Tyrosine hydroxylase deficiency

Last updated
Tyrosine hydroxylase deficiency
Simplified overview of the biosynthesis and catabolism of serotonin and the catecholamines TH circled in red.jpg
Simplified overview of the biosynthesis and catabolism of serotonin and the catecholamines, with tyrosine hydroxylase (TH) and its cofactor tetrahydrobiopterin (BH4) circled in red. Note that different parts of these processes take place in different tissues. Abbreviations: 3-MT, 3-methoxytyramine; 5-HTP, 5-hydroxytryptophan; 5HIAA, 5-hydroxyindolacetic acid; AAAHs, aromatic amino acid hydroxylases; AAAs, aromatic amino acids; AADC, aromatic acid decarboxylase; BH4, (6R)-L-erythro-5,6,7,8-tetrahydrobiopterin; COMT, catechol-O-methyltransferase; DBH, dopamine beta-hydroxylase; DOPAC, 3,4-dihydroxyphenylacetic acid; HVA, homovanillic acid; L-DOPA, L-3,4-dihydroxyphenylalanine; MN, metanephrine; MAO, monoamine oxidase; MPHG, 3-methoxy-4-hydroxyphenylethylene glycol; NMN, normetanephrine; PAH, phenylalanine hydroxylase; PLP, pyridoxal phosphate; PNMT, phenylethanolamine N-methyltransferase; TH, tyrosine hydroxylase; TPH, tryptophan hydroxylase. From a review by Gyrid Nygaard et al., 2021. [1]

Tyrosine hydroxylase deficiency (THD) is a disorder caused by disfunction of tyrosine hydroxylase, an enzyme involved in the biosynthesis of dopamine. This condition is one of the causes of dopa-responsive dystonia. [2]

Contents

Symptoms and signs

Patients present with symptoms reflecting the decreased production of dopamine: hypokinetic-rigid syndrome, dystonia, complex encephalopathy. Symptom severity and age at onset are highly variable. A review published on GeneReviews and last updated in 2017 suggests the approximate subdivision of patients into three groups based on differences in severity of symptoms, nature of symptoms, and age at onset. [3] A review published more recently, in 2021, suggests that the disease may have a more gradual and overlapping spectrum, and categorization may be imprecise. [1]

According to the classification on GeneReviews, [3] three approximate phenotypes could be discerned:

Cause

Diagnosis

In order to diagnose tyrosine hydroxylase deficiency, a sample of the patient's cerebrospinal fluid may be obtained to assess neurotransmitter metabolites that may be affected, as illustrated by the metabolic links in Figure 1. Patients typically have normal levels of 5-hydroxyindolacetic acid (5HIAA), low levels of homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylethylene glycol (MHPG), and a low HVA:5-HIAA ratio. [1] Upon finding a pattern of CSF abrormalities suggestive of the disease, the diagnosis may be confirmed by analysing the TH gene encoding the enzyme. [1]

According to a review of dopa-responsive dystonias published in 2021, tyrosine hydroxylase deficiency may be hard to diagnose, with a median diagnostic delay of 4 years, [2] and misdiagnosis happens in a significant proportion of patients, with cerebral palsy being the most common erroneous diagnosis. [2]

Treatment

Patients with tyrosine hydroxylase deficiency are treated with L-dopa in conjunction with decarboxylase inhibitors. A significant percentage of patients do not achieve a complete response on this regimen. [1]

History

The first case reports of "Segawa syndrome" and parkinsonism caused by mutations in the tyrosine hydroxylase gene were published in 1995 [1] [4] and 1996. [5] [6]

Alternative names

Related Research Articles

<span class="mw-page-title-main">Chorea-acanthocytosis</span> Rare autosomal recessive genetic condition

Chorea-acanthocytosis is a rare hereditary disease caused by a mutation in a gene that directs structural proteins in red blood cells. It belongs to a group of four diseases characterized under the name neuroacanthocytosis. When a patient's blood is viewed under a microscope, some of the red blood cells appear thorny. These thorny cells are called acanthocytes.

<span class="mw-page-title-main">Tetrahydrobiopterin deficiency</span> Medical condition

Tetrahydrobiopterin deficiency (THBD, BH4D) is a rare metabolic disorder that increases the blood levels of phenylalanine. Phenylalanine is an amino acid obtained normally through the diet, but can be harmful if excess levels build up, causing intellectual disability and other serious health problems. In healthy individuals, it is metabolised (hydroxylated) into tyrosine, another amino acid, by phenylalanine hydroxylase. However, this enzyme requires tetrahydrobiopterin as a cofactor and thus its deficiency slows phenylalanine metabolism.

<span class="mw-page-title-main">Nijmegen breakage syndrome</span> Medical condition

Nijmegen breakage syndrome (NBS) is a rare autosomal recessive congenital disorder causing chromosomal instability, probably as a result of a defect in the double Holliday junction DNA repair mechanism and/or the synthesis dependent strand annealing mechanism for repairing double strand breaks in DNA.

