351
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Ney DM, Etzel MR. Designing medical foods for inherited metabolic disorders: why intact protein is superior to amino acids. Curr Opin Biotechnol 2017; 44:39-45. [DOI: 10.1016/j.copbio.2016.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/22/2016] [Indexed: 01/22/2023]
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352
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Mihali C, Petrescu M, Mândruţiu I, Bechet D, Nistor T, Turcuş V, Ardelean A, Benga G. COMPARISON OF PLASMA PHENYLALANINE DETERMINATION BY DENSITOMETRY OF THIN-LAYER CHROMATOGRAMS AND BY HIGH PERFORMANCE LIQUID CHROMATOGRAPHY IN RELATION WITH THE SCREENING OF PHENYLKETONURIA. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2017; 13:203-208. [PMID: 31149174 PMCID: PMC6516440 DOI: 10.4183/aeb.2017.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare two chromatographic methodologies for determination of plasma phenylalanine (Phe) and their usefulness for diagnosing hyperphenylalaninemia (HPA) and phenylketonuria (PKU). METHODS The plasma amino acids were isolated and concentrated from blood collected from infants with HPA detected by newborn screening. The plasma Phe was determined in parallel by HPLC and by image-densitometry of 2D-TLC plates. RESULTS Typical examples of 2D-TLC plates and HPLC chromatograms from infants with HPA and PKU are presented and evaluated. The Phe spot was visible on 2D - TLC plates at Phe concentrations higher than 300 µmol/L. The standard calibration curve traced after image-densitometry of the Phe spot presented high dispersion of values at each concentration of Phe, high SD values, the equation of the curve having a low R-squared value (0.862). In contrast, the standard calibration curve obtained by HPLC shows linearity on the range of concentrations from 100 - 16,000 µmol/L, extremely small SD values, the equation of the curve has a very high R-squared value (0.999). CONCLUSIONS The HPLC methodology is appropriate to confirm HPA detected by newborn or selective screening of PKU. The 2D - TLC methodology is adequate to detect patients with severe PKU.
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Affiliation(s)
- C.V. Mihali
- “Vasile Goldiş” Western University of Arad - Institute of Life Sciences, Arad, Romania
| | - M.C. Petrescu
- “Vasile Goldiş” Western University of Arad - Institute of Life Sciences, Arad, Romania
| | - I. Mândruţiu
- Cluj County Clinical Emergency Hospital - Laboratory of Genetic Explorations, Cluj-Napoca, Romania
| | - D. Bechet
- Cluj County Clinical Emergency Hospital - Laboratory of Genetic Explorations, Cluj-Napoca, Romania
| | - T.V. Nistor
- “Iuliu Haţieganu” University of Medicine and Pharmacy of Cluj-Napoca - Discipline of Biochemistry, Cluj-Napoca, Romania
| | - V. Turcuş
- “Vasile Goldiş” Western University of Arad - Institute of Life Sciences, Arad, Romania
| | - A. Ardelean
- “Vasile Goldiş” Western University of Arad - Institute of Life Sciences, Arad, Romania
| | - Gh. Benga
- “Vasile Goldiş” Western University of Arad - Institute of Life Sciences, Arad, Romania
- Cluj County Clinical Emergency Hospital - Laboratory of Genetic Explorations, Cluj-Napoca, Romania
- Romanian Academy - Cluj-Napoca Branch, Cluj-Napoca, Romania
- Academy of Medical Sciences of Romania - Cluj-Napoca Branch, Cluj-Napoca, Romania
- The Gheorghe Benga Foundation, Cluj-Napoca, Romania
- The OUTNOBEL Foundation, Cluj-Napoca, Romania
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353
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Jurecki E, Cunningham A, Birardi V, Gagol G, Acquadro C. Development of the US English version of the phenylketonuria - quality of life (PKU-QOL) questionnaire. Health Qual Life Outcomes 2017; 15:46. [PMID: 28274259 PMCID: PMC5343404 DOI: 10.1186/s12955-017-0620-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/23/2017] [Indexed: 11/22/2022] Open
Abstract
Background Phenylketonuria (PKU) is a rare genetic disorder caused by a defect in the metabolism of phenylalanine (PHE) resulting in elevated blood and brain PHE levels, and leading to cognitive, emotional, and psychosocial problems. The phenylketonuria – quality of life (PKU-QOL) questionnaire was the first self-administered disease-specific instrument developed to assess the impact of PKU and its treatment on the health-related quality of life (HRQL) of patients and their caregivers. Available in four versions (child, adolescent, adult and parent), the PKU-QOL was simultaneously developed and validated in seven countries [i.e., France, Germany, Italy, The Netherlands, Spain, Turkey and the United Kingdom (UK)]. The objectives of our study were to develop and linguistically validate the PKU-QOL questionnaire for use in the United States (US). Methods The UK versions served as a basis for the development of the US English PKU-QOL questionnaire. The linguistic validation process consisted of 4 steps: 1) adaptation of the UK versions into US English by a translator native of US English and living in the US; 2) a clinician review; 3) cognitive interviews with patients and caregivers to test the appropriateness, understandability and clarity of the US translations; and 4) two proof-readings. Results The adaptation from UK to US English revealed the usual syntactic and idiomatic differences between the two languages, such as differences in: 1) Spelling, e.g., “dietician” (UK) vs. “dietitian” (US), or “mum” (UK) vs. “mom” (US); 2) Syntax or punctuation; and 3) Words/expressions use, e.g., “holidays” (UK) vs. “vacation” (US), or “biscuits” (UK) vs. “crackers” (US). The major issue was cultural, and consisted of using a different terminology to describe PKU treatment throughout the questionnaires. The clinician, with the patients and the caregivers, during the interviews suggested to replace “supplement and amino-acid mixture” or “supplements” with “medical formula.” This wording was later changed to “medical food” to be consistent with the terminology used in current US published guidelines. Conclusions The translation of the UK English PKU-QOL questionnaire into US English did not raise critical semantic and cultural issues. The PKU-QOL will be valuable for US healthcare providers in individualizing treatment and managing patients with PKU.
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Affiliation(s)
- Elaina Jurecki
- BioMarin Pharmaceutical Inc., 770 Lindaro Street, San Rafael, 94901, CA, USA
| | - Amy Cunningham
- Hayward Genetics Center SL-31, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, 70112, LA, USA
| | - Vanessa Birardi
- BioMarin Pharmaceutical Inc., 770 Lindaro Street, San Rafael, 94901, CA, USA
| | - Grégory Gagol
- Mapi Language Services, 27 rue de la Villette, Lyon, 69003, France
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354
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Landau YE, Waisbren SE, Chan LMA, Levy HL. Long-term outcome of expanded newborn screening at Boston children's hospital: benefits and challenges in defining true disease. J Inherit Metab Dis 2017; 40:209-218. [PMID: 28054209 DOI: 10.1007/s10545-016-0004-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION There is no universal consensus of the disorders included in newborn screening programs. Few studies so far, mostly short-term, have compared the outcome of disorders detected by expanded newborn screening (ENBS) to the outcome of the same disorders detected clinically. METHODS We compared the clinical and neurodevelopmental outcomes in patients with metabolic disorders detected by ENBS, including biotinidase testing, with those detected clinically and followed at the Metabolism Clinic at Boston Children's Hospital. RESULTS One hundred eighty-nine patients came to attention from ENBS and 142 were clinically diagnosed. 3-methylcrotonyl-CoA carboxylase, biotinidase, and carnitine deficiencies were exclusively identified by ENBS and medium chain acyl-CoA dehydrogenase (MCADD) and very long chain acyl-CoA dehydrogenase deficiencies (VLCADD) were predominantly identified by ENBS whereas the organic acid disorders more often came to attention clinically. Only 2% of the ENBS-detected cases had clinically severe outcomes compared to 42% of those clinically detected. The mean IQ score was 103 + 17 for the ENBS-detected cases and 77 + 24 for those clinically detected. Those newly included disorders that seem to derive the greatest benefit from ENBS include the fatty acid oxidation disorders, profound biotinidase deficiency, tyrosinemia type 1, and perhaps carnitine deficiency. CONCLUSION Although the NBS-identified and clinically-identified cohorts were not completely comparable, this long-term study shows likely substantial improvement overall in the outcome of these metabolic disorders in the NBS infants. Infants with mild disorders and benign variants may represent a significant number of infants identified by ENBS. The future challenge will be to unequivocally differentiate the disorders most benefitting from ENBS and adjust programs accordingly.
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Affiliation(s)
- Yuval E Landau
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Genetics and Genomics, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, 1 Autumn Street, Rm 526.1, Boston, MA, 02115, USA
| | - Susan E Waisbren
- Division of Genetics and Genomics, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, 1 Autumn Street, Rm 526.1, Boston, MA, 02115, USA
| | - Lawrence M A Chan
- Division of Genetics and Genomics, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, 1 Autumn Street, Rm 526.1, Boston, MA, 02115, USA
| | - Harvey L Levy
- Division of Genetics and Genomics, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, 1 Autumn Street, Rm 526.1, Boston, MA, 02115, USA.
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355
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Jurecki ER, Cederbaum S, Kopesky J, Perry K, Rohr F, Sanchez-Valle A, Viau KS, Sheinin MY, Cohen-Pfeffer JL. Adherence to clinic recommendations among patients with phenylketonuria in the United States. Mol Genet Metab 2017; 120:190-197. [PMID: 28162992 DOI: 10.1016/j.ymgme.2017.01.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Assess current management practices of phenylketonuria (PKU) clinics across the United States (US) based on the key treatment metrics of blood phenylalanine (Phe) concentrations and blood Phe testing frequency, as well as patient adherence to their clinic's management practice recommendations. METHODS An online survey was conducted with medical professionals from PKU clinics across the US from July to September 2015. Forty-four clinics participated in the survey and account for approximately half of PKU patients currently followed in clinics in the US (Berry et al., 2013). RESULTS The majority of PKU clinics recommended target blood Phe concentrations to be between 120 and 360μM for all patients; the upper threshold was relaxed by some clinics for adult patients (from 360 to 600μM) and tightened for patients who are pregnant/planning to become pregnant (to 240μM). Patient adherence to these recommendations (percentage of patients with blood Phe below the upper recommended threshold) was age-dependent, decreasing from 88% in the 0-4years age group to 33% in adults 30+ years. Patient adherence to recommendations for blood testing frequency followed a similar trend. Higher staffing intensity (specialists per 100 PKU patients) was associated with better patient adherence to clinics' blood Phe concentrations recommendations. CONCLUSION Clinic recommendations of target blood Phe concentrations in the US are now stricter compared to prior years, and largely reflect recent guidelines by the American College of Medical Genetics and Genomics (Vockley et al., 2014). Adherence to recommended Phe concentrations remains suboptimal, especially in older patients. However, despite remaining above the guidelines, actual blood Phe concentrations in adolescents and adults are lower than those reported in the past (Walter et al., 2002; Freehauf et al., 2013). Continued education and support for PKU patients by healthcare professionals, including adequate clinic staffing, are needed to improve adherence. Future research is needed to understand how to improve adherence to reduce the number of patients lost to follow-up, as the findings of this and similar surveys do not address how to keep patients in clinic.
