Analysis of body composition and nutritional status in Brazilian phenylketonuria patients.

BACKGROUND: Phenylketonuria (PKU) is characterized by phenylalanine (Phe) accumulation to toxic levels due to the low activity of phenylalanine-hydroxylase. PKU patients must follow a Phe-restricted diet, which may put them in risk of nutritional disturbances. Therefore, we aimed to characterize body composition parameters and nutritional status in Brazilian PKU patients also considering their metabolic control. METHODS: Twenty-seven treated PKU patients older than 5 years, and 27 age- and gender-matched controls, were analyzed for anthropometric features and body composition by bioelectrical impedance (BIA). Patients' metabolic control was assessed by historical Phe levels. RESULTS: There was no effect of PKU type, time of diagnosis, or metabolic control for any analyzed parameter. About 75% of patients and controls were eutrophic, according to their BMI values. There were no difference between groups regarding body composition and other BIA-derived parameters. CONCLUSIONS: Brazilian PKU patients do not show differences in body composition and nutritional status in comparison with controls, regardless metabolic control. Although similar to controls, PKU patients may be in risk of disturbed nutritional and metabolic markers as seen for the general population.

Voluntary Exercise Prevents Oxidative Stress in the Brain of Phenylketonuria Mice.

BACKGROUND: High phenylalanine levels in phenylketonuria (PKU) have been associated with brain oxidative stress and amino acid imbalance. Exercise has been shown to improve brain function in hyperphenylalaninemia and neurodegenerative diseases. This study aimed to verify the effects of exercise on coordination and balance, plasma and brain amino acid levels, and brain oxidative stress markers in PKU mice. METHODS: Twenty wild-type (WT) and 20 PAH(enu2) (PKU) C57BL/6 mice were placed in cages with (exercise, Exe) or without (sedentary, Sed) running wheels during 53 days. At day 43, a balance beam test was performed. Plasma and brain were collected for analyses of amino acid levels and the oxidative stress parameters superoxide dismutase (SOD) activity, sulfhydryl and reduced glutathione (GSH) contents, total radical-trapping antioxidant potential (TRAP), and total antioxidant reactivity (TAR). RESULTS: SedPKU showed poor coordination (p < 0.001) and balance (p < 0.001), higher plasma and brain phenylalanine (p < 0.001), and increased brain oxidative stress (p < 0.05) in comparison to SedWT. ExePKU animals ran less than ExeWT (p = 0.018). Although no improvement was seen in motor coordination and balance, exercise in PKU restored SOD, sulfhydryl content, and TRAP levels to controls. TAR levels were increased in ExePKU in comparison to SedPKU (p = 0.012). Exercise decreased plasma and brain glucogenic amino acids in ExePKU, but did not change plasma and brain phenylalanine in both WT and PKU. CONCLUSIONS: Exercise prevents oxidative stress in the brain of PKU mice without modifying phenylalanine levels. Hence, exercise positively affects the brain, demonstrating its value as an intervention to improve brain quality in PKU.

Neonatal hyperglycemia induces oxidative stress in the rat brain: the role of pentose phosphate pathway enzymes and NADPH oxidase.

Recently, the consequences of diabetes on the central nervous system (CNS) have received great attention. However, the mechanisms by which hyperglycemia affects the central nervous system remain poorly understood. In addition, recent studies have shown that hyperglycemia induces oxidative damage in the adult rat brain. In this regard, no study has assessed oxidative stress as a possible mechanism that affects the brain normal function in neonatal hyperglycemic rats. Thus, the present study aimed to investigate whether neonatal hyperglycemia elicits oxidative stress in the brain of neonate rats subjected to a streptozotocin-induced neonatal hyperglycemia model (5-day-old rats). The activities of glucose-6-phosphate-dehydrogenase (G6PD), 6-phosphogluconate-dehydrogenase (6-PGD), NADPH oxidase (Nox), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSHPx), the production of superoxide anion, the thiobarbituric acid-reactive substances (TBA-RS), and the protein carbonyl content were measured. Neonatal hyperglycemic rats presented increased activities of G6PD, 6PGD, and Nox, which altogether may be responsible for the enhanced production of superoxide radical anion that was observed. The enhanced antioxidant enzyme activities (SOD, CAT, and GSHPx) that were observed in neonatal hyperglycemic rats, which may be caused by a rebound effect of oxidative stress, were not able to hinder the observed lipid peroxidation (TBA-RS) and protein damage in the brain. Consequently, these results suggest that oxidative stress could represent a mechanism that explains the harmful effects of neonatal hyperglycemia on the CNS.