<span class="mw-page-title-main">GTP cyclohydrolase I</span>

GTP cyclohydrolase I (GTPCH) (EC 3.5.4.16) is a member of the GTP cyclohydrolase family of enzymes. GTPCH is part of the folate and biopterin biosynthesis pathways. It is responsible for the hydrolysis of guanosine triphosphate (GTP) to form 7,8-dihydroneopterin triphosphate (7,8-DHNP-3'-TP, 7,8-NH2-3'-TP).

<span class="mw-page-title-main">Tyrosine hydroxylase</span> Enzyme found in Homo sapiens that converts l-tyrosine to l-dopa, the precursor of cathecolamines

Tyrosine hydroxylase or tyrosine 3-monooxygenase is the enzyme responsible for catalyzing the conversion of the amino acid L-tyrosine to L-3,4-dihydroxyphenylalanine (L-DOPA). It does so using molecular oxygen (O2), as well as iron (Fe2+) and tetrahydrobiopterin as cofactors. L-DOPA is a precursor for dopamine, which, in turn, is a precursor for the important neurotransmitters norepinephrine (noradrenaline) and epinephrine (adrenaline). Tyrosine hydroxylase catalyzes the rate limiting step in this synthesis of catecholamines. In humans, tyrosine hydroxylase is encoded by the TH gene, and the enzyme is present in the central nervous system (CNS), peripheral sympathetic neurons and the adrenal medulla. Tyrosine hydroxylase, phenylalanine hydroxylase and tryptophan hydroxylase together make up the family of aromatic amino acid hydroxylases (AAAHs).

<span class="mw-page-title-main">Congenital muscular dystrophy</span> Medical condition

Congenital muscular dystrophies are autosomal recessively-inherited muscle diseases. They are a group of heterogeneous disorders characterized by muscle weakness which is present at birth and the different changes on muscle biopsy that ranges from myopathic to overtly dystrophic due to the age at which the biopsy takes place.

<span class="mw-page-title-main">Purine nucleoside phosphorylase deficiency</span> Medical condition

Purine nucleoside phosphorylase deficiency is a rare autosomal recessive metabolic disorder which results in immunodeficiency.

Warburg Micro syndrome (WARBM), a Complex Hereditary Spastic Paraplegia or RAB18 Deficiency, is a rare autosomal recessive genetic disorder characterized by congenital cataract, hypotonia, spastic diplegia, intellectual or developmental disability, microcephaly, microcornea, optic atrophy, and hypogenitalism.

Dopamine-responsive dystonia (DRD) also known as Segawa syndrome (SS), is a genetic movement disorder which usually manifests itself during early childhood at around ages 5–8 years.

<span class="mw-page-title-main">Dopamine beta hydroxylase deficiency</span> Medical condition

Dopamine beta (β)-hydroxylase deficiency is a human medical condition involving inadequate dopamine beta-hydroxylase. It is characterized by increased amounts of serum dopamine and the absence of norepinephrine (NE) and epinephrine.

<span class="mw-page-title-main">Gillespie syndrome</span> Medical condition

Gillespie syndrome, also called aniridia, cerebellar ataxia and mental deficiency, is a rare genetic disorder. The disorder is characterized by partial aniridia, ataxia, and, in most cases, intellectual disability. It is heterogeneous, inherited in either an autosomal dominant or autosomal recessive manner. Gillespie syndrome was first described by American ophthalmologist Fredrick Gillespie in 1965.

<span class="mw-page-title-main">Mohr–Tranebjærg syndrome</span> Medical condition

Mohr–Tranebjærg syndrome (MTS) is a rare X-linked recessive syndrome also known as deafness–dystonia syndrome and caused by mutation in the TIMM8A gene. It is characterized by clinical manifestations commencing with early childhood onset hearing loss, followed by adolescent onset progressive dystonia or ataxia, visual impairment from early adulthood onwards and dementia from the 4th decade onwards. The severity of the symptoms may vary, but they progress usually to severe deafness and dystonia and sometimes are accompanied by cortical deterioration of vision and mental deterioration.

<span class="mw-page-title-main">Kufor–Rakeb syndrome</span> Medical condition

Kufor–Rakeb syndrome (KRS) is an autosomal recessive disorder of juvenile onset also known as Parkinson disease-9 (PARK9). It is named after Kufr Rakeb in Irbid, Jordan. Kufor–Rakeb syndrome was first identified in this region in Jordan with a Jordanian couple's 5 children who had rigidity, mask-like face, and bradykinesia. The disease was first described in 1994 by Najim Al-Din et al. The OMIM number is 606693.

