Phenylketonuria: A Comprehensive Review of Pathophysiology, Diagnosis, and Management Strategies
DOI:
https://doi.org/10.12775/QS.2024.18.53878Keywords
Phenylketonuria, PKU diagnosis, phenylketonuria newborn screening, genetic testing for PKU, Quality of Life in PKU patientsAbstract
Introduction: Phenylketonuria (PKU) is a genetically determined congenital metabolic disorder characterized by the body's inability to properly metabolize the amino acid phenylalanine, which is ingested through food. This deficiency leads to the accumulation of phenylalanine in the blood. If untreated, this can result in neurological damage and cognitive impairments. Despite significant progress in understanding the disease, along with advancements in diagnostic methods, the fundamental approach to managing PKU has remained consistent: early detection and adherence to a diet low in phenylalanine are essential to preventing the adverse effects of the disorder.
Purpose of the work: The aim of the study is to analyze and present the current knowledge about phenylketonuria and the quality of life of patients suffering from this disease, as well as methods of its detection.
Materials and methods: An analysis of research papers available on PubMed and Google Scholar was undertaken using the following keywords: phenylketonuria; PKU diagnosis; phenylketonuria newborn screening; genetic testing for PKU; Quality of Life in PKU patients.
Results: There are various diagnostic methods used in newborn screening and to confirm diagnosis. Regardless of the method, early diagnosis and the introduction of an appropriate diet are crucial. Adherence to dietary restrictions and monitoring phenylalanine levels, along with managing the effects of elevated levels in the body, may negatively impact the quality of life for individuals affected by PKU.
References
Elhawary NA, AlJahdali IA, Abumansour IS, Elhawary EN, Gaboon N, Dandini M, Madkhali A, Alosaimi W, Alzahrani A, Aljohani F, Melibary EM, Kensara OA. Genetic etiology and clinical challenges of phenylketonuria. Hum Genomics. 2022 Jul 19;16(1):22. doi: 10.1186/s40246-022-00398-9.
Ho G, Christodoulou J. Phenylketonuria: translating research into novel therapies. Transl Pediatr. 2014 Apr;3(2):49-62. doi: 10.3978/j.issn.2224-4336.2014.01.01.
Williams RA, Mamotte CD, Burnett JR. Phenylketonuria: an inborn error of phenylalanine metabolism. Clin Biochem Rev. 2008 Feb;29(1):31-41.
Stone WL, Basit H, Los E. Phenylketonuria. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30570999.
Williams RA, Mamotte CD, Burnett JR. Phenylketonuria: an inborn error of phenylalanine metabolism. Clin Biochem Rev. 2008 Feb;29(1):31-41.
van Wegberg AMJ, MacDonald A, Ahring K, Bélanger-Quintana A, Blau N, Bosch AM, Burlina A, Campistol J, Feillet F, Giżewska M, Huijbregts SC, Kearney S, Leuzzi V, Maillot F, Muntau AC, van Rijn M, Trefz F, Walter JH, van Spronsen FJ. The complete European guidelines on phenylketonuria: diagnosis and treatment. Orphanet J Rare Dis. 2017 Oct 12;12(1):162. doi: 10.1186/s13023-017-0685-2.
Hillert A, Anikster Y, Belanger-Quintana A, Burlina A, Burton BK, Carducci C, Chiesa AE, Christodoulou J, Đorđević M, Desviat LR, Eliyahu A, Evers RAF, Fajkusova L, Feillet F, Bonfim-Freitas PE, Giżewska M, Gundorova P, Karall D, Kneller K, Kutsev SI, Leuzzi V, Levy HL, Lichter-Konecki U, Muntau AC, Namour F, Oltarzewski M, Paras A, Perez B, Polak E, Polyakov AV, Porta F, Rohrbach M, Scholl-Bürgi S, Spécola N, Stojiljković M, Shen N, Santana-da Silva LC, Skouma A, van Spronsen F, Stoppioni V, Thöny B, Trefz FK, Vockley J, Yu Y, Zschocke J, Hoffmann GF, Garbade SF, Blau N. The Genetic Landscape and Epidemiology of Phenylketonuria. Am J Hum Genet. 2020 Aug 6;107(2):234-250. doi: 10.1016/j.ajhg.2020.06.006.
