of planned, full-term pregnancies in patients with phenylketonuria (PKU). METHOD Married patients with PKU from 2012 to 2017 were enrolled to receive prenatal counseling and regular health assessments. Study-related assessments included the timing of Phe-restricted diets, maternal weight gain, gestational age, pregnancy complications, and blood Phe concentrations (both pre-conception and during pregnancy), obstetrical data, and offspring outcomes(e.g. anthropomorphic measurements and developmental quotients [DQs]). RESULTS A total of six offspring were successfully delivered. The mean ± SD (range) age of the mother at delivery was 26.3 ± 4.7 (range: 21.1-32.5) years. The mean duration of Phe control before pregnancy was 5.5 ± 1.3(range: 3.1-6.5) months. During pregnancy, the proportion of blood Phe concentrations within the clinically-recommended target range (120-360 μmol/L) ranged from 63.2-83.5%. Low birth weight (< 2500 g) offspring occurred in two women who experienced suboptimal metabolic control. In addition, offspring DQ was related to the proportion of blood Phe levels per trimester that were within the recommended range (r = 0.886, p = 0.016). CONCLUSION This is the first report of women in China with PKU who successfully gave birth to clinically healthy babies. Infant outcomes were related to maternal blood Phe management prior to and during pregnancy. In maternal PKU patients with poor compliance to dietary treatment, sapropterin dihydrochloride (6R-BH4) may be an option to improve the management of blood Phe levels.
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Affiliation(s)
- Lin Wang
- Department of Preventive Health Care, China-Japan Friendship Hospital, No. 2, Yinghua East Street, Chaoyang district, Beijing, 100029, China
| | - Fang Ye
- Department of Pediatrics, China-Japan Friendship Hospital, No. 2, Yinghua East Street, Chaoyang district, Beijing, 100029, China
| | - Hui Zou
- Newborn Screening Center, Jinan Maternity and Child Care Hospital, Jinan, Shandong, China
| | - Kundi Wang
- Department of Pediatrics, China-Japan Friendship Hospital, No. 2, Yinghua East Street, Chaoyang district, Beijing, 100029, China
| | - Zhihua Chen
- Clinical Research Institute, China-Japan Friendship Hospital, No. 2, Yinghua East Street, Chaoyang district, Beijing, 100029, China
| | - Qin Hui
- Department of Pediatrics, China-Japan Friendship Hospital, No. 2, Yinghua East Street, Chaoyang district, Beijing, 100029, China
| | - Bingjuan Han
- Newborn Screening Center, Jinan Maternity and Child Care Hospital, Jinan, Shandong, China
| | - Chun He
- Clinical Research Institute, China-Japan Friendship Hospital, No. 2, Yinghua East Street, Chaoyang district, Beijing, 100029, China
| | - Xiaowen Li
- Department of Nutrition, China-Japan Friendship Hospital, No. 2, Yinghua East Street, Chaoyang district, Beijing, 100029, China.
| | - Ming Shen
- Department of Pediatrics, China-Japan Friendship Hospital, No. 2, Yinghua East Street, Chaoyang district, Beijing, 100029, China.
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Yilmaz O, Daly A, Pinto A, Ashmore C, Evans S, Gupte G, Santra S, Preece MA, Mckiernan P, Kitchen S, Yabanci Ayhan N, MacDonald A. Natural Protein Tolerance and Metabolic Control in Patients with Hereditary Tyrosinaemia Type 1. Nutrients 2020; 12:E1148. [PMID: 32325917 PMCID: PMC7230348 DOI: 10.3390/nu12041148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 12/23/2022] Open
Abstract
In a longitudinal retrospective study, we aimed to assess natural protein (NP) tolerance and metabolic control in a cohort of 20 Hereditary Tyrosinaemia type I (HTI) patients. Their median age was 12 years ([3.2-17.7 years], n = 11 female, n = 8 Caucasian, n = 8 Asian origin, n = 2 Arabic and n = 2 Indian). All were on nitisinone (NTBC) with a median dose of 0.7 g/kg/day (range 0.4-1.5 g/kg/day) and were prescribed a tyrosine (Tyr)/phenylalanine (Phe)-restricted diet supplemented with Tyr/Phe-free L-amino acids. Data were collected on clinical signs at presentation, medical history, annual dietary prescriptions, and blood Phe and Tyr levels from diagnosis until transition to the adult service (aged 16-18 years) or liver transplantation (if it preceded transition). The median age of diagnosis was 2 months (range: 0 to 24 months), with n = 1 diagnosed by newborn screening, n = 3 following phenylketonuria (PKU) screening and n = 7 by sibling screening. Five patients were transplanted (median age 6.3 years), and one died due to liver cancer. The median follow-up was 10 years (3-16 years), and daily prescribed NP intake increased from a median of 5 to 24 g/day. Lifetime median blood Tyr (370 µmol/L, range 280-420 µmol/L) and Phe (50 µmol/L, 45-70 µmol/L) were maintained within the target recommended ranges. This cohort of HTI patients were able to increase the daily NP intake with age while maintaining good metabolic control. Extra NP may improve lifelong adherence to the diet.