Acute exercise in treated phenylketonuria patients: Physical activity and biochemical response.

BACKGROUND: In phenylketonuria, dietary treatment prevents most of the severe brain disease. However, patients have to follow a diet restricted in several natural components, what may cause decreased bone density and obesity. Exercise is known to improve both mental functioning and bone density also avoiding obesity, and could optimize aspects of central and peripheral outcome, regardless changes in phenylalanine (Phe) levels. However, the acute effects of exercise on metabolic parameters in phenylketonuria patients are unknown and thereby long-term adaptations are unclear. Therefore, this study aimed to evaluate patients' basal metabolic rate (BMR), and their acute response to an aerobic exercise session on plasma concentrations of Phe, tyrosine (Tyr), and branched-chain amino acids (BCAA), as well as metabolic and hormonal responses. METHODS: Five early- and four late diagnosed phenylketonuria patients aged 21 ± 4 years and 17 sex-, age-, and BMI-matched controls were evaluated for BMR, peak oxygen consumption (VO2peak) and plasma amino acid, glucose, lipid profile and hormonal levels. At least one week later, participants performed a 30-min aerobic exercise session (intensities individually calculated using the VO2peak results). Blood samples were collected in fasted state (moment 1, M1) and immediately after a small breakfast, which included the metabolic formula for patients but not for controls, and the exercise session (moment 2, M2). RESULTS: Phenylketonuria patients and controls showed similar BMR and physical capacities. At M1, patients presented higher Phe concentration and Phe/Tyr ratio; and lower levels of BCAA and total cholesterol than controls. Besides that, poorly controlled patients tended to stay slightly below the prescribed VO2 during exercise. Both patients and controls showed increased levels of total cholesterol and LDL at M2 compared with M1. Only controls showed increased levels of Tyr, lactate, and HDL; and decreased Phe/Tyr ratio and glucose levels at M2 compared to values at M1. CONCLUSIONS: Acute aerobic exercise followed by a Phe-restricted breakfast did not change Phe concentrations in treated phenylketonuria patients, but it was associated with decreased Phe/Tyr only in controls. Further studies are necessary to confirm our results in a higher number of patients.

Respostas de lactato, esforço percebido, frequência cardíaca, triptofano, prolactina e ácidos graxos à série de natação na velocidade crítica / Responses of lactate, perceived exertion, heart rate, tryptophan, prolactin and fatty acid in swimming series held in critical speed / Respuestas de lactato, esfuerzo percibido, frecuencia cardíaca, triptófano, prolactina y ácidos grasos en serie de natación en la velocidad crítica

O estudo avaliou, na intensidade de 100% da velocidade crítica (VC), o comportamento de concentração de lactato sanguíneo ([LA]), esforço percebido (EP), frequência cardíaca (FC), concentrações plasmáticas de triptofano [TRP], de prolactina ([PRL]) e de ácidos graxos livres ([AGL]). Catorze nadadores realizaram dois protocolos distintos: 1) repetições de 200 e 400 m, em máxima intensidade (V200 e V400) para a determinação da VC; 2) série VC (repetições de 400 m), com intervalos de 40 s. Os principais resultados foram: (1) [TRP] e [AGL] não apresentaram diferenças entre repouso e exaustão (p > 0,05); (2) aumento da [PRL], da [LA], da FC e do EP (p < 0,05) ao longo da série VC. Assim o aumento da [PRL] pode indicar manifestação de fadiga central na intensidade correspondente à VC.

The study assessed, at the intensity of 100% of the critical speed (CS), the behavior of blood lactate concentration ([La]), rating of perceived exertion (RPE), heart rate (HR), plasma concentrations of tryptophan [TRP] of prolactin ([PRL]) and free fatty acids ([FFA]). Fourteen swimmers performed two protocols: 1) trials of 200 and 400 m at maximum intensity (V200 and V400) for the CS, 2) CS series (trials of 400 m), and rest intervals of 40 s. The main results were: (1) [TRP] and [FFA] did not differ between rest and exhaustion (p> 0.05), (2) increased [PRL], the [La], HR and RPE (p <0.05) throughout the series CS. Thus the increase in [PRL] may indicate manifestation of central fatigue in intensity corresponding to the CS.

