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Bouchereau J, Leduc-Leballeur J, Pichard S, Imbard A, Benoist JF, Abi Warde MT, Arnoux JB, Barbier V, Brassier A, Broué P, Cano A, Chabrol B, Damon G, Gay C, Guillain I, Habarou F, Lamireau D, Ottolenghi C, Paermentier L, Sabourdy F, Touati G, Ogier de Baulny H, de Lonlay P, Schiff M. Neurocognitive profiles in MSUD school-age patients. J Inherit Metab Dis 2017; 40:377-383. [PMID: 28324240 DOI: 10.1007/s10545-017-0033-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/22/2017] [Accepted: 02/26/2017] [Indexed: 01/07/2023]
Abstract
Maple syrup urine disease (MSUD), an inborn error of amino acids catabolism is characterized by accumulation of branched chain amino acids (BCAAs) leucine, isoleucine, valine and their corresponding alpha-ketoacids. Impact on the cognitive development has been reported historically, with developmental delays of varying degree. Currently, earlier diagnosis and improved management allow a better neurodevelopment, without requirement of special education. However, specific impairments can be observed, and so far, results of detailed neurocognitive assessments are not available. The aim of this study was to analyse neurocognitive profiles of French MSUD patients. This was a multicentre retrospective study on MSUD patients who underwent neurocognitive evaluation at primary school age. Twenty-one patients with classical neonatal onset MSUD were included. The patients' mean age at the time of evaluation was 8.7 years. The mean intellectual quotient (IQ) score was in the normal range (95.1 ± 12.6). In a subset of eight patients, a consistent developmental pattern of higher verbal than performance IQ was observed (mean of the difference 25.7 ± 8.7, p < 0.0001). No correlation could be established between this pattern and long-term metabolic balance (BCAA blood levels), or severity of acute metabolic imbalances, or leucine blood levels at diagnosis and time to toxin removal procedure. These data show that some MSUD patients may exhibit an abnormal neurocognitive profile with higher verbal than performance abilities. This might suggest an executive dysfunction disorder that would need to be further investigated by specialized testing. This pattern is important to detect in MSUD, as appropriate neuropsychological treatment strategies should be proposed.
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Affiliation(s)
- Juliette Bouchereau
- Reference Centre for Inborn Errors of Metabolism, Robert Debré University Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France
| | - Julie Leduc-Leballeur
- Reference Centre for Inborn Errors of Metabolism, Robert Debré University Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France
| | - Samia Pichard
- Reference Centre for Inborn Errors of Metabolism, Robert Debré University Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France
| | - Apolline Imbard
- Biochemistry Department, Robert Debré University Hospital, APHP, Paris, France
- Robert Debré University Hospital, PROTECT, INSERM U1141, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-François Benoist
- Biochemistry Department, Robert Debré University Hospital, APHP, Paris, France
- Robert Debré University Hospital, PROTECT, INSERM U1141, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Marie-Thérèse Abi Warde
- Reference Centre for Inborn Errors of Metabolism, Necker University Hospital, APHP, Paris, France
| | - Jean-Baptiste Arnoux
- Reference Centre for Inborn Errors of Metabolism, Necker University Hospital, APHP, Paris, France
| | - Valérie Barbier
- Reference Centre for Inborn Errors of Metabolism, Necker University Hospital, APHP, Paris, France
| | - Anaïs Brassier
- Reference Centre for Inborn Errors of Metabolism, Necker University Hospital, APHP, Paris, France
| | - Pierre Broué
- Metabolic Disease Department, Children University Hospital, Toulouse, France
| | - Aline Cano
- Reference Centre for Inborn Errors of Metabolism, La Timone University Hospital, APHM, Marseille, France
| | - Brigitte Chabrol
- Reference Centre for Inborn Errors of Metabolism, La Timone University Hospital, APHM, Marseille, France
| | - Gilles Damon
- Pediatrics Department, Hôpital Nord, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Claire Gay
- Pediatrics Department, Hôpital Nord, Saint-Etienne University Hospital, Saint-Etienne, France
