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Bregalda A, Carducci C, Pascucci T, Ambrogini P, Sartini S, Pierigè F, di Carlo E, Fiori E, Ielpo D, Pagliarini M, Leuzzi V, Magnani M, Rossi L. New findings about neuropathological outcomes in the PKU mouse throughout lifespan. Mol Genet Metab 2024; 143:108543. [PMID: 39047302 DOI: 10.1016/j.ymgme.2024.108543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
Phenylketonuria (PKU, OMIM 261600) is a genetic disorder caused by a deficiency of the hepatic enzyme phenylalanine hydroxylase (PAH). If left untreated, PKU leads to systemic phenylalanine (Phe) accumulation, which can result in irreversible brain damage and intellectual disabilities. In the last 60 years, early and strict dietary restriction of phenylalanine (Phe) intake proved to prevent the severe clinical phenotype of untreated PKU. While the specific mechanisms through which phenylalanine causes brain damage are still poorly understood, preclinical models have been deeply explored to characterize the neurotoxic effect of Phe on neurodevelopmental processes. At the same time, that on the aging brain still needs to be explored. In the brain of untreated PAHEnu2(-/-) mouse, we previously reported a reduction of myelin basic protein (MBP) during postnatal development up to 60 PND. Later in the diseased mouse's life, a spontaneous and persistent restoration of MBP was detected. In this present longitudinal study, ranging from 14 to 540 post-natal days (PND) of untreated PAHEnu2(-/-) mice, we further investigated: a) the long-life consistency of two Phe-related brain metabolic alterations, such as large neutral amino acids (LNAA) and biogenic amine neurotransmitters' depletion; b) the outcome of locomotor functions during the same life span; c) the integrity of myelin as assessed ex vivo by central (hippocampus) and peripheral (extensor digitorum longus-sciatic nerve) action potential conduction velocities. In contrast with the results of other studies, brain Leu, Ile, and Val concentrations were not significantly altered in the brain PAHEnu2(-/-) mouse. On the other hand, 3-O-Methyldopa (3-OMD, a biomarker of L-DOPA), serotonin, and its associated metabolites were reduced throughout most of the considered time points, with consistent reductions observed prevalently from 14 to 60 PND. Normal saltatory conduction was restored after 60 PND and remained normal at the last examination at 360 PND, resulting nonetheless in a persistent locomotor impairment throughout a lifetime. These new findings contribute to laying the foundations for the preclinical characterization of aging in PKU, confirming neurotransmitter defects as consistent metabolic traits. LNAAs have a minor role, if any, in brain damage pathogenesis. Transient myelin synthesis failure may impact brain connectivity during postnatal development but not nervous signal conduction.
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Affiliation(s)
- Alessandro Bregalda
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy; Pathology Unit, Centro di Riferimento Oncologico di Aviano (C.R.O.) IRCCS, via Franco Gallini 2, 33081 Aviano (PN), Italy.
| | - Claudia Carducci
- Department of Experimental Medicine, Sapienza University, viale del Policlinico 155, 00161 Rome, Italy
| | - Tiziana Pascucci
- Fondazione Santa Lucia IRCCS, via Del Fosso di Fiorano, 64, 00143 Rome, Italy; Department of Psychology and Centro "Daniel Bovet", Sapienza University, via dei Marsi 78, 00185 Rome, Italy
| | - Patrizia Ambrogini
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy
| | - Stefano Sartini
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy
| | - Francesca Pierigè
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy
| | - Emanuele di Carlo
- Department of Experimental Medicine, Sapienza University, viale del Policlinico 155, 00161 Rome, Italy
| | - Elena Fiori
- Fondazione Santa Lucia IRCCS, via Del Fosso di Fiorano, 64, 00143 Rome, Italy; Technopole Foundation, P.le Aldo Moro 5, 00185 Rome, Italy
| | - Donald Ielpo
- Fondazione Santa Lucia IRCCS, via Del Fosso di Fiorano, 64, 00143 Rome, Italy; Department of Psychology and Centro "Daniel Bovet", Sapienza University, via dei Marsi 78, 00185 Rome, Italy
| | - Marica Pagliarini
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Sapienza University, via dei Sabelli 108, 00185 Rome, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy; EryDel SpA, via Antonio Meucci 3, 20091 Bresso (MI), Italy
| | - Luigia Rossi
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy; EryDel SpA, via Antonio Meucci 3, 20091 Bresso (MI), Italy
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van Wegberg AMJ, van der Weerd JC, Engelke UFH, Coene KLM, Jahja R, Bakker SJL, Huijbregts SCJ, Wevers RA, Heiner-Fokkema MR, van Spronsen FJ. The clinical relevance of novel biomarkers as outcome parameter in adults with phenylketonuria. J Inherit Metab Dis 2024; 47:624-635. [PMID: 38556470 DOI: 10.1002/jimd.12732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024]
Abstract
Recent studies in PKU patients identified alternative biomarkers in blood using untargeted metabolomics. To test the added clinical value of these novel biomarkers, targeted metabolomics of 11 PKU biomarkers (phenylalanine, glutamyl-phenylalanine, glutamyl-glutamyl-phenylalanine, N-lactoyl-phenylalanine, N-acetyl-phenylalanine, the dipeptides phenylalanyl-phenylalanine and phenylalanyl-leucine, phenylalanine-hexose conjugate, phenyllactate, phenylpyruvate, and phenylacetate) was performed in stored serum samples of the well-defined PKU patient-COBESO cohort and a healthy control group. Serum samples of 35 PKU adults and 20 healthy age- and sex-matched controls were analyzed using ultra-high performance liquid chromatography quadrupole time-of-flight mass spectrometry. Group differences were tested using the Mann-Whitney U test. Multiple linear regression analyses were performed with these biomarkers as predictors of (neuro-)cognitive functions working memory, sustained attention, inhibitory control, and mental health. Compared to healthy controls, phenylalanine, glutamyl-phenylalanine, N-lactoyl-phenylalanine, N-acetyl-phenylalanine, phenylalanine-hexose conjugate, phenyllactate, phenylpyruvate, and phenylacetate were significant elevated in PKU adults (p < 0.001). The remaining three were below limit of detection in PKU and controls. Both phenylalanine and N-lactoyl-phenylalanine were associated with DSM-VI Attention deficit/hyperactivity (R2 = 0.195, p = 0.039 and R2 = 0.335, p = 0.002, respectively) of the ASR questionnaire. In addition, N-lactoyl-phenylalanine showed significant associations with ASR DSM-VI avoidant personality (R2 = 0.265, p = 0.010), internalizing (R2 = 0.192, p = 0.046) and externalizing problems (R2 = 0.217, p = 0.029) of the ASR questionnaire and multiple aspects of the MS2D and FI tests, reflecting working memory with R2 between 0.178 (p = 0.048) and 0.204 (p = 0.033). Even though the strength of the models was not considered strong, N-lactoyl-phenylalanine outperformed phenylalanine in its association with working memory and mental health outcomes.
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Affiliation(s)
- A M J van Wegberg
- Division of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, The Netherlands
| | - J C van der Weerd
- Department of Laboratory Medicine, Laboratory of Metabolic Diseases, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - U F H Engelke
- Department of Human Genetics, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K L M Coene
- Laboratory of Clinical Chemistry and Hematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - R Jahja
- Division of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, The Netherlands
| | - S J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
| | - S C J Huijbregts
- Department of Clinical Child and Adolescent Studies-Neurodevelopmental Disorders, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
| | - R A Wevers
- Department of Human Genetics, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M R Heiner-Fokkema
- Department of Laboratory Medicine, Laboratory of Metabolic Diseases, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - F J van Spronsen
- Division of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, The Netherlands
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Pardo J, Capdevila-Lacasa C, Segura B, Pané A, Montserrat C, de Talló Forga-Visa M, Moreno PJ, Garrabou G, Grau-Junyent JM, Junqué C. Volumetric brain reductions in adult patients with phenylketonuria and their relationship with blood phenylalanine levels. J Neurodev Disord 2024; 16:33. [PMID: 38907189 PMCID: PMC11193301 DOI: 10.1186/s11689-024-09553-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Continued dietary treatment since early diagnosis through newborn screening programs usually prevents brain-related complications in phenylketonuria (PKU). However, subtle neurocognitive and brain alterations may be observed in some adult patients despite early treatment. Nevertheless, neuropsychological and neuroimaging studies in the field remain scarce. OBJECTIVES This work aimed to determine possible neuropsychological and structural brain alterations in treated adult patients with PKU. METHODS Thirty-five patients with PKU and 22 healthy controls (HC) underwent neuropsychological assessment and T1-weighted magnetic resonance imaging on a 3 T scanner. FreeSurfer (v.7.1) was used to obtain volumetric measures and SPSS (v27.0.1.0) was used to analyze sociodemographic, neuropsychological, volumetric, and clinical data (p < 0.05). RESULTS Adult patients with PKU showed significantly lower performance than HC in Full Scale IQ (t = 2.67; p = .010) from the WAIS-IV. The PKU group also showed significantly lower volumes than HC in the pallidum (U = 224.000; p = .008), hippocampus (U = 243.000; p = .020), amygdala (U = 200.000; p = .002), and brainstem (t = 3.17; p = .006) as well as in total cerebral white matter volume (U = 175.000; p = .001). Blood phenylalanine (Phe) levels in PKU patients were negatively correlated with the pallidum (r = -0.417; p = .013) and brainstem (r = -0.455, p = .006) volumes. CONCLUSIONS Adult patients with early-treated PKU showed significantly lower global intelligence than HC. Moreover, these patients showed reduced global white matter volume as well as reductions in the volume of several subcortical grey matter structures, which might be related to the existence of underlying neurodevelopmental alterations. Higher blood Phe levels were also negatively correlated with pallidum and brainstem, suggesting a higher vulnerability of these structures to Phe toxicity.
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Affiliation(s)
- Jèssica Pardo
- Institute of Neurosciences, Medical Psychology Unit, Department of Medicine, University of Barcelona, C/ Casanova 143, Barcelona, Catalonia, 08036, Spain
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain
| | - Clara Capdevila-Lacasa
- Institute of Neurosciences, Medical Psychology Unit, Department of Medicine, University of Barcelona, C/ Casanova 143, Barcelona, Catalonia, 08036, Spain
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain
| | - Bàrbara Segura
- Institute of Neurosciences, Medical Psychology Unit, Department of Medicine, University of Barcelona, C/ Casanova 143, Barcelona, Catalonia, 08036, Spain.
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain.
- Biomedical Research Networking Center On Neurodegenerative Diseases (CIBERNED: CB06/05/0018-ISCIII), Barcelona, Catalonia, Spain.
| | - Adriana Pané
- Biomedical Research Networking Center on Physiopathology of Obesity and Nutrition (CIBEROBN), Barcelona, Catalonia, Spain
- Endocrinology and Nutrition Department, Adult Inherited Metabolic Disorders Unit (UECMA), Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Cristina Montserrat
- Endocrinology and Nutrition Department, Adult Inherited Metabolic Disorders Unit (UECMA), Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Maria de Talló Forga-Visa
- Endocrinology and Nutrition Department, Adult Inherited Metabolic Disorders Unit (UECMA), Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Pedro J Moreno
- Internal Medicine Department, Adult Inherited Metabolic Disorders Unit (UECMA), Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Inherited Metabolic Diseases and Muscle Disorders Research, Centre de Recerca Biomèdica CELLEX - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
- Biomedical Research Networking Center on Rare Diseases (CIBERER), Barcelona, Catalonia, Spain
| | - Glòria Garrabou
- Internal Medicine Department, Adult Inherited Metabolic Disorders Unit (UECMA), Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Inherited Metabolic Diseases and Muscle Disorders Research, Centre de Recerca Biomèdica CELLEX - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
- Biomedical Research Networking Center on Rare Diseases (CIBERER), Barcelona, Catalonia, Spain
| | - Josep M Grau-Junyent
- Internal Medicine Department, Adult Inherited Metabolic Disorders Unit (UECMA), Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Inherited Metabolic Diseases and Muscle Disorders Research, Centre de Recerca Biomèdica CELLEX - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain
- Biomedical Research Networking Center on Rare Diseases (CIBERER), Barcelona, Catalonia, Spain
| | - Carme Junqué
- Institute of Neurosciences, Medical Psychology Unit, Department of Medicine, University of Barcelona, C/ Casanova 143, Barcelona, Catalonia, 08036, Spain
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain
- Biomedical Research Networking Center On Neurodegenerative Diseases (CIBERNED: CB06/05/0018-ISCIII), Barcelona, Catalonia, Spain
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Delbreil P, Dhondt S, Kenaan El Rahbani RM, Banquy X, Mitchell JJ, Brambilla D. Current Advances and Material Innovations in the Search for Novel Treatments of Phenylketonuria. Adv Healthc Mater 2024:e2401353. [PMID: 38801163 DOI: 10.1002/adhm.202401353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/22/2024] [Indexed: 05/29/2024]
Abstract
Phenylketonuria (PKU) is a genetically inherited disease caused by a mutation of the gene encoding phenylalanine hydroxylase (PAH) and is the most common inborn error of amino acid metabolism. A deficiency of PAH leads to increased blood and brain levels of phenylalanine (Phe), which may cause permanent neurocognitive symptoms and developmental delays if untreated. Current management strategies for PKU consist of early detection through neonatal screening and implementation of a restrictive diet with minimal amounts of natural protein in combination with Phe-free supplements and low-protein foods to meet nutritional requirements. For milder forms of PKU, oral treatment with synthetic sapropterin (BH4), the cofactor of PAH, may improve metabolic control of Phe and allow for more natural protein to be included in the patient's diet. For more severe forms, daily injections of pegvaliase, a PEGylated variant of phenylalanine ammonia-lyase (PAL), may allow for normalization of blood Phe levels. However, the latter treatment has considerable drawbacks, notably a strong immunogenicity of the exogenous enzyme and the attached polymeric chains. Research for novel therapies of PKU makes use of innovative materials for drug delivery and state-of-the-art protein engineering techniques to develop treatments which are safer, more effective, and potentially permanent.
