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Bregalda A, Carducci C, Pascucci T, Ambrogini P, Sartini S, Pierigè F, di Carlo E, Fiori E, Ielpo D, Pagliarini M, Leuzzi V, Magnani M, Rossi L. New findings about neuropathological outcomes in the PKU mouse throughout lifespan. Mol Genet Metab 2024; 143:108543. [PMID: 39047302 DOI: 10.1016/j.ymgme.2024.108543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
Phenylketonuria (PKU, OMIM 261600) is a genetic disorder caused by a deficiency of the hepatic enzyme phenylalanine hydroxylase (PAH). If left untreated, PKU leads to systemic phenylalanine (Phe) accumulation, which can result in irreversible brain damage and intellectual disabilities. In the last 60 years, early and strict dietary restriction of phenylalanine (Phe) intake proved to prevent the severe clinical phenotype of untreated PKU. While the specific mechanisms through which phenylalanine causes brain damage are still poorly understood, preclinical models have been deeply explored to characterize the neurotoxic effect of Phe on neurodevelopmental processes. At the same time, that on the aging brain still needs to be explored. In the brain of untreated PAHEnu2(-/-) mouse, we previously reported a reduction of myelin basic protein (MBP) during postnatal development up to 60 PND. Later in the diseased mouse's life, a spontaneous and persistent restoration of MBP was detected. In this present longitudinal study, ranging from 14 to 540 post-natal days (PND) of untreated PAHEnu2(-/-) mice, we further investigated: a) the long-life consistency of two Phe-related brain metabolic alterations, such as large neutral amino acids (LNAA) and biogenic amine neurotransmitters' depletion; b) the outcome of locomotor functions during the same life span; c) the integrity of myelin as assessed ex vivo by central (hippocampus) and peripheral (extensor digitorum longus-sciatic nerve) action potential conduction velocities. In contrast with the results of other studies, brain Leu, Ile, and Val concentrations were not significantly altered in the brain PAHEnu2(-/-) mouse. On the other hand, 3-O-Methyldopa (3-OMD, a biomarker of L-DOPA), serotonin, and its associated metabolites were reduced throughout most of the considered time points, with consistent reductions observed prevalently from 14 to 60 PND. Normal saltatory conduction was restored after 60 PND and remained normal at the last examination at 360 PND, resulting nonetheless in a persistent locomotor impairment throughout a lifetime. These new findings contribute to laying the foundations for the preclinical characterization of aging in PKU, confirming neurotransmitter defects as consistent metabolic traits. LNAAs have a minor role, if any, in brain damage pathogenesis. Transient myelin synthesis failure may impact brain connectivity during postnatal development but not nervous signal conduction.
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Affiliation(s)
- Alessandro Bregalda
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy; Pathology Unit, Centro di Riferimento Oncologico di Aviano (C.R.O.) IRCCS, via Franco Gallini 2, 33081 Aviano (PN), Italy.
| | - Claudia Carducci
- Department of Experimental Medicine, Sapienza University, viale del Policlinico 155, 00161 Rome, Italy
| | - Tiziana Pascucci
- Fondazione Santa Lucia IRCCS, via Del Fosso di Fiorano, 64, 00143 Rome, Italy; Department of Psychology and Centro "Daniel Bovet", Sapienza University, via dei Marsi 78, 00185 Rome, Italy
| | - Patrizia Ambrogini
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy
| | - Stefano Sartini
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy
| | - Francesca Pierigè
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy
| | - Emanuele di Carlo
- Department of Experimental Medicine, Sapienza University, viale del Policlinico 155, 00161 Rome, Italy
| | - Elena Fiori
- Fondazione Santa Lucia IRCCS, via Del Fosso di Fiorano, 64, 00143 Rome, Italy; Technopole Foundation, P.le Aldo Moro 5, 00185 Rome, Italy
| | - Donald Ielpo
- Fondazione Santa Lucia IRCCS, via Del Fosso di Fiorano, 64, 00143 Rome, Italy; Department of Psychology and Centro "Daniel Bovet", Sapienza University, via dei Marsi 78, 00185 Rome, Italy
| | - Marica Pagliarini
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Sapienza University, via dei Sabelli 108, 00185 Rome, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy; EryDel SpA, via Antonio Meucci 3, 20091 Bresso (MI), Italy
| | - Luigia Rossi
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Ca' Le Suore 2, 61029 Urbino (PU), Italy; EryDel SpA, via Antonio Meucci 3, 20091 Bresso (MI), Italy
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Bhinderwala F, Roth HE, Filipi M, Jack S, Powers R. Potential Metabolite Biomarkers of Multiple Sclerosis from Multiple Biofluids. ACS Chem Neurosci 2024; 15:1110-1124. [PMID: 38420772 DOI: 10.1021/acschemneuro.3c00678] [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] [Indexed: 03/02/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic and progressive neurological disorder without a cure, but early intervention can slow disease progression and improve the quality of life for MS patients. Obtaining an accurate diagnosis for MS is an arduous and error-prone task that requires a combination of a detailed medical history, a comprehensive neurological exam, clinical tests such as magnetic resonance imaging, and the exclusion of other possible diseases. A simple and definitive biofluid test for MS does not exist, but is highly desirable. To address this need, we employed NMR-based metabolomics to identify potentially unique metabolite biomarkers of MS from a cohort of age and sex-matched samples of cerebrospinal fluid (CSF), serum, and urine from 206 progressive MS (PMS) patients, 46 relapsing-remitting MS (RRMS) patients, and 99 healthy volunteers without a MS diagnosis. We identified 32 metabolites in CSF that varied between the control and PMS patients. Utilizing patient-matched serum samples, we were able to further identify 31 serum metabolites that may serve as biomarkers for PMS patients. Lastly, we identified 14 urine metabolites associated with PMS. All potential biomarkers are associated with metabolic processes linked to the pathology of MS, such as demyelination and neuronal damage. Four metabolites with identical profiles across all three biofluids were discovered, which demonstrate their potential value as cross-biofluid markers of PMS. We further present a case for using metabolic profiles from PMS patients to delineate biomarkers of RRMS. Specifically, three metabolites exhibited a variation from healthy volunteers without MS through RRMS and PMS patients. The consistency of metabolite changes across multiple biofluids, combined with the reliability of a receiver operating characteristic classification, may provide a rapid diagnostic test for MS.
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Affiliation(s)
- Fatema Bhinderwala
- Department of Chemistry, University of Nebraska-Lincoln, Lincoln, Nebraska 68588-0304, United States
- Nebraska Center for Integrated Biomolecular Communication, University of Nebraska-Lincoln, Lincoln, Nebraska 68588-0304, United States
| | - Heidi E Roth
- Department of Chemistry, University of Nebraska-Lincoln, Lincoln, Nebraska 68588-0304, United States
| | - Mary Filipi
- Multiple Sclerosis Clinic, Saunders Medical Center, Wahoo, Nebraska 68066, United States
| | - Samantha Jack
- Multiple Sclerosis Clinic, Saunders Medical Center, Wahoo, Nebraska 68066, United States
| | - Robert Powers
- Department of Chemistry, University of Nebraska-Lincoln, Lincoln, Nebraska 68588-0304, United States
- Nebraska Center for Integrated Biomolecular Communication, University of Nebraska-Lincoln, Lincoln, Nebraska 68588-0304, United States
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Bose S, Mandal S, Khan R, Maji HS, Ashique S. Current Landscape on Development of Phenylalanine and Toxicity of its Metabolites - A Review. Curr Drug Saf 2024; 19:208-217. [PMID: 36999718 DOI: 10.2174/1574886318666230331112800] [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: 09/26/2022] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 04/01/2023]
Abstract
Phenylalanine, an essential amino acid, is the "building block" of protein. It has a tremendous role in different aspects of metabolic events. The tyrosine pathway is the prime one and is typically used to degrade dietary phenylalanine. Phenylalanine exceeds its limit in bodily fluids and the brain when the enzyme, phenylalanine decarboxylase, phenylalanine transaminase, phenylalanine hydroxylase (PAH) or its cofactor tetrahydrobiopterin (BH4) is deficient causes phenylketonuria, schizophrenia, attentiondeficit/ hyperactivity disorder and another neuronal effect. Tyrosine, an amino acid necessary for synthesizing the pigments in melanin, is produced by its primary metabolic pathway. Deficiency/abnormality in metabolic enzymes responsible for the catabolism pathway of Phenylalanine causes an accumulation of the active intermediate metabolite, resulting in several abnormalities, such as developmental delay, tyrosinemias, alkaptonuria, albinism, hypotension and several other undesirable conditions. Dietary restriction of the amino acid(s) can be a therapeutic approach to avoid such undesirable conditions when the level of metabolic enzyme is unpredictable. After properly identifying the enzymatic level, specific pathophysiological conditions can be managed more efficiently.
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Affiliation(s)
- Samrat Bose
- Division of Pharmacology, Guru Nanak Institute of Pharmaceutical Science and Technology, 157/F, Nilgunj Road, Kolkata, 700114, West Bengal, India
| | - Shirsendu Mandal
- Division of Pharmacology, Guru Nanak Institute of Pharmaceutical Science and Technology, 157/F, Nilgunj Road, Kolkata, 700114, West Bengal, India
| | - Rajesh Khan
- Division of Pharmacology, Guru Nanak Institute of Pharmaceutical Science and Technology, 157/F, Nilgunj Road, Kolkata, 700114, West Bengal, India
| | - Himangshu Sekhar Maji
- Division of Pharmaceutical Technology, JIS University, 81, Nilgunj Road, Agarpara, Kolkata, 700109, West Bengal, India
| | - Sumel Ashique
- Department of Pharmaceutics, Bharat Institute of Technology (BIT), School of Pharmacy, Meerut, 250103, UP, India
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De Giorgi A, Nardecchia F, Manti F, Campistol J, Leuzzi V. Neuroimaging in early-treated phenylketonuria patients and clinical outcome: A systematic review. Mol Genet Metab 2023; 139:107588. [PMID: 37149991 DOI: 10.1016/j.ymgme.2023.107588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023]
Abstract
Lacking direct neuropathological data, neuroimaging exploration has become the most powerful tool to give insight into pathophysiological alterations of early-treated PKU (ETPKU) patients. We conducted a systematic review of neuroimaging studies in ETPKU patients to explore 1) the occurrence of consistent neuroimaging alterations; 2) the relationship between them and neurological and cognitive disorders; 3) the contribution of neuroimaging in the insight of neuropathological background of ETPKU subjects; 4) whether brain neuroimaging may provide additional information in the monitoring of the disease course. Thirty-eight studies met the inclusion criteria for the full-text review, including morphological T1/T2 sequences, diffusion brain imaging (DWI/DTI) studies, brain MRI volumetric, functional neuroimaging studies, neurotransmission and brain energetic imaging studies. Non-progressive brain white matter changes were the most frequent and precocious alterations. As confirmed in hundreds of young adults with ETPKU, they affect over 90% of ETPKU patients. Consistent correlations are emerging between microstructural alteration (as detected by DWI/DTI) and metabolic control, which have also been confirmed in a few interventional trials. Volumetric studies detected later and less consistent cortical and subcortical grey matter alterations, which seem to be influenced by the patient's age and metabolic control. The few functional neuroimaging studies so far showed preliminary but interesting data about cortical activation patterns, skill performance, and brain connectivity. Further research is mandatory in these more complex areas. Recurrent methodological limitations include restricted sample sizes concerning the clinical variability of the disease, large age-range, variable measures of metabolic control, and prevalence of cross-sectional rather than longitudinal interventional studies.
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Affiliation(s)
- Agnese De Giorgi
- Division of Child Neurology and Infantile Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Nardecchia
- Division of Child Neurology and Infantile Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Filippo Manti
- Division of Child Neurology and Infantile Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Jaume Campistol
- Neuropaediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Vincenzo Leuzzi
- Division of Child Neurology and Infantile Psychiatry, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
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Rovelli V, Longo N. Phenylketonuria and the brain. Mol Genet Metab 2023; 139:107583. [PMID: 37105048 DOI: 10.1016/j.ymgme.2023.107583] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
Classic phenylketonuria (PKU) is caused by defective activity of phenylalanine hydroxylase (PAH), the enzyme that coverts phenylalanine (Phe) to tyrosine. Toxic accumulation of phenylalanine and its metabolites, left untreated, affects brain development and function depending on the timing of exposure to elevated levels. The specific mechanisms of Phe-induced brain damage are not completely understood, but they correlate to phenylalanine levels and on the stage of brain growth. During fetal life, high levels of phenylalanine such as those seen in maternal PKU can result in microcephaly, neuronal loss and corpus callosum hypoplasia. Elevated phenylalanine levels during the first few years of life can cause acquired microcephaly, severe cognitive impairment and epilepsy, likely due to the impairment of synaptogenesis. During late childhood, elevated phenylalanine can cause alterations in neurological functioning, leading to ADHD, speech delay and mild IQ reduction. In adolescents and adults, executive function and mood are affected, with some of the abnormalities reversed by better control of phenylalanine levels. Altered brain myelination can be present at this stage. In this article, we review the current knowledge about the consequences of high phenylalanine levels in PKU patients and animal models through different stages of brain development and its effect on cognitive, behavioural and neuropsychological function.