Sepiapterin reductase deficiency is an inherited pediatric disorder characterized by movement problems, and most commonly displayed as a pattern of involuntary sustained muscle contractions known as dystonia. Symptoms are usually present within the first year of age, but diagnosis is delayed due to physicians lack of awareness and the specialized diagnostic procedures. Individuals with this disorder also have delayed motor skills development including sitting, crawling, and need assistance when walking. Additional symptoms of this disorder include intellectual disability, excessive sleeping, mood swings, and an abnormally small head size. SR deficiency is a very rare condition. The first case was diagnosed in 2001, and since then there have been approximately 30 reported cases. At this time, the condition seems to be treatable, but the lack of overall awareness and the need for a series of atypical procedures used to diagnose this condition pose a dilemma.

The TH gene codes for the enzyme tyrosine hydroxylase.

Gene therapy in Parkinson's disease consists of the creation of new cells that produce a specific neurotransmitter (dopamine), protect the neural system, or the modification of genes that are related to the disease. Then these cells are transplanted to a patient with the disease. There are different kinds of treatments that focus on reducing the symptoms of the disease but currently there is no cure.

Dopamine transporter deficiency syndrome (DTDS), also known as infantile parkinsonism-dystonia, is a rare movement disorder that causes progressively worsening dystonia and parkinsonism. It is the first known inherited dopamine 'transportophathy.'

Autosomal recessive GTP cyclohydrolase I deficiency (AR-GTPCHD) is a disorder associated with the deficient operation of the enzyme GTP cyclohydrolase I. The condition leads to insufficient production of the cofactor tetrahydrobiopterin necessary for the proper synthesis of dopamine and serotonin and for maintenance of adequate levels of phenylalanine. As of 2020, autosomal recessive GTP cyclohydrolase I deficiency was one of the six known causes of tetrahydrobiopterin deficiency. It is also considered part of the spectrum of dopa-responsive dystonias.

Autosomal dominant GTP cyclohydrolase I deficiency (AD-GTPCHD) is a disease caused by dysfunction of GTP cyclohydrolase I, an enzyme that plays an important role in the synthesis of tetrahydrobiopterin, and, as a consequence, of dopamine. This condition is one of the six known causes of tetrahydrobiopterin deficiency and is the most frequently-reported cause of dopa-responsive dystonia.

Biotin-thiamine-responsive basal ganglia disease (BTBGD) is a rare disease that affects the nervous system, particularly the basal ganglia in the brain. It is a treatable neurometabolic disorder with autosomal recessive inheritance. First described in 1998 and then genetically distinguished in 2005, the disease is characterized by progressive brain damage that, if left untreated, can lead to coma and/or death. Commonly observed in individuals with BTBGD is recurring subacute encephalopathy along with confusion, seizures, and disordered movement (hypokinesia).

References

  1. 1 2 3 4 5 6 Nygaard G, Szigetvari PD, Grindheim AK, Ruoff P, Martinez A, Haavik J, Kleppe R, Flydal MI (November 2021). "Personalized Medicine to Improve Treatment of Dopa-Responsive Dystonia-A Focus on Tyrosine Hydroxylase Deficiency". Journal of Personalized Medicine. 11 (11): 1186. doi: 10.3390/jpm11111186 . PMC   8625014 . PMID   34834538.
  2. 1 2 3 4 Weissbach A, Pauly MG, Herzog R, Hahn L, Halmans S, Hamami F, Bolte C, Camargos S, Jeon B, Kurian MA, Opladen T, Brüggemann N, Huppertz HJ, König IR, Klein C, Lohmann K (February 2022). "Relationship of Genotype, Phenotype, and Treatment in Dopa-Responsive Dystonia: MDSGene Review". Movement Disorders. 37 (2): 237–252. doi:10.1002/mds.28874. PMID   34908184. S2CID   245260405.
  3. 1 2 Adam, M. P.; Feldman, J.; Mirzaa, G. M.; Pagon, R. A.; Wallace, S. E.; Amemiya, A.; Furukawa, Y.; Kish, S. (1993). "Tyrosine Hydroxylase Deficiency". Tyrosine Hydroxylase Deficiency - GeneReviews® - NCBI Bookshelf. University of Washington, Seattle. PMID   20301610 . Retrieved 20 June 2022.
  4. Lüdecke B, Dworniczak B, Bartholomé K (January 1995). "A point mutation in the tyrosine hydroxylase gene associated with Segawa's syndrome". Human Genetics. 95 (1): 123–5. doi:10.1007/BF00225091. PMID   7814018. S2CID   26870241.
  5. "Segawa syndrome, autosomal recessive; Online Mendelian Inheritance in Man (OMIM)". OMIM. 2022-06-20. Retrieved 2022-06-20.
  6. Lüdecke B, Knappskog PM, Clayton PT, Surtees RA, Clelland JD, Heales SJ, Brand MP, Bartholomé K, Flatmark T (July 1996). "Recessively inherited L-DOPA-responsive parkinsonism in infancy caused by a point mutation (L205P) in the tyrosine hydroxylase gene". Human Molecular Genetics. 5 (7): 1023–8. doi: 10.1093/hmg/5.7.1023 . PMID   8817341.