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Affiliation(s)
- E R Jurecki
- Medical Affairs, BioMarin Pharmaceutical, Inc., Novato, CA, United States.
| | - S Cederbaum
- Department of Psychiatry, University of California, Los Angeles, CA, United States; Department of Pediatrics, and Human Genetics, University of California, Los Angeles, CA, United States
| | - J Kopesky
- Department of Clinical Nutrition, Children's Hospital of Wisconsin, Milwaukee, WI, United States; Department of Genetics, Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | - K Perry
- Trinity Partners, Waltham, MA, United States
| | - F Rohr
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, United States
| | - A Sanchez-Valle
- Division of Genetics and Metabolism, University of South Florida, Florida, United States
| | - K S Viau
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT, United States
| | - M Y Sheinin
- Trinity Partners, Waltham, MA, United States
| | - J L Cohen-Pfeffer
- Medical Affairs, BioMarin Pharmaceutical, Inc., Novato, CA, United States
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356
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Castro G, Hamilton V, Cornejo V. Chilean Nutrition Management Protocol for Patients With Phenylketonuria. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2017. [DOI: 10.1177/2326409816689788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Gabriela Castro
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Valerie Hamilton
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Verónica Cornejo
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
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357
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Turki A, Ueda K, Cheng B, Giezen A, Salvarinova R, Stockler-Ipsiroglu S, Elango R. The Indicator Amino Acid Oxidation Method with the Use of l-[1-13C]Leucine Suggests a Higher than Currently Recommended Protein Requirement in Children with Phenylketonuria. J Nutr 2017; 147:211-217. [PMID: 28053173 DOI: 10.3945/jn.116.240218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/01/2016] [Accepted: 12/01/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Phenylketonuria is characterized by mutations in the Phe hydroxylase gene that leads to the accumulation of Phe in plasma and the brain. The standard of care for phenylketonuria is nutritional management with dietary restriction of Phe and the provision of sufficient protein and energy for growth and health maintenance. The protein requirement in children with phenylketonuria is empirically determined based upon phenylketonuria nutritional guidelines that are adjusted individually in response to biochemical markers and growth. OBJECTIVE We determined dietary protein requirements in children with phenylketonuria with the use of the indicator amino acid oxidation (IAAO) technique, with l-[1-13C]Leu as the indicator amino acid. METHODS Four children (2 males; 2 females) aged 9-18 y with phenylketonuria [mild hyperphenylalanemia (mHPA); 6-10 mg/dL (360-600 μmol/L)] were recruited to participate in ≥7 separate test protein intakes (range: 0.2-3.2 g ⋅ kg-1 ⋅ d-1) with the IAAO protocol with the use of l-[1-13C]Leu followed by the collection of breath and urine samples over 8 h. The diets were isocaloric and provided energy at 1.7 times the resting energy expenditure. Protein was provided as a crystalline amino acid mixture based on an egg protein pattern, except Phe and Leu, which were maintained at a constant across intakes. Protein requirement was determined with the use of a 2-phase linear-regression crossover analysis of the rate of l-[1-13C]Leu tracer oxidation. RESULTS The mean protein requirement was determined to be 1.85 g ⋅ kg-1 ⋅ d-1 (R2 = 0.66; 95% CI: 1.37, 2.33). This result is substantially higher than the 2014 phenylketonuria recommendations (1.14-1.33 g ⋅ kg-1 ⋅ d-1; based on 120-140% above the current RDA for age). CONCLUSIONS To our knowledge, this is the first study to directly define a quantitative requirement for protein intake in children with mHPA and indicates that current protein recommendations in children with phenylketonuria may be insufficient. This trial was registered at clinicaltrials.gov as NCT01965691.
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Affiliation(s)
- Abrar Turki
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics and
| | - Keiko Ueda
- Department of Pediatrics and.,Division of Biochemical Diseases, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Barbara Cheng
- Department of Pediatrics and.,Division of Biochemical Diseases, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Alette Giezen
- Department of Pediatrics and.,Division of Biochemical Diseases, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Ramona Salvarinova
- Department of Pediatrics and.,Division of Biochemical Diseases, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Sylvia Stockler-Ipsiroglu
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics and.,Division of Biochemical Diseases, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Rajavel Elango
- Department of Pediatrics and .,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; and.,Division of Biochemical Diseases, BC Children's Hospital, Vancouver, British Columbia, Canada
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358
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Spécola N, Chiesa A. Alternative Therapies for PKU. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2017. [DOI: 10.1177/2326409816685734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Norma Spécola
- Unidad de Metabolismo, Hospital de Niños de La Plata, Buenos Aires, Argentina
| | - Ana Chiesa
- División de Endocrinología. Hospital de Niños R, FEI, Gutiérrez, Buenos Aires, Argentina
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359
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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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360
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Yildiz Y, Dursun A, Tokatli A, Coskun T, Sivri S. Partial hydatidiform mole in a phenylketonuria patient treated with sapropterin dihydrochloride. Gynecol Endocrinol 2017; 33:19-20. [PMID: 27898272 DOI: 10.1080/09513590.2016.1247796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Strict control of hyperphenylalaninemia is necessary in pregnant women with phenylketonuria (PKU) in order to prevent phenylalanine embryopathy in the fetus, characterized by intrauterine growth restriction, dysmorphic facies, congenital heart disease, microcephaly and intellectual disability, collectively known as maternal PKU syndrome. Sapropterin dihydrochloride (SD), an alternative or adjunct to dietary therapy in patients with tetrahydrobiopterin (BH4)-responsive PKU, has recently been used in several cases to treat PKU during pregnancy with satisfactory results. Here, we report two pregnancies treated with SD and unrestricted diet in a patient with BH4-responsive mild PKU. The first pregnancy resulted in a partial hydatidiform mole and was terminated, whereas a healthy infant was born from the second pregnancy. Phenylalanine control was optimal in both pregnancies. To the best of our knowledge, this is the first report on the development of partial hydatidiform mole associated with SD treatment and the second report on molar pregnancy in PKU. While the relation between SD and molar pregnancy is unknown, further studies may be needed to investigate the possible effects of SD on fertilization.
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Affiliation(s)
- Yilmaz Yildiz
- a Division of Pediatric Metabolism , Department of Pediatrics, Faculty of Medicine, Hacettepe University , Ankara , Turkey
| | - Ali Dursun
- a Division of Pediatric Metabolism , Department of Pediatrics, Faculty of Medicine, Hacettepe University , Ankara , Turkey
| | - Aysegul Tokatli
- a Division of Pediatric Metabolism , Department of Pediatrics, Faculty of Medicine, Hacettepe University , Ankara , Turkey
| | - Turgay Coskun
- a Division of Pediatric Metabolism , Department of Pediatrics, Faculty of Medicine, Hacettepe University , Ankara , Turkey
| | - Serap Sivri
- a Division of Pediatric Metabolism , Department of Pediatrics, Faculty of Medicine, Hacettepe University , Ankara , Turkey
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361
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Cornejo V. Editorial Letter to Special Issue on Phenylketonuria. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2017. [DOI: 10.1177/2326409816689787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Verónica Cornejo
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Dr Fernando Monckeberg Barros, Universidad de Chile, Santiago, Chile
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362
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Bilder DA, Noel JK, Baker ER, Irish W, Chen Y, Merilainen MJ, Prasad S, Winslow BJ. Systematic Review and Meta-Analysis of Neuropsychiatric Symptoms and Executive Functioning in Adults With Phenylketonuria. Dev Neuropsychol 2016; 41:245-260. [PMID: 27805419 PMCID: PMC5152552 DOI: 10.1080/87565641.2016.1243109] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This systematic review and meta-analysis (MA) investigates the impact of elevated blood phenylalanine (Phe) on neuropsychiatric symptoms in adults with phenylketonuria (PKU). The meta-analysis of PKU is challenging because high-quality evidence is lacking due to the limited number of affected individuals and few placebo-controlled, double-blind studies of adults with high and low blood Phe. Neuropsychiatric symptoms associated with PKU exceed general population estimates for inattention, hyperactivity, depression, and anxiety. High Phe is associated with an increased prevalence of neuropsychiatric symptoms and executive functioning deficits whereas low Phe is associated with improved neurological performance. Findings support lifelong maintenance of low blood Phe.
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Affiliation(s)
- Deborah A Bilder
- a Department of Psychiatry , University of Utah , Salt Lake City , Utah
| | - J Kay Noel
- b CTI Clinical Trial and Consulting Services Inc ., Cincinnati , Ohio
| | - Erin R Baker
- b CTI Clinical Trial and Consulting Services Inc ., Cincinnati , Ohio
| | - William Irish
- b CTI Clinical Trial and Consulting Services Inc ., Cincinnati , Ohio
| | - Yinpu Chen
- c BioMarin Pharmaceutical Inc ., Novato , California
| | | | - Suyash Prasad
- d Audentes Therapeutics , San Francisco , California
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363
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Abstract
Cerebral neurotransmitter (NT) deficiency has been suggested as a contributing factor in the pathophysiology of brain dysfunction in phenylketonuria (PKU), even in early-treated phenylketonuric patients. The study aimed to review dopamine and serotonin status in PKU, and the effect of the impaired neurotransmission. Several mechanisms are involved in the pathophysiology of PKU, primarily characterized by impaired dopamine and serotonin synthesis. These deficits are related to executive dysfunctions and social-emotional problems, respectively, in early treated patients. Blood phenylalanine is the main biomarker for treatment compliance follow-up, but further investigations and validation of peripheral biomarkers may be performed to monitor NT status. The development of new therapies is needed not only for decreasing blood and brain phenylalanine levels but also to improve NT syntheses.
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364
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Isley L, Falk RE, Shamonki J, Sims CA, Callum P. Management of the risks for inherited disease in donor-conceived offspring. Fertil Steril 2016; 106:1479-1484. [DOI: 10.1016/j.fertnstert.2016.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 06/14/2016] [Accepted: 08/01/2016] [Indexed: 12/25/2022]
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365
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Sun H, Wang B, Wang J, Liu H, Liu J. Biomarker and pathway analyses of urine metabolomics in dairy cows when corn stover replaces alfalfa hay. J Anim Sci Biotechnol 2016; 7:49. [PMID: 27583137 PMCID: PMC5006375 DOI: 10.1186/s40104-016-0107-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/10/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alfalfa hay and corn stover are different type of forages which can significantly impact a cow's lactation performance, but the underlying metabolic mechanism has been poorly studied. We used biomarker and pathway analyses to characterize related biomarkers and pathways based on urine metabolomics data from different forage treatments. Urine was collected from 16 multiparous Holstein dairy cows fed alfalfa hay (AH, high-quality forage, n = 8) and corn stover (CS, low-quality forage, n = 8) respectively. Gas chromatography-time of flight/mass spectrometry (GC-TOF/MS) was performed to identify metabolites in urine and the metaboanalyst online platform was used to do biomarker and pathway analysis. RESULTS Hippuric acid (HUA) and N-methyl-glutamic (NML-Glu) indicated the most significant difference between the two diets, when statistically validated by biomarker analysis. HUA was also validated by standard compound quantitative method and showed significant higher concentration in CS group than AH group (2.8282 vs. 0.0005 mg/mL; P < 0.01). The significant negative correlation between milk yield and HUA (R(2) = 0.459; P < 0.01) and significant positive correlation between milk yield and NML-Glu (R(2) = 0.652; P < 0.01) were characterized. The pathway analysis revealed that these different metabolites were involved in 17 pathways including 7 influential pathways (pathway impact value > 0): Tyr metabolism, starch and sucrose metabolism, amino sugar and nucleotide sugar metabolism, galactose metabolism, Phe, Tyr and Try biosynthesis, purine metabolism, and glycerolipid metabolism. Based on the metabolome view map, the Phe, Tyr and Try biosynthesis pathway exhibited the highest impact value (0.50), and the Holm-Bonferroni multiple testing-based analysis revealed the most significant difference in the Tyr metabolism pathway (Holm P = 0.048). CONCLUSIONS The identified HUA and NML-Glu may serve as potential biomarkers for discriminating CS and AH diets and could be used as candidates for milk yield related mechanistic investigations. Integrated network pathways associated with related metabolites provide a helpful perspective for discovering the effectiveness of forage quality in lactation performance and provides novel insights into developing strategies for better utilization of CS and other low-quality forage in China.