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Affiliation(s)
- Valentina Rovelli
- Clinical Department of Pediatrics, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy.
| | - Nicola Longo
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Bregalda A, Carducci C, Viscomi MT, Pierigè F, Biagiotti S, Menotta M, Biancucci F, Pascucci T, Leuzzi V, Magnani M, Rossi L. Myelin basic protein recovery during PKU mice lifespan and the potential role of microRNAs on its regulation. Neurobiol Dis 2023; 180:106093. [PMID: 36948260 DOI: 10.1016/j.nbd.2023.106093] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023] Open
Abstract
Untreated phenylketonuria (PKU) patients and PKU animal models show hypomyelination in the central nervous system and white matter damages, which are accompanied by myelin basic protein (MBP) impairment. Despite many assumptions, the primary explanation of the mentioned cerebral outcomes remains elusive. In this study, MBP protein and mRNA expression on brains of wild type (WT) and phenylketonuric (ENU2) mice were analyzed throughout mice lifespan (14-60-180-270-360-540 post-natal days, PND). The results confirmed the low MBP expression at first PND times, while revealed an unprecedented progressive MBP protein expression recovery in aged ENU2 mice. Unexpectedly, unaltered MBP mRNA expression between WT and ENU2 was always observed. Additionally, for the same time intervals, a significant decrease of the phenylalanine concentration in the peripheral blood and brain of ENU2 mice was detected, to date, for the first time. In this scenario, a translational hindrance of MBP during initial and late cerebral development in ENU2 mice was hypothesized, leading to the execution of a microRNA microarray analysis on 60 PND brains, which was followed by a proteomic assay on 60 and 360 PND brains in order to validate in silico miRNA-target predictions. Taken together, miR-218 - 1-3p, miR - 1231-3p and miR-217-5p were considered as the most impactful microRNAs, since a downregulation of their potential targets (MAG, CNTNAP2 and ANLN, respectively) can indirectly lead to a low MBP protein expression. These miRNAs, in addition, follow an opposite expression trend compared to MBP during adulthood, and their target proteins revealed a complete normalization in aged ENU2 mice. In conclusion, these results provide a new perspective on the PKU pathophysiology understanding and on a possible treatment, emphasizing the potential modulating role of differentially expressed microRNAs in MBP expression on PKU brains during PKU mouse lifespan.
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Affiliation(s)
- Alessandro Bregalda
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029 Urbino, PU, Italy.
| | - Claudia Carducci
- Department of Experimental Medicine, Sapienza University, viale del Policlinico 155, 00161 Rome, Italy
| | - Maria Teresa Viscomi
- Department of Life Sciences and Public Health, Sect. Histology and Embryology, Università Cattolica del S. Cuore, Largo F. Vito 1, 00168 Rome, Italy; Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, 00168 Rome, Italy
| | - Francesca Pierigè
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029 Urbino, PU, Italy
| | - Sara Biagiotti
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029 Urbino, PU, Italy
| | - Michele Menotta
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029 Urbino, PU, Italy
| | - Federica Biancucci
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029 Urbino, PU, Italy
| | - Tiziana Pascucci
- Fondazione Santa Lucia IRCCS, via Ardeatina 306, 00142 Rome, Italy; Department of Psychology and Centro "Daniel Bovet", Sapienza University, via dei Marsi 78, 00185 Rome, Italy
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Sapienza University, via dei Sabelli 108, 00185 Rome, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029 Urbino, PU, Italy; EryDel SpA, via Antonio Meucci 3, 20091 Bresso, Milan, Italy
| | - Luigia Rossi
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029 Urbino, PU, Italy; EryDel SpA, via Antonio Meucci 3, 20091 Bresso, Milan, Italy
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Cha E, Ahn HJ, Kang W, Jung KI, Ohn SH, Bashir S, Yoo WK. Correlations between COMT polymorphism and brain structure and cognition in elderly subjects: An observational study. Medicine (Baltimore) 2022; 101:e29214. [PMID: 35550471 PMCID: PMC9276462 DOI: 10.1097/md.0000000000029214] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/14/2022] [Indexed: 01/04/2023] Open
Abstract
The catechol-O-methyltransferase (COMT) gene has been noted to play an important role in individual variations in the aging process. We investigated whether COMT polymorphism could influence cognition related to white matter networks. More specifically, we examined whether methionine (Met) allele loading is associated with better individual cognitive performance. Thirty-four healthy elderly participants were recruited; each participant's COMT genotype was determined, and Korean version of Montreal Cognitive Assessment scores and a diffusion tensor image were obtained for all participants. The Met carrier group showed significantly lower mean diffusivity, axial diffusivity, and radial diffusivity values for the right hippocampus, thalamus, uncinate fasciculus, and left caudate nucleus than the valine homozygote group. The Met carrier group also scored higher for executive function and attention on the Korean version of Montreal Cognitive Assessment. Based on these results, we can assume that the COMT Met allele has a protective effect on cognitive decline contributing to individual differences in cognitive function in late life period.
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Affiliation(s)
- Eunsil Cha
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Hyun Jung Ahn
- Hallym Institute of Translational Genomics & Bioinformatics, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Wonil Kang
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Kwang-Ik Jung
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
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Winn SR, Dudley S, Scherer T, Rimann N, Thöny B, Boutros S, Krenik D, Raber J, Harding CO. Modeling the cognitive effects of diet discontinuation in adults with phenylketonuria (PKU) using pegvaliase therapy in PAH-deficient mice. Mol Genet Metab 2022; 136:46-64. [PMID: 35339387 PMCID: PMC9106909 DOI: 10.1016/j.ymgme.2022.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Existing phenylalanine hydroxylase (PAH)-deficient mice strains are useful models of untreated or late-treated human phenylketonuria (PKU), as most contemporary therapies can only be initiated after weaning and the pups have already suffered irreversible consequences of chronic hyperphenylalaninemia (HPA) during early brain development. Therefore, we sought to evaluate whether enzyme substitution therapy with pegvaliase initiated near birth and administered repetitively to C57Bl/6-Pahenu2/enu2 mice would prevent HPA-related behavioral and cognitive deficits and form a model for early-treated PKU. The main results of three reported experiments are: 1) lifelong weekly pegvaliase treatment prevented the cognitive deficits associated with HPA in contrast to persisting deficits in mice treated with pegvaliase only as adults. 2) Cognitive deficits reappear in mice treated with weekly pegvaliase from birth but in which pegvaliase is discontinued at 3 months age. 3) Twice weekly pegvaliase injection also prevented cognitive deficits but again cognitive deficits emerged in early-treated animals following discontinuation of pegvaliase treatment during adulthood, particularly in females. In all studies, pegvaliase treatment was associated with complete correction of brain monoamine neurotransmitter content and with improved overall growth of the mice as measured by body weight. Mean total brain weight however remained low in all PAH deficient mice regardless of treatment. Application of enzyme substitution therapy with pegvaliase, initiated near birth and continued into adulthood, to PAH-deficient Pahenu2/enu2 mice models contemporary early-treated human PKU. This model will be useful for exploring the differential pathophysiologic effects of HPA at different developmental stages of the murine brain.
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Affiliation(s)
- Shelley R Winn
- Department of Medical and Molecular Genetics, Oregon Health & Science University, Mailstop L-103, 3181 Sam Jackson Park Rd., Portland, OR 97239, USA
| | - Sandra Dudley
- Department of Medical and Molecular Genetics, Oregon Health & Science University, Mailstop L-103, 3181 Sam Jackson Park Rd., Portland, OR 97239, USA
| | - Tanja Scherer
- Department of Pediatrics, University of Zurich, Steinwiessstrasse 75, Zurich CH-8032, Switzerland
| | - Nicole Rimann
- Department of Pediatrics, University of Zurich, Steinwiessstrasse 75, Zurich CH-8032, Switzerland
| | - Beat Thöny
- Department of Pediatrics, University of Zurich, Steinwiessstrasse 75, Zurich CH-8032, Switzerland
| | - Sydney Boutros
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 Sam Jackson Park Rd., Portland, OR 97239, USA
| | - Destine Krenik
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 Sam Jackson Park Rd., Portland, OR 97239, USA
| | - Jacob Raber
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 Sam Jackson Park Rd., Portland, OR 97239, USA; Departments of Neurology and Radiation Medicine, Division of Neuroscience, ONPRC, Oregon Health & Science University, 3181 Sam Jackson Park Rd., Portland, OR 97239, USA
| | - Cary O Harding
- Department of Medical and Molecular Genetics, Oregon Health & Science University, Mailstop L-103, 3181 Sam Jackson Park Rd., Portland, OR 97239, USA.
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Borges AC, Broersen K, Leandro P, Fernandes TG. Engineering Organoids for in vitro Modeling of Phenylketonuria. Front Mol Neurosci 2022; 14:787242. [PMID: 35082602 PMCID: PMC8784555 DOI: 10.3389/fnmol.2021.787242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/29/2021] [Indexed: 12/15/2022] Open
Abstract
Phenylketonuria is a recessive genetic disorder of amino-acid metabolism, where impaired phenylalanine hydroxylase function leads to the accumulation of neurotoxic phenylalanine levels in the brain. Severe cognitive and neuronal impairment are observed in untreated/late-diagnosed patients, and even early treated ones are not safe from life-long sequelae. Despite the wealth of knowledge acquired from available disease models, the chronic effect of Phenylketonuria in the brain is still poorly understood and the consequences to the aging brain remain an open question. Thus, there is the need for better predictive models, able to recapitulate specific mechanisms of this disease. Human induced pluripotent stem cells (hiPSCs), with their ability to differentiate and self-organize in multiple tissues, might provide a new exciting in vitro platform to model specific PKU-derived neuronal impairment. In this review, we gather what is known about the impact of phenylalanine in the brain of patients and highlight where hiPSC-derived organoids could contribute to the understanding of this disease.
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Affiliation(s)
- Alice C. Borges
- Department of Bioengineering and iBB – Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
- Associate Laboratory i4HB – Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Kerensa Broersen
- Department of Applied Stem Cell Technologies, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Paula Leandro
- Faculty of Pharmacy, iMed.ULisboa - Research Institute for Medicines, Universidade de Lisboa, Lisbon, Portugal
| | - Tiago G. Fernandes
- Department of Bioengineering and iBB – Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
- Associate Laboratory i4HB – Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
- *Correspondence: Tiago G. Fernandes,
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Mitelman SA, Buchsbaum MS, Christian BT, Merrill BM, Buchsbaum BR, Mukherjee J, Lehrer DS. Dopamine receptor density and white mater integrity: 18F-fallypride positron emission tomography and diffusion tensor imaging study in healthy and schizophrenia subjects. Brain Imaging Behav 2021; 14:736-752. [PMID: 30523488 DOI: 10.1007/s11682-018-0012-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dopaminergic dysfunction and changes in white matter integrity are among the most replicated findings in schizophrenia. A modulating role of dopamine in myelin formation has been proposed in animal models and healthy human brain, but has not yet been systematically explored in schizophrenia. We used diffusion tensor imaging and 18F-fallypride positron emission tomography in 19 healthy and 25 schizophrenia subjects to assess the relationship between gray matter dopamine D2/D3 receptor density and white matter fractional anisotropy in each diagnostic group. AFNI regions of interest were acquired for 42 cortical Brodmann areas and subcortical gray matter structures as well as stereotaxically placed in representative white matter areas implicated in schizophrenia neuroimaging literature. Welch's t-test with permutation-based p value adjustment was used to compare means of z-transformed correlations between fractional anisotropy and 18F-fallypride binding potentials in hypothesis-driven regions of interest in the diagnostic groups. Healthy subjects displayed an extensive pattern of predominantly negative correlations between 18F-fallypride binding across a range of cortical and subcortical gray matter regions and fractional anisotropy in rostral white matter regions (internal capsule, frontal lobe, anterior corpus callosum). These patterns were disrupted in subjects with schizophrenia, who displayed significantly weaker overall correlations as well as comparatively scant numbers of significant correlations with the internal capsule and frontal (but not temporal) white matter, especially for dopamine receptor density in thalamic nuclei. Dopamine D2/D3 receptor density and white matter integrity appear to be interrelated, and their decreases in schizophrenia may stem from hyperdopaminergia with dysregulation of dopaminergic impact on axonal myelination.
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Affiliation(s)
- Serge A Mitelman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA. .,Department of Psychiatry, Division of Child and Adolescent Psychiatry, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY, 11373, USA.
| | - Monte S Buchsbaum
- Departments of Psychiatry and Radiology, University of California, San Diego, 11388 Sorrento Valley Road, San Diego, CA, 92121, USA.,Department of Psychiatry and Human Behavior, Irvine School of Medicine, University of California, 101 The City Dr. S, Orange, CA, 92868, USA
| | - Bradley T Christian
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, 1500 Highland Avenue, Room T231, Madison, WI, 53705, USA
| | - Brian M Merrill
- Department of Psychiatry, Boonshoft School of Medicine, Wright State University, East Medical Plaza, Dayton, OH, 45408, USA
| | - Bradley R Buchsbaum
- The Rotman Research Institute, Baycrest Centre for Geriatric Care and Department of Psychiatry, University of Toronto, 3560 Bathurst St, Toronto, ON, M6A 2E1, Canada
| | - Jogeshwar Mukherjee
- Department of Radiological Sciences, Preclinical Imaging, Irvine School of Medicine, University of California, Irvine, CA, 92697, USA
| | - Douglas S Lehrer
- Department of Psychiatry, Boonshoft School of Medicine, Wright State University, East Medical Plaza, Dayton, OH, 45408, USA
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11
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Bortoluzzi VT, Dutra Filho CS, Wannmacher CMD. Oxidative stress in phenylketonuria-evidence from human studies and animal models, and possible implications for redox signaling. Metab Brain Dis 2021; 36:523-543. [PMID: 33580861 DOI: 10.1007/s11011-021-00676-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/24/2021] [Indexed: 01/11/2023]
Abstract
Phenylketonuria (PKU) is one of the commonest inborn error of amino acid metabolism. Before mass neonatal screening was possible, and the success of introducing diet therapy right after birth, the typical clinical finds in patients ranged from intellectual disability, epilepsy, motor deficits to behavioral disturbances and other neurological and psychiatric symptoms. Since early diagnosis and treatment became widespread, usually only those patients who do not strictly follow the diet present psychiatric, less severe symptoms such as anxiety, depression, sleep pattern disturbance, and concentration and memory problems. Despite the success of low protein intake in preventing otherwise severe outcomes, PKU's underlying neuropathophysiology remains to be better elucidated. Oxidative stress has gained acceptance as a disturbance implicated in the pathogenesis of PKU. The conception of oxidative stress has evolved to comprehend how it could interfere and ultimately modulate metabolic pathways regulating cell function. We summarize the evidence of oxidative damage, as well as compromised antioxidant defenses, from patients, animal models of PKU, and in vitro experiments, discussing the possible clinical significance of these findings. There are many studies on oxidative stress and PKU, but only a few went further than showing macromolecular damage and disturbance of antioxidant defenses. In this review, we argue that these few studies may point that oxidative stress may also disturb redox signaling in PKU, an aspect few authors have explored so far. The reported effect of phenylalanine on the expression or activity of enzymes participating in metabolic pathways known to be responsive to redox signaling might be mediated through oxidative stress.