| | | | - Florence Habarou
- Biochemistry Department, Necker University Hospital, APHP, Paris, France
- INSERM UMR-S 1124, University Paris Descartes, Paris, France
| | - Delphine Lamireau
- Pediatrics Department, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Chris Ottolenghi
- Biochemistry Department, Necker University Hospital, APHP, Paris, France
- INSERM UMR-S 1124, University Paris Descartes, Paris, France
| | - Laetitia Paermentier
- Reference Centre for Inborn Errors of Metabolism, La Timone University Hospital, APHM, Marseille, France
| | - Frédérique Sabourdy
- Biochemistry Department, Institut Fédératif de Biologie, Purpan University Hospital, Toulouse, France
- INSERM UMR1037, Toulouse III University, Toulouse, France
| | - Guy Touati
- Metabolic Disease Department, Children University Hospital, Toulouse, France
| | - Hélène Ogier de Baulny
- Reference Centre for Inborn Errors of Metabolism, Robert Debré University Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France
| | - Pascale de Lonlay
- Reference Centre for Inborn Errors of Metabolism, Necker University Hospital, APHP, Paris, France
- INSERM UMR-S 1124, University Paris Descartes, Paris, France
| | - Manuel Schiff
- Reference Centre for Inborn Errors of Metabolism, Robert Debré University Hospital, APHP, 48 boulevard Sérurier, 75019, Paris, France.
- Robert Debré University Hospital, PROTECT, INSERM U1141, University Paris Diderot, Sorbonne Paris Cité, Paris, France.
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Palermo L, Geberhiwot T, MacDonald A, Limback E, Hall SK, Romani C. Cognitive outcomes in early-treated adults with phenylketonuria (PKU): A comprehensive picture across domains. Neuropsychology 2017; 31:255-267. [PMID: 28080075 PMCID: PMC5328133 DOI: 10.1037/neu0000337] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Phenylketonuria (PKU) is an inherited metabolic disease which affects cognitive functions due to an inability to metabolize phenylalanine which leads to the accumulation of toxic by-products (Phe) in the brain. PKU can be effectively treated with a low phenylalanine diet, but some cognitive deficits remain. Studies have reported impairments, especially for processing speed and executive functions, but there is a lack of comprehensive assessment across cognitive domains. Moreover, it is important to establish outcomes in early treated adults with PKU (AwPKU) who have better metabolic control than groups previously reported in the literature. METHOD We tested 37 AwPKU with an unprecedented number of tasks (N = 28) and measures (N = 44) and compared results with 30 controls matched for age and education. RESULTS We found (a) group impairments, particularly in tasks tapping speed of processing and complex executive functions; (b) high variability across participants, with a sizable number of AwPKU with completely normal performance (about 38%); (c) but also a sizable number of participants who were clearly impaired (about 24%); and (d) good performance in tasks tapping verbal learning, verbal memory and orthographic processing, indicating no generalized learning impairment. CONCLUSION Our results indicate good outcomes, but also that deficits are still present with current treatment policies. (PsycINFO Database Record
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Affiliation(s)
- Liana Palermo
- School of Life and Health Sciences, Aston University
| | | | | | - Ellie Limback
- School of Life and Health Sciences, Aston University
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Yano S, Moseley K, Fu X, Azen C. Evaluation of Tetrahydrobiopterin Therapy with Large Neutral Amino Acid Supplementation in Phenylketonuria: Effects on Potential Peripheral Biomarkers, Melatonin and Dopamine, for Brain Monoamine Neurotransmitters. PLoS One 2016; 11:e0160892. [PMID: 27513937 PMCID: PMC4981358 DOI: 10.1371/journal.pone.0160892] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/26/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Phenylketonuria (PKU) is due to a defective hepatic enzyme, phenylalanine (Phe) hydroxylase. Transport of the precursor amino acids from blood into the brain for serotonin and dopamine synthesis is reported to be inhibited by high blood Phe concentrations. Deficiencies of serotonin and dopamine are involved