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Affiliation(s)
- Philippe Delbreil
- Faculty of Pharmacy, Université de Montréal, Québec, H3T 1J4, Canada
| | - Sofie Dhondt
- Faculty of Pharmacy, Université de Montréal, Québec, H3T 1J4, Canada
| | | | - Xavier Banquy
- Faculty of Pharmacy, Université de Montréal, Québec, H3T 1J4, Canada
| | - John J Mitchell
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Québec, H4A 3J1, Canada
| | - Davide Brambilla
- Faculty of Pharmacy, Université de Montréal, Québec, H3T 1J4, Canada
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Trefz F, Frauendienst-Egger G, Dienel G, Cannet C, Schmidt-Mader B, Haas D, Blau N, Himmelreich N, Spraul M, Freisinger P, Dobrowolski S, Berg D, Pilotto A. Does hyperphenylalaninemia induce brain glucose hypometabolism? Cerebral spinal fluid findings in treated adult phenylketonuric patients. Mol Genet Metab 2024; 142:108464. [PMID: 38537426 DOI: 10.1016/j.ymgme.2024.108464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 05/08/2024]
Abstract
Despite numerous studies in human patients and animal models for phenylketonuria (PKU; OMIM#261600), the pathophysiology of PKU and the underlying causes of brain dysfunction and cognitive problems in PKU patients are not well understood. In this study, lumbar cerebral spinal fluid (CSF) was obtained immediately after blood sampling from early-treated adult PKU patients who had fasted overnight. Metabolite and amino acid concentrations in the CSF of PKU patients were compared with those of non-PKU controls. The CSF concentrations and CSF/plasma ratios for glucose and lactate were found to be below normal, similar to what has been reported for glucose transporter1 (GLUT1) deficiency patients who exhibit many of the same clinical symptoms as untreated PKU patients. CSF glucose and lactate levels were negatively correlated with CSF phenylalanine (Phe), while CSF glutamine and glutamate levels were positively correlated with CSF Phe levels. Plasma glucose levels were negatively correlated with plasma Phe concentrations in PKU subjects, which partly explains the reduced CSF glucose concentrations. Although brain glucose concentrations are unlikely to be low enough to impair brain glucose utilization, it is possible that the metabolism of Phe in the brain to produce phenyllactate, which can be transported across the blood-brain barrier to the blood, may consume glucose and/or lactate to generate the carbon backbone for glutamate. This glutamate is then converted to glutamine and carries the Phe-derived ammonia from the brain to the blood. While this mechanism remains to be tested, it may explain the correlations of CSF glutamine, glucose, and lactate concentrations with CSF Phe.
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Affiliation(s)
- Friedrich Trefz
- Heidelberg University, Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic Medicine, Heidelberg, Germany.
| | | | - Gerald Dienel
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Department of Cell Biology and Physiology, University of New Mexico, Albuquerque, NM, United States
| | | | - Brigitte Schmidt-Mader
- Heidelberg University, Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic Medicine, Heidelberg, Germany
| | - Dorothea Haas
- Heidelberg University, Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic Medicine, Heidelberg, Germany
| | - Nenad Blau
- University Children's Hospital Zürich, Zürich, Switzerland
| | | | | | - Peter Freisinger
- Klinikum Reutlingen, Department of Pediatrics, Reutlingen, Germany
| | - Steven Dobrowolski
- Department of Pathology, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15224, United States
| | - Daniela Berg
- Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
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Parolisi S, Montanari C, Borghi E, Cazzorla C, Zuvadelli J, Tosi M, Barone R, Bensi G, Bonfanti C, Dionisi Vici C, Biasucci G, Burlina A, Carbone MT, Verduci E. Possible role of tryptophan metabolism along the microbiota-gut-brain axis on cognitive & behavioral aspects in Phenylketonuria. Pharmacol Res 2023; 197:106952. [PMID: 37804926 DOI: 10.1016/j.phrs.2023.106952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 10/09/2023]
Abstract
Cognitive and psychiatric disorders are well documented across the lifetime of patients with inborn errors of metabolism (IEMs). Gut microbiota impacts behavior and cognitive functions through the gut-brain axis (GBA). According to recent research, a broad spectrum of GBA disorders may be influenced by a perturbed Tryptophan (Trp) metabolism and are associated with alterations in composition or function of the gut microbiota. Furthermore, early-life diets may influence children's neurodevelopment and cognitive deficits in adulthood. In Phenylketonuria (PKU), since the main therapeutic intervention is based on a life-long restrictive diet, important alterations of gut microbiota have been observed. Studies on PKU highlight the impact of alterations of gut microbiota on the central nervous system (CNS), also investigating the involvement of metabolic pathways, such as Trp and kynurenine (KYN) metabolisms, involved in numerous neurodegenerative disorders. An alteration of Trp metabolism with an imbalance of the KYN pathway towards the production of neurotoxic metabolites implicated in numerous neurodegenerative and inflammatory diseases has been observed in PKU patients supplemented with Phe-free amino acid medical foods (AA-MF). The present review investigates the possible link between gut microbiota and the brain in IEMs, focusing on Trp metabolism in PKU. Considering the evidence collected, cognitive and behavioral well-being should always be monitored in routine IEMs clinical management. Further studies are required to evaluate the possible impact of Trp metabolism, through gut microbiota, on cognitive and behavioral functions in IEMs, to identify innovative dietetic strategies and improve quality of life and mental health of these patients.
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Affiliation(s)
- Sara Parolisi
- UOSD Metabolic Diseases, AORN Santobono-Pausilipon, Naples, Italy
| | - Chiara Montanari
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Elisa Borghi
- Department of Health Science, University of Milan, Milan, Italy
| | - Chiara Cazzorla
- Division of Inherited Metabolic Diseases, DIDAS Department of Diagnostic Services, University Hospital, Padua, Italy
| | - Juri Zuvadelli
- Clinical Department of Pediatrics, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Martina Tosi
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy; Department of Health Science, University of Milan, Milan, Italy
| | - Rita Barone
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, AOU Policlinico "G.Rodolico-San Marco", University of Catania, Catania, Italy
| | - Giulia Bensi
- Paediatrics & Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Cristina Bonfanti
- Rare metabolic disease unit, Pediatric Department, San Gerardo Hospital, Monza, Italy
| | | | - Giacomo Biasucci
- Paediatrics & Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Alberto Burlina
- Division of Inherited Metabolic Diseases, DIDAS Department of Diagnostic Services, University Hospital, Padua, Italy
| | - Maria T Carbone
- UOSD Metabolic Diseases, AORN Santobono-Pausilipon, Naples, Italy
| | - Elvira Verduci
- Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy; Department of Health Science, University of Milan, Milan, Italy.
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Wong RSH, Mohammad S, Parayil Sankaran B, Junek R, Kim WT, Wotton T, Devanapalli B, Bandodkar S, Balasubramaniam S. Developmental delay and non-phenylketonuria (PKU) hyperphenylalaninemia in DNAJC12 deficiency: Case and approach. Brain Dev 2023; 45:523-531. [PMID: 37156708 DOI: 10.1016/j.braindev.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/04/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Hyperphenylalaninemia is a biomarker for several monogenic neurotransmitter disorders where the body cannot metabolise phenylalanine to tyrosine. Biallelic pathogenic variants in DNAJC12, co-chaperone of phenylalanine, tyrosine, and tryptophan hydroxylases, leads to hyperphenylalaninemia and biogenic amines deficiency. METHODS AND RESULTS A male firstborn to non-consanguineous Sudanese parents had hyperphenylalaninemia 247 µmol/L [reference interval (RI) < 200 µmol/L] at newborn screening. Dried blood spot dihydropteridine reductase (DHPR) assay and urine pterins were normal. He had severe developmental delay and autism spectrum disorder without a notable movement disorder. A low phenylalanine diet was introduced at two years without any clinical improvements. Cerebrospinal fluid (CSF) neurotransmitters at five years demonstrated low homovanillic acid (HVA) 0.259 µmol/L (reference interval (RI) 0.345-0.716) and 5-hydroxyindoleaetic acid (5HIAA) levels 0.024 µmol/L (reference interval (RI) 0.100-0.245). Targeted neurotransmitter gene panel analysis identified a homozygous c.78 + 1del variant in DNAJC12. At six years, he was commenced on 5-hydroxytryptophan 20 mg daily, and his protein-restricted diet was liberalised, with continued good control of phenylalanine levels. Sapropterin dihydrochloride 7.2 mg/kg/day was added the following year with no observable clinical benefits. He remains globally delayed with severe autistic traits. CONCLUSIONS Urine, CSF neurotransmitter studies, and genetic testing will differentiate between phenylketonuria, tetrahydrobiopterin or DNAJC12 deficiency, with the latter characterised by a clinical spectrum ranging from mild autistic features or hyperactivity to severe intellectual disability, dystonia, and movement disorder, normal DHPR, reduced CSF HIAA and HVA. DNAJC12 deficiency should be considered early in the differential workup of hyperphenylalaninemia identified from newborn screening, with its genotyping performed once deficiencies of phenylalanine hydroxylase (PAH) and tetrahydrobiopterin (BH4) have been biochemically or genetically excluded.
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Affiliation(s)
- Rachel Sze Hui Wong
- Metabolic Genetics Service, The Sydney Children's Hospitals Network, Westmead, NSW, Australia; TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Shekeeb Mohammad
- TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Bindu Parayil Sankaran
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rosie Junek
- NSW Newborn Screening (NBS) Programme, Sydney, NSW, Australia
| | - Won-Tae Kim
- NSW Newborn Screening (NBS) Programme, Sydney, NSW, Australia
| | - Tiffany Wotton
- NSW Newborn Screening (NBS) Programme, Sydney, NSW, Australia
| | - Beena Devanapalli
- NSW Biochemical Genetics Service, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Sushil Bandodkar
- Department of Biochemistry, The Sydney Children's Hospital Network, Westmead, NSW, Australia; University of Sydney Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Shanti Balasubramaniam
- Metabolic Genetics Service, The Sydney Children's Hospitals Network, Westmead, NSW, Australia; Discipline of Genomic Medicine, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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Cannet C, Bayat A, Frauendienst-Egger G, Freisinger P, Spraul M, Himmelreich N, Kockaya M, Ahring K, Godejohann M, MacDonald A, Trefz F. Phenylketonuria (PKU) Urinary Metabolomic Phenotype Is Defined by Genotype and Metabolite Imbalance: Results in 51 Early Treated Patients Using Ex Vivo 1H-NMR Analysis. Molecules 2023; 28:4916. [PMID: 37446577 DOI: 10.3390/molecules28134916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
Phenylketonuria (PKU) is a rare metabolic disorder caused by mutations in the phenylalanine hydroxylase gene. Depending on the severity of the genetic mutation, medical treatment, and patient dietary management, elevated phenylalanine (Phe) may occur in blood and brain tissues. Research has recently shown that high Phe not only impacts the central nervous system, but also other organ systems (e.g., heart and microbiome). This study used ex vivo proton nuclear magnetic resonance (1H-NMR) analysis of urine samples from PKU patients (mean 14.9 ± 9.2 years, n = 51) to identify the impact of elevated blood Phe and PKU treatment on metabolic profiles. Our results found that 24 out of 98 urinary metabolites showed a significant difference (p < 0.05) for PKU patients compared to age-matched healthy controls (n = 51) based on an analysis of urinary metabolome. These altered urinary metabolites were related to Phe metabolism, dysbiosis, creatine synthesis or intake, the tricarboxylic acid (TCA) cycle, end products of nicotinamide-adenine dinucleotide degradation, and metabolites associated with a low Phe diet. There was an excellent correlation between the metabolome and genotype of PKU patients and healthy controls of 96.7% in a confusion matrix model. Metabolomic investigations may contribute to a better understanding of PKU pathophysiology.
