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Feillet F, Arnoux JB, Delgado MB, Burlina A, Chabrol B, Kucuksayrac E, Lagler FB, Muntau AC, Olsson D, Paci S, Rutsch F, van Spronsen FJ. Long-term safety of sapropterin in paediatric and adult individuals with phenylalanine hydroxylase deficiency: Final results of the Kuvan® Adult Maternal Paediatric European Registry multinational observational study. J Inherit Metab Dis 2024. [PMID: 39237321 DOI: 10.1002/jimd.12796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 08/08/2024] [Accepted: 08/22/2024] [Indexed: 09/07/2024]
Abstract
Phenylketonuria is a rare inherited disorder that disrupts the metabolism of phenylalanine (Phe) to tyrosine by phenylalanine hydroxylase (PAH). Sapropterin dihydrochloride (Kuvan®) is approved for use in Europe to reduce blood Phe levels and improve Phe tolerance in sapropterin-responsive individuals. KAMPER (NCT01016392) is an observational, multinational registry assessing long-term safety and efficacy of sapropterin. Five hundred and seventy-six participants with PAH deficiency were enrolled from nine European countries (69 sites; December 2009-May 2016). Participants were aged <4 years (n = 11), 4 to <12 years (n = 329), 12 to <18 years (n = 141), and ≥18 years (n = 95) at enrolment. Overall, 401 (69.6%) participants experienced a total of 1960 adverse events; 61 events in 42 participants were serious, and two were considered sapropterin-related by the investigator. Mean (standard deviation) actual dietary Phe intake increased from baseline across all age groups: 957 (799) mg/day to a maximum of 1959 (1121) mg/day over a total study period of 11 years. Most participants exhibited an increase in Phe tolerance while blood Phe levels remained in the target range for their age (120-360 μmol/L for <12 years; 120-600 μmol/L for ≥12 years). Most participants exhibited normal growth for height, weight, and body mass index. No additional safety concerns were identified. As an observational study, limitations include variability in routine care practices and inconsistent availability of data. Long-term sapropterin use demonstrates a favourable safety profile in real-world settings and increases Phe tolerance in participants with PAH deficiency while maintaining blood Phe levels in the target ranges.
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Affiliation(s)
| | | | | | | | | | | | | | - Ania C Muntau
- University Children's Hospital, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David Olsson
- Karolinska University Hospital, Stockholm, Sweden
| | - Sabrina Paci
- Pediatric Department, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Frank Rutsch
- Muenster University Children's Hospital, Muenster, Germany
| | - Francjan J van Spronsen
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands
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Buonamassa R, Boscia G, Gaudiomonte M, Guerriero S, Fischetto R, Montepara A, Grassi MO, Pignataro MG, Puzo P, Giancipoli E, D’addario M, Alessio G, Boscia F, Viggiano P. Neurovascular retinal impairment in early-treated adults with phenylketonuria. Front Neurol 2024; 15:1305984. [PMID: 38974690 PMCID: PMC11225547 DOI: 10.3389/fneur.2024.1305984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose To compare radial peripapillary capillary (RPC) vascular plexus parameters and peripapillary retinal nerve fiber layer (pRNFL) thickness between Early-Treated Adults with Phenylketonuria (ETPKU) and controls. Methods This observational study was a monocentric, case control study including 36 eyes of 36 participants. Among these, 18 were early-treated PKU (ETPKU) and 18 were controls. A SD-OCTA (XR Avanti AngioVue OCTA; Optovue Inc., Fremont, CA) was employed to assess the OCT and OCTA parameters of all the participants. The main outcome measures were the RPC vessels density (VD) %, and the pRNFL thickness. Results The average pRNFL thickness was significantly reduced in ETPKU (110.78 ± 12.48 μm) compared to controls (113.22 ± 13.95 μm), p = 0.046. The mean VD% of the small vessels of the RPC plexus was 52.31 ± 2.2 in ETPKU and 50.71 ± 3.2 in controls (p = 0.049), while the VD% of all the radial peripapillary capillary plexus (RPCP) was 58.5 ± 2.2 in ETPKU and 55.08 ± 3.4 in controls (p < 0.001). By contrast, there were no differences in age, sex, and IOP between the two groups. Conclusion Through structural OCT and OCTA, we observed thinning of the nerve fibers accompanied by an increase in perfusion of the RPC plexus. Thus, our conclusions suggest that OCTA may serve as a noninvasive method to identify novel retinal biomarkers in ETPKU.
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Affiliation(s)
- Rosa Buonamassa
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Giacomo Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Marida Gaudiomonte
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Silvana Guerriero
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Rita Fischetto
- Metabolic Diseases and Clinical Genetics Unit, Department of Pediatric Medicine, Giovanni XXIII Children’s Hospital, Bari, Italy
| | - Alfonso Montepara
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Maria Oliva Grassi
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Maria Grazia Pignataro
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Pasquale Puzo
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | | | - Marina D’addario
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Giovanni Alessio
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Francesco Boscia
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
| | - Pasquale Viggiano
- Department of Translational Biomedicine Neuroscience, University of Bari “Aldo Moro”, Bari, Italy
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Luengo-Pérez LM, Fernández-Bueso M, Guzmán-Carmona C, López-Navia A, García-Lobato C. Morphofunctional Assessment beyond Malnutrition: Fat Mass Assessment in Adult Patients with Phenylketonuria-Systematic Review. Nutrients 2024; 16:1833. [PMID: 38931188 PMCID: PMC11206948 DOI: 10.3390/nu16121833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/04/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Morphofunctional assessment was developed to evaluate disease-related malnutrition. However, it can also be used to assess cardiometabolic risk, as excess adiposity increases this risk. Phenylketonuria (PKU) is the most prevalent inherited metabolic disease among adults, and obesity in PKU has recently gained interest, although fat mass correlates better with cardiometabolic risk than body mass index. In this systematic review, the objective was to assess whether adult patients with PKU have higher fat mass than healthy controls. Studies of adult PKU patients undergoing dietary treatment in a metabolic clinic reporting fat mass were included. The PubMed and EMBASE databases were searched. Relevance of articles, data collection, and risk of bias were evaluated by two independent reviewers. Ten articles were evaluated, six with a control group, including 310 subjects with PKU, 62 with mild hyperphenylalaninemia, and 157 controls. One study reported a significant and four a tendency towards an increased fat mass in all patients or only females with PKU. Limitations included not having a healthy control group, not reporting sex-specific results and using different techniques to assess fat mass. Evaluation of fat mass should be included in the morphofunctional assessment of cardiometabolic risk in adult patients with PKU.
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Affiliation(s)
- Luis M. Luengo-Pérez
- Medical Sciences Department, Faculty of Medicine and Health Sciences, University of Extremadura, 06006 Badajoz, Spain
- Clinical Nutrition and Dietetics Unit, Endocrinology and Nutrition Section, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (C.G.-L.)
| | - Mercedes Fernández-Bueso
- Clinical Nutrition and Dietetics Unit, Endocrinology and Nutrition Section, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (C.G.-L.)
| | - Carlos Guzmán-Carmona
- Endocrinology and Nutrition, Don Benito-Villanueva de la Serena Hospital Complex, 06400 Don Benito, Spain; (C.G.-C.); (A.L.-N.)
| | - Ana López-Navia
- Endocrinology and Nutrition, Don Benito-Villanueva de la Serena Hospital Complex, 06400 Don Benito, Spain; (C.G.-C.); (A.L.-N.)
| | - Claudia García-Lobato
- Clinical Nutrition and Dietetics Unit, Endocrinology and Nutrition Section, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (C.G.-L.)
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Harding CO, Longo N, Northrup H, Sacharow S, Singh R, Thomas JA, Vockley J, Zori RT, Bulloch Whitehall K, Lilienstein J, Lindstrom K, Levy DG, Jones S, Burton BK. Pegvaliase for the treatment of phenylketonuria: Final results of a long-term phase 3 clinical trial program. Mol Genet Metab Rep 2024; 39:101084. [PMID: 38694233 PMCID: PMC11061743 DOI: 10.1016/j.ymgmr.2024.101084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/04/2024] Open
Abstract
Phenylketonuria (PKU) is a genetic disorder caused by deficiency of the enzyme phenylalanine hydroxylase (PAH), which results in phenylalanine (Phe) accumulation in the blood and brain, and requires lifelong treatment to keep blood Phe in a safe range. Pegvaliase is an enzyme-substitution therapy approved for individuals with PKU and uncontrolled blood Phe concentrations (>600 μmol/L) despite prior management. Aggregated results from the PRISM clinical trials demonstrated substantial and sustained reductions in blood Phe with a manageable safety profile, but also noted individual variation in time to and dose needed for a first response. This analysis reports longer-term aggregate findings and characterizes individual participant responses to pegvaliase using final data from the randomized trials PRISM-1 (NCT01819727) and PRISM-2 (NCT01889862), and the open-label extension study 165-304 (NCT03694353). In 261 adult participants with a mean of 36.6 months of pegvaliase treatment, 71.3%, 65.1%, and 59.4% achieved clinically significant blood Phe levels of ≤600, ≤360, and ≤ 120 μmol/L, respectively. Some participants achieved blood Phe reductions with <20 mg/day pegvaliase, although most required higher doses. Based on Kaplan-Meier analysis, median (minimum, maximum) time to first achievement of a blood Phe threshold of ≤600, ≤360, or ≤ 120 μmol/L was 4.4 (0.0, 54.0), 8.0 (0.0, 57.0), and 11.6 (0.0, 66.0) months, respectively. Once achieved, blood Phe levels remained below clinical threshold in most participants. Sustained Phe response (SPR), a new method described within for measuring durability of blood Phe response, was achieved by 85.5%, 84.7%, and 78.1% of blood Phe responders at blood Phe thresholds of ≤600, ≤360, or ≤ 120 μmol/L, respectively. Longer-term safety data were consistent with previous reports, with the most common adverse events (AEs) being arthralgia, injection site reactions, headache, and injection site erythema. The incidence of most AEs, including hypersensitivity AEs, was higher during the early treatment phase (≤6 months) than later during treatment. In conclusion, using data from three key pegvaliase clinical trials, participants treated with pegvaliase were able to reach clinically significant blood Phe reductions to clinical thresholds of ≤600, ≤360, or ≤ 120 μmol/L during early treatment, with safety profiles improving from early to sustained treatment. This study also supports the use of participant-level data and new ways of looking at durable blood Phe responses to better characterize patients' individual PKU treatment journeys.
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Affiliation(s)
- Cary O. Harding
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Nicola Longo
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Hope Northrup
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth) and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Stephanie Sacharow
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Rani Singh
- Emory University School of Medicine, Decatur, GA, USA
| | - Janet A. Thomas
- Department of Pediatrics, Section of Clinical Genetics and Metabolism, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jerry Vockley
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Feldmann R, Och U, Beckmann LS, Weglage J, Rutsch F. Children and Adolescents with Early Treated Phenylketonuria: Cognitive Development and Fluctuations of Blood Phenylalanine Levels. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:431. [PMID: 38673342 PMCID: PMC11050632 DOI: 10.3390/ijerph21040431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND We assessed the relationship between the cognitive development of children and adolescents with phenylketonuria (PKU) and fluctuations in peripheral phenylalanine (Phe) levels. METHODS We examined the neurocognitive performance of 33 children and adolescents with early treated PKU, of whom 18 were treated with sapropterin dihydrochloride, and 15 were on a classic diet. For 26 weeks, patients were assessed weekly for their blood phenylalanine (Phe) levels. Phe levels were analyzed for fluctuations indicated by the individual standard deviation. Fluctuations were compared to the standard deviation of 26 Phe level measurements before the study interval. We also assessed the concurrent IQ of the patients. This was repeated at one-, two-, and seven-year intervals. RESULTS Full-scale IQ in patients treated with a classic diet did not change within the follow-up. In patients treated with Sapropterin dihydrochloride, however, there was a considerable gain in full-scale IQ. This was particularly true if blood Phe fluctuations increased in patients of this treatment group. CONCLUSIONS Sapropterin dihydrochloride enhances Phe tolerance in patients with PKU. Increasing blood Phe fluctuations following enhanced Phe tolerance may indicate that the treatment not only allows patients to relax their Phe-restricted diet but also may support cognitive development in patients.
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Affiliation(s)
- Reinhold Feldmann
- Department of General Pediatrics, Münster University Children’s Hospital, 48149 Münster, Germany; (U.O.); (F.R.)
- Children’s Healthcare Center “Haus Walstedde”, 48317 Drensteinfurt, Germany
| | - Ulrike Och
- Department of General Pediatrics, Münster University Children’s Hospital, 48149 Münster, Germany; (U.O.); (F.R.)
| | - Lisa Sophie Beckmann
- Department of General Pediatrics, Münster University Children’s Hospital, 48149 Münster, Germany; (U.O.); (F.R.)
| | - Josef Weglage
- Children’s Healthcare Center “Haus Walstedde”, 48317 Drensteinfurt, Germany
| | - Frank Rutsch
- Department of General Pediatrics, Münster University Children’s Hospital, 48149 Münster, Germany; (U.O.); (F.R.)
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Rohr F, Burton B, Dee A, Harding CO, Lilienstein J, Lindstrom K, MacLeod E, Rose S, Singh R, van Calcar S, Whitehall K. Evaluating change in diet with pegvaliase treatment in adults with phenylketonuria: Analysis of phase 3 clinical trial data. Mol Genet Metab 2024; 141:108122. [PMID: 38184920 DOI: 10.1016/j.ymgme.2023.108122] [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: 11/02/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
Phenylketonuria (PKU), a genetic disorder characterized by phenylalanine hydroxylase (PAH) deficiency and phenylalanine (Phe) accumulation, is primarily managed with a protein-restricted diet and PKU-specific medical foods. Pegvaliase is an enzyme substitution therapy approved for individuals with PKU and uncontrolled blood Phe concentrations (>600 μmol/L) despite prior management. This analysis assessed the effect of pegvaliase on dietary intake using data from the Phase 3 PRISM-1 (NCT01819727), PRISM-2 (NCT01889862), and 165-304 (NCT03694353) clinical trials. Participants (N = 250) had a baseline diet assessment, blood Phe ≥600 μmol/L, and had discontinued sapropterin; they were not required to follow a Phe-restricted diet. Outcomes were analyzed by baseline dietary group, categorized as >75%, some (>0% but ≤75%), or no protein intake from medical food. At baseline, mean age was 29.1 years, 49.2% were female, mean body mass index was 28.4 kg/m2, and mean blood Phe was 1237.0 μmol/L. Total protein intake was stable up to 48 months for all 3 baseline dietary groups. Over this time, intact protein intake increased in all groups, and medical protein intake decreased in those who consumed any medical protein at baseline. Of participants consuming some or >75% medical protein at baseline, 49.1% and 34.1% were consuming no medical protein at last assessment, respectively. Following a first hypophenylalaninemia (HypoPhe; 2 consecutive blood Phe measurements <30 μmol/L) event, consumption of medical protein decreased and consumption of intact protein increased. Substantial and sustained Phe reductions were achieved in all 3 baseline dietary groups. The probability of achieving sustained Phe response (SPR) at ≤600 μmol/L was significantly greater for participants consuming medical protein versus no medical protein in an unadjusted analysis, but no statistically significant difference between groups was observed for probability of achieving SPR ≤360 or SPR ≤120 μmol/L. Participants with alopecia (n = 49) had longer pegvaliase treatment durations, reached HypoPhe sooner, and spent longer in HypoPhe than those who did not have alopecia. Most (87.8%) had an identifiable blood Phe drop before their first alopecia episode, and 51.0% (n = 21/41) of first alopecia episodes with known duration resolved before the end of the HypoPhe episode. In conclusion, pegvaliase treatment allowed adults with PKU to lower their blood Phe, reduce their reliance on medical protein, and increase their intact and total protein intake. Results also suggest that HypoPhe does not increase the risk of protein malnutrition in adults with PKU receiving pegvaliase.
