Phenylketonuria (PKU) General Overview

Total Page:16

File Type:pdf, Size:1020Kb

Phenylketonuria (PKU) General Overview Phenylketonuria (PKU) General Overview Q. What is PKU? A. Phenylketonuria (PKU) is a treatable disorder that affects the way the body processes protein. Children with PKU cannot use a part of the protein called phenylalanine. If left untreated, phenylalanine builds up in the bloodstream and causes brain damage. Q. How does the body normally process phenylalanine? A. The body normally converts phenylalanine into tyrosine, which is used by the body in other metabolic functions. This conversion is made possible by an enzyme called phenylalanine hydroxylase. Q. What happens to phenylalanine in a child with PKU? A. In a child with PKU, phenylalanine cannot be converted to tyrosine because the phenylalanine hydroxylase enzyme does not work properly. This results in dangerously high levels of phenylalanine that build up in the blood and become toxic to the brain and nervous system. Q. What are the effects of having PKU if it is not treated? A. Untreated PKU results in severe mental retardation and other problems of the nervous system. Q. What is the treatment for PKU? A. Phenylketonuria is treated with a special diet that is low in phenyalanine. To prevent mental retardation, treatment must begin shortly after birth. Since protein is essential for normal growth and development, the child must continue on a special formula that provides protein and essential nutrients, but contains little or no phenylalanine. People with PKU require specialized treatment through a clinic with experience in treating this disorder. Q. Why would a child have PKU? A. Phenylketonuria is an inherited disorder. It results when a baby receives a double-dose of a non- working phenylalanine hydroxylase gene (one from each parent). For more information about this, contact your health care provider or a genetic counselor. Q. How common is PKU? About one in every 15,000 babies in Washington State is born with PKU. For more information about PKU, please see the Disorders section of our website: www.doh.wa.gov/nbs. Washington State Department of Health • Newborn Screening Program 1610 NE 150th Street, K17-9 • Shoreline, WA 98155-0729 • www.doh.wa.gov/nbs Phone: (206) 418-5410 • FAX: (206) 418-5415 • E-mail: [email protected] Revised: 04/04.
Recommended publications
  • Incidence of Inborn Errors of Metabolism by Expanded Newborn
    Original Article Journal of Inborn Errors of Metabolism & Screening 2016, Volume 4: 1–8 Incidence of Inborn Errors of Metabolism ª The Author(s) 2016 DOI: 10.1177/2326409816669027 by Expanded Newborn Screening iem.sagepub.com in a Mexican Hospital Consuelo Cantu´-Reyna, MD1,2, Luis Manuel Zepeda, MD1,2, Rene´ Montemayor, MD3, Santiago Benavides, MD3, Hector´ Javier Gonza´lez, MD3, Mercedes Va´zquez-Cantu´,BS1,4, and Hector´ Cruz-Camino, BS1,5 Abstract Newborn screening for the detection of inborn errors of metabolism (IEM), endocrinopathies, hemoglobinopathies, and other disorders is a public health initiative aimed at identifying specific diseases in a timely manner. Mexico initiated newborn screening in 1973, but the national incidence of this group of diseases is unknown or uncertain due to the lack of large sample sizes of expanded newborn screening (ENS) programs and lack of related publications. The incidence of a specific group of IEM, endocrinopathies, hemoglobinopathies, and other disorders in newborns was obtained from a Mexican hospital. These newborns were part of a comprehensive ENS program at Ginequito (a private hospital in Mexico), from January 2012 to August 2014. The retrospective study included the examination of 10 000 newborns’ results obtained from the ENS program (comprising the possible detection of more than 50 screened disorders). The findings were the following: 34 newborns were confirmed with an IEM, endocrinopathies, hemoglobinopathies, or other disorders and 68 were identified as carriers. Consequently, the estimated global incidence for those disorders was 3.4 in 1000 newborns; and the carrier prevalence was 6.8 in 1000. Moreover, a 0.04% false-positive rate was unveiled as soon as diagnostic testing revealed negative results.
