Characterization of changes in the tyrosine pathway by 24-h profiling during nitisinone treatment in alkaptonuria

Ranganath, LR, Milan, AM, Hughes, AT, Davison, AS ORCID: 0000-0001-5501-4475, Khedr, M, Norman, BP ORCID: 0000-0001-9293-4852, Bou-Gharios, G, Gallagher, JA ORCID: 0000-0002-0852-279X, Gornall, M, Jackson, R
et al (show 4 more authors) (2022) Characterization of changes in the tyrosine pathway by 24-h profiling during nitisinone treatment in alkaptonuria. Molecular Genetics and Metabolism Reports, 30. p. 100846.

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<h4>Background</h4>Although changes in the tyrosine pathway during nitisinone therapy are known, a complete characterization of the induced tyrosinaemia is lacking to improve disease management.<h4>Patients and methods</h4>Our research aims were addressed by 24-h blood sampling. 40 patients with alkaptonuria (AKU), treated with 0, 1, 2, 4 and 8 mg nitisinone daily (<i>n</i> = 8), were studied over four weeks. Serum homogentisic acid (sHGA), tyrosine (sTYR), phenylalanine (sPHE), hydroxyphenylpyruvate (sHPPA), hydroxyphenyllactate (sHPLA) and nitisinone (sNIT) were measured at baseline and after four weeks.<h4>Results</h4>sNIT showed a clear dose-proportional response. sTYR increased markedly but with less clear-cut dose responses after nitisinone. Fasting and average 24-h (C<sub>av</sub>) sTYR responses were similar. Individual patient sTYR 24-h profiles showed significant fluctuations during nitisinone therapy. At week 4, sTYR, sHPPA and sHPPL all showed dose-related increases compared to V0, with the greatest difference between 1 and 8 mg nitisinone seen for HPLA, while there was no change from V0 in sPHE. sHGA decreased to values around the lower limit of quantitation.<h4>Discussion</h4>There was sustained tyrosinaemia after four weeks of nitisinone therapy with significant fluctuations over the day in individual patients. Diet and degree of conversion of HPPA to HPLA may determine extent of nitisinone-induced tyrosinaemia.<h4>Conclusion</h4>A fasting blood sample is recommended to monitor sTYR during nitisinone therapy Adaptations in HPPA metabolites as well as the inhibition of tyrosine aminotransferase could be contributing factors generating tyrosinaemia during nitisinone therapy.

Item Type: Article
Uncontrolled Keywords: Alkaptonuria, Homogentisic acid, Tyrosine, Hydroxyphenylpyruvate, Hydroxyphenyllactate, Phenylalanine, Nitisinone, 24-h sampling
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 09 Feb 2022 10:36
Last Modified: 18 Jan 2023 21:13
DOI: 10.1016/j.ymgmr.2022.100846
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