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Affiliation(s)
| | - Barbara Burton
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Anne Dee
- BioMarin Pharmaceutical Inc., Novato, CA, USA.
| | | | | | | | - Erin MacLeod
- Children's National Rare Disease Institute, Washington, DC, USA.
| | - Sarah Rose
- BioMarin Pharmaceutical Inc., Novato, CA, USA.
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Fazio TN, Healy L, Heise T, Inwood A, Manolikos C, Rahman Y, Woerle HJ, Hendriksz CJ. Pharmacodynamics, safety, tolerability and pharmacokinetics of a single oral dose of an engineered phenylalanine ammonia-lyase in patients with phenylketonuria. Mol Genet Metab Rep 2023; 37:101012. [PMID: 38053938 PMCID: PMC10694774 DOI: 10.1016/j.ymgmr.2023.101012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 12/07/2023] Open
Abstract
The cornerstone treatment of hyperphenylalaninemia (HPA) and phenylketonuria (PKU) is a lifelong low-protein diet with phenylalanine (Phe) free L-amino acid supplements. However, the PKU diet has significant shortcomings, and there is a clinically unmet need for new therapeutics to improve patient outcomes. CDX-6114 is a modified phenylalanine ammonia-lyase (PAL) enzyme obtained by a mutation in the Anabaena variabilis PAL sequence. CodeEvolver® protein engineering technology has been applied to improve the degradation resistance of the enzyme. In our first phase I trial, 19 patients were given a single oral dose of CDX-6114 at 7.5 g, 2.5 g, 0.7 g, or placebo in a cross-over design. After an overnight fast, patients received a standardised breakfast of 20 g of protein, thus exceeding the dietary recommendations for a single meal in patients with PKU. Plasma levels of Phe and cinnamic acid (CA) were measured over a 5-h period following CDX-6114 dosing. During the development of CDX-6114, a stability assessment using reverse-phase high-performance liquid chromatography (HPLC) assay revealed two peaks. The second peak was identified as CA. It was not previously known that as part of the mechanism of action, the CA remained associated with the protein following the conversion of Phe. Thus, recalculating the historical PAL enzyme amounts in CDX-6114 bulk substance was necessary. An updated extinction coefficient was achieved by applying a correction factor of 0.771 to previously reported doses. Postprandial plasma levels of Phe increased in all dose cohorts over time between 10% and 30% from baseline, although the actual peak of Phe levels was not achieved within the 5-h observation. When accounting for the interquartile ranges, these concentrations were similar to the placebo. As plasma levels of Phe were no longer a reliable marker for pharmacodynamics, the consistently detectable amount of CA seen in all patients who received CDX-6114 provided proof of the enzymatic activity of CDX-6114 in metabolising gastrointestinal Phe. Peak levels of CA were seen shortly after CDX-6114 intake, with a rapid decline, and remained low compared with the plasma Phe levels. This pattern indicates a short half-life, possibly due to the liquid formulation or the inability to withstand the lower pH in the human stomach compared with animal models in earlier studies. This was the first trial in patients with PKU to establish the safety and tolerability of CDX-6114. A single dose of CDX-6114 was safe and well tolerated, with no serious adverse events or presence of anti-drug antibodies detected. Efficacy will be explored in future trials using an optimised formulation.
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Affiliation(s)
- Timothy Nicholas Fazio
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Louise Healy
- Metabolic Dietary Disorders Association, PO Box 33, Montrose, Victoria, 3765, Australia
| | | | - Anita Inwood
- Queensland Lifespan Metabolic Medicine Service, Brisbane, Queensland, Australia
| | | | - Yusof Rahman
- Department of Genetic Medicine, Westmead Hospital, Sydney, Australia
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Ramos-Álvarez R, Kapp M, Bélanger-Quintana A, Rodríguez-Ruiz MM, Solano-Galvis CA, Campos Soto A, Ahring K, Waisbren SE. Parent knowledge regarding food selection for children with PKU: Results of a survey in the United States. Nutrition 2023; 116:112201. [PMID: 37804556 DOI: 10.1016/j.nut.2023.112201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES Dietary treatment is the main therapy for most patients with phenylketonuria (PKU). Parental knowledge regarding food selection is crucial to ensure adequate metabolic control and brain development during childhood and to promote lifelong adherence and healthy dietary behavior in the offspring. The aims of this study were to assess whether parental or caregiver knowledge regarding nutritional selection for children with PKU is in accordance with medical recommendations and to evaluate factors that influence their level of knowledge. METHODS This was a cross-sectional observational study. An online or paper survey (N = 178) was distributed throughout the United States. The survey included a validated food selection questionnaire to assess whether the respondent adequately identified foods that require certain restrictions versus foods that can be consumed freely by an individual with PKU. RESULTS General knowledge of food selection among the caregivers was very high or high in nearly 60% (60-98th score percentile). Participants with the lowest scores in general knowledge of the PKU diet (quartile 1) were more likely to label allowed foods incorrectly. Respondents with the highest scores (quartile 4) were more likely to label limited foods correctly but incorrectly label allowed items. CONCLUSION Knowledge of restricted foods is important to avoid poor metabolic control, but knowledge of allowed foods can be just as important to allow for a diet that is diverse, palatable, and nutritionally balanced.
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Affiliation(s)
- Rodolfo Ramos-Álvarez
- Department of Social Psychology, Melilla Campus, University of Granada, Melilla, Spain.
| | - Maili Kapp
- Teaching Innovation Project, Melilla Campus, University of Granada, Melilla, Spain
| | - Amaya Bélanger-Quintana
- Metabolic Diseases Unit, Department of Paediatrics, Ramón y Cajal Hospital, CSUR, MetabERN, Madrid, Spain
| | | | | | - Antonio Campos Soto
- Department of Didactics and School Organization, Melilla Campus, University of Granada, Melilla, Spain
| | - Kirsten Ahring
- Center for PKU, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susan E Waisbren
- Genetics and Metabolism Programs, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Sundstrom R, Wetherill L, Sapp K, McPheron M, Lah M. Relationship satisfaction in adults with phenylketonuria is positively associated with following recommended treatment, having a partner involved in management, and maintaining good health. J Community Genet 2023; 14:627-638. [PMID: 37798460 PMCID: PMC10725410 DOI: 10.1007/s12687-023-00667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Abstract
RATIONALE Phenylketonuria (PKU) is a metabolic condition that requires treatment for life. There is increasing evidence that chronic illnesses put strain on relationships and marriages. However, no studies have examined the unique factors that metabolic conditions have on affected individuals and their relationship satisfaction. We surveyed a population of adult patients with PKU and assessed how management, treatment, and lifestyle factors impact their relationship satisfaction. PURPOSE The purpose of our study was to explore whether factors such as involvement of partner in PKU management, impact of challenges unique to PKU (e.g., diet, family planning, mood disturbances), and PKU treatment types were associated with the degree of relationship satisfaction. METHOD We surveyed adult patients with PKU (n = 82) who were either currently in or had previously been in a long-term relationship. We developed a 78-question survey that included unique questions regarding lifestyle, treatment, and management of their PKU in addition to a validated Relationship Assessment Score. Questions included single choice, multiple choice, and 3 open-ended questions. RESULTS We found that higher relationship satisfaction was associated with increased partner involvement, increased health, and adherence to recommended PKU treatments. Participants utilizing both diet and pharmaceutical treatment had the highest relationship satisfaction. Finally, participants who reported that their PKU did not contribute to the ending of a previous relationship reported higher relationship satisfaction scores. CONCLUSION This study suggests that involvement of partners in the management and treatment of a chronic illness and adherence to recommended treatments can significantly improve relationship satisfaction.
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Affiliation(s)
- Rachel Sundstrom
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut, IB 130, Indianapolis, IN, 46202, USA
- Froedtert & The Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut, IB 130, Indianapolis, IN, 46202, USA
| | - Katie Sapp
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut, IB 130, Indianapolis, IN, 46202, USA
| | - Molly McPheron
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut, IB 130, Indianapolis, IN, 46202, USA
| | - Melissa Lah
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut, IB 130, Indianapolis, IN, 46202, USA.
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Rocha JC, Ahring KK, Bausell H, Bilder DA, Harding CO, Inwood A, Longo N, Muntau AC, Pessoa ALS, Rohr F, Sivri S, Hermida Á. Expert Consensus on the Long-Term Effectiveness of Medical Nutrition Therapy and Its Impact on the Outcomes of Adults with Phenylketonuria. Nutrients 2023; 15:3940. [PMID: 37764724 PMCID: PMC10536918 DOI: 10.3390/nu15183940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Many adults with phenylketonuria (PKU) rely on medical nutrition therapy (MNT; low phenylalanine (Phe) diet with protein substitutes/medical foods) to maintain blood Phe concentrations within recommended ranges and prevent PKU-associated comorbidities. Despite disease detection through newborn screening and introduction of MNT as early as birth, adherence to MNT often deteriorates from childhood onwards, complicating the assessment of its effectiveness in the long term. Via a modified Delphi process, consensus (≥70% agreement) was sought on 19 statements among an international, multidisciplinary 13-member expert panel. After three iterative voting rounds, the panel achieved consensus on 17 statements related to the limitations of the long-term effectiveness of MNT (7), the burden of long-term reliance on MNT (4), and its potential long-term detrimental health effects (6). According to the expert panel, the effectiveness of MNT is limited in the long term, is associated with a high treatment burden, and demonstrates that adults with PKU are often unable to achieve metabolic control through dietary management alone, creating an unmet need in the adult PKU population.
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Affiliation(s)
- Júlio César Rocha
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Kirsten K. Ahring
- Departments of Paediatrics and Clinical Genetics, PKU Clinic, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Heather Bausell
- Division of Genetics, Genomics, and Metabolism, Ann & Robert H Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, USA
| | - Deborah A. Bilder
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of Utah Huntsman Mental Health Institute, 501 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Cary O. Harding
- Department of Molecular and Medical Genetics, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR 97239, USA
| | - Anita Inwood
- Queensland Lifespan Metabolic Medicine Service, Queensland Children’s Hospital, 501 Stanley St., South Brisbane, QLD 4101, Australia
- School of Nursing and Social Work, The University of Queensland, Chamberlain Building, St. Lucia, QLD 4072, Australia
| | - Nicola Longo
- Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Ania C. Muntau
- Department of Pediatrics, University Children’s Hospital, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - André L. Santos Pessoa
- Albert Sabin Children’s Hospital, R. Tertuliano Sales, 544—Vila União, Fortaleza 60410-794, CE, Brazil
- Av. Dr. Silas Munguba, 1700—Itaperi, State University of Ceará (UECE), Fortaleza 60714-903, CE, Brazil
| | | | - Serap Sivri
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Gevher Nesibe Cd., 06230 Ankara, Turkey
| | - Álvaro Hermida
- Diagnosis and Treatment of Congenital Metabolic Diseases Unit (UDyTEMC), Department of Pediatrics, Faculty of Medicine, Clinical University Hospital of Santiago de Compostela, University of Santiago de Compostela, CIBERER, MetabERN, Institute of Clinical Research of Santiago de Compostela (IDIS), Rúa de San Francisco s/n, 15706 Santiago de Compostela, Spain
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11
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Grant ML, Jurecki ER, McCandless SE, Stahl SM, Bilder DA, Sanchez-Valle A, Dimmock D. Neuropsychiatric Function Improvement in Pediatric Patients with Phenylketonuria. J Pediatr 2023; 260:113526. [PMID: 37263523 DOI: 10.1016/j.jpeds.2023.113526] [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: 11/23/2022] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate effects of sapropterin dihydrochloride on blood phenylalanine (Phe) and symptoms of neuropsychiatric impairment in children and adolescents with phenylketonuria (PKU). STUDY DESIGN PKU subjects 8-17 years of age (n = 86) were randomized to double-blind treatment with sapropterin (n = 43) or placebo (n = 43) for 13 weeks, then all received open-label sapropterin therapy for an additional 13 weeks. Blood Phe and symptoms of inattention, hyperactivity/impulsivity (Attention-Deficit/Hyperactivity Disorder Rating Scale IV [ADHD RS-IV]), executive functioning (Behavior Rating Inventory of Executive Function), depression (Hamilton Rating Scale for Depression), and anxiety (Hamilton Rating Scale for Anxiety) were assessed. RESULTS Following the 13-week randomization phase, the sapropterin and placebo groups had mean changes in blood Phe of -20.9% and +2.9%, respectively. Corresponding least square mean differences in ADHD RS-IV scores were significantly greater for the sapropterin vs the placebo group: Total (-3.2 points, P = .02), Inattention subscale (-1.8 points, P = .04), and Hyperactivity/Impulsivity subscale (-1.6 points, P = .02). Forest plots favored sapropterin treatment over placebo for all ADHD RS-IV and Behavior Rating Inventory of Executive Function indices. There were no significant differences in reported problems with attention or executive function between the 2 groups at baseline or at week 26 following the 13-week open-label treatment period. Anxiety and depression scores did not differ significantly between cohorts at any time. Sapropterin was well tolerated, with a favorable safety profile. CONCLUSIONS Sapropterin reduced blood Phe and was associated with significant improvement in parent-reported symptoms of inattention, hyperactivity/impulsivity, and executive functioning in children and adolescents with PKU. TRIAL REGISTRATION ClinicalTrials.gov, NCT01114737. Registered 27 April 2010, https://clinicaltrials.gov/ct2/show/NCT01114737.
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Affiliation(s)
| | | | - Shawn E McCandless
- University of Colorado, Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO
| | - Stephen M Stahl
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Deborah A Bilder
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, University of Utah, Salt Lake City, UT
| | - Amarilis Sanchez-Valle
- Department of Pediatrics, Division of Genetics and Metabolism, University of South Florida, Tampa, FL
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12
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Adams AD, Fiesco-Roa MÓ, Wong L, Jenkins GP, Malinowski J, Demarest OM, Rothberg PG, Hobert JA. Phenylalanine hydroxylase deficiency treatment and management: A systematic evidence review of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2023; 25:100358. [PMID: 37470789 DOI: 10.1016/j.gim.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 07/21/2023] Open
Abstract
PURPOSE Elevated serum phenylalanine (Phe) levels due to biallelic pathogenic variants in phenylalanine hydroxylase (PAH) may cause neurodevelopmental disorders or birth defects from maternal phenylketonuria. New Phe reduction treatments have been approved in the last decade, but uncertainty on the optimal lifespan goal Phe levels for patients with PAH deficiency remains. METHODS We searched Medline and Embase for evidence of treatment concerning PAH deficiency up to September 28, 2021. Risk of bias was evaluated based on study design. Random-effects meta-analyses were performed to compare IQ, gestational outcomes, and offspring outcomes based on Phe ≤ 360 μmol/L vs > 360 μmol/L and reported as odds ratio and 95% CI. Remaining results were narratively synthesized. RESULTS A total of 350 studies were included. Risk of bias was moderate. Lower Phe was consistently associated with better outcomes. Achieving Phe ≤ 360 μmol/L before conception substantially lowered the risk of negative effect to offspring in pregnant individuals (odds ratio = 0.07, 95% CI = 0.04-0.14; P < .0001). Adverse events due to pharmacologic treatment were common, but medication reduced Phe levels, enabling dietary liberalization. CONCLUSIONS Reduction of Phe levels to ≤360 μmol/L through diet or medication represents effective interventions to treat PAH deficiency.
