title: Evaluation of Tetrahydrobiopterin Therapy with Large Neutral Amino Acid Supplementation in Phenylketonuria: Effects on Potential Peripheral Biomarkers, Melatonin and Dopamine, for Brain Monoamine Neurotransmitters.
abstract: BACKGROUND
  Phenylketonuria (PKU) is due to a defective hepatic enzyme, phenylalanine (Phe) hydroxylase. Transport of the precursor amino acids from blood into the brain for serotonin and dopamine synthesis is reported to be inhibited by high blood Phe concentrations. Deficiencies of serotonin and dopamine are involved in neurocognitive dysfunction in PKU.
  
  
  OBJECTIVE
  (1) To evaluate the effects of sapropterin (BH4) and concurrent use of large neutral amino acids (LNAA) on the peripheral biomarkers, melatonin and dopamine with the hypothesis they reflect brain serotonin and dopamine metabolism. (2) To evaluate synergistic effects with BH4 and LNAA. (3) To determine the effects of blood Phe concentrations on the peripheral biomarkers concentrations.
  
  
  METHODS
  Nine adults with PKU completed our study consisting of four 4-week phases: (1) LNAA supplementation, (2) Washout, (3) BH4 therapy, and (4) LNAA with BH4 therapy. An overnight protocol measured plasma amino acids, serum melatonin, and 6-sulfatoxymelatonin and dopamine in first void urine after each phase.
  
  
  RESULTS
  (1) Three out of nine subjects responded to BH4. A significant increase of serum melatonin levels was observed in BH4 responders with decreased blood Phe concentration. No significant change in melatonin, dopamine or Phe levels was observed with BH4 in the subjects as a whole. (2) Synergistic effects with BH4 and LNAA were observed in serum melatonin in BH4 responders. (3) The relationship between serum melatonin and Phe showed a significant negative slope (p = 0.0005) with a trend toward differing slopes among individual subjects (p = 0.066). There was also a negative association overall between blood Phe and urine 6-sulfatoxymelatonin and dopamine (P = 0.040 and 0.047).
  
  
  CONCLUSIONS
  Blood Phe concentrations affected peripheral monoamine neurotransmitter biomarker concentrations differently in each individual with PKU. Melatonin levels increased with BH4 therapy only when blood Phe decreased. Monitoring peripheral neurotransmitter metabolites may assist in optimizing individualized treatment in PKU.
authors: Genetics Division, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
authors: Shoji
authors: S
authors: Yano
authors: Genetics Division, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
authors: Kathryn
authors: K
authors: Moseley
authors: Department of Pathology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
authors: Xiaowei
authors: X
authors: Fu
authors: Clinical and Translational Science Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
authors: Colleen
authors: C
authors: Azen
mesh_terms: D000328:Adult; D021542:Amino Acids, Neutral / Q000627:therapeutic use*; D015415:Biomarkers / Q000378:metabolism; D001708:Biopterins / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019587:Dietary Supplements; D004298:Dopamine / Q000378:metabolism / Q000652:urine; D004357:Drug Synergism; D005260:Female; D006801:Humans; D008297:Male; D008550:Melatonin / Q000097:blood / Q000378:metabolism / Q000652:urine; D008875:Middle Aged; D010649:Phenylalanine / Q000097:blood; D010661:Phenylketonurias / Q000188:drug therapy*; D012701:Serotonin / Q000378:metabolism*
chemical_list: D021542:Amino Acids, Neutral; D015415:Biomarkers; D001708:Biopterins; D012701:Serotonin; D010649:Phenylalanine; C003402:sapropterin; D008550:Melatonin; D004298:Dopamine