Tehran University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share this content! On (X network) By
Four Years of Diagnostic Challenges With Tetrahydrobiopterin Deficiencies in Iranian Patients Publisher



Khatami S1 ; Dehnabeh SR1 ; Zeinali S2, 3 ; Thony B4 ; Alaei M5 ; Salehpour S6 ; Setoodeh A7 ; Rohani F8 ; Hajivalizadeh F9 ; Samavat A9
Authors
Show Affiliations
Authors Affiliations
  1. 1. Department of Biochemistry, Pasteur Institute of Iran, Pasteur Street, No. 69, Tehran, 1316943551, Iran
  2. 2. Genetic Laboratory of Dr Zeinali, Tehran, Iran
  3. 3. Department of Medical Molecular, Pasteur Institute of Iran, Tehran, Iran
  4. 4. Division of Clinical Chemistry and Biochemistry, Laboratory of Molecular Genetic Investigation, University Children’s Hospital Zurich, Zurich, Switzerland
  5. 5. Mofid Children’s Hospital, Shaid Beheshti University of Medical Sciences, Tehran, Iran
  6. 6. Genomic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  7. 7. Growth and Development Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
  8. 8. Department of Pediatrics Endocrinology and Metabolism, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran
  9. 9. Genetics Office, CDC, Ministry of Health of Iran, Tehran, Iran

Source: JIMD Reports Published:2017


Abstract

Hyperphenylalaninemia (HPA) is a condition caused by tetrahydrobiopterin (BH4) and phenylalanine hydroxylase (PAH) deficiencies. It is essential that differential diagnosis be conducted to distinguish these two causes of HPA, because BH4 deficiency is a more severe disease involving progressive neurologic deterioration. Based on the biological findings, HPA is defined as a plasma phenylalanine level of >2.0 mg/dl (>120 μmol/l). The National Biochemistry Reference Laboratory at the Pasteur Institute of Iran initiated BH4 deficiency screening tests for the first time during the implementation of a nationwide phenylketonuria (PKU) screening program. Measurement of blood phenylalanine and urinary neopterin and biopterin was conducted by high-performance liquid chromatography in 617 patients with HPA. Dihydropteridine reductase (DHPR) activity was measured in all patients by kinetic spectrophotometry. Differential diagnosis was conducted for PKU, transient HPA, and BH4 deficiencies. Our results indicated that out of 76 cases involving BH4 deficiencies, 37 had 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency, 35 had DHPR deficiency, 1 case had pterin-4a-carbinolamine dehydratase (PCD) deficiency, and 3 cases had GTP cyclohydrolase I (GTPCH) deficiency. In this study, 1 novel deletion mutation and 18 novel missense mutations were reported in addition to mutations that had previously been identified and registered in BIOMDB. At present, the screening program for PKU in Iran includes tests that detect different forms of BH4 deficiency presenting with HPA. Newborns that are BH4-deficient benefit from the availability of the tests because they can receive necessary care before being clinically affected. © SSIEM and Springer-Verlag Berlin Heidelberg 2016.