Diffusivity alterations related to cognitive performance and phenylalanine levels in early-treated adults with phenylketonuria

Abstract Background Altered white matter (WM) is consistently reported in patients with phenylketonuria (PKU). However, the knowledge about WM microstructural integrity in early-treated adults with classical PKU and its relationship with cognition and metabolic parameters is inconclusive. This study...

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Main Authors: Jèssica Pardo, Clara Capdevila-Lacasa, Bàrbara Segura, Adriana Pané, Pedro J. Moreno, Glòria Garrabou, Josep M. Grau-Junyent, Carme Junqué, Consortium PKU.cat
Format: Article
Language:English
Published: BMC 2025-07-01
Series:Journal of Neurodevelopmental Disorders
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Online Access:https://doi.org/10.1186/s11689-025-09622-8
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author Jèssica Pardo
Clara Capdevila-Lacasa
Bàrbara Segura
Adriana Pané
Pedro J. Moreno
Glòria Garrabou
Josep M. Grau-Junyent
Carme Junqué
Consortium PKU.cat
author_facet Jèssica Pardo
Clara Capdevila-Lacasa
Bàrbara Segura
Adriana Pané
Pedro J. Moreno
Glòria Garrabou
Josep M. Grau-Junyent
Carme Junqué
Consortium PKU.cat
author_sort Jèssica Pardo
collection DOAJ
description Abstract Background Altered white matter (WM) is consistently reported in patients with phenylketonuria (PKU). However, the knowledge about WM microstructural integrity in early-treated adults with classical PKU and its relationship with cognition and metabolic parameters is inconclusive. This study aims to explore the cerebral WM microstructural alterations in adult patients with early-treated classical PKU and their association with blood phenylalanine (Phe) levels and neuropsychological performance using whole-brain diffusion tensor imaging (DTI). Methods Twenty-nine patients with early-treated classical PKU (mean age = 30.86, SD = 7.74) and 31 healthy controls (mean age = 32.45, SD = 9.40) underwent neuropsychological assessment and MRI. Phe dry blood spot (DBS-Phe) samples, along with venous Phe levels, were collected from the PKU sample to calculate the index of dietary control (IDC). Tract-based spatial statistics (TBSS) of the mean diffusivity (MD), and fractional anisotropy (FA), were carried out with FSL v6.0.4 to assess between-group differences and to explore associations with both cognitive and clinical data. Results Patients exhibited a widespread white matter tract involvement, with lower MD and higher FA values compared to controls. The most affected tracts were the inferior longitudinal fasciculus and inferior fronto-occipital fasciculus for MD, and the anterior corona radiata, uncinate fasciculus and forceps minor for FA. MD negatively correlated with IDC and venous Phe levels, whereas FA negatively correlated with full-scale intelligence quotient (FSIQ) (p-value ≤0.05 FWE-corrected). Conclusions Microstructural WM alterations were present in adults with early-treated classical PKU, and these abnormalities were related to global intelligence and metabolic control markers. Although our results suggest the importance of proper disease management, further studies are needed to determine its long-term relevance.
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spelling doaj-art-3adf2624d7dc4e5a86043992e473b57b2025-08-20T03:45:22ZengBMCJournal of Neurodevelopmental Disorders1866-19552025-07-0117111210.1186/s11689-025-09622-8Diffusivity alterations related to cognitive performance and phenylalanine levels in early-treated adults with phenylketonuriaJèssica Pardo0Clara Capdevila-Lacasa1Bàrbara Segura2Adriana Pané3Pedro J. Moreno4Glòria Garrabou5Josep M. Grau-Junyent6Carme Junqué7Consortium PKU.catMedical Psychology Unit, Department of Medicine, Institute of Neurosciences, University of BarcelonaMedical Psychology Unit, Department of Medicine, Institute of Neurosciences, University of BarcelonaMedical Psychology Unit, Department of Medicine, Institute of Neurosciences, University of BarcelonaBiomedical Research Networking Center on Physiopathology of Obesity and Nutrition (CIBEROBN)Muscular and Inherited Metabolic Disorders Adults Unit, Hospital Clínic de BarcelonaMuscular and Inherited Metabolic Disorders Adults Unit, Hospital Clínic de BarcelonaFundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS)Medical Psychology Unit, Department of Medicine, Institute of Neurosciences, University of BarcelonaAbstract Background Altered white matter (WM) is consistently reported in patients with phenylketonuria (PKU). However, the knowledge about WM microstructural integrity in early-treated adults with classical PKU and its relationship with cognition and metabolic parameters is inconclusive. This study aims to explore the cerebral WM microstructural alterations in adult patients with early-treated classical PKU and their association with blood phenylalanine (Phe) levels and neuropsychological performance using whole-brain diffusion tensor imaging (DTI). Methods Twenty-nine patients with early-treated classical PKU (mean age = 30.86, SD = 7.74) and 31 healthy controls (mean age = 32.45, SD = 9.40) underwent neuropsychological assessment and MRI. Phe dry blood spot (DBS-Phe) samples, along with venous Phe levels, were collected from the PKU sample to calculate the index of dietary control (IDC). Tract-based spatial statistics (TBSS) of the mean diffusivity (MD), and fractional anisotropy (FA), were carried out with FSL v6.0.4 to assess between-group differences and to explore associations with both cognitive and clinical data. Results Patients exhibited a widespread white matter tract involvement, with lower MD and higher FA values compared to controls. The most affected tracts were the inferior longitudinal fasciculus and inferior fronto-occipital fasciculus for MD, and the anterior corona radiata, uncinate fasciculus and forceps minor for FA. MD negatively correlated with IDC and venous Phe levels, whereas FA negatively correlated with full-scale intelligence quotient (FSIQ) (p-value ≤0.05 FWE-corrected). Conclusions Microstructural WM alterations were present in adults with early-treated classical PKU, and these abnormalities were related to global intelligence and metabolic control markers. Although our results suggest the importance of proper disease management, further studies are needed to determine its long-term relevance.https://doi.org/10.1186/s11689-025-09622-8PhenylketonuriaNeuropsychological performanceDiffusion tensor imagingCerebral white matterDietary control
spellingShingle Jèssica Pardo
Clara Capdevila-Lacasa
Bàrbara Segura
Adriana Pané
Pedro J. Moreno
Glòria Garrabou
Josep M. Grau-Junyent
Carme Junqué
Consortium PKU.cat
Diffusivity alterations related to cognitive performance and phenylalanine levels in early-treated adults with phenylketonuria
Journal of Neurodevelopmental Disorders
Phenylketonuria
Neuropsychological performance
Diffusion tensor imaging
Cerebral white matter
Dietary control
title Diffusivity alterations related to cognitive performance and phenylalanine levels in early-treated adults with phenylketonuria
title_full Diffusivity alterations related to cognitive performance and phenylalanine levels in early-treated adults with phenylketonuria
title_fullStr Diffusivity alterations related to cognitive performance and phenylalanine levels in early-treated adults with phenylketonuria
title_full_unstemmed Diffusivity alterations related to cognitive performance and phenylalanine levels in early-treated adults with phenylketonuria
title_short Diffusivity alterations related to cognitive performance and phenylalanine levels in early-treated adults with phenylketonuria
title_sort diffusivity alterations related to cognitive performance and phenylalanine levels in early treated adults with phenylketonuria
topic Phenylketonuria
Neuropsychological performance
Diffusion tensor imaging
Cerebral white matter
Dietary control
url https://doi.org/10.1186/s11689-025-09622-8
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