Update on phenylketonuria

L-carnitine protects DNA oxidative damage induced by phenylalanine and its keto acid derivatives in neural cells: a possible pathomechanism and adjuvant therapy for brain injury in phenylketonuria

Although phenylalanine (Phe) is known to be neurotoxic in phenylketonuria (PKU), its exact pathogenetic mechanisms of brain damage are still poorly known. Furthermore, much less is known about the role of the Phe derivatives phenylacetic (PAA), phenyllactic (PLA) and phenylpyruvic (PPA) acids that also accumulate in this this disorder on PKU neuropathology. Previous in vitro and in vivo studies have shown that Phe elicits oxidative stress in brain of rodents and that this deleterious process also occurs in peripheral tissues of phenylketonuric patients. In the present study, we investigated whether Phe and its derivatives PAA, PLA and PPA separately or in combination could induce reactive oxygen species (ROS) formation and provoke DNA damage in C6 glial cells. We also tested the role of L-carnitine (L-car), which has been recently considered an antioxidant agent and easily cross the blood brain barrier on the alterations of C6 redox status provoked by Phe and its metabolites. We first observed that cell viability was not changed by Phe and its metabolites. Furthermore, Phe, PAA, PLA and PPA, at concentrations found in plasma of PKU patients, provoked marked DNA damage in the glial cells separately and when combined. Of note, these effects were totally prevented (Phe, PAA and PPA) or attenuated (PLA) by L-car pre-treatment. In addition, a potent ROS formation also induced by Phe and PAA, whereas only moderate increases of ROS were caused by PPA and PLA. Pre-treatment with L-car also prevented Phe- and PAA-induced ROS generation, but not that provoked by PLA and PPA. Thus, our data show that Phe and its major metabolites accumulated in PKU provoke extensive DNA damage in glial cells probably by ROS formation and that L-car may potentially represent an adjuvant therapeutic agent in PKU treatment.

Aptamer-based assay for monitoring genetic disorder phenylketonuria (PKU)

The genetic disorder phenylketonuria (PKU) is the inability to metabolize phenylalanine because of a lack of the enzyme phenylalanine hydroxylase. Phenylalanine is used to biochemically form proteins, coded for by DNA. The development of an apta-assay for detection of l-Phenylalanine is presented in this work. A highly specific DNA-aptamer, selected to l-Phenylalanine was immobilized onto a gold nanostructure and electrochemical measurements were performed in a solution containing the phosphate buffer solution with physiological pH. We have constructed an aptamer immobilized gold nanostructure mediated, ultrasensitive electrochemical biosensor (Apt/AuNSs/Au electrode) for l-Phenylalanine detection without any additional signal amplification strategy. The aptamer assemble onto the AuNSs makes Apt/AuNSs/Au electrode an excellent platform for the l-Phenylalanine detection in physiological like condition. Differential pulse voltammetry were used for the quantitative l-Phenylalanine detection. The Apt/AuNSs/Au electrode offers an ultrasensitive and selective detection of l-Phenylalanine down to 0.23 μM level with a wide dynamic range from 0.72 μM-6 mM. The aptasensor exhibited excellent selectivity and stability. The real sample analysis was performed by spiking the unprocessed human serum samples with various concentration of l-Phenylalanine and obtained recovery within 2% error value. The sensor is found to be more sensitive than most of the literature reports. The simple and easy way of construction of this apta-assay provides an efficient and promising diagnosis of phenylketonuria.

Aptamer-based biosensor for detection of phenylalanine at physiological pH

A simple, sensitive aptamer-based biosensor for the detection of phenylalanine is developed using the electrochemical transduction method. For this proposed aptasensor, a 5-thiol-terminated aptamer is covalently attached onto a gold electrode. At the first time, the electrode was evaluated as an electrochemical aptasensor for determination of phenylalanine in aqueous solutions. This sensor was tested in a Tris-HCl buffer with physiological pH = 7.4 by cyclic voltammetry and differential pulse voltammetry. The detection limit and sensitivity of the modified electrode toward phenylalanine were estimated to be 1 nM (S/N = 3) and 0.367 μA nM(-1), respectively. The linear range of the signal was observed between 1 and 10 nM of phenylalanine with 0.9914 correlation factor. The herein-described approach is expected to promote the exploitation of aptamer-based biosensors for protein assays in biochemical and biomedical studies.

Dietary habits and metabolic control in adolescents and young adults with phenylketonuria: self-imposed protein restriction may be harmful

BACKGROUND

In untreated patients, phenylketonuria (PKU) results in severe encephalopathy with mental retardation. A protein-restricted diet is recommended which can be relaxed in adolescence/adulthood.

METHODS

We contacted all 72 adult/adolescent PKU patients who had been treated in our center during early childhood. Some still regularly attended our outpatient clinics, while others were lost for follow-up, giving 51 patients in our study. We asked all patients to complete a dietary protocol as well as a questionnaire on quality of life. Blood and urine were analyzed and body impedance plethysmography and cerebral MRI were performed.