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Affiliation(s)
- Vanessa Trindade Bortoluzzi
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2600-Anexo, Porto Alegre, RS, CEP 90.035-003, Brazil.
| | - Carlos Severo Dutra Filho
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2600-Anexo, Porto Alegre, RS, CEP 90.035-003, Brazil
| | - Clovis Milton Duval Wannmacher
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2600-Anexo, Porto Alegre, RS, CEP 90.035-003, Brazil
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12
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Ferreira BK, Rodrigues MT, Streck EL, Ferreira GC, Schuck PF. White matter disturbances in phenylketonuria: Possible underlying mechanisms. J Neurosci Res 2020; 99:349-360. [PMID: 32141105 DOI: 10.1002/jnr.24598] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/09/2020] [Accepted: 02/04/2020] [Indexed: 12/24/2022]
Abstract
White matter pathologies, as well as intellectual disability, microcephaly, and other central nervous system injuries, are clinical traits commonly ascribed to classic phenylketonuria (PKU). PKU is an inherited metabolic disease elicited by the deficiency of phenylalanine hydroxylase. Accumulation of l-phenylalanine (Phe) and its metabolites is found in tissues and body fluids in phenylketonuric patients. In order to mitigate the clinical findings, rigorous dietary Phe restriction constitutes the core of therapeutic management in PKU. Myelination is the process whereby the oligodendrocytes wrap myelin sheaths around the axons, supporting the conduction of action potentials. White matter injuries are implicated in the brain damage related to PKU, especially in untreated or poorly treated patients. The present review summarizes evidence toward putative mechanisms driving the white matter pathology in PKU patients.
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Affiliation(s)
- Bruna Klippel Ferreira
- Laboratório de Neuroenergética e Erros Inatos do Metabolismo, Programa de Bioquímica e Biofísica Celular, Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Porto Alegre, Brazil
| | - Melissa Torres Rodrigues
- Laboratório de Erros Inatos do Metabolismo, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-graduação em Biologia Celular e Molecular, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emilio Luiz Streck
- Laboratório de Neurologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil
| | - Gustavo Costa Ferreira
- Laboratório de Neuroenergética e Erros Inatos do Metabolismo, Programa de Bioquímica e Biofísica Celular, Instituto de Bioquímica Médica Leopoldo de Meis, Universidade Federal do Rio de Janeiro, Porto Alegre, Brazil
| | - Patricia Fernanda Schuck
- Laboratório de Erros Inatos do Metabolismo, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-graduação em Biologia Celular e Molecular, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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13
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Oussalah A, Jeannesson-Thivisol E, Chéry C, Perrin P, Rouyer P, Josse T, Cano A, Barth M, Fouilhoux A, Mention K, Labarthe F, Arnoux JB, Maillot F, Lenaerts C, Dumesnil C, Wagner K, Terral D, Broué P, De Parscau L, Gay C, Kuster A, Bédu A, Besson G, Lamireau D, Odent S, Masurel A, Rodriguez-Guéant RM, Feillet F, Guéant JL, Namour F. Population and evolutionary genetics of the PAH locus to uncover overdominance and adaptive mechanisms in phenylketonuria: Results from a multiethnic study. EBioMedicine 2020; 51:102623. [PMID: 31923802 PMCID: PMC7000351 DOI: 10.1016/j.ebiom.2019.102623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Phenylketonuria (PKU) is the most common inborn error of amino acid metabolism in Europe. The reasons underlying the high prevalence of heterozygous carriers are not clearly understood. We aimed to look for pathogenic PAH variant enrichment according to geographical areas and patients' ethnicity using a multiethnic nationwide cohort of patients with PKU in France. We subsequently appraised the population differentiation, balancing selection and the molecular evolutionary history of the PAH locus. METHODS The French nationwide PKU study included patients who have been referred at the national level to the University Hospital of Nancy, and for whom a molecular diagnosis of phenylketonuria was made by Sanger sequencing. We performed enrichment analyses by comparing alternative allele frequencies using Fisher's exact test with Bonferroni adjustment. We estimated the amount of genetic differentiation among populations using Wright's fixation index (Fst). To estimate the molecular evolutionary history of the PAH gene, we performed phylogenetic and evolutionary analyses using whole-genome and exome-sequencing data from healthy individuals and non-PKU patients, respectively. Finally, we used exome-wide association study to decipher potential genetic loci associated with population divergence on PAH. FINDINGS The study included 696 patients and revealed 132 pathogenic PAH variants. Three geographical areas showed significant enrichment for a pathogenic PAH variant: North of France (p.Arg243Leu), North-West of France (p.Leu348Val), and Mediterranean coast (p.Ala403Val). One PAH variant (p.Glu280Gln) was significantly enriched among North-Africans (OR = 23·23; 95% CI: 9·75-55·38). PAH variants exhibiting a strong genetic differentiation were significantly enriched in the 'Biopterin_H' domain (OR = 6·45; 95% CI: 1·99-20·84), suggesting a balancing selection pressure on the biopterin function of PAH. Phylogenetic and timetree analyses were consistent with population differentiation events on European-, African-, and Asian-ancestry populations. The five PAH variants most strongly associated with a high selection pressure were phylogenetically close and were located within the biopterin domain coding region of PAH or in its vicinity. Among the non-PAH loci potentially associated with population divergence, two reached exome-wide significance: SSPO (SCO-spondin) and DBH (dopamine beta-hydroxylase), involved in neuroprotection and metabolic adaptation, respectively. INTERPRETATION Our data provide evidence on the combination of evolutionary and adaptive events in populations with distinct ancestries, which may explain the overdominance of some genetic variants on PAH. FUNDING French National Institute of Health and Medical Research (INSERM) UMR_S 1256.
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Affiliation(s)
- Abderrahim Oussalah
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France; Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, Nutrition, and Metabolism, University Hospital of Nancy, Nancy, France; Reference Centre for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy F-54000, France.
| | - Elise Jeannesson-Thivisol
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, Nutrition, and Metabolism, University Hospital of Nancy, Nancy, France; Reference Centre for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy F-54000, France
| | - Céline Chéry
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France; Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, Nutrition, and Metabolism, University Hospital of Nancy, Nancy, France; Reference Centre for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy F-54000, France
| | - Pascal Perrin
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, Nutrition, and Metabolism, University Hospital of Nancy, Nancy, France; Reference Centre for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy F-54000, France
| | - Pierre Rouyer
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France
| | - Thomas Josse
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, Nutrition, and Metabolism, University Hospital of Nancy, Nancy, France; Reference Centre for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy F-54000, France
| | - Aline Cano
- Centre of Reference for Inborn Metabolic Diseases, University Hospital La Timone, Marseille, France
| | - Magalie Barth
- Department of Genetics, University Hospital of Angers, Angers, France
| | - Alain Fouilhoux
- Metabolic Diseases Unit, Woman-Mother-Child Hospital, University Hospital of Lyon, Lyon, France
| | | | | | - Jean-Baptiste Arnoux
- Reference Centre for Inherited Metabolic Diseases, Necker-Sick Children's Hospital, Imagine Institute, Paris Descartes University, Paris, France
| | - François Maillot
- Department of Internal Medicine, University Hospital of Tours, François Rabelais University, Tours, France
| | - Catherine Lenaerts
- Department of Paediatrics, University Hospital of Amiens, Amiens, France
| | - Cécile Dumesnil
- Paediatric Haematology and Oncology, University Hospital of Rouen, Rouen, France
| | - Kathy Wagner
- Department of Paediatrics, Lenval Hospital, Nice, France
| | - Daniel Terral
- Department of Paediatrics, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Broué
- Reference Centre for Inborn Errors of Metabolism, University Children Hospital, Toulouse, France
| | - Loic De Parscau
- Department of Paediatrics, University Hospital Morvan, Brest, France
| | - Claire Gay
- Department of Paediatrics, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Alice Kuster
- Paediatric Department, University Hospital of Nantes, Nantes, France
| | - Antoine Bédu
- Department of Neonatology, Mother and Child Hospital, Limoges, France
| | - Gérard Besson
- Department of Neurology, University Hospital of Grenoble, Grenoble, France
| | - Delphine Lamireau
- Department of Paediatrics, Pellegrin-Enfants Hospital, Bordeaux, France
| | - Sylvie Odent
- Department of Clinical Genetics, University Hospital of Rennes, Rennes, France
| | - Alice Masurel
- Department of Medical Genetics, Dijon Bourgogne University Hospital, Dijon, France
| | - Rosa-Maria Rodriguez-Guéant
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France; Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, Nutrition, and Metabolism, University Hospital of Nancy, Nancy, France; Reference Centre for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy F-54000, France
| | - François Feillet
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France; Reference Centre for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy F-54000, France; Department of Paediatrics, University Hospital of Nancy, Nancy, France
| | - Jean-Louis Guéant
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France; Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, Nutrition, and Metabolism, University Hospital of Nancy, Nancy, France; Reference Centre for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy F-54000, France.
| | - Fares Namour
- University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, Nancy, France; Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, Nutrition, and Metabolism, University Hospital of Nancy, Nancy, France; Reference Centre for Inborn Errors of Metabolism (ORPHA67872), University Hospital of Nancy, Nancy F-54000, France
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14
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Romani C, Manti F, Nardecchia F, Valentini F, Fallarino N, Carducci C, De Leo S, MacDonald A, Palermo L, Leuzzi V. Adult cognitive outcomes in phenylketonuria: explaining causes of variability beyond average Phe levels. Orphanet J Rare Dis 2019; 14:273. [PMID: 31779649 PMCID: PMC6883518 DOI: 10.1186/s13023-019-1225-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
Objective The objective was to deepen the understanding of the causes of individual variability in phenylketonuria (PKU) by investigating which metabolic variables are most important for predicting cognitive outcomes (Phe average vs Phe variation) and by assessing the risk of cognitive impairment associated with adopting a more relaxed approach to the diet than is currently recommended. Method We analysed associations between metabolic and cognitive measures in a mixed sample of English and Italian early-treated adults with PKU (N = 56). Metabolic measures were collected through childhood, adolescence and adulthood; cognitive measures were collected in adulthood. Metabolic measures included average Phe levels (average of median values for each year in a given period) and average Phe variations (average yearly standard deviations). Cognition was measured with IQ and a battery of cognitive tasks. Results Phe variation was as important, if not more important, than Phe average in predicting adult outcomes and contributed independently. Phe variation was particularly detrimental in childhood. Together, childhood Phe variation and adult Phe average predicted around 40% of the variation in cognitive scores. Poor cognitive scores (> 1 SD from controls) occurred almost exclusively in individuals with poor metabolic control and the risk of poor scores was about 30% higher in individuals with Phe values exceeding recommended thresholds. Conclusions Our results provide support for current European guidelines (average Phe value = < 360 μmol/l in childhood; = < 600 μmo/l from 12 years onwards), but they suggest an additional recommendation to maintain stable levels (possibly Phe SD = < 180 μmol/l throughout life). Public significance statements We investigated the relationship between how well people with phenylketonuria control blood Phe throughout their life and their ability to carry out cognitive tasks in adulthood. We found that avoiding blood Phe peaks was as important if not more important that maintaining average low Phe levels. This was particularly essential in childhood. We also found that blood Phe levels above recommended European guidelines was associated with around 30% increase in the risk of poor cognitive outcomes.
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Affiliation(s)
- Cristina Romani
- School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, England, B4 7ET, UK.
| | - Filippo Manti
- Department of Human Neuroscience - Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Francesca Nardecchia
- Department of Human Neuroscience - Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | | | - Claudia Carducci
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Sabrina De Leo
- Department of Clinical Medicine, Policlinico Umberto I, Rome, Italy
| | - Anita MacDonald
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Liana Palermo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Vincenzo Leuzzi
- Department of Human Neuroscience - Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
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15
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Du B, Li H, Zheng H, Fan C, Liang M, Lian Y, Wei Z, Zhang Y, Bi X. Minocycline Ameliorates Depressive-Like Behavior and Demyelination Induced by Transient Global Cerebral Ischemia by Inhibiting Microglial Activation. Front Pharmacol 2019; 10:1247. [PMID: 31695615 PMCID: PMC6817504 DOI: 10.3389/fphar.2019.01247] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/27/2019] [Indexed: 12/19/2022] Open
Abstract
Global cerebral ischemia (GCI) commonly occurs in the elderly. Subcortical white matter lesions and oligodendrocyte (OLG) loss caused by cerebral ischemia have been implicated in the development of post-ischemic depression and cognitive impairment. OLGs are necessary for axonal myelination; the disrupted differentiation of OLG progenitor cells (OPCs) is associated with impaired remyelination. Evidence has indicated that increased levels of inflammatory cytokines released from activated microglia induce depression-like behaviors by affecting neurotransmitter pathways, but the mechanisms remain elusive. We explored the potential mechanisms that link microglia activation with GCI-induced depression and cognitive dysfunction by studying effects of minocycline on white matter damage, cytokine levels, and the monoaminergic neurotransmitters. An acute GCI animal model was generated through bilateral common carotid artery occlusion to induce ischemic inflammation and subcortical white matter damage. Minocycline, an inhibitor of microglia activation, was intraperitoneally administrated immediately after surgery and continued daily for additional six days. Minocycline shortened the immobile duration in tail suspension test and forced swimming test, while no improvement was found in Morris water maze test. The plasma levels of IL-1β, IL-6, TNF-α, HMGB1, and netrin-1 were significantly reduced with the treatment of minocycline. Minocycline treatment substantially reversed demyelination in corpus callosum and hippocampus, alleviated hippocampal microglia activation, and promoted OPCs maturation, while no effect was found on hippocampal neurodegeneration. Besides, the content of dopamine (DA) in the hippocampus was upregulated by minocycline treatment after GCI. Collectively, our data demonstrated that minocycline exerts an anti-depressant effect by inhibiting microglia activation, promoting OPCs maturation and remyelination. Increased DA in hippocampus may also play a role in ameliorating depressive behavior with minocycline treatment.
