Abstract
Background
Phenylketonuria (PKU) is one of the most common types of inborn error of metabolism. The mainstay of therapy for PKU has been dietary phenylalanine (Phe) restriction. Sapropterin dihydrochloride has been shown to be effective in reducing Phe levels in PKU patients.
Methods
This study was a clinical trial performed in the pediatric endocrine clinic of Imam Reza Hospital, Mashhad, Iran.
Results
All children between 1 and 10 years of age with a diagnosis of PKU whose serum Phe levels were between 120 and 360 μmol/L, in Khorasan Razavi province in the north-east of Iran, were enrolled. Twenty-four patients were enrolled in the study. Intervention: A free diet for 72 h was allowed and then a 20-mg/kg/day dose of Kuvan® was administered. More than 30% reduction in blood Phe levels was described as responsive. Eight patients responded to the loading test and were eligible for the second stage of the study. In this stage, Phe powder in combination with Kuvan was provided. Patients’ serum Phe was measured weekly for 3 months. All eight patients showed Phe tolerance in 3 months, and their serum Phe levels remained within the range.
Conclusions
Treatment with Kuvan can help reduce blood Phe levels in our pediatric PKU population and allows patients to follow a more liberal diet.
Acknowledgments
We wish to thank our patients and their families for their kind cooperation, and the staff of the pediatric metabolic clinic of Imam Reza hospital for their valuable help. We also thank Mrs. Zahra Rezaei for her kind cooperation.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Chen YF, Jia HT, Chen ZH, Song JP, Liang Y, et al. Mutational spectrum of phenylketonuria in Jiangsu province. Eur J Pediatr 2015;174:1333–8.10.1007/s00431-015-2539-zSuche in Google Scholar PubMed
2. Scala I, Concolino D, Casa RD, Nastasi A, Ungaro C, et al. Long-term follow-up of patients with phenylketonuria treated with tetrahydrobiopterin: a seven years experience. Orphanet J Rare Dis 2015;10:14.10.1186/s13023-015-0227-8Suche in Google Scholar PubMed PubMed Central
3. Kumru B, Ozturk Hismi B, Kaplan DS, Celik H. Studying the effect of large neutral amino acid supplements on oxidative stress in phenylketonuric patients. J Pediatr Endocrinol Metab 2019;32:269–74.10.1515/jpem-2018-0454Suche in Google Scholar PubMed
4. Tavana S, Amini S, Hakhamaneshi MS, Andalibi P, Hajir MS, et al. Prooxidant-antioxidant balance in patients with phenylketonuria and its correlation to biochemical and hematological parameters. J Pediatr Endocrinol Metab 2016;29:675–80.10.1515/jpem-2015-0398Suche in Google Scholar PubMed
5. van Wegberg AM, MacDonald A, Ahring K, Belanger-Quintana A, Blau N, et al. The complete European guidelines on phenylketonuria: diagnosis and treatment. Orphanet J Rare Dis 2017;12:162.10.1186/s13023-017-0685-2Suche in Google Scholar PubMed PubMed Central
6. O’Neill CA, Eisensmith RC, Croke DT, Naughten ER, Cahalane SF, et al. Molecular analysis of PKU in Ireland. Acta Paediatr Suppl 1994;407:43–4.10.1111/j.1651-2227.1994.tb13448.xSuche in Google Scholar PubMed
7. Hatam N, Askarian M, Shirvani S, Pourmohammadi K. Cost utility of neonatal screening program for phenylketonuria in shiraz university of medical sciences. Hakim Res J 2014;16: 329–36.Suche in Google Scholar
8. Demirdas S, Coakley KE, Bisschop PH, Hollak CE, Bosch AM, et al. Bone health in phenylketonuria: a systematic review and meta-analysis. Orphanet J Rare Dis 2015;10:17.10.1186/s13023-015-0232-ySuche in Google Scholar PubMed PubMed Central
9. Burgard P. Development of intelligence in early treated phenylketonuria. Eur J Pediatr 2000;159:S74–9.10.1007/PL00014388Suche in Google Scholar PubMed
10. Vockley J, Andersson HC, Antshel KM, Braverman NE, Burton BK, et al. Phenylalanine hydroxylase deficiency: diagnosis and management guideline. Genet Med 2014;16:188–200.10.1038/gim.2013.157Suche in Google Scholar PubMed
11. Burnett J. Sapropterin dihydrochloride (Kuvan/Phenoptin) an orally active synthetic form of BH4 for the treatment of phenylketonuria. IDrugs 2007;10:805–13.Suche in Google Scholar
