The Genetic Landscape and Epidemiology of Phenylketonuria

Phenylketonuria (PKU), caused by variants in the phenylalanine hydroxylase (PAH) gene, is the most common autosomal-recessive Mendelian phenotype of amino acid metabolism. We estimated that globally 0.45 million individuals have PKU, with global prevalence 1:23,930 live births (range 1:4,500 [Italy]-1:125,000 [Japan]). Comparing genotypes and metabolic phenotypes from 16,092 affected subjects revealed differences in disease severity in 51 countries from 17 world regions, with the global phenotype distribution of 62% classic PKU, 22% mild PKU, and 16% mild hyperphenylalaninemia. A gradient in genotype and phenotype distribution exists across Europe, from classic PKU in the east to mild PKU in the southwest and mild hyperphenylalaninemia in the south. The c.1241A>G (p.Tyr414Cys)-associated genotype can be traced from Northern to Western Europe, from Sweden via Norway, to Denmark, to the Netherlands. The frequency of classic PKU increases from Europe (56%) via Middle East (71%) to Australia (80%). Of 758 PAH variants, c.1222C>T (p.Arg408Trp) (22.2%), c.1066-11G>A (IVS10-11G>A) (6.4%), and c.782G>A (p.Arg261Gln) (5.5%) were most common and responsible for two prevalent genotypes: p.[Arg408Trp];[Arg408Trp] (11.4%) and c.[1066-11G>A];[1066-11G>A] (2.6%). Most genotypes (73%) were compound heterozygous, 27% were homozygous, and 55% of 3,659 different genotypes occurred in only a single individual. PAH variants were scored using an allelic phenotype value and correlated with pre-treatment blood phenylalanine concentrations (n = 6,115) and tetrahydrobiopterin loading test results (n = 4,381), enabling prediction of both a genotype-based phenotype (88%) and tetrahydrobiopterin responsiveness (83%). This study shows that large genotype databases enable accurate phenotype prediction, allowing appropriate targeting of therapies to optimize clinical outcome.

Functional and structural characterisation of 5 missense mutations of the phenylalanine hydroxylase

Phenylketonuria (PKU) and hyperphenylalaninemia (HPA) are a group of genetic disorders predominantly caused by mutations in the phenylalanine hydroxylase (PAH) gene. To date, more than 950 variants have been identified, however the pathogenic mechanism of many variants remains unknown. In this study, in silico prediction and in vitro prokaryotic and eukaryotic expression systems were used to functionally characterize five PAH missense variants (p.F233I, p.R270I, p.F331S, p.S350Y, and p.L358F) previously identified in Slovak and Czech patients. p.F233I, p.R270I, and p.S350Y were classified as deleterious mutations since they showed no specific activity in functional assay and no response to chaperone co-expression. Protein levels of these PAH variants were very low when expressed in HepG2 cells, and only p.S350Y responded to BH4 precursor overload by significant increase in PAH monomer, probably due to reduced rate of protein degradation as the result of proper protein folding. Variants p.F331S and p.L358F exerted residual enzymatic activity in vitro. While the first can be classified as probably pathogenic due to its very low protein levels in HepG2 cells, the latter is considered to be mild mutation with protein levels of approximately 17.85% compared to wt PAH. Our findings contribute to better understanding of structure and function of PAH mutated enzymes and optimal treatment of PKU patients carrying these mutations using BH4 supplementation.

Phenylalanine hydroxylase deficiency in the Slovak population: genotype-phenotype correlations and genotype-based predictions of BH4-responsiveness

We investigated the mutation spectrum of the phenylalanine hydroxylase gene (PAH) in a cohort of patients from 135 Slovak PKU families. Mutational screening of the known coding region, including conventional intron splice sites, was performed using high-resolution melting analysis, with subsequent sequencing analysis of the samples showing deviated melting profiles compared to control samples. The PAH gene was also screened for deletions and duplications using MLPA analysis. Forty-eight different disease causing mutations were identified in our patient group, including 30 missense, 8 splicing, 7 nonsense, 2 large deletions and 1 small deletion with frameshift; giving a detection rate of 97.6%. The most prevalent mutation was the p.R408W, occurring in 47% of all alleles, which concurs with results from neighboring and other Slavic countries. Other frequent mutations were: p.R158Q (5.3%), IVS12+1G>A (5.3%), p.R252W (5.1%), p.R261Q (3.9%) and p.A403V (3.6%). We also identified three novel missense mutations: p.F233I, p.R270I, p.F331S and one novel variant: c.-30A>T in the proximal part of the PAH gene promoter. A spectrum of 84 different genotypes was observed and a genotype based predictions of BH4-responsiveness were assessed. Among all genotypes, 36 were predicted to be BH4-responsive represented by 51 PKU families. In addition, genotype-phenotype correlations were performed.