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Affiliation(s)
- April D Adams
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Division of Maternal-Fetal Medicine, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Moisés Ó Fiesco-Roa
- Programa de Maestría y Doctorado en Ciencias Médicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico; Laboratorio de Citogenética, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | | | | | | | - Paul G Rothberg
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Judith A Hobert
- University of Utah School of Medicine, Salt Lake City, UT; ARUP Laboratories, Salt Lake City, UT
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13
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Krämer J, Baerwald C, Heimbold C, Kamrath C, Parhofer KG, Reichert A, Rutsch F, Stolz S, Weinhold N, Muntau AC. Two years of pegvaliase in Germany:Experiences and best practice recommendations. Mol Genet Metab 2023; 139:107564. [PMID: 37086569 DOI: 10.1016/j.ymgme.2023.107564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND In 2019, pegvaliase was approved in Europe for the treatment of phenylketonuria (PKU) in patients aged 16 years and older with blood phenylalanine (Phe) concentrations above 600 μmol/L despite prior management with available treatment options. Since its European approval, German metabolic centres have gained valuable experience, which may be of benefit to other treatment centres managing patients on pegvaliase. METHODS After a virtual meeting that was attended by nine German physicians, three German dietitians and one American physician, a follow-up discussion was held via an online platform to develop a set of recommendations on the use of pegvaliase in Germany. Eight German physicians contributed to the follow-up discussion and subsequent consensus voting, using a modified Delphi technique. The recommendations were supported by literature and retrospectively collected patient data. RESULTS Consensus (≥75% agreement) was achieved on 25 recommendations, covering seven topics deemed relevant by the expert panel when considering pegvaliase an option for the treatment of patients with PKU. In addition to the recommendations, a retrospective chart review was conducted in seven of the centres and included 71 patients who initiated treatment with pegvaliase. Twenty-seven patients had been treated for at least 24 months and 23 (85.2%) had achieved blood Phe ≤600 μmol/L with some degree of diet normalisation. Of these patients, 14 had physiological blood Phe on a normalised diet. CONCLUSION The practical consensus recommendations provide guidance on the different steps along the pegvaliase journey from clinical site requirements to treatment goals and outcomes. The recommendations are intended to support less experienced European metabolic centres with the implementation of pegvaliase, emphasising that a core treatment team consisting of at least a dietitian and metabolic physician is sufficient to initiate pegvaliase and support patients during their treatment journey.
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14
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Paermentier L, Cano A, Chabrol B, Roy A. Neuropsychological Disorders in Moderate Hyperphenylalaninemia: Literature Review. Dev Neuropsychol 2023; 48:31-45. [PMID: 36594744 DOI: 10.1080/87565641.2022.2162902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Moderate hyperphenylalaninemia (mHPA) is a hydroxylase deficiency corresponding to phenylalanine levels, at newborn screening, below 360 μmol/l. The neurological impact of mHPA is usually considered to be very low, but few studies have investigated the neuropsychological profile of mHPA patients.A systematic review of the neuropsychological aspects of mHPA was therefore conducted.The results showed a preservation of cognitive functions (intelligence, memory, visuoperception…). However, several indicators point to executive difficulties in this population. In regard to the important impact of executive functions in daily life, it is essential to conduct other studies in mHPA patients by proposing an integrative approach.
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Affiliation(s)
- L Paermentier
- Reference Center for Inborn Errors of Metabolism, Marseille University Children's Hospital, Marseille, France.,Neuro-Metabolism Department, Marseille University Children's Hospital, Marseille, France.,Psychology Laboratory, University of Angers, Angers, France
| | - A Cano
- Reference Center for Inborn Errors of Metabolism, Marseille University Children's Hospital, Marseille, France.,Neuro-Metabolism Department, Marseille University Children's Hospital, Marseille, France
| | - B Chabrol
- Reference Center for Inborn Errors of Metabolism, Marseille University Children's Hospital, Marseille, France.,Neuro-Metabolism Department, Marseille University Children's Hospital, Marseille, France
| | - A Roy
- Psychology Laboratory, University of Angers, Angers, France.,Neurofibromatosis Clinic and Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France
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15
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Thau-Zuchman O, Pallier PN, Savelkoul PJM, Kuipers AAM, Verkuyl JM, Michael-Titus AT. High phenylalanine concentrations induce demyelination and microglial activation in mouse cerebellar organotypic slices. Front Neurosci 2022; 16:926023. [PMID: 36248632 PMCID: PMC9559601 DOI: 10.3389/fnins.2022.926023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
Phenylketonuria (PKU) is an inborn error of metabolism. Mutations in the enzyme phenylalanine hydroxylase (PAH)-encoding gene lead to a decreased metabolism of the amino acid phenylalanine (Phe). The deficiency in PAH increases Phe levels in blood and brain. Accumulation of Phe can lead to delayed development, psychiatric problems and cognitive impairment. White matter (WM) damage is a neuropathological hallmark of PKU and can be seen even in early detected and treated PKU patients. The mechanisms linking high Phe concentrations to WM abnormalities remain unclear. We tested the effects of high Phe concentrations on myelin in three in vitro models of increasing complexity: two simple cell culture models and one model that preserves local brain tissue architecture, a cerebellar organotypic slice culture prepared from postnatal day (P) 8 CD-1 mice. Various Phe concentrations (0.1–10 mM) and durations of exposure were tested. We found no toxic effect of high Phe in the cell culture models. On the contrary, the treatment promoted the maturation of oligodendrocytes, particularly at the highest, non-physiological Phe concentrations. Exposure of cerebellar organotypic slices to 2.4 mM Phe for 21 days in vitro (DIV), but not 7 or 10 DIV, resulted in a significant decrease in myelin basic protein (MBP), calbindin-stained neurites, and neurites co-stained with MBP. Following exposure to a toxic concentration of Phe, a switch to the control medium for 7 days did not lead to remyelination, while very active remyelination was seen in slices following demyelination with lysolecithin. An enhanced number of microglia, displaying an activated type morphology, was seen after exposure of the slices to 2.4 mM Phe for 10 or 21 DIV. The results suggest that prolonged exposure to high Phe concentrations can induce microglial activation preceding significant disruption of myelin.
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Affiliation(s)
- Orli Thau-Zuchman
- Centre for Neuroscience, Surgery and Trauma, Barts and The London School of Medicine and Dentistry, The Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Patrick N. Pallier
- Centre for Neuroscience, Surgery and Trauma, Barts and The London School of Medicine and Dentistry, The Blizard Institute, Queen Mary University of London, London, United Kingdom
- *Correspondence: Patrick N. Pallier,
| | | | | | | | - Adina T. Michael-Titus
- Centre for Neuroscience, Surgery and Trauma, Barts and The London School of Medicine and Dentistry, The Blizard Institute, Queen Mary University of London, London, United Kingdom
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16
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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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Burton BK, Hermida Á, Bélanger-Quintana A, Bell H, Bjoraker KJ, Christ SE, Grant ML, Harding CO, Huijbregts SCJ, Longo N, McNutt MC, Nguyen-Driver MD, Santos Pessoa AL, Rocha JC, Sacharow S, Sanchez-Valle A, Sivri HS, Vockley J, Walterfang M, Whittle S, Muntau AC. Management of early treated adolescents and young adults with phenylketonuria: Development of international consensus recommendations using a modified Delphi approach. Mol Genet Metab 2022; 137:114-126. [PMID: 36027720 DOI: 10.1016/j.ymgme.2022.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/16/2022] [Accepted: 07/23/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Early treated patients with phenylketonuria (PKU) often become lost to follow-up from adolescence onwards due to the historical focus of PKU care on the pediatric population and lack of programs facilitating the transition to adulthood. As a result, evidence on the management of adolescents and young adults with PKU is limited. METHODS Two meetings were held with a multidisciplinary international panel of 25 experts in PKU and comorbidities frequently experienced by patients with PKU. Based on the outcomes of the first meeting, a set of statements were developed. During the second meeting, these statements were voted on for consensus generation (≥70% agreement), using a modified Delphi approach. RESULTS A total of 37 consensus recommendations were developed across five areas that were deemed important in the management of adolescents and young adults with PKU: (1) general physical health, (2) mental health and neurocognitive functioning, (3) blood Phe target range, (4) PKU-specific challenges, and (5) transition to adult care. The consensus recommendations reflect the personal opinions and experiences from the participating experts supported with evidence when available. Overall, clinicians managing adolescents and young adults with PKU should be aware of the wide variety of PKU-associated comorbidities, initiating screening at an early age. In addition, management of adolescents/young adults should be a joint effort between the patient, clinical center, and parents/caregivers supporting adolescents with gradually gaining independent control of their disease during the transition to adulthood. CONCLUSIONS A multidisciplinary international group of experts used a modified Delphi approach to develop a set of consensus recommendations with the aim of providing guidance and offering tools to clinics to aid with supporting adolescents and young adults with PKU.
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Affiliation(s)
- Barbara K Burton
- Ann and Robert H. Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Álvaro Hermida
- Clinical University Hospital of Santiago de Compostela, University of Santiago de Compostela, CIBERER, MetabERN, Institute of Clinical Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | | | - Heather Bell
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Shawn E Christ
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Mitzie L Grant
- Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Cary O Harding
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | | | - Nicola Longo
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Markey C McNutt
- McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mina D Nguyen-Driver
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - André L Santos Pessoa
- Pediatric Neurology Service, Albert Sabin Children's Hospital, University of Ceará State, Fortaleza, Ceará, Brazil
| | - Júlio César Rocha
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Portugal; Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia; Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Sacharow
- CINTESIS-Center for Health Technology and Services Research, NOVA Medical School, Lisboa, Portugal; Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Amarilis Sanchez-Valle
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - H Serap Sivri
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | - Jerry Vockley
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mark Walterfang
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Sarah Whittle
- Hacettepe University, Faculty of Medicine, Department of Pediatrics, Section of Pediatric Metabolism, Ankara, Turkey
| | - Ania C Muntau
- Department of Pediatrics, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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18
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Regier DS, Bąk A, Bausell H, O'Reilly E, Cowsert LM. Starting the conversation on gene therapy for phenylketonuria: Current perspectives of patients, caregivers, and advocates. Mol Genet Metab Rep 2022; 31:100855. [PMID: 35782620 PMCID: PMC9248220 DOI: 10.1016/j.ymgmr.2022.100855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022] Open
Abstract
Phenylketonuria (PKU) is a rare genetic condition caused by inborn error(s) in the gene for the enzyme phenylalanine hydroxylase. Resulting loss of phenylalanine (Phe) metabolism requires strict dietary therapy and/or medication to prevent toxic accumulation of Phe. Novel investigational therapies, including gene therapies that aim to address underlying causes of PKU, are now entering clinical trials. However, perceptions of this technology in the PKU community have not been assessed. We conducted a qualitative survey recruiting adult patients, caregivers, and patient advocates from the US and 3 EU countries to assess the impact of living with PKU and the perceptions of gene therapy. Telephone interviews were conducted for up to 60 min following a standardized discussion guide. Interviewers classified each participant by their level of knowledge regarding gene therapy as either: low (little or no prior awareness); moderate (awareness of gene therapy as a concept in PKU); or high (working knowledge of gene therapy, e.g., vectors). In total, 33 participants were recruited (patients, n = 24; caregivers, n = 5; advocates, n = 4). The patient sample was well balanced among age groups, sex, and US/EU geographies. The participants' experiences and burden of living with PKU were largely negative, characterized by frustrations with current management consistent with prior reports. Most participants (n = 18/33) were identified as displaying moderate gene-therapy knowledge, 10/33 as displaying high knowledge, and 5/33 as displaying low knowledge. Both positive and negative perceptions were observed; positive perceptions were often linked to “hope” that gene therapy may represent a cure, whereas negative perceptions were linked to the “uncertainty” of outcomes. High knowledge of gene therapy appeared to trend with negative perceptions; 7/10 participants from this group reported high levels of concern over gene therapy. In contrast, participants who displayed low knowledge reported low (n = 3/5) or moderate (n = 2/5) concern, with predominantly positive perceptions. These data highlight the need for education around the theoretical risk:benefit profile of gene therapy. Despite current unknowns around gene therapy, our study demonstrates the important role of healthcare providers as educators who can use available data to provide balanced information to patients and caregivers. Gene therapy is a novel treatment modality under investigation in PKU. First survey of gene therapy perspectives among members of the US/EU PKU community. General awareness of gene therapy was present, but knowledge level varied. Greater gene therapy knowledge may lead to greater levels of concern on this topic. Balanced information and choice of language are vital for education on gene therapy.
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Affiliation(s)
- Debra S. Regier
- Rare Disease Institute, Children's National Hospital, 7125 13th Place, NW, Washington, DC 20012, USA
- Corresponding author at: Children's National Hospital, 7125 13th Place, NW, Washington, DC 20012, USA.
| | - Agata Bąk
- Federación Española de Enfermedades Metabólicas Hereditarias, Luis Ruiz, 75 local 30, 28017 Madrid, Spain
- Universidad Autónoma del Estado de México, Insitutio Literario 100, Centro, Toluca, State of Mexico, Mexico
| | - Heather Bausell
- Division of Clinical Nutrition & Genetics, Ann and Robert H Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, USA
| | - Emer O'Reilly
- PKU Association of Ireland, 25 Church Street, Skerries, Dublin, Ireland
| | - Lex M. Cowsert
- National Phenylketonuria Alliance, 2809 E. Hamilton Ave., #311, Eau Claire, WI 54701, USA
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Bu T, Zhang L, Liu L, Yu S, Zheng J, Wu J, Yang K. Evaluation of the anti-osteoporotic effect of a low-phenylalanine whey protein hydrolysate in an ovariectomized mice model. Food Funct 2022; 13:3957-3967. [PMID: 35293905 DOI: 10.1039/d1fo04030h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A phenylalanine (Phe)-restricted diet is indispensable to control the blood Phe for individuals with phenylketonuria (PKU), who are also confronted with progressive bone impairment. Thus, the development of a low-Phe protein substitute that could positively regulate bone metabolism is desired for their bone health. Our previous study reported the preparation of a low-Phe containing whey hydrolysate (LPH) from a selected whey protein hydrolysate (TAH). However, the effect of LPH on the bone status is unknown. In this study, we used an ovariectomized (OVX) mice model to evaluate the anti-osteoporotic potential of oral administration of whey protein concentrate (WPC, protein control), TAH, and LPH on bone physiology and bone metabolism. The results showed that after 12 weeks of treatment, the decreased bone mineral density, the deteriorated trabecular microarchitecture, and the reduced ultimate load due to ovariectomy were significantly attenuated by two whey protein hydrolysates (TAH and LPH); meanwhile, the body weight, uterine weight, bone composition, and the femoral elastic load of OVX mice had not been significantly affected by whey samples. In addition, LPH and TAH dual-regulated bone remodeling in OVX mice through triggering osteogenesis (promoted the expression of runt-related protein 2 (Runx2) and osteoformation markers) and inhibiting osteoresorption as well as inflammation. The modulated mitogen-activated protein kinase signaling and the inhibited nuclear factor κB signaling by LPH and TAH might relate to the dual-regulatory activities on bone. Overall, in the OVX mice model, LPH exerted higher osteoprotective potential than TAH of the same dose by activating the bone formation markers and inhibiting the inflammatory status. The current study demonstrated for the first time the potential use of a low-Phe whey hydrolysate, a protein substitute for PKU individuals, in the prevention of osteoporosis.
