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Dihydrobiopterin biosynthesis deficiency

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Abstract

For the last 2 years, a program has been developed to screen all hyperphenylalaninemic babies for tetrahydrobiopterin deficiency, by measurement of pterins in urine.

High neopterin and low biopterin levels were found in the urine of a 1-month-old girl. Further investigations confirmed an impaired conversion of neopterin to biopterin. No neurological signs were noted, but, in regard to the laboratory data, neurotransmitter replacement therapy was instituted at 2.5 months of age.

The most remarkable feature was a rapid increase in the dietetic phenylalanine tolerance, despite the proof that the child was not able to clear a challenging dose of phenylalanine and the record of unchanged pathologically low excretion of biopterin during a 2 month period.

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References

  1. Bartholome K, Lutz P, Bickel H (1975) Determination of phenylalanine hydroxylase activity in patients with phenylketonuria and hyperphenylalaninemia. Pediatr Res 9:899–903

    Google Scholar 

  2. Bartholome K, Byrd DJ, Kaufman S, Milstien S (1977) Atypical phenylketonuria with normal phenylalanine hydroxylase and dihydropteridine reductase activity in vitro. Pediatrics 59:757–761

    Google Scholar 

  3. Berlow S (1980) Progress in phenylketonuria: defects in the metabolism of biopterin. Pediatrics 65:837–839

    Google Scholar 

  4. Butler IJ, Koslow SH, Krumholz A, Holtzman NA, Kaufman S (1978) A disorder of biogenic amines in dihydropteridine reductase deficiency. Ann Neurol 3:224–230

    Google Scholar 

  5. Danks DM, Cotton RGH (1980) Early diagnosis of hyperphenylalaninemia due to tetrahydrobiopterin deficiency (malignant hyperphenylalaninemia). J Pediatr 96:854–856

    Google Scholar 

  6. Danks DM, Bartholome K, Clayton BE, Curtius H, Grobe H, Kaufman S, Leeming R, Pfleiderer W, Rembold H, Rey F (1978) Malignant hyperphenylalaninemia—Current status (June, 1977). J Inher Metab Dis 1:49–53

    Google Scholar 

  7. Danks DM, Schlesinger P, Firgaira F, Cotton RGH, Watson BM, Rembold H, Hennings G (1979) Malighant hyperphenylalaninemia—Clinical features, biochemical findings and experience with administration of biopterins. Pediatr Res 13:1150–1155

    Google Scholar 

  8. Dhondt JL, Ardouin P, Hayte JM, Farriaux JP (1981) Developmental aspects of pteridine metabolism and relationships with phenylalanine metabolism. Clin Chim Acta 116:143–152

    Google Scholar 

  9. Dhondt JL, Bonneterre J, Farriaux JP, Lefebvre J, Demaille J (1981) Dihydropteridine-reductase activity in breast cancer. Preliminary report. Biomedicine 35:58–60

    Google Scholar 

  10. Dhondt JL, Largilliere C, Ardouin P, Farriaux JP, Dautrevaux M (1981) Diagnosis of variants of hyperphenylalaninemia by determination of pterins in urine. Clin Chim Acta 110:205–214

    Google Scholar 

  11. Dhondt JL, Delcroix M, Farriaux JP (1982) Unconjugated pteridines in human milk. Clin Chim Acta 121:33–35

    Google Scholar 

  12. Grobe H, Bartholome K, Milstien S, Kaufman S (1978) Hyperphenylalaninemia due to dihydropteridine reductase deficiency. Eur J Pediatr 129:93–98

    Google Scholar 

  13. Kaufman S (1980) Differential diagnosis of variant forms of hyperphenylalaninemia. Pediatrics 65:840–842

    Google Scholar 

  14. Kaufman S, Berlow S, Summer GK, Milstien S, Schulman JD, Orloff S, Spielberg S, Pueschel S (1978) Hyperphenylalaninemia due to a deficiency of biopterin—A variant form of phenylketonuria. New Engl J Med 299:673–679

    Google Scholar 

  15. Leeming RJ, Blair JA, Green A, Raine KN (1976) Biopterin in derivatives in normal and phenylketonuric patients after oral loads of L-phenylalanine, L-tyrosine and L-tryptophan. Arch Dis Child 51:771–777

    Google Scholar 

  16. Leeming RJ, Pheasant AE, Blair JA (1981) The role of tetrahydrobiopterin in neurological disease: a review. J Ment Defic Res 25: 231–241

    Google Scholar 

  17. Milstien S, Kaufman S, Summer GK (1980) Hyperphenylalaninemia due to dihydropteridine reductase deficiency: diagnosis by measurement of oxidized and reduced pterins in urine. Pediatrics 65:806–810

    Google Scholar 

  18. Niederwieser A, Curtius HCh, Bettoni O, Bieri J, Schircks B, Viscontini M, Schaub J (1979) Atypical phenylketonuria caused by 7,8 dihydrobiopterin synthetase deficiency. Lancet I:131–133

    Google Scholar 

  19. Niederwieser A, Curtius HCh, Gitzelmann R, Otten A, Baerlocher K, Blehova B, Berlow S, Grobe H, Rey F, Schaub J, Scheibenreiter S, Schmidt H, Viscontini M (1980) Excretion of pterins in phenylketonuria and phenylketonuria variants. Helv Paediatr Acta 35:335–342

    Google Scholar 

  20. Niederwieser A, Staudenmann W, Wang M, Curtius HCh, Atares M, Cardesa Garcia J (1982) Hyperphenylalaninemia with neopterin deficiency—A new enzyme defect presumably of GTP cyclohydrolase (Abstract). Eur J Pediatr 138:97

    Google Scholar 

  21. Nielsen KH, Simonsen V, Lind KE (1969) Dihydropteridine reductase—A method for the measurement of activity, and investigations of the specificity for NADH and NADPH. Eur J Biochem 9:497–502

    Google Scholar 

  22. Rey F, Harpey JP, Leeming RJ, Blair JA, Aicardi J, Rey J (1977) Les hyperphénylalaninémies avec activité normale de la phénylalanine hydroxylase. Le déficit en tétrahydrobioptérine et le déficit en dihydroptéridine réductase. Arch Fr Pédiatr 34, supplement 11:109–120

    Google Scholar 

  23. Rey F, Leeming RJ, Blair JA, Rey J (1980) Biopterin defect in a normal appearing child affected by a transient phenylketonuria. Arch Dis Child 55:637–639

    Google Scholar 

  24. O'Brien D, Berlow S, Donnell G, Justice P, Kaufman S, Levy HL, McCabe ERB, Snyderman S (1980) New developments in hyperphenylalaninemia. Pediatrics 65:844–846

    Google Scholar 

  25. Schaub J, Daumling S, Curtius HCh, Niederwieser A, Bartholome K, Viscontini M, Schircks B, Bieri JH (1978) Tetrahydrobiopterin therapy of atypical phenylketonuria due to defective dihydrobiopterin biosythesis. Arch Dis Child 53:674–683

    Google Scholar 

  26. Tanaka T, Aihara K, Iwai K, Kohashi M, Tomita K, Narisawa K, Arai N, Yoshida H, Usui T (1981) Hyperphenylalaninemia due to impaired dihydrobiopterin biosynthesis. Eur J Pediatr 136:275–280

    Google Scholar 

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Dhondt, J.L., Leroux, B., Farriaux, J.P. et al. Dihydrobiopterin biosynthesis deficiency. Eur J Pediatr 141, 92–95 (1983). https://doi.org/10.1007/BF00496797

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  • DOI: https://doi.org/10.1007/BF00496797

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