Neuroimaging and Neurocognitive Assessment and Response to Sapropterin Dihydrochloride Treatment in Phenylketonuria (PKU)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01412437
Recruitment Status : Withdrawn (poor recruitment)
First Posted : August 9, 2011
Last Update Posted : December 17, 2014
Georgetown University
Information provided by (Responsible Party):
Andrea Gropman, Children's Research Institute

Brief Summary:
The investigators will use different types of brain imaging (MRI) in patients with Phenylketonuria (PKU) who are currently not on a strict diet to test the hypothesis that there is improvement in brain circuitry and biochemistry after return to diet and/or sapropterin dihydrochloride (Kuvan).

Condition or disease Intervention/treatment Phase
PKU Dietary Supplement: diet Drug: sapropterin dihydrochloride Not Applicable

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Detailed Description:

We plan to enroll 36 subjects with PKU. They will all be counseled to follow the PKU diet. They will be randomized to receive Kuvan. We will plan to enroll 12 in the diet alone group and 24 in the Kuvan group with the hope of 12 being responders (as defined by a 30% drop in blood phe levels). Those who do not have a blood response with decreased Phe will still be evaluated for a neurological response as measured by neurocognitive testing and neuroimaging as outlined in this protocol. All 24 in the Kuvan group will receive a 1 month trial of Kuvan and then the responders will have their insurance cover the drug and for the non responders Biomarin will supply Kuvan.

Aim 1: To test the hypothesis that stable patients with PKU who are not currently on diet have specific brain biomarkers quantifiable by DTI, fMRI and MRS and that the levels of these biomarkers correlate with the clinical severity and outcome. Our pilot study and the research of others have suggested the following as potential biomarkers for neural injury in PKU:

  • Metabolic abnormalities: elevated Phe concentrations as measured by MRS.
  • White matter microstructure: measured by apparent diffusion coefficient, (ADC), using DTI.
  • Working memory and attention/executive function: measured by fMRI, Near infrared spectroscopy (NIRS) and neuropsychological testing.

We will study these potential biomarkers in a group of well characterized adults with PKU who are not currently on diet or a strict diet as evidenced by elevated Phe, but who were identified by the newborn screen and may have been on diet during childhood, with varying severity of clinical involvement.

Aim 2: To measure changes in biomarkers validated in Aim 1 after return to diet +/- Kuvan (sapropterin dihydrochloride; Kuvan)

Based on our preliminary data and that of others, Aim 1 should provide us with a number of candidate biomarkers for brain injury in PKU. We expect that these will include three types of markers that can be correlated: metabolic, structural and cognitive. We will use these biomarkers to study subjects during return to diet and/or initiation of Kuvan.

Aim 3: To compare cognitive performance in our subjects prior to and after return to diet +/- Kuvan. using the following tests:

Comprehensive Trail making test (CTMT) -Parts A and B Stroop WASI (IQ, digit span) BRIEF Edinburgh Handedness Inventory Hand Preference Demonstration Test

Outcome variables The primary endpoints in this study are 1) an estimate of the white matter damage (macroscopic and microscopic) in participants with PKU versus controls at baseline and after return to diet +/- Kuvan; 2) determination of a profile of brain biochemical abnormalities in participants with PKU versus controls at baseline and after return to diet/Kuvan, 3) assessment of cognitive and motor systems abnormalities (by fMRI and cognitive testing) in the participant cohort as compared to age matched typically developing non disease controls at baseline and after return to diet/Kuvan; 4) coefficient of variability of scoring on traditional neurocognitive.

After the conclusion of this study, future areas of research would include expansion to study long term effects of Kuvan, study of more impaired populations and response to Kuvan, and using optical imaging methods we are currently piloting in OTCD.