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Affiliation(s)
- Tingting Bu
- Department of Food Science and Technology, Zhejiang University of Technology, Hangzhou, 310014, China.
| | - Ling Zhang
- Department of Food Science and Technology, Zhejiang University of Technology, Hangzhou, 310014, China.
| | - Ling Liu
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, 310058, China
| | - Songfeng Yu
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, 310058, China
| | - Jiexia Zheng
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, 310058, China
| | - Jianping Wu
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, T6G 2P5, Canada
| | - Kai Yang
- Department of Food Science and Technology, Zhejiang University of Technology, Hangzhou, 310014, China.
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20
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Besada C, Hakami A, Pillai G, Yetsko K, Truong N, Little T, Pantano S, Dmello A. Preformulation studies with phenylalanine ammonia lyase: essential prelude to a microcapsule formulation for the management of phenylketonuria. J Pharm Sci 2022; 111:1857-1867. [DOI: 10.1016/j.xphs.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 01/10/2023]
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21
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Liemburg GB, Huijbregts SCJ, Rutsch F, Feldmann R, Jahja R, Weglage J, Och U, Burgerhof JGM, van Spronsen FJ. Metabolic control during the neonatal period in phenylketonuria: associations with childhood IQ. Pediatr Res 2022; 91:874-878. [PMID: 34497359 DOI: 10.1038/s41390-021-01728-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/13/2021] [Accepted: 07/09/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND In phenylketonuria, treatment and subsequent lowering of phenylalanine levels usually occur within the first month of life. This study investigated whether different indicators of metabolic control during the neonatal period were associated with IQ during late childhood/early adolescence. METHODS Overall phenylalanine concentration during the first month of life (total "area under the curve"), proportion of phenylalanine concentrations above upper target level (360 μmol/L) and proportion below lower target level (120 μmol/L) during this period, diagnostic phenylalanine levels, number of days until phenylalanine levels were <360 μmol/L, and lifetime and concurrent phenylalanine levels were correlated with IQ scores of 64 PKU patients (mean age 10.8 years, SD 2.9). RESULTS Overall phenylalanine concentration and proportion of phenylalanine concentrations >360 μmol/L during the first month of life negatively correlated with IQ in late childhood/early adolescence. Separately, phenylalanine concentrations during different periods within the first month of life (0-10 days, 11-20 days, 21-30 days) were negatively correlated with later IQ as well, but correlation strengths did not differ significantly. No further significant associations were found. CONCLUSIONS In phenylketonuria, achievement of target-range phenylalanine levels during the neonatal period is important for cognition later in life, also when compared to other indicators of metabolic control. IMPACT In phenylketonuria, it remains unclear during which age periods or developmental stages metabolic control is most important for later cognitive outcomes. Phenylalanine levels during the neonatal period were clearly and negatively related to later IQ, whereas no significant associations were observed for other indices of metabolic control. This emphasizes the relative importance of this period for cognitive development in phenylketonuria. No further distinctions were observed in strength of associations with later IQ between different indicators of metabolic control during the neonatal period. Thus, achievement of good metabolic control within 1 month after birth appears "safe" with respect to later cognitive outcomes.
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Affiliation(s)
- Geertje B Liemburg
- Division of Metabolic Diseases, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan C J Huijbregts
- Department of Clinical Child and Adolescent Studies/Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands.
| | - Frank Rutsch
- Department of Pediatrics, Münster University, University Children's Hospital, Münster, Germany
| | - Reinhold Feldmann
- Department of Pediatrics, Münster University, University Children's Hospital, Münster, Germany
| | - Rianne Jahja
- Division of Metabolic Diseases, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Josef Weglage
- Department of Pediatrics, Münster University, University Children's Hospital, Münster, Germany
| | - Ulrike Och
- Department of Pediatrics, Münster University, University Children's Hospital, Münster, Germany
| | - Johannes G M Burgerhof
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Francjan J van Spronsen
- Division of Metabolic Diseases, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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22
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From PKU Online Lessons for Dietetics Students to the PKU Sandwiches Album. EDUCATION SCIENCES 2022. [DOI: 10.3390/educsci12020136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of the manuscript is to present to academic teachers, doctors and nutritionists how practical online classes with dietetics students can be used to develop ready-made tools at work and for the education of phenylketonuria (PKU) patients and their caregivers/parents. During online classes in 2020, as part of the subject—diet therapy of metabolic blocks, 53 students prepared PKU sandwiches at home. Each PKU sandwich has a calculated nutritional value, and phenylalanine exchanger content, but does not include low-protein bread. The selection of a particular type of PKU bread depends solely on the PKU patient, hence it was deliberately not included in the calculations. The sandwiches, made by students and assessed by academic teachers, will be published with the following title “The PKU Sandwiches Album”. The Album with more than 400 colorful pictures of PKU sandwiches, will be expected to inspire patients and help them add appeal to their diet, enriching it with new tastes, at the same time facilitating the memorizing process of ingredients, thanks to visualization and presented calculations, and motivating them to comply with strict dietary recommendation. The same nutritional calculations and ideas for sandwiches, with the use of different bread, e.g., gluten-free, may be useful in other diseases, such as celiac disease.
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23
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Cicek C, Eren-Koçak E, Telkoparan-Akillilar P, Gok M, Bodur E. cAMP/PKA-CREB-BDNF signaling pathway in hippocampus of rats subjected to chemically-induced phenylketonuria. Metab Brain Dis 2022; 37:545-557. [PMID: 34800207 DOI: 10.1007/s11011-021-00865-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 10/31/2021] [Indexed: 12/13/2022]
Abstract
Phenylketonuria (PKU) is an inborn error disease in phenylalanine metabolism resulting from defects in the stages of converting phenylalanine to tyrosine. Although the pathophysiology of PKU is not elucidated yet, the toxic effect of phenylalanine on the brain causes severe mental retardation. In relation to learning and memory, the hippocampal PKA / CREB / BDNF pathway may play a role in learning deficits in PKU patients. This study aimed to investigate PKA/CREB/BDNF pathway in hippocampus of chemically induced PKU rats with regard to gender. Sprague-Dawley rat pups were randomized into two groups of both genders. To chemically induce PKU, animals received subcutaneous administration of phenylalanine (5.2 mmol / g) plus p-chlorophenylalanine, phenylalanine hydroxylase inhibitor (0.9 mmol / g); control animals received 0.9% NaCl. Injections started on the 6th day and continued until the 21st day after which locomotor activity, learning and memory were tested. In male PKU rats, locomotor activity was reduced. There were no differences in learning and memory performances of male and female PKU rats. In PKU rats, pCREB / CREB levels in males was unchanged while it decreased in females. Elevated PKA activity, BDNF levels and decreased pCREB/CREB ratio found in female PKU rats were not replicated in PKU males in which BDNF is decreased. Our results display that in this disease model a gender specific differential activation of cAMP/PKA-CREB-BDNF signaling pathway in hippocampus occurs investigation of which can help us to a better understanding of disease pathophysiology.
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Affiliation(s)
- Cigdem Cicek
- Department of Medical Biochemistry, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
- Department of Medical Biochemistry, Yuksek Ihtisas University, Faculty of Medicine, 06520, Ankara, Turkey
| | - Emine Eren-Koçak
- Hacettepe University, Institute of Neurological Sciences and Psychiatry, 06100, Ankara, Turkey
| | | | - Muslum Gok
- Department of Medical Biochemistry, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
- Department of Medical Biochemistry, Mugla Sitki Kocman University, Faculty of Medicine, 48000, Mugla, Turkey
| | - Ebru Bodur
- Department of Medical Biochemistry, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey.
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24
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Robertson L, Adam S, Ellerton C, Ford S, Hill M, Randles G, Woodall A, Young C, MacDonald A. Dietetic Management of Adults with Phenylketonuria (PKU) in the UK: A Care Consensus Document. Nutrients 2022; 14:nu14030576. [PMID: 35276935 PMCID: PMC8838652 DOI: 10.3390/nu14030576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 02/05/2023] Open
Abstract
There is an increasing number of adults and elderly patients with phenylketonuria (PKU) who are either early, late treated, or untreated. The principal treatment is a phenylalanine-restricted diet. There is no established UK training for dietitians who work with adults within the specialty of Inherited Metabolic Disorders (IMDs), including PKU. To address this, a group of experienced dietitians specializing in IMDs created a standard operating procedure (SOP) on the dietetic management of adults with PKU to promote equity of care in IMD dietetic services and to support service provision across the UK. The group met virtually over a period of 12 months until they reached 100% consensus on the SOP content. Areas of limited evidence included optimal blood phenylalanine reporting times to patients, protein requirements in older adults, management of weight and obesity, and management of disordered eating and eating disorders. The SOP does not include guidance on maternal PKU management. The SOP can be used as a tool for training dietitians new to the specialty and to raise the standard of education and care for patients with PKU in the UK.
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Affiliation(s)
- Louise Robertson
- Department of Inherited Metabolic Disorders, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
- Correspondence: ; Tel.: +44-121-3716989
| | - Sarah Adam
- NHS Greater Glasgow and Clyde, Royal Hospital for Children, Glasgow G51 4TF, UK; (S.A.); (C.Y.)
| | - Charlotte Ellerton
- Charles Dent Metabolic Unit, University College London Hospitals NHS Foundation Trust, National Hospital for Neurology & Neurosurgery, Queen Square, London WC1N 3BG, UK;
| | - Suzanne Ford
- North Bristol NHS Trust, Southmead Road, Bristol BS10 5NB, UK;
- National Society for Phenylketonuria, Richard House, Winckley Square, Preston PR1 3HP, UK
| | - Melanie Hill
- Adult Inherited Metabolic Disorders Service at Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield S5 7AU, UK;
| | - Gemma Randles
- Guys and St Thomas NHS Foundation Trust, London SE1 7EU, UK;
| | - Alison Woodall
- Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK;
| | - Carla Young
- NHS Greater Glasgow and Clyde, Royal Hospital for Children, Glasgow G51 4TF, UK; (S.A.); (C.Y.)
| | - Anita MacDonald
- Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK;
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25
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van der Goot E, Vink SN, van Vliet D, van Spronsen FJ, Falcao Salles J, van der Zee EA. Gut-Microbiome Composition in Response to Phenylketonuria Depends on Dietary Phenylalanine in BTBR Pah enu2 Mice. Front Nutr 2022; 8:735366. [PMID: 35059423 PMCID: PMC8763796 DOI: 10.3389/fnut.2021.735366] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/17/2021] [Indexed: 01/03/2023] Open
Abstract
Phenylketonuria (PKU) is a metabolic disorder caused by a hepatic enzyme deficiency causing high blood and brain levels of the amino acid Phenylalanine (Phe), leading to severe cognitive and psychological deficits that can be prevented, but not completely, by dietary treatment. The behavioral outcome of PKU could be affected by the gut-microbiome-brain axis, as diet is one of the major drivers of the gut microbiome composition. Gut-microbiome alterations have been reported in treated patients with PKU, although the question remains whether this is due to PKU, the dietary treatment, or their interaction. We, therefore, examined the effects of dietary Phe restriction on gut-microbiome composition and relationships with behavioral outcome in mice. Male and female BTBR Pahenu2 mice received either a control diet (normal protein, “high” Phe), liberalized Phe-restricted (33% natural protein restriction), or severe Phe-restricted (75% natural protein restriction) diet with protein substitutes for 10 weeks (n = 14 per group). Their behavioral performance was examined in an open field test, novel and spatial object location tests, and a balance beam. Fecal samples were collected and sequenced for the bacterial 16S ribosomal RNA (rRNA) region. Results indicated that PKU on a high Phe diet reduced Shannon diversity significantly and altered the microbiome composition compared with wild-type animals. Phe-restriction prevented this loss in Shannon diversity but changed community composition even more than the high-Phe diet, depending on the severity of the restriction. Moreover, on a taxonomic level, we observed the highest number of differentially abundant genera in animals that received 75% Phe-restriction. Based on correlation analyses with differentially abundant taxa, the families Entereococacceae, Erysipelotrichaceae, Porphyromonadaceae, and the genus Alloprevotella showed interesting relationships with either plasma Phe levels and/or object memory. According to our results, these bacterial taxa could be good candidates to start examining the microbial metabolic potential and probiotic properties in the context of PKU. We conclude that PKU leads to an altered gut microbiome composition in mice, which is least severe on a liberalized Phe-restricted diet. This may suggest that the current Phe-restricted diet for PKU patients could be optimized by taking dietary effects on the microbiome into account.
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Affiliation(s)
- Els van der Goot
- Molecular Neurobiology, Groningen Institute for Evolutionary Sciences, University of Groningen, Groningen, Netherlands.,Microbial Ecology Cluster, Groningen Institute for Evolutionary Sciences, University of Groningen, Groningen, Netherlands
| | - Stefanie N Vink
- Microbial Ecology Cluster, Groningen Institute for Evolutionary Sciences, University of Groningen, Groningen, Netherlands
| | - Danique van Vliet
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, Netherlands
| | - Francjan J van Spronsen
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, Netherlands
| | - Joana Falcao Salles
- Microbial Ecology Cluster, Groningen Institute for Evolutionary Sciences, University of Groningen, Groningen, Netherlands
| | - Eddy A van der Zee
- Molecular Neurobiology, Groningen Institute for Evolutionary Sciences, University of Groningen, Groningen, Netherlands
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26
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Torul H, Çalık Kayiş E, Boyaci IH, Tamer U. An ECL sensor combined with a paper electrode for the determination of phenylalanine. Analyst 2022; 147:4866-4875. [DOI: 10.1039/d2an01340a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
An electrochemiluminescence (ECL) sensor combined with a paper electrode was developed for the detection of phenylalanine (l-Phe) in blood samples.