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Affiliation(s)
| | - Allan Bayat
- Kennedy Centre, Center for PKU, 2600 Glostrup, Denmark
| | | | - Peter Freisinger
- Department of Pediatrics, School of Medicine, University of Tübingen, 72074 Tübingen, Germany
| | | | | | - Musa Kockaya
- Private Pediatric Practice, 68307 Mannheim, Germany
| | | | | | - Anita MacDonald
- Dietetic Department, Birmingham Children's Hospital, Birmingham B4 6NH, UK
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9
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De Giorgi A, Nardecchia F, Manti F, Campistol J, Leuzzi V. Neuroimaging in early-treated phenylketonuria patients and clinical outcome: A systematic review. Mol Genet Metab 2023; 139:107588. [PMID: 37149991 DOI: 10.1016/j.ymgme.2023.107588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023]
Abstract
Lacking direct neuropathological data, neuroimaging exploration has become the most powerful tool to give insight into pathophysiological alterations of early-treated PKU (ETPKU) patients. We conducted a systematic review of neuroimaging studies in ETPKU patients to explore 1) the occurrence of consistent neuroimaging alterations; 2) the relationship between them and neurological and cognitive disorders; 3) the contribution of neuroimaging in the insight of neuropathological background of ETPKU subjects; 4) whether brain neuroimaging may provide additional information in the monitoring of the disease course. Thirty-eight studies met the inclusion criteria for the full-text review, including morphological T1/T2 sequences, diffusion brain imaging (DWI/DTI) studies, brain MRI volumetric, functional neuroimaging studies, neurotransmission and brain energetic imaging studies. Non-progressive brain white matter changes were the most frequent and precocious alterations. As confirmed in hundreds of young adults with ETPKU, they affect over 90% of ETPKU patients. Consistent correlations are emerging between microstructural alteration (as detected by DWI/DTI) and metabolic control, which have also been confirmed in a few interventional trials. Volumetric studies detected later and less consistent cortical and subcortical grey matter alterations, which seem to be influenced by the patient's age and metabolic control. The few functional neuroimaging studies so far showed preliminary but interesting data about cortical activation patterns, skill performance, and brain connectivity. Further research is mandatory in these more complex areas. Recurrent methodological limitations include restricted sample sizes concerning the clinical variability of the disease, large age-range, variable measures of metabolic control, and prevalence of cross-sectional rather than longitudinal interventional studies.
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Affiliation(s)
- Agnese De Giorgi
- Division of Child Neurology and Infantile Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Nardecchia
- Division of Child Neurology and Infantile Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Filippo Manti
- Division of Child Neurology and Infantile Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Jaume Campistol
- Neuropaediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Vincenzo Leuzzi
- Division of Child Neurology and Infantile Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
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10
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Keathley J, White J, Reid G. The Impact of Nutrition, Physical Activity, Beneficial Microbes, and Fecal Microbiota Transplant for Improving Health. Life (Basel) 2023; 13:life13051124. [PMID: 37240769 DOI: 10.3390/life13051124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/18/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
The recognition that microbes are integral to human life has led to studies on how to manipulate them in favor of health outcomes. To date, there has been no conjoint recommendation for the intake of dietary compounds that can complement the ingested organisms in terms of promoting an improved health outcome. The aim of this review is to discuss how beneficial microbes in the form of probiotics, fermented foods, and donor feces are being used to manage health. In addition, we explore the rationale for selecting beneficial microbial strains and aligning diets to accommodate their propagation in the gut. A pilot clinical trial design is presented to examine the effects of probiotics and exercise in patients with phenylketonuria (PKU); it is the most common inborn error of amino acid metabolism, and it is a complication that requires lifelong dietary intervention. The example design is provided to illustrate the importance of using omics technology to see if the intervention elevates neuroactive biogenic amines in the plasma; increases the abundance of Eubacterium rectale, Coprococcus eutactus, Akkermansia muciniphila, or Butyricicoccus; and increases Escherichia/Shigella in the gut, all as markers of improved health. By emphasizing the combined importance of diet, microbial supplements, and the gut microbiome, we hope that future studies will better align these components, not only to improve outcomes, but also to enhance our understanding of the mechanisms.
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Affiliation(s)
- Justine Keathley
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada
| | - Jessica White
- Department of Food and Nutritional Sciences, Brescia College, 1285 Western Road, London, ON N6G 1H2, Canada
| | - Gregor Reid
- Departments of Microbiology & Immunology and Surgery, The University of Western Ontario, London, ON N6A 3K7, Canada
- Lawson Health Research Institute, 268 Grosvenor Street, London, ON N6A 4V2, Canada
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11
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Christ SE, Clocksin HE, Zalik M, Goodlett BD, Sacharow SJ, Abbene EE. Neuropsychological assessment of adults with phenylketonuria using the NIH toolbox. Mol Genet Metab 2023; 139:107579. [PMID: 37099821 DOI: 10.1016/j.ymgme.2023.107579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023]
Abstract
Among researchers and clinicians, there is a call for the development and validation of new measures to better assess and characterize neurocognitive difficulties associated with early-treated phenylketonuria (ETPKU) and other metabolic disorders. The NIH Toolbox represents a relatively new computer-administered assessment tool and provides a sampling of performance across multiple cognitive domains, several of which (e.g., executive function, processing speed) are at risk for disruption in ETPKU. The goal of the present study was to provide an initial evaluation of the value and sensitivity of the NIH Toolbox for use with individuals with ETPKU. To this end, a sample of adults with ETPKU and a demographically-matched comparison group without PKU completed the cognitive and motor batteries of the Toolbox. Results indicate that overall performance (as reflected by the Fluid Cognition Composite) was sensitive to both group differences (ETPKU vs non-PKU) as well as blood Phe levels (a marker of metabolic control). The present findings offer preliminary support for the utility of the NIH Toolbox as a measure of neurocognitive functioning in individuals with ETPKU. Future research including a larger sample size and broader age range is needed to fully validate the Toolbox for clinical and research use with individuals with ETPKU.
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Affiliation(s)
- Shawn E Christ
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA.
| | - Hayley E Clocksin
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Maia Zalik
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | | | - Stephanie J Sacharow
- Boston Children's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Emily E Abbene
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
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12
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Cannet C, Frauendienst-Egger G, Freisinger P, Götz H, Götz M, Himmelreich N, Kock V, Spraul M, Bus C, Biskup S, Trefz F. Ex vivo proton spectroscopy ( 1 H-NMR) analysis of inborn errors of metabolism: Automatic and computer-assisted analyses. NMR IN BIOMEDICINE 2023; 36:e4853. [PMID: 36264537 DOI: 10.1002/nbm.4853] [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: 05/21/2021] [Revised: 07/29/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
There are about 1500 genetic metabolic diseases. A small number of treatable diseases are diagnosed by newborn screening programs, which are continually being developed. However, most diseases can only be diagnosed based on clinical symptoms or metabolic findings. The main biological fluids used are urine, plasma and, in special situations, cerebrospinal fluid. In contrast to commonly used methods such as gas chromatography and high performance liquid chromatography mass spectrometry, ex vivo proton spectroscopy (1 H-NMR) is not yet used in routine clinical practice, although it has been recommended for more than 30 years. Automatic analysis and improved NMR technology have also expanded the applications used for the diagnosis of inborn errors of metabolism. We provide a mini-overview of typical applications, especially in urine but also in plasma, used to diagnose common but also rare genetic metabolic diseases with 1 H-NMR. The use of computer-assisted diagnostic suggestions can facilitate interpretation of the profiles. In a proof of principle, to date, 182 reports of 59 different diseases and 500 reports of healthy children are stored. The percentage of correct automatic diagnoses was 74%. Using the same 1 H-NMR profile-targeted analysis, it is possible to apply an untargeted approach that distinguishes profile differences from healthy individuals. Thus, additional conditions such as lysosomal storage diseases or drug interferences are detectable. Furthermore, because 1 H-NMR is highly reproducible and can detect a variety of different substance categories, the metabolomic approach is suitable for monitoring patient treatment and revealing additional factors such as nutrition and microbiome metabolism. Besides the progress in analytical techniques, a multiomics approach is most effective to combine metabolomics with, for example, whole exome sequencing, to also diagnose patients with nondetectable metabolic abnormalities in biological fluids. In this mini review we also provide our own data to demonstrate the role of NMR in a multiomics platform in the field of inborn errors of metabolism.
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Affiliation(s)
| | - Georg Frauendienst-Egger
- Department of Pediatrics, Reutlingen, Klinikum Reutlingen, School of Medicine, University of Tuebingen, Reutlingen, Germany
| | - Peter Freisinger
- Department of Pediatrics, Reutlingen, Klinikum Reutlingen, School of Medicine, University of Tuebingen, Reutlingen, Germany
| | | | | | | | - Vanessa Kock
- Department of Pediatrics, Reutlingen, Klinikum Reutlingen, School of Medicine, University of Tuebingen, Reutlingen, Germany
| | | | - Christine Bus
- CEGAT, Tübingen, Germany and Human Genetics Institute, Tübingen, Germany
| | - Saskia Biskup
- CEGAT, Tübingen, Germany and Human Genetics Institute, Tübingen, Germany
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13
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Muri R, Maissen‐Abgottspon S, Rummel C, Rebsamen M, Wiest R, Hochuli M, Jansma BM, Trepp R, Everts R. Cortical thickness and its relationship to cognitive performance and metabolic control in adults with phenylketonuria. J Inherit Metab Dis 2022; 45:1082-1093. [PMID: 36117142 PMCID: PMC9827942 DOI: 10.1002/jimd.12561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 01/12/2023]
Abstract
Despite good control of phenylalanine (Phe) levels during childhood and adolescence, adults with phenylketonuria (PKU) often show abnormalities in the white matter of the brain, which have been associated with poorer cognitive performance. However, whether such a relationship exists with cortical gray matter is still unknown. Therefore, we investigated cortical thickness and surface area in adults with early-treated PKU and their relationship to cognitive functions and metabolic control. We included 30 adult patients with early-treated and metabolically well-controlled PKU (median age: 35.5 years) and 54 healthy controls (median age: 29.3 years). Surface-based morphometry was derived from T1-weighted magnetic resonance images using FreeSurfer, and general intelligence, executive functions, and attention were assessed. Concurrent plasma Phe, tyrosine, and tryptophan levels were measured in patients. In addition, Phe levels were collected retrospectively to calculate the index of dietary control. Patients showed a thinner cortex than controls in regions of the bilateral temporal, parietal, and occipital lobes (effect size r = -0.34 to -0.42, p < 0.05). No group differences in surface area were found. In patients, accuracy in the working memory task was positively correlated with thickness in the left insula (r = 0.45, p = 0.013), left fusiform gyrus (r = 0.39, p = 0.032), and right superior temporal gyrus (r = 0.41, p = 0.024), but did not survive false discovery rate correction. Neither concurrent nor historical metabolic parameters were related to cortical thickness. Taken together, adults with PKU showed widespread reductions in cortical thickness despite good metabolic control in childhood and adolescence. However, alterations in cortical thickness were unrelated to metabolic parameters and cognitive performance.