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Affiliation(s)
- Bingying Du
- Department of Neurology, Shanghai Changhai Hospital, the Second Military Medical University, Shanghai, China.,Department of Neurology, General Hospital of Central Theater Command of Chinese People's Liberation Army, Wuhan, China
| | - Hailong Li
- Department of Neurology, Shanghai Changhai Hospital, the Second Military Medical University, Shanghai, China.,Department of Rehabilitation Medicine, Zhejiang Hospital, Hangzhou, China
| | - Huiwen Zheng
- Department of Neurology, Shanghai Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Cunxiu Fan
- Department of Neurology, Shanghai Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Meng Liang
- Department of Neurology, Shanghai Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Yongjie Lian
- Department of Neurology, Shanghai Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Zelan Wei
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Yanbo Zhang
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Xiaoying Bi
- Department of Neurology, Shanghai Changhai Hospital, the Second Military Medical University, Shanghai, China
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16
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Hawks Z, Hood AM, Lerman-Sinkoff DB, Shimony JS, Rutlin J, Lagoni D, Grange DK, White DA. White and gray matter brain development in children and young adults with phenylketonuria. NEUROIMAGE-CLINICAL 2019; 23:101916. [PMID: 31491833 PMCID: PMC6627563 DOI: 10.1016/j.nicl.2019.101916] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/09/2019] [Accepted: 06/29/2019] [Indexed: 12/27/2022]
Abstract
Phenylketonuria (PKU) is a recessive disorder characterized by disruption in the metabolism of the amino acid phenylalanine (Phe). Prior research indicates that individuals with PKU have substantial white matter (WM) compromise. Much less is known about gray matter (GM) in PKU, but a small body of research suggests volumetric differences compared to controls. To date, developmental trajectories of GM structure in individuals with PKU have not been examined, nor have trajectories of WM and GM been examined within a single study. To address this gap in the literature, we compared longitudinal brain development over a three-year period in individuals with PKU (n = 35; 18 male) and typically-developing controls (n = 71; 35 male) aged 7–21 years. Using diffusion tensor imaging (DTI) and structural magnetic resonance imaging (MRI), we observed whole-brain and regional WM differences between individuals with PKU and controls, which were often exacerbated with increasing age. In marked contrast with trajectories of WM development, trajectories of GM development did not differ between individuals with PKU and controls, indicating that neuropathology in PKU is more prominent in WM than GM. Within individuals with PKU, mediation analyses revealed that whole-brain mean diffusivity (MD) and regional MD in the corpus callosum and centrum semiovale mediated the relationship between dietary treatment compliance (i.e., Phe control) and executive abilities, suggesting a plausible neurobiological mechanism by which Phe control may influence cognitive outcomes. Our findings clarify the specificity, timing, and cognitive consequences of whole-brain and regional WM pathology, with implications for treatment and research in PKU. Individuals with PKU exhibited widespread, age-related white matter compromise. Developmental trajectories of gray matter were comparable for PKU and controls. Within PKU, white matter compromise influenced cognitive outcomes.
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Affiliation(s)
- Zoë Hawks
- Department of Psychological & Brain Sciences, Campus Box 1125, Washington University, St. Louis, MO, United States.
| | - Anna M Hood
- Department of Psychological & Brain Sciences, Campus Box 1125, Washington University, St. Louis, MO, United States.
| | - Dov B Lerman-Sinkoff
- Department of Psychological & Brain Sciences, Campus Box 1125, Washington University, St. Louis, MO, United States; Department of Biomedical Engineering, Washington University, St. Louis, MO, United States
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jerrel Rutlin
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Daniel Lagoni
- Department of Psychological & Brain Sciences, Campus Box 1125, Washington University, St. Louis, MO, United States
| | - Dorothy K Grange
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Desirée A White
- Department of Psychological & Brain Sciences, Campus Box 1125, Washington University, St. Louis, MO, United States; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
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17
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Ashe K, Kelso W, Farrand S, Panetta J, Fazio T, De Jong G, Walterfang M. Psychiatric and Cognitive Aspects of Phenylketonuria: The Limitations of Diet and Promise of New Treatments. Front Psychiatry 2019; 10:561. [PMID: 31551819 PMCID: PMC6748028 DOI: 10.3389/fpsyt.2019.00561] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 07/17/2019] [Indexed: 12/30/2022] Open
Abstract
Phenylketonuria (PKU) is a recessive disorder of phenylalanine metabolism due to mutations in the gene for phenylalanine hydroxylase (PAH). Reduced PAH activity results in significant hyperphenylalaninemia, which leads to alterations in cerebral myelin and protein synthesis, as well as reduced levels of serotonin, dopamine, and noradrenaline in the brain. When untreated, brain development is grossly disrupted and significant intellectual impairment and behavioral disturbance occur. The advent of neonatal heel prick screening has allowed for diagnosis at birth, and the institution of a phenylalanine restricted diet. Dietary treatment, particularly when maintained across neurodevelopment and well into adulthood, has resulted in markedly improved outcomes at a cognitive and psychiatric level for individuals with PKU. However, few individuals can maintain full dietary control lifelong, and even with good control, an elevated risk remains of-in particular-mood, anxiety, and attentional disorders across the lifespan. Increasingly, dietary recommendations focus on maintaining continuous dietary treatment lifelong to optimize psychiatric and cognitive outcomes, although the effect of long-term protein restricted diets on brain function remains unknown. While psychiatric illness is very common in adult PKU populations, very little data exist to guide clinicians on optimal treatment. The advent of new treatments that do not require restrictive dietary management, such as the enzyme therapy Pegvaliase, holds the promise of allowing patients a relatively normal diet alongside optimized mental health and cognitive functioning.
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Affiliation(s)
- Killian Ashe
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Julie Panetta
- Statewide Adult Metabolic Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Tim Fazio
- Statewide Adult Metabolic Service, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Gerard De Jong
- Statewide Adult Metabolic Service, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Melbourne Neuropsychiatry Centre, University of Melbourne and North-Western Mental Health, Melbourne, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
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18
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Scherer T, Allegri G, Sarkissian CN, Ying M, Grisch-Chan HM, Rassi A, Winn SR, Harding CO, Martinez A, Thöny B. Tetrahydrobiopterin treatment reduces brain L-Phe but only partially improves serotonin in hyperphenylalaninemic ENU1/2 mice. J Inherit Metab Dis 2018; 41:709-718. [PMID: 29520738 PMCID: PMC6041158 DOI: 10.1007/s10545-018-0150-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 12/16/2022]
Abstract
Hyperphenylalaninemia (HPA) caused by hepatic phenylalanine hydroxylase (PAH) deficiency has severe consequences on brain monoamine neurotransmitter metabolism. We have studied monoamine neurotransmitter status and the effect of tetrahydrobiopterin (BH4) treatment in Pahenu1/enu2 (ENU1/2) mice, a model of partial PAH deficiency. These mice exhibit elevated blood L-phenylalanine (L-Phe) concentrations similar to that of mild hyperphenylalaninemia (HPA), but brain levels of L-Phe are still ~5-fold elevated compared to wild-type. We found that brain L-tyrosine, L-tryptophan, BH4 cofactor and catecholamine concentrations, and brain tyrosine hydroxylase (TH) activity were normal in these mice but that brain serotonin, 5-hydroxyindolacetic acid (5HIAA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) content, and brain TH protein, as well as tryptophan hydroxylase type 2 (TPH2) protein levels and activity were reduced in comparison to wild-type mice. Parenteral L-Phe loading conditions did not lead to significant changes in brain neurometabolite concentrations. Remarkably, enteral BH4 treatment, which normalized brain L-Phe levels in ENU1/2 mice, lead to only partial recovery of brain serotonin and 5HIAA concentrations. Furthermore, indirect evidence indicated that the GTP cyclohydrolase I (GTPCH) feedback regulatory protein (GFRP) complex may be a sensor for brain L-Phe elevation to ameliorate the toxic effects of HPA. We conclude that BH4 treatment of HPA toward systemic L-Phe lowering reverses elevated brain L-Phe content but the recovery of TPH2 protein and activity as well as serotonin levels is suboptimal, indicating that patients with mild HPA and mood problems (depression or anxiety) treated with the current diet may benefit from supplementation with BH4 and 5-OH-tryptophan.
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Affiliation(s)
- Tanja Scherer
- Department of Pediatrics, Divisions of Metabolism and of Clinical Chemistry and Biochemistry, University of Zürich, Zürich, Switzerland
| | - Gabriella Allegri
- Department of Pediatrics, Divisions of Metabolism and of Clinical Chemistry and Biochemistry, University of Zürich, Zürich, Switzerland
| | | | - Ming Ying
- Department of Biomedicine and K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
| | - Hiu Man Grisch-Chan
- Department of Pediatrics, Divisions of Metabolism and of Clinical Chemistry and Biochemistry, University of Zürich, Zürich, Switzerland
| | - Anahita Rassi
- Department of Pediatrics, Divisions of Metabolism and of Clinical Chemistry and Biochemistry, University of Zürich, Zürich, Switzerland
| | - Shelley R Winn
- Department of Molecular and Medical Genetics, School of Medicine, Oregon Science & Health University, Portland, OR, USA
| | - Cary O Harding
- Department of Molecular and Medical Genetics, School of Medicine, Oregon Science & Health University, Portland, OR, USA
| | - Aurora Martinez
- Department of Biomedicine and K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Bergen, Norway.
| | - Beat Thöny
- Department of Pediatrics, Divisions of Metabolism and of Clinical Chemistry and Biochemistry, University of Zürich, Zürich, Switzerland.
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19
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Pascucci T, Rossi L, Colamartino M, Gabucci C, Carducci C, Valzania A, Sasso V, Bigini N, Pierigè F, Viscomi MT, Ventura R, Cabib S, Magnani M, Puglisi-Allegra S, Leuzzi V. A new therapy prevents intellectual disability in mouse with phenylketonuria. Mol Genet Metab 2018; 124:39-49. [PMID: 29661557 DOI: 10.1016/j.ymgme.2018.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 01/20/2023]
Abstract
Untreated phenylketonuria (PKU) results in severe neurodevelopmental disorders, which can be partially prevented by an early and rigorous limitation of phenylalanine (Phe) intake. Enzyme substitution therapy with recombinant Anabaena variabilis Phe Ammonia Lyase (rAvPAL) proved to be effective in reducing blood Phe levels in preclinical and clinical studies of adults with PKU. Aims of present study were: a) to gather proofs of clinical efficacy of rAvPAL treatment in preventing neurological impairment in an early treated murine model of PKU; b) to test the advantages of an alternative delivering system for rAvPAL such as autologous erythrocytes. BTBR-Pahenu2-/- mice were treated from 15 to 64 post-natal days with weekly infusions of erythrocytes loaded with rAvPAL. Behavioral, neurochemical, and brain histological markers denoting untreated PKU were examined in early treated adult mice in comparison with untreated and wild type animals. rAvPAL therapy normalized blood and brain Phe; prevented cognitive developmental failure, brain depletion of serotonin, dendritic spine abnormalities, and myelin basic protein reduction. No adverse events or inactivating immune reaction were observed. In conclusion present study testifies the clinical efficacy of rAvPAL treatment in a preclinical model of PKU and the advantages of erythrocytes as carrier of the enzyme in term of frequency of the administrations and prevention of immunological reactions.
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Affiliation(s)
- Tiziana Pascucci
- Department of Psychology and Centro "Daniel Bovet", Sapienza University, via dei Marsi 78, 00185 Rome, Italy; Fondazione Santa Lucia, IRCCS, via Ardeatina 306, 00142 Rome, Italy
| | - Luigia Rossi
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029 Urbino (PU), Italy; EryDel SpA, via Sasso 36, 61029 Urbino (PU), Italy
| | - Marco Colamartino
- Department of Psychology and Centro "Daniel Bovet", Sapienza University, via dei Marsi 78, 00185 Rome, Italy; Fondazione Santa Lucia, IRCCS, via Ardeatina 306, 00142 Rome, Italy
| | - Claudia Gabucci
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029 Urbino (PU), Italy
| | - Claudia Carducci
- Department of Experimental Medicine, Sapienza University, viale del Policlinico 155, 00161 Rome, Italy
| | - Alessandro Valzania
- Department of Psychology and Centro "Daniel Bovet", Sapienza University, via dei Marsi 78, 00185 Rome, Italy; Fondazione Santa Lucia, IRCCS, via Ardeatina 306, 00142 Rome, Italy
| | - Valeria Sasso
- Fondazione Santa Lucia, IRCCS, via Ardeatina 306, 00142 Rome, Italy
| | - Noemi Bigini
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029 Urbino (PU), Italy
| | - Francesca Pierigè
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029 Urbino (PU), Italy
| | | | - Rossella Ventura
- Department of Psychology and Centro "Daniel Bovet", Sapienza University, via dei Marsi 78, 00185 Rome, Italy; Fondazione Santa Lucia, IRCCS, via Ardeatina 306, 00142 Rome, Italy
| | - Simona Cabib
- Department of Psychology and Centro "Daniel Bovet", Sapienza University, via dei Marsi 78, 00185 Rome, Italy; Fondazione Santa Lucia, IRCCS, via Ardeatina 306, 00142 Rome, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", via Saffi 2, 61029 Urbino (PU), Italy; EryDel SpA, via Sasso 36, 61029 Urbino (PU), Italy
| | - Stefano Puglisi-Allegra
- Department of Psychology and Centro "Daniel Bovet", Sapienza University, via dei Marsi 78, 00185 Rome, Italy; Fondazione Santa Lucia, IRCCS, via Ardeatina 306, 00142 Rome, Italy
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Sapienza University of Rome, via dei Sabelli 108, 00185 Rome, Italy.
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20
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Boot E, Hollak CEM, Huijbregts SCJ, Jahja R, van Vliet D, Nederveen AJ, Nieman DH, Bosch AM, Bour LJ, Bakermans AJ, Abeling NGGM, Bassett AS, van Amelsvoort TAMJ, van Spronsen FJ, Booij J. Cerebral dopamine deficiency, plasma monoamine alterations and neurocognitive deficits in adults with phenylketonuria. Psychol Med 2017; 47:2854-2865. [PMID: 28552082 DOI: 10.1017/s0033291717001398] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Phenylketonuria (PKU), a genetic metabolic disorder that is characterized by the inability to convert phenylalanine to tyrosine, leads to severe intellectual disability and other cerebral complications if left untreated. Dietary treatment, initiated soon after birth, prevents most brain-related complications. A leading hypothesis postulates that a shortage of brain monoamines may be associated with neurocognitive deficits that are observable even in early-treated PKU. However, there is a paucity of evidence as yet for this hypothesis. METHODS We therefore assessed in vivo striatal dopamine D2/3 receptor (D2/3R) availability and plasma monoamine metabolite levels together with measures of impulsivity and executive functioning in 18 adults with PKU and average intellect (31.2 ± 7.4 years, nine females), most of whom were early and continuously treated. Comparison data from 12 healthy controls that did not differ in gender and age were available. RESULTS Mean D2/3R availability was significantly higher (13%; p = 0.032) in the PKU group (n = 15) than in the controls, which may reflect reduced synaptic brain dopamine levels in PKU. The PKU group had lower plasma levels of homovanillic acid (p < 0.001) and 3-methoxy-4-hydroxy-phenylglycol (p < 0.0001), the predominant metabolites of dopamine and norepinephrine, respectively. Self-reported impulsivity levels were significantly higher in the PKU group compared with healthy controls (p = 0.033). Within the PKU group, D2/3R availability showed a positive correlation with both impulsivity (r = 0.72, p = 0.003) and the error rate during a cognitive flexibility task (r = 0.59, p = 0.020). CONCLUSIONS These findings provide further support for the hypothesis that executive functioning deficits in treated adult PKU may be associated with cerebral dopamine deficiency.