    [Show full text]
  • Tetrahydrobiopterin Loading Test in Hyperphenylalaninemia
    003 1-399819113005-0435$03.00/0 PEDIATRIC RESEARCH Vol. 30, No. 5, 1991 Copyright 0 199 1 International Pediatric Research Foundation, Inc. Pr~ntc.d in U.S. A Tetrahydrobiopterin Loading Test in Hyperphenylalaninemia ALBERT0 PONZONE, ORNELLA GUARDAMAGNA, SILVIO FERRARIS, GIOVANNI B. FERRERO, IRMA DIANZANI, AND RICHARD G. H. COTTON InstiflifeofPediatric Clinic(A.P., O.G., S.F., G.B.F., I.D.], University of Torino, 10126 Torino, Italy and Olive Miller Laboratory [R.G.H.C.],Murdoch Institute, Royal Children's Hospital, Vicroria,Australia 3052 ABSTRACT. Some cases of primary hyperphenylalanine- PKU to describe some cases clinically unresponsive to a Phe- mia are not caused by the lack of phenylalanine hydroxyl- restricted diet and later shown to be due to BH4 deficiency ase, but by the lack of its cofactor tetrahydrobiopterin. ( 1-4). These patients are not clinically responsive to a phenylal- By analyzing all the essential components of the complex anine-restricted diet, but need specific substitution therapy. hydroxylation system of aromatic amino acids, it became appar- Thus, it became necessary to examine all newborns ent that a defect in the BH4 recycling enzyme DHPR (EC screened as positive with the Guthrie test for tetrahydro- 1.66.99.7) and two defects in BH4 synthetic pathway enzymes, biopterin deficiency. Methods based on urinary pterin or guanosine triphosphate cyclohydrolase I (EC 3.5.4.16) and 6- on specific enzyme activity measurements are limited in PPH4S, may lead to cofactor deficiency resulting in HPA and in their availability, and the simplest method, based on the impaired production of dopamine and serotonin (5-7).
    [Show full text]
  • Gene Function
    Gene Function Chapter 12 The Central Dogma of Biology GATC transcription GAUC translation 20 amino acids Gene Control of Enzyme Structure • Genes encode proteins, including enzymes. • Genes work in sets to accomplish biochemical pathways. • Genes often work in cooperation with other genes. • These discoveries are the foundation of modern molecular genetics. Genetic Approach to Studying the Gene – Enzyme Connection Beadle (Drosophila geneticist) and Tatum (biochemist), 1940’s • Tried for 6 years (1935- 1941) to link genes to chemical reactions in Drosophila. • Switched to a simpler organism: Neurospora crassa • Irradiated and isolated many arginine auxotrophs. Beadle and Tatum and Neurospora mutants • Mutagenized normal Neurospora cells; undergo meiosis… • Isolated individual cells (ascospores) into separate tubes with complete media (growth media that is rich with amino acids, nucleotides, etc… opposite of minimal media). • Tested each for the ability to grow on minimal media. Neurospora Mutants Certain cells did not grow on minimal medium. The type of auxotrophy was tested on media with various supplements. Arginine Mutants Identified • After isolating mutants deficient in amino acid production, specific amino acid deficiencies were identified. • For the purpose of our discussion, we will focus on the arginine mutants. • Several independent arginine mutants were isolated. arg X arg mutant 1 mutant 2 Only if strains are mutant for heterokaryon: a different transient diploid genes How Do We Figure Out The Pathway? Each complementation group responded differently to supplements which were thought to be intermediates in the biochemical synthesis pathway leading to arginine. l ornithine a m i n i m citrulline - - - arginine Next, figure out at which step in the pathway each complementation group (gene) acts… Mutant minimal citrulline ornithine arginine arg-1 - + + + arg-2 - + - + arg-3 - - - + arg-1 arg-2 arg-3 enz.