in neurocognitive dysfunction in PKU. OBJECTIVE (1) To evaluate the effects of sapropterin (BH4) and concurrent use of large neutral amino acids (LNAA) on the peripheral biomarkers, melatonin and dopamine with the hypothesis they reflect brain serotonin and dopamine metabolism. (2) To evaluate synergistic effects with BH4 and LNAA. (3) To determine the effects of blood Phe concentrations on the peripheral biomarkers concentrations. METHODS Nine adults with PKU completed our study consisting of four 4-week phases: (1) LNAA supplementation, (2) Washout, (3) BH4 therapy, and (4) LNAA with BH4 therapy. An overnight protocol measured plasma amino acids, serum melatonin, and 6-sulfatoxymelatonin and dopamine in first void urine after each phase. RESULTS (1) Three out of nine subjects responded to BH4. A significant increase of serum melatonin levels was observed in BH4 responders with decreased blood Phe concentration. No significant change in melatonin, dopamine or Phe levels was observed with BH4 in the subjects as a whole. (2) Synergistic effects with BH4 and LNAA were observed in serum melatonin in BH4 responders. (3) The relationship between serum melatonin and Phe showed a significant negative slope (p = 0.0005) with a trend toward differing slopes among individual subjects (p = 0.066). There was also a negative association overall between blood Phe and urine 6-sulfatoxymelatonin and dopamine (P = 0.040 and 0.047). CONCLUSION Blood Phe concentrations affected peripheral monoamine neurotransmitter biomarker concentrations differently in each individual with PKU. Melatonin levels increased with BH4 therapy only when blood Phe decreased. Monitoring peripheral neurotransmitter metabolites may assist in optimizing individualized treatment in PKU.
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Affiliation(s)
- Shoji Yano
- Genetics Division, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Kathryn Moseley
- Genetics Division, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Xiaowei Fu
- Department of Pathology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Colleen Azen
- Clinical and Translational Science Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
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Manti F, Nardecchia F, Chiarotti F, Carducci C, Carducci C, Leuzzi V. Psychiatric disorders in adolescent and young adult patients with phenylketonuria. Mol Genet Metab 2016; 117:12-8. [PMID: 26655635 DOI: 10.1016/j.ymgme.2015.11.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Psychiatric symptoms are a challenging aspect in adolescent and adult early treated phenylketonuric (ETPKU) patients. To assess the occurrence of psychiatric disorders we explored the presence of symptoms requiring intervention and further investigated the link between psychiatric disorders, the quality of biochemical control and cognitive functioning. PATIENTS AND METHODS Forty-six ETPKU patients (aged 12 to 44) and 30 age-matched healthy controls were subjected to cognitive and psychiatric assessment by means of self-report questionnaires and psychiatric interview. Psychiatric diagnoses, if detected, were made according to DSM-5 criteria. Concomitant IQ, historical and concurrent biochemical metabolic controls were included in the statistical analysis. RESULTS Twenty-five out of 46 ETPKUs showed clinical scores on at least one scale of the psychiatric assessment (7/30 in controls); anxiety and withdrawal were the most frequent self-reported symptoms. Seventeen patients (and no controls) met criteria for a psychiatric diagnosis, most of them belonging to the Anxiety Disorders category. The occurrence of psychiatric symptoms was not associated with the life-long and concurrent quality of metabolic control but patients with good metabolic control (≤ 500 μM) in the first 11 years of life showed higher frequency of psychiatric diagnosis (Fisher's exact p=.0300). DISCUSSION/CONCLUSION ETPKUs show a higher than normal vulnerability to psychiatric disorders, which cannot be explained by the usual biochemical alterations influencing intellectual outcome. Our data support the hypothesis that the burden of the disease acts as psychological stress for children and their families. Possible involvement of neuromediators in the pathogenesis of these complex symptoms requires further investigation.