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Affiliation(s)
- Hilal Torul
- Faculty of Pharmacy, Department of Analytical Chemistry, Gazi University, 06330 Ankara, Turkey
| | - Elif Çalık Kayiş
- Faculty of Pharmacy, Department of Analytical Chemistry, Gazi University, 06330 Ankara, Turkey
| | - I. Hakki Boyaci
- Department of Food Engineering, Hacettepe University, Beytepe, 06512 Ankara, Turkey
| | - Ugur Tamer
- Faculty of Pharmacy, Department of Analytical Chemistry, Gazi University, 06330 Ankara, Turkey
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27
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Lotz-Havla AS, Weiß K, Schiergens K, Regenauer-Vandewiele S, Parhofer KG, Christmann T, Böhm L, Havla J, Maier EM. Optical Coherence Tomography to Assess Neurodegeneration in Phenylalanine Hydroxylase Deficiency. Front Neurol 2021; 12:780624. [PMID: 34956063 PMCID: PMC8703042 DOI: 10.3389/fneur.2021.780624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
In phenylalanine hydroxylase (PAH) deficiency, an easily feasible method to access the progression of neurodegeneration is warranted to contribute to current discussions on treatment indications and targets. The objective of the present study was to investigate whether optical coherence tomography (OCT) measures as markers of neurodegeneration differ between patients with PAH deficiency and healthy controls (HCs) according to phenotype and metabolic control. In this single-center cross-sectional study, 92 patients with different phenotypes of PAH deficiency [PAH deficiency not requiring treatment, early treated phenylketonuria (ETPKU), and late-diagnosed phenylketonuria (PKU)] compared with 76 HCs were examined using spectral-domain OCT. Indices of phenylalanine elevation and variability were correlated with OCT parameters. Late-diagnosed PKU patients showed reduced peripapillary retinal nerve fiber layer (pRNFL) thickness and combined ganglion cell and inner plexiform layer (GCIPL) volume. Adult ETPKU patients were found to have lower GCIPL volume (p = 0.016), which correlated with the indices of phenylalanine control. In pediatric ETPKU patients with poor metabolic control, pRNFL was significantly reduced (p = 0.004). Patients with PAH deficiency not requiring treatment did not exhibit retinal degeneration. Inner nuclear layer (INL) was significantly increased in the pediatric ETPKU patients, driven by those with current poor metabolic control (p = 0.006). Our data provide evidence of retinal neuroaxonal degeneration and INL swelling, depending on the phenotype, current age, and metabolic control. These findings suggest that OCT is suitable to investigate neurodegeneration in PKU and we propose OCT as a sensitive, reliable, safe, low-burden, and low-cost examination for future multicenter studies.
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Affiliation(s)
- Amelie S Lotz-Havla
- Dr. von Hauner Children's Hospital, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Katharina Weiß
- Dr. von Hauner Children's Hospital, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Katharina Schiergens
- Dr. von Hauner Children's Hospital, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Klaus G Parhofer
- Medical Department IV - Grosshadern, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tara Christmann
- Institute of Clinical Neuroimmunology, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Luise Böhm
- Institute of Clinical Neuroimmunology, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Esther M Maier
- Dr. von Hauner Children's Hospital, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
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28
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Becsei D, Hiripi R, Kiss E, Szatmári I, Arató A, Reusz G, Szabó AJ, Bókay J, Zsidegh P. Quality of life in children living with PKU - a single-center, cross-sectional, observational study from Hungary. Mol Genet Metab Rep 2021; 29:100823. [PMID: 34900594 PMCID: PMC8639791 DOI: 10.1016/j.ymgmr.2021.100823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background Phenylketonuria (PKU) is an inherited error of metabolism, screened at 48–72 h of life since 1975 in Hungary. The patients have to keep a strict lifelong protein-restricted diet, resulting in PKU and its treatment can lead to social and financial burdens. The current study aimed to evaluate the health-related quality of life (HRQoL) of children living with PKU. Patients and methods A single-centre, cross-sectional, observational study was conducted at the Center of Newborn Screening and Inherited Metabolic Disorders of Budapest, Hungary, using the PKU-quality of life (PKU-QoL) questionnaire. Responses of 59 parents and 11 teenagers were collected. Numerous aspects regarding HRQoL were analysed according to clinical compliance and severity. The patients were classified into groups with good or suboptimal adherence based on regular phenylalanine (Phe) values. The online officially translated versions of the adolescent or parental PKU-QoL questionnaire were used and analysed anonymously. Differences in HRQoL were compared - PKU vs. Hyperphenylalaninaemia (HPA) and good vs. suboptimal adherence. Results Twenty-five of 32 examined parameters had no or little impact on HRQoL. The most frequently reported symptom was irritability. Food enjoyment was the most impacted domain, with a major severity score in the adolescent group (median 62,5, IQR: 25–75). The emotional impact was scored at moderate severity by both the adolescents and parents. Classical PKU patients with good metabolic control were more frequently tired than HPA patients (0,0027). The group with poor metabolic adherence showed more frequent tiredness (p = 0,03), slow thinking (p = 0,018) and anxiety (p = 0,015). Conclusion Overall, our patients showed an excellent HRQoL; most domains (29/36) were reported as little/no impacted. Worse QoL was found in patients with suboptimal metabolic control. Particular attention should be paid to the emotional health of PKU patients.
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Key Words
- Children
- DBS, dried blood spot
- DPR, dietary protein restriction
- GMP, glycomacropeptide
- HPA, hyperphenylalaninaemia
- HRQoL
- HRQoL, health-related quality of life
- Health-related quality of life
- IQ, intelligence quotient
- IQR, interquartile range
- PAH, phenylalanine hydroxylase
- PKU
- PKU, phenylketonuria
- Parents
- Phenylketonuria
- QoL, quality of life,
- SD, standard deviation
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Affiliation(s)
- Dóra Becsei
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
| | - Réka Hiripi
- Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest 1085, Hungary
| | - Erika Kiss
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
| | - Ildiko Szatmári
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
| | - András Arató
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
| | - György Reusz
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
| | - Attila J Szabó
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary.,ELKH-SE Pediatrics and Nephrology Research Group, Budapest, Hungary
| | - János Bókay
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
| | - Petra Zsidegh
- 1st Department of Pediatrics, Semmelweis University, Bókay J. u. 53-54, Budapest 1083, Hungary
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29
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Burton BK, Skalicky A, Baerwald C, Bilder DA, Harding CO, Ilan AB, Jurecki E, Longo N, Madden DT, Sivri HS, Wilcox G, Thomas J, Delaney K. A non-interventional observational study to identify and validate clinical outcome assessments for adults with phenylketonuria for use in clinical trials. Mol Genet Metab Rep 2021; 29:100810. [PMID: 34815941 PMCID: PMC8591457 DOI: 10.1016/j.ymgmr.2021.100810] [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: 07/29/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Current clinical outcome assessments (COAs) are not effectively capturing the complex array of symptoms of adults with phenylketonuria (PKU). This study aimed to identify concepts of interest relevant to adults with PKU. Based on these concepts, COAs for patient-reported outcomes (PROs), observer-reported outcomes (ObsROs), and clinician-reported outcomes (ClinROs) were selected or developed and content validity was assessed. Materials and methods Concept-elicitation interviews were conducted with an international cohort of adults with PKU (n = 30), family member observers (n = 14), and clinical experts (n = 8). Observers and clinical experts were included to overcome the risk of lack of self-awareness among adults with PKU. The concepts of interests endorsed by ≥30% of patients, observers, and/or clinical experts were selected, mapped to items in existing COAs, and used to develop global impression items for patients, observers, and clinicians. Next, the content validity of the COAs and global impression items was evaluated by cognitive interviews with patients (n = 22), observers (n = 11), and clinical experts (n = 8). All patients were categorized according to blood phenylalanine (Phe) levels (i.e., <600 μmol/L, 600–1200 μmol/L, and >1200 μmol/L). Results Concepts of interests were identified across four domains: emotional, cognitive, physical, and behavioral. After mapping, eight existing COAs were selected based on the concept coverage (six PROs, one ObsRO, and one ClinRO). The six PRO measures were considered as potentially fit-for-purpose. The ObsRO measure was not deemed relevant for use in observers of adults with PKU and only a subscale of the ClinRO measure was considered valid for assessing adults with PKU by clinicians. Due to the lack of existing COAs covering all concepts of interests, global impression items for symptom severity and change in symptoms were developed, which were limited to one question covering in total 14 concepts. Upon validation, some of the patient and observer global impression items were excluded as they were subject to lack of insight or could not be reported by observers. Due to the limited interaction time between clinician and patient, use of the clinician global impression items was not supported. Conclusion Existing COAs relevant to adults with PKU were selected and PKU-specific global impression items were developed by mapping the most frequently identified concepts of interests from internationally-conducted in-depth interviews. Future studies should address the appropriateness of the selected COAs and global impression items to assess if these can be used as efficacy endpoints in PKU clinical trials.
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Key Words
- ADHD RS-IV, Attention Deficit Hyperactivity Disorders Rating Scale-IV
- ADHD, Attention Deficit Hyperactivity Disorder
- Adults
- CAARS-O:Long, Conners' Adult ADHD Rating Scales-Observer Report Long Version
- CGI, Clinician Global Impression
- COAs, Clinical Outcome Assessments
- COIs, Concepts Of Interests
- ClinROs, Clinician-Reported Outcomes
- Clinical outcome assessments
- Clinician-reported outcomes
- FDA, Food and Drug Administration
- HRQoL, Health-Related Quality of Life
- IRB, Institutional Review Board
- Neuro-QoL, Quality of Life in Neurological Disorders
- OGI, Observer Global Impression
- ObsROs, Observer-Reported Outcomes
- Observer-reported outcomes
- PAH, Phenylalanine Hydroxylase
- PGI, Patient Global Impression
- PKU
- PKU, Phenylketonuria
- PKU-QOL, PKU Quality of Life
- PROMIS, Patient Reported Outcome Measurement Information System
- PROs, Patient-Reported Outcomes
- Patient-reported outcomes
- Phe, Phenylalanine
- Phenylketonuria
- QoL, Quality of Life
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Affiliation(s)
- Barbara K Burton
- Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anne Skalicky
- Patient-Centered Research, Evidera, Seattle, WA, USA
| | - Christoph Baerwald
- Rheumatology Unit, Department of Internal Medicine, Neurology and Dermatology, University Medical Center Leipzig, Leipzig, Germany
| | - Deborah A Bilder
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA
| | - Cary O Harding
- Department of Medical and Molecular Genetics, Oregon Health & Science University, Portland, OR, USA
| | | | | | - Nicola Longo
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | | | - H Serap Sivri
- Hacettepe University Faculty of Medicine, Division of Pediatric Metabolism, Ankara, Turkey
| | - Gisela Wilcox
- School of Medical Sciences, University of Manchester & The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Janet Thomas
- Department of Pediatrics, Section of Clinical Genetics and Metabolism, University of Colorado School of Medicine, Aurora, CO, USA
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Manek R, Zhang YV, Berthelette P, Hossain M, Cornell CS, Gans J, Anarat-Cappillino G, Geller S, Jackson R, Yu D, Singh K, Ryan S, Bangari DS, Xu EY, Kyostio-Moore SRM. Blood phenylalanine reduction reverses gene expression changes observed in a mouse model of phenylketonuria. Sci Rep 2021; 11:22886. [PMID: 34819582 PMCID: PMC8613214 DOI: 10.1038/s41598-021-02267-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022] Open
Abstract
Phenylketonuria (PKU) is a genetic deficiency of phenylalanine hydroxylase (PAH) in liver resulting in blood phenylalanine (Phe) elevation and neurotoxicity. A pegylated phenylalanine ammonia lyase (PEG-PAL) metabolizing Phe into cinnamic acid was recently approved as treatment for PKU patients. A potentially one-time rAAV-based delivery of PAH gene into liver to convert Phe into tyrosine (Tyr), a normal way of Phe metabolism, has now also entered the clinic. To understand differences between these two Phe lowering strategies, we evaluated PAH and PAL expression in livers of PAHenu2 mice on brain and liver functions. Both lowered brain Phe and increased neurotransmitter levels and corrected animal behavior. However, PAL delivery required dose optimization, did not elevate brain Tyr levels and resulted in an immune response. The effect of hyperphenylalanemia on liver functions in PKU mice was assessed by transcriptome and proteomic analyses. We observed an elevation in Cyp4a10/14 proteins involved in lipid metabolism and upregulation of genes involved in cholesterol biosynthesis. Majority of the gene expression changes were corrected by PAH and PAL delivery though the role of these changes in PKU pathology is currently unclear. Taken together, here we show that blood Phe lowering strategy using PAH or PAL corrects both brain pathology as well as previously unknown lipid metabolism associated pathway changes in liver.
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Affiliation(s)
- Rachna Manek
- Genomic Medicine Unit, Sanofi, Framingham, MA, USA.
| | - Yao V Zhang
- Genomic Medicine Unit, Sanofi, Framingham, MA, USA
| | | | | | | | - Joseph Gans
- Translational Sciences, Sanofi, Framingham, MA, USA
| | | | - Sarah Geller
- Pre-Development Sciences NA, Analytical R&D, Sanofi, Framingham, MA, USA
| | | | - Dan Yu
- Genomic Medicine Unit, Sanofi, Framingham, MA, USA
| | - Kuldeep Singh
- Global Discovery Pathology, Sanofi, Framingham, MA, USA
| | - Sue Ryan
- Global Discovery Pathology, Sanofi, Framingham, MA, USA
| | | | - Ethan Y Xu
- Translational Sciences, Sanofi, Framingham, MA, USA
- Excision BioTherapeutics, Cambridge, MA, USA
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31
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Walkowiak D, Mikołuć B, Mozrzymas R, Kałużny Ł, Didycz B, Korycińska-Chaaban D, Patalan M, Jagłowska J, Chrobot A, Starostecka E, Zarębska J, Walkowiak J. The Impact of the COVID-19 Pandemic on the Perception of Health and Treatment-Related Issues among Patients with Phenylketonuria in Poland-The Results of a National Online Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126399. [PMID: 34199184 PMCID: PMC8296241 DOI: 10.3390/ijerph18126399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/06/2021] [Accepted: 06/10/2021] [Indexed: 11/21/2022]
Abstract
There is agreement that the pandemic has affected the healthcare system and behaviour of patients. This study aims to identify problems encountered by patients with phenylketonuria (PKU) and their parents/caregivers during the six-week pandemic lockdown in Poland (15 March to 30 April 2020). To determine the factors that influenced health and treatment-related issues, as well as the respondents’ perception of the impact of the pandemic, study participants were asked to complete a non-validated online questionnaire comprising 31 questions (including 27 single-choice, two multiple-choice and two open-ended ones). A total of 571 patients or their parents completed the questionnaire, with 9.5% of respondents not performing any blood phenylalanine (Phe) test in the analysed period, 21.3% declaring a blood Phe increase, and 15.3% a decrease. Increased problems in contacting the doctor or dietitian were reported by 26.1% of subjects, whereas 39.3% of them felt restricted access to dietary products. Most (63.4%) participants were satisfied with remote contact with their PKU clinic. Better compliance was associated with higher odds of acceptance of remote contact and of reporting fewer problems with contacting the doctor, and with lower odds of missing Phe testing. Self-reported high stress was associated with higher odds of reporting the limited availability of low-Phe products and Phe-free formulas, as well as with increased Phe concentrations and non-PKU-related health problems. These patients also had poor dietary compliance and experienced more problems in contacting specialists. Health and treatment-related problems experienced during the pandemic lockdown were related to a higher intensity of stress in patient’s family and worse therapy compliance before the pandemic. Previous experience of remote visits resulted in a better perception of this method of contact. It seems that this form of communication should be popularized and improved to increase therapy effectiveness in case of different limitations in the future. Special attention should be paid to vulnerable patients who may be at extra risk when the provision of standard care is affected.