    [Show full text]
  • Screening for Inherited Metabolic Disease in Wales Using Urine-Impregnated Filter Paper
    Arch Dis Child: first published as 10.1136/adc.50.4.264 on 1 April 1975. Downloaded from Archives of Disease in Childhood, 1975, 50, 264. Screening for inherited metabolic disease in Wales using urine-impregnated filter paper D. M. BRADLEY From the Department of Medicine, Welsh National School of Medicine, Heath Park, Cardiff Bradley, D. M. (1975). Archives of Disease in Childhood, 50, 264. Screening for inherited metabolic disease in Wales using urine-impregnated filter paper. Urine specimens from 135 295 infants have been collected on filter paper and tested for 7 abnormal urinary constituents using spot tests and paper chromato- graphy. The method has detected 5 infants with phenylketonuria, 4 with histidinae- mia, 5 with cystinuria, 5 with diabetes mellitus, and one with alcaptonuria. Transient abnormalities such as tyrosyluria, generalized aminoaciduria, cystinuria, and glyco- suria have been noted. 2 phenylketonuric infants failed to excrete a detectable quantity of o-hydroxyphenylacetic acid at the time of testing. The findings show that the detection of this compound in urine is an unreliable method of screening for phenylketonuria. Early detection of phenylketonuria became Method essential when it was found that the severe mental Collection of urine specimens. The recom- retardation associated with this disorder could be mended time of testing is between the 10th and 14th prevented by introducing a low phenylalanine diet day of life. In practice, 53% of all specimens are in the first months of life (Bickel, Gerrard, and collected by the 14th day, rising to 98% by the 28th Hickmans, 1953). The Medical Research Council day (Table I).
    [Show full text]
  • Living with Classical Homocystinuria
    Living with Classical Homocystinuria This brochure will help you understand what classical homocystinuria is, how it affects your body, and how you can manage your condition A few words about this brochure What is homocystinuria? Has your doctor diagnosed you or your child You may have heard the word “homocystinuria” with homocystinuria (HO-mo-SIS-tin-YUR- for the first time when your doctor talked to ee-uh)? There are three types of genetic you about possibly having this condition. disorders that cause homocystinuria. Each Homocystinuria is a rare disorder involving type has a different cause and different the amino acid homocysteine (HO-mo-SIS- health issues. This brochure will talk about teen). Amino acids are building blocks that your classical homocystinuria. The information body uses to make proteins. Homocystinuria will help you understand classical occurs when there is a buildup of the amino acid homocystinuria and how you can manage homocysteine in your blood and urine. your condition. High levels of homocysteine can be harmful to your body. You may be reading this brochure because you have classical homocystinuria or Why is there homocysteine because your child or a sibling or a friend in your body? has it. Or perhaps you’re a healthcare professional. Please note the brochure It starts with the foods you eat. Your body addresses “you,” but it’s understood that makes homocysteine from another amino acid “you,” the reader, may not have classical called methionine (meh-THIGH-uh-neen). Most homocystinuria yourself. foods contain some methionine. But high-protein foods such as meat, fish, eggs, or cheese tend to have the most methionine.
    [Show full text]
  • The PAH Gene, Phenylketonuria, and a Paradigm Shift
    HUMAN MUTATION 28(9), 831^845, 2007 WILEY 200TH ANNIVERSARY TRIBUTE ARTICLE The PAH Gene, Phenylketonuria, and a Paradigm Shift Charles R. Scriver1–4Ã 1Department of Human Genetics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; 2Department of Biochemistry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; 3Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; 4Department of Biology, Faculty of Science, McGill University, Montreal, Quebec, Canada Communicated by Johannes Zschocke ‘‘Inborn errors of metabolism,’’ first recognized 100 years ago by Garrod, were seen as transforming evidence for chemical and biological individuality. Phenylketonuria (PKU), a Mendelian autosomal recessive phenotype, was identified in 1934 by Asbjo¨rn Fo¨lling. It is a disease with impaired postnatal cognitive development resulting from a neurotoxic effect of hyperphenylalaninemia (HPA). Its metabolic phenotype is accountable to multifactorial origins both in nurture, where the normal nutritional experience introduces L-phenylalanine, and in nature, where mutations (4500 alleles) occur in the phenylalanine hydroxylase gene (PAH) on chromosome 12q23.2 encoding the L-phenylalanine hydroxylase enzyme (EC 1.14.16.1). The PAH enzyme converts phenylalanine to tyrosine in the presence of molecular oxygen and catalytic amounts of tetrahydrobiopterin (BH4), its nonprotein cofactor. PKU is among the first of the human genetic diseases to enter, through newborn screening, the domain of public health, and to show a treatment effect. This effect caused a paradigm shift in attitudes about genetic disease. The PKU story contains many messages, including: a framework on which to appreciate the complexity of PKU in which phenotype reflects both locus-specific and genomic components; what the human PAH gene tells us about human population genetics and evolution of modern humans; and how our interest in PKU is served by a locus-specific mutation database (http://www.pahdb.mcgill.ca; last accessed 20 March 2007).