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Affiliation(s)
- Filippo Manti
- Department of Child and Adolescent Neuropsychiatry, SAPIENZA University of Rome, Via dei Sabelli 108, 00185 Rome, Italy.
| | - Francesca Nardecchia
- Department of Child and Adolescent Neuropsychiatry, SAPIENZA University of Rome, Via dei Sabelli 108, 00185 Rome, Italy; Department of Physiology and Pharmacology, SAPIENZA University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Flavia Chiarotti
- Istituto Superiore di Sanità, Department of Cell Biology and Neuroscience, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Claudia Carducci
- Department of Experimental Medicine, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Roma, Italy.
| | - Carla Carducci
- Department of Experimental Medicine, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
| | - Vincenzo Leuzzi
- Department of Child and Adolescent Neuropsychiatry, SAPIENZA University of Rome, Via dei Sabelli 108, 00185 Rome, Italy.
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Mastrangelo M, Chiarotti F, Berillo L, Caputi C, Carducci C, Di Biasi C, Manti F, Nardecchia F, Leuzzi V. The outcome of white matter abnormalities in early treated phenylketonuric patients: A retrospective longitudinal long-term study. Mol Genet Metab 2015; 116:171-7. [PMID: 26283467 DOI: 10.1016/j.ymgme.2015.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pathogenesis and clinical consequences of white matter abnormalities on magnetic resonance imaging (MRI) in phenylketonuric (PKU) patients are incompletely known. OBJECTIVE To study white matter alterations progression and outcome and its relationships with phenylalanine levels and intelligence quotient (IQ) in early treated PKU subjects who underwent serial MRIs during a prolonged follow-up. METHODS 47 early treated PKU patients (mean age 25.1 ± 5.6 years; range 12-37 years) have been enrolled when two or more consecutive brain MRIs, a complete biochemical history, and MRI-concurrent blood phenylalanine levels were available. The severity and extension of white matter abnormalities were expressed in a computed score. Consecutive IQ assessments were available in 24 patients. We analyzed intra- and interindividual white matter alterations variations and their relationship with quality of biochemical control and cognitive outcome. RESULTS Early treated PKU patients showed a high rate of white matter alterations with a relevant increase in frequency/severity from the second decade of life onwards. Age and quality of dietary control before or between subsequent examinations showed an independent cumulative effect on white matter alterations outcome. No significant association was found between white matter alterations and cognitive outcome. A remarkable interindividual variability was found and several patients disclosed incongruity between the trajectory of white matter alterations and biochemical control. About 30% of white matter alterations variability remains unexplained by the disease-associated determinants. CONCLUSIONS The evolution of white matter alterations is not significantly affected by intellectual outcome and is affected by aging, chronic exposure to phenylalanine, and unknown individual factors.
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Affiliation(s)
- Mario Mastrangelo
- Department of Paediatrics, Child Neurology and Psychiatry, Sapienza University of Rome.
| | - Flavia Chiarotti
- Section of NeuroToxicology and Neuroendocrinology, Department of Cell Biology and Neuroscience, National Institute of Health, Rome.
| | - Luana Berillo
- Department of Paediatrics, Child Neurology and Psychiatry, Sapienza University of Rome.
| | - Caterina Caputi
- Department of Paediatrics, Child Neurology and Psychiatry, Sapienza University of Rome.
| | - Claudia Carducci
- Department of Experimental Medicine, "Sapienza University of Rome".
| | - Claudio Di Biasi
- Department of Emergency Radiology, "Sapienza University of Rome"
| | - Filippo Manti
- Department of Paediatrics, Child Neurology and Psychiatry, Sapienza University of Rome.
| | - Francesca Nardecchia
- Department of Paediatrics, Child Neurology and Psychiatry, Sapienza University of Rome; Department of Physiology and Pharmacology, "Sapienza University of Rome".
| | - Vincenzo Leuzzi
- Department of Paediatrics, Child Neurology and Psychiatry, Sapienza University of Rome.
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