12. Stanford M, Veating G. Sapropterin: a review of its use in the treatment of primary hyperphenylalaninemia. Drugs 2009;69:461–76.10.2165/00003495-200969040-00006Suche in Google Scholar PubMed
13. Lee P, Treacy E, Crombez E, Wasserstein M, Waber L, et al. The Sapropterin Research Group, 2008. Safety and efficacy of 22 weeks of treatment with sapropterin dihydrochloride in patients with phenylketonuria. Am J Med Genet 2008;146: 2851–9.10.1002/ajmg.a.32562Suche in Google Scholar
14. Burton BK, Adams DJ, Grange DK, Malone JI, Jurecki E, et al. Tetrahydrobiopterin therapy for phenylketonuria in infants and young children. J Peds 2011;158:410–5.10.1016/j.jpeds.2010.08.016Suche in Google Scholar
15. Vernon HJ, Koerner CB, Johnson MR, Bergner A, Hamosh A. Introduction of sapropterin dihydrochloride as standard of care in patients with phenylketonuria. Mol Genet Metab 2010;100L:229–33.10.1016/j.ymgme.2010.03.022Suche in Google Scholar
16. Longo N, Arnold GL, Pridjian G, Enns GM, Ficicioglu C, et al. Longterm safety and efficacy of sapropterin: the PKUDOS registry experience. Mol Genet Metab 2015;114:557–63.10.1016/j.ymgme.2015.02.003Suche in Google Scholar
17. Kor D, Yilmaz BS, Ceylaner S, Mungan N. Improved metabolic control in tetrahydrobiopterin (BH4) responsive phenylketonuria with sapropterin administered in two divided doses vs. a single. J Pediatr Endocrinol Metab 2017;30:713–8.10.1515/jpem-2016-0461Suche in Google Scholar
18. Milstein S, Kaufman S. Studies on the phenylalanine hydroxylase system in liver slices. J Biol Chem 1975;250:4777–81.10.1016/S0021-9258(19)41370-7Suche in Google Scholar
19. Setoodeh A, Yarali B, Rabbani A, Khatami S, Shams S. Tetrahydrobiopterin responsiveness in a series of 53 cases of phenylketonuria and hyperphenylalaninemia in Iran. Mol Genet Metab Rep 2015;2:77–9.10.1016/j.ymgmr.2015.01.001Suche in Google Scholar
20. Levy HL, Milanowski A, Chakrapani A, Cleary M, Lee P, et al. Sapropterin Research Group Efficacy of sapropterin dihydrochloride (tetrahydrobiopterin, 6R-BH4) for reduction of phenylalanine concentration in patients with phenylketonuria: a phase III randomised placebo-controlled study. Lancet 2007;370:504–10.10.1016/S0140-6736(07)61234-3Suche in Google Scholar
21. Trefz FK, Burton BK, Longo N, Casanova MM, Gruskin DJ, et al. Efficacy of sapropterin dihydrochloride in increasing phenylalanine tolerance in children with phenylketonuria: a phase III, randomized, double-blind, placebo-controlled study. J Pediatr 2009;154:700–7.10.1016/j.jpeds.2008.11.040Suche in Google Scholar PubMed
22. Burton BK, Grange DK, Milanowski A, Vockley J, Feillet F, et al. The response of patients with phenylketonuria and elevated serum phenylalanine to treatment with oral sapropterin dihydrochloride (6R-tetrahydrobiopterin): a phase II, multicentre, open-label, screening study. J Inherit Metab Dis 2007;30:700–7.10.1007/s10545-007-0605-zSuche in Google Scholar PubMed
23. Blau N, Belanger-Quintana A, Demirkol M, Feillet F, Giovannini M, et al. Optimizing the use of sapropterin (BH(4)) in the management of phenylketonuria. Mol Genet Metab 2009;96:158–63.10.1016/j.ymgme.2009.01.002Suche in Google Scholar PubMed
24. Feillet F, Van Spronsen FJ, MacDonald A. Challenges and pitfalls in the management of phenylketonuria. Pediatrics 2010;126:333–41.10.1542/peds.2009-3584Suche in Google Scholar PubMed
25. MacDonald A, Ahring K, Dokoupil K, Gokmen-Ozel H, Lammardo AM, et al. Adjusting diet with sapropterin in phenylketonuria: what factors should be considered? Br J Nutr 2011;106:175–82.10.1017/S0007114511000298Suche in Google Scholar PubMed
©2019 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Mini Review
- Endocrine manifestations of PHACE syndrome
- Original Articles
- Quantitation of the arginine family amino acids in the blood of full-term infants perinatally in relation to their birth weight
- Effect of supplementation with omega-3 fatty acids on hypertriglyceridemia in pediatric patients with obesity
- Pediatric diabetes inpatient care: can medical staff knowledge be improved?