    [Show full text]
  • Molecular Patterns Behind Immunological and Metabolic Alterations in Lysinuric Protein Intolerance
    MOLECULAR PATTERNS BEHIND IMMUNOLOGICAL AND METABOLIC ALTERATIONS IN LYSINURIC PROTEIN INTOLERANCE Johanna Kurko TURUN YLIOPISTON JULKAISUJA – ANNALES UNIVERSITATIS TURKUENSIS Sarja - ser. D osa - tom. 1220 | Medica - Odontologica | Turku 2016 University of Turku Faculty of Medicine Institute of Biomedicine Department of Medical Biochemistry and Genetics Turku Doctoral Programme of Molecular Medicine (TuDMM) Supervised by Adjunct Professor Juha Mykkänen, Ph.D Professor Harri Niinikoski, MD, Ph.D Research Centre of Applied and Department of Paediatrics and Preventive Cardiovascular Medicine Adolescent Medicine University of Turku Turku University Hospital Turku, Finland University of Turku Turku, Finland Reviewed by Adjunct Professor Risto Lapatto, MD, Ph.D Adjunct Professor Outi Monni, Ph.D Department of Paediatrics Research Programs’ Unit and Institute of Helsinki University Hospital Biomedicine University of Helsinki University of Helsinki Helsinki, Finland Helsinki, Finland Opponent Adjunct Professor Päivi Saavalainen, Ph.D Research Programs Unit University of Helsinki Helsinki, Finland The originality of this thesis has been checked in accordance with the University of Turku quality assurance system using the Turnitin OriginalityCheck service. ISBN 978-951-29-6399-7 (PRINT) ISBN 978-951-29-6400-0 (PDF) ISSN 0355-9483 (PRINT) ISSN 2343-3213 (ONLINE) Painosalama Oy - Turku, Finland 2016 ‘Nothing has such power to broaden the mind as the ability to investigate systematically and truly all that comes under thy observation in life.’ Marcus
    [Show full text]
  • Disorders Alphabetical by Disease Updated 1/2020
    Disorders Alphabetical by Disease updated 1/2020 Disorders Abbreviation Classification Recommended Uniform Screening Panel (RUSP) Classification 2,4 Dienoyl CoA Reductase Deficiency DE RED Fatty Acid Oxidation Disorder Secondary Condition 2-Methyl 3 Hydroxy Butyric Aciduria 2M3HBA Organic Acid Disorder Secondary Condition 2-Methyl Butyryl-CoA Dehydrogenase Deficiency 2MBG Organic Acid Disorder Secondary Condition (called 2-Methylbutyrylglycinuria on RUSP) 3-Hydroxy-3-Methylglutaryl CoA Lyase Deficiency HMG Organic Acid Disorder Core Condition 3-Methylcrotonyl CoA Carboxylase Deficiency 3MCC Organic Acid Disorder Core Condition 3-Methylglutaconic Aciduria 3MGA Organic Acid Disorder Secondary Condition Alpha-Thalassemia (Bart's Hb) Hemoglobin Bart's Hemoglobin Disorder Secondary Conditoin Argininemia, Arginase Deficiency ARG Amino Acid Disorder Secondary Condition Arginosuccinic Aciduria ASA Amino Acid Disorder Core Condition Benign Hyperphenylalaninemia PHE Amino Acid Disorder Secondary Condition Beta-Ketothiolase Deficiency BKT Organic Acid Disorder Core Condition Biopterin Defect in Cofactor Biosynthesis BIOPT (BS) Amino Acid Disorder Secondary Condition Biopterin Defect in Cofactor Regeneration BIOPT (Reg) Amino Acid Disorder Secondary Condition Biotinidase Deficiency BIO Metabolic Disorder of Biotin Recycling Core Condition Carbamoyltransferase Deficiency, Carbamoyl Phosphate Synthetase I Deficiency CPS Amino Acid Disorder Not on RUSP Carnitine Palmitoyl Transferase Deficiency Type 1 CPT I Fatty Acid Oxidation Disorder Secondary Condition
    [Show full text]
  • Diagnosis, Classification, and Genetics of Phenylketonuria and Tetrahydrobiopterin (BH4) Deficiencies
    Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2011 Diagnosis, classification, and genetics of phenylketonuria and tetrahydrobiopterin (BH4) deficiencies Blau, N ; Hennermann, J B ; Langenbeck, U ; Lichter-Konecki, U Abstract: This article summarizes the present knowledge, recent developments, and common pitfalls in the diagnosis, classification, and genetics of hyperphenylalaninemia, including tetrahydrobiopterin (BH4) deficiency. It is a product of the recent workshop organized by the European Phenylketonuria Groupin March 2011 in Lisbon, Portugal. Results of the workshop demonstrate that following newborn screening for phenylketonuria (PKU), using tandem mass-spectrometry, every newborn with even slightly elevated blood phenylalanine (Phe) levels needs to be screened for BH4 deficiency. Dried blood spots are the best sample for the simultaneous measurement of amino acids (phenylalanine and tyrosine), pterins (neopterin and biopterin), and dihydropteridine reductase activity from a single specimen. Following diagnosis, the patient’s phenotype and individually tailored treatment should be established as soon as possible. Not only blood Phe levels, but also daily tolerance for dietary Phe and potential responsiveness to BH4 are part of the investigations. Efficiency testing with synthetic BH4 (sapropterin dihydrochloride) over several weeks should follow the initial 24-48-hour screening test with 20mg/kg/day BH4. The specific genotype, i.e. the combination of both PAH alleles of the patient, helps or facilitates to determine both the biochemical phenotype (severity of PKU) and the responsiveness to BH4. The rate of Phe metabolic disposal after Phe challenge may be an additional useful tool in the interpretation of phenotype-genotype correlation.
    [Show full text]
  • Comparison of the Estimated Prevalence of Diagnosed Homocystinuria and Phenylketonuria in the United States
    Comparison of the Estimated Prevalence of Diagnosed Homocystinuria and Phenylketonuria in the United States Marcia Sellos-Moura1, Frank Glavin1, David Lapidus2, Patrick T. Horn1, Kristin Evans4, Carolyn R. Lew3, Debra E. Irwin4 1Orphan Technologies, 430 Bedford Street, Suite 195, Lexington, MA 02420, USA; 2LapidusData Inc., 321 NE 4th St, Oklahoma City, OK 73104, USA; 3IBM Watson Health, 6200 S. Syracuse Way, Ste. 300, Greenwood Village, CO, 80111, USA; 4IBM Watson Health, 7700 Old Georgetown Rd, Bethesda, MD 20814, USA Background Table 1. Demographic Characteristics at First Recorded Diagnosis in Study Period HCU PKU p-value • Classical homocystinuria (HCU) is a rare inherited (genetic) disorder in which the body is unable to process N=6,613 N=5,120 the toxic compound homocysteine (HCY), which is involved in several important metabolic processes. HCU Average age (years) 55.5 (SD 14.8) 17.5 (SD 21.0) <0.001 Male 0.019 1 49.2% 47.0% is caused by mutations in the cystathionine beta synthase CBS gene. Region 1.000 Northeast 12.4% 17.7% • At least 1 in 200,000–335,000 people worldwide, and 1 in 100,000 to 200,000 in the United States, are North Central 23.8% 19.8% 2,3,4 South 43.5% 34.2% estimated to have homocystinuria (HCU). West 20.0% 27.1% Missing 0.3% 1.2% • However, these prevalence estimates are widely believed to be an underestimate of the prevalence of HCU. Residence in an urban area 90.4% 85.1% <0.001 Several studies have estimated the birth prevalence of HCU to be much higher.
