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Phenylalanine Effects on Brain Function in Adult Phenylketonuria
Andrea Pilotto1, Carl M Zipser2, Edytha Leks2
1From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands. pilottoandreae@gmail.com.
High phenylalanine levels in adults with phenylketonuria correlate with brain function deficits and neuropsychiatric symptoms. This study highlights the impact of phenylalanine on neurological and cognitive health in PKU patients.
Area of Science:
- Neuroscience
- Biochemistry
- Genetics
Background:
- Phenylketonuria (PKU) is a genetic disorder requiring lifelong dietary management.
- Elevated phenylalanine levels can negatively impact brain development and function.
- Long-term effects of phenylalanine on adult brain health in PKU are not fully understood.
Purpose of the Study:
- To investigate the relationship between circulating phenylalanine levels and brain function in adults with PKU.
- To assess the correlation between phenylalanine and neuropsychiatric symptoms in adult PKU patients.
Main Methods:
- Prospective cross-sectional study of early-treated PKU patients (>30 years) and age/sex-matched controls.
- Comprehensive evaluations including neurologic, neuropsychological, and behavioral assessments.
- Neuroimaging (MRI), neurophysiologic testing (evoked potentials), and CSF analysis for neurodegenerative markers.
Main Results:
- PKU patients showed increased neurological symptoms, cognitive/behavioral issues, and autonomic dysfunction compared to controls.
- Brain imaging revealed atrophy in the putamen and right thalamus in PKU patients.
- Elevated CSF markers (amyloid-beta, tau) and strong correlations between plasma phenylalanine and cognitive deficits, neuropsychiatric symptoms, and brain atrophy were observed.
Conclusions:
- Phenylalanine levels are strongly associated with clinical, cognitive, neurophysiologic, and imaging alterations in adult PKU patients.
- These findings underscore the importance of phenylalanine level management for long-term brain health in PKU.
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