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Affiliation(s)
- Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Przybyszewskiego 39, 60-356 Poznan, Poland
- Correspondence: ; Tel./Fax: +48-61-658-44-93
| | - Bożena Mikołuć
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, 15-274 Bialystok, Poland;
| | - Renata Mozrzymas
- Research and Development Center, Regional Specialist Hospital, 51-124 Wrocław, Poland;
| | - Łukasz Kałużny
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (Ł.K.); (J.W.)
| | - Bożena Didycz
- Outpatient Metabolic Clinic, University Children’s Hospital, 30-663 Krakow, Poland;
| | | | - Michał Patalan
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Joanna Jagłowska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | | | - Ewa Starostecka
- The Regional Center of Rare Diseases, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
| | - Joanna Zarębska
- Upper Silesian Child Health Centre, 40-752 Katowice, Poland;
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (Ł.K.); (J.W.)
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Trefz F, Muntau AC, Schneider KM, Altevers J, Jacob C, Braun S, Greiner W, Jha A, Jain M, Alvarez I, Lane P, Zeiss C, Rutsch F. Health economic burden of patients with phenylketonuria (PKU) - A retrospective study of German health insurance claims data. Mol Genet Metab Rep 2021; 27:100764. [PMID: 34036045 PMCID: PMC8138676 DOI: 10.1016/j.ymgmr.2021.100764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022] Open
Abstract
This retrospective matched-cohort analysis compared health-economic burdens of adults (≥18 years; n = 377) with phenylketonuria (PKU) and age/gender-matched non-PKU controls (n = 3770) in Germany. Healthcare costs and resource-utilization were analyzed for the year 2015. Differences between groups were tested using 95% CI of mean differences (MD). PKU patients had significantly higher mean costs in total (MD €3307, 95% CI €1736–€4879), for pharmaceuticals (MD €1912, 95% CI €1195–€2629) [including dietary amino-acid supplements (MD €1268, 95% CI €864–€1672)], and outpatient costs (MD €395, 95% CI €115–€675). Inpatient costs (MD €904, 95% CI -€293 to €2100) and costs for aids and remedies (MD €97, 95% CI -€10 to €203) were also higher in PKU patients. PKU patients had more outpatient visits and stayed longer in hospital. Adult PKU patients incur higher total healthcare costs than non-PKU controls, especially regarding pharmaceuticals and outpatient costs, and more frequent resource-utilization, resulting in higher health-economic burden for the statutory healthcare system.
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Affiliation(s)
- Friedrich Trefz
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Ania C Muntau
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | - Wolfgang Greiner
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Germany
| | - Ashok Jha
- BioMarin Europe Ltd., London, United Kingdom
| | - Mohit Jain
- BioMarin Europe Ltd., London, United Kingdom
| | | | - Paul Lane
- BioMarin Europe Ltd., London, United Kingdom
| | | | - Frank Rutsch
- Klinik für Kinder- und Jugendmedizin - Allgemeine Pädiatrie, Universitätsklinikum Münster, Münster, Germany
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33
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van Wegberg A, Evers R, Burgerhof J, van Dam E, Heiner-Fokkema MR, Janssen M, de Vries MC, van Spronsen FJ. Effect of BH4 on blood phenylalanine and tyrosine variations in patients with phenylketonuria. Mol Genet Metab 2021; 133:49-55. [PMID: 33766497 DOI: 10.1016/j.ymgme.2021.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND In patients with phenylketonuria, stability of blood phenylalanine and tyrosine concentrations might influence brain chemistry and therefore patient outcome. This study prospectively investigated the effects of tetrahydrobiopterin (BH4), as a chaperone of phenylalanine hydroxylase on diurnal and day-to-day variations of blood phenylalanine and tyrosine concentrations. METHODS Blood phenylalanine and tyrosine were measured in dried blood spots (DBS) four times daily for 2 days (fasting, before lunch, before dinner, evening) and once daily (fasting) for 6 days in a randomized cross-over design with a period with BH4 and a period without BH4. The sequence was randomized. Eleven proven BH4 responsive PKU patients participated, 5 of them used protein substitutes during BH4 treatment. Natural protein intake and protein substitute dosing was adjusted during the period without BH4 in order to keep DBS phenylalanine levels within target range. Patients filled out a 3-day food diary during both study periods. Variations of DBS phenylalanine and Tyr were expressed in standard deviations (SD) and coefficient of variation (CV). RESULTS BH4 treatment did not significantly influence day-to-day phenylalanine and tyrosine variations nor diurnal phenylalanine variations, but decreased diurnal tyrosine variations (median SD 17.6 μmol/l, median CV 21.3%, p = 0.01) compared to diet only (median SD 34.2 μmol/l, median CV 43.2%). Consequently, during BH4 treatment diurnal phenylalanine/tyrosine ratio variation was smaller, while fasting tyrosine levels tended to be higher. CONCLUSION BH4 did not impact phenylalanine variation but decreased diurnal tyrosine and phenylalanine/tyrosine ratio variations, possibly explained by less use of protein substitute and increased tyrosine synthesis.
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Affiliation(s)
- Amj van Wegberg
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Raf Evers
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Jgm Burgerhof
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - E van Dam
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands
| | - M R Heiner-Fokkema
- Department of Laboratory Medicine, Laboratory of Metabolic Diseases, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - McH Janssen
- Department of Internal Medicine, Radboudumc, Nijmegen, the Netherlands
| | - M C de Vries
- Department of Pediatrics, Radboudumc Nijmegen, the Netherlands
| | - F J van Spronsen
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.
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34
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Guerra IMS, Diogo L, Pinho M, Melo T, Domingues P, Domingues MR, Moreira ASP. Plasma Phospholipidomic Profile Differs between Children with Phenylketonuria and Healthy Children. J Proteome Res 2021; 20:2651-2661. [PMID: 33819046 DOI: 10.1021/acs.jproteome.0c01052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Phenylketonuria (PKU) is a disease of the catabolism of phenylalanine (Phe), caused by an impaired function of the enzyme phenylalanine hydroxylase. Therapeutics is based on the restriction of Phe intake, which mostly requires a modification of the diet. Dietary restrictions can lead to imbalances in specific nutrients, including lipids. In the present study, the plasma phospholipidome of PKU and healthy children (CT) was analyzed by hydrophilic interaction liquid chromatography-tandem mass spectrometry and gas chromatography-mass spectrometry. Using this approach, 187 lipid species belonging to nine different phospholipid classes and three ceramides were identified. Principal component analysis of the lipid species data set showed a distinction between PKU and CT groups. Univariate analysis revealed that 146 species of phospholipids were significantly different between both groups. Lipid species showing significant variation included phosphatidylcholines, containing polyunsaturated fatty acids (PUFA), which were more abundant in PKU. The high level of PUFA-containing lipid species in children with PKU may be related to a diet supplemented with PUFA. This study was the first report comparing the plasma polar lipidome of PKU and healthy children, highlighting that the phospholipidome of PKU children is significantly altered compared to CT. However, further studies with larger cohorts are needed to clarify whether these changes are specific to phenylketonuric children.
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Affiliation(s)
- Inês M S Guerra
- Mass Spectrometry Center, LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - Luísa Diogo
- Reference Center of Inherited Metabolic Diseases, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
| | - Marisa Pinho
- ECOMARE, CESAM-Center for Environmental and Marine Studies, Department of Biology, University of Aveiro, Campus de Santiago, 3810-193 Aveiro, Portugal
| | - Tânia Melo
- Mass Spectrometry Center, LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.,CESAM-Centre for Environmental and Marine Studies, Department of Chemistry, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - Pedro Domingues
- Mass Spectrometry Center, LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - M Rosário Domingues
- Mass Spectrometry Center, LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.,CESAM-Centre for Environmental and Marine Studies, Department of Chemistry, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - Ana S P Moreira
- Mass Spectrometry Center, LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.,CICECO-Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
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35
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Evers RAF, van Wegberg AMJ, Ahring K, Beblo S, Bélanger-Quintana A, Bosch AM, Burlina A, Campistol J, Coskun T, Feillet F, Giżewska M, Huijbregts SCJ, Kearney S, Langeveld M, Leuzzi V, Maillot F, Muntau AC, Rocha JC, Romani C, Trefz FK, MacDonald A, van Spronsen FJ. Defining tetrahydrobiopterin responsiveness in phenylketonuria: Survey results from 38 countries. Mol Genet Metab 2021; 132:215-219. [PMID: 33610470 DOI: 10.1016/j.ymgme.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND A subset of patients with phenylketonuria benefit from treatment with tetrahydrobiopterin (BH4), although there is no consensus on the definition of BH4 responsiveness. The aim of this study therefore was to gain insight into the definitions of long-term BH4 responsiveness being used around the world. METHODS We performed a web-based survey targeting healthcare professionals involved in the treatment of PKU patients. Data were analysed according to geographical region (Europe, USA/Canada, other). RESULTS We analysed 166 responses. Long-term BH4 responsiveness was commonly defined using natural protein tolerance (95.6%), improvement of metabolic control (73.5%) and increase in quality of life (48.2%). When a specific value for a reduction in phenylalanine concentrations was reported (n = 89), 30% and 20% were most frequently used as cut-off values (76% and 19% of respondents, respectively). When a specific relative increase in natural protein tolerance was used to define long-term BH4 responsiveness (n = 71), respondents most commonly reported cut-off values of 30% and 100% (28% of respondents in both cases). Respondents from USA/Canada (n = 50) generally used less strict cut-off values compared to Europe (n = 96). Furthermore, respondents working within the same center answered differently. CONCLUSION The results of this study suggest a very heterogeneous situation on the topic of defining long-term BH4 responsiveness, not only at a worldwide level but also within centers. Developing a strong evidence- and consensus-based definition would improve the quality of BH4 treatment.
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Affiliation(s)
- R A F Evers
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Metabolic Diseases, the Netherlands
| | - A M J van Wegberg
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Metabolic Diseases, the Netherlands
| | - K Ahring
- Department of PKU, Copenhagen University Hospital, Denmark
| | - S Beblo
- Center for Pediatric Research Leipzig, Department of Women and Child Health, Hospital for Children and Adolescents, University Hospitals, Germany
| | - A Bélanger-Quintana
- Metabolic Diseases Unit, Department of Pediatrics, Hospital Ramon y Cajal, Madrid, Spain
| | - A M Bosch
- Department of Pediatrics, Division of Metabolic Disorders, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - A Burlina
- Division of Inherited Metabolic Diseases, Department of Integrated Diagnostics, University Hospital of Padova, Padova, Italy
| | - J Campistol
- Neuropaediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - T Coskun
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nutrition & Metabolism, Hacettepe, Ankara, Turkey
| | - F Feillet
- Inborn Errors of Metabolism, Pediatric unit, University Hospital of Nancy, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Nancy, France
| | - M Giżewska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - S C J Huijbregts
- Department of Clinical Child and Adolescent Studies-Neurodevelopmental Disorders, Faculty of Social Sciences, Leiden University, Leiden, Netherlands
| | - S Kearney
- Clinical Psychology Department, Birmingham Children's Hospital, Birmingham, UK
| | - M Langeveld
- Department of Endocrinology and Metabolism, Amterdam UMC, University of Amsterdam, AZ, Amsterdam, the Netherlands
| | - V Leuzzi
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - F Maillot
- Department of Internal Medicine, CHRU de Tours, Université de Tours, Tours, France
| | - A C Muntau
- University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J C Rocha
- Centro de Referência na área de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário do Porto - CHUP, Porto, Portugal; Centre for Health Technology and Services Research (CINTESIS), Portugal; Nutrition & Metabolism, Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - C Romani
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - F K Trefz
- University Children's Hospital, Dietmar-Hoppe Metabolic Centre, Heidelberg, Germany
| | - A MacDonald
- Dietetic Department, Birmingham Children's Hospital, Birmingham, UK
| | - F J van Spronsen
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Metabolic Diseases, the Netherlands.
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Singh K, Cornell CS, Jackson R, Kabiri M, Phipps M, Desai M, Fogle R, Ying X, Anarat-Cappillino G, Geller S, Johnson J, Roberts E, Malley K, Devlin T, DeRiso M, Berthelette P, Zhang YV, Ryan S, Rao S, Thurberg BL, Bangari DS, Kyostio-Moore S. CRISPR/Cas9 generated knockout mice lacking phenylalanine hydroxylase protein as a novel preclinical model for human phenylketonuria. Sci Rep 2021; 11:7254. [PMID: 33790381 PMCID: PMC8012645 DOI: 10.1038/s41598-021-86663-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/18/2021] [Indexed: 02/01/2023] Open
Abstract
Phenylketonuria (PKU) is an autosomal recessive inborn error of L-phenylalanine (Phe) metabolism. It is caused by a partial or complete deficiency of the enzyme phenylalanine hydroxylase (PAH), which is necessary for conversion of Phe to tyrosine (Tyr). This metabolic error results in buildup of Phe and reduction of Tyr concentration in blood and in the brain, leading to neurological disease and intellectual deficits. Patients exhibit retarded body growth, hypopigmentation, hypocholesterolemia and low levels of neurotransmitters. Here we report first attempt at creating a homozygous Pah knock-out (KO) (Hom) mouse model, which was developed in the C57BL/6 J strain using CRISPR/Cas9 where codon 7 (GAG) in Pah gene was changed to a stop codon TAG. We investigated 2 to 6-month-old, male, Hom mice using comprehensive behavioral and biochemical assays, MRI and histopathology. Age and sex-matched heterozygous Pah-KO (Het) mice were used as control mice, as they exhibit enough PAH enzyme activity to provide Phe and Tyr levels comparable to the wild-type mice. Overall, our findings demonstrate that 6-month-old, male Hom mice completely lack PAH enzyme, exhibit significantly higher blood and brain Phe levels, lower levels of brain Tyr and neurotransmitters along with lower myelin content and have significant behavioral deficit. These mice exhibit phenotypes that closely resemble PKU patients such as retarded body growth, cutaneous hypopigmentation, and hypocholesterolemia when compared to the age- and sex-matched Het mice. Altogether, biochemical, behavioral, and pathologic features of this novel mouse model suggest that it can be used as a reliable translational tool for PKU preclinical research and drug development.