RESULTS

42 % of the patients followed protein restriction supplemented with amino acid mixtures (AAM), others had a vegan diet with (8 %) or without (14 %) AAM; 36 % said they were eating normally and did not need any AAM. However, based on dietary protocols and blood urea levels, protein intake was restricted in this patient group. None of the patients examined had serious nutritional deficits. Phenylalanine levels were higher in patients not taking AAM. MRI of the brain was not different from those following protein restriction and taking AAM. The lesions score and mood correlated best with the cumulative phenylalanine values during the first 10 years of life.

CONCLUSION

In summary, 50 % of adult/adolescent patients from our center did not take AAM at the start of our survey although they unknowingly followed self-imposed protein restriction. They had no overt nutritional deficits; however, long-term brain function may be compromised. Our study emphasizes the need for specialized metabolic care in PKU during adulthood.

Neurocognitive function in mild hyperphenylalaninemia

AIM

The purpose of this review was to provide an update on cognitive function in individuals with mild hyperphenylalaninemia (mHPA), the most clinically and biochemically benign form of phenylketonuria.

METHOD

A review was conducted of the existing literature on mHPA. Individuals with mHPA, whose plasma phenylalanine concentration had always remained lower than 360 μmol/L without dietary restriction, were considered.

RESULTS

The review of the literature indicated that there is no consensus concerning the definition of mHPA. There are few studies regarding the cognitive functions of individuals with mHPA, results are contradictory, and samples are difficult to compare from one study to another. Most studies focus only on descriptions of IQ when assessing cognitive functions. The existing literature indicates that, in general, children with mHPA do not show significant cognitive impairments, but usually achieve scores between those of individuals with phenylketonuria and those of comparison groups with regard to the cognitive functions assessed.

INTERPRETATION

When assessing cognitive functions in individuals with hyperphenylalaninemia, it is not enough to measure only IQ, as deficits in executive functions can be present even when an individual's IQ is within a normal range. Further studies are needed of individuals with mHPA, using consistent selection criteria, in order to make it possible to exclude the presence of cognitive impairment and to establish a consensus regarding the level of phenylalanine that necessitates dietary treatment.

L-carnitine blood levels and oxidative stress in treated phenylketonuric patients

AIMS

L-carnitine exerts an important role by facilitating the mitochondrial transport of fatty acids, but is also a scavenger of free radicals, protecting cells from oxidative damage. Phenylketonuria (PKU), an inborn error of phenylalanine (Phe) metabolism, is currently treated with a special diet consisting of severe restriction of protein-enriched foods, therefore potentially leading to L-carnitine depletion. The aim of this study was to determine L-carnitine levels and oxidative stress parameters in blood of two groups of PKU patients, with good and poor adherence to treatment.

METHODS

Treatment of patients consisted of a low protein diet supplemented with a synthetic amino acids formula not containing Phe, L-carnitine, and selenium. L-carnitine concentrations and the oxidative stress parameters thiobarbituric acid reactive species (TBARS) and total antioxidant reactivity (TAR) were measured in blood of the two groups of treated PKU patients and controls.

RESULTS

We verified a significant decrease of serum L-carnitine levels in patients who strictly adhered to the diet, as compared to controls and patients who did not comply with the diet. Furthermore, TBARS measurement was significantly increased and TAR was significantly reduced in both groups of phenylketonuric patients relatively to controls. We also found a significant negative correlation between TBARS and L-carnitine levels and a significant positive correlation between TAR and L-carnitine levels in well-treated PKU patients.

CONCLUSIONS

Our results suggest that L-carnitine should be measured in plasma of treated PKU patients, and when a decrease of this endogenous component is detected in plasma, supplementation should be considered as an adjuvant therapy.

Investigation of oxidative stress parameters in treated phenylketonuric patients

Phenylketonuria (PKU) is the most frequent disturbance of amino acid metabolism being caused by severe deficiency of phenylalanine hydroxylase activity. Untreated PKU patients present severe mental retardation whose pathophysiology is not completely estabilished. Despite the low-Phe diet, a considerable number of phenylketonuric patients present a mild to moderate psychomotor delay and decreased cognitive functions. In the present study we evaluated various parameters of oxidative stress namely thiobarbituric acid-reactive species (TBA-RS), total antioxidant reactivity (TAR) and activities of the antioxidant enzymes catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) in two groups of treated PKU patients, one with well controlled and the other with high Phe blood levels in order to investigate whether blood Phe concentrations could be correlated with the extend of oxidative stress. We initially verified a marked increase of TBA-RS, and a decrease of TAR in plasma, as well as a reduction of erythrocyte GSH-Px activity which were similar in both groups of PKU patients, when compared to controls of similar ages. In contrast, CAT and SOD activities were not altered in PKU patients. These results show that oxidative stress occurs in PKU patients and that this pathogenic process is probably not directly correlated to Phe blood levels.