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Affiliation(s)
- Raphaela Muri
- Department of Diabetes, Endocrinology, Nutritional Medicine and MetabolismInselspital, Bern University Hospital and University of BernBernSwitzerland
- Support Center for Advanced Neuroimaging (SCAN)University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalBernSwitzerland
- Graduate School for Health SciencesUniversity of BernBernSwitzerland
- Translational Imaging Center (TIC)Swiss Institute for Translational and Entrepreneurial MedicineBernSwitzerland
| | - Stephanie Maissen‐Abgottspon
- Department of Diabetes, Endocrinology, Nutritional Medicine and MetabolismInselspital, Bern University Hospital and University of BernBernSwitzerland
- Translational Imaging Center (TIC)Swiss Institute for Translational and Entrepreneurial MedicineBernSwitzerland
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN)University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalBernSwitzerland
| | - Michael Rebsamen
- Support Center for Advanced Neuroimaging (SCAN)University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalBernSwitzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN)University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalBernSwitzerland
- Translational Imaging Center (TIC)Swiss Institute for Translational and Entrepreneurial MedicineBernSwitzerland
| | - Michel Hochuli
- Department of Diabetes, Endocrinology, Nutritional Medicine and MetabolismInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Bernadette M. Jansma
- Department of Cognitive NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
- Maastricht Brain Imaging Center (M‐BIC)MaastrichtThe Netherlands
| | - Roman Trepp
- Department of Diabetes, Endocrinology, Nutritional Medicine and MetabolismInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Regula Everts
- Department of Diabetes, Endocrinology, Nutritional Medicine and MetabolismInselspital, Bern University Hospital and University of BernBernSwitzerland
- Translational Imaging Center (TIC)Swiss Institute for Translational and Entrepreneurial MedicineBernSwitzerland
- Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, InselspitalBern University Hospital, University of BernBernSwitzerland
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14
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Lotz-Havla AS, Katzdobler S, Nuscher B, Weiß K, Levin J, Havla J, Maier EM. Serum glial fibrillary acidic protein and neurofilament light chain in patients with early treated phenylketonuria. Front Neurol 2022; 13:1011470. [PMID: 36247773 PMCID: PMC9559705 DOI: 10.3389/fneur.2022.1011470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/12/2022] [Indexed: 12/01/2022] Open
Abstract
To pave the way for healthy aging in early treated phenylketonuria (ETPKU) patients, a better understanding of the neurological course in this population is needed, requiring easy accessible biomarkers to monitor neurological disease progression in large cohorts. The objective of this pilot study was to investigate the potential of glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) as blood biomarkers to indicate changes of the central nervous system in ETPKU. In this single-center cross-sectional study, GFAP and NfL concentrations in serum were quantified using the Simoa® multiplex technology in 56 ETPKU patients aged 6–36 years and 16 age matched healthy controls. Correlation analysis and hierarchical linear regression analysis were performed to investigate an association with disease-related biochemical parameters and retinal layers assessed by optical coherence tomography. ETPKU patients did not show significantly higher GFAP concentrations (mean 73 pg/ml) compared to healthy controls (mean 60 pg/ml, p = 0.140). However, individual pediatric and adult ETPKU patients had GFAP concentrations above the healthy control range. In addition, there was a significant association of GFAP concentrations with current plasma tyrosine concentrations (r = −0.482, p = 0.036), a biochemical marker in phenylketonuria, and the retinal inner nuclear layer volume (r = 0.451, p = 0.04). There was no evidence of NfL alterations in our ETPKU cohort. These pilot results encourage multicenter longitudinal studies to further investigate serum GFAP as a complementary tool to better understand and monitor neurological disease progression in ETPKU. Follow-up investigations on aging ETPKU patients are required to elucidate the potential of serum NfL as biomarker.
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Affiliation(s)
- Amelie S. Lotz-Havla
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Sabrina Katzdobler
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Brigitte Nuscher
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Weiß
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Johannes Levin
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases, site Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, University Hospital, LMU Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, LMU Munich, Munich, Germany
- *Correspondence: Joachim Havla
| | - Esther M. Maier
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- Esther M. Maier
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15
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O'Shea ME, Sheehan Gilroy B, Greaney AM, MacDonald A. Moving through adulthood: The lived experience of Irish adults with PKU. Front Psychol 2022; 13:983154. [PMID: 36176784 PMCID: PMC9513515 DOI: 10.3389/fpsyg.2022.983154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis paper represents a portion of the findings from one of the first research studies eliciting the lived experience of adults with an early diagnosis of Phenylketonuria (PKU) living in Ireland. Ireland has one of the highest prevalence rates of PKU in Europe, however, little is known about the experience of Irish adults with PKU. Furthermore, Ireland is one of the first countries in the world to introduce neonatal screening followed by the introduction of long-term dietary therapy over 50 years ago. This study presents the first comprehensive assessment of the lived experience of Irish adults with PKU on long term dietary therapy.MethodsNarrative data was collected from eleven self-selected participants, using semi-structured interviews. The interviews were divided into five sections focused on eliciting a holistic understanding of the lived experience of adults with PKU living in Ireland. Thematic analysis was guided by Colaizzi's Framework (1978) in conjunction with NVivo qualitative data analysis software.FindingsFindings from the original research encompassed a broad understanding of the lived experience of adults with PKU living in Ireland, including factors influencing dietary therapy and managing PHE blood levels. The themes being discussed within this article are those which appear to be least represented within current literature: living with PKU, including reproductive health, the importance of self-management and establishing routine, support networks in adulthood and concerns regarding aging with PKU.ConclusionIt was evident from the findings that a diagnosis of PKU can influence how adults with PKU may experience aging and their own mortality. These findings offer new insight into the vulnerability attached to the experience of aging with PKU and may be beneficial to advocacy groups and for future development of policy and practice.
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Affiliation(s)
- Mary-Ellen O'Shea
- School of Health and Social Sciences, Munster Technological University, Kerry, Ireland
- *Correspondence: Mary-Ellen O'Shea
| | | | - Anna-Marie Greaney
- School of Health and Social Sciences, Munster Technological University, Kerry, Ireland
| | - Anita MacDonald
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
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16
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Elhawary NA, AlJahdali IA, Abumansour IS, Elhawary EN, Gaboon N, Dandini M, Madkhali A, Alosaimi W, Alzahrani A, Aljohani F, Melibary EM, Kensara OA. Genetic etiology and clinical challenges of phenylketonuria. Hum Genomics 2022; 16:22. [PMID: 35854334 PMCID: PMC9295449 DOI: 10.1186/s40246-022-00398-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/08/2022] [Indexed: 02/08/2023] Open
Abstract
This review discusses the epidemiology, pathophysiology, genetic etiology, and management of phenylketonuria (PKU). PKU, an autosomal recessive disease, is an inborn error of phenylalanine (Phe) metabolism caused by pathogenic variants in the phenylalanine hydroxylase (PAH) gene. The prevalence of PKU varies widely among ethnicities and geographic regions, affecting approximately 1 in 24,000 individuals worldwide. Deficiency in the PAH enzyme or, in rare cases, the cofactor tetrahydrobiopterin results in high blood Phe concentrations, causing brain dysfunction. Untreated PKU, also known as PAH deficiency, results in severe and irreversible intellectual disability, epilepsy, behavioral disorders, and clinical features such as acquired microcephaly, seizures, psychological signs, and generalized hypopigmentation of skin (including hair and eyes). Severe phenotypes are classic PKU, and less severe forms of PAH deficiency are moderate PKU, mild PKU, mild hyperphenylalaninaemia (HPA), or benign HPA. Early diagnosis and intervention must start shortly after birth to prevent major cognitive and neurological effects. Dietary treatment, including natural protein restriction and Phe-free supplements, must be used to maintain blood Phe concentrations of 120-360 μmol/L throughout the life span. Additional treatments include the casein glycomacropeptide (GMP), which contains very limited aromatic amino acids and may improve immunological function, and large neutral amino acid (LNAA) supplementation to prevent plasma Phe transport into the brain. The synthetic BH4 analog, sapropterin hydrochloride (i.e., Kuvan®, BioMarin), is another potential treatment that activates residual PAH, thus decreasing Phe concentrations in the blood of PKU patients. Moreover, daily subcutaneous injection of pegylated Phe ammonia-lyase (i.e., pegvaliase; PALYNZIQ®, BioMarin) has promised gene therapy in recent clinical trials, and mRNA approaches are also being studied.
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Affiliation(s)
- Nasser A. Elhawary
- grid.412832.e0000 0000 9137 6644Department of Medical Genetics, College of Medicine, Umm Al-Qura University, P.O. Box 57543, Mecca, 21955 Saudi Arabia
| | - Imad A. AlJahdali
- grid.412832.e0000 0000 9137 6644Department of Community Medicine, College of Medicine, Umm Al-Qura University, P.O. Box 57543, Mecca, 21955 Saudi Arabia
| | - Iman S. Abumansour
- grid.412832.e0000 0000 9137 6644Department of Medical Genetics, College of Medicine, Umm Al-Qura University, P.O. Box 57543, Mecca, 21955 Saudi Arabia
| | - Ezzeldin N. Elhawary
- grid.123047.30000000103590315Faculty of Medicine, MS Genomic Medicine Program, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Nagwa Gaboon
- grid.7269.a0000 0004 0621 1570Department of Clinical Genetics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohammed Dandini
- Department of Laboratory and Blood Bank, Maternity and Children Hospital, Mecca, Saudi Arabia
| | - Abdulelah Madkhali
- grid.415254.30000 0004 1790 7311Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Wafaa Alosaimi
- Department of Hematology, Maternity and Children Hospital, Mecca, Saudi Arabia
| | - Abdulmajeed Alzahrani
- Department of Laboratory and Blood Bank at Maternity and Children Hospital, Mecca, Saudi Arabia
| | - Fawzia Aljohani
- Department of Pediatric Clinics, Maternity and Children Hospital, King Salman Medical City, Madinah, Saudi Arabia
| | - Ehab M. Melibary
- grid.412832.e0000 0000 9137 6644Department of Medical Genetics, College of Medicine, Umm Al-Qura University, P.O. Box 57543, Mecca, 21955 Saudi Arabia
| | - Osama A. Kensara
- grid.412832.e0000 0000 9137 6644Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Jeddah, Saudi Arabia
- Department of Biochemistry, Batterjee Medical College, Jeddah, Saudi Arabia
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17
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Impact of Nitisinone on the Cerebrospinal Fluid Metabolome of a Murine Model of Alkaptonuria. Metabolites 2022; 12:metabo12060477. [PMID: 35736410 PMCID: PMC9230570 DOI: 10.3390/metabo12060477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Nitisinone-induced hypertyrosinaemia is well documented in Alkaptonuria (AKU), and there is uncertainty over whether it may contribute to a decline in cognitive function and/or mood by altering neurotransmitter metabolism. The aim of this work was to evaluate the impact of nitisinone on the cerebrospinal fluid (CSF) metabolome in a murine model of AKU, with a view to providing additional insight into metabolic changes that occur following treatment with nitisinone. Methods: 17 CSF samples were collected from BALB/c Hgd−/− mice (n = 8, treated with nitisinone—4 mg/L and n = 9, no treatment). Samples were diluted 1:1 with deionised water and analysed using a 1290 Infinity II liquid chromatography system coupled to a 6550 quadrupole time-of-flight mass spectrometry (Agilent, Cheadle, UK). Raw data were processed using a targeted feature extraction algorithm and an established in-house accurate mass retention time database. Matched entities (±10 ppm theoretical accurate mass and ±0.3 min retention time window) were filtered based on their frequency and variability. Experimental groups were compared using a moderated t-test with Benjamini−Hochberg false-discovery rate adjustment. Results: L-Tyrosine, N-acetyl-L-tyrosine, γ-glutamyl-L-tyrosine, p-hydroxyphenylacetic acid, and 3-(4-hydroxyphenyl)lactic acid were shown to increase in abundance (log2 fold change 2.6−6.9, 3/5 were significant p < 0.05) in the mice that received nitisinone. Several other metabolites of interest were matched, but no significant differences were observed, including the aromatic amino acids phenylalanine and tryptophan, and monoamine metabolites adrenaline, 3-methoxy-4-hydroxyphenylglycol, and octopamine. Conclusions: Evaluation of the CSF metabolome of a murine model of AKU revealed a significant increase in the abundance of a limited number of metabolites following treatment with nitisinone. Further work is required to understand the significance of these findings and the mechanisms by which the altered metabolite abundances occur.
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Borges AC, Broersen K, Leandro P, Fernandes TG. Engineering Organoids for in vitro Modeling of Phenylketonuria. Front Mol Neurosci 2022; 14:787242. [PMID: 35082602 PMCID: PMC8784555 DOI: 10.3389/fnmol.2021.787242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/29/2021] [Indexed: 12/15/2022] Open
Abstract
Phenylketonuria is a recessive genetic disorder of amino-acid metabolism, where impaired phenylalanine hydroxylase function leads to the accumulation of neurotoxic phenylalanine levels in the brain. Severe cognitive and neuronal impairment are observed in untreated/late-diagnosed patients, and even early treated ones are not safe from life-long sequelae. Despite the wealth of knowledge acquired from available disease models, the chronic effect of Phenylketonuria in the brain is still poorly understood and the consequences to the aging brain remain an open question. Thus, there is the need for better predictive models, able to recapitulate specific mechanisms of this disease. Human induced pluripotent stem cells (hiPSCs), with their ability to differentiate and self-organize in multiple tissues, might provide a new exciting in vitro platform to model specific PKU-derived neuronal impairment. In this review, we gather what is known about the impact of phenylalanine in the brain of patients and highlight where hiPSC-derived organoids could contribute to the understanding of this disease.