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Affiliation(s)
- Kuldeep Singh
- grid.417555.70000 0000 8814 392XGlobal Discovery Pathology, Translational In-Vivo Models Research Platform, Sanofi, 5 The Mountain Road, Framingham, MA 01701 USA ,Present Address: WuXi AppTec Inc., 8th Floor, 55 Cambridge Parkway, Cambridge, MA 02142 USA
| | - Cathleen S. Cornell
- grid.417555.70000 0000 8814 392XGenomic Medicine Unit, Sanofi, 49 New York Avenue, Framingham, MA 01701 USA
| | - Robert Jackson
- grid.417555.70000 0000 8814 392XGenomic Medicine Unit, Sanofi, 49 New York Avenue, Framingham, MA 01701 USA
| | - Mostafa Kabiri
- grid.420214.1Transgenic Model and Technology, Translational In-Vivo Research Platform, Industrie Park Hoechst, Sanofi, Frankfurt, Germany
| | - Michael Phipps
- grid.417555.70000 0000 8814 392XTransgenic Model and Technology, Translational In-Vivo Models Research Platform, Sanofi, 5 The Mountain Road, Framingham, MA 01701 USA
| | - Mitul Desai
- grid.417555.70000 0000 8814 392XGlobal Bioimaging, Translational In-Vivo Models Research Platform, Sanofi, Framingham, MA 01701 USA
| | - Robert Fogle
- grid.417555.70000 0000 8814 392XGlobal Bioimaging, Translational In-Vivo Models Research Platform, Sanofi, Framingham, MA 01701 USA
| | - Xiaoyou Ying
- grid.417555.70000 0000 8814 392XGlobal Bioimaging, Translational In-Vivo Models Research Platform, Sanofi, Framingham, MA 01701 USA
| | - Gulbenk Anarat-Cappillino
- grid.417555.70000 0000 8814 392XPre-Development Sciences NA, Analytical R&D, Sanofi, Framingham, MA 01701 USA
| | - Sarah Geller
- grid.417555.70000 0000 8814 392XPre-Development Sciences NA, Analytical R&D, Sanofi, Framingham, MA 01701 USA
| | - Jennifer Johnson
- grid.417555.70000 0000 8814 392XGlobal Discovery Pathology, Translational In-Vivo Models Research Platform, Sanofi, 5 The Mountain Road, Framingham, MA 01701 USA
| | - Errin Roberts
- grid.417555.70000 0000 8814 392XGlobal Discovery Pathology, Translational In-Vivo Models Research Platform, Sanofi, 5 The Mountain Road, Framingham, MA 01701 USA
| | - Katie Malley
- grid.417555.70000 0000 8814 392XGlobal Discovery Pathology, Translational In-Vivo Models Research Platform, Sanofi, 5 The Mountain Road, Framingham, MA 01701 USA
| | - Tim Devlin
- grid.417555.70000 0000 8814 392XTransgenic Model and Technology, Translational In-Vivo Models Research Platform, Sanofi, 5 The Mountain Road, Framingham, MA 01701 USA
| | - Matthew DeRiso
- grid.417555.70000 0000 8814 392XTransgenic Model and Technology, Translational In-Vivo Models Research Platform, Sanofi, 5 The Mountain Road, Framingham, MA 01701 USA
| | - Patricia Berthelette
- grid.417555.70000 0000 8814 392XGenomic Medicine Unit, Sanofi, 49 New York Avenue, Framingham, MA 01701 USA
| | - Yao V. Zhang
- grid.417555.70000 0000 8814 392XGenomic Medicine Unit, Sanofi, 49 New York Avenue, Framingham, MA 01701 USA
| | - Susan Ryan
- grid.417555.70000 0000 8814 392XGlobal Discovery Pathology, Translational In-Vivo Models Research Platform, Sanofi, 5 The Mountain Road, Framingham, MA 01701 USA
| | - Srinivas Rao
- grid.417555.70000 0000 8814 392XTranslational In-Vivo Models Research Platform, Sanofi, 49 New York Avenue, Framingham, MA 01701 USA
| | - Beth L. Thurberg
- grid.417555.70000 0000 8814 392XGlobal Discovery Pathology, Translational In-Vivo Models Research Platform, Sanofi, 5 The Mountain Road, Framingham, MA 01701 USA
| | - Dinesh S. Bangari
- grid.417555.70000 0000 8814 392XGlobal Discovery Pathology, Translational In-Vivo Models Research Platform, Sanofi, 5 The Mountain Road, Framingham, MA 01701 USA
| | - Sirkka Kyostio-Moore
- grid.417555.70000 0000 8814 392XGenomic Medicine Unit, Sanofi, 49 New York Avenue, Framingham, MA 01701 USA
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Implementing a Transition Program from Paediatric to Adult Services in Phenylketonuria: Results After Two Years of Follow-Up with an Adult Team. Nutrients 2021; 13:nu13030799. [PMID: 33671057 PMCID: PMC8001271 DOI: 10.3390/nu13030799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/01/2021] [Accepted: 02/24/2021] [Indexed: 12/15/2022] Open
Abstract
We aimed to report the implementation of a phenylketonuria (PKU) transition program and study the effects of follow-up with an adult team on metabolic control, adherence, and loss of follow-up. Fifty-five PKU patients were analysed in the study periods (SP): 2 years before (SP1) and after the beginning of adult care (SP2). Retrospective data on metabolic control and number of clinic appointments were collected for each SP, and protein intakes were analysed. In SP2, three patients (6%) were lost to follow-up. There was a small but statistically significant increase in median number of annual blood spots from SP1 to SP2: 11 (7–15) vs. 14 (7–20); p = 0.002. Mean ± SD of median blood Phe remained stable (525 ± 248 µmol/L vs. 552 ± 225 µmol/L; p = 0.100); median % of blood Phe < 480 µmol/L decreased (51 (4–96)% vs. 37 (5–85)%; p = 0.041) and median number of clinic appointments increased from SP1 to SP2: (5 (4–6) vs. 11 (8–13); p < 0.001). No significant differences were found regarding any parameter of protein intake. Our results suggest that the implementation of an adult service was successful as impact on metabolic control was limited and attendance remained high. Continuous dietetic care likely contributed to these results by keeping patients in follow-up and committed to treatment.
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Mitchell AE, Morawska A, Kirby G, McGill J, Coman D, Inwood A. Triple P for Parents of Children with Phenylketonuria: A Nonrandomized Trial. J Pediatr Psychol 2021; 46:208-218. [PMID: 33296470 DOI: 10.1093/jpepsy/jsaa100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Families of children with phenylketonuria (PKU) report child emotional and behavioral problems, parenting stress, and parenting difficulties, which are associated with worse health-related quality of life. This study aimed to examine acceptability and feasibility of a brief, group-based parenting program (Healthy Living Triple P) for families of children with PKU. METHODS An uncontrolled nonrandomized trial design was used. Families of children aged 2-12 years (N = 17) completed questionnaire measures assessing child behavior and impact of PKU on quality of life (primary outcomes), and parenting behavior, self-efficacy and stress, and children's behavioral and emotional adjustment (secondary outcomes). Routinely collected blood phenylalanine (Phe) levels were obtained from the treating team. Parents selected two child behaviors as targets for change. The intervention comprised two, 2-hr group sessions delivered face-to-face or online. Assessment was repeated at 4-week postintervention (T2) and 4-month follow-up (T3). RESULTS Attrition was low and parent satisfaction with the intervention (face-to-face and online) was high. All families achieved success with one or both child behavior goals, and 75% of families achieved 100% success with both behavior goals by T3; however, there was no change in health-related quality of life. There were moderate improvements in parent-reported ineffective parenting (total score, d = 0.87, 95% CI -1.01 to 2.75) and laxness (d = 0.59, 95% CI -1.27 to 2.46), but no effects on parenting stress or children's adjustment. Phe levels improved by 6month post-intervention for children with elevated preintervention levels. CONCLUSIONS Results support intervention acceptability and feasibility. A randomized controlled trial is warranted to establish intervention efficacy.
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Affiliation(s)
- Amy E Mitchell
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Australia
| | - Alina Morawska
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Australia
| | - Grace Kirby
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Australia
| | - James McGill
- Queensland Lifespan Metabolic Medicine Service, Queensland Children's Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - David Coman
- Queensland Lifespan Metabolic Medicine Service, Queensland Children's Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Anita Inwood
- Queensland Lifespan Metabolic Medicine Service, Queensland Children's Hospital, Brisbane, Australia; School of Nursing and Social Work, The University of Queensland, Brisbane, Australia
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Waisbren S, Burton BK, Feigenbaum A, Konczal LL, Lilienstein J, McCandless SE, Rowell R, Sanchez-Valle A, Whitehall KB, Longo N. Long-term preservation of intellectual functioning in sapropterin-treated infants and young children with phenylketonuria: A seven-year analysis. Mol Genet Metab 2021; 132:119-127. [PMID: 33485801 PMCID: PMC8684368 DOI: 10.1016/j.ymgme.2021.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/19/2022]
Abstract
Sapropterin dihydrochloride has been approved for the treatment of hyperphenylalaninemia in infants and young children with phenylketonuria (PKU). Sapropterin can reduce phenylalanine (Phe) levels in tetrahydrobiopterin (BH4)-responsive patients, potentially preventing the intellectual impairment caused by elevated Phe levels. The long-term effect of sapropterin on intellectual functioning was assessed using the Full-Scale Intelligence Quotient (FSIQ) in 62 children who began treatment before the age of 6 years. Over each 2-year interval, the estimate of mean change in FSIQ was -0.5768 with a lower limit of the 95% confidence interval (CI) of -1.60. At the end of the follow-up period (Year 7), the least squares mean estimate of the change in FSIQ from baseline was 1.14 with a lower limit of the 95% CI of -3.53. These lower limits were both within the clinically expected variation of 5 points. During the whole study period, mean blood Phe levels remained within the American College of Medical Genetics (ACMG) target range of 120-360 μmol/L. In addition, height, weight, and head circumference were maintained within normal ranges throughout follow-up, as defined by growth charts from the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) for children below and above the age of 24 months, respectively. All patients (n = 65) enrolled in this study experienced at least one adverse event, as expected from previous studies. In conclusion, long-term use of sapropterin in individuals with PKU helps to control blood Phe, preserve intellectual functioning, and maintain normal growth in BH4-responsive children who initiated treatment between the ages of 0 to 6 years.
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Affiliation(s)
- Susan Waisbren
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Barbara K Burton
- Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annette Feigenbaum
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Laura L Konczal
- Center for Human Genetics, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | | | - Shawn E McCandless
- Section of Genetics and Metabolism, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA
| | | | | | | | - Nicola Longo
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
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Diffusion kurtosis imaging detects subclinical white matter abnormalities in Phenylketonuria. NEUROIMAGE-CLINICAL 2021; 29:102555. [PMID: 33461111 PMCID: PMC7814191 DOI: 10.1016/j.nicl.2020.102555] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/02/2020] [Accepted: 12/29/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Phenylketonuria (PKU) is an autosomal recessive disorder whereby deficiencies in phenylalanine metabolism cause progressive neurological dysfunction. Managing PKU is challenging, with disease monitoring focussed on short-term phenylalanine control rather than measures of neuronal damage. Conventional imaging lacks sensitivity, however diffusion kurtosis imaging (DKI), a new MRI method may reveal subclinical white matter structural changes in PKU. METHODS This cohort study involved adults with PKU recruited during routine clinical care. MRI, neurocognitive assessment and historical phenylalanine (Phe) levels were collected. A hypothesis-generating case study comparing diet-compliant and non-compliant siblings confirmed that DKI metrics are sensitive to dietary adherence and prompted a candidate metric (Krad/KFA ratio). We then tested this metric in a Replication cohort (PKU = 20; controls = 43). RESULTS Both siblings scored outside the range of controls for all DKI-based metrics, with severe changes in the periventricular white matter and a gradient of severity toward the cortex. Krad/KFA provided clear separation by diagnosis in the Replication cohort (p < 0.001 in periventricular, deep and pericortical compartments). The ratio also correlated negatively with attention (r = -0.51 & -0.50, p < 0.05) and positively with 3-year mean Phe (r = 0.45 & 0.58, p < 0.01). CONCLUSION DKI reveals regionally-specific, progressive abnormalities of brain diffusion characteristics in PKU, even in the absence of conspicuous clinical signs or abnormalities on conventional MRI. A DKI-based marker derived from these scores (Krad/KFA ratio) was sensitive to cognitive impairment and PKU control over the medium term and may provide a meaningful subclinical biomarker of end-organ damage.
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True Restriction in Diffusion-Weighted Imaging in a Mistreated Patient With Phenylketonuria. Neurologist 2020; 26:20-21. [DOI: 10.1097/nrl.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Weng HL, Yang FJ, Chen PR, Hwu WL, Lee NC, Chien YH. Dietary intake and nutritional status of patients with phenylketonuria in Taiwan. Sci Rep 2020; 10:14537. [PMID: 32883979 PMCID: PMC7471922 DOI: 10.1038/s41598-020-71361-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/10/2020] [Indexed: 01/10/2023] Open
Abstract
Phenylalanine hydroxylase (PAH) deficiency leads to phenylalanine accumulation and results in phenylketonuria (PKU). Phenylketonuria can contribute to severe inability such as mental impairment. Early diagnosis and dietary intervention can have beneficial effects on maintaining normal neural and cognitive function in patients with PKU. However, a long-term low phenylalanine diet may put children at risk of malnutrition. A food supplement was therefore used for children with PKU under dietician supervision according to dietary reference intakes (DRIs). In this cross-sectional study, we enrolled patients with PKU and age-matched controls to compare their anthropometry data [weight, height, body mass index (BMI), and body composition using bioelectrical impedance analysis (BIA)], and correlated it with their dietary intake based on 24-h dietary recall. For continuous parameters, the data were expressed as median ± standard deviation (SD), and the Mann–Whitney U test was used to test the difference among the groups. Correlation by natural proteins, body fat, and fat-free mass were evaluated using the Pearson correlation coefficient. Twenty-two participants diagnosed with PKU (ages 8–27 years; mean 15.23 ± 5.23) and a control group of 22 non-PKU participants (ages 8–39 years; mean 19.73 ± 10.6) were recruited for this study. Between the two groups of participants, no significant difference was found in height, weight, BMI, muscle mass, or fat mass. The percentage of natural protein has no effect on body composition. We found a significant positive correlation between the total protein intake percentage of DRIs and muscle mass (r = 0.491, p = 0.020) and a significant negative correlation in the total protein intake percentage of DRIs and fat mass (r = -0.475, p = 0.025) in participants with PKU. There were no significant differences in body composition and nutrition intake between patients with PKU (under metabolic control) and healthy subjects. Thus, giving proper nutrition treatment may have beneficial effects on body growth and nutrition status in patients with PKU in Taiwan.
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Affiliation(s)
- Hui-Ling Weng
- Department of Dietetics, National Taiwan University Hospital, Taipei, Taiwan.,School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Feng-Jung Yang
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Rare Diseases Center and Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan.
| | - Pey-Rong Chen
- Department of Dietetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wuh-Liang Hwu
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ni-Chung Lee
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Hsiu Chien
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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van der Goot E, van Spronsen FJ, Falcão Salles J, van der Zee EA. A Microbial Community Ecology Perspective on the Gut-Microbiome-Brain Axis. Front Endocrinol (Lausanne) 2020; 11:611. [PMID: 32982988 PMCID: PMC7492586 DOI: 10.3389/fendo.2020.00611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Els van der Goot
- Molecular Neurobiology, Groningen Institute for Evolutionary Sciences, University of Groningen, Groningen, Netherlands
- Microbial Ecology Cluster, Groningen Institute for Evolutionary Sciences, University of Groningen, Groningen, Netherlands
| | - Francjan J. van Spronsen
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, Netherlands
| | - Joana Falcão Salles
- Microbial Ecology Cluster, Groningen Institute for Evolutionary Sciences, University of Groningen, Groningen, Netherlands
| | - Eddy A. van der Zee
- Molecular Neurobiology, Groningen Institute for Evolutionary Sciences, University of Groningen, Groningen, Netherlands
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Schiergens KA, Weiß KJ, Dokoupil K, Fleissner S, Maier EM. [Dietary treatment of inborn errors of metabolism-a balancing act between indulgence and therapy]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:864-871. [PMID: 32542434 DOI: 10.1007/s00103-020-03168-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For many inborn metabolic diseases, a lifelong diet is a crucial part of the therapy since pharmacological therapy is available for only a few conditions and patients. The implementation of a low natural protein diet with a reduced intake of natural protein and the complementary use of synthetic amino acid mixtures is described using the examples of phenylketonuria and urea cycle disorders focusing on children and adolescents. For phenylketonuria, the amino acid supplement is free of phenylalanine whereas for urea cycle disorders, it exclusively consists of essential amino acids. The dietary treatment aims to maintain metabolic stability and to prevent accumulation of toxic metabolites. At the same time, the nutritional requirements to ensure growth and development must be met. Therefore, patients need to follow strict rules regarding the choice of food products. This restrictive therapy interferes with the desire for autonomy and the joy of eating and often results in a reduced quality of life.Following the diet is crucial for a favorable outcome. To meet its requirements, patients and their families are provided with training. It is a great challenge not only to support the patients and their families in all practical aspects of dietary management, but also to motivate them to lifelong adherence in order to ensure the best possible outcome.