Este estudio evaluó, en la intensidad del 100% de la velocidad crítica (CV), el comportamiento de la concentración de lactato en la sangre ([LA]), esfuerzo percibido (PE), frecuencia cardíaca (FC), concentración plasmática de triptófano [TRP], prolactina ([PRL]) y de ácidos grasos libres ([AGL]). Catorce nadadores realizaron dos protocolos: 1) repeticiones de 200 y 400 m en máxima intensidad (V200 y V400) para la determinación de la CV, 2) serie VC (repeticiones de 400 m), con intervalos de 40 s. Los principales resultados fueron: (1) [TRP] y [FFA] no fueran diferentes entre el descanso y el agotamiento (p> 0,05), (2) mayores [PRL], [LA], FC y EP (p <0,05) a lo largo de la serie VC. Por lo tanto, el aumento de [PRL] pude indicar manifestación de fatiga central en la intensidad correspondiente a la VC.

Pipecolic acid induces oxidative stress in vitro in cerebral cortex of young rats and the protective role of lipoic acid.

Pipecolic acid (PA) levels are increased in severe metabolic disorders of the central nervous system such as Zellweger syndrome, infantile Refsum disease, neonatal adrenoleukodystrophy and hyperlysinemia. The affected individuals present progressive neurological dysfunction, hypotonia and growth retardation. The mechanisms of brain damage of these disorders remain poorly understood. Since PA catabolism can produce H2O2 by oxidases, oxidative stress may be a possible mechanism involved in the pathophysiology of these diseases. Lipoic acid (LA) is considered an efficient antioxidant and has been shown to prevent oxidative stress in experimental models of many disorders of the neurologic system. Considering that to our knowledge no study investigated the role of PA on oxidative stress, in the present work we investigated the in vitro effects of PA on some oxidative stress parameters and evaluated the LA efficacy against possible pro-oxidant effects of PA in cerebral cortex of 14-day-old rats. The activities of catalase (CAT), glutathione peroxidase (GPx), glucose 6-phosphate dehydrogenase (G6PD), and glutathione S-transferase (GST) along with reduced glutathione (GSH) content were significantly decreased, while superoxide dismutase (SOD) activity and thiobarbituric acid-reactive substances (TBA-RS) were significantly enhanced by PA. LA was able to prevent these effects by improving the activity of antioxidant enzymes, increasing GSH content and reducing TBA-RS. In contrast, glutathione reductase and 6-phosphogluconate dehydrogenase activities and sulfhydryl content were not affected. Taken together, it may be presumed that PA in vitro elicits oxidative stress and LA is able to prevent these effects.

Antioxidant treatment strategies for hyperphenylalaninemia.

Hyperphenylalaninemia (HPA) leads to increased oxidative stress in patients with phenylketonuria (PKU) and in animal models of PKU. Early diagnosis and immediate adherence to a phenylalanine-restricted diet prevents HPA and, consequently, severe brain damage. However, treated adolescent and adult PKU patients have difficulties complying with the diet, leading to an oscillation of phenylalanine levels and associated oxidative stress. The brain is especially susceptible to reactive species, and oxidative stress might add to the impaired cognitive function found in these patients. The restricted PKU diet has a very limited nutrient content from natural foods and almost no animal protein, which reduces the intake of important compounds. These specific compounds can act as scavengers of reactive species and can be co-factors of antioxidant enzymes. Supplementation with nutrients, vitamins, and tetrahydropterin has given quite promising results in patients and animal models. Antioxidant supplementation has been studied in HPA, however there is no consensus about its always beneficial effects. In this way, regular exercise could be a beneficial addition on antioxidant status in PKU patients. A deeper understanding of PKU molecular biochemistry, and genetics, as well as the need for improved targeted treatment options, could lead to the development of new therapeutic strategies.

Effects of ß-alanine administration on selected parameters of oxidative stress and phosphoryltransfer network in cerebral cortex and cerebellum of rats.

ß-Alanine is a ß-amino acid derivative of the degradation of pyrimidine uracil and precursor of the oxidative substrate acetyl-coenzyme A (acetyl-CoA). The accumulation of ß-alanine occurs in ß-alaninemia, an inborn error of metabolism. Patients with ß-alaninemia may develop neurological abnormalities whose mechanisms are far from being understood. In this study we evaluated the effects of ß-alanine administration on some parameters of oxidative stress and on creatine kinase, pyruvate kinase, and adenylate kinase in cerebral cortex and cerebellum of 21-day-old rats. The animals received three peritoneal injections of ß-alanine (0.3 mg /g of body weight) and the controls received the same volume (10 µL/g of body weight) of saline solution (NaCl 0.85 %) at 3 h intervals. CSF levels of ß-alanine increased five times, achieving 80 µM in the rats receiving the amino acid. The results of ß-alanine administration in the parameters of oxidative stress were similar in both tissues studied: reduction of superoxide dismutase activity, increased oxidation of 2',7'-dihydrodichlorofluorescein, total content of sulfhydryl and catalase activity. However, the results of the phosphoryltransfer network enzymes were similar in all enzymes, but different in the tissues studied: the ß-alanine administration was able to inhibit the enzyme pyruvate kinase, cytosolic creatine kinase, and adenylate kinase activities in cerebral cortex, and increase in cerebellum. In case this also occurs in the patients, these results suggest that oxidative stress and alteration of the phosphoryltransfer network may be involved in the pathophysiology of ß-alaninemia. Moreover, the ingestion of ß-alanine to improve muscular performance deserves more attention in respect to possible side-effects.