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Affiliation(s)
- E Boot
- Department of Nuclear Medicine,Academic Medical Center,Amsterdam,The Netherlands
| | - C E M Hollak
- Division of Endocrinology and Metabolism, Department of Internal Medicine,Academic Medical Center,Amsterdam,The Netherlands
| | - S C J Huijbregts
- Department of Clinical Child and Adolescent Studies & Leiden,Institute for Brain and Cognition, Leiden University,Leiden,The Netherlands
| | - R Jahja
- Division of Metabolic Diseases,University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital,Groningen,The Netherlands
| | - D van Vliet
- Division of Metabolic Diseases,University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital,Groningen,The Netherlands
| | - A J Nederveen
- Department of Radiology,Academic Medical Center,Amsterdam,The Netherlands
| | - D H Nieman
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - A M Bosch
- Department of Pediatrics,Emma Children's Hospital, Academic Medical Center,Amsterdam,The Netherlands
| | - L J Bour
- Department of Neurology and Clinical Neurophysiology,Academic Medical Center,Amsterdam,The Netherlands
| | - A J Bakermans
- Department of Radiology,Academic Medical Center,Amsterdam,The Netherlands
| | - N G G M Abeling
- Laboratory for Genetic Metabolic Diseases,Academic Medical Center,Amsterdam,The Netherlands
| | - A S Bassett
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, andCenter for Mental Health, University Health Network,Toronto, Ontario,Canada
| | - T A M J van Amelsvoort
- Department of Psychiatry and Psychology,Maastricht University,Maastricht,The Netherlands
| | - F J van Spronsen
- Division of Metabolic Diseases,University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital,Groningen,The Netherlands
| | - J Booij
- Department of Nuclear Medicine,Academic Medical Center,Amsterdam,The Netherlands
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21
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Fiori E, Oddi D, Ventura R, Colamartino M, Valzania A, D’Amato FR, Bruinenberg V, van der Zee E, Puglisi-Allegra S, Pascucci T. Early-onset behavioral and neurochemical deficits in the genetic mouse model of phenylketonuria. PLoS One 2017; 12:e0183430. [PMID: 28850618 PMCID: PMC5574541 DOI: 10.1371/journal.pone.0183430] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/01/2017] [Indexed: 11/19/2022] Open
Abstract
Phenylketonuria (PKU) is one of the most common human inborn errors of metabolism, caused by phenylalanine hydroxylase deficiency, leading to high phenylalanine and low tyrosine levels in blood and brain causing profound cognitive disability, if untreated. Since 1960, population is screened for hyperphenylalaninemia shortly after birth and submitted to early treatment in order to prevent the major manifestations of the disease. However, the dietetic regimen (phenylalanine free diet) is difficult to maintain, and despite the recommendation to a strict and lifelong compliance, up to 60% of adolescents partially or totally abandons the treatment. The development and the study of new treatments continue to be sought, taking advantage of preclinical models, the most used of which is the PAHenu2 (BTBR ENU2), the genetic murine model of PKU. To date, adult behavioral and neurochemical alterations have been mainly investigated in ENU2 mice, whereas there are no clear indications about the onset of these deficiencies. Here we investigated and report, for the first time, a comprehensive behavioral and neurochemical assay of the developing ENU2 mice. Overall, our findings demonstrate that ENU2 mice are significantly smaller than WT until pnd 24, present a significant delay in the acquisition of tested developmental reflexes, impaired communicative, motor and social skills, and have early reduced biogenic amine levels in several brain areas. Our results extend the understanding of behavioral and cerebral abnormalities in PKU mice, providing instruments to an early preclinical evaluation of the effects of new treatments.
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Affiliation(s)
- Elena Fiori
- Department of Psychology and Centro “Daniel Bovet”, Sapienza University, Rome, Italy
- Cell Biology and Neurobiology Institute, National Research Council, Rome, Italy
- European Brain Research Institute EBRI, Rome, Italy
- Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Diego Oddi
- Cell Biology and Neurobiology Institute, National Research Council, Rome, Italy
- Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Rossella Ventura
- Department of Psychology and Centro “Daniel Bovet”, Sapienza University, Rome, Italy
- Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Marco Colamartino
- Department of Psychology and Centro “Daniel Bovet”, Sapienza University, Rome, Italy
- Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Alessandro Valzania
- Department of Psychology and Centro “Daniel Bovet”, Sapienza University, Rome, Italy
- Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Francesca Romana D’Amato
- Cell Biology and Neurobiology Institute, National Research Council, Rome, Italy
- Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Vibeke Bruinenberg
- Molecular Neurobiology, GELIFES, University of Groningen, Groningen, The Netherlands
| | - Eddy van der Zee
- Molecular Neurobiology, GELIFES, University of Groningen, Groningen, The Netherlands
| | - Stefano Puglisi-Allegra
- Department of Psychology and Centro “Daniel Bovet”, Sapienza University, Rome, Italy
- Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Tiziana Pascucci
- Department of Psychology and Centro “Daniel Bovet”, Sapienza University, Rome, Italy
- Fondazione Santa Lucia, IRCCS, Rome, Italy
- * E-mail:
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22
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Palermo L, Geberhiwot T, MacDonald A, Limback E, Hall SK, Romani C. Cognitive outcomes in early-treated adults with phenylketonuria (PKU): A comprehensive picture across domains. Neuropsychology 2017; 31:255-267. [PMID: 28080075 PMCID: PMC5328133 DOI: 10.1037/neu0000337] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Phenylketonuria (PKU) is an inherited metabolic disease which affects cognitive functions due to an inability to metabolize phenylalanine which leads to the accumulation of toxic by-products (Phe) in the brain. PKU can be effectively treated with a low phenylalanine diet, but some cognitive deficits remain. Studies have reported impairments, especially for processing speed and executive functions, but there is a lack of comprehensive assessment across cognitive domains. Moreover, it is important to establish outcomes in early treated adults with PKU (AwPKU) who have better metabolic control than groups previously reported in the literature. METHOD We tested 37 AwPKU with an unprecedented number of tasks (N = 28) and measures (N = 44) and compared results with 30 controls matched for age and education. RESULTS We found (a) group impairments, particularly in tasks tapping speed of processing and complex executive functions; (b) high variability across participants, with a sizable number of AwPKU with completely normal performance (about 38%); (c) but also a sizable number of participants who were clearly impaired (about 24%); and (d) good performance in tasks tapping verbal learning, verbal memory and orthographic processing, indicating no generalized learning impairment. CONCLUSION Our results indicate good outcomes, but also that deficits are still present with current treatment policies. (PsycINFO Database Record
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Affiliation(s)
- Liana Palermo
- School of Life and Health Sciences, Aston University
| | | | | | - Ellie Limback
- School of Life and Health Sciences, Aston University
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Abstract
Cerebral neurotransmitter (NT) deficiency has been suggested as a contributing factor in the pathophysiology of brain dysfunction in phenylketonuria (PKU), even in early-treated phenylketonuric patients. The study aimed to review dopamine and serotonin status in PKU, and the effect of the impaired neurotransmission. Several mechanisms are involved in the pathophysiology of PKU, primarily characterized by impaired dopamine and serotonin synthesis. These deficits are related to executive dysfunctions and social-emotional problems, respectively, in early treated patients. Blood phenylalanine is the main biomarker for treatment compliance follow-up, but further investigations and validation of peripheral biomarkers may be performed to monitor NT status. The development of new therapies is needed not only for decreasing blood and brain phenylalanine levels but also to improve NT syntheses.
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24
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Carvalho JC, Lisboa PC, de Oliveira E, Peixoto-Silva N, Pinheiro CR, Fraga MC, Claudio-Neto S, Franci CR, Manhães AC, Moura EG. Effects of early and late neonatal bromocriptine treatment on hypothalamic neuropeptides, dopaminergic reward system and behavior of adult rats. Neuroscience 2016; 325:175-87. [DOI: 10.1016/j.neuroscience.2016.03.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
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25
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Christ SE, Price MH, Bodner KE, Saville C, Moffitt AJ, Peck D. Morphometric analysis of gray matter integrity in individuals with early-treated phenylketonuria. Mol Genet Metab 2016; 118:3-8. [PMID: 26947918 DOI: 10.1016/j.ymgme.2016.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/15/2016] [Accepted: 02/15/2016] [Indexed: 11/23/2022]
Abstract
The most widely-reported neurologic finding in individuals with early-treated phenylketonuria (PKU) is abnormality in the white matter of the brain. In contrast, much less is known regarding the impact of PKU on cortical gray matter (GM) structures. Presently, we applied advanced morphometric methods to the analysis of high-resolution structural MRI images from a sample of 19 individuals with early-treated PKU and an age- and gender-matched comparison group of 22 healthy individuals without PKU. Data analysis revealed decreased GM volume in parietal cortex for the PKU group compared with the non-PKU group. A similar trend was observed for occipital GM volume. There was no evidence of group-related differences in frontal or temporal GM volume. Within the PKU group, we also found a significant relationship between blood phenylalanine levels and GM volume for select posterior cortical sub-regions. Taken together with previous research on white matter and gray matter abnormalities in PKU, the present findings point to the posterior cortices as the primary site of neurostructural changes related to early-treated PKU.
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Affiliation(s)
- Shawn E Christ
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States.
| | - Mason H Price
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
| | - Kimberly E Bodner
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
| | - Christopher Saville
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
| | - Amanda J Moffitt
- Department of Human Development and Family Studies, University of Missouri, Columbia, MO, United States
| | - Dawn Peck
- Department of Child Health, University of Missouri, Columbia, MO, United States
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26
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A Specific Nutrient Combination Attenuates the Reduced Expression of PSD-95 in the Proximal Dendrites of Hippocampal Cell Body Layers in a Mouse Model of Phenylketonuria. Nutrients 2016; 8:185. [PMID: 27102170 PMCID: PMC4848654 DOI: 10.3390/nu8040185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/24/2016] [Accepted: 03/22/2016] [Indexed: 11/16/2022] Open
Abstract
The inherited metabolic disease phenylketonuria (PKU) is characterized by increased concentrations of phenylalanine in the blood and brain, and as a consequence neurotransmitter metabolism, white matter, and synapse functioning are affected. A specific nutrient combination (SNC) has been shown to improve synapse formation, morphology and function. This could become an interesting new nutritional approach for PKU. To assess whether treatment with SNC can affect synapses, we treated PKU mice with SNC or an isocaloric control diet and wild-type (WT) mice with an isocaloric control for 12 weeks, starting at postnatal day 31. Immunostaining for post-synaptic density protein 95 (PSD-95), a post-synaptic density marker, was carried out in the hippocampus, striatum and prefrontal cortex. Compared to WT mice on normal chow without SNC, PKU mice on the isocaloric control showed a significant reduction in PSD-95 expression in the hippocampus, specifically in the granular cell layer of the dentate gyrus, with a similar trend seen in the cornus ammonis 1 (CA1) and cornus ammonis 3 (CA3) pyramidal cell layer. No differences were found in the striatum or prefrontal cortex. PKU mice on a diet supplemented with SNC showed improved expression of PSD-95 in the hippocampus. This study gives the first indication that SNC supplementation has a positive effect on hippocampal synaptic deficits in PKU mice.
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27
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Korner G, Scherer T, Adamsen D, Rebuffat A, Crabtree M, Rassi A, Scavelli R, Homma D, Ledermann B, Konrad D, Ichinose H, Wolfrum C, Horsch M, Rathkolb B, Klingenspor M, Beckers J, Wolf E, Gailus-Durner V, Fuchs H, Hrabě de Angelis M, Blau N, Rozman J, Thöny B. Mildly compromised tetrahydrobiopterin cofactor biosynthesis due to Pts variants leads to unusual body fat distribution and abdominal obesity in mice. J Inherit Metab Dis 2016; 39:309-19. [PMID: 26830550 DOI: 10.1007/s10545-015-9909-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/04/2015] [Accepted: 12/04/2015] [Indexed: 12/31/2022]
Abstract
Tetrahydrobiopterin (BH4) is an essential cofactor for the aromatic amino acid hydroxylases, alkylglycerol monooxygenase, and nitric oxide synthases (NOS). Inborn errors of BH4 metabolism lead to severe insufficiency of brain monoamine neurotransmitters while augmentation of BH4 by supplementation or stimulation of its biosynthesis is thought to ameliorate endothelial NOS (eNOS) dysfunction, to protect from (cardio-) vascular disease and/or prevent obesity and development of the metabolic syndrome. We have previously reported that homozygous knock-out mice for the 6-pyruvolytetrahydropterin synthase (PTPS; Pts-ko/ko) mice with no BH4 biosynthesis die after birth. Here we generated a Pts-knock-in (Pts-ki) allele expressing the murine PTPS-p.Arg15Cys with low residual activity (15% of wild-type in vitro) and investigated homozygous (Pts-ki/ki) and compound heterozygous (Pts-ki/ko) mutants. All mice showed normal viability and depending on the severity of the Pts alleles exhibited up to 90% reduction of PTPS activity concomitant with neopterin elevation and mild reduction of total biopterin while blood L-phenylalanine and brain monoamine neurotransmitters were unaffected. Yet, adult mutant mice with compromised PTPS activity (i.e., Pts-ki/ko, Pts-ki/ki or Pts-ko/wt) had increased body weight and elevated intra-abdominal fat. Comprehensive phenotyping of Pts-ki/ki mice revealed alterations in energy metabolism with proportionally higher fat content but lower lean mass, and increased blood glucose and cholesterol. Transcriptome analysis indicated changes in glucose and lipid metabolism. Furthermore, differentially expressed genes associated with obesity, weight loss, hepatic steatosis, and insulin sensitivity were consistent with the observed phenotypic alterations. We conclude that reduced PTPS activity concomitant with mildly compromised BH4-biosynthesis leads to abnormal body fat distribution and abdominal obesity at least in mice. This study associates a novel single gene mutation with monogenic forms of obesity.