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Affiliation(s)
- Katharina A Schiergens
- Abteilung für angeborene Stoffwechselerkrankungen, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital der LMU München, Lindwurmstr. 4, 80337, München, Deutschland
| | - Katharina J Weiß
- Abteilung für angeborene Stoffwechselerkrankungen, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital der LMU München, Lindwurmstr. 4, 80337, München, Deutschland
| | - Katharina Dokoupil
- Abteilung für angeborene Stoffwechselerkrankungen, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital der LMU München, Lindwurmstr. 4, 80337, München, Deutschland
| | - Sandra Fleissner
- Abteilung für angeborene Stoffwechselerkrankungen, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital der LMU München, Lindwurmstr. 4, 80337, München, Deutschland
| | - Esther M Maier
- Abteilung für angeborene Stoffwechselerkrankungen, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital der LMU München, Lindwurmstr. 4, 80337, München, Deutschland.
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Burlina AP, Cazzorla C, Massa P, Loro C, Gueraldi D, Burlina AB. The Impact of a Slow-Release Large Neutral Amino Acids Supplement on Treatment Adherence in Adult Patients with Phenylketonuria. Nutrients 2020; 12:nu12072078. [PMID: 32674279 PMCID: PMC7400920 DOI: 10.3390/nu12072078] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 01/08/2023] Open
Abstract
The gold standard treatment for phenylketonuria (PKU) is a lifelong low-phenylalanine (Phe) diet supplemented with Phe-free protein substitutes. Adherence to therapy becomes difficult after childhood. Supplementing with large neutral amino acids (LNAAs) has been proposed as an alternative medication to Phe-free protein substitutes (i.e., amino acid mixtures). The aim of this study was to evaluate adherence to therapy and quality of life (QoL) in a cohort of sub-optimally controlled adult PKU patients treated with a new LNAA formulation. Twelve patients were enrolled in a 12-month-trial of slow-release LNAAs (1g/kg/day) plus a Phe-restricted diet. Medication adherence was measured with the Morisky Green Levine Medication Adherence Scale; the QoL was measured using the phenylketonuria-quality of life (PKU-QoL) questionnaire. Phe, tyrosine (Tyr) levels, and Phe/Tyr ratios were measured fortnightly. Before treatment, 3/12 patients self-reported a ‘medium’ adherence to medication and 9/12 reported a low adherence; 60% of patients reported a full adherence over the past four weeks. After 12 months of LNAA treatment, all patients self-reported a high adherence to medication, with 96% reporting a full adherence. Phe levels remained unchanged, while Tyr levels increased in most patients. The Phy/Tyr ratio decreased. All patients had a significant improvement in the QoL. LNAAs may give patients a further opportunity to improve medication adherence and, consequently, their QoL.
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Affiliation(s)
- Alessandro P. Burlina
- Neurological Unit, St. Bassiano Hospital, Via dei Lotti 40, 36061 Bassano del Grappa, Italy;
| | - Chiara Cazzorla
- Division of Inherited Metabolic Diseases, Department of Women and Children’s Health, University Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy; (C.C.); (P.M.); (C.L.); (D.G.)
| | - Pamela Massa
- Division of Inherited Metabolic Diseases, Department of Women and Children’s Health, University Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy; (C.C.); (P.M.); (C.L.); (D.G.)
| | - Christian Loro
- Division of Inherited Metabolic Diseases, Department of Women and Children’s Health, University Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy; (C.C.); (P.M.); (C.L.); (D.G.)
| | - Daniela Gueraldi
- Division of Inherited Metabolic Diseases, Department of Women and Children’s Health, University Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy; (C.C.); (P.M.); (C.L.); (D.G.)
| | - Alberto B. Burlina
- Division of Inherited Metabolic Diseases, Department of Women and Children’s Health, University Hospital of Padova, Via Giustiniani 3, 35128 Padova, Italy; (C.C.); (P.M.); (C.L.); (D.G.)
- Correspondence: ; Tel.: +39-049 8213569
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Lipids and phenylketonuria: Current evidences pointed the need for lipidomics studies. Arch Biochem Biophys 2020; 688:108431. [DOI: 10.1016/j.abb.2020.108431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
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Barta AG, Sumánszki C, Turgonyi Z, Kiss E, Simon E, Serfőző C, Reismann P. Health Related Quality of Life assessment among early-treated Hungarian adult PKU patients using the PKU-QOL adult questionnaire. Mol Genet Metab Rep 2020; 23:100589. [PMID: 32346514 PMCID: PMC7183227 DOI: 10.1016/j.ymgmr.2020.100589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 11/27/2022] Open
Abstract
Background: The implementation of neonatal screening and the early initiation of lifelong therapy have helped to prevent severe complications and enabled much more favorable outcomes for early-treated phenylketonuria (ETPKU) patients. However, PKU patients tend to develop subtle cognitive and psychosocial abnormalities and the strict dietary therapy can present financial and social burden. Thus, PKU is expected to affect the quality of life (QoL) of these patients. There is insufficient evidence regarding the relationship between metabolic control and Health-Related QoL (HRQoL). We aimed to assess the effect of short- and long-term therapy on QoL among Hungarian adult PKU patients using the standardized PKU-specific PKU-QoL questionnaire. Methods: We conducted a single-centre, cross-sectional, observational study in Hungary. We included adult PKU patients treated with diet and amino acid supplements only. Patients reported HRQoL using the standardized adult PKU-QoL questionnaire and mean blood Phe concentrations were assessed for three different time periods: the previous 10 years, the previous year and concentration at the time of completing the questionnaire. The correlation between patients’ QoL scores and their Phe levels was assessed. The classical PKU group was further divided into “good” and “suboptimal” adherence groups based on individual mean Phe levels in the examined time period. We evaluated differences in QoL among the two subgroups of classical PKU patients. QoL scores between classical and non-classical patients were also compared. Results: Data from 88 adult patients were analysed (66 had classical PKU). No median PKU-QoL score reached major or severe impact/frequent symptoms in any domain. The highest scores (meaning larger burden) were mostly related to emotional impact of PKU and disease management. When performing correlation analysis between Phe levels and QoL scores by all patients we found weak to fair positive correlation in several domains either short or long term. Patients with classical PKU reported greater financial impact of PKU than patients with less severe PKU. Classical PKU patients with good therapy adherence tended to report better HRQoL scores than patients with suboptimal adherence. Conclusion: We conclude that patients showed good HRQoL using the PKU-specific questionnaire. Our study demonstrates that suboptimal metabolic control is negatively associated with patients' HRQoL.
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Key Words
- AAS, amino acid supplements
- Adult
- ETPKU, early-treated phenylketonuria
- Early treated
- GMP, glycomacropeptide
- HPA, hyperphenylalaninaemia
- HRQoL
- HRQoL, health related quality of life
- Health related quality of life
- IQR, interquartile range
- PKU
- PKU, phenylketonuria
- PKU-QoL, Phenylketonuria Quality of Life questionnaires
- Phe, phenylalanine
- Phenylketonuria
- SD, standard deviation
- Tyr, tyrosine
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Affiliation(s)
- András Gellért Barta
- 2 Department of Internal Medicine, Semmelweis University,Szentkirályi street 46, Budapest 1088, Hungary
| | - Csaba Sumánszki
- 2 Department of Internal Medicine, Semmelweis University,Szentkirályi street 46, Budapest 1088, Hungary
| | - Zsófia Turgonyi
- Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest 1085, Hungary
| | - Erika Kiss
- 1 Department of Pediatrics, Semmelweis University, Bokay J. street 53-54, Budapest 1083, Hungary
| | - Erika Simon
- 1 Department of Pediatrics, Semmelweis University, Bokay J. street 53-54, Budapest 1083, Hungary
| | - Csilla Serfőző
- Department of Ophthalmology, Semmelweis University, Mária street 39, Budapest 1085, Hungary
| | - Péter Reismann
- 2 Department of Internal Medicine, Semmelweis University,Szentkirályi street 46, Budapest 1088, Hungary
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Wild J, Shanmuganathan M, Hayashi M, Potter M, Britz-McKibbin P. Metabolomics for improved treatment monitoring of phenylketonuria: urinary biomarkers for non-invasive assessment of dietary adherence and nutritional deficiencies. Analyst 2020; 144:6595-6608. [PMID: 31608347 DOI: 10.1039/c9an01642b] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Management of phenylketonuria (PKU) requires lifelong restriction of phenylalanine (Phe) intake using specialized medical foods to prevent neurocognitive impairment in affected patients. However, dietary adherence is challenging to maintain while ensuring adequate nutrition, which can lead to sub-optimal clinical outcomes. Metabolomics offers a systematic approach to identify new biomarkers of disease progression in PKU when using urine as a surrogate for blood specimens that is more accurate than self-reported diet records. Herein, the plasma and urine metabolome of a cohort of classic PKU patients (median age = 11 years; n = 22) mainly prescribed (78%) a Phe-restricted diet were characterized using multisegment injection-capillary electrophoresis-mass spectrometry (MSI-CE-MS). Overall, there was good mutual agreement between plasma Phe and tyrosine (Tyr) concentrations measured from PKU patients when using an amino acid analyzer based on UPLC-UV as compared to MSI-CE-MS with a mean bias of 12% (n = 82). Longitudinal measurements of recently diagnosed PKU infants (n = 3) revealed good long-term regulation of blood Phe with dietary management, and only occasional episodes exceeding the recommended therapeutic range (>360 μM) unlike older PKU patients. Plasma metabolomic studies demonstrated that non-adherent PKU patients had lower circulating concentrations of Tyr, arginine, 2-aminobutyric acid, and propionylcarnitine (q < 0.05, FDR) that were inversely correlated to Phe (r ≈ -0.600 to -0.830). Nontargeted metabolite profiling also revealed urinary biomarkers associated with poor dietary adherence among PKU patients, including elevated concentrations of catabolites indicative of Phe intoxication (e.g., phenylpyruvic acid, phenylacetylglutamine, hydroxyphenylacetic acid). Additionally, PKU patients with poor blood Phe control had lower excretion of urinary compounds derived from co-metabolism of Tyr due to microbiota activity (e.g., cresol sulfate, phenylsulfate), as well as several metabolites associated with inadequate nutrient intake, including low carnitine and B vitamin status (e.g., folic acid, vitamin B12). Interestingly, an unknown urinary metabolite was strongly correlated with Phe excretion in PKU patients (r = 0.861), which was subsequently identified as imidazole lactic acid when using high resolution MS/MS. Overall, urine profiling offers a non-invasive approach for better treatment monitoring of individual PKU patients, which can also guide the design of novel therapies that improve adherence to Phe-restricted diets without acquired nutritional deficiencies.
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Affiliation(s)
- Jennifer Wild
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada.
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Sundermann B, Garde S, Dehghan Nayyeri M, Weglage J, Rau J, Pfleiderer B, Feldmann R. Approaching altered inhibitory control in phenylketonuria: A functional MRI study with a Go-NoGo task in young female adults. Eur J Neurosci 2020; 52:3951-3962. [PMID: 32277784 DOI: 10.1111/ejn.14738] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/30/2020] [Accepted: 03/31/2020] [Indexed: 11/27/2022]
Abstract
Subtle executive function deficits, particularly regarding inhibitory control, have been reported in patients with phenylketonuria (PKU) despite early dietary treatment. Purpose of this study was to assess whether young female adults with PKU exhibit altered neural activity underlying such deficits, particularly in a fronto-parietal cognitive control network (CCN). Behavioural data and functional magnetic resonance imaging (fMRI) data were acquired during a Go-NoGo task in 16 young adult patients with PKU and 17 control subjects. Hypothesis-driven analyses of behavioural and fMRI data in the CCN were supplemented by exploratory whole brain activation analyses. PKU patients exhibited a trend towards higher errors of commission. Patients exhibited marginally increased activation associated with inhibitory control in only one CCN core region (right middle frontal gyrus, p = .043). Whole brain analyses revealed widespread relatively increased activation in adults with PKU in the main task contrast (NoGo > Go). This increased activation was mainly observed outside the CCN and largely overlapped with the default mode network (DMN). In conclusion, only subtle inhibitory control deficits and associated brain activity differences were observed in young adults with PKU. Thus, this work adds to the notion that this particular population seems to be only slightly affected by such cognitive deficits. While there were also only minimal increases when compared to healthy subjects in brain activity in a cognitive control network, we observed more widespread activation increases outside this network. These results support the assumption of DMN dysfunction in PKU.
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Affiliation(s)
- Benedikt Sundermann
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Muenster, Germany
| | - Stefan Garde
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Muenster, Germany
| | - Mahboobeh Dehghan Nayyeri
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Muenster, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LVR Clinic, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Josef Weglage
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Johanna Rau
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Muenster, Germany.,Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Bettina Pfleiderer
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Muenster, Germany.,Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, Muenster, Germany
| | - Reinhold Feldmann
- Department of General Pediatrics, University Hospital Muenster, Muenster, Germany
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Morawska A, Mitchell AE, Etel E, Kirby G, McGill J, Coman D, Inwood A. Psychosocial functioning in children with phenylketonuria: Relationships between quality of life and parenting indicators. Child Care Health Dev 2020; 46:56-65. [PMID: 31782540 DOI: 10.1111/cch.12727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/26/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aimed to assess the impact of phenylketonuria (PKU) and its treatment on parent and child health-related quality of life (HRQoL) and to identify the parenting-related correlates of parent and child HRQoL, as well as metabolic control. METHODS Eighteen mothers of 2- to 12-year-old children with PKU participated and completed a series of self-report questionnaires including the PKU Impact and Treatment Quality of Life Questionnaire (PKU-QOL). RESULTS Mothers reported that the most significant impact of PKU on HRQoL was in relation to the impact of their child's anxiety during blood tests on their own HRQoL and guilt related to poor adherence to dietary restrictions and supplementation regimens. Higher reported intensity of child emotional and behavioural difficulties and parenting stress were associated with higher scores for PKU symptoms on the PKU-QOL, higher scores for emotional, social, and overall impact of PKU, and higher scores for the impact of dietary restriction. Where mothers reported greater use of overreactivity as a parenting strategy, children tended to have better lifetime phenylalanine levels; however, the overall impact of PKU and the impact of supplement administration on mothers' HRQoL were worse for these families. CONCLUSIONS These findings have implications for a holistic family-centred approach to the care of children with PKU and their families.
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Affiliation(s)
- Alina Morawska
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Amy E Mitchell
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Evren Etel
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Grace Kirby
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - James McGill
- Queensland Lifespan Metabolic Medicine Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David Coman
- Queensland Lifespan Metabolic Medicine Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Anita Inwood
- Queensland Lifespan Metabolic Medicine Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Nursing and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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