ABSTRACT. Maternal phenylketonuria results in a high incidence of children born who are mentally retarded. It has been suggested that blood-brain-barrier transport of phenylalanine may be reduced by competitive inhibition of transporter uptake by supplemental administration of other large neutral amino acids. We hypothesized that large neutral amino acids might also be effective at improving the outcome of fetuses exposed to hyperphenylalaninemia in utero. If correct, sparing of embryonic CNS development might be possible. Pregnant rats were given a hyperphenylalaninemic diet alone or the same diet supplemented with a combination of valine, isoleucine, and leucine. As adults, the progeny exposed in utero to hyperphenylalaninemia showed characteristic learning deficits in a complex maze, while those exposed in utero to hyperphenylalaninemia combined with valine, isoleucine, and leucine showed no deficits in maze acquisition. The valine, isoleucine, and leucine supplement may show promise as a treatment for intrauterinely acquired mental deficiency associated with maternal phenylketonuria. (2) found that 95% of pregnant PKU women with serum phenylalanine levels 220 mg/dL delivered at least one child who was mentally deficient. Other findings were microcephaly (90%), growth retardation (56%), and congenital heart defects (40%). Reinstatement of a phenylalaninerestricted diet before or after recognition of pregnancy has produced mixed, but generally unsatisfactory, results (2-7).This has led to the search for new approaches. Phenylalanine and other LNAA share a common transport carrier for selective CNS uptake (8-12). It has been established that increasing the concentration of one or more LNAA competitively inhibits the transport into brain of other amino acids in this group. This approach has been suggested as a means of reducing the influx of phenylalanine in PKU (13)(14)(15)(16)(17)(18). Early experiments to assess this have shown promise (13-1 5, 17-22), but in no case was evidence provided that such approaches could produce lasting cognitive improvement. Given that mental retardation is the most prevalent untoward effect of maternal PKU, we sought to test the efficacy of the branched-chain LNAA to improve embryo-fetal development in pregnant hyperphenylalaninemic rats to determine if sparing of CNS development in the progeny was possible.
MATERIALS AND METHODS
PCPA, ~,~~~-c h l o r o~h e n~l a l a n i n eNulliparous female Sprague-Dawley CD (VAF/Plus) rats PFC, pair-fed control (Charles River Breeding Laboratories, Portage, MI) were bred VIL, valine, isoleucine, and leucine and on d 4 (sperm plug = d 0) were randomly assigned to one of three treatment groups on a wt matched basis. Experimental diets were provided on gestation d 5-15. The PKU group received diet containing 2.5% added L-phenylalanine (phe) and PKU, an inherited disorder of phenylalanine metabolism, has 0.12% PCPA by wt (23-25) ad libitum. PCPA is a ~h e n~l a l a n