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Affiliation(s)
- Huizeng Sun
- Institute of Dairy Science, MoE Key Laboratory of Molecular Animal Nutrition, College of Animal Sciences, Zhejiang University, Hangzhou, 310058 People's Republic of China
| | - Bing Wang
- Institute of Dairy Science, MoE Key Laboratory of Molecular Animal Nutrition, College of Animal Sciences, Zhejiang University, Hangzhou, 310058 People's Republic of China
| | - Jiakun Wang
- Institute of Dairy Science, MoE Key Laboratory of Molecular Animal Nutrition, College of Animal Sciences, Zhejiang University, Hangzhou, 310058 People's Republic of China
| | - Hongyun Liu
- Institute of Dairy Science, MoE Key Laboratory of Molecular Animal Nutrition, College of Animal Sciences, Zhejiang University, Hangzhou, 310058 People's Republic of China
| | - Jianxin Liu
- Institute of Dairy Science, MoE Key Laboratory of Molecular Animal Nutrition, College of Animal Sciences, Zhejiang University, Hangzhou, 310058 People's Republic of China
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366
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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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367
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Sampson J, Groshong M, Parilo DMW. What nurses need to know about PKU. Nursing 2016; 46:66-67. [PMID: 27438669 DOI: 10.1097/01.nurse.0000484979.82162.1e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Janice Sampson
- At the School of Nursing at California State University, Sacramento, Janice Sampson is an assistant professor, Megan Groshong is a recent graduate, and Denise M. Wall Parilo is a professor
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368
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Ney DM, Stroup BM, Clayton MK, Murali SG, Rice GM, Rohr F, Levy HL. Glycomacropeptide for nutritional management of phenylketonuria: a randomized, controlled, crossover trial. Am J Clin Nutr 2016; 104:334-45. [PMID: 27413125 PMCID: PMC4962165 DOI: 10.3945/ajcn.116.135293] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/10/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To prevent cognitive impairment, phenylketonuria requires lifelong management of blood phenylalanine (Phe) concentration with a low-Phe diet. The diet restricts intake of Phe from natural proteins in combination with traditional amino acid medical foods (AA-MFs) or glycomacropeptide medical foods (GMP-MFs) that contain primarily intact protein and a small amount of Phe. OBJECTIVE We investigated the efficacy and safety of a low-Phe diet combined with GMP-MFs or AA-MFs providing the same quantity of protein equivalents in free-living subjects with phenylketonuria. DESIGN This 2-stage, randomized crossover trial included 30 early-treated phenylketonuria subjects (aged 15-49 y), 20 with classical and 10 with variant phenylketonuria. Subjects consumed, in random order for 3 wk each, their usual low-Phe diet combined with AA-MFs or GMP-MFs. The treatments were separated by a 3-wk washout with AA-MFs. Fasting plasma amino acid profiles, blood Phe concentrations, food records, and neuropsychological tests were obtained. RESULTS The frequency of medical food intake was higher with GMP-MFs than with AA-MFs. Subjects rated GMP-MFs as more acceptable than AA-MFs and noted improved gastrointestinal symptoms and less hunger with GMP-MFs. ANCOVA indicated no significant mean ± SE increase in plasma Phe (62 ± 40 μmol/L, P = 0.136), despite a significant increase in Phe intake from GMP-MFs (88 ± 6 mg Phe/d, P = 0.026). AA-MFs decreased plasma Phe (-85 ± 40 μmol/L, P = 0.044) with stable Phe intake. Blood concentrations of Phe across time were not significantly different (AA-MFs = 444 ± 34 μmol/L, GMP-MFs = 497 ± 34 μmol/L), suggesting similar Phe control. Results of the Behavior Rating Inventory of Executive Function were not significantly different. CONCLUSIONS GMP-MFs provide a safe and acceptable option for the nutritional management of phenylketonuria. The greater acceptability and fewer side effects noted with GMP-MFs than with AA-MFs may enhance dietary adherence for individuals with phenylketonuria. This trial was registered at www.clinicaltrials.gov as NCT01428258.
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Affiliation(s)
| | | | - Murray K Clayton
- Statistics, and Plant Pathology, University of Wisconsin-Madison, Madison, WI
| | | | - Gregory M Rice
- Waisman Center and Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI; and
| | - Frances Rohr
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Harvey L Levy
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA
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369
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Conventional Phenylketonuria Treatment. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2016. [DOI: 10.1177/2326409816685733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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370
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Singh RH, Cunningham AC, Mofidi S, Douglas TD, Frazier DM, Hook DG, Jeffers L, McCune H, Moseley KD, Ogata B, Pendyal S, Skrabal J, Splett PL, Stembridge A, Wessel A, Rohr F. Updated, web-based nutrition management guideline for PKU: An evidence and consensus based approach. Mol Genet Metab 2016; 118:72-83. [PMID: 27211276 DOI: 10.1016/j.ymgme.2016.04.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND In 2014, recommendations for the nutrition management of phenylalanine hydroxylase deficiency were published as a companion to the concurrently published American College of Medical Genetics and Genomics guideline for the medical treatment of phenylketonuria (PKU). These were developed primarily from a summary of findings from the PKU scientific review conference sponsored by the National Institutes of Health and Agency for Healthcare Research & Quality along with additional systematic literature review. Since that time, the Genetic Metabolic Dietitians International and the Southeast Regional Newborn Screening and Genetics Collaborative have partnered to create a web-based technology platform for the update and development of nutrition management guidelines for inherited metabolic disorders. OBJECTIVE The purpose of this PKU guideline is to establish harmonization in treatment and monitoring, to guide the integration of nutrition therapy in the medical management of PKU, and to improve outcomes (nutritional, cognitive, and developmental) for individuals with PKU in all life stages while reducing associated medical, educational, and social costs. METHODS Six research questions critical to PKU nutrition management were formulated to support guideline development: Review, critical appraisal, and abstraction of peer-reviewed studies and unpublished practice literature, along with expert Delphi survey feedback, nominal group process, and external review from metabolic physicians and dietitians were utilized for development of recommendations relevant to each question. Recommendations address nutrient intake, including updated protein requirements, optimal blood phenylalanine concentrations, nutrition interventions, monitoring parameters specific to life stages, adjunct therapies, and pregnancy and lactation. Recommendations were graded using a rigorous system derived from the Academy of Nutrition and Dietetics. RESULTS AND CONCLUSION These guidelines, updated utilizing a thorough and systematic approach to literature analysis and national consensus process, are now easily accessible to the global community via the newly developed digital platform. For additional details on specific topics, readers are encouraged to review materials on the online portal: https://GMDI.org/.
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Affiliation(s)
- Rani H Singh
- Department of Human Genetics, Emory University School of Medicine, 2165 North Decatur Road, Decatur, Atlanta, GA 30033, USA; Nutrition Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University School of Arts and Sciences, Atlanta, GA, USA.
| | - Amy C Cunningham
- Hayward Genetics Center, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA 70112, USA.
| | - Shideh Mofidi
- Inherited Metabolic Disease Center, Maria Fareri Childrens Hospital, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
| | - Teresa D Douglas
- Department of Human Genetics, Emory University School of Medicine, 2165 North Decatur Road, Decatur, Atlanta, GA 30033, USA.
| | - Dianne M Frazier
- Division of Genetics and Metabolism, University of North Carolina School of Medicine, 1100 Manning Drive, Chapel Hill, NC 27599, USA.
| | | | - Laura Jeffers
- Cleveland Clinic, Center for Human Nutrition, 9500 Euclid Ave, Cleveland, OH 44195, USA.
| | - Helen McCune
- Pediatric Genetics and Metabolism, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32607, USA.
| | - Kathryn D Moseley
- Genetics Division, USC/Keck School of Medicine, 1801 Marengo St. Rm. 1G-24, Los Angeles, CA 90033, USA.
| | - Beth Ogata
- University of Washington, Department of Pediatrics, UW-CHDD, Box 357920, Seattle, WA 98195, USA.
| | - Surekha Pendyal
- Division of Genetics and Metabolism, University of North Carolina School of Medicine, 1100 Manning Drive, Chapel Hill, NC 27599, USA.
| | - Jill Skrabal
- Department of Medical Genetics, University of Nebraska Medical Center/Children's Hospital and Medical Center, 981200 Nebraska Medical Center, Omaha, NE. 68198-1200, USA.
| | - Patricia L Splett
- Evaluation Consultant Splett & Associates, LLC, 399 Badger Blvd W., Stanchfield, MN 55080, USA.
| | - Adrya Stembridge
- Department of Human Genetics, Emory University School of Medicine, 2165 North Decatur Road, Decatur, Atlanta, GA 30033, USA.
| | - Ann Wessel
- Division of Genetics and Genomics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Frances Rohr
- Division of Genetics and Genomics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
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371
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Tavana S, Amini S, Hakhamaneshi MS, Andalibi P, Hajir MS, Ardalan A, Abdi M, Fathollahpour A. Prooxidant-antioxidant balance in patients with phenylketonuria and its correlation to biochemical and hematological parameters. J Pediatr Endocrinol Metab 2016; 29:675-80. [PMID: 27008692 DOI: 10.1515/jpem-2015-0398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/22/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The balance between reactive oxygen species production and antioxidant activity has an important role in oxidative stress associated diseases such as phenylketonuria (PKU). We aimed in this study to evaluate the possible association between oxidative balance and clinical features of PKU patients. METHODS Twenty patients and 50 healthy subjects were selected. Prooxidant-antioxidant balance (PAB) was measured and phenylalanine (Phe), tyrosine (Tyr), Phe/Tyr ratio and hematological indices were determined. RESULTS A significantly higher PAB value was observed in the patient group (152.0±14.1 HK unit) compared to the controls (88.1±13.88 HK) (p<0.05). There was significant correlation between PAB with serum Phe, Tyr, Phe/Tyr ratio, white blood cells (WBC) and red blood cells (RBC) counts. CONCLUSIONS The serum PAB values were higher in patients with PKU and this was associated with the serum Phe and Tyr and Phe/Tyr ratio. Therefore, because of its low cost and simplicity to perform, PAB value might be considered as a useful monitoring marker among the other tools in these patients.
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372
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Zaki OK, El-Wakeel L, Ebeid Y, Ez Elarab HS, Moustafa A, Abdulazim N, Karara H, Elghawaby A. The Use of Glycomacropeptide in Dietary Management of Phenylketonuria. J Nutr Metab 2016; 2016:2453027. [PMID: 27313877 PMCID: PMC4904101 DOI: 10.1155/2016/2453027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/20/2016] [Accepted: 04/24/2016] [Indexed: 11/18/2022] Open
Abstract
Dietary therapy is the most common therapy applied in treatment of Phenylketonuria (PKU) with restriction of intake of most natural proteins that are rich in Phenylalanine (Phe). Recently, it has been claimed that caseinoglycomacropeptide (GMP), derived of whey, may be used to replace the amino acid formulae (AAF). The Aim of Work. To study the feasibility of use of GMP for partial replacement of artificial formula in treatment of children with PKU. Methods. Ten patients with PKU were included in the study. They received the recommended daily allowances of protein in the form of AAF or a combination of AAF and GMP. The percent of intake of GMP in phases 1 and 2 was 50% and zero%, respectively. Results. The median and interquartiles of phenyl alanine Phe levels phase were not significantly different in phases I and II, 376 (167-551) μmol/L versus 490 (289-597) μmol/L, respectively. Phenylalanine/tyrosine ratio, amino acids, and other laboratory data showed no significant difference between the two phases. Conclusion. GMP may be used to replace 50% of the protein intake to improve the nutritive value and palatability of diet and to provide a more satisfactory diet. No toxicity or side effects were reported in patients on that regimen.