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Affiliation(s)
- Alice C. Borges
- Department of Bioengineering and iBB – Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
- Associate Laboratory i4HB – Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Kerensa Broersen
- Department of Applied Stem Cell Technologies, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Paula Leandro
- Faculty of Pharmacy, iMed.ULisboa - Research Institute for Medicines, Universidade de Lisboa, Lisbon, Portugal
| | - Tiago G. Fernandes
- Department of Bioengineering and iBB – Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
- Associate Laboratory i4HB – Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
- *Correspondence: Tiago G. Fernandes,
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van Vliet D, van der Goot E, van Ginkel WG, van Faassen HJR, de Blaauw P, Kema IP, Heiner-Fokkema MR, van der Zee EA, van Spronsen FJ. The increasing importance of LNAA supplementation in phenylketonuria at higher plasma phenylalanine concentrations. Mol Genet Metab 2022; 135:27-34. [PMID: 34974973 DOI: 10.1016/j.ymgme.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/01/2021] [Accepted: 11/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Large neutral amino acid (LNAA) treatment has been suggested as alternative to the burdensome severe phenylalanine-restricted diet. While its working mechanisms and optimal composition have recently been further elucidated, the question whether LNAA treatment requires the natural protein-restricted diet, has still remained. OBJECTIVE Firstly, to determine whether an additional liberalized natural protein-restricted diet could further improve brain amino acid and monoamine concentrations in phenylketonuria mice on LNAA treatment. Secondly, to compare the effect between LNAA treatment (without natural protein) restriction and different levels of a phenylalanine-restricted diet (without LNAA treatment) on brain amino acid and monoamine concentrations in phenylketonuria mice. DESIGN BTBR Pah-enu2 mice were divided into two experimental groups that received LNAA treatment with either an unrestricted or semi phenylalanine-restricted diet. Control groups included Pah-enu2 mice on the AIN-93 M diet, a severe or semi phenylalanine-restricted diet without LNAA treatment, and wild-type mice receiving the AIN-93 M diet. After ten weeks, brain and plasma samples were collected to measure amino acid profiles and brain monoaminergic neurotransmitter concentrations. RESULTS Adding a semi phenylalanine-restricted diet to LNAA treatment resulted in lower plasma phenylalanine but comparable brain amino acid and monoamine concentrations as compared to LNAA treatment (without phenylalanine restriction). LNAA treatment (without phenylalanine restriction) resulted in comparable brain monoamine but higher brain phenylalanine concentrations compared to the severe phenylalanine-restricted diet, and significantly higher brain monoamine but comparable phenylalanine concentrations as compared to the semi phenylalanine-restricted diet. CONCLUSIONS Present results in PKU mice suggest that LNAA treatment in PKU patients does not need the phenylalanine-restricted diet. In PKU mice, LNAA treatment (without phenylalanine restriction) was comparable to a severe phenylalanine-restricted diet with respect to brain monoamine concentrations, notwithstanding the higher plasma and brain phenylalanine concentrations, and resulted in comparable brain phenylalanine concentrations as on a semi phenylalanine-restricted diet.
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Affiliation(s)
- D van Vliet
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, the Netherlands
| | - E van der Goot
- University of Groningen, Groningen Institute for Evolutionary Life Sciences, Department of Molecular Neurobiology, Groningen, the Netherlands
| | - W G van Ginkel
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, the Netherlands
| | - H J R van Faassen
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, Groningen, the Netherlands
| | - P de Blaauw
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, Groningen, the Netherlands
| | - I P Kema
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, Groningen, the Netherlands
| | - M R Heiner-Fokkema
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, Groningen, the Netherlands
| | - E A van der Zee
- University of Groningen, Groningen Institute for Evolutionary Life Sciences, Department of Molecular Neurobiology, Groningen, the Netherlands
| | - F J van Spronsen
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, the Netherlands.
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Bernstein L, Hansen J, Kogelmann C, Ellerbrok M, Giżewska M, Gaughan S, Rocha JC, Belanger-Quintana A, Rohr F. Normalizing Diet in Individuals with Phenylketonuria Treated with Pegvaliase: A Case Series and Patient Perspective. NUTRITION AND DIETARY SUPPLEMENTS 2021. [DOI: 10.2147/nds.s337135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Cannon Homaei S, Barone H, Kleppe R, Betari N, Reif A, Haavik J. ADHD symptoms in neurometabolic diseases: Underlying mechanisms and clinical implications. Neurosci Biobehav Rev 2021; 132:838-856. [PMID: 34774900 DOI: 10.1016/j.neubiorev.2021.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022]
Abstract
Neurometabolic diseases (NMDs) are typically caused by genetic abnormalities affecting enzyme functions, which in turn interfere with normal development and activity of the nervous system. Although the individual disorders are rare, NMDs are collectively relatively common and often lead to lifelong difficulties and high societal costs. Neuropsychiatric manifestations, including ADHD symptoms, are prominent in many NMDs, also when the primary biochemical defect originates in cells and tissues outside the nervous system. ADHD symptoms have been described in phenylketonuria, tyrosinemias, alkaptonuria, succinic semialdehyde dehydrogenase deficiency, X-linked ichthyosis, maple syrup urine disease, and several mitochondrial disorders, but are probably present in many other NMDs and may pose diagnostic and therapeutic challenges. Here we review current literature linking NMDs with ADHD symptoms. We cite emerging evidence that many NMDs converge on common neurochemical mechanisms that interfere with monoamine neurotransmitter synthesis, transport, metabolism, or receptor functions, mechanisms that are also considered central in ADHD pathophysiology and treatment. Finally, we discuss the therapeutic implications of these findings and propose a path forward to increase our understanding of these relationships.
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Affiliation(s)
- Selina Cannon Homaei
- Division of Psychiatry, Haukeland University Hospital, Norway; Department of Biomedicine, University of Bergen, Norway.
| | - Helene Barone
- Regional Resource Center for Autism, ADHD, Tourette Syndrome and Narcolepsy, Western Norway, Division of Psychiatry, Haukeland University Hospital, Norway.
| | - Rune Kleppe
- Division of Psychiatry, Haukeland University Hospital, Norway; Norwegian Centre for Maritime and Diving Medicine, Department of Occupational Medicine, Haukeland University Hospital, Norway.
| | - Nibal Betari
- Department of Biomedicine, University of Bergen, Norway.
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Norway; Department of Biomedicine, University of Bergen, Norway.
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22
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Dijkstra AM, van Vliet N, van Vliet D, Romani C, Huijbregts SCJ, van der Goot E, Hovens IB, van der Zee EA, Kema IP, Heiner-Fokkema MR, van Spronsen FJ. Correlations of blood and brain biochemistry in phenylketonuria: Results from the Pah-enu2 PKU mouse. Mol Genet Metab 2021; 134:250-256. [PMID: 34656426 DOI: 10.1016/j.ymgme.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/12/2021] [Accepted: 09/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In phenylketonuria (PKU), treatment monitoring is based on frequent blood phenylalanine (Phe) measurements, as this is the predictor of neurocognitive and behavioural outcome by reflecting brain Phe concentrations and brain biochemical changes. Despite clinical studies describing the relevance of blood Phe to outcome in PKU patients, blood Phe does not explain the variance in neurocognitive and behavioural outcome completely. METHODS In a PKU mouse model we investigated 1) the relationship between plasma Phe and brain biochemistry (Brain Phe and monoaminergic neurotransmitter concentrations), and 2) whether blood non-Phe Large Neutral Amino Acids (LNAA) would be of additional value to blood Phe concentrations to explain brain biochemistry. To this purpose, we assessed blood amino acid concentrations and brain Phe as well as monoaminergic neurotransmitter levels in in 114 Pah-Enu2 mice on both B6 and BTBR backgrounds using (multiple) linear regression analyses. RESULTS Plasma Phe concentrations were strongly correlated to brain Phe concentrations, significantly negatively correlated to brain serotonin and norepinephrine concentrations and only weakly correlated to brain dopamine concentrations. From all blood markers, Phe showed the strongest correlation to brain biochemistry in PKU mice. Including non-Phe LNAA concentrations to the multiple regression model, in addition to plasma Phe, did not help explain brain biochemistry. CONCLUSION This study showed that blood Phe is still the best amino acid predictor of brain biochemistry in PKU. Nevertheless, neurocognitive and behavioural outcome cannot fully be explained by blood or brain Phe concentrations, necessitating a search for other additional parameters. TAKE-HOME MESSAGE Blood Phe is still the best amino acid predictor of brain biochemistry in PKU. Nevertheless, neurocognitive and behavioural outcome cannot fully be explained by blood or brain Phe concentrations, necessitating a search for other additional parameters.
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Affiliation(s)
- Allysa M Dijkstra
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, the Netherlands
| | - Ninke van Vliet
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, the Netherlands
| | - Danique van Vliet
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, the Netherlands
| | - Cristina Romani
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Stephan C J Huijbregts
- Department of Clinical Child and Adolescent Studies-Neurodevelopmental Disorders, Faculty of Social Sciences, Leiden University, Leiden, the Netherlands
| | - Els van der Goot
- University of Groningen, Groningen Institute for Evolutionary Life Sciences (GELIFES), Department of Molecular Neurobiology, Groningen, the Netherlands
| | - Iris B Hovens
- University of Groningen, Groningen Institute for Evolutionary Life Sciences (GELIFES), Department of Molecular Neurobiology, Groningen, the Netherlands
| | - Eddy A van der Zee
- University of Groningen, Groningen Institute for Evolutionary Life Sciences (GELIFES), Department of Molecular Neurobiology, Groningen, the Netherlands
| | - Ido P Kema
- University of Groningen, University Medical Center Groningen, Department of laboratory Medicine, Groningen, the Netherlands
| | - M Rebecca Heiner-Fokkema
- University of Groningen, University Medical Center Groningen, Department of laboratory Medicine, Groningen, the Netherlands
| | - Francjan J van Spronsen
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, the Netherlands.
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Mainka T, Fischer JF, Huebl J, Jung A, Lier D, Mosejova A, Skorvanek M, de Koning TJ, Kühn AA, Freisinger P, Ziagaki A, Ganos C. The neurological and neuropsychiatric spectrum of adults with late-treated phenylketonuria. Parkinsonism Relat Disord 2021; 89:167-175. [PMID: 34391119 DOI: 10.1016/j.parkreldis.2021.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 06/02/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Phenylketonuria (PKU) is a rare, treatable inborn error of metabolism with frequent neurological and neuropsychiatric complications, especially in undiagnosed or insufficiently treated individuals. Given the wide range of clinical presentations and the importance of treatment implications, we here delineate the neurological and neuropsychiatric symptom spectrum in a large cohort of previously unreported adults with late-treated PKU. METHODS We consecutively evaluated late-treated PKU cases and pooled clinical and paraclinical data, including video-material, from three centers with expertise in complex movement disorders, inborn errors of metabolism and pediatrics. RESULTS 26 individuals were included (10 females, median age 52 years). Developmental delay and intellectual disability were omnipresent with severe impairment of expressive communication noted in 50% of cases. Movement disorders were prevalent (77%), including tremor (38%, mostly postural), stereotypies (38%), and tics (19%). One case had neurodegenerative levodopa-responsive parkinsonism. Mild ataxia was noted in 54% of cases and 31% had a history of seizures. Neuropsychiatric characteristics included obsessive-compulsive (35%) and self-injurious behaviors (31%), anxiety (27%), depression (19%) and features compatible with those observed in individuals with autism spectrum disorder (19%). Neuroimaging revealed mild white matter changes. Adherence to dietary treatment was inconsistent in the majority of cases, particularly throughout adolescence. CONCLUSION A history of movement disorders, particularly tremor, stereotypies and tics, in the presence of developmental delay, intellectual disability and neuropsychiatric features, such as obsessive-compulsive and self-injurious behaviors in adults should prompt the diagnostic consideration of PKU. Initiation and adherence to (dietary) treatment can ameliorate the severity of these symptoms.