- Association of lipid profile and BMI Z-score in southern Iranian children and adolescents
- Arterial stiffness in children and adolescents with and without continuous insulin infusion
- Fasting during the holy month of Ramadan among older children and adolescents with type 1 diabetes in Kuwait
- Evaluation of the relationship between short-term glycemic control and netrin-1, a urinary proximal tubular injury marker in children with type 1 diabetes
- Incidence of diabetic ketoacidosis in newly diagnosed type 1 diabetes children in western Saudi Arabia: 11-year experience
- Novel mutations and spectrum of the disease of NR0B1 (DAX1)-related adrenal insufficiency in Indian children
- Metabolic profile, cardiovascular risk factors and health-related quality of life in children, adolescents and young adults with congenital adrenal hyperplasia
- Safety and effectiveness of growth hormone therapy in infants with Prader-Willi syndrome younger than 2 years: a prospective study
- Response to sapropterin hydrochloride (Kuvan®) in children with phenylketonuria (PKU): a clinical trial
- Prophylactic thyroidectomy in multiple endocrine neoplasia type 2A in children: a single centre experience
- Benign thyroid nodules in pediatric patients: determining best practices for repeat ultrasound evaluations
- Letter to the Editor
- Thyroid function in males with fragile X syndrome
- Case Reports
- A case of a severe reaction following the use of bisphosphonates in a patient with osteogenesis imperfecta
- Cushing disease in a patient with nonbullous congenital ichthyosiform erythroderma: lessons in avoiding glucocorticoids in ichthyosis
- Contiguous gene deletion in a Chinese family with X-linked nephrogenic diabetes insipidus: challenges in early diagnosis and implications for affected families
Artikel in diesem Heft
- Frontmatter
- Mini Review
- Endocrine manifestations of PHACE syndrome
- Original Articles
- Quantitation of the arginine family amino acids in the blood of full-term infants perinatally in relation to their birth weight
- Effect of supplementation with omega-3 fatty acids on hypertriglyceridemia in pediatric patients with obesity
- Pediatric diabetes inpatient care: can medical staff knowledge be improved?
- Association of lipid profile and BMI Z-score in southern Iranian children and adolescents
- Arterial stiffness in children and adolescents with and without continuous insulin infusion
- Fasting during the holy month of Ramadan among older children and adolescents with type 1 diabetes in Kuwait
- Evaluation of the relationship between short-term glycemic control and netrin-1, a urinary proximal tubular injury marker in children with type 1 diabetes
- Incidence of diabetic ketoacidosis in newly diagnosed type 1 diabetes children in western Saudi Arabia: 11-year experience
- Novel mutations and spectrum of the disease of NR0B1 (DAX1)-related adrenal insufficiency in Indian children
- Metabolic profile, cardiovascular risk factors and health-related quality of life in children, adolescents and young adults with congenital adrenal hyperplasia
- Safety and effectiveness of growth hormone therapy in infants with Prader-Willi syndrome younger than 2 years: a prospective study
- Response to sapropterin hydrochloride (Kuvan®) in children with phenylketonuria (PKU): a clinical trial
- Prophylactic thyroidectomy in multiple endocrine neoplasia type 2A in children: a single centre experience
- Benign thyroid nodules in pediatric patients: determining best practices for repeat ultrasound evaluations
- Letter to the Editor
- Thyroid function in males with fragile X syndrome
- Case Reports
- A case of a severe reaction following the use of bisphosphonates in a patient with osteogenesis imperfecta
- Cushing disease in a patient with nonbullous congenital ichthyosiform erythroderma: lessons in avoiding glucocorticoids in ichthyosis
- Contiguous gene deletion in a Chinese family with X-linked nephrogenic diabetes insipidus: challenges in early diagnosis and implications for affected families