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Affiliation(s)
- Ozlem Yilmaz
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
- Department of Nutrition and Dietetics, Ankara Yildirim Beyazit University, 06760 Ankara, Turkey
| | - Anne Daly
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Alex Pinto
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Catherine Ashmore
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Sharon Evans
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Girish Gupte
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Saikat Santra
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Mary Anne Preece
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Patrick Mckiernan
- Gastroenterology/ Hepatic/Nutrition, UPMC, Children’s Hospital of Pittsburg, Pittsburg, PA 15224, USA;
| | - Steve Kitchen
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | | | - Anita MacDonald
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
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Rigamonti AE, Leoncini R, De Col A, Tamini S, Cicolini S, Abbruzzese L, Cella SG, Sartorio A. The Appetite-Suppressant and GLP-1-Stimulating Effects of Whey Proteins in Obese Subjects are Associated with Increased Circulating Levels of Specific Amino Acids. Nutrients 2020; 12:nu12030775. [PMID: 32183423 PMCID: PMC7146343 DOI: 10.3390/nu12030775] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 01/06/2023] Open
Abstract
The satiating effect of whey proteins depends upon their unique amino acid composition because there is no difference when comparing whey proteins or a mix of amino acids mimicking the amino acid composition of whey proteins. The specific amino acids underlying the satiating effect of whey proteins have not been investigated to date. AIMS AND METHODS The aim of the present study was to evaluate the appetite-suppressant effect of an isocaloric drink containing whey proteins or maltodextrins on appetite (satiety/hunger measured by a visual analogue scale or VAS), anorexigenic gastrointestinal peptides (circulating levels of glucagon-like peptide 1 (GLP-1) and peptide tyrosine tyrosine (PYY)) and amino acids (circulating levels of single, total [TAA] and branched-chain amino acids [BCAA]) in a cohort of obese female subjects (n = 8; age: 18.4 ± 3.1 years; body mass index, BMI: 39.2 ± 4.6 kg/m2). RESULTS Each drink significantly increased satiety and decreased hunger, the effects being more evident with whey proteins than maltodextrins. Similarly, circulating levels of GLP-1, PYY and amino acids (TAA, BCAA and alanine, arginine, asparagine, citrulline, glutamine, hydroxyproline, isoleucine, histidine, leucine, lysine, methionine, ornithine, phenylalanine, proline, serine, threonine, tyrosine, and valine) were significantly higher with whey proteins than maltodextrins. In subjects administered whey proteins (but not maltodextrins), isoleucine, leucine, lysine, methionine, phenylalanine, proline, tyrosine, and valine were significantly correlated with hunger (negatively), satiety, and GLP-1 (positively). CONCLUSIONS Eight specific amino acids (isoleucine, leucine, lysine, methionine, phenylalanine, proline, tyrosine, and valine) were implicated in the appetite-suppressant and GLP-1-stimulating effects of whey proteins, which may be mediated by their binding with nutrient-sensing receptors expressed by L cells within the gastrointestinal wall. The long-term satiating effect of whey proteins and the effectiveness of a supplementation with these amino acids (i.e., as a nutraceutical intervention) administered during body weight reduction programs need to be further investigated.
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Affiliation(s)
- Antonello E. Rigamonti
- Department of Clinical Sciences and Community Health, University of Milan, 20129 Milan, Italy;
- Correspondence: ; Tel.: +39-02-503-17013; Fax: +39-02-503-17011
| | - Roberto Leoncini
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy;
| | - Alessandra De Col
- Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (A.D.C.); (S.T.); (S.C.); (A.S.)
| | - Sofia Tamini
- Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (A.D.C.); (S.T.); (S.C.); (A.S.)
| | - Sabrina Cicolini
- Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (A.D.C.); (S.T.); (S.C.); (A.S.)
| | - Laura Abbruzzese
- Division of Auxology and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy;
| | - Silvano G. Cella
- Department of Clinical Sciences and Community Health, University of Milan, 20129 Milan, Italy;
| | - Alessandro Sartorio
- Experimental Laboratory for Auxo-endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (A.D.C.); (S.T.); (S.C.); (A.S.)