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Affiliation(s)
- Osama K. Zaki
- Genetics Unit, Pediatrics Hospital, Ain Shams University, Ramsis Street, Abbasia, Cairo 11566, Egypt
| | - Lamia El-Wakeel
- College of Pharmacy, Ain Shams University, Abbasia, Cairo, Egypt
| | - Yasmin Ebeid
- College of Pharmacy, Ain Shams University, Abbasia, Cairo, Egypt
| | - Hanan S. Ez Elarab
- Genetics Unit, Pediatrics Hospital, Ain Shams University, Ramsis Street, Abbasia, Cairo 11566, Egypt
| | - Aisha Moustafa
- Genetics Unit, Pediatrics Hospital, Ain Shams University, Ramsis Street, Abbasia, Cairo 11566, Egypt
| | - Nayera Abdulazim
- Genetics Unit, Pediatrics Hospital, Ain Shams University, Ramsis Street, Abbasia, Cairo 11566, Egypt
| | - Hala Karara
- Genetics Unit, Pediatrics Hospital, Ain Shams University, Ramsis Street, Abbasia, Cairo 11566, Egypt
| | - Ahmed Elghawaby
- Genetics Unit, Pediatrics Hospital, Ain Shams University, Ramsis Street, Abbasia, Cairo 11566, Egypt
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373
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Coakley KE, Douglas TD, Goodman M, Ramakrishnan U, Dobrowolski SF, Singh RH. Modeling correlates of low bone mineral density in patients with phenylalanine hydroxylase deficiency. J Inherit Metab Dis 2016; 39:363-372. [PMID: 26883219 DOI: 10.1007/s10545-015-9910-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/17/2015] [Accepted: 12/04/2015] [Indexed: 11/26/2022]
Abstract
Phenylalanine hydroxylase (PAH) deficiency is an inherited metabolic disorder requiring life-long restriction of dietary protein and phenylalanine-free medical food. Low bone mineral density (BMD) is reported, but factors associated with BMD Z-score (standard deviations from normal) are unknown. We examined associations between clinical and dietary parameters and total BMD Z-score in PAH deficiency patients, and developed models to predict Z-score. Data collected from patients >4 years of age (n = 88; mean age = 18.8 y; 61 % female) included demographic, clinical, laboratory, and dietary intakes. Adjusted Spearman's correlation coefficients were calculated between parameters and TBMD Z-score, measured by dual energy x-ray absorptiometry (DXA). Parameters approaching significance (p-value < 0.10) were candidate predictors for four linear regression models predicting TBMD Z-score. To validate, model-predicted Z-scores were compared to DXA Z-scores. Mean TBMD Z-score was -0.326; 18 (20.4 %) had Z-score < -1. Z-scores were positively correlated with dietary vitamin D, calcium, and medical food intake and compliance with prescription, and negatively with dietary carbohydrate, sugar, caffeine intake, glycemic load, and prescribed medical food (grams protein/day; p-value < 0.05). The best model included medical food compliance, medical food intake, caffeine intake, and bone-specific alkaline phosphatase (r-square = 0.364). This model predicted Z-score category [normal or low (<-1)] with sensitivity = 66.7 %, likelihood ratio = 14.7, and AUC = 0.83 compared to DXA Z-score. No subjects had low BMD for chronological age (Z-score ≤ -2). Compliance with medical food prescription was the strongest predictor of TBMD Z-score. One model, if validated in a separate sample of patients with more cases of low BMD, showed potential to estimate TBMD Z-score using routine clinical patient parameters.
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Affiliation(s)
- Kathryn E Coakley
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA.
- , 2165 North Decatur Road, Decatur, GA, 30033, USA.
| | - Teresa D Douglas
- Post-Doctoral Fellow, Department of Neurology, Emory University, Atlanta, GA, USA
| | - Michael Goodman
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Usha Ramakrishnan
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Steven F Dobrowolski
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rani H Singh
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
- Department of Human Genetics and Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
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374
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Mütze U, Thiele AG, Baerwald C, Ceglarek U, Kiess W, Beblo S. Ten years of specialized adult care for phenylketonuria - a single-centre experience. Orphanet J Rare Dis 2016; 11:27. [PMID: 27008844 PMCID: PMC4806494 DOI: 10.1186/s13023-016-0410-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Specialized adult care of phenylketonuria (PKU) patients is of increasing importance. Adult outpatient clinics for inherited errors of metabolism can help to achieve this task, but experience is limited. Ten years after establishment of a coordinated transition process and specialised adult care for inherited metabolic diseases, adult PKU care was evaluated with respect to metabolic control, therapy satisfaction, life satisfaction, sociodemographic data, economical welfare as well as pregnancy outcome. Methods All PKU patients transferred from paediatric to adult care between 2005 and 2015 were identified. A retrospective data analysis and a cross-sectional survey in a sub-cohort of 30 patients including a questionnaire for assessing quality of life (FLZm) were performed as a single-centre investigation at the metabolic department of the University Hospital Leipzig, Germany. For statistical analysis, Mann-Whitney-U-test, t-test for independent samples, ANOVA and chi square test were used as appropriate. Results 96 PKU patients (56 females/40 males; median age 32 years, range 18–62) were included. In the last 3-year period, 81 % of the transferred patients still kept contact to the adult care centre. Metabolic control was stable over the evaluation period and dried blood phenylalanine concentrations mostly remained within the therapeutic range (median 673.0 μmol/l, range 213.0–1381.1). Sociodemographic data, economical welfare and life satisfaction data were comparable to data from the general population. However, differences could be revealed when splitting the cohort according to time of diagnosis and to management during childhood. 83 % of the PKU adults were satisfied with the transition process and current adult care. 25 completed pregnancies were supervised; three newborns, born after unplanned pregnancy, showed characteristic symptoms of maternal PKU syndrome. Conclusions Continuous care for adult PKU patients in a specialized outpatient clinic is successful, leading to good to satisfactory metabolic control and social outcomes. Uninterrupted good metabolic treatment throughout childhood and adolescence positively influences educational, professional and economic success in later life. Further effort in specialized paediatric and adult metabolic care is needed to prevent loss of follow-up and to support the recommended life-long treatment and/or care.
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Affiliation(s)
- Ulrike Mütze
- Department of Women and Child Health, Hospital for Children and Adolescents, Centre for Paediatric Research Leipzig (CPL), University Hospitals, University of Leipzig, Liebigstr. 20 a, 04103, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospitals, University of Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany.,Division of Neuropediatrics and Inherited Metabolic Diseases, Department of General Pediatrics, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Alena Gerlinde Thiele
- Department of Women and Child Health, Hospital for Children and Adolescents, Centre for Paediatric Research Leipzig (CPL), University Hospitals, University of Leipzig, Liebigstr. 20 a, 04103, Leipzig, Germany.
| | - Christoph Baerwald
- Department of Internal Medicine, University Hospitals, University of Leipzig, Liebigstr.20, 04103, Leipzig, Germany
| | - Uta Ceglarek
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospitals, University of Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany
| | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents, Centre for Paediatric Research Leipzig (CPL), University Hospitals, University of Leipzig, Liebigstr. 20 a, 04103, Leipzig, Germany
| | - Skadi Beblo
- Department of Women and Child Health, Hospital for Children and Adolescents, Centre for Paediatric Research Leipzig (CPL), University Hospitals, University of Leipzig, Liebigstr. 20 a, 04103, Leipzig, Germany
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375
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Robinson R, Wong L, Monnat RJ, Fu E. Development of a Whole Blood Paper-Based Device for Phenylalanine Detection in the Context of PKU Therapy Monitoring. MICROMACHINES 2016; 7:mi7020028. [PMID: 30407401 PMCID: PMC6190008 DOI: 10.3390/mi7020028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 11/30/2022]
Abstract
Laboratory-based testing does not allow for the sufficiently rapid return of data to enable optimal therapeutic monitoring of patients with metabolic diseases such as phenylketonuria (PKU). The typical turn-around time of several days for current laboratory-based testing is too slow to be practically useful for effective monitoring or optimizing therapy. This report describes the development of a rapid, paper-based, point-of-care device for phenylalanine detection using a small volume (40 μL) of whole blood. The quantitative resolution and reproducibility of this device with instrumented readout are described, together with the potential use of this device for point-of-care monitoring by PKU patients.
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Affiliation(s)
- Robert Robinson
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, OR 97331, USA.
| | - Liam Wong
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, OR 97331, USA.
| | - Raymond J Monnat
- Departments of Pathology and Genome Sciences, University of Washington, Seattle, WA 98195, USA.
| | - Elain Fu
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, OR 97331, USA.
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376
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Stroup BM, Held PK, Williams P, Clayton MK, Murali SG, Rice GM, Ney DM. Clinical relevance of the discrepancy in phenylalanine concentrations analyzed using tandem mass spectrometry compared with ion-exchange chromatography in phenylketonuria. Mol Genet Metab Rep 2016; 6:21-6. [PMID: 27014575 PMCID: PMC4789345 DOI: 10.1016/j.ymgmr.2016.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/05/2016] [Indexed: 11/05/2022] Open
Abstract
Introduction Metabolic control of phenylketonuria (PKU) and compliance with the low-phenylalanine (phe) diet are frequently assessed by measuring blood phe concentrations in dried blood spots (DBS) collected by patients instead of plasma phe concentrations. Objective Our objective was to investigate the difference in blood phe concentrations in DBS collected by subjects and analyzed using either a validated newborn screening tandem mass spectrometry (MS/MS) protocol or ion-exchange chromatography (IEC) compared to plasma phe concentrations obtained simultaneously and analyzed using IEC. Design Three to four fasting blood samples were obtained from 29 subjects with PKU, ages 15–49 years. Capillary blood was spotted on filter paper by each subject and the DBS analyzed using both MS/MS and IEC. Plasma was isolated from venous blood and analyzed using IEC. Results Blood phe concentrations in DBS analyzed using MS/MS are 28% ± 1% (n = 110, p < 0.0001) lower than plasma phe concentrations analyzed using IEC resulting in a blood phe concentration of 514 ± 23 μmol/L and a plasma phe concentration of 731 ± 32 μmol/L (mean ± SEM). This discrepancy is larger when plasma phe is > 600 μmol/L. Due to the large variability across subjects of 13.2%, a calibration factor to adjust blood phe concentrations is not recommended. Analysis of DBS using IEC reduced the discrepancy to 15 ± 2% lower phe concentrations compared to plasma analyzed using IEC (n = 38, p = 0.0001). This suggests that a major contributor to the discrepancy in phe concentrations is the analytical method. Conclusion Use of DBS analyzed using MS/MS to monitor blood phe concentrations in individuals with PKU yields significantly lower phe levels compared to plasma phe levels analyzed using IEC. Optimization of current testing methodologies for measuring phe in DBS, along with patient education regarding the appropriate technique for spotting blood on filter paper is needed to improve the accuracy of using DBS to measure phe concentrations in PKU management. Phe concentration in dried blood spots is significantly lower than plasma phe. Blood phe concentration cannot be adjusted due to large variability across subjects. Analysis of dried blood spots using IEC instead of MS/MS improves accuracy. Plasma phe concentration using IEC is the most accurate for metabolic monitoring in PKU.
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Affiliation(s)
- Bridget M Stroup
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Patrice K Held
- Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, WI, United States
| | - Phillip Williams
- Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, WI, United States
| | - Murray K Clayton
- Departments of Plant Pathology and Statistics, University of Wisconsin-Madison, Madison, WI, United States
| | - Sangita G Murali
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Gregory M Rice
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Denise M Ney
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
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377
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Diagnostic and management practices for phenylketonuria in 19 countries of the South and Eastern European Region: survey results. Eur J Pediatr 2016; 175:261-72. [PMID: 26350228 PMCID: PMC4724370 DOI: 10.1007/s00431-015-2622-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/10/2015] [Accepted: 08/14/2015] [Indexed: 01/17/2023]
Abstract
UNLABELLED To avoid potentially severe outcomes, phenylketonuria (PKU) must be detected as soon as possible after birth and managed with life-long treatment. A questionnaire-based survey was performed to document diagnosis and management practices for PKU in a region of Southern and Eastern Europe. Prevalence and management data were obtained from 37/59 (63 %) centres within 19/22 (86%) contacted countries (N = 8600 patients). The main results' analysis was based on completed questionnaires obtained from 31 centres (53%) within 15 countries (68%). A median of 10 % of patients per centre had been diagnosed after the newborn period. Metabolic dieticians and specialised adult PKU clinics were lacking in 36 and 84% of centres, respectively. In 26% of centres, treatment initiation was delayed until >15 days of life. Blood phenylalanine (Phe) thresholds to start treatment and upper Phe targets were inconsistent across centres. Ten percent of centres reported monitoring Phe every 2 weeks for pregnant women with PKU, which is insufficient to minimise risk of neonatal sequalae. Sapropterin dihydrochloride treatment was available in 48% of centres, with 24-h responsiveness tests most common (36%). Only one centre among the five countries lacking newborn screening provided a completed questionnaire. CONCLUSION Targeted efforts by health care professionals and governments are needed to optimise diagnostic and management approaches for PKU in Southern and Eastern Europe. WHAT IS KNOWN PKU must be detected early and optimally managed throughout life to avoid poor outcomes, yet newborn screening is not universal and diagnostic and management practices for PKU are known to vary widely between different centres and countries. Targeted efforts by health care professionals and governments are needed to optimise diagnostic and management approaches. WHAT IS NEW PKU management practices are documented in 19 South and Eastern European countries indicating a heterogeneous situation across the region. Key areas for improvement identified in surveyed centres include a need for comprehensive screening in all countries, increased number of metabolic dietitians and specialised adult PKU clinics, delayed time to treatment initiation, appropriate Phe thresholds, Phe targets and monitoring frequencies, and universal access to currently available treatment options.
