Phenylketonuria Clinical Trial
Official title:
A Pilot Study of FDG PET Findings in Patients With Phenylketonuria Before and After BH4 Supplementation
The aim of this pilot study is to determine if there are any changes in brain glucose metabolism in the gray matter of patients with Phenylketonuria (PKU) and whether administration of Sapropterin (KUVAN) therapy can improve such deficits.
Phenylketonuria (PKU) is an autosomal recessive disorder resulting from a deficiency of
phenylalanine hydroxylase, which converts phenylalanine to tyrosine. Phenylalanine
hydroxylase is one of the three aromatic amino acid hydroxylases that utilizes
tetrahydrobiopterin (BH4) as cofactor. The published reports indicate that there is altered
energy metabolism in the brain of patients with PKU. Phenylalanine and its metabolites
appear to impair several aspects of brain energetics including: (1) Inhibition of glucose
uptake; (2) diminished glycosylation of cytoskeletal proteins; (3) Inhibition of pyruvate
kinase; and (4) reduced flux through the glycolysis. Studies in vivo with magnetic resonance
spectroscopy have demonstrated phenylalanine-responsive abnormalities in cerebral energy
metabolism.
Positron Emission Tomography (PET) scanning with fluorodeoxyglucose (FDG-PET) is a
non-invasive method that measures regional glucose metabolic rate with high resolution and
absolute quantitation. To date this technology has been used only for single case reports or
the investigation of white matter abnormalities in small numbers of patients with PKU.
The aim of this pilot study is to determine if there are any changes in brain glucose
metabolism in the gray matter of patients with PKU and whether Sapropterin (KUVAN) can
improve such deficits. This study will also elucidate the relationship between
hyperphenylalaninemia, phenylalanine intake in diet, altered brain glucose handling and the
neurocognitive profile of the patients with PKU before and after KUVAN therapy.
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Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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