Exercício aeróbico agudo restaura a concentração de triptofano em cérebro de ratos com hiperfenilalaninemia / Acute aerobic exercise restores tryptophan concentration in the brain of rats with hyperphenylalaninemia

INTRODUÇÃO: A fenilcetonúria (PKU) é caracterizada pela deficiência da enzima fenilalanina hidroxilase, causando acúmulo de fenilalanina. O diagnóstico precoce e a subordinação à dieta pobre em fenilalanina são importantes para prevenir os efeitos prejudiciais da hiperfenilalaninemia. Não aderir estritamente à dieta provoca, entre outros efeitos, um desequilíbrio entre os aminoácidos neutros que usam o mesmo transportador da fenilalanina na barreira hematoencefálica, causando, então, a diminuição da entrada de triptofano, o precursor de serotonina no cérebro. Esse neurotransmissor tem sido implicado na regulação dos estados de humor, sendo sua alta produção ligada à fadiga central em indivíduos submetidos a exercício prolongado. O exercício físico aumenta os níveis de triptofano livre no sangue, o que facilita seu influxo no cérebro, podendo, portanto, ser útil nos estados hiperfenilalaninêmicos. OBJETIVO: Avaliar se o exercício aeróbico é capaz de normalizar as concentrações de triptofano no cérebro de ratos com hiperfenilalaninemia. MÉTODOS: Trinta e dois ratos foram separados nos grupos sedentário (Sed) e exercício (Exe), e cada um deles subdividido em controle (SAL) e hiperfenilalaninemia (PKU). A hiperfenilalaninemia foi induzida pela administração de alfa-metilfenilalanina e fenilalanina durante três dias, enquanto os grupos SAL receberam salina. Os grupos Exe realizaram uma sessão de exercício aeróbico com duração de 60min e velocidade de 12m.min-1. RESULTADOS: A concentração de triptofano no cérebro nos grupos PKU foi significativamente menor que nos grupos SAL, tanto Sed como Exe, compatível com a condição hiperfenilalaninêmica. O exercício aumentou a concentração cerebral de triptofano comparada aos animais sedentários. O achado mais interessante foi que a concentração cerebral de triptofano no grupo ExePKU não foi diferente do SedSAL. CONCLUSÃO: Os resultados indicam um importante papel do exercício aeróbico para restaurar a concentração de triptofano no cérebro em ratos hiperfenilalaninêmicos.

INTRODUCTION: Phenylketonuria (PKU) is characterized by deficiency of the enzyme phenylalanine hydroxylase, leading to accumulation of phenylalanine. Early diagnosis and subordination to low-phenylalanine diet are important to prevent the harmful effects of hyperphenylalaninemia. In case the diet is not strictly followed, some possible effects are imbalance in the neutral amino acids that use the same carrier of phenylalanine to cross the blood-brain barrier, causing hence reduction in tryptophan entry, the precursor of serotonin in the brain. This neurotransmitter has been implicated in the regulation of mood states, and its high production is linked to central fatigue in individuals subjected to prolonged exercise. Physical exercise increases free tryptophan levels in the blood, which facilitates its influx in the brain, and therefore, may be useful in hyperphenylalaninemia states. OBJECTIVE: To assess whether aerobic exercise is able to normalize the concentrations of tryptophan in the brain of rats with hyperphenylalaninemia. METHODS: 32 rats were randomly assigned to sedentary (Sed) and exercise (Exe) groups, and then divided into control (HEA) and hyperphenylalaninemia (PKU). Hyperphenylalaninemia was induced by administration of alpha-metylphenylalanine and phenylalanine for three days, while the HEA groups received saline. Exe groups held a session of aerobic exercise lasting 60 minutes and speed of 12 m.min-1. RESULTS: The concentration of tryptophan in the brain of PKU groups was significantly lower than HEA groups (both in Sed and Exe groups), compatible with the condition of hyperphenylalaninemia. The exercise increased brain tryptophan levels comparing to sedentary animals. The most interesting finding was that the brain tryptophan levels of ExePKU group were not different from SedHEA group. CONCLUSION: The results indicate an important role of aerobic exercise to restore the concentration of tryptophan in the brain in hyperphenylalaninemic rats.