Method to investigate biomarkers of disease We plan to use 1HMRS to identify markers of disease severity such as elevations of Phe and decreases in NAA. This will be compared in participants and normal age matched controls. Additionally, diffusion tensor imaging will allow us to probe white matter fiber tracts that may be especially vulnerable in this disorder selectively. Lastly, fMRI may identify regions of differential activation in the brain that are different in participants versus age matched controls at rest and with a cognitive task probing working memory and attention.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 0 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Multimodal Neuroimaging and Neurocognitive Assessment of Biomarkers and Response to Sapropterin Dihydrochloride Treatment in Phenylketonuria
Study Start Date : April 2011
Actual Primary Completion Date : March 2012
Actual Study Completion Date : December 2012

Arm Intervention/treatment
Experimental: Diet
12 participants will be randomized to diet. Phe levels will be followed by blood levels. A dietician will analyze diet for phe content and advise
Dietary Supplement: diet
12 participants will be randomized to diet. Phe levels will be followed by blood levels. A dietician will analyze diet for phe content and advise
Other Name: PKU diet
Experimental: sapropterin dihydrochloride
Intervention: 24 participants will be randomized to receive the drug 10 mg/kg per day. Responders and non responders will remain on drug for four months
Drug: sapropterin dihydrochloride
20 mg/kg for 4 months
Other Name: Biomarin Kuvan
Drug: sapropterin dihydrochloride
Other Name: Kuvan

Primary Outcome Measures :
  1. Neuroimaging biomarkers [ Time Frame: at 4 months ]
    An estimate of the change in white matter damage and biochemistry in participants with PKU after either diet/Kuvan

Secondary Outcome Measures :
  1. Brain biochemistry [ Time Frame: at 4 months ]
    Assessment of cognitive systems abnormalities (by fMRI ) in the participant cohort after diet/Kuvan

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Ages Eligible for Study:   18 Years to 40 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Patients with PKU identified on Newborn screening and with phe concentration >12mg/dl on the newborn screen
  2. Baseline phe level at study enrollment > 20 mg/dl (this is the level required for inclusion in the study, regardless of the level used to make diagnosis)
  3. Age range: 18-45 years
  4. Able to comply with neuroimaging without requiring sedation (typically requires IQ over 65). The IQ will be checked with the WASI (Weschler Adult scales of intelligence) before determining eligibility
  5. Able to undergo neuroimaging safely (i.e. without presence of ferromagnetic devices)
  6. Subject has ability to follow instructions in English
  7. Female of childbearing age who is sexually active agrees to urine pregnancy test
  8. Availability to come to Washington, DC to participate in this study

Exclusion Criteria:

  1. Age range <18 or >45 years
  2. Inability to comply with neuroimaging without the use of sedation (low IQ or claustrophobic)
  3. Presence of ferromagnetic device(s) that preclude safe imaging including cardiac pacemaker, neural pacemaker, surgical clips in the brain or blood vessels, surgically implanted metal plates, screws or pins, cochlear implants or metal objects in their body
  4. Pregnant female or breastfeeding at screening or planning to become pregnant at any time during the study.
  5. Baseline phe < 20 mg/dl
  6. Currently on Kuvan
  7. History of substance abuse

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01412437

United States, District of Columbia
Children's Research Institute
Washington, District of Columbia, United States, 20010
Sponsors and Collaborators
Children's Research Institute
Georgetown University
Principal Investigator: Andrea L Gropman, M.D. Children's Research Institute

Responsible Party: Andrea Gropman, Associate Professor, Children's Research Institute Identifier: NCT01412437     History of Changes
Other Study ID Numbers: BMRN 9956
First Posted: August 9, 2011    Key Record Dates
Last Update Posted: December 17, 2014
Last Verified: December 2014

Keywords provided by Andrea Gropman, Children's Research Institute:
sapropterin dihydrochloride

Additional relevant MeSH terms:
Brain Diseases, Metabolic, Inborn
Brain Diseases, Metabolic
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Amino Acid Metabolism, Inborn Errors
Metabolism, Inborn Errors
Genetic Diseases, Inborn
Metabolic Diseases
Anti-Arrhythmia Agents
Calcium Channel Blockers
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Vasodilator Agents