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378
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Cassis L, Cortès-Saladelafont E, Molero-Luis M, Yubero D, González MJ, Herrero AO, Fons C, Jou C, Sierra C, Castejon Ponce E, Ramos F, Armstrong J, O’Callaghan MM, Casado M, Montero R, Olivas SMM, Artuch R, Barić I, Bartoloni F, Bellettato CM, Bonifazi F, Ceci A, Cvitanović-Šojat L, Dali CI, D’Avanzo F, Fumic K, Giannuzzi V, Lampe C, Scarpa M, Cazorla ÁG. Review and evaluation of the methodological quality of the existing guidelines and recommendations for inherited neurometabolic disorders. Orphanet J Rare Dis 2015; 10:164. [PMID: 26714856 PMCID: PMC4696316 DOI: 10.1186/s13023-015-0376-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/10/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Inherited neurometabolic disorders (iNMDs) represent a group of almost seven hundred rare diseases whose common manifestations are clinical neurologic or cognitive symptoms that can appear at any time, in the first months/years of age or even later in adulthood. Early diagnosis and timely treatments are often pivotal for the favorable course of the disease. Thus, the elaboration of new evidence-based recommendations for iNMD diagnosis and management is increasingly requested by health care professionals and patients, even though the methodological quality of existing guidelines is largely unclear. InNerMeD-I-Network is the first European network on iNMDs that was created with the aim of sharing and increasing validated information about diagnosis and management of neurometabolic disorders. One of the goals of the project was to determine the number and the methodological quality of existing guidelines and recommendations for iNMDs. METHODS We performed a systematic search on PubMed, the National Guideline Clearinghouse (NGC), the Guidelines International Network (G-I-N), the Scottish Intercollegiate Guideline Network (SIGN) and the National Institute for Health and Care Excellence (NICE) to identify all the published guidelines and recommendations for iNMDs from January 2000 to June 2015. The methodological quality of the selected documents was determined using the AGREE II instrument, an appraisal tool composed of 6 domains covering 23 key items. RESULTS A total of 55 records met the inclusion criteria, 11 % were about groups of disorders, whereas the majority encompassed only one disorder. Lysosomal disorders, and in particular Fabry, Gaucher disease and mucopolysaccharidoses where the most studied. The overall methodological quality of the recommendation was acceptable and increased over time, with 25 % of the identified guidelines strongly recommended by the appraisers, 64 % recommended, and 11 % not recommended. However, heterogeneity in the obtained scores for each domain was observed among documents covering different groups of disorders and some domains like 'stakeholder involvement' and 'applicability' were generally scarcely addressed. CONCLUSIONS Greater efforts should be devoted to improve the methodological quality of guidelines and recommendations for iNMDs and AGREE II instrument seems advisable for new guideline development. The elaboration of new guidelines encompassing still uncovered disorders is badly needed.
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Affiliation(s)
- Linda Cassis
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Elisenda Cortès-Saladelafont
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Marta Molero-Luis
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Delia Yubero
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Maria Julieta González
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Aida Ormazabal Herrero
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Carme Fons
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Cristina Jou
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Cristina Sierra
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Esperanza Castejon Ponce
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Federico Ramos
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Judith Armstrong
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - M. Mar O’Callaghan
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Mercedes Casado
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Raquel Montero
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Silvia Maria Meavilla Olivas
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Rafael Artuch
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
| | - Ivo Barić
- />Department of Pediatrics, University Hospital Center Zagreb, Zagreb & University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Franco Bartoloni
- />Gianni Benzi Pharmacological Research Foundation, Valenzano, BA Italy
| | | | - Fedele Bonifazi
- />Gianni Benzi Pharmacological Research Foundation, Valenzano, BA Italy
| | - Adriana Ceci
- />Gianni Benzi Pharmacological Research Foundation, Valenzano, BA Italy
| | - Ljerka Cvitanović-Šojat
- />Department of Pediatrics, University Hospital Center Zagreb, Zagreb & University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Christine I Dali
- />Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Francesca D’Avanzo
- />Department of Women and Children Health, Brains for Brain Foundation, Padova, Italy
| | - Ksenija Fumic
- />Department of Pediatrics, University Hospital Center Zagreb, Zagreb & University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Viviana Giannuzzi
- />Gianni Benzi Pharmacological Research Foundation, Valenzano, BA Italy
| | - Christina Lampe
- />Department of Women and Children Health, Brains for Brain Foundation, Padova, Italy
- />Department of Pediatric and Adolescent Medicine, Centre for Rare Diseases, Horst Schmidt Klinik Wiesbaden, Wiesbaden, Germany
| | - Maurizio Scarpa
- />Department of Women and Children Health, Brains for Brain Foundation, Padova, Italy
- />Department of Pediatric and Adolescent Medicine, Centre for Rare Diseases, Horst Schmidt Klinik Wiesbaden, Wiesbaden, Germany
- />Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - Ángels Garcia- Cazorla
- />Neurology, gastroenterology pathology and clinical biochemistry Departments, IRP-HSJD and CIBERER, Barcelona, Spain
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379
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Brown CS, Lichter-Konecki U. Phenylketonuria (PKU): A problem solved? Mol Genet Metab Rep 2015; 6:8-12. [PMID: 27014571 PMCID: PMC4789336 DOI: 10.1016/j.ymgmr.2015.12.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 11/30/2022] Open
Abstract
Phenylketonuria (PKU) is a rare metabolic disorder characterized by impaired conversion of phenylalanine (Phe) to tyrosine. If left untreated, the resultant accumulation of excess blood Phe can cause physiological, neurological, and intellectual disabilities. The National PKU Alliance (NPKUA) conducted a survey of its membership to assess current health status and interest in new treatments for PKU. Of the 625 survey respondents, less than half (46.7%) reported blood Phe within (120–360 μmol/L) — the range recommended by the American College of Medical Genetics and Genomics (ACMG). The survey results also showed that younger (≤ 18 years) individuals were about 3-times as successful in keeping their blood Phe concentrations within the recommended clinical range compared with adults. Blood Phe over 360 μmol/L was reported in one-quarter (25.5%) of ≤ 18 year old individuals and almost two-thirds (61.5%) of adults. A little more than half (51.7%) of respondents reported having difficulty in managing their PKU, including the maintenance of a Phe-restricted diet. Individuals with PKU desire new treatments that would allow them to increase their intake of natural protein, discontinue or reduce their intake of medical foods (medical formula and foods modified to be low in protein), improve their mental health (including a reduction in depression and anxiety), and a reduction of their blood Phe concentrations. Respondents preferred oral administration of any newly developed therapies and, in general, disliked therapeutic injections. Injections at home were preferred over injections at a clinic. Payers, government agencies, clinicians, and industry partners should consider patient input when developing and approving new therapies and treatments for PKU.
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Affiliation(s)
| | - Uta Lichter-Konecki
- Section of Neurology, St. Christopher's Hospital for Children, Dept. of Pediatrics, Drexel University College of Medicine, United States
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380
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Rohde C, Thiele AG, Och U, Schönherr K, Meyer U, Rosenbaum-Fabian S, Maddalon C, Matzken S, Blessing H, Lang F, Jörg-Streller M, Beblo S. Effect of dietary regime on metabolic control in phenylketonuria: Is exact calculation of phenylalanine intake really necessary? Mol Genet Metab Rep 2015. [PMID: 28649540 PMCID: PMC5471407 DOI: 10.1016/j.ymgmr.2015.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background A phenylalanine (Phe) restricted dietary management is required in phenylketonuria (PKU) to maintain good metabolic control. Nevertheless, five different models of dietary regimes, which differ in their accuracy of Phe documentation, are used. To investigate the effect of the dietary regime on metabolic control, a multicenter evaluation was performed. Patients/Methods 149 patients (max. 800 mg Phe-intake/day; 108 children aged 1–9 years and 41 adolescents aged 10–15 years) could be included. They were separated according to age and dietary regime, revealed by a questionnaire on dietary habits. Dietary regimes vary from daily strict calculation of all Phe-intake (group 1) to a rather loose regime only estimating Phe-intake and including high protein food (group 5). Data were analyzed with respect to metabolic control (Phe-concentrations, Phe-concentrations above upper recommended limit during 6 months before the interview), Phe-intake (mg/day) and age (years). Results Median Phe-concentrations in children did not differ significantly among diet groups (group 1: 161; 2: 229, 3: 236, 4: 249, 5: 288 μmol/l, p = 0.175). However, exact daily Phe calculation led to significantly lower percentage of Phe concentrations above the upper recommended limit (group 1: 17, 2: 50, 3: 42, 4: 50, 5: 75%, p = 0.035). All included patients showed good to acceptable metabolic control. Patients on the dietary regime with the least accuracy, consuming also high protein foods, showed the poorest metabolic control. Median Phe concentrations of all other groups remained within recommended ranges, including from groups not calculating special low protein foods, fruit and vegetables and using a simplified system of recording Phe-intake. In adolescents no significant differences among diet groups were revealed. Conclusion Exact calculation of Phe content of all food is not necessary to achieve good metabolic control in children and adolescents with PKU. Excluding special low protein food, as well as fruit and vegetables from calculation of Phe-intake has no impact on metabolic control. However including protein rich food into the diet and simply estimating all Phe-intake appears insufficient. The simplification of dietary regime may be helpful in enhancing acceptability and feasibility.
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Affiliation(s)
- Carmen Rohde
- Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Liebigstraße 20 a, 04103 Leipzig, Germany
| | - Alena Gerlinde Thiele
- Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Liebigstraße 20 a, 04103 Leipzig, Germany
| | - Ulrike Och
- Muenster University Children's Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Katrin Schönherr
- University Children's Hospital, Department of Clinical Genetics, Centre of treatment of metabolic diseases, Kochstr. 2, 07745 Jena, Germany
| | - Uta Meyer
- Medical School Hannover, Clinic of Pediatrics, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Stefanie Rosenbaum-Fabian
- Center of Pediatrics and Adolescent Medicine, University Hospital, Department of Pediatrics, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Cornelia Maddalon
- University Children's Hospital, Steinwiesstrasse 75, 8032 Zürich, Switzerland
| | - Sabine Matzken
- Justus Liebig University, Department for General Pediatrics, Metabolic Unit, Rudolf-Buchheim-Straße, 35392 Giessen, Germany
| | - Holger Blessing
- Department for Inborn Metabolic Diseases, Children's and Adolescents' Hospital, University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany
| | - Frauke Lang
- Departement of Pediatric and Adolscent Medicine, Villa Metabolica, University Medical Center, Johannes Gutenberg-University of Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Monika Jörg-Streller
- Clinic for Pediatrics I, Inherited Metabolic Disorders, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Skadi Beblo
- Hospital for Children and Adolescents, Department of Women and Child Health, University Hospitals, University of Leipzig, Liebigstraße 20 a, 04103 Leipzig, Germany
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381
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Urinary biomarkers of oxidative stress and plasmatic inflammatory profile in phenylketonuric treated patients. Int J Dev Neurosci 2015; 47:259-65. [DOI: 10.1016/j.ijdevneu.2015.10.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 11/24/2022] Open
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382
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Castañeda MT, Adachi O, Hours RA. Reduction of l-phenylalanine in protein hydrolysates using l-phenylalanine ammonia-lyase from Rhodosporidium toruloides. ACTA ACUST UNITED AC 2015; 42:1299-307. [DOI: 10.1007/s10295-015-1664-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/24/2015] [Indexed: 12/20/2022]
Abstract
Abstract
l-Phenylalanine ammonia-lyase (PAL, EC 4.3.1.25) from Rhodosporidium toruloides was utilized to remove l-phenylalanine (l-Phe) from different commercial protein hydrolysates. A casein acid hydrolysate (CAH, l-Phe ~2.28 %) was employed as a model substrate. t-Cinnamic acid resulting from deamination of l-Phe was extracted, analyzed at λ = 290 nm, and used for PAL activity determination. Optimum reaction conditions, optimized using successive Doehlert design, were 35 mg mL−1 of CAH and 800 mU mL−1 of PAL, while temperature and pH were 42 °C and 8.7, respectively. Reaction kinetics of PAL with CAH was determined under optimized conditions. Then, removal of l-Phe from CAH was tested. Results showed that more than 92 % of initial l-Phe was eliminated. Similar results were obtained with other protein hydrolysates. These findings demonstrate that PAL is a useful biocatalyst for l-Phe removal from protein hydrolysates, which can be evaluated as potential ingredients in foodstuffs for PKU patients.