- Division of Auxology and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy;
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Levy H, Lamppu D, Anastosoaie V, Baker JL, DiBona K, Hawthorne S, Lindenberger J, Kinch D, Seymour A, McIlduff M, Watling S, Vockley J. 5-year retrospective analysis of patients with phenylketonuria (PKU) and hyperphenylalaninemia treated at two specialized clinics. Mol Genet Metab 2020; 129:177-185. [PMID: 31883647 DOI: 10.1016/j.ymgme.2019.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Phenylketonuria (PKU) is an autosomal recessive disease caused by mutations in the PAH gene, resulting in deficiency of phenylalanine hydroxylase (PAH), an enzyme that converts phenylalanine (Phe) to tyrosine (Tyr). The purpose of this study was to capture real-world data associated with managing PKU under current standard of care and to characterize a representative population for a planned gene therapy trial. METHODS A retrospective chart review was conducted at two U.S. clinics for individuals 10-40 years old diagnosed with PKU-related hyperphenylalaninemia (HPA). Demographics, medical history, treatments and blood Phe data were collected from electronic medical records spanning a five-year period ending in November 2017. RESULTS 152 patients were enrolled (65.8% had classical PKU). Although >95% of patients were prescribed a Phe-restricted diet, blood Phe concentrations remained substantially elevated, particularly in patients diagnosed with classical PKU. As the Phe threshold was lowered (Phe < 600, 360, 120 or 30 μmol/L), the number of patients with consecutive lab values below the threshold decreased, suggesting that many patients' Phe levels are inadequately controlled. 62.5% of patients were reported as having a history of at least one neuropsychiatric comorbidity, and adults were more likely than adolescents (69.5% vs. 54.3%). 92 of 98 PAH genotypes collected were distinct mutations; the 6 null-null genotypes were associated with classical PKU. Overall the demographics and clinical data were consistent across both sites. CONCLUSION Despite dietary restrictions, mean Phe concentrations were > 360 μmol/L (a level considered well-controlled based on current U.S. treatment guidelines) for mild, moderate, and classical PKU patients. There remains an unmet need for therapies to control Phe concentrations.
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Affiliation(s)
- Harvey Levy
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Vera Anastosoaie
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | - Jennifer L Baker
- Division Medical Genetics, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin DiBona
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Hawthorne
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | - Jessica Lindenberger
- Division Medical Genetics, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Mark McIlduff
- Boston Biomedical Associates, LLC, Marlborough, MA, USA
| | | | - Jerry Vockley
- Division Medical Genetics, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
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Vardy ERLC, MacDonald A, Ford S, Hofman DL. Phenylketonuria, co-morbidity, and ageing: A review. J Inherit Metab Dis 2020; 43:167-178. [PMID: 31675115 DOI: 10.1002/jimd.12186] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 12/17/2022]
Abstract
Phenylketonuria (PKU) is a metabolic condition which, left untreated, results in severe and irreversible brain damage. Newborn screening and the development of the low phenylalanine (Phe) diet have transformed the outcomes for people with PKU. Those who have benefited from early treatment are now approaching their fifth and sixth decade. It is therefore timely to consider multi-morbidity in PKU and the effects of ageing, in parallel with the wider benefits of emerging treatment options in addition to dietary relaxation. We have conducted the first literature review of co-morbidity and ageing in the context of PKU. Avenues explored have emerged from limited study of multi-morbidity to date and the knowledge and critical enquiry of the authors. Findings suggest PKU to have a wider impact than brain development, and result in several intriguing questions that require investigation to attain the best outcomes for people with PKU in adulthood moving through to older age. We recognise the difficulty in studying longitudinal outcomes in rare diseases and emphasise the necessity to develop PKU registries and cohorts that facilitate well-designed studies to answer some of the questions raised in this review. Whilst awaiting new information in these areas we propose that clinicians engage with patients to make personalised and well-informed decisions around Phe control and assessment for co-morbidity.