Kumar Dalei S, Adlakha N. Food Regime for Phenylketonuria: Presenting Complications and Possible Solutions. J Multidiscip Healthc. 2022 Jan 18;15:125-136. doi: 10.2147/JMDH.S330845.
van Spronsen FJ, Blau N, Harding C, Burlina A, Longo N, Bosch AM. Phenylketonuria. Nat Rev Dis Primers. 2021 May 20;7(1):36. doi: 10.1038/s41572-021-00267-0.
Schuck PF, Malgarin F, Cararo JH, Cardoso F, Streck EL, Ferreira GC. Phenylketonuria Pathophysiology: on the Role of Metabolic Alterations. Aging Dis. 2015 Oct 1;6(5):390-9. doi: 10.14336/AD.2015.0827.
Jarochowicz S, Mazur A. Fenyloketonuria – choroba metaboliczna uwarunkowana genetycznie. Przegląd Medyczny Uniwersytetu Rzeszowskiego. Rzeszów 2007, 1, 76–90. Wydawnictwo UR 2007 ISSN 1730-3524.
Rohde C, Thiele AG, Baerwald C, Ascherl RG, Lier D, Och U, Heller C, Jung A, Schönherr K, Joerg-Streller M, Luttat S, Matzgen S, Winkler T, Rosenbaum-Fabian S, Joos O, Beblo S. Preventing maternal phenylketonuria (PKU) syndrome: important factors to achieve good metabolic control throughout pregnancy. Orphanet J Rare Dis. 2021 Nov 18;16(1):477. doi: 10.1186/s13023-021-02108-5.
Caletti MT, Bettocchi I, Baronio F, Brodosi L, Cataldi S, Petroni ML, Cassio A, Marchesini G. Maternal PKU: Defining phenylalanine tolerance and its variation during pregnancy, according to genetic background. Nutr Metab Cardiovasc Dis. 2020 Jun 9;30(6):977-983. doi: 10.1016/j.numecd.2020.02.003.
Alghamdi MA, O'Donnell-Luria A, Almontashiri NA, AlAali WY, Ali HH, Levy HL. Classical phenylketonuria presenting as maternal PKU syndrome in the offspring of an intellectually normal woman. JIMD Rep. 2023 Jul 25;64(5):312-316. doi: 10.1002/jmd2.12384.
Grohmann-Held K, Burgard P, Baerwald CGO, Beblo S, Vom Dahl S, Das A, Dokoupil K, Fleissner S, Freisinger P, Heddrich-Ellerbrok M, Jung A, Korpel V, Krämer J, Lier D, Maier EM, Meyer U, Mühlhausen C, Newger M, Och U, Plöckinger U, Rosenbaum-Fabian S, Rutsch F, Santer R, Schick P, Schwarz M, Spiekerkötter U, Strittmatter U, Thiele AG, Ziagaki A, Mütze U, Gleich F, Garbade SF, Kölker S. Impact of pregnancy planning and preconceptual dietary training on metabolic control and offspring's outcome in phenylketonuria. J Inherit Metab Dis. 2022 Nov;45(6):1070-1081. doi: 10.1002/jimd.12544.
Joint WHO/FAO/UNU Expert Consultation. Protein and amino acid requirements in human nutrition. World Health Organ Tech Rep Ser. 2007;(935):1-265, back cover. PMID: 18330140.
Scientific Opinion on Dietary Reference Values for protein [Internet]. [Cited 25.07.2024]. Available from: https://www.efsa.europa.eu/en/efsajournal/pub/2557.
Newborn Metabolic Screening Provider Frequently Asked Questions [Internet]. [Cited: 25.07.2024]. Available from: https://health.maryland.gov/phpa/cyshcn/Pages/NBS_Provider_FAQ.aspx.
Phenylketonuria (PKU) [Internet]. [Cited: 25.07.2024]. Available from: https://www.mayoclinic.org/diseases-conditions/phenylketonuria/diagnosis-treatment/drc-20376308
Badania przesiewowe noworodków Zakład Badań Przesiewowych i diagnostyki Metabolicznej [Internet]. [Cited: 25.07.2024]. Available from: https://przesiew.imid.med.pl/badaniaprzesiewowe.html
Janzen N, Sander J. Entwicklung der Analytik im Neugeborenen-Screening – Von der Guthrie-Karte zur Genetik [Development of analytics in newborn screening-from the Guthrie card to genetics]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2023 Nov;66(11):1214-1221. German. doi: 10.1007/s00103-023-03774-5.