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Affiliation(s)
- Tina Mainka
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | | | - Julius Huebl
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany; Department of Neurology, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Munich, Germany
| | - Alexandra Jung
- Interdisciplinary Center of Metabolism: Endocrinology, Diabetes and Metabolism, University-Medicine Berlin, Campus Virchow-Klinikum, Germany
| | - Dinah Lier
- Department of Pediatrics, Klinikum Reutlingen, Reutlingen, Germany
| | - Alexandra Mosejova
- Department of Neurology, P.J. Safarik University, Košice, Slovakia; Department of Neurology, University Hospital L. Pasteur, Košice, Slovakia
| | - Matej Skorvanek
- Department of Neurology, P.J. Safarik University, Košice, Slovakia; Department of Neurology, University Hospital L. Pasteur, Košice, Slovakia
| | - Tom J de Koning
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Pediatrics, Department of Clinical Sciences, Lund University, Sweden
| | - Andrea A Kühn
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Peter Freisinger
- Department of Pediatrics, Klinikum Reutlingen, Reutlingen, Germany
| | - Athanasia Ziagaki
- Interdisciplinary Center of Metabolism: Endocrinology, Diabetes and Metabolism, University-Medicine Berlin, Campus Virchow-Klinikum, Germany
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.
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Abstract
Phenylketonuria (PKU; also known as phenylalanine hydroxylase (PAH) deficiency) is an autosomal recessive disorder of phenylalanine metabolism, in which especially high phenylalanine concentrations cause brain dysfunction. If untreated, this brain dysfunction results in severe intellectual disability, epilepsy and behavioural problems. The prevalence varies worldwide, with an average of about 1:10,000 newborns. Early diagnosis is based on newborn screening, and if treatment is started early and continued, intelligence is within normal limits with, on average, some suboptimal neurocognitive function. Dietary restriction of phenylalanine has been the mainstay of treatment for over 60 years and has been highly successful, although outcomes are still suboptimal and patients can find the treatment difficult to adhere to. Pharmacological treatments are available, such as tetrahydrobiopterin, which is effective in only a minority of patients (usually those with milder PKU), and pegylated phenylalanine ammonia lyase, which requires daily subcutaneous injections and causes adverse immune responses. Given the drawbacks of these approaches, other treatments are in development, such as mRNA and gene therapy. Even though PAH deficiency is the most common defect of amino acid metabolism in humans, brain dysfunction in individuals with PKU is still not well understood and further research is needed to facilitate development of pathophysiology-driven treatments.
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Affiliation(s)
- Francjan J van Spronsen
- Beatrix Children's Hospital, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
| | - Nenad Blau
- University Children's Hospital in Zurich, Zurich, Switzerland
| | - Cary Harding
- Department of Molecular and Medical Genetics and Department of Pediatrics, Oregon Health & Science University, Oregon, USA
| | | | - Nicola Longo
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Annet M Bosch
- University of Amsterdam, Department of Pediatrics, Division of Metabolic Disorders, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Brain neurochemical monitoring. Biosens Bioelectron 2021; 189:113351. [PMID: 34049083 DOI: 10.1016/j.bios.2021.113351] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/05/2021] [Accepted: 05/13/2021] [Indexed: 02/08/2023]
Abstract
Brain neurochemical monitoring aims to provide continuous and accurate measurements of brain biomarkers. It has enabled significant advances in neuroscience for application in clinical diagnostics, treatment, and prevention of brain diseases. Microfabricated electrochemical and optical spectroscopy sensing technologies have been developed for precise monitoring of brain neurochemicals. Here, a comprehensive review on the progress of sensing technologies developed for brain neurochemical monitoring is presented. The review provides a summary of the widely measured clinically relevant neurochemicals and commonly adopted recognition technologies. Recent advances in sampling, electrochemistry, and optical spectroscopy for brain neurochemical monitoring are highlighted and their application are discussed. Existing gaps in current technologies and future directions to design industry standard brain neurochemical sensing devices for clinical applications are addressed.
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Dobrowolski SF, Phua YL, Sudano C, Spridik K, Zinn PO, Wang Y, Bharathi S, Vockley J, Goetzman E. Phenylalanine hydroxylase deficient phenylketonuria comparative metabolomics identifies energy pathway disruption and oxidative stress. Mol Genet Metab 2021:S1096-7192(21)00686-7. [PMID: 33846068 DOI: 10.1016/j.ymgme.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 11/15/2022]
Abstract
Classical phenylketonuria (PKU, OMIM 261600) owes to hepatic deficiency of phenylalanine hydroxylase (PAH) that enzymatically converts phenylalanine (Phe) to tyrosine (Tyr). PKU neurologic phenotypes include impaired brain development, decreased myelination, early onset mental retardation, seizures, and late-onset features (neuropsychiatric, Parkinsonism). PAH deficiency leads to systemic hyperphenylalaninemia; however, the impact of Phe varies between tissues. To characterize tissue response to hyperphenylalaninemia, metabolomics was applied to tissue from therapy noncompliant classical PKU patients (blood, liver), the Pahenu2 classical PKU mouse (blood, liver, brain) and the PAH deficient pig (blood, liver, brain, cerebrospinal fluid). In blood, liver, and CSF from both patients and animal models over-represented analytes were principally Phe, Phe catabolites, and Phe-related analytes (conjugates, Phe-containing dipeptides). In addition to Phe and Phe-related analytes, the metabolomic profile of PKU brain tissue (mouse, pig) evidenced oxidative stress responses and energy dysregulation. In Pahenu2 and PKU pig brain tissues, anti-oxidative response by glutathione and homocarnosine is apparent. Oxidative stress in Pahenu2 brain was further demonstrated by increased reactive oxygen species. In Pahenu2 and PKU pig brain, an increased NADH/NAD ratio suggests a respiratory chain dysfunction. Respirometry in PKU brain mitochondria (mouse, pig) functionally confirmed reduced respiratory chain activity. Glycolysis pathway analytes are over-represented in PKU brain tissue (mouse, pig). PKU pathologies owe to liver metabolic deficiency; yet, PKU liver tissue (mouse, pig, human) shows neither energy disruption nor anti-oxidative response. Unique aspects of metabolomic homeostasis in PKU brain tissue along with increased reactive oxygen species and respiratory chain deficit provide insight to neurologic disease mechanisms. While some elements of assumed, long standing PKU neuropathology are enforced by metabolomic data (e.g. reduced tryptophan and serotonin representation), energy dysregulation and tissue oxidative stress expand mechanisms underlying neuropathology.
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Affiliation(s)
- Steven F Dobrowolski
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, United States.
| | - Yu Leng Phua
- Division of Medical Genetics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, United States
| | - Cayla Sudano
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, United States
| | - Kayla Spridik
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, United States
| | - Pascal O Zinn
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, United States
| | - Yudong Wang
- Division of Medical Genetics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, United States
| | - Sivakama Bharathi
- Division of Medical Genetics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, United States
| | - Jerry Vockley
- Division of Medical Genetics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, United States
| | - Eric Goetzman
- Division of Medical Genetics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15224, United States
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Burlina A, Leuzzi V, Spada M, Carbone MT, Paci S, Tummolo A. The management of phenylketonuria in adult patients in Italy: a survey of six specialist metabolic centers. Curr Med Res Opin 2021; 37:411-421. [PMID: 33222540 DOI: 10.1080/03007995.2020.1847717] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Phenylketonuria (PKU) is a rare autosomal recessive disorder caused by a deficiency of phenylalanine hydroxylase (PAH). Its prevalence is estimated to be 1:10,000 in Europe. PKU is the commonest congenital inborn error of metabolism. The aim of our study was to investigate the characteristics of clinical practice in relation to PKU in Italy, in order to raise awareness about the current management and therapeutic approaches adopted. METHODS Six Italian experts conducted a systematic literature review as well as an internal survey to investigate the relevant clinical aspects. Collectively, the expert panel managed a total of 678 PKU patients treated in the early stages of the condition over a 16-year period across six centers. RESULTS The management of PKU varied markedly between centers, with differences in the composition of the multidisciplinary team, dietary treatments, compliance and adherence to management, tetrahydrobiopterin use, and patient follow-up. Patients were mostly managed by a pediatric reference center from the initial PKU diagnosis during newborn screening until adulthood, without transition to a specialized adult clinician. Fogginess, concentration reduction, low attention, anxiety, irritability, memory deficit, headache, and unstable mood were common features in patients with uncontrolled blood phenylalanine levels (generally above 600 µmol/L). CONCLUSION A homogeneous and shared approach to the management of PKU patients is important. Our survey demonstrates the current management of PKU in Italy, with the aim of promoting the implementation of therapeutic strategies and follow-up, increased patient compliance and adherence, and the achievement of the phenylalanine level targets recommended by European Union guidelines. Emerging therapies are likely to become a standard treatment for patients unable to comply with diet therapy and maintain their phenylalanine levels below the threshold values. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/03007995.2020.1847717.
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Affiliation(s)
- Alberto Burlina
- Inherited Metabolic Diseases Division, Regional Center for Expanded Neonatal Screening, Women and Children's Health Department, University Hospital of Padua, Padua, Italy
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, University La Sapienza, Rome, Italy
| | - Marco Spada
- Department of Pediatrics, Regina Margherita Children's Hospital, University of Torino, Torino, Italy
| | - Maria Teresa Carbone
- Pediatric Division, Metabolic and Rare Diseases, Santobono Pausilipon Hospital, Naples, Italy
| | - Sabrina Paci
- Pediatric Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Albina Tummolo
- Metabolic Diseases Department, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Bari, Italy
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Porta F, Giorda S, Ponzone A, Spada M. Tyrosine metabolism in health and disease: slow-release amino acids therapy improves tyrosine homeostasis in phenylketonuria. J Pediatr Endocrinol Metab 2020; 33:1519-1523. [PMID: 33581706 DOI: 10.1515/jpem-2020-0319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Phenylalanine (Phe) hydroxylase (PAH) deficiency leads to hyperphenylalaninemia (HPA) and tyrosine (Tyr) depletion. We investigated Tyr homeostasis in patients with PAH deficiency and the effect of a slow-release amino acids therapy in phenylketonuria (PKU). METHODS We performed four complementary investigations: (1) Tyr concentrations were monitored in 114 patients (10.6 ± 11.9 years) with PKU on dietary treatment supplemented with traditional amino acid formulations (n=52, 1175 samples) or non-PKU HPA on a free diet (n=62, 430 samples); (2) Tyr metabolism in PKU was quantitatively evaluated in three patients by a simple Tyr oral loading test (100 mg/kg); (3) diurnal and (4) long-term Tyr concentrations were evaluated in 5 and 13 patients with PKU, respectively, who switched from traditional to slow-release amino acids therapy. RESULTS 1) Tyr concentrations in the PKU population were subnormal and significantly lower than in non-PKU HPA (p<0.01); (2) the response to a Tyr loading test in PKU was normal, with basal Tyr concentrations reached within 12 h; (3) the diurnal metabolic profile in patients on slow-release amino acids therapy revealed higher morning fasting and nocturnal Tyr concentrations with respect to traditional therapy (p<0.01); (4) this picture was confirmed at follow-up, with normalization of morning fasting Tyr concentrations in patients on slow-release amino acids therapy (p<0.01) and unchanged Phe control (p=0.19). CONCLUSIONS Slow-release amino acids therapy can improve Tyr homeostasis in PKU. If associated to optimized Phe control, such a metabolic goal may allow long-term clinical benefits in patients with PKU.
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Affiliation(s)
- Francesco Porta
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Sara Giorda
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Alberto Ponzone
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Marco Spada
- Department of Pediatrics, University of Torino, Torino, Italy
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Aldridge K, Cole KK, Moffitt Gunn AJ, Peck D, White DA, Christ SE. The effects of early-treated phenylketonuria on volumetric measures of the cerebellum. Mol Genet Metab Rep 2020; 25:100647. [PMID: 32995290 PMCID: PMC7505805 DOI: 10.1016/j.ymgmr.2020.100647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 11/03/2022] Open
Abstract
Past murine studies of phenylketonuria (PKU) have documented significant effects on cerebellum at both the gross and cellular levels. The profile of neurocognitive and motor difficulties associated with early-treated PKU (ETPKU) is also consistent with potential cerebellar involvement. Previous neuroanatomical studies of cerebellum in patients with PKU, however, have yielded mixed results. The objective of the present study was to further examine potential differences in cerebellar morphometry between individuals with and without ETPKU. To this end, we analyzed high resolution T1-weighted MR images from a sample of 20 individuals with ETPKU and an age-matched comparison group of 20 healthy individuals without PKU. Measurements of whole brain volume, whole cerebellum volume, cerebellar gray matter volume, and cerebellar white matter volume were collected by means of semiautomatic volumetric analysis. Data analysis revealed no significant group differences in whole brain volume, whole cerebellar volume, or cerebellar white matter volume. A significant reduction in cerebellar gray matter volume, however, was observed for the ETPKU group compared to the non-PKU comparison group. These findings expand on previous animal work suggesting that cerebellar gray matter is impacted by PKU. It is also consistent with the hypothesis that the cognitive difficulties experienced by individuals with ETPKU may be related to disruptions in gray matter. Additional studies are needed to fully elucidate the timing and extent of the impact of ETPKU on cerebellum and the associated neurocognitive consequences.