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Affiliation(s)
- María Teresita Castañeda
- grid.9499.d 0000 0001 2097 3940 Research and Development Center for Industrial Fermentations (CINDEFI; UNLP, CONICET La Plata), School of Science La Plata National University 47 y 115 B1900ASH La Plata Argentina
| | - Osao Adachi
- grid.268397.1 0000000106607960 Department of Biological Chemistry, Faculty of Agriculture Yamaguchi University 753-8515 Yamaguchi Japan
| | - Roque Alberto Hours
- grid.9499.d 0000 0001 2097 3940 Research and Development Center for Industrial Fermentations (CINDEFI; UNLP, CONICET La Plata), School of Science La Plata National University 47 y 115 B1900ASH La Plata Argentina
- Department of Chemical Engineering National Technological University-La Plata Regional Faculty (UTN-FRLP) 60 y 124 La Plata Argentina
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383
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Raval DB, Merideth M, Sloan JL, Braverman NE, Conway RL, Manoli I, Venditti CP. Methylmalonic acidemia (MMA) in pregnancy: a case series and literature review. J Inherit Metab Dis 2015; 38:839-46. [PMID: 25567501 PMCID: PMC4496322 DOI: 10.1007/s10545-014-9802-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 11/26/2014] [Accepted: 12/02/2014] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Women with inherited metabolic disorders, including those with previously life-limiting conditions such as MMA, are reaching child-bearing age more often due to advances in early diagnosis and improved pediatric care. Information surrounding maternal and fetal complications associated with the underlying disorders remains largely unexplored. METHODS Pregnancies affected by maternal MMA were ascertained through study 04-HG-0127 "Clinical and Basic Investigations of Methylmalonic Acidemia and Related Disorders" (clinicaltrials.gov identifier: NCT00078078) and via literature review. Prenatal and delivery records in study participants were reviewed. RESULTS Seventeen pregnancies were identified in women with isolated MMA, including three abortions, one termination, and 13 completed pregnancies [three cases with cblA (four pregnancies), four cases of mut- (one cobalamin responsive, three non-responsive), five cases with unknown type of MMA]. Seventeen percent (3/17) of the pregnancies resulted in a first trimester abortion, while 38.5% (5/13) of the completed pregnancies resulted in preterm deliveries. A cesarean delivery rate of 53.8% (7/13) was noted among the cohort. Fetal distress or nonreassuring fetal status was the indication for 57% (4/7) cesarean deliveries. One patient was reported to have metabolic crisis as well as episodes of mild hyperammonemia. Malformations or adverse outcomes in the progeny were not observed. CONCLUSION Although there have been a small number of pregnancies identified in women with MMA, the cumulative results suggest that the majority of pregnancies can be complicated by cesarean delivery and increased risk of prematurity. A pregnancy registry could clarify perinatal complications and define management approaches needed to ensure optimal maternal and fetal outcomes in this growing patient population.
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Affiliation(s)
- Donna B Raval
- Genetics and Molecular Biology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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384
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Crujeiras V, Aldámiz-Echevarría L, Dalmau J, Vitoria I, Andrade F, Roca I, Leis R, Fernandez-Marmiesse A, Couce ML. Vitamin and mineral status in patients with hyperphenylalaninemia. Mol Genet Metab 2015; 115:145-50. [PMID: 26123187 DOI: 10.1016/j.ymgme.2015.06.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
Natural sources of protein and some vitamins and minerals are limited in phenylketonuria (PKU) treated patients, who should receive optimal supplementation although this is not yet fully established. We conducted a cross-sectional observational multicenter study including 156 patients with hyperphenylalaninemia. Patients were stratified by age, phenotype, disease detection and type of treatment. Annual median blood phenylalanine (Phe) levels, Phe tolerance, anthropometric measurements, and biochemical parameters (total protein, prealbumin, electrolytes, selenium, zinc, B12, folic acid, ferritin, 25-OH vitamin D) were collected in all patients. 81.4% of patients had biochemical markers out of recommended range but no clinical symptoms. Total protein, calcium, phosphorus, B12, ferritin, and zinc levels were normal in most patients. Prealbumin was reduced in 34.6% of patients (74% with PKU phenotype and 94% below 18 years old), showing almost all (96.3%) an adequate adherence to diet. Selenium was diminished in 25% of patients (95% with PKU phenotype) and also 25-OHD in 14%. Surprisingly, folic acid levels were increased in 39% of patients, 66% with classic PKU. Phosphorus and B12 levels were found diminished in patients with low adherence to diet. Patients under BH4 therapy only showed significant lower levels of B12. This study shows a high percentage of prealbumin and selenium deficiencies as well as an increased level of folic acid in PKU treated patients, which should lead us to assess an adjustment for standards supplements formulated milks.
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Affiliation(s)
- Vanesa Crujeiras
- Unit of Gastroenterology and Nutrition, Department of Pediatrics, Hospital Clinico Universitario de Santiago, Travesía da Choupana s/n, 15706 Santiago de Compostela, A Coruña, Spain
| | - Luis Aldámiz-Echevarría
- Unit of Metabolism, Department of Pediatrics, Hospital de Cruces, Group of Metabolism, Biocruces Health Research Institute, CIBERER, Plaza de Cruces s/n, 48903 Barakaldo, Vizcaya, Spain.
| | - Jaime Dalmau
- Unit of Metabolopathies, Hospital Universitario la Fe, Bulevarsur s/n, 46021 Valencia, Spain.
| | - Isidro Vitoria
- Unit of Metabolopathies, Hospital Universitario la Fe, Bulevarsur s/n, 46021 Valencia, Spain.
| | - Fernando Andrade
- Unit of Metabolism, Department of Pediatrics, Hospital de Cruces, Group of Metabolism, Biocruces Health Research Institute, CIBERER, Plaza de Cruces s/n, 48903 Barakaldo, Vizcaya, Spain.
| | - Iria Roca
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, S. Neonatology, Department of Pediatrics, Hospital Clinico Universitario de Santiago, Travesía da Choupana s/n, 15706 Santiago de Compostela, A Coruña, Spain.
| | - Rosaura Leis
- Unit of Gastroenterology and Nutrition, Department of Pediatrics, Hospital Clinico Universitario de Santiago, IDIS, Travesía da Choupana s/n, 15706 Santiago de Compostela, A Coruña, Spain.
| | - Ana Fernandez-Marmiesse
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, S. Neonatology, Department of Pediatrics, Hospital Clinico Universitario de Santiago, CIBERER, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, A Coruña, Spain.
| | - María L Couce
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, S. Neonatology, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, CIBERER, Health Research Institute of Santiago de Compostela (IDIS), A Choupana, s/n, 15706 Santiago de Compostela, A Coruña, Spain.
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385
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Bannick AA, Laufman JD, Edwards HL, Ventimiglia J, Feldman GL. Outcomes of referrals to Child Protective Services for medical neglect in patients with phenylketonuria: Experiences at a single treatment center. Mol Genet Metab 2015; 115:151-6. [PMID: 26138304 DOI: 10.1016/j.ymgme.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/13/2015] [Accepted: 06/13/2015] [Indexed: 11/18/2022]
Abstract
Phenylketonuria (PKU) results in an accumulation of phenylalanine (phe) in the blood which can lead to multiple health consequences in affected individuals. Treatment for PKU is available; however adherence to medical management recommendations can be difficult. When recommendations are not followed and the health of a child is at risk, one intervention that may be necessary is a referral for medical neglect to the local child protective services (CPS) agency. This study summarizes the cases that were referred from our metabolic clinic at the Children's Hospital of Michigan to CPS, and the outcomes of that intervention. CPS referrals helped to improve adherence to medical management recommendations in the majority of cases, including a lower blood phe level for the child; however, at times that improvement did not occur until after a second referral and/or the child's temporary removal from the home.
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Affiliation(s)
- Allison A Bannick
- Department of Pediatrics, Division of Genetic and Metabolic Disorders, Detroit Medical Center, Children's Hospital of Michigan, 3950 Beaubien, Detroit, MI 48201, United States.
| | - Jason D Laufman
- Wayne State University School of Medicine, 540 East Canfield, Detroit, MI 48201, United States.
| | - Heidi L Edwards
- Department of Pediatrics, Division of Genetic and Metabolic Disorders, Detroit Medical Center, Children's Hospital of Michigan, 3950 Beaubien, Detroit, MI 48201, United States.
| | - June Ventimiglia
- Department of Pediatrics, Division of Genetic and Metabolic Disorders, Detroit Medical Center, Children's Hospital of Michigan, 3950 Beaubien, Detroit, MI 48201, United States.
| | - Gerald L Feldman
- Department of Pediatrics, Division of Genetic and Metabolic Disorders, Detroit Medical Center, Children's Hospital of Michigan, 3950 Beaubien, Detroit, MI 48201, United States; Center for Molecular Medicine and Genetics, Departments of Pediatrics and Pathology, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI 48201, United States.
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386
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Micronutrient in hyperphenylalaninemia. Data Brief 2015; 4:614-21. [PMID: 26322328 PMCID: PMC4543207 DOI: 10.1016/j.dib.2015.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 11/21/2022] Open
Abstract
The data presented here are the biochemical parameters of 156 patients with hyperphenylalaninemia. PKU patients, who, in order to maintain optimal serum Phe concentrations, receive dietary treatment consisting of a diet low in natural protein supplemented with special low protein foods and a Phe-free amino acid mixture, vitamins and minerals. The obtained data reflects a high percentage of patients with prealbumin and selenium deficiencies, as well as an increased level of folic acid. This data article is related to the research article entitled, “Vitamin and mineral status in patients with hyperphenylalaninemia”, by Crujeiras et al. [1].
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387
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Deon M, Landgraf SS, Lamberty JF, Moura DJ, Saffi J, Wajner M, Vargas CR. Protective effect of L-carnitine on Phenylalanine-induced DNA damage. Metab Brain Dis 2015; 30:925-33. [PMID: 25600689 DOI: 10.1007/s11011-015-9649-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/07/2015] [Indexed: 11/28/2022]
Abstract
The pathogenesis and the progression of phenylketonuria (PKU), an inborn error of phenylalanine (Phe) metabolism, have been associated with oxidative damage. Moreover, it has been increasingly postulated the antioxidant properties of L-Carnitine (LC). The aim of this study was to verify the effect of LC on Phe-induced DNA damage. The in vitro effect of different concentrations of LC (15, 30, 120 and 150 μM) on DNA damage-induced by high phenylalanine levels (1000 and 2500 μM) was examined in white blood cells from normal individuals using the comet assay. Urinary 8-hydroxydeoguanosine (8-OHdG) levels, a biomarker of oxidative DNA damage, and plasmatic sulfhydryl content were measured in eight patients with classical PKU, under therapy with protein restriction and supplemented with a special formula containing LC, and in controls individuals. Both in vitro tested Phe concentrations (1000 and 2500 μM) have resulted in DNA damage index significantly higher than control group. The in vitro co-treatment with Phe and LC reduced significantly DNA damage index when compared to Phe group. The urinary excretion of 8-OHdG and plasmatic sulfhydryl content presented similar levels in both groups analyzed (controls and treated PKU patients). In treated PKU patients, urinary 8-OHdG levels were positively correlated with blood Phe levels and negatively correlated with blood LC concentration and plasmatic sulfhydryl content. The present work yields experimental evidence that LC can reduce the in vitro DNA injury induced by high concentrations of phenylalanine, as well as, allow to hypothesize that LC protect against DNA damage in patients with PKU.