    [Show full text]
  • Metabolic Diseases Abstract G227 Mean Phe Levels(Μmol/L)
    A74 Arch Dis Child 2002;86(Suppl I):A74–A75 Arch Dis Child: first published as 10.1136/adc.86.suppl_1.A74 on 1 April 2002. Downloaded from Metabolic diseases Abstract G227 Mean phe levels(µmol/l) Median IQR WHAT IS THE SIGNIFICANCE OF A RAISED G226 0–4 yr 337 287–392 PHENYLALANINE IN NEONATAL SCREENING? 5–9 yr 400 340–507 10–14 yr 577 464–793 1 2 2 2 1 M. Galogavrou , M. Downing , R.J. Pollitt , J.R. Bonham ,M.J. Sharrard . 15–19 yr 893 660–1116 Departments of Paediatrics1 and Chemical Pathology and Neonatal Screening2, Sheffield Children’s Hospital Frequency of blood sampling (%) Median IQR Infants born in UK are screened for phenylketonuria (PKU) on day 6. False positive results are inevitably generated by screening 0–4 yr 81 63–90 programmes; in PKU screening, galactosaemia may be a cause of 5–9 yr 86 58–113 elevated phenylalanine (phe), but the clinical significance in others is 10–14 yr 71 50–94 unknown. 15–19 yr 46 25–75 Aim: to examine the outcome of non-PKU infants with a raised phe Samples > recommended phe (%) on neonatal screening, and to determine the incidence of raised phe in galactosaemia. Median IQR Method: (1) All infants born and screened in Trent between 0–4 yr 28 18–45 1/10/99 and 30/09/01 were included. Those with persistently 5–9 yr 27 11–48 raised phe were followed by enquiry, and galactose measured in the 10–14 yr 50 26–79 screening blood spot.
    [Show full text]
  • Early Diagnosis of Classic Homocystinuria in Kuwait Through Newborn Screening: a 6-Year Experience
    International Journal of Neonatal Screening Article Early Diagnosis of Classic Homocystinuria in Kuwait through Newborn Screening: A 6-Year Experience Hind Alsharhan 1,2,3,*, Amir A. Ahmed 4,5 , Naser M. Ali 5 , Ahmad Alahmad 6, Buthaina Albash 3, Reem M. Elshafie 3,5, Sumaya Alkanderi 3,5, Usama M. Elkazzaz 7, Parakkal Xavier Cyril 8, Rehab M. Abdelrahman 4, Alaa A. Elmonairy 3, Samia M. Ibrahim 9, Yasser M. E. Elfeky 10, Doaa I. Sadik 3, Sara D. Al-Enezi 6, Ayman M. Salloum 11, Yadav Girish 12, Mohammad Al-Ali 5, Dina G. Ramadan 13, Rasha Alsafi 14, May Al-Rushood 4 and Laila Bastaki 3 1 Department of Pediatrics, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait 2 Department of Pediatrics, Farwaniya Hospital, Ministry of Health, Sabah Al-Nasser 92426, Kuwait 3 Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; [email protected] (B.A.); [email protected] (R.M.E.); [email protected] (S.A.); [email protected] (A.A.E.); [email protected] (D.I.S.); [email protected] (L.B.) 4 Newborn Screening Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; [email protected] (A.A.A.); [email protected] (R.M.A.); [email protected] (M.A.-R.) 5 Next Generation Sequencing Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; [email protected] (N.M.A.); [email protected] (M.A.-A.) 6 Molecular Genetics Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait;
    [Show full text]