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Affiliation(s)
- Germaine Korner
- Division of Metabolism, University Children's Hospital Zürich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland
- Affiliated with the Neuroscience Center Zurich (ZNZ), University of Zurich and ETH Zurich, Zürich, Switzerland
- Children's Research Center (CRC), Zürich, Switzerland
| | - Tanja Scherer
- Division of Metabolism, University Children's Hospital Zürich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland
- Affiliated with the Neuroscience Center Zurich (ZNZ), University of Zurich and ETH Zurich, Zürich, Switzerland
- Children's Research Center (CRC), Zürich, Switzerland
| | - Dea Adamsen
- Division of Metabolism, University Children's Hospital Zürich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland
- Affiliated with the Neuroscience Center Zurich (ZNZ), University of Zurich and ETH Zurich, Zürich, Switzerland
- Children's Research Center (CRC), Zürich, Switzerland
| | - Alexander Rebuffat
- Division of Metabolism, University Children's Hospital Zürich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland
| | - Mark Crabtree
- BHF Centre of Excellence, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, OX3 9DU, Oxford, UK
| | - Anahita Rassi
- Division of Clinical Chemistry and Biochemistry, University Children's Hospital Zürich, Zürich, Switzerland
| | - Rossana Scavelli
- Division of Metabolism, University Children's Hospital Zürich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland
| | - Daigo Homma
- Department of Life Science, Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Yokohama, Japan
| | - Birgit Ledermann
- Division of Animal Facility, University of Zurich, Zürich, Switzerland
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital Zürich, Zürich, Switzerland
| | - Hiroshi Ichinose
- Department of Life Science, Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Yokohama, Japan
| | - Christian Wolfrum
- Institute of Food Nutrition and Health, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland
| | - Marion Horsch
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
| | - Birgit Rathkolb
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-Universität München, Feodor-Lynen-Str. 25, 81377, Munich, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
| | - Martin Klingenspor
- Molecular Nutritional Medicine, Else Kröner-Fresenius Center, Technische Universität München, Am Forum 8, 85354, Freising-Weihenstephan, Germany
- ZIEL - Center for Nutrition and Food Sciences, Technische Universität München, D-85350, Freising, Germany
| | - Johannes Beckers
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
- Chair of Experimental Genetics, Center of Life and Food Sciences Weihenstephan, Technische Universität München, D-85354, Freising-Weihenstephan, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
| | - Eckhard Wolf
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-Universität München, Feodor-Lynen-Str. 25, 81377, Munich, Germany
| | - Valérie Gailus-Durner
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
| | - Helmut Fuchs
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
| | - Martin Hrabě de Angelis
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
- Chair of Experimental Genetics, Center of Life and Food Sciences Weihenstephan, Technische Universität München, D-85354, Freising-Weihenstephan, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany
| | - Nenad Blau
- Division of Metabolism, University Children's Hospital Zürich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland.
- Dietmar-Hopp Metabolic Center, University Children's Hospital Heidelberg, Im Neuenheimer Feld 669, D-69120, Heidelberg, Germany.
| | - Jan Rozman
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany.
- Molecular Nutritional Medicine, Else Kröner-Fresenius Center, Technische Universität München, Am Forum 8, 85354, Freising-Weihenstephan, Germany.
- German Center for Diabetes Research (DZD), Ingolstädter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Beat Thöny
- Division of Metabolism, University Children's Hospital Zürich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland.
- Affiliated with the Neuroscience Center Zurich (ZNZ), University of Zurich and ETH Zurich, Zürich, Switzerland.
- Children's Research Center (CRC), Zürich, Switzerland.
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White matter microstructure and the variable adult outcome of childhood attention deficit hyperactivity disorder. Neuropsychopharmacology 2015; 40:746-54. [PMID: 25241803 PMCID: PMC4289964 DOI: 10.1038/npp.2014.241] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/11/2014] [Accepted: 08/16/2014] [Indexed: 01/26/2023]
Abstract
Changes in cerebral cortical anatomy have been tied to the clinical course of attention deficit hyperactivity disorder (ADHD). We now ask if alterations in white matter tract microstructure are likewise linked with the adult outcome of childhood ADHD. Seventy-five young adults, 32 with ADHD persisting from childhood and 43 with symptom remission were contrasted against 74 never-affected comparison subjects. Using diffusion tensor imaging, we defined fractional anisotropy, a metric related to white matter microstructure, along with measures of diffusion perpendicular (radial) and parallel (axial) to the axon. Analyses were adjusted for head motion, age and sex, and controlled for multiple comparisons and medication history. Tract-based analyses showed that greater adult inattention, but not hyperactivity-impulsivity, was associated with significantly lower fractional anisotropy in the left uncinate (standardized β=-0.37, t=3.28, p=0.002) and inferior fronto-occipital fasciculi (standardized β=-0.37, t=3.29, p=0.002). The ADHD group with symptoms persisting into adulthood had significantly lower fractional anisotropy than the never-affected controls in these tracts, differences associated with medium to large effect sizes. By contrast, the ADHD group that remitted by adulthood did not differ significantly from controls. The anomalies were found in tracts that connect components of neural systems pertinent to ADHD, such as attention control (inferior fronto-occipital fasciculus) and emotion regulation and the processing of reward (the uncinate fasciculus). Change in radial rather than axial diffusivity was the primary driver of this effect, suggesting pathophysiological processes including altered myelination as future targets for pharmacological and behavioral interventions.
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Horling K, Schlegel G, Schulz S, Vierk R, Ullrich K, Santer R, Rune GM. Hippocampal synaptic connectivity in phenylketonuria. Hum Mol Genet 2014; 24:1007-18. [PMID: 25296915 DOI: 10.1093/hmg/ddu515] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
In humans, lack of phenylalanine hydroxylase (Pah) activity results in phenylketonuria (PKU), which is associated with the development of severe mental retardation after birth. The underlying mechanisms, however, are poorly understood. Mutations of the Pah gene in Pah(enu2)/c57bl6 mice result in elevated levels of phenylalanine in serum similar to those in humans suffering from PKU. In our study, long-term potentiation (LTP) and paired-pulse facilitation, measured at CA3-CA1 Schaffer collateral synapses, were impaired in acute hippocampal slices of Pah(enu2)/c57bl6 mice. In addition, we found reduced expression of presynaptic proteins, such as synaptophysin and the synaptosomal-associated protein 25 (SNAP-25), and enhanced expression of postsynaptic marker proteins, such as synaptopodin and spinophilin. Stereological counting of spine synapses at the ultrastructural level revealed higher synaptic density in the hippocampus, commencing at 3 weeks and persisting up to 12 weeks after birth. Consistent effects were seen in response to phenylalanine treatment in cultures of dissociated hippocampal neurones. Most importantly, in the hippocampus of Pah(enu2)/c57bl6 mice, we found a significant reduction in microglia activity. Reorganization of hippocampal circuitry after birth, namely synaptic pruning, relies on elimination of weak synapses by activated microglia in response to neuronal activity. Hence, our data strongly suggest that reduced microglial activity in response to impaired synaptic transmission affects physiological postnatal remodelling of synapses in the hippocampus and may trigger the development of mental retardation in PKU patients after birth.
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Affiliation(s)
- Katja Horling
- Institute of Neuroanatomy, Institute of Anatomy and Experimental Morphology and
| | | | | | | | - Kurt Ullrich
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - René Santer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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30
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Papenberg G, Lövdén M, Laukka EJ, Kalpouzos G, Keller L, Graff C, Köhncke Y, Li TQ, Fratiglioni L, Bäckman L. Magnified effects of the COMT gene on white-matter microstructure in very old age. Brain Struct Funct 2014; 220:2927-38. [DOI: 10.1007/s00429-014-0835-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
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31
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Abhilash M, Alex M, Mathews VV, Nair RH. Chronic Effect of Aspartame on Ionic Homeostasis and Monoamine Neurotransmitters in the Rat Brain. Int J Toxicol 2014; 33:332-341. [DOI: 10.1177/1091581814537087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aspartame is one of the most widely used artificial sweeteners globally. Data concerning acute neurotoxicity of aspartame is controversial, and knowledge on its chronic effect is limited. In the current study, we investigated the chronic effects of aspartame on ionic homeostasis and regional monoamine neurotransmitter concentrations in the brain. Our results showed that aspartame at high dose caused a disturbance in ionic homeostasis and induced apoptosis in the brain. We also investigated the effects of aspartame on brain regional monoamine synthesis, and the results revealed that there was a significant decrease of dopamine in corpus striatum and cerebral cortex and of serotonin in corpus striatum. Moreover, aspartame treatment significantly alters the tyrosine hydroxylase activity and amino acids levels in the brain. Our data suggest that chronic use of aspartame may affect electrolyte homeostasis and monoamine neurotransmitter synthesis dose dependently, and this might have a possible effect on cognitive functions.
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Affiliation(s)
- M. Abhilash
- School of Biosciences, Mahatma Gandhi University, Kottayam, Kerala, India
| | - Manju Alex
- School of Biosciences, Mahatma Gandhi University, Kottayam, Kerala, India
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Pascucci T, Giacovazzo G, Andolina D, Accoto A, Fiori E, Ventura R, Orsini C, Conversi D, Carducci C, Leuzzi V, Puglisi-Allegra S. Behavioral and neurochemical characterization of new mouse model of hyperphenylalaninemia. PLoS One 2013; 8:e84697. [PMID: 24376837 PMCID: PMC3869930 DOI: 10.1371/journal.pone.0084697] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/18/2013] [Indexed: 11/19/2022] Open
Abstract
Hyperphenylalaninemia (HPA) refers to all clinical conditions characterized by increased amounts of phenylalanine (PHE) in blood and other tissues. According to their blood PHE concentrations under a free diet, hyperphenylalaninemic patients are commonly classified into phenotypic subtypes: classical phenylketonuria (PKU) (PHE > 1200 µM/L), mild PKU (PHE 600-1200 µM/L) and persistent HPA (PHE 120-600 µM/L) (normal blood PHE < 120 µM/L). The current treatment for hyperphenylalaninemic patients is aimed to keep blood PHE levels within the safe range of 120-360 µM/L through a PHE-restricted diet, difficult to achieve. If untreated, classical PKU presents variable neurological and mental impairment. However, even mildly elevated blood PHE levels, due to a bad compliance to dietary treatment, produce cognitive deficits involving the prefrontal cortical areas, extremely sensible to PHE-induced disturbances. The development of animal models of different degrees of HPA is a useful tool for identifying the metabolic mechanisms underlying cognitive deficits induced by PHE. In this paper we analyzed the behavioral and biochemical phenotypes of different forms of HPA (control, mild-HPA, mild-PKU and classic-PKU), developed on the base of plasma PHE concentrations. Our results demonstrated that mice with different forms of HPA present different phenotypes, characterized by increasing severity of behavioral symptoms and brain aminergic deficits moving from mild HPA to classical PKU forms. In addition, our data identify preFrontal cortex and amygdala as the most affected brain areas and confirm the highest susceptibility of brain serotonin metabolism to mildly elevated blood PHE.
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Affiliation(s)
- Tiziana Pascucci
- Dipartimento di Psicologia and Centro “Daniel Bovet”, Sapienza - Università di Roma, Roma, Italy
- Fondazione Santa Lucia, IRCCS, Roma, Italy
- * E-mail:
| | - Giacomo Giacovazzo
- Dipartimento di Psicologia and Centro “Daniel Bovet”, Sapienza - Università di Roma, Roma, Italy
- Fondazione Santa Lucia, IRCCS, Roma, Italy
| | - Diego Andolina
- Fondazione Santa Lucia, IRCCS, Roma, Italy
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, University of L'Aquila, L'Aquila, Italy
| | - Alessandra Accoto
- Dipartimento di Psicologia and Centro “Daniel Bovet”, Sapienza - Università di Roma, Roma, Italy
- Fondazione Santa Lucia, IRCCS, Roma, Italy
| | - Elena Fiori
- Dipartimento di Psicologia and Centro “Daniel Bovet”, Sapienza - Università di Roma, Roma, Italy
- Fondazione Santa Lucia, IRCCS, Roma, Italy
| | - Rossella Ventura
- Dipartimento di Psicologia and Centro “Daniel Bovet”, Sapienza - Università di Roma, Roma, Italy
- Fondazione Santa Lucia, IRCCS, Roma, Italy
| | - Cristina Orsini
- Dipartimento di Psicologia and Centro “Daniel Bovet”, Sapienza - Università di Roma, Roma, Italy
- Fondazione Santa Lucia, IRCCS, Roma, Italy
| | - David Conversi
- Dipartimento di Psicologia and Centro “Daniel Bovet”, Sapienza - Università di Roma, Roma, Italy
- Fondazione Santa Lucia, IRCCS, Roma, Italy
| | - Claudia Carducci
- Dipartimento di Medicina sperimentale e Patologia, Sapienza - Università di Roma, Roma, Italy
| | - Vincenzo Leuzzi
- Dipartimento di Scienze Neurologiche, Psichiatriche e Riabilitative dell'Età Evolutiva, Università di Roma, Roma, Italy
| | - Stefano Puglisi-Allegra
- Dipartimento di Psicologia and Centro “Daniel Bovet”, Sapienza - Università di Roma, Roma, Italy
- Fondazione Santa Lucia, IRCCS, Roma, Italy
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Huang X, Lu Z, Lv Z, Yu T, Yang P, Shen Y, Ding Y, Fu D, Zhang X, Fu Q, Yu Y. The Fas/Fas ligand death receptor pathway contributes to phenylalanine-induced apoptosis in cortical neurons. PLoS One 2013; 8:e71553. [PMID: 23940767 PMCID: PMC3737091 DOI: 10.1371/journal.pone.0071553] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 07/02/2013] [Indexed: 11/18/2022] Open
Abstract
Phenylketonuria (PKU), an autosomal recessive disorder of amino acid metabolism caused by mutations in the phenylalanine hydroxylase (PAH) gene, leads to childhood mental retardation by exposing neurons to cytotoxic levels of phenylalanine (Phe). A recent study showed that the mitochondria-mediated (intrinsic) apoptotic pathway is involved in Phe-induced apoptosis in cultured cortical neurons, but it is not known if the death receptor (extrinsic) apoptotic pathway and endoplasmic reticulum (ER) stress-associated apoptosis also contribute to neurodegeneration in PKU. To answer this question, we used specific inhibitors to block each apoptotic pathway in cortical neurons under neurotoxic levels of Phe. The caspase-8 inhibitor Z-IETD-FMK strongly attenuated apoptosis in Phe-treated neurons (0.9 mM, 18 h), suggesting involvement of the Fas receptor (FasR)-mediated cell death receptor pathway in Phe toxicity. In addition, Phe significantly increased cell surface Fas expression and formation of the Fas/FasL complex. Blocking Fas/FasL signaling using an anti-Fas antibody markedly inhibited apoptosis caused by Phe. In contrast, blocking the ER stress-induced cell death pathway with salubrinal had no effect on apoptosis in Phe-treated cortical neurons. These experiments demonstrate that the Fas death receptor pathway contributes to Phe-induced apoptosis and suggest that inhibition of the death receptor pathway may be a novel target for neuroprotection in PKU patients.