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Affiliation(s)
- Marion Deon
- Serviço de Genética Médica, HCPA, Rua Ramiro Barcelos, 2350, CEP 90035-003, Porto Alegre, RS, Brazil,
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388
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Boyer SW, Barclay LJ, Burrage LC. Inherited Metabolic Disorders: Aspects of Chronic Nutrition Management. Nutr Clin Pract 2015; 30:502-10. [PMID: 26079521 PMCID: PMC4515158 DOI: 10.1177/0884533615586201] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The introduction of newborn screening and the development of new therapies have led to an expanding population of patients with inherited metabolic disorders, and these patients are now entering adulthood. Dietary therapy is the mainstay of treatment for many of these disorders, and thus, trained metabolic dietitians are critical members of the multidisciplinary team required for management of such patients. The main goals of dietary therapy in inborn errors of metabolism are the maintenance of normal growth and development while limiting offending metabolites and providing deficient products. Typically, the offending metabolite is either significantly reduced or removed completely from the diet and then reintroduced in small quantities until blood levels are within the normal range. Such treatment is required in infancy, childhood, and adulthood and requires careful monitoring of micronutrient and macronutrient intake throughout the life span. The goal of this review is to highlight the basic principles of chronic nutrition management of the inborn errors of protein, carbohydrate, and fat metabolism.
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Affiliation(s)
- Suzanne W Boyer
- Department of Molecular and Human Genetics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Lisa J Barclay
- Department of Food and Nutrition, Texas Children's Hospital, Houston, Texas
| | - Lindsay C Burrage
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
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389
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Turki A, Murthy G, Ueda K, Cheng B, Giezen A, Stockler-Ipsiroglu S, Elango R. Minimally invasive (13)C-breath test to examine phenylalanine metabolism in children with phenylketonuria. Mol Genet Metab 2015; 115:78-83. [PMID: 25943030 DOI: 10.1016/j.ymgme.2015.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/25/2015] [Accepted: 04/25/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Phenylketonuria (PKU) is an autosomal recessive disorder caused by deficiency of hepatic phenylalanine hydroxylase (PAH) leading to increased levels of phenylalanine in the plasma. Phenylalanine levels and phenylalanine hydroxylase (PAH) activity monitoring are currently limited to conventional blood dot testing. 1-(13)C-phenylalanine, a stable isotope can be used to examine phenylalanine metabolism, as the conversion of phenylalanine to tyrosine occurs in vivo via PAH and subsequently releases the carboxyl labeled (13)C as (13)CO2 in breath. OBJECTIVE Our objective was to examine phenylalanine metabolism in children with PKU using a minimally-invasive 1-(13)C-phenylalanine breath test ((13)C-PBT). DESIGN Nine children (7 M: 2 F, mean age 12.5 ± 2.87 y) with PKU participated in the study twice: once before and once after sapropterin supplementation. Children were provided 6 mg/kg oral dose of 1-(13)C-phenylalanine and breath samples were collected at 20 min intervals for a period of 2h. Rate of CO2 production was measured at 60 min post-oral dose using indirect calorimetry. The percentage of 1-(13)C-phenylalanine exhaled as (13)CO2 was measured over a 2h period. Prior to studying children with PKU, we tested the study protocol in healthy children (n = 6; 4M: 2F, mean age 10.2 ± 2.48 y) as proof of principle. RESULTS Production of a peak enrichment (Cmax) of (13)CO2 (% of dose) in all healthy children occurred at 20 min ranging from 17-29% of dose, with a subsequent return to ~5% by the end of 2h. Production of (13)CO2 from 1-(13)C-phenylalanine in all children with PKU prior to sapropterin treatment remained low. Following sapropterin supplementation for a week, production of (13)CO2 significantly increased in five children with a subsequent decline in blood phenylalanine levels, suggesting improved PAH activity. Sapropterin treatment was not effective in three children whose (13)CO2 production remained unchanged, and did not show a reduction in blood phenylalanine levels and improvement in dietary phenylalanine tolerance. CONCLUSIONS Our study shows that the (13)C-PBT can be a minimally invasive, safe and reliable measure to examine phenylalanine metabolism in children with phenylketonuria. The breath data are corroborated by blood phenylalanine levels in children who had increased responses in (13)CO2 production, as reviewed post-hoc from clinical charts.
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Affiliation(s)
- Abrar Turki
- Child & Family Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Gayathri Murthy
- Child & Family Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Keiko Ueda
- Department of Pediatrics, University of British Columbia, British Columbia, Canada; Division of Biochemical Diseases, BC Children's Hospital, British Columbia, Canada
| | - Barbara Cheng
- Department of Pediatrics, University of British Columbia, British Columbia, Canada; Division of Biochemical Diseases, BC Children's Hospital, British Columbia, Canada
| | - Alette Giezen
- Department of Pediatrics, University of British Columbia, British Columbia, Canada; Division of Biochemical Diseases, BC Children's Hospital, British Columbia, Canada
| | - Sylvia Stockler-Ipsiroglu
- Child & Family Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, British Columbia, Canada; Division of Biochemical Diseases, BC Children's Hospital, British Columbia, Canada
| | - Rajavel Elango
- Child & Family Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, British Columbia, Canada; School of Population and Public Health, University of British Columbia, British Columbia, Canada.
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390
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391
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Nardecchia F, Manti F, Chiarotti F, Carducci C, Carducci C, Leuzzi V. Neurocognitive and neuroimaging outcome of early treated young adult PKU patients: A longitudinal study. Mol Genet Metab 2015; 115:84-90. [PMID: 25952249 DOI: 10.1016/j.ymgme.2015.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/22/2015] [Accepted: 04/25/2015] [Indexed: 10/23/2022]
Abstract
The aim of the study was to explore the outcome of neurocognitive deficits and neuroimaging correlates in young adult early treated phenylketonuric (PKU) patients. We conducted a longitudinal study of 14 PKU patients that were assessed for IQ and neuropsychological functioning including executive functions (EF) over 14 years of follow-up (age range at 1st and 2nd assessments were 7.8-13.5 and 22.2-27.7 years, respectively). The IQ of all 14 PKU patients was within the normal range. With respect to the 1st assessment, mean IQ at follow-up did not decrease significantly. Compared to control subjects (n = 14), mean IQ of patients was significantly lower (p = .0005). Throughout adolescence and early adulthood there was an improvement of neuropsychological functioning of PKU patients in spite of the relaxation of diet, however some deficits were still detectable when compared to controls. All patients that underwent a second MRI scan showed white matter alterations ranging from mild to severe which was correlated neither with IQ nor with EF scoring. Cognitive, neuropsychological and neuroimaging outcome was influenced from life-long and/or second decade of life metabolic control. Nevertheless patients' developmental trajectories were in some cases independent from metabolic control. Our results support the hypothesis of an individual vulnerability to phenylalanine. However, as long as individual factors that account for the vulnerability to Phe are not recognized, strict dietary control is recommended for all the patients also in the second decade of life.
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Affiliation(s)
- Francesca Nardecchia
- Department of Pediatrics and 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.
| | - Filippo Manti
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, SAPIENZA University of Rome, Via dei Sabelli 108, 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 Rome, Italy.
| | - Carla Carducci
- Department of Experimental Medicine, SAPIENZA University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
| | - Vincenzo Leuzzi
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, SAPIENZA University of Rome, Via dei Sabelli 108, 00185 Rome, Italy.
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392
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Bravo P, Raimann E, Cabello JF, Arias C, Peredo P, Castro G, Hamilton V, Campo K, Cornejo V. [What should the paediatrician know about hyperphenylalaninaemia?]. REVISTA CHILENA DE PEDIATRIA 2015; 86:214-218. [PMID: 26363863 DOI: 10.1016/j.rchipe.2015.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/04/2015] [Indexed: 06/05/2023]
Abstract
Hyperphenylalaninaemias are defined by a blood phenylalanine over 2mg/dl. The main cause is due to a mutation in the gene that codes the phenylalanine hydroxylase that catalyses the reaction that converts phenylalanine into tyrosine. The hyperphenylalaninaemias are classified into benign or mild hyperphenylalaninaemias, or mild, moderate or classic phenylketonurias. Due to its delayed detection outside the neonatal period it causes severe mental retardation. Its detection along with congenital hypothyroidism has been part of the National Neonatal Screening Program since 1992 in Chile. This article aims to answer the most common questions asked by the paediatrician when faced with a patient with hyperphenylalaninaemias.
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Affiliation(s)
- Paulina Bravo
- Laboratorio de Genética y Enfermedades Metabólicas (LabGEM), Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile.
| | - Erna Raimann
- Laboratorio de Genética y Enfermedades Metabólicas (LabGEM), Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Juan Francisco Cabello
- Laboratorio de Genética y Enfermedades Metabólicas (LabGEM), Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Carolina Arias
- Laboratorio de Genética y Enfermedades Metabólicas (LabGEM), Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Pilar Peredo
- Laboratorio de Genética y Enfermedades Metabólicas (LabGEM), Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Gabriela Castro
- Laboratorio de Genética y Enfermedades Metabólicas (LabGEM), Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Valerie Hamilton
- Laboratorio de Genética y Enfermedades Metabólicas (LabGEM), Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Karen Campo
- Laboratorio de Genética y Enfermedades Metabólicas (LabGEM), Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Verónica Cornejo
- Laboratorio de Genética y Enfermedades Metabólicas (LabGEM), Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
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393
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New insights in growth of phenylketonuric patients. Eur J Pediatr 2015; 174:651-9. [PMID: 25367055 DOI: 10.1007/s00431-014-2446-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Treatment of phenylketonuria involves a restriction in the intake of natural proteins. This can lead to growth impairment. Weight, height and body mass index of 109 hyperphenylalaninemic patients (mild hyperphenylalaninemia (HPA) and phenylketonuria (PKU)) were determined from birth until 18 years, every 6 months, and differences to the healthy population, depending on the age, sex and phenotype, were analyzed. Data collection was longitudinal retrospective during 31 years. Statistical analysis of z-score values was performed by advanced statistical tools. Long-term evolution of anthropometric z-scores showed no significant statistical differences between PKU and mild HPA individuals, according to the general population. For PKU individuals, height is slightly lower and weight slightly higher than in the healthy population, but differences are smaller than one standard deviation. Nevertheless, over-time evolutions of female height z-scores are different in each type of pathology, with a crossover between 8 and 12 years (p = 0.0186). CONCLUSIONS It is nowadays possible to achieve a long-term normal growth in PKU patients with appropriate dietary treatment. There is however an acceleration of growth up to 8 years old for PKU female patients that leads to a slightly lower final height. Detection of this behaviour was possible by using nonlinear mixed effects models.