Perko D, Groselj U, Cuk V, Iztok Remec Z, Zerjav Tansek M, Drole Torkar A, Krhin B, Bicek A, Oblak A, Battelino T, Repic Lampret B. Comparison of Tandem Mass Spectrometry and the Fluorometric Method-Parallel Phenylalanine Measurement on a Large Fresh Sample Series and Implications for Newborn Screening for Phenylketonuria. Int J Mol Sci. 2023 Jan 27;24(3):2487. doi: 10.3390/ijms24032487. PMID: 36768810; PMCID: PMC9916910.
Gelb MH, Basheeruddin K, Burlina A, Chen HJ, Chien YH, Dizikes G, Dorley C, Giugliani R, Hietala A, Hong X, Kao SM, Khaledi H, Klug T, Kubaski F, Liao HC, Martin M, Manning A, Orsini J, Peng Y, Ranieri E, Rohrwasser A, Szabo-Fresnais N, Turgeon CT, Vaz FM, Wang LY, Matern D. Liquid Chromatography-Tandem Mass Spectrometry in Newborn Screening Laboratories. Int J Neonatal Screen. 2022 Nov 28;8(4):62. doi: 10.3390/ijns8040062.
Sanger F, Nicklen S, Coulson AR. DNA sequencing with chain-terminating inhibitors. Proc Natl Acad Sci U S A. 1977 Dec;74(12):5463-7. doi: 10.1073/pnas.74.12.5463.
White-Corey S, Peck JL, Pérez RI. Ethical implications of next-generation sequencing and the future of newborn screening. J Am Assoc Nurse Pract. 2021 Jun 30;33(7):492-495. doi: 10.1097/JXX.0000000000000631.
Takarada Y, Kagawa S, Okano Y, Tanizawa T. Rapid single-base mismatch detection in genotyping for phenylketonuria. Mol Biotechnol. 2003 Jul;24(3):233-42. doi: 10.1385/MB:24:3:233.
Wang R, Shen N, Ye J, Han L, Qiu W, Zhang H, Liang L, Sun Y, Fan Y, Wang L, Wang Y, Gong Z, Liu H, Wang J, Yan H, Blau N, Gu X, Yu Y. Mutation spectrum of hyperphenylalaninemia candidate genes and the genotype-phenotype correlation in the Chinese population. Clin Chim Acta. 2018 Jun;481:132-138. doi: 10.1016/j.cca.2018.02.035.
Moat SJ, Schulenburg-Brand D, Lemonde H, Bonham JR, Weykamp CW, Mei JV, Shortland GS, Carling RS. Performance of laboratory tests used to measure blood phenylalanine for the monitoring of patients with phenylketonuria. J Inherit Metab Dis. 2020 Mar;43(2):179-188. doi: 10.1002/jimd.12163.
MacDonald A, van Wegberg AMJ, Ahring K, Beblo S, Bélanger-Quintana A, Burlina A, Campistol J, Coşkun T, Feillet F, Giżewska M, Huijbregts SC, Leuzzi V, Maillot F, Muntau AC, Rocha JC, Romani C, Trefz F, van Spronsen FJ. PKU dietary handbook to accompany PKU guidelines. Orphanet J Rare Dis. 2020 Jun 30;15(1):171. doi: 10.1186/s13023-020-01391-y. Erratum in: Orphanet J Rare Dis. 2020 Sep 1;15(1):230. doi: 10.1186/s13023-020-01486-6.
Regier DS, Greene CL. Phenylalanine Hydroxylase Deficiency. In: Adam MP, Everman DB, Mirzaa GM, et al., editors. GeneReviews [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2023. 2000 Jan 10. [Cited: 25.07.2024]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1504/
Jahangiri Z, Rostampour N, Hovsepian S, Chegini R, Hashemipour M. Quality of Life in Patients with Phenylketonuria: A Systematic Review. Adv Biomed Res. 2024 Feb 26;13:15. doi: 10.4103/abr.abr_238_23.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Agata Konopka, Zuzanna Szczepaniak, Natalia Wdowiak, Dominika Ziółkowska, Kinga Adamska, Karina Lissak
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 152
Number of citations: 0