title: Biopterin-dependent hyperphenylalaninemia due to deficiency of 6-pyruvoyl tetrahydropterin synthase.
abstract: We describe the clinical, neurologic, and biochemical findings in 10 patients with 6-pyruvoyl tetrahydropterin synthase (6-PTS) deficiency from seven families, all of whom originate from one large tribe in Saudi Arabia. This deficiency presents with severe, early onset of failure to thrive, neurologic deterioration, and morbidity and mortality secondary to repeated episodes of bronchopneumonia or cardiorespiratory abnormalities. The urinary pterin excretion pattern indicates deficient activity of 6-PTS, which has been confirmed by direct enzyme assay in red blood cells of three patients. We treated our patients with combined use of tetrahydrobiopterin 20 mg/kg/d, L-dihydroxyphenylalanine 15 mg/kg/d, carbidopa 3.75 mg/kg/d, and L-5-hydroxytryptophan 5 mg/kg/d. Neurologic findings improved significantly in all after 5 to 24 months. Although head circumference and weight returned to the lower limit of normal in four, height normalized only in one of seven patients. Despite an unrestricted diet during combined therapy, blood phenylalanine and urinary excretion of neopterin and biopterin returned to normal.
authors.affiliation: Department of Pediatrics, King Faisal Specialist Hospital Research Center, Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: al Aqeel
authors.forename: P T
authors.initials: PT
authors.lastname: Ozand
authors.forename: G
authors.initials: G
authors.lastname: Gascon
authors.forename: M
authors.initials: M
authors.lastname: Nester
authors.forename: M
authors.initials: M
authors.lastname: al Nasser
authors.forename: J
authors.initials: J
authors.lastname: Brismar
authors.forename: N
authors.initials: N
authors.lastname: Blau
authors.forename: H
authors.initials: H
authors.lastname: Hughes
authors.forename: S B
authors.initials: SB
authors.lastname: Subramanyan
authors.forename: C T
authors.initials: CT
authors.lastname: Reynolds
mesh_terms: D000429:Alcohol Oxidoreductases / Q000172:deficiency*; D000592:Amino Acid Metabolism, Inborn Errors / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics; D001708:Biopterins / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D010649:Phenylalanine / Q000097:blood / Q000378:metabolism*; D019761:Phosphorus-Oxygen Lyases; D012529:Saudi Arabia
chemical_list: D001708:Biopterins; D010649:Phenylalanine; D000429:Alcohol Oxidoreductases; D019761:Phosphorus-Oxygen Lyases; C043497:6-pyruvoyltetrahydropterin synthase; C003402:sapropterin