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Affiliation(s)
- Emma R L C Vardy
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust, Salford Care Organisation, Part of Northern Care Alliance NHS Group, Salford, UK
| | - Anita MacDonald
- Department of dietetics, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Suzanne Ford
- National Society for Phenylketonuria, Preston, UK
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Moat SJ, Schulenburg-Brand D, Lemonde H, Bonham JR, Weykamp CW, Mei JV, Shortland GS, Carling RS. Performance of laboratory tests used to measure blood phenylalanine for the monitoring of patients with phenylketonuria. J Inherit Metab Dis 2020; 43:179-188. [PMID: 31433494 PMCID: PMC7957320 DOI: 10.1002/jimd.12163] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 01/16/2023]
Abstract
Analysis of blood phenylalanine is central to the monitoring of patients with phenylketonuria (PKU) and age-related phenylalanine target treatment-ranges (0-12 years; 120-360 μmol/L, and >12 years; 120-600 μmol/L) are recommended in order to prevent adverse neurological outcomes. These target treatment-ranges are based upon plasma phenylalanine concentrations. However, patients are routinely monitored using dried bloodspot (DBS) specimens due to the convenience of collection. Significant differences exist between phenylalanine concentrations in plasma and DBS, with phenylalanine concentrations in DBS specimens analyzed by flow-injection analysis tandem mass spectrometry reported to be 18% to 28% lower than paired plasma concentrations analyzed using ion-exchange chromatography. DBS specimens with phenylalanine concentrations of 360 and 600 μmol/L, at the critical upper-target treatment-range thresholds would be plasma equivalents of 461 and 768 μmol/L, respectively, when a reported difference of 28% is taken into account. Furthermore, analytical test imprecision and bias in conjunction with pre-analytical factors such as volume and quality of blood applied to filter paper collection devices to produce DBS specimens affect the final test results. Reporting of inaccurate patient results when comparing DBS results to target treatment-ranges based on plasma concentrations, together with inter-laboratory imprecision could have a significant impact on patient management resulting in inappropriate dietary change and potentially adverse patient outcomes. This review is intended to provide perspective on the issues related to the measurement of phenylalanine in blood specimens and to provide direction for the future needs of PKU patients to ensure reliable monitoring of metabolic control using the target treatment-ranges.
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Affiliation(s)
- Stuart J. Moat
- Department of Medical Biochemistry, Immunology & Toxicology, University Hospital Wales, Cardiff, UK
- School of Medicine, Cardiff University, University Hospital Wales, Cardiff, UK
| | - Danja Schulenburg-Brand
- Department of Medical Biochemistry, Immunology & Toxicology, University Hospital Wales, Cardiff, UK
| | - Hugh Lemonde
- Paediatric Metabolic Medicine, Evelina Children’s Hospital, Guys & St Thomas’ NHSFT, London, UK
| | - James R. Bonham
- Department of Clinical Chemistry, Sheffield Children’s (NHS) FT, Sheffield, UK
| | - Cas W. Weykamp
- MCA Laboratory, Queen Beatrix Hospital, Winterswijk, The Netherlands
| | - Joanne V. Mei
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Rachel S. Carling
- Biochemical Sciences, Viapath, Guys & St Thomas’ NHSFT, London, UK
- GKT School of Medical Education, King’s College, London, UK
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47
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van Wegberg AMJ, Evers RAF, van Dam E, de Vries MC, Janssen MCH, Heiner-Fokkema MR, van Spronsen FJ. Does the 48-hour BH4 loading test miss responsive PKU patients? Mol Genet Metab 2020; 129:186-192. [PMID: 31924462 DOI: 10.1016/j.ymgme.2019.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/13/2019] [Accepted: 12/22/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Phenylketonuria (PKU) is an inborn error of phenylalanine (Phe) metabolism. Besides dietary treatment, some patients are responsive to and treated with tetrahydrobiopterin (BH4). Our primary objective was to examine whether the 48-hour BH4 loading test misses BH4-responsive PKU patients. Secondary, we assessed if it would be beneficial to 1) use a cut-off value of 20% Phe reduction instead of commonly used 30%, and 2) extend the loading test to 7 days. METHODS 24 patients with a 20-30% decrease of blood Phe levels during their initial 48-hour BH4 loading test or at least one mutation associated with long-term BH4 responsiveness, were invited to participate. 22 of them underwent the 7-day BH4 loading test. During the BH4 loading test, BH4 was administered orally once daily for 7 days (20 mg/kg/day). Blood samples on filter paper were collected at 13 time points. Potential BH4 responders (≥20% decrease in blood Phe concentrations at ≥1 moment within the first 48 h or ≥30% at ≥1 moment during the entire test) underwent a treatment trial to assess true long-term responsiveness (≥30% decrease of Phe levels compared to baseline and/or ≥50% increase in natural protein tolerance in accordance with the Dutch guidelines before 2017). The duration of the treatment trial varied from 2 to 18 months. RESULTS Of the 22 patients who completed the 7-day BH4 loading test, 2 were excluded, 8 had negative tests and 12 were considered to be potential BH4 responders. Of these 12 potential BH4-responsive PKU patients, 5 turned out to be false positive, 6 true-responder and 1 was withdrawn. CONCLUSION Even though the 48-hour BH4 loading test has proven its efficacy in the past, a full week may be necessary to detect all responders. So, if blood Phe concentrations during the 48-hour BH4 test shows a clear tendency, but not sufficient decrease, a full week (with only measurements each 24 h) could be offered. A threshold of ≥20% decrease within 48 h is not useful for predicting true BH4 responsiveness.