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Affiliation(s)
- Kristina Aldridge
- Department of Pathology & Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, USA
| | - Kimberly K Cole
- Department of Pathology & Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Dawn Peck
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - Desirée A White
- Departments of Psychological & Brain Sciences and Pediatrics, Washington University, St. Louis, MO, USA
| | - Shawn E Christ
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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Pilotto A, Zipser CM, Leks E, Haas D, Gramer G, Freisinger P, Schaeffer E, Liepelt-Scarfone I, Brockmann K, Maetzler W, Schulte C, Deuschle C, Hauser AK, Hoffmann GF, Scheffler K, van Spronsen FJ, Padovani A, Trefz F, Berg D. Phenylalanine Effects on Brain Function in Adult Phenylketonuria. Neurology 2020; 96:e399-e411. [PMID: 33093221 DOI: 10.1212/wnl.0000000000011088] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between circulating phenylalanine and brain function as well as neuropsychiatric symptoms in adults with phenylketonuria. METHODS In this prospective cross-sectional study, early-treated patients with phenylketonuria older than 30 years and age- and sex-matched controls were included. Extensive neurologic evaluation, neuropsychological and behavioral testing, sensory and motor evoked potentials, and MRI were performed. CSF concentrations of neurodegenerative markers were evaluated in addition in a subset of 10 patients. RESULTS Nineteen patients with phenylketonuria (median age 41 years) with different phenylalanine levels (median 873 μmol/L) entered the study. They showed higher prevalence of neurologic symptoms, cognitive and behavioral abnormalities, autonomic dysfunction, alterations in neurophysiologic measures, and atrophy in putamen and right thalamus compared to controls. In CSF, patients with phenylketonuria exhibited higher β-amyloid 1-42 (p = 0.003), total tau (p < 0.001), and phosphorylated tau (p = 0.032) levels compared to controls. Plasma phenylalanine levels highly correlated with the number of failed neuropsychological tests (r = 0.64, p = 0.003), neuropsychiatric symptoms (r = 0.73, p < 001), motor evoked potential latency (r = 0.48, p = 0.030), and parietal lobe atrophy. CONCLUSIONS Our study provides strong evidence for a correlation between phenylalanine levels and clinical, neuropsychological, neurophysiologic, biochemical, and imaging alterations in adult patients with phenylketonuria.
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Affiliation(s)
- Andrea Pilotto
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.
| | - Carl M Zipser
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Edytha Leks
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Dorothea Haas
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Gwendolyn Gramer
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Peter Freisinger
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Eva Schaeffer
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Inga Liepelt-Scarfone
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Kathrin Brockmann
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Walter Maetzler
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Claudia Schulte
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Christian Deuschle
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Ann Kathrin Hauser
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Georg F Hoffmann
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Klaus Scheffler
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Francjan J van Spronsen
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Alessandro Padovani
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Friedrich Trefz
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Daniela Berg
- From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
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Boulet L, Besson G, Van Noolen L, Faure P, Maillot F, Corne C. Tryptophan metabolism in phenylketonuria: A French adult cohort study. J Inherit Metab Dis 2020; 43:944-951. [PMID: 32392388 DOI: 10.1002/jimd.12250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/23/2020] [Accepted: 05/08/2020] [Indexed: 11/09/2022]
Abstract
Many similarities between tryptophan (Trp) and phenylalanine (Phe) metabolisms exist. It is possible that a modification of Trp metabolism might be seen in phenylketonuria (PKU). As some of these metabolites have neuroactive properties, they should be consider in neurological impairment seen in this pathology and not totally explained by blood Phe concentrations. One hundred and fifty-one adult PKU patients (mean age 26.8 years) were included for this study. Plasma Trp, kynurenine (KYN), 3-hydroxykynurenic acid (3HK), and kynurenic acid (KA) were analyzed by liquid chromatography coupled with tandem mass spectrometry. KYN and 3HK were significantly lower in PKU patients compared to general population (P < .0001), and KA was significantly enhanced is this population (P = .009). Furthermore, 3HK concentration was significantly different between PKU patients underwent controlled low-Phe diet compared to PKU patients without this diet (P = .0016). In PKU patients with diet, taking AA substitute enable higher plasma 3HK concentration than without (P = .0008) but still not reaching general population level (P < .0001). Although further study has to be done, it is clear that Trp metabolism is modified in adult PKU patients. An exploration of complete Trp metabolism, and not only Trp concentration, is needed in PKU population, but also in other inborn error of metabolism treated with hypoprotidic diet.
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Affiliation(s)
- Lysiane Boulet
- Laboratoire des Maladies Héréditaires du Métabolisme, Service de Biochimie, Biologie Moléculaire, Toxicologie Environnementale, CHU de Grenoble-Alpes site Nord- Institut de Biologie et de Pathologie, La Tronche, France
| | - Gérard Besson
- Service de Neurologie Générale, CHU de Grenoble-Alpes site Nord, La Tronche, France
| | - Laetitia Van Noolen
- Laboratoire des Maladies Héréditaires du Métabolisme, Service de Biochimie, Biologie Moléculaire, Toxicologie Environnementale, CHU de Grenoble-Alpes site Nord- Institut de Biologie et de Pathologie, La Tronche, France
| | - Patrice Faure
- Service de Biochimie, Biologie Moléculaire, Toxicologie Environnementale, CHU de Grenoble-Alpes site Nord- Institut de Biologie et de Pathologie, La Tronche, France
| | - François Maillot
- CHRU de Tours, médecine interne, université de Tours, INSERM 1253, Tours, France
| | - Christelle Corne
- Laboratoire des Maladies Héréditaires du Métabolisme, Service de Biochimie, Biologie Moléculaire, Toxicologie Environnementale, CHU de Grenoble-Alpes site Nord- Institut de Biologie et de Pathologie, La Tronche, France
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32
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Aspartame and Phe-Containing Degradation Products in Soft Drinks across Europe. Nutrients 2020; 12:nu12061887. [PMID: 32599819 PMCID: PMC7353418 DOI: 10.3390/nu12061887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022] Open
Abstract
Phenylketonuria and tyrosinemia type 1 are treated with dietary phenylalanine (Phe) restriction. Aspartame is a Phe-containing synthetic sweetener used in many products, including many ‘regular’ soft drinks. Its amount is (often) not declared; therefore, patients are advised not to consume aspartame-containing foods. This study aimed to determine the variation in aspartame concentrations and its Phe-containing degradation products in aspartame-containing soft drinks. For this, an LC–MS/MS method was developed for the analysis of aspartame, Phe, aspartylphenylalanine, and diketopiperazine in soft drinks. In total, 111 regularly used soft drinks from 10 European countries were analyzed. The method proved linear and had an inter-assay precision (CV%) below 5% for aspartame and higher CVs% of 4.4–49.6% for the degradation products, as many concentrations were at the limit of quantification. Aspartame and total Phe concentrations in the aspartame-containing soft drinks varied from 103 to 1790 µmol/L (30–527 mg/L) and from 119 to 2013 µmol/L (20–332 mg/L), respectively, and were highly variable among similar soft drinks bought in different countries. Since Phe concentrations between drinks and countries highly vary, we strongly advocate the declaration of the amount of aspartame on soft drink labels, as some drinks may be suitable for consumption by patients with Phe-restricted diets.
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Vardy ERLC, MacDonald A, Ford S, Hofman DL. Phenylketonuria, co-morbidity, and ageing: A review. J Inherit Metab Dis 2020; 43:167-178. [PMID: 31675115 DOI: 10.1002/jimd.12186] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 12/17/2022]
Abstract
Phenylketonuria (PKU) is a metabolic condition which, left untreated, results in severe and irreversible brain damage. Newborn screening and the development of the low phenylalanine (Phe) diet have transformed the outcomes for people with PKU. Those who have benefited from early treatment are now approaching their fifth and sixth decade. It is therefore timely to consider multi-morbidity in PKU and the effects of ageing, in parallel with the wider benefits of emerging treatment options in addition to dietary relaxation. We have conducted the first literature review of co-morbidity and ageing in the context of PKU. Avenues explored have emerged from limited study of multi-morbidity to date and the knowledge and critical enquiry of the authors. Findings suggest PKU to have a wider impact than brain development, and result in several intriguing questions that require investigation to attain the best outcomes for people with PKU in adulthood moving through to older age. We recognise the difficulty in studying longitudinal outcomes in rare diseases and emphasise the necessity to develop PKU registries and cohorts that facilitate well-designed studies to answer some of the questions raised in this review. Whilst awaiting new information in these areas we propose that clinicians engage with patients to make personalised and well-informed decisions around Phe control and assessment for co-morbidity.
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Affiliation(s)
- Emma R L C Vardy
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust, Salford Care Organisation, Part of Northern Care Alliance NHS Group, Salford, UK
| | - Anita MacDonald
- Department of dietetics, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Suzanne Ford
- National Society for Phenylketonuria, Preston, UK
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Cannet C, Pilotto A, Rocha JC, Schäfer H, Spraul M, Berg D, Nawroth P, Kasperk C, Gramer G, Haas D, Piel D, Kölker S, Hoffmann G, Freisinger P, Trefz F. Lower plasma cholesterol, LDL-cholesterol and LDL-lipoprotein subclasses in adult phenylketonuria (PKU) patients compared to healthy controls: results of NMR metabolomics investigation. Orphanet J Rare Dis 2020; 15:61. [PMID: 32106880 PMCID: PMC7047385 DOI: 10.1186/s13023-020-1329-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background Phenylketonuria (PKU; OMIM#261600) is a rare metabolic disorder caused by mutations in the phenylalanine hydroxylase (PAH) gene resulting in high phenylalanine (Phe) in blood and brain. If not treated early this results in intellectual disability, behavioral and psychiatric problems, microcephaly, motor deficits, eczematous rash, autism, seizures, and developmental problems. There is a controversial discussion of whether patients with PKU have an additional risk for atherosclerosis due to interference of Phe with cholesterol synthesis and LDL-cholesterol regulation. Since cholesterol also plays a role in membrane structure and myelination, better insight into the clinical significance of the impact of Phe on lipoprotein metabolism is desirable. In 22 treated PKU patients (mean age 38.7 years) and 14 healthy controls (mean age 35.2 years), we investigated plasma with NMR spectroscopy and quantified 105 lipoprotein parameters (including lipoprotein subclasses) and 24 low molecular weight parameters. Analysis was performed on a 600 MHz Bruker AVANCE IVDr spectrometer as previously described. Results Concurrent plasma Phe in PKU patients showed a wide range with a mean of 899 μmol/L (50–1318 μmol/L). Total cholesterol and LDL-cholesterol were significantly lower in PKU patients versus controls: 179.4 versus 200.9 mg/dL (p < 0.02) and 79.5 versus 104.1 mg/dL (p < 0.0038), respectively. PKU patients also had lower levels of 22 LDL subclasses with the greatest differences in LDL2 Apo-B, LDL2 Particle Number, LDL2-phospholipids, and LDL2-cholesterol (p < 0.0001). There was a slight negative correlation of total cholesterol and LDL-cholesterol with concurrent Phe level. VLDL5-free cholesterol, VLDL5-cholesterol, VLDL5-phospholipids, and VLDL4-free cholesterol showed a significant (p < 0.05) negative correlation with concurrent Phe level. There was no difference in HDL and their subclasses between PKU patients and controls. Tyrosine, glutamine, and creatinine were significantly lower in PKU patients compared to controls, while citric and glutamic acids were significantly higher. Conclusions Using NMR spectroscopy, a unique lipoprotein profile in PKU patients can be demonstrated which mimics a non-atherogenic profile as seen in patients treated by statins.
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Affiliation(s)
| | - Andrea Pilotto
- Department of Neurodegeneration, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Parkinson's Disease Rehabilitation Centre, FERB ONLUS S, Isidoro Hospital, Trescore Balneario, Italy
| | - Júlio César Rocha
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | - Daniela Berg
- Department of Neurology, University-Hospital-Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Peter Nawroth
- Department of Endocrinology and Metabolism, University Hospital, Heidelberg, Germany
| | - Christian Kasperk
- Department of Endocrinology and Metabolism, University Hospital, Heidelberg, Germany
| | - Gwendolyn Gramer
- Department of Pediatrics, Centre for Pediatric and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, University Hospital, Heidelberg, Germany
| | - Dorothea Haas
- Department of Pediatrics, Centre for Pediatric and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, University Hospital, Heidelberg, Germany
| | - David Piel
- Pediatrics, Reutlingen Hospital, Reutlingen, Germany
| | - Stefan Kölker
- Department of Pediatrics, Centre for Pediatric and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, University Hospital, Heidelberg, Germany
| | - Georg Hoffmann
- Department of Pediatrics, Centre for Pediatric and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, University Hospital, Heidelberg, Germany
| | | | - Friedrich Trefz
- Department of Pediatrics, Centre for Pediatric and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, University Hospital, Heidelberg, Germany. .,Metabolic Consulting, Reutlingen, Germany.
