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Imrich R, Zatkova A, Lukacova O, Sedlakova J, Zanova E, Vlcek M, Penesova A, Radikova Z, Havranova A, Ranganath L. Nutritional interventions for patients with alkaptonuria: A minireview. Endocr Regul 2023; 57:61-67. [PMID: 36966367 DOI: 10.2478/enr-2023-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2023] Open
Abstract
Alkaptonuria (AKU, OMIM, No. 203500) is a rare, slow-progressing, irreversible, multisystemic disease resulting from a deficiency of the homogentisate 1,2-dioxygenase enzyme, which leads to the accumulation of homogentisic acid (HGA) and subsequent deposition as pigment in connective tissues called ochronosis. As a result, severe arthropathy of large joints and spondyloarthropathy with frequent fractures, ligament ruptures, and osteoporosis develops in AKU patients. Since 2020, the first-time treatment with nitisinone has become available in the European Union. Nitisinone significantly reduces HGA production and arrests ochronosis in AKU patients. However, blocking of the tyrosine metabolic pathway by the drug leads to tyrosine plasma and tissue concentrations increase. The nitisinone-induced hypertyrosinemia can lead to the development of corneal keratopathy, and once it develops, the treatment needs to be interrupted. A decrease in overall protein intake reduces the risk of the keratopathy during nitisinone-induced hypertyrosinemia in AKU patients. The low-protein diet is not only poorly tolerated by patients, but over longer periods, leads to a severe muscle loss and weight gain due to increased energy intake from carbohydrates and fats. Therefore, the development of novel nutritional approaches is required to prevent the adverse events due to nitisinone-induced hypertyrosinemia and the negative impact on skeletal muscle metabolism in AKU patients.
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Affiliation(s)
- Richard Imrich
- 1Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
- 2National Institute of Rheumatic Diseases, Piestany, Slovakia
| | - Andrea Zatkova
- 1Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Olga Lukacova
- 2National Institute of Rheumatic Diseases, Piestany, Slovakia
| | - Jana Sedlakova
- 2National Institute of Rheumatic Diseases, Piestany, Slovakia
| | | | - Miroslav Vlcek
- 1Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
- 2National Institute of Rheumatic Diseases, Piestany, Slovakia
| | - Adela Penesova
- 1Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
- 2National Institute of Rheumatic Diseases, Piestany, Slovakia
| | - Zofia Radikova
- 1Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
- 2National Institute of Rheumatic Diseases, Piestany, Slovakia
| | - Andrea Havranova
- 1Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
- 2National Institute of Rheumatic Diseases, Piestany, Slovakia
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Braconi D, Millucci L, Ghezzi L, Santucci A. Redox proteomics gives insights into the role of oxidative stress in alkaptonuria. Expert Rev Proteomics 2014; 10:521-35. [PMID: 24206226 DOI: 10.1586/14789450.2013.858020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Alkaptonuria (AKU) is an ultra-rare metabolic disorder of the catabolic pathway of tyrosine and phenylalanine that has been poorly characterized at molecular level. As a genetic disease, AKU is present at birth, but its most severe manifestations are delayed due to the deposition of a dark-brown pigment (ochronosis) in connective tissues. The reasons for such a delayed manifestation have not been clarified yet, though several lines of evidence suggest that the metabolite accumulated in AKU sufferers (homogentisic acid) is prone to auto-oxidation and induction of oxidative stress. The clarification of the pathophysiological molecular mechanisms of AKU would allow a better understanding of the disease, help find a cure for AKU and provide a model for more common rheumatic diseases. With this aim, we have shown how proteomics and redox proteomics might successfully overcome the difficulties of studying a rare disease such as AKU and the limitations of the hitherto adopted approaches.