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Affiliation(s)
- Xiaodong Huang
- Department of Internal Medicine, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhaohui Lu
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhongwei Lv
- Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tingting Yu
- Department of Laboratory Medicine, Shanghai Children Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Peirong Yang
- Department of Internal Medicine, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongnian Shen
- Department of Internal Medicine, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yu Ding
- Department of Internal Medicine, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Da Fu
- Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoping Zhang
- Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- * E-mail: (XPZ); (YGY)
| | - Qihua Fu
- Department of Laboratory Medicine, Shanghai Children Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongguo Yu
- Institute of Pediatric Translational Medicine, Shanghai Children Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
- * E-mail: (XPZ); (YGY)
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Teraishi T, Sasayama D, Hori H, Yamamoto N, Fujii T, Matsuo J, Nagashima A, Kinoshita Y, Hattori K, Ota M, Fujii S, Kunugi H. Possible association between common variants of the phenylalanine hydroxylase (PAH) gene and memory performance in healthy adults. Behav Brain Funct 2013; 9:30. [PMID: 23898865 PMCID: PMC3733818 DOI: 10.1186/1744-9081-9-30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/25/2013] [Indexed: 11/10/2022] Open
Abstract
Background Phenylalanine hydroxylase (PAH) is the enzyme that metabolizes phenylalanine, an essential amino acid required for catecholamine synthesis. Rare mutations in PAH are causal to phenylketonuria (PKU), an autosomal recessive disease characterized by neuropsychiatric symptoms including intellectual disability. We examined whether there is an association between common single nucleotide polymorphisms (SNPs) of PAH and memory performance in the Japanese population. Methods Subjects were 599 healthy adults (166 males and 433 females; mean age 43.8 ± 15.5 years). The Wechsler Memory Scale-Revised (WMS-R) was administered to all participants to assess memory performance. Genotyping was performed for 6 selected tagging SNPs of PAH (rs1722387, rs3817446, rs1718301, rs2037639, rs10860936 and rs11111419). Results Analyses of covariance controlling for sex and education years, indicated a significant association between a SNP (rs2037639) and age-corrected verbal memory index of WMS-R (nominal p = 0.0013) which remained significant after correction for multiple testing ( p = 0.0013 < 0.0017 = 0.05/30tests). Individuals with the GG genotype showed a significantly lower mean verbal memory score, compared with those individuals carrying the AA/AG genotype (106.0 ± 16.0 vs. 111.7 ± 13.4; p = 0.00099). A haplotype block containing two markers of rs2037639 and rs10860936 was associated with verbal memory index (permutation global p = 0.0091). Conclusions Our findings suggest that common genetic variations in PAH are associated with verbal memory in healthy adults. Unknown functional polymorphisms in PAH or those in other genes nearby might affect memory performance.
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Walterfang M, Bonnot O, Mocellin R, Velakoulis D. The neuropsychiatry of inborn errors of metabolism. J Inherit Metab Dis 2013; 36:687-702. [PMID: 23700255 DOI: 10.1007/s10545-013-9618-y] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/29/2013] [Accepted: 04/30/2013] [Indexed: 12/15/2022]
Abstract
A number of metabolic disorders that affect the central nervous system can present in childhood, adolescence or adulthood as a phenocopy of a major psychiatric syndrome such as psychosis, depression, anxiety or mania. An understanding and awareness of secondary syndromes in metabolic disorders is of great importance as it can lead to the early diagnosis of such disorders. Many of these metabolic disorders are progressive and may have illness-modifying treatments available. Earlier diagnosis may prevent or delay damage to the central nervous system and allow for the institution of appropriate treatment and family and genetic counselling. Metabolic disorders appear to result in neuropsychiatric illness either through disruption of late neurodevelopmental processes (metachromatic leukodystrophy, adrenoleukodystrophy, GM2 gangliosidosis, Niemann-Pick type C, cerebrotendinous xanthomatosis, neuronal ceroid lipofuscinosis, and alpha mannosidosis) or via chronic or acute disruption of excitatory/inhibitory or monoaminergic neurotransmitter systems (acute intermittent porphyria, maple syrup urine disease, urea cycle disorders, phenylketonuria and disorders of homocysteine metabolism). In this manuscript we review the evidence for neuropsychiatric illness in major metabolic disorders and discuss the possible models for how these disorders result in psychiatric symptoms. Treatment considerations are discussed, including treatment resistance, the increased propensity for side-effects and the possibility of some treatments worsening the underlying disorder.
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Affiliation(s)
- Mark Walterfang
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, Australia.
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36
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Pascucci T, Giacovazzo G, Andolina D, Conversi D, Cruciani F, Cabib S, Puglisi-Allegra S. In vivo catecholaminergic metabolism in the medial prefrontal cortex of ENU2 mice: an investigation of the cortical dopamine deficit in phenylketonuria. J Inherit Metab Dis 2012; 35:1001-9. [PMID: 22447154 PMCID: PMC3470696 DOI: 10.1007/s10545-012-9473-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 02/27/2012] [Accepted: 02/29/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Phenylketonuria (PKU) is an inherited metabolic disease characterized by plasma hyperphenylalaninemia and several neurological symptoms that can be controlled by rigorous dietetic treatment. The cellular mechanisms underlying impaired brain functions are still unclear. It has been proposed, however, that phenylalanine interference in cognitive functions depends on impaired dopamine (DA) transmission in the prefrontal cortical area due to reduced availability of the precursor tyrosine. Here, using Pah(enu2) (ENU2) mice, the genetic murine model of PKU, we investigated all metabolic steps of catecholamine neurotransmission within the medial preFrontal Cortex (mpFC), availability of the precursor tyrosine, synthesis and release, to find an easy way to reinstate normal cortical DA neurotransmission. METHODS AND RESULTS Analysis of blood and brain levels of tyrosine showed reduced plasma and cerebral levels of tyrosine in ENU2 mice. Western blot analysis demonstrated deficient tyrosine hydroxylase (TH) protein levels in mpFC of ENU2 mice. Cortical TH activity, determined in vivo by measuring the accumulation of l-3,4-dihydroxyphenylalanine (L-DOPA) in mpFC after inhibition of L-aromatic acid decarboxylase with NSD-1015, was reduced in ENU2 mice. Finally, a very low dose of L-DOPA, which bypasses the phenylalanine-inhibited metabolic steps, restored DA prefrontal transmission to levels found in healthy mice. CONCLUSION The data suggests that a strategy of using tyrosine supplementation to treat PKU is unlikely to be effective, whereas small dose L-DOPA administration is likely to have a positive therapeutic effect.
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Affiliation(s)
- Tiziana Pascucci
- Department of Psychology and Centre Daniel Bovet, Sapienza University, via dei Marsi 78, 00185, Rome, Italy.
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Abstract
Phenylketonuria (PKU) is a common genetic disorder arising from a deficiency of phenylalanine hydroxylase. If left untreated, the accumulation of phenylalanine leads to brain damage and neuropsychological dysfunction. One of the abnormalities found in hyperphenylalaninemic patients and a mouse model of PKU is an aminergic deficit in the brain. We previously showed correction of hyperphenylalaninemia and concomitant behavioral recovery in PKU mice after liver-targeted gene transfer with a viral vector. Here, we addressed whether such a functional recovery was substantiated by an improved amine metabolism in the brain. After gene transfer, brain dopamine, norepinephrine, and serotonin levels in the PKU mice were significantly elevated to normal or near-normal levels, along with systemic improvement of phenylalanine catabolism. The results of biochemical analyses validated the efficacy of PKU gene therapy in the central nervous system.
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Lu L, Gu X, Li D, Liang L, Zhao Z, Gao J. Mechanisms regulating superoxide generation in experimental models of phenylketonuria: an essential role of NADPH oxidase. Mol Genet Metab 2011; 104:241-8. [PMID: 21640623 DOI: 10.1016/j.ymgme.2011.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/13/2011] [Accepted: 05/13/2011] [Indexed: 11/20/2022]
Abstract
This study was designed to investigate whether nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, a superoxide-producing enzyme, could be involved in phenylketonuria (PKU)-associated oxidative stress. A Pah(enu2)-BTBR PKU mouse model, and an in vitro cell culture model of PKU mimicking high phenylalanine insults in PKU, were employed for this study. The concentration of phenylalanine in mouse cerebral cortex was determined by liquid chromatography-tandem mass spectrometry. Superoxide production was displayed with dihydroethidium staining. NADPH oxidase expression level was measured by real-time RT-PCR, Western blotting and immunofluorescence. NADPH oxidase activity was measured by the colorimetric method. The phenylalanine concentrations in cerebral cortices of PKU mice were significantly higher than those in wild-type control mice. Similar results concerning superoxide production and NADPH oxidase protein expression and activity, were also found in this brain region. In addition, it was found that cerebral cortical neurons subjected to an in vitro high phenylalanine insult, displayed increased superoxide production accompanied by increases of NADPH oxidase protein expression and activity. Pretreatment with the inhibitor of this oxidase (diphenylene iodonium or apocynin) prevented this superoxide-increasing effect. Collectively, these findings provide evidence that NADPH oxidase might be a key enzyme involved in enhanced superoxide production in PKU and suggest that it may be a potential therapeutic target in neuroprotective strategies against phenylalanine-evoked oxidative brain injury in PKU.
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Affiliation(s)
- Lihua Lu
- Department of Pediatric Endocrinology and Genetical Metabolism, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute for Pediatric Research, 1665 Kongjiang Road, Shanghai 200092, China
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5-Hydroxytryptophan during critical postnatal period improves cognitive performances and promotes dendritic spine maturation in genetic mouse model of phenylketonuria. Int J Neuropsychopharmacol 2011; 14:479-89. [PMID: 21040618 PMCID: PMC3110346 DOI: 10.1017/s1461145710001288] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Although phenylketonuria (PKU) is the most common genetic cause of mental retardation, the cellular mechanisms underlying impaired brain function are still unclear. Using PAHenu2 mice (ENU2), the genetic mouse model of PKU, we previously demonstrated that high phenylalanine levels interfere with brain tryptophan hydroxylase activity by reducing the availability of serotonin (5-hydroxytryptamine, 5-HT), crucial for maturation of neuronal connectivity in the prefrontal cortex (PFC), around the third postnatal week, a critical period for cortical maturation. 5-Hydroxytryptophan (5-HTP), the product of tryptophan hydroxylation, is known to be a better treatment to increase brain 5-HT levels. In this study we investigated the role of 5-HT during the early postnatal period in cognitive disturbances and in cortical dendritic alterations of PKU subjects by restoring temporarily (postnatal days 14-21) physiological brain levels of 5-HT in ENU2 through 5-HTP treatment. In adult ENU2 mice early 5-HTP treatment reverses cognitive deficits in spatial and object recognition tests accompanied by an increase in spine maturation of pyramidal neurons in layer V of the prelimbic/infralimbic area of the PFC, although locomotor deficits are not recovered by treatment. Taken together, our results support the hypothesis that mental retardation in PKU depends on reduced availability of brain 5-HT during critical developmental periods that interferes with cortical maturation and point to 5-HTP supplementation as a highly promising additional tool to heal PKU patients.
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ten Hoedt AE, de Sonneville LMJ, Francois B, ter Horst NM, Janssen MCH, Rubio-Gozalbo ME, Wijburg FA, Hollak CEM, Bosch AM. High phenylalanine levels directly affect mood and sustained attention in adults with phenylketonuria: a randomised, double-blind, placebo-controlled, crossover trial. J Inherit Metab Dis 2011; 34:165-71. [PMID: 21153445 PMCID: PMC3026661 DOI: 10.1007/s10545-010-9253-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/09/2010] [Accepted: 11/17/2010] [Indexed: 11/21/2022]
Abstract
The main debate in the treatment of Phenylketonuria (PKU) is whether adult patients need the strict phenylalanine (Phe)-restricted diet. Physicians and patients lack evidence-based guidelines to help them make well-informed choices. We have carried out the first randomised double-blind placebo-controlled trial into the effects of short-term elevation of Phe levels on neuropsychological functions and mood of adults with PKU. Nine continuously treated adults with PKU underwent two 4-week supplementation periods: one with Phe, mimicking normal dietary intake, and one with placebo in randomly allocated order via a randomisation coding list in a double-blind cross-over design. A set of neuropsychological tests (Amsterdam Neuropsychological Tasks) was administered at the end of each study period. In addition, patients and for each patient a friend or relative, completed weekly Profile of Mood States (POMS) questionnaires, evaluating the patients' mood. Phe levels were measured twice weekly. Mean plasma Phe levels were significantly higher during Phe supplementation compared with placebo (p = 0.008). Neuropsychological tests demonstrated an impairment in sustained attention during Phe supplementation (p = 0.029). Both patients and their friend or relative reported lower scores on the POMS questionnaires during Phe supplementation (p = 0.017 and p = 0.040, respectively). High plasma Phe levels have a direct negative effect on both sustained attention and on mood in adult patients with PKU. A Phe-restricted "diet for life" might be an advisable option for many.