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394
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Translating rare-disease therapies into improved care for patients and families: what are the right outcomes, designs, and engagement approaches in health-systems research? Genet Med 2015; 18:117-23. [DOI: 10.1038/gim.2015.42] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 02/23/2015] [Indexed: 01/04/2023] Open
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395
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Trefz F, Lichtenberger O, Blau N, Muntau AC, Feillet F, Bélanger-Quintana A, van Spronsen F, Munafo A. Tetrahydrobiopterin (BH4) responsiveness in neonates with hyperphenylalaninemia: a semi-mechanistically-based, nonlinear mixed-effect modeling. Mol Genet Metab 2015; 114:564-9. [PMID: 25726095 DOI: 10.1016/j.ymgme.2015.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 11/30/2022]
Abstract
Neonatal loading studies with tetrahydrobiopterin (BH4) are used to detect hyperphenylalaninemia due to BH4 deficiency by evaluating decreases in blood phenylalanine (Phe) concentrations post BH4 load. BH4 responsiveness in phenylalanine hydroxylase (PAH)-deficient patients introduced a new diagnostic aspect for this test. In older children, a broad spectrum of different levels of responsiveness has been described. The primary objective of this study was to develop a pharmacodynamic model to improve the description of individual sensitivity to BH4 in the neonatal period. Secondary objectives were to evaluate BH4 responsiveness in a large number of PAH-deficient patients from a neonatal screening program and in patients with various confirmed BH4 deficiencies from the BIODEF database. Descriptive statistics in patients with PAH deficiency with 0-24-h data available showed that 129 of 340 patients (37.9%) had a >30% decrease in Phe levels post load. Patients with dihydropteridine reductase deficiency (n = 53) could not be differentiated from BH4-responsive patients with PAH deficiency. The pharmacologic turnover model, "stimulation of loss" of Phe following BH4 load, fitted the data best. Using the model, 193 of 194 (99.5%) patients with a proven BH4 synthesis deficiency or recycling defect were classified as BH4 sensitive. Among patients with PAH deficiency, 216 of 375 (57.6%) patients showed sensitivity to BH4, albeit with a pronounced variability; PAH-deficient patients with blood Phe <1200 μmol/L at time 0 showed higher sensitivity than patients with blood Phe levels >1200 μmol/L. External validation showed good correlation between the present approach, using 0-24-h blood Phe data, and the published 48-h prognostic test. Pharmacodynamic modeling of Phe levels following a BH4 loading test is sufficiently powerful to detect a wide range of responsiveness, interpretable as a measure of sensitivity to BH4. However, the clinical relevance of small responses needs to be evaluated by further studies of their relationship to long-term response to BH4 treatment.
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Affiliation(s)
- Friedrich Trefz
- Outpatient Medical Centre for Women, Children and Adolescents, Kreiskliniken Reutlingen GmbH, 72501 Gammertingen, Marktstrasse 4, Germany.
| | | | - Nenad Blau
- University Children's Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.
| | - Ania C Muntau
- University Children's Hospital, Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Francois Feillet
- Reference Centre for Inborn Metabolic Diseases, Pediatric Unit, Children's Hospital, CHU Brabois, Allée du Morvan, 54511 Vandoeuvre les Nancy, France.
| | - Amaya Bélanger-Quintana
- Unidad de Enfermedades Metabolicas, Servicio de Pediatria, Hospital Ramon y Cajal, Crta Colmenar km 9, 1 Madrid 28034, Spain.
| | - Francjan van Spronsen
- Beatrix Children's Hospital, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands.
| | - Alain Munafo
- Merck Institute for Pharmacometrics, Merck Serono S.A., EPFL Innovation Park - Building I, CH-1015 Lausanne, Switzerland.
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396
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Longo N, Arnold GL, Pridjian G, Enns GM, Ficicioglu C, Parker S, Cohen-Pfeffer JL. Long-term safety and efficacy of sapropterin: the PKUDOS registry experience. Mol Genet Metab 2015; 114:557-63. [PMID: 25724073 DOI: 10.1016/j.ymgme.2015.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/10/2015] [Accepted: 02/10/2015] [Indexed: 11/26/2022]
Abstract
The Phenylketonuria (PKU) Demographics, Outcomes and Safety (PKUDOS) registry is designed to provide longitudinal safety and efficacy data on subjects with PKU who are (or have been) treated with sapropterin dihydrochloride. The PKUDOS population consists of 1189 subjects with PKU: N = 504 who were continuously exposed to sapropterin from date of registry enrollment, N = 211 who had intermittent exposure to the drug, and N = 474 with some other duration of exposure. Subjects continuously exposed to sapropterin showed an average 34% decrease in blood phenylalanine (Phe)--from 591 ± 382 μmol/L at baseline to 392 ± 239 μmol/L (p = 0.0009) after 5 years. This drop in blood Phe was associated with an increase in dietary Phe tolerance [from 1000 ± 959 mg/day (pre-sapropterin baseline) to 1539 ± 840 mg/day after 6 years]. Drug-related adverse events (AEs) were reported in 6% of subjects, were mostly considered non-serious, and were identified in the gastrointestinal, respiratory, and nervous systems. Serious drug-related AEs were reported in ≤ 1% of subjects. Similar safety and efficacy data were observed for children<4 years. Long-term data from the PKUDOS registry suggest that sapropterin has a tolerable safety profile and that continuous use is associated with a significant and persistent decrease in blood Phe and improvements in dietary Phe tolerance.
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Affiliation(s)
- Nicola Longo
- University of Utah, Division of Medical Genetics, Salt Lake City, UT 84108, USA
| | - Georgianne L Arnold
- University of Pittsburgh School of Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA 15238, USA
| | - Gabriella Pridjian
- Tulane University School of Medicine, Hayward Genetics Center, New Orleans, LA 70112, USA
| | - Gregory M Enns
- Stanford University, Division of Medical Genetics, Stanford, CA 94305-5208, USA
| | - Can Ficicioglu
- The Children's Hospital of Philadelphia, Perelman School of Medicine,University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Susan Parker
- BioMarin Pharmaceutical Inc., 105 Digital Drive, Novato, CA 94949, USA
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397
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Sharman R, Sullivan KA, Jones T, Young RM, McGill J. Executive functioning of 4 children with hyperphenylalaninemia from childhood to adolescence. Pediatrics 2015; 135:e1072-4. [PMID: 25825540 DOI: 10.1542/peds.2013-4200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Hyperphenylalaninemia is a variant of phenylketonuria, and debate remains as to what, if any, active management of this condition is required to preserve cognitive function and psychological well-being. This study is the first to examine longitudinally the executive function (EF) in adolescents with hyperphenylalaninemia. Two sibling pairs with mild hyperphenylalaninemia underwent neuropsychological examination in early childhood and again in adolescence using EF tests that were highly sensitive to phenylalanine exposure. By early adolescence, none of the 4 children demonstrated EF impairment. The children demonstrated a typical developmental trajectory of EF from childhood to adolescence, given phenylalanine exposure consistent with their condition.
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Affiliation(s)
- Rachael Sharman
- University of the Sunshine Coast, Sunshine Coast, Queensland, Australia;
| | - Karen A Sullivan
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Toni Jones
- Great Southern Psychiatric and Psychological Services, Albany, Western Australia; and
| | - Ross McD Young
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jim McGill
- Neurometabolic Department, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
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398
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Stockler-Ipsiroglu S, Yuskiv N, Salvarinova R, Apatean D, Ho G, Cheng B, Giezen A, Lillquist Y, Ueda K. Individualized long-term outcomes in blood phenylalanine concentrations and dietary phenylalanine tolerance in 11 patients with primary phenylalanine hydroxylase (PAH) deficiency treated with Sapropterin-dihydrochloride. Mol Genet Metab 2015; 114:409-14. [PMID: 25497838 DOI: 10.1016/j.ymgme.2014.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/20/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
We analyzed long-term sustainability of improved blood Phenylalanine (Phe) control and changes to dietary Phe tolerance in 11 patients (1 month to 16 years), with various forms of primary PAH deficiency (classic, moderate, severe phenylketonuria [PKU], mild hyperphenylalaninemia [HPA]), who were treated with 15-20mg/kg/d Sapropterin-dihydrochloride during a period of 13-44 months. 7/11 patients had a sustainable, significant reduction of baseline blood Phe concentrations and 6 of them also had an increase in mg/kg/day Phe tolerance. In 2 patients with mild HPA, blood Phe concentrations remained in the physiologic range even after a 22 and 36% increase in mg/kg/day Phe tolerance and an achieved Phe intake at 105% and 268% of the dietary reference intake (DRI) for protein. 2 of these responders had classic PKU. 1 patient with mild HPA who started treatment at 2 months of life, had a significant and sustainable reduction in pretreatment blood Phe concentrations, but no increase in the mg/kg/day Phe tolerance. An increase in Phe tolerance could only be demonstrated when expressing the patient's daily Phe tolerance with the DRI for protein showing an increase from 58% at baseline to 78% of normal DRI at the end of the observation. Long-term follow-up of patients with an initial response to treatment with Sapropterin is essential to determine clinically meaningful outcomes. Phenylalanine tolerance should be expressed in mg/kg/day and/or % of normal DRI to differentiate medical therapy related from physiologic growth related increase in daily Phe intake.
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Affiliation(s)
- Sylvia Stockler-Ipsiroglu
- Department of Pediatrics, University of British Columbia, Division of Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada.
| | - Nataliya Yuskiv
- Department of Pediatrics, University of British Columbia, Division of Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada
| | - Ramona Salvarinova
- Department of Pediatrics, University of British Columbia, Division of Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada
| | - Delia Apatean
- Department of Pediatrics, University of British Columbia, Division of Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada
| | - Gloria Ho
- Department of Pediatrics, University of British Columbia, Division of Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada
| | - Barbara Cheng
- Department of Pediatrics, University of British Columbia, Division of Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada
| | - Alette Giezen
- Department of Pediatrics, University of British Columbia, Division of Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada
| | - Yolanda Lillquist
- Department of Pediatrics, University of British Columbia, Division of Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada
| | - Keiko Ueda
- Department of Pediatrics, University of British Columbia, Division of Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada
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Burton B, Grant M, Feigenbaum A, Singh R, Hendren R, Siriwardena K, Phillips J, Sanchez-Valle A, Waisbren S, Gillis J, Prasad S, Merilainen M, Lang W, Zhang C, Yu S, Stahl S. A randomized, placebo-controlled, double-blind study of sapropterin to treat ADHD symptoms and executive function impairment in children and adults with sapropterin-responsive phenylketonuria. Mol Genet Metab 2015; 114:415-24. [PMID: 25533024 DOI: 10.1016/j.ymgme.2014.11.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 11/23/2022]
Abstract
Symptoms of attention deficit-hyperactivity disorder (ADHD), particularly inattention, and impairments in executive functioning have been reported in early and continuously treated children, adolescents, and adults with phenylketonuria (PKU). In addition, higher blood phenylalanine (Phe) levels have been correlated with the presence of ADHD symptoms and executive functioning impairment. The placebo-controlled PKU ASCEND study evaluated the effects of sapropterin therapy on PKU-associated symptoms of ADHD and executive and global functioning in individuals who had a therapeutic blood Phe response to sapropterin therapy. The presence of ADHD inattentive symptoms and executive functioning deficits was confirmed in this large cohort of 206 children and adults with PKU, of whom 118 responded to sapropterin therapy. In the 38 individuals with sapropterin-responsive PKU and ADHD symptoms at baseline, sapropterin therapy resulted in a significant improvement in ADHD inattentive symptoms in the first 4 weeks of treatment, and improvements were maintained throughout the 26 weeks of treatment. Sapropterin was well-tolerated with a favorable safety profile. The improvements in ADHD inattentive symptoms and aspects of executive functioning in response to sapropterin therapy noted in a large cohort of individuals with PKU indicate that these symptoms are potentially reversible when blood Phe levels are reduced.
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Affiliation(s)
- B Burton
- The Ann and Robert H. Lurie Children's Hospital and the Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - M Grant
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - A Feigenbaum
- The Hospital for Sick Children and University of Toronto, ON, Canada
| | - R Singh
- Emory University School of Medicine, Decatur, GA, USA
| | - R Hendren
- University of California, San Francisco, San Francisco, CA, USA
| | - K Siriwardena
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - J Phillips
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - A Sanchez-Valle
- University of South Florida and Tampa General Hospital, Tampa, FL, USA
| | - S Waisbren
- Boston Children's Hospital, Boston, MA, USA
| | - J Gillis
- IWK Health Centre Maritime Medical Genetics Services, Halifax, NS, Canada
| | - S Prasad
- BioMarin Pharmaceutical Inc., Novato, CA, USA
| | | | - W Lang
- BioMarin Pharmaceutical Inc., Novato, CA, USA
| | - C Zhang
- BioMarin Pharmaceutical Inc., Novato, CA, USA
| | - S Yu
- BioMarin Pharmaceutical Inc., Novato, CA, USA
| | - S Stahl
- University of California, San Diego School of Medicine, San Diego, CA, USA
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