• 대한유전성대사질환학회지
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• 제13권2호
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• pp.104-110
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• 2013

Purpose: Phenylketonuria (PKU) is the first inherited metabolic disease of which treatment is known. We performed this study to find out clinical symptoms and prognosis of tetrahydrobiopterin (BH4) responsive PKU patients and genetic relation. Methods: Clinical, biochemical, genetic analysis were done retrospectively in 23 patients diagnosed BH4 responsive PKU in Soonchunhyang University Hospital from March 2000 to September 2012. Results: Patients were classified to mild hyperphenylalaninemia and mild phenylketonuria with initial plasma phenylalanine level below 20 mg/dL. After BH4 loading, blood phenylalanine decrease level ranged between 37% and 99%. Initial treatment with low phenylalanine formula or BH4 was started before 2 month after birth except 2 patients. And one of them resulted in developmental delay in language and social activity. The others showed satisfactory progress without developmental delay. In genetic analysis, of 46 allele, R241C allele mutation was identified most commonly (41%). R241C/A259T, R241C/R243Q, R241C/V388M, R241C/T278I was detected in 5 (21.7%), 3 (13%), 2 (8%), 2 (8%) patients, respectively. Conclusion: R241C mutation was detected most frequently in this study group and R243Q mutation which is known to be prevalent in Korean PKU patients was found in 4 patients (8.6%). Early diagnosis and treatment is important in PKU patients.

• 대한유전성대사질환학회지
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• 제15권2호
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• pp.55-58
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• 2015

Tetrahydrobiopterin ($BH_4$) can normalize blood phenylalanine (Phe) levels in $BH_4$ deficiency, but typically not in phenylketonuria (PKU). In 1999, Kure et al. reported that some PKU patients showed decreased blood Phe levels after $BH_4$ loading, and thereafter, those PKU patients were identified by neonatal PKU screening. A natural cofactor for phenylalanine hydroxylase (PAH) is a 6R-isomer of $BH_4$, which is first synthesized in Japan as Sapropterin dihydrochloride (Biopten$^{(R)}$) in 1982. In Japan, Biopten$^{(R)}$ is first approved for the treatment of $BH_4$ deficiency in 1992, and then for $BH_4$-responsive PAH deficiency (BPKU) in 2008. The discovery of BPKU has vast clinical implications. After Biopten$^{(R)}$ (Kuvan$^{(R)}$) is available for the treatment of BPKU, the QOL of both patients and their families were improved very much, since the serum phenylalanine levels were controlled within 4 mg/dL by $BH_4$ mono-therapy with a normal diet or $BH_4$ combined use of mild phenylalanine-restricted diet. Biopten$^{(R)}$ therapy in patients with BPKU is highly efficacious (70%) at maintaining serum Phe levels within recommended control range and provides excellent safety at least average use period of 10 years (range, 1-17 years) with no unwarranted side effects in Japan. In addition it has been confirmed that sapropterin therapy initiated before 4 years of age was very effective to maintain plasma Phe levels within the favorable range and was safe in Japanese patients with BPKU.

• 대한유전성대사질환학회지
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• 제15권3호
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• pp.110-117
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• 2015

All infants should be screened for phenylketonuria (PKU) within the three days of life, in order to allow timely dietary intervention to protect children with PKU from neurologic damage in Korea. A commonly used cut-off level for diagnosis of PKU is $240{\mu}mol/L$ (4 mg/dL). Up to 2% of cases of hyperphenylalaninemias (HPA) detected by the screening test will account for a disorder of $BH_4$ metabolism. Therefore, analysis of blood or urinary pterins is essential, backed up with measurement of DHPR activity, as this allows differentiation of $BH_4$ disorders. A $BH_4$ loading test and measurement of neurotransmitters in CSF provide further important information to the severity of $BH_4$ deficiency and $BH_4$ loading test can detect patients with $BH_4$ deficiency and $BH_4$ responsive PKU. Several protocols for $BH_4$ loading test have been described, involving treatment with $BH_4$ for periods ranging from 1 day to 1 month, and using doses of $BH_4$ of 10-20 mg/kg. There is general agreement that a reduction on blood phenylalanine of at least 30% in response to $BH_4$ loading indicates a clinically significant effect, although in some tests a lower cut-off value may be defined for individual patients, or no specific cut-off value is proposed. The frequency of $BH_4$ responsiveness is highest in patients with mild HPA and mild to moderate PKU resulting from PAH mutations with residual activity.