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Prospects for Cell-Directed Curative Therapy of Phenylketonuria (PKU)

Overview
Journal Mol Front J
Specialty Molecular Biology
Date 2020 Jun 12
PMID 32524084
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Abstract

Phenylketonuria (PKU) due to recessively inherited phenylalanine hydroxylase (PAH) deficiency is among the most common inborn errors of metabolism. Dietary therapy begun early in infancy prevents the major manifestations of the disease but shortcomings to treatment continue to exist including lifelong commitment to a complicated and unpalatable diet, poor adherence to diet in adolescence and adulthood, and consequently a range of unsatisfactory outcomes, including neuropsychiatric disorders, frequently develop. Novel treatments that do not strictly depend upon dietary protein restriction are actively sought. This review discusses the potential for and the limitations of permanently curative cell-directed treatment of PKU, including liver-directed gene therapy and gene editing, if initiated during early infancy. A fictional but realistic vignette of a family with a new baby girl recently diagnosed with PKU is presented. What is needed to permanently cure her?

References
1.
Platt L, Koch R, Hanley W, Levy H, Matalon R, Rouse B . The international study of pregnancy outcome in women with maternal phenylketonuria: report of a 12-year study. Am J Obstet Gynecol. 2000; 182(2):326-33. DOI: 10.1016/s0002-9378(00)70219-5. View

2.
Levy H, Milanowski A, Chakrapani A, Cleary M, Lee P, Trefz F . Efficacy of sapropterin dihydrochloride (tetrahydrobiopterin, 6R-BH4) for reduction of phenylalanine concentration in patients with phenylketonuria: a phase III randomised placebo-controlled study. Lancet. 2007; 370(9586):504-10. DOI: 10.1016/S0140-6736(07)61234-3. View

3.
McDonald J, Bode V, Dove W, Shedlovsky A . Pahhph-5: a mouse mutant deficient in phenylalanine hydroxylase. Proc Natl Acad Sci U S A. 1990; 87(5):1965-7. PMC: 53605. DOI: 10.1073/pnas.87.5.1965. View

4.
Hamman K, Clark H, Montini E, Al-Dhalimy M, Grompe M, Finegold M . Low therapeutic threshold for hepatocyte replacement in murine phenylketonuria. Mol Ther. 2005; 12(2):337-44. PMC: 2694052. DOI: 10.1016/j.ymthe.2005.03.025. View

5.
Harding C, Amato R, Stuy M, Longo N, Burton B, Posner J . Pegvaliase for the treatment of phenylketonuria: A pivotal, double-blind randomized discontinuation Phase 3 clinical trial. Mol Genet Metab. 2018; 124(1):20-26. DOI: 10.1016/j.ymgme.2018.03.003. View