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Affiliation(s)
- Daniela Braconi
- Dipartimento di Biotecnologie, Chimica e Farmacia, via Fiorentina 1, Università degli Studi di Siena, 53100 Siena, Italy
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García A, Barbas C, Aguilar R, Castro M. Capillary electrophoresis for rapid profiling of organic acidurias. Clin Chem 1998. [DOI: 10.1093/clinchem/44.9.1905] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Organic acids analysis is a powerful technique in the diagnosis of inborn errors of metabolism. Clinically, patients present with severe symptoms, and early detection and appropriate treatment are often lifesaving. Most of the existing methods are based on gas chromatography in combination with mass spectrometry and require sophisticated equipment and complex sample pretreatment and derivatization. We propose a rapid, simple, and automated capillary electrophoretic method for routine analysis of urine to detect 27 organic acids related to metabolic diseases. With this method, direct measurements are performed on samples after initial centrifugation and dilution, if needed. Separation is performed in pH 6.0 phosphate buffer with methanol added as an organic modifier, −10 kV applied potential, and ultraviolet detection at 200 nm. The assay is completed in <15 min, and alternative separation conditions are proposed in case of overlapping peaks. The developed method allows the identification and quantitation of methylmalonic, pyroglutamic, and glutaric acids in samples of patients with diseases related to these acids.
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Deutsch JC, Santhosh-Kumar CR. Quantitation of homogentisic acid in normal human plasma. JOURNAL OF CHROMATOGRAPHY. B, BIOMEDICAL APPLICATIONS 1996; 677:147-51. [PMID: 8925087 DOI: 10.1016/0378-4347(95)00442-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A new stable isotope dilution gas chromatograph-mass spectrometric method of analysis of homogentisic acid is described. Using this method, homogentisic acid is measured for the first time in normal human plasma. The assay of sera from nine normal individuals yielded a range of values from 2.4 to 12 ng/ml. The method appears to be very sensitive and may be useful in the characterization of heterozygotes for alkaptonuria and other disorders of tyrosine degradation.
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Affiliation(s)
- J C Deutsch
- Division of Gastroenterology, University of Colorado Health Sciences Center, Denver 80220, USA
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Mass spectrometry in disorders of organic acid metabolism. Clin Chim Acta 1995. [DOI: 10.1016/s0009-8981(00)89110-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Organic acid analysis is a powerful technique in the diagnosis of inborn errors of metabolism. Since the development of the technique over twenty-five years ago, it has evolved into a sophisticated and powerful method and is an essential tool in the diagnosis of the organic acidurias. The chemistry and biochemistry of organic acids, as well as sample preparation, instrumentation, and many aspects of the more commonly used methods for the analysis of these compounds, are reviewed. The biochemical and clinical characteristics of each of the primary organic acidurias are described. In addition, the various noninherited causes of secondary organic acidurias that lead to the excretion of abnormal organic acids are also described, and ways of differentiating primary from secondary causes are discussed.
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Affiliation(s)
- D C Lehotay
- Department of Clinical Biochemistry, Hospital for Sick Children, University of Toronto, Ontario, Canada
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Neill GP, Davies NW, McLean S. Automated screening procedure using gas chromatography-mass spectrometry for identification of drugs after their extraction from biological samples. JOURNAL OF CHROMATOGRAPHY 1991; 565:207-24. [PMID: 1874868 DOI: 10.1016/0378-4347(91)80384-o] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A novel analytical screening procedure has been developed, using computer-controlled gas chromatography-mass spectrometry (GC-MS), to detect 120 drugs of interest to road safety. This paper describes GC-MS methodology suitable for use on extracts of biological origin, while extraction procedures will be the subject of a future communication. The method was devised to identify drugs in extracts of blood samples, as part of an investigation into the involvement of drugs, other than alcohol, in road accidents. The method could be adapted to screen for other substances. The method depends on a "macro" program which was written to automate the search of GC-MS data for target drugs. The strategy used was to initially search for each drug in the database by monitoring for a single characteristic ion at the expected retention time. If a peak is found in this first mass chromatogram, a peak for a second characteristic ion is sought within 0.02 min of the first and, if found, the ratio of peak areas calculated. Probable drug identification is based on the simultaneous appearance of peaks for both characteristic ions at the expected retention time and in the correct ratio. If the ratio is outside acceptable limits, a suspected drug (requiring further investigation) is reported. The search macro can use either full mass spectra or, for enhanced sensitivity, data from selected ion monitoring (which requires switching between groups of ions during data acquisition). Quantitative data can be obtained in the usual way by the addition of internal standards.
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Affiliation(s)
- G P Neill
- School of Pharmacy, University of Tasmania, Hobart, Australia
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