Mitral annular calcifications and aortic plaques as predictors of increased cardiovascular mortality

OBJECTIVES

Mitral annular calcifications (MAC) and aortic plaques are predictive for higher incidence of recurrent embolic events, the presence and severity of coronary artery disease and total cardiac deaths. However, no data exist comparing the impact of combined presence of both aortic plaques and MAC on embolic events, deaths associated with cerebral embolism or cardiac deaths during the follow-up.

PATIENTS AND METHODS

In 100 consecutive patients with aortic plaques detected by transesophageal echocardiography (mean age 69.8 + 8.9 years, range 39-93 years, 49 males, 51 females) and in 49 age- and sex-matched control subjects (mean age 69.4 + 7.8 years, range 46-89 years, 27 males, 22 females) without aortic plaques (control group), the incidence of embolic events, deaths associated with embolic events and total cardiac deaths were evaluated during a mean follow-up of 32 +/- 9.7 months. The effect of the presence or absence of MAC on these parameters was also evaluated.

RESULTS

Compared with the control group, patients with aortic plaques had a higher frequency of hypertension (p < 0.001), hypercholesterolemia (p < 0.01), smoking history (p < 0.01), MAC (p < 0.00001) and the presence of atherosclerotic changes in the carotid arteries (p < 0.05). During the follow-up, patients with aortic plaques had a higher incidence of stroke or transient ischemic attack (p < 0.0001), deaths associated with stroke (p < 0.005) and total cardiac deaths (p < 0.05) compared with the control group. Patients with both aortic plaques and presence of MAC had during the follow-up a significantly higher incidence of deaths associated with stroke (p < 0.0001, 16.0 times higher) and total cardiac deaths (p < 0.005, 4.7 times higher) compared with those without MAC and the presence of aortic plaques. Multivariant regression analysis showed MAC (p < 0.01) and hypercholesterolemia (p < 0.05) were the only independent predictors of stroke. MAC (p < 0.05) and age (p < 0.000001) were the only independent predictors of total cardiac death and stroke. Independent predictors of both aortic plaques and MAC were coronary artery disease (p < 0.00001), stroke (p < 0.005), hypertension (p < 0.001), female gender (p < 0.01) and hypercholesterolemia (p < 0.005).

CONCLUSIONS

The findings of both aortic plaque and mitral annular calcification are highly predictive not only for strokes, but also for deaths associated with cerebral embolism and total cardiac deaths and are probably strong markers for higher severity of coronary artery disease. They are more predictive if both are present simultaneously compared to the presence of either MAC or aortic plaque alone.

Minimax optimization-based inverse treatment planning for interstitial thermal therapy

The following work represents the development and evaluation of a minimax optimization-based inverse treatment planning approach for interstitial thermal therapy of cancer and benign disease. The goal is to determine a priori optimal applicator placements and power level settings to maintain the minimum tumour temperature, Tmin, and maximum normal tissue temperature, Tmax within a prescribed therapeutic temperature range. The temperature distribution is approximated by a finite element method (FEM) solution of a bioheat transfer equation on a nonuniform finite element mesh. Lower and upper therapeutic temperature thresholds are specified in the tumour and surrounding normal tissues. A constrained minimax optimization problem is formulated to determine optimal applicator positions and power level settings that minimize the maximum (rather than average) temperature errors in the target tumour region and surrounding normal tissues. The optimization problem is formulated for two general classes of interstitial heating applicators, those with and without a surface cooling mechanism. The viability and sensitivity of this approach is investigated in the two-dimensional setting for various tumour shapes and blood perfusion levels using surface-cooled and direct-coupled interstitial ultrasound applicator power deposition models. These preliminary results indicate the utility of this approach for meeting a prescribed Tmin/Tmax-based clinical objective criterion, and its potential for generating optimal treatment plans that can withstand variations or uncertainty in blood perfusion levels.

Asexual sporulation in coprinus cinereus: structure and development of oidiophores and oidia in an amut bmut homokaryon

Polak, E., Hermann, R., Kues, U., and Aebi, M. 1997. Asexual sporulation in Coprinus cinereus: Structure and development of oidiophores and oidia in an Amut Bmut homokaryon. 22, 112-126. Coprinus cinereus strain AmutBmut is a homokaryon with mutations in both mating type loci. It produces asexual spores (oidia) in sticky liquid droplets on specialized aerial structures (oidiophores). These oidiophores have uninucleate cells and are organized as those of the monokaryon 5026 from which the strain derived. However, unlike in the monokaryon, oidiophores in strain AmutBmut are induced by light. Young oidiophores are easily detected upon light induction and the process of oidiophore development is readily followed in this strain. Fully grown oidiophores consecutively give rise to short branches (oidial hyphae) that break up into two or occasionally three uninucleate oidia (arthroconidia) until up to 200 oidia are collected at the tip of the oidiophore. Mature spores are enclosed by a mucilage and a double-layered primary cell wall with hair-like structures except for the sides of former cell attachments. In a summary of our microscopic observations on developing oidiophores and nuclear stainings we present a model showing the successive steps of oidiophore and spore development.

