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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-26460

Kusmierska, K; Jansen, E E W; Jakobs, C; Szymanska, K; Malunowicz, E; Meilei, D; Thony, B; Blau, N; Tryfon, J; Rokicki, D; Pronicka, E; Sykut-Cegielska, J (2009). Sepiapterin reductase deficiency in a 2-year-old girl with incomplete response to treatment during short-term follow-up. Journal of Inherited Metabolic Disease, 32(S1):5-10.

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Abstract

Sepiapterin reductase (SR) catalyses the last step in the tetrahydrobiopterin biosynthesis pathway; it converts 6-pyruvoyl-tetrahydropterin (6-PTP) to BH(4) in an NADPH-dependent reaction. SR deficiency is a very rare autosomal recessive disorder with normal phenylalanine (Phe) concentration in blood and diagnostic abnormalities are detected in CSF. We present a 16-month-old girl with SR deficiency. From the newborn period she presented with an adaptation regulatory disorder. At the age of 3 months, abnormal eye movements with dystonic signs and at 4.5 months psychomotor retardation were noticed. Since that time axial hypotonia with limb spasticity (or rather delayed reflex development), gastro-oesophageal reflux and fatigue at the end of the day has been observed. Brain MRI was normal; EEG was without epileptiform discharges. Analysis of biogenic amine metabolites in CSF at the age of 16 months showed very low HVA and 5-HIAA concentrations. Analysis of CSF pterins revealed strongly elevated dihydrobiopterin (BH(2)), slightly elevated neopterin and elevated sepiapterin levels. Plasma and CSF amino acids concentrations were normal. A phenylalanine loading test showed increased Phe after 1 h, 2 h and 4 h and very high Phe/Tyr ratios. SR deficiency was confirmed in fibroblasts and a novel homozygous g.1330C>G (p.N127K) SPR mutation was identified. On L: -dopa and then additionally 5-hydroxytryptophan, the girl showed slow but remarkable progress in motor and intellectual ability. Now, at the age of 3 years, she is able to sit; expressive speech is delayed (to 1 1/2 years), passive speech is well developed. Her visual-motor skills, eye-hand coordination and social development correspond to the age of 2 1/2 years.

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
DDC:610 Medicine & health
Language:English
Date:07 January 2009
Deposited On:10 Jan 2010 13:29
Last Modified:19 Dec 2012 03:00
Publisher:Springer
ISSN:0141-8955
Additional Information:The original publication is available at www.springerlink.com
Publisher DOI:10.1007/s10545-008-1009-4
PubMed ID:19130291
Citations:Google Scholarā„¢

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