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Affiliation(s)
- Annemiek M J van Wegberg
- Department of Metabolic Diseases, Beatrix Children's Hospital, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Roeland A F Evers
- Department of Metabolic Diseases, Beatrix Children's Hospital, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Esther van Dam
- Department of Metabolic Diseases, Beatrix Children's Hospital, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Maaike C de Vries
- Department of Paediatrics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mirian C H Janssen
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M Rebecca Heiner-Fokkema
- Department of Laboratory Medicine, Laboratory of Metabolic Diseases, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Francjan J van Spronsen
- Department of Metabolic Diseases, Beatrix Children's Hospital, University of Groningen, University Medical Centre Groningen, the Netherlands.
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Evers RAF, van Vliet D, van Spronsen FJ. Tetrahydrobiopterin treatment in phenylketonuria: A repurposing approach. J Inherit Metab Dis 2020; 43:189-199. [PMID: 31373030 DOI: 10.1002/jimd.12151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/01/2019] [Accepted: 07/04/2019] [Indexed: 12/24/2022]
Abstract
In phenylketonuria (PKU) patients, early diagnosis by neonatal screening and immediate institution of a phenylalanine-restricted diet can prevent severe intellectual impairment. Nevertheless, outcome remains suboptimal in some patients asking for additional treatment strategies. Tetrahydrobiopterin (BH4 ) could be one of those treatment options, as it may not only increase residual phenylalanine hydroxylase activity in BH4 -responsive PKU patients, but possibly also directly improves neurocognitive functioning in both BH4 -responsive and BH4 -unresponsive PKU patients. In the present review, we aim to further define the theoretical working mechanisms by which BH4 might directly influence neurocognitive functioning in PKU having passed the blood-brain barrier. Further research should investigate which of these mechanisms are actually involved, and should contribute to the development of an optimal BH4 treatment regimen to directly improve neurocognitive functioning in PKU. Such possible repurposing approach of BH4 treatment in PKU may improve neuropsychological outcome and mental health in both BH4 -responsive and BH4 -unresponsive PKU patients.
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Affiliation(s)
- Roeland A F Evers
- Division of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Danique van Vliet
- Division of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Francjan J van Spronsen
- Division of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
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Ennis MA, Rasmussen BF, Lim K, Ball RO, Pencharz PB, Courtney-Martin G, Elango R. Dietary phenylalanine requirements during early and late gestation in healthy pregnant women. Am J Clin Nutr 2020; 111:351-359. [PMID: 31758682 PMCID: PMC6997087 DOI: 10.1093/ajcn/nqz288] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 10/28/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Phenylalanine is an indispensable amino acid and, via tyrosine, is the precursor for the neurotransmitters dopamine, norepinephrine, and epinephrine. Currently, dietary requirements for phenylalanine during pregnancy are unknown. OBJECTIVES This study's aim was to determine phenylalanine requirements (in the presence of excess tyrosine) during early and late gestation using direct amino acid oxidation (DAAO; with l-[1-13C]phenylalanine) and indicator amino acid oxidation (IAAO; with l-[1-13C]leucine). METHODS Twenty-three healthy women (age: 30.4 ± 3.1 y, mean ± SD) were studied at a range of phenylalanine intakes (5.5-30.5 mg · kg-1 · d-1 in early and late pregnancy using DAAO, and 2.5-30.5 mg · kg-1 · d-1 in late pregnancy using IAAO) for a total of 76 study days. Test intakes were provided as 8 isocaloric and isonitrogenous meals with 1.5 g · kg-1 · d-1 protein and energy at 1.7 times the measured resting energy expenditure. Breath samples were analyzed on an isotope ratio mass spectrometer for 13C enrichment. Phenylalanine requirement was determined using a 2-phase linear regression crossover model to identify a breakpoint in 13CO2 production (representing the mean requirement) in response to phenylalanine intakes. RESULTS Phenylalanine requirement during early pregnancy was determined to be 15 mg · kg-1 · d-1 (95% CI: 10.4, 19.9 mg · kg-1 · d-1); during late pregnancy, it was determined to be 21 mg · kg-1 · d-1 by DAAO (95% CI: 17.4, 24.7 mg · kg-1 · d-1) and IAAO (95% CI: 10.5, 32.2 mg · kg-1 · d-1). CONCLUSIONS Our results suggest a higher requirement (40%) for phenylalanine during late pregnancy than during early pregnancy. Moreover, the early pregnancy requirements are higher than the previous adult male requirement (9.1 mg · kg-1 · d-1; 95% CI: 4.6, 13.6 mg · kg-1 · d-1), although the 95% CIs overlap. Both DAAO and IAAO methods provided similar breakpoints in late pregnancy, showing that the DAAO method was appropriate even though low phenylalanine intakes could not be tested. These results have potential implications for gestation stage-specific dietary phenylalanine recommendations in future.This trial was registered at clinicaltrials.gov as NCT02669381.
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Affiliation(s)
- Madeleine A Ennis
- BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Betina F Rasmussen
- BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Lim
- BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, BC Women's Hospital, Vancouver, British Columbia, Canada
| | - Ronald O Ball
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Paul B Pencharz
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Glenda Courtney-Martin
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Faculty of Kinesiology, University of Toronto, Toronto, Ontario, Canada
| | - Rajavel Elango
- BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Address correspondence to RE (e-mail: )
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50
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Cheung KM, Yang KA, Nakatsuka N, Zhao C, Ye M, Jung ME, Yang H, Weiss PS, Stojanović MN, Andrews AM. Phenylalanine Monitoring via Aptamer-Field-Effect Transistor Sensors. ACS Sens 2019; 4:3308-3317. [PMID: 31631652 PMCID: PMC6957227 DOI: 10.1021/acssensors.9b01963] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Determination of the amino acid phenylalanine is important for lifelong disease management in patients with phenylketonuria, a genetic disorder in which phenylalanine accumulates and persists at levels that alter brain development and cause permanent neurological damage and cognitive dysfunction. Recent approaches for treating phenylketonuria focus on injectable medications that efficiently break down phenylalanine but sometimes result in detrimentally low phenylalanine levels. We have identified new DNA aptamers for phenylalanine in two formats, initially as fluorescent sensors and then, incorporated with field-effect transistors (FETs). Aptamer-FET sensors detected phenylalanine over a wide range of concentrations (fM to mM). para-Chlorophenylalanine, which inhibits the enzyme that converts phenylalanine to tyrosine, was used to induce hyperphenylalaninemia during brain development in mice. Aptamer-FET sensors were specific for phenylalanine versus para-chlorophenylalanine and differentiated changes in mouse serum phenylalanine at levels expected in patients. Aptamer-FETs can be used to investigate models of hyperphenylalanemia in the presence of structurally related enzyme inhibitors, as well as naturally occurring amino acids. Nucleic acid-based receptors that discriminate phenylalanine analogs, some that differ by a single substituent, indicate a refined ability to identify aptamers with binding pockets tailored for high affinity and specificity. Aptamers of this type integrated into FETs enable rapid, electronic, label-free phenylalanine sensing.
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Affiliation(s)
- Kevin M. Cheung
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Kyung-Ae Yang
- Department of Medicine, Columbia University, New York, New York 10032, United States
| | - Nako Nakatsuka
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Chuanzhen Zhao
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Mao Ye
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Michael E. Jung
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Hongyan Yang
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, and Hatos Center for Neuropharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Paul S. Weiss
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
- Departments of Bioengineering and Materials Science and Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Milan N. Stojanović
- Department of Medicine, Columbia University, New York, New York 10032, United States
- Departments of Biomedical Engineering and Systems Biology, Columbia University, New York, New York 10032, United States
| | - Anne M Andrews
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, and Hatos Center for Neuropharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
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