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Affiliation(s)
- Amber E. ten Hoedt
- Department of Pediatrics (H7-270), Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | | | - Baudouin Francois
- Department of Metabolic Diseases, Centrum Pinocchio, Diepenbeek, Belgium
| | - Nienke M. ter Horst
- Department of Pediatrics (H7-270), Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Mirian C. H. Janssen
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M. Estela Rubio-Gozalbo
- Department of Pediatrics and Laboratory Genetic Metabolic Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frits A. Wijburg
- Department of Pediatrics (H7-270), Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Carla E. M. Hollak
- Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Annet M. Bosch
- Department of Pediatrics (H7-270), Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Takahashi N, Sakurai T, Davis KL, Buxbaum JD. Linking oligodendrocyte and myelin dysfunction to neurocircuitry abnormalities in schizophrenia. Prog Neurobiol 2010; 93:13-24. [PMID: 20950668 DOI: 10.1016/j.pneurobio.2010.09.004] [Citation(s) in RCA: 226] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/03/2010] [Accepted: 09/30/2010] [Indexed: 01/05/2023]
Abstract
Multiple lines of evidence in schizophrenia, from brain imaging, studies in postmortem brains, and genetic association studies, have implicated oligodendrocyte and myelin dysfunction in this disease. Recent studies suggest that oligodendrocyte and myelin dysfunction leads to changes in synaptic formation and function, which could lead to cognitive dysfunction, a core symptom of schizophrenia. Furthermore, there is accumulating data linking oligodendrocyte and myelin dysfunction with dopamine and glutamate abnormalities, both of which are found in schizophrenia. These findings implicate oligodendrocyte and myelin dysfunction as a primary change in schizophrenia, not only as secondary consequences of the illness or treatment. Strategies targeting oligodendrocyte and myelin abnormalities could therefore provide therapeutic opportunities for patients suffering from schizophrenia.
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Affiliation(s)
- Nagahide Takahashi
- Conte Center for the Neuroscience of Mental Disorders and the Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA
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Schoemans R, Aigrot MS, Wu C, Marée R, Hong P, Belachew S, Josse C, Lubetzki C, Bours V. Oligodendrocyte development and myelinogenesis are not impaired by high concentrations of phenylalanine or its metabolites. J Inherit Metab Dis 2010; 33:113-20. [PMID: 20151197 PMCID: PMC3071566 DOI: 10.1007/s10545-010-9052-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 01/11/2010] [Accepted: 01/13/2010] [Indexed: 10/19/2022]
Abstract
Phenylketonuria (PKU) is a metabolic genetic disease characterized by deficient phenylalanine hydroxylase (PAH) enzymatic activity. Brain hypomyelination has been reported in untreated patients, but its mechanism remains unclear. We therefore investigated the influence of phenylalanine (Phe), phenylpyruvate (PP), and phenylacetate (PA) on oligodendrocytes. We first showed in a mouse model of PKU that the number of oligodendrocytes is not different in corpus callosum sections from adult mutants or from control brains. Then, using enriched oligodendroglial cultures, we detected no cytotoxic effect of high concentrations of Phe, PP, or PA. Finally, we analyzed the impact of Phe, PP, and PA on the myelination process in myelinating cocultures using both an in vitro index of myelination, based on activation of the myelin basic protein (MBP) promoter, and the direct quantification of myelin sheaths by both optical measurement and a bioinformatics method. None of these parameters was affected by the increased levels of Phe or its derivatives. Taken together, our data demonstrate that high levels of Phe, such as in PKU, are unlikely to directly induce brain hypomyelination, suggesting involvement of alternative mechanisms in this myelination defect.
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Affiliation(s)
- Renaud Schoemans
- Human Genetics, GIGA-Research, University of Liège, Liège, Belgium
| | | | - Chaohong Wu
- Michtom School of Computer Science, Volen Center for Complex Systems, Room 261, Brandeis University, Waltham, MA 02454, USA
| | - Raphaël Marée
- Bioinformatics platform, GIGA-Research, University of Liège, Liège, Belgium
| | - Pengyu Hong
- Michtom School of Computer Science, Volen Center for Complex Systems, Room 261, Brandeis University, Waltham, MA 02454, USA
| | | | - Claire Josse
- Human Genetics, GIGA-Research, University of Liège, Liège, Belgium
| | | | - Vincent Bours
- Human Genetics, GIGA-Research, University of Liège, Liège, Belgium
- Genetics Center, CHU Liège, Liège, Belgium
- Department of Genetics, CHU Liège, Université de Liège B34, Avenue de l’hôpital 1, 4000 Liège, Belgique, Belgium
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Experimental Evidence that Phenylalanine Provokes Oxidative Stress in Hippocampus and Cerebral Cortex of Developing Rats. Cell Mol Neurobiol 2009; 30:317-26. [DOI: 10.1007/s10571-009-9455-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 09/03/2009] [Indexed: 12/12/2022]
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5-Hydroxytryptophan rescues serotonin response to stress in prefrontal cortex of hyperphenylalaninaemic mice. Int J Neuropsychopharmacol 2009; 12:1067-79. [PMID: 19664307 DOI: 10.1017/s1461145709990381] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Adult early treated hyperphenylalaninaemic patients can show specific deficits of prefrontal cortical functions. The development of additional therapeutic strategies for these patients requires the understanding of the mechanisms involved in phenylalanine-dependent impairment of fronto-cortical functions. We tested the hypothesis of phenylalanine interference with aminergic neurotransmission in the prefrontal cortex by evaluating, in vivo, amine release in adult Pah(enu2) mice, the genetic model of phenylketonuria. Mice of healthy background responded to a psychogenic stressor with the classic time-dependent increase of norepinephrine, dopamine and serotonin release from prefrontal cortical terminals. Neither the dopaminergic nor the serotoninergic responses were observable in the Pah(enu2) mice. Temporary reduction of circulating phenylalanine, by phenylalanine-free diet without amino- acid supplement, promoted recovery of the serotonin response only, demonstrating direct interference with serotonin synthesis in the mature brain. Evaluation of different steps of serotonin synthesis in the prefrontal cortex of hyperphenylalaninaemic mice demonstrated inhibition of cortical tryptophan hydroxylase activity. Finally, systemic administration of 5-hydroxytryptophan, the product of tryptophan hydroxylase activity, allowed frontal cortical serotonin response to stress in hyperphenylalaninaemic mice. Collectively, these results demonstrate that hyperphenylalaninaemia interferes with the ability of the mature prefrontal cortex to respond to psychological challenges, point to serotonin synthesis as the target of phenylalanine interference, and support the use of 5-hydroxytryptophan in lifelong treatment of hyperphenylalaninaemic subjects.
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Fligny C, Hatia S, Amireault P, Mallet J, Côté F. Mammalian prenatal development: the influence of maternally derived molecules. Bioessays 2009; 31:935-43. [DOI: 10.1002/bies.200800217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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van Spronsen FJ, Hoeksma M, Reijngoud DJ. Brain dysfunction in phenylketonuria: is phenylalanine toxicity the only possible cause? J Inherit Metab Dis 2009; 32:46-51. [PMID: 19191004 DOI: 10.1007/s10545-008-0946-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 10/16/2008] [Accepted: 11/20/2008] [Indexed: 11/25/2022]
Abstract
In phenylketonuria, mental retardation is prevented by a diet that severely restricts natural protein and is supplemented with a phenylalanine-free amino acid mixture. The result is an almost normal outcome, although some neuropsychological disturbances remain. The pathology underlying cognitive dysfunction in phenylketonuria is unknown, although it is clear that the high plasma concentrations of phenylalanine influence the blood-brain barrier transport of large neutral amino acids. The high plasma phenylalanine concentrations increase phenylalanine entry into brain and restrict the entry of other large neutral amino acids. In the literature, emphasis has been on high brain phenylalanine as the pathological substrate that causes mental retardation. Phenylalanine was found to interfere with different cerebral enzyme systems. However, apart from the neurotoxicity of phenylalanine, a deficiency of the other large neutral amino acids in brain may also be an important factor affecting cognitive function in phenylketonuria. Cerebral protein synthesis was found to be disturbed in a mouse model of phenylketonuria and could be caused by shortage of large neutral amino acids instead of high levels of phenylalanine. Therefore, in this review we emphasize the possibility of a different idea about the pathogenesis of mental dysfunction in phenylketonuria patients and the aim of treatment strategies. The aim of treatment in phenylketonuria might be to normalize cerebral concentrations of all large neutral amino acids rather than prevent high cerebral phenylalanine concentrations alone. In-depth studies are necessary to investigate the role of large neutral amino acid deficiencies in brain.
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Affiliation(s)
- F J van Spronsen
- Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Pascucci T, Andolina D, Ventura R, Puglisi-Allegra S, Cabib S. Reduced availability of brain amines during critical phases of postnatal development in a genetic mouse model of cognitive delay. Brain Res 2008; 1217:232-8. [PMID: 18502400 DOI: 10.1016/j.brainres.2008.04.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 04/02/2008] [Accepted: 04/04/2008] [Indexed: 10/22/2022]
Abstract
Serotonin (5-HT), dopamine (DA) and noradrenaline (NE) play important roles in brain postnatal maturation. Therefore, deficits in brain availability of biogenic amines during critical developmental phases might underlie neurodevelopmental disturbances associated with cognitive impairment. To test this hypothesis we evaluated brain availability of 5-HT, DA and NE, of their immediate precursors 5-hydroxytryptophan and 3,4-dihydroxy-l-phenylalanine, and of large neutral amino acids phenylalanine, tyrosine and tryptophan, in developing PahEnu2 mice, the genetic model of Phenylketonuria (PKU) a cause of severe cognitive delay. We found deficits of brain amine levels in PKU pups between day 14 and 35 of postnatal life, when pups of the healthy background showed developmental peak increases of amines and precursors. 5-HT deficits were most pronounced, were unrelated with brain availability of the amino acid precursor tryptophan, but overlapped with peak brain phenylalanine concentrations and reduced availability of 5-HT direct precursor 5-hydroxytryptophan. These results identify a critical window of brain amine availability susceptible to disturbances in a genetic mouse model of pathological neurodevelopment and suggest a mechanism of interference with brain aminergic synthesis in PKU and non-PKU hyperphenylalaninemia.
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Affiliation(s)
- Tiziana Pascucci
- Dipartimento di Psicologia and Centro Daniel Bovet, Sapienza University, Rome, Italy.
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Martynyuk AE, Ucar DA, Yang DD, Norman WM, Carney PR, Dennis DM, Laipis PJ. Epilepsy in Phenylketonuria: A Complex Dependence on Serum Phenylalanine Levels. Epilepsia 2007; 48:1143-50. [PMID: 17484755 DOI: 10.1111/j.1528-1167.2007.01115.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Phenylketonuria (PKU) is a disorder of phenylalanine (Phe) metabolism that frequently results in epilepsy if a low Phe diet was not implemented at birth. The mechanisms by which Phe affects the brain are poorly understood. METHODS Audiogenic seizures (AGS) were studied in female homozygous Pah(enu2) BTBR (PKU) mice. RESULTS Adult PKU mice, 18-20 weeks of age, in contrast to wild-type and heterozygous counterparts, exhibited a full range of AGS. Younger PKU mice, 5-7 weeks of age, had higher serum Phe levels (2.22 +/- 0.20 mM) in comparison with the adult animals (1.72 +/- 0.05 mM) and were not susceptible to AGS. Among adult mice, animals susceptible to AGS had significantly lower serum Phe levels (1.62 +/- 0.06 mM) in comparison with those resistant to AGS (1.86 +/- 0.07 mM). Susceptibility to AGS tended to increase in the afternoon when serum Phe concentration decreased in comparison to evening and morning. Normalization of serum Phe level by instituting a low Phe diet generally prevented susceptibility to AGS within 12 h. Although return to a standard diet raised Phe levels to hyperphenylalaninemic within 12 h in animals treated with a low Phe diet for 2 weeks, more than 7 weeks were needed for a complete resumption of AGS. CONCLUSIONS Transient decrease in Phe levels within hyperphenylalaninemic range may be a necessary condition for PKU-related seizures to occur. A low Phe diet prevents susceptibility to seizures, which can resume with the significant delay after termination of dietary treatment.
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Affiliation(s)
- Anatoly E Martynyuk
- Department of Anesthesiology, University of Florida, Gainesville, FL 32610-0254, USA.
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Moyle JJ, Fox AM, Bynevelt M, Arthur M, Burnett JR. A neuropsychological profile of off-diet adults with phenylketonuria. J Clin Exp Neuropsychol 2007; 29:436-41. [PMID: 17497567 DOI: 10.1080/13803390600745829] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The metabolic disorder phenylketonuria (PKU) is treated early by a low-phenylalanine diet. While this prevents global cognitive impairment, some patients still experience cognitive and neurophysiological abnormalities. Neuropsychological testing of early treated, currently off-diet, PKU patients attending an adult PKU clinic showed a reduction in the Perceptual Organization Index (POI), Processing Speed Index (PSI) from the Wechsler Adult Intelligence Scale Third Edition (WAIS-III), and Part A of the Trail Making Test for the PKU group relative to controls. Taken together, these results supported a profile of reduced information-processing speed.
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Affiliation(s)
- J J Moyle
- School of Psychology, The University of Western Australia, Perth, WA, Australia.
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Moyle JJ, Fox AM, Arthur M, Bynevelt M, Burnett JR. Meta-Analysis of Neuropsychological Symptoms of Adolescents and Adults with PKU. Neuropsychol Rev 2007; 17:91-101. [PMID: 17410469 DOI: 10.1007/s11065-007-9021-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 12/08/2006] [Indexed: 10/23/2022]
Abstract
Phenylketonuria (PKU; OMIM 261600) is an autosomal recessive inborn error of phenylanaline metabolism. PKU is characterized by deficient or defective phenylalanine hydroxylase activity and persistantly increased levels of the essential amino acid phenylalanine in the circulation. The present article examines current understanding of the etiology of PKU, along with a meta-analysis examining neuropsychological and intellectual presentations in continuously treated adolescents and adults. Patients with PKU differed significantly from controls on Full-Scale IQ, processing speed, attention, inhibition, and motor control. Future research utilizing an integrative approach and detailed analysis of specific cognitive domains will assist both the scientist and clinician, and ultimately the patient.
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Affiliation(s)
- J J Moyle
- School of Psychology, The University of Western Australia, Perth, Australia.
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