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Jaulent P, Charriere S, Feillet F, Douillard C, Fouilhoux A, Thobois S. Neurological manifestations in adults with phenylketonuria: new cases and review of the literature. J Neurol 2019; 267:531-542. [PMID: 31701331 DOI: 10.1007/s00415-019-09608-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Phenylketonuria (PKU) is a rare autosomal recessive disease characterised by high plasma phenylalanine levels inducing, if untreated, serious neurological manifestations in children but also, rarely, in adults who stopped their diet. The objective of the study was to describe the neurological manifestations observed in adults with PKU. METHODS We analysed cases reported in French reference centres for inborn errors of metabolism and cases already reported in the literature. RESULTS We report 8 new cases of neurological manifestations and 22 cases in the literature, which occurred in adult PKU patients, associated with chronic or rapid increase of phenylalanine levels, mostly when strict low-phenylalanine diet was stopped early in life. Neurological symptoms consisted in cerebellar ataxia, tremor, brisk reflexes, visual loss, sensory manifestations, and/or headaches. Visual loss was more frequent in the new cases (4/8) of the present series than in the literature (4/22). These neurological complications were associated with leucopathy on brain magnetic resonance imaging (27/29). The start of a low-phenylalanine diet improved or fully reversed neurological manifestations, even in patients with late diagnosis during adulthood. CONCLUSION Neurological manifestations can complicate PKU in adult patients with elevated phenylalanine levels, after long or short period of diet discontinuation. Neurologists should be aware of this diagnosis, and measure phenylalaninemia in case of neurological symptoms associated with non-specific leucopathy on brain MRI. PKU patients should be systematically encouraged to continue their diet and their medical follow-up to avoid neurological complications.
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Affiliation(s)
- Paul Jaulent
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Neurologie C, 69677, Bron Cedex, France
| | - Sybil Charriere
- Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Fédération D'endocrinologie, Maladies métaboliques, diabète Et Nutrition, Groupement Hospitalier Est, 28 avenue Doyen Lépine, 69677, Bron Cedex, France. .,INSERM U1060, Laboratoire Carmen, Université Lyon 1, INRA U1235, INSA de Lyon, 69621, Villeurbanne, France. .,CENS, Centre de Recherche en Nutrition Humaine Rhône Alpes, 69921, Oullins Cedex, France. .,Université Lyon 1 Claude Bernard, Faculté de médecine Lyon EST, 69373, Lyon, France. .,Hospices Civils de Lyon, Centre de référence Des Maladies héréditaires du métabolisme de Lyon, Groupement Hospitalier Est, 69677, Bron Cedex, France.
| | - François Feillet
- CHU de Nancy, Hôpitaux de Brabois, Centre de référence Des Maladies héréditaires du métabolisme de Nancy, 54511, Vandoeuvre-les Nancy, France
| | - Claire Douillard
- Centre Hospitalier Régional Universitaire de Lille, Hopital Claude Huriez, Service D'Endocrinologie-Diabétologie-Métabolisme, Hopital Huriez, 59037, Lille, France
| | - Alain Fouilhoux
- Hospices Civils de Lyon, Centre de référence Des Maladies héréditaires du métabolisme de Lyon, Groupement Hospitalier Est, 69677, Bron Cedex, France
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Neurologie C, 69677, Bron Cedex, France.,Université Lyon 1 Claude Bernard, Faculté de médecine Lyon EST, 69373, Lyon, France.,CNRS, Institut Des Sciences Cognitives Marc Jeannerod, UMR 5229, 69675, Bron, France
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Large Neutral Amino Acid Therapy Increases Tyrosine Levels in Adult Patients with Phenylketonuria: A Long-Term Study. Nutrients 2019; 11:nu11102541. [PMID: 31640267 PMCID: PMC6835503 DOI: 10.3390/nu11102541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 12/23/2022] Open
Abstract
The standard treatment for phenylketonuria (PKU) is a lifelong low-phenylalanine (Phe) diet, supplemented with Phe-free protein substitutes; however, adult patients often show poor adherence to therapy. Alternative treatment options include the use of large neutral amino acids (LNAA). The aim of this study was to determine the Phe, tyrosine (Tyr), and Phe/Tyr ratio in a cohort of sub-optimally controlled adult patients with classical PKU treated with a new LNAA formulation. Twelve patients received a Phe-restricted diet plus a slow-release LNAA product taken three times per day, at a dose of 1 g/kg body weight (mean 0.8 ± 0.24 g/kg/day), over a 12-month period. The product is in a microgranulated formulation, which incorporates all amino acids and uses sodium alginate as a hydrophilic carrier to prolong its release. This LNAA formulation provides up to 80% of the total protein requirement, with the rest of the protein supplied by natural food. Patients had fortnightly measurements of Phe and Tyr levels over a 12-month period after the introduction of LNAA. All patients completed the 12-month treatment period. Overall, adherence to the new LNAA tablets was very good compared with a previous amino acid mixture, for which taste was a major complaint by patients. Phe levels remained unchanged (p = 0.0522), and Tyr levels increased (p = 0.0195). Consequently, the Phe/Tyr ratio decreased significantly (p < 0.05) in the majority of patients treated. In conclusion, LNAA treatment increases Tyr levels in sub-optimally controlled adult PKU patients, while offering the potential to improve their adherence to treatment.
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Determining factors of the cognitive outcome in early treated PKU: A study of 39 pediatric patients. Mol Genet Metab Rep 2019; 20:100498. [PMID: 31384561 PMCID: PMC6664159 DOI: 10.1016/j.ymgmr.2019.100498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 11/23/2022] Open
Abstract
Phenylketonuria (PKU) is a disorder of phenylalanine metabolism, characterized by a neurotoxic phenylalanine (Phe) accumulation, and treatable with a life-long Phe-restricted diet. Though early and continuously treated PKU (ETPKU) patients exhibit normal IQ, their cognitive outcome remains suboptimal. In this longitudinal study, we aimed at assessing the determinants of IQ subscales and quality of metabolic control in ETPKU children. We collected blood Phe levels, numbers of blood samples for Phe determination, parents' socio-professional categories and school achievement data of 39 classical and moderate ETPKU patients who underwent two cognitive evaluations performed by the same neuropsychologist (at 6.5 and 10y of mean age). We then sought to evaluate the determinants of 1) the changes in their IQ between the two testings (delta IQ) and 2) the quality of metabolic control (evaluated by the median Phe levels during the year before the second test) with multivariate regression analysis. Though in the normal range, mean total IQ slightly decreased between the two evaluations, and we observed a better verbal than performance outcome. Modeling the determining factors of the delta IQ, we found a significant influence of the number of blood samples (β = 0.46, 95%CI = 0.13 to 0.79, p < 0.01) and the moderate type of PKU (β = 12.40, 95%CI = 3.69 to 21.11, p < 0.01) on verbal outcome. We failed to find any determining factors that would statistically influence metabolic control. In conclusion, ETPKU cognitive outcome is influenced by a network of metabolic and environmental factors, which is not reflected by the sole metabolic control.
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Hawks Z, Hood AM, Lerman-Sinkoff DB, Shimony JS, Rutlin J, Lagoni D, Grange DK, White DA. White and gray matter brain development in children and young adults with phenylketonuria. NEUROIMAGE-CLINICAL 2019; 23:101916. [PMID: 31491833 PMCID: PMC6627563 DOI: 10.1016/j.nicl.2019.101916] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/09/2019] [Accepted: 06/29/2019] [Indexed: 12/27/2022]
Abstract
Phenylketonuria (PKU) is a recessive disorder characterized by disruption in the metabolism of the amino acid phenylalanine (Phe). Prior research indicates that individuals with PKU have substantial white matter (WM) compromise. Much less is known about gray matter (GM) in PKU, but a small body of research suggests volumetric differences compared to controls. To date, developmental trajectories of GM structure in individuals with PKU have not been examined, nor have trajectories of WM and GM been examined within a single study. To address this gap in the literature, we compared longitudinal brain development over a three-year period in individuals with PKU (n = 35; 18 male) and typically-developing controls (n = 71; 35 male) aged 7–21 years. Using diffusion tensor imaging (DTI) and structural magnetic resonance imaging (MRI), we observed whole-brain and regional WM differences between individuals with PKU and controls, which were often exacerbated with increasing age. In marked contrast with trajectories of WM development, trajectories of GM development did not differ between individuals with PKU and controls, indicating that neuropathology in PKU is more prominent in WM than GM. Within individuals with PKU, mediation analyses revealed that whole-brain mean diffusivity (MD) and regional MD in the corpus callosum and centrum semiovale mediated the relationship between dietary treatment compliance (i.e., Phe control) and executive abilities, suggesting a plausible neurobiological mechanism by which Phe control may influence cognitive outcomes. Our findings clarify the specificity, timing, and cognitive consequences of whole-brain and regional WM pathology, with implications for treatment and research in PKU. Individuals with PKU exhibited widespread, age-related white matter compromise. Developmental trajectories of gray matter were comparable for PKU and controls. Within PKU, white matter compromise influenced cognitive outcomes.
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Affiliation(s)
- Zoë Hawks
- Department of Psychological & Brain Sciences, Campus Box 1125, Washington University, St. Louis, MO, United States.
| | - Anna M Hood
- Department of Psychological & Brain Sciences, Campus Box 1125, Washington University, St. Louis, MO, United States.
| | - Dov B Lerman-Sinkoff
- Department of Psychological & Brain Sciences, Campus Box 1125, Washington University, St. Louis, MO, United States; Department of Biomedical Engineering, Washington University, St. Louis, MO, United States
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jerrel Rutlin
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Daniel Lagoni
- Department of Psychological & Brain Sciences, Campus Box 1125, Washington University, St. Louis, MO, United States
| | - Dorothy K Grange
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Desirée A White
- Department of Psychological & Brain Sciences, Campus Box 1125, Washington University, St. Louis, MO, United States; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
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Plenis A, Olędzka I, Kowalski P, Miękus N, Bączek T. Recent Trends in the Quantification of Biogenic Amines in Biofluids as Biomarkers of Various Disorders: A Review. J Clin Med 2019; 8:E640. [PMID: 31075927 PMCID: PMC6572256 DOI: 10.3390/jcm8050640] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 01/10/2023] Open
Abstract
Biogenic amines (BAs) are bioactive endogenous compounds which play a significant physiological role in many cell processes like cell proliferation and differentiation, signal transduction and membrane stability. Likewise, they are important in the regulation of body temperature, the increase/decrease of blood pressure or intake of nutrition, as well as in the synthesis of nucleic acids and proteins, hormones and alkaloids. Additionally, it was confirmed that these compounds can be considered as useful biomarkers for the diagnosis, therapy and prognosis of several neuroendocrine and cardiovascular disorders, including neuroendocrine tumours (NET), schizophrenia and Parkinson's Disease. Due to the fact that BAs are chemically unstable, light-sensitive and possess a high tendency for spontaneous oxidation and decomposition at high pH values, their determination is a real challenge. Moreover, their concentrations in biological matrices are extremely low. These issues make the measurement of BA levels in biological matrices problematic and the application of reliable bioanalytical methods for the extraction and determination of these molecules is needed. This article presents an overview of the most recent trends in the quantification of BAs in human samples with a special focus on liquid chromatography (LC), gas chromatography (GC) and capillary electrophoresis (CE) techniques. Thus, new approaches and technical possibilities applied in these methodologies for the assessment of BA profiles in human samples and the priorities for future research are reported and critically discussed. Moreover, the most important applications of LC, GC and CE in pharmacology, psychology, oncology and clinical endocrinology in the area of the analysis of BAs for the diagnosis, follow-up and monitoring of the therapy of various health disorders are presented and critically evaluated.
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Affiliation(s)
- Alina Plenis
- Department of Pharmaceutical Chemistry, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland.
| | - Ilona Olędzka
- Department of Pharmaceutical Chemistry, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland.
| | - Piotr Kowalski
- Department of Pharmaceutical Chemistry, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland.
| | - Natalia Miękus
- Department of Pharmaceutical Chemistry, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland.
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland.
| | - Tomasz Bączek
- Department of Pharmaceutical Chemistry, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland.
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