Regular exercise prevents oxidative stress in the brain of hyperphenylalaninemic rats.

Phenylketonuria (PKU) is caused by deficiency of phenylalanine hydroxylase, leading to accumulation of phenylalanine and its metabolites. Clinical features of PKU patients include mental retardation, microcephaly, and seizures. Oxidative stress has been found in these patients, and is possibly related to neurophysiopatology of PKU. Regular exercise can leads to adaptation of antioxidant system, improving its capacity to detoxification reactive species. The aim of this study was to verify the effects of regular exercise on oxidative stress parameters in the brain of hyperphenylalaninemic rats. Animals were divided into sedentary (Sed) and exercise (Exe) groups, and subdivided into saline (SAL) and hyperphenylalaninemia (HPA). HPA groups were induced HPA through administration of alpha-methylphenylalanine and phenylalanine for 17 days, while SAL groups (n = 16-20) received saline. Exe groups conducted 2-week aerobic exercise for 20 min/day. At 18th day, animals were killed and the brain was homogenized to determine thiobarbituric acid reactives substances (TBA-RS) content, superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) activities. Soleus muscles were collected to determine glycogen content as a marker of oxidative adaptation. Exe groups showed enhanced glycogen content. HPA condition caused an increase in TBA-RS and SOD, and reduces CAT and GPx. Exercise was able to prevent all changes seen in the HPA group, reaching control values, except for SOD activity. No changes were found in the ExeSAL group compared to SedSAL. Hyperphenylalaninemic rats were more responsive to the benefits provided by regular exercise. Physical training may be an interesting strategy to restore the antioxidant system in HPA.

Cinemática do Nado Crawl de nadadores não-competitivos / Front crawl kinematics for non-competitive swimmers

Para nadadores não-competitivos (NC) há poucas informações sobre relações cinemáticas do nado, geralmente, pesquisas são realizadas com atletas de elite. Objetivo: verificar comprimento médio de braçada (CB), comprimento médio corrigido pela envergadura (CBc), freqüência média de braçada (FB) e velocidade média (VN) do nado crawl sob diferentes intensidades em NC. Participaram 24 indivíduos, separados nos grupos G1 e G2, respectivamente, mulheres e homens que nadam, aproximadamente, 3000 m por sessão, três vezes semanais; G3 e G4, respectivamente, mulheres e homens que nadam, aproximadamente, 1000 m por sessão, duas vezes semanais. Dados de idade e antropométricos foram obtidos. Três repetições de 25 m, sob três intensidades foram realizadas em ordem aleatória (intervalo: 2 min). Foram registrados os tempos do percurso entre os 10 e os 20 m e de três ciclos de braçadas realizados dentro desses 10 m. Resultados: o aumento significativo de VN ocorreu paralelamente ao aumento da intensidade, com aumento da FB e diminuição da CBc, todos significativos. G1 e G2 apresentam maiores valores médios dessas variáveis em relação a G3 e G4. NC apresentam similar estratégia para incremento de VN que nadadores de alto nível. Mesmo nesse nível, a técnica é influenciada pela prática.

For non-competitive swimmers (NC), it has few information about swimming kinematics relations, generally, researches are carried through with elite athlete. Objective: to verify front crawl stroke’s averages stroke length (CB), length corrected by the upper limb span (CBc), stroke rate (FB) and swim velocity (VN) under different intensities in NC. 24 individuals had participated, separate in groups G1 and G2, respectively, women and men who swim, approximately, 3.000 m per session, three times weekly; G3 and G4, respectively, women and men who swim, approximately, 1.000 m per session, two times weekly. Data of age and anthropometrics has been obtained. Three 25 m trials, under three different intensities were carried through in random sequence (rest interval: 2 min). It has been timed the passage between the 10 and the 20 m and three cycles of stroke performed inside these 10 m. Significant increase in VN occurred parallel to increase in intensity, with increase in FB and reduction in CBc, all significant ones. G1 and G2 present increased average values of these variables when compared to G3 and G4. NC present similar strategies for VN increment than high level swimmers. Exactly in this level, the technique is influenced by the practical one.