Altered pulsatile pattern of luteinizing hormone in men with idiopathic normogonadotropic oligospermia

Gonadotropin serum levels and pulsatile secretion of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH) are regulated by sexual steroids and perhaps inhibin, but the relative rates of LH and follicle-stimulating hormone (FSH) secretion are modulated by the frequency of GnRH pulses. This study evaluated LH pulsatility in patients with idiopathic normogonadotropic oligospermia (INO) and normal men before and after clomiphene citrate (CC) administration. INO patients evidenced a lower mean LH levels (P less than 0.001), a higher mean pulse frequency (P less than 0.05) and similar pulse amplitude than normal men. CC induced in normal men a higher LH and testosterone (T) increments and increased pulse amplitude only in normal men. Estradiol (E2) showed no difference in either group. Patients with INO might evidence a hypothalamic disorder that may alter pulsatile GnRH secretion. A different response to CC in patients with INO seems to lend support to a primary hypothalamic lesion. A probable gonadotropin imbalance might alter intratesticular concentrations of T and E2 and be the cause of spermatogenic failure.

Intraoral periosteal nodular fasciitis

Intraoral periosteal nodular fasciitis is an extremely rare tumor with only 2 cases having been previously recorded in the literature. We report here the 3rd case and review the characteristic features, the differential diagnosis and the treatment of intraoral periosteal nodular fasciitis.

Chemical-modification studies on rat olfactory mucosa using a thiol-specific reagent and enzymatic iodination

1. A rat olfactory preparation, suitable for biochemical studies in vitro on olfactory mechanisms, is described. 2. The effects of the impermeant chemical modification reagents mersalyl (a thiol reagent) and enzymatic iodination, on the amplitude of the electroolfactogram (EOG) responses elicited from rat olfactory mucosa by pulses of odorant vapours was studied using 12 odorants differing widely in odour quality and molecular structure: amyl acetate, carvone, decanal, butylamine, cineole, citronellol, cresol, diacetyl, dimethylethyl-pyrazine, naphthalene, octanethiol and valeric acid. 3. Both reagents irreversibly reduced the EOG amplitude to all odorants to an extent dependent on the reagent concentration. Two subpopulations of animal preparations could be distinguished on the basis of the extent to which they survived the iodination whereas mersalyl appeared to sample a single population of preparations. 4. Small but statistically significant differences were observed between the responses of each odorant with each reagent but no simple correlation between either the molecular structure or odour quality of the odorants and the reagent effect is apparent for the case of mersalyl. With iodination the responses from the three flexible-aliphatic-chain odorants were reduced to a greater extent than the other odorants, all of which had a dissimilar molecular structure. 5. The ability of three odorants, amyl acetate, carvone and decanal, to protect the receptors for the odorants against chemical modification was investigated. The protecting odorants were applied directly to the mucosa as a dilute solution in Ringer's medium. No specific odorant protection effects were observed. 6. The results are discussed in relation to a model of the olfactory mechanism involving relatively non-specific receptor proteins. Each receptor type is envisaged as interacting weakly with a number of odorants and each odorant interacts with a number of receptors.

On the Equivalence of Discrete Systems in Time-Optimal Control

It is shown in this paper that under a transformation which maps the state space of a system onto a sequence space in a one-to-one manner, time-optimal discrete regulator systems with different dynamics and modulators can be brought to equivalence and that this fact may be used to construct an optimal control strategy for one system from the known optimal control strategy of another one. In particular, the optimal control strategy for a pulse-width-modulated discrete system with a plant described by an nth order linear differential equation is derived in this manner.

Minimum Time Control of Second Order Pulse-Width-Modulated Sampled-Data Systems

This paper treats the minimal time control problem for two second order pulse-width-modulated sampled-data systems, one with a double integrator type plant and one with a plant described by an integral and a time constant. Such plants are encountered in systems with hydraulic components. It is shown rigorously that for minimal time control the phase plane can be divided into two regions: a striplike region around the optimal switching trajectory for a continuous relay system with the same plants, in which the pulse width must be adjusted for optimal action; and the rest of the phase plane in which an optimal p.w.m. system of the type described behaves like a continuous optimal relay system, the pulse duration being equal to the sampling period. A brief description of an electromechanical computer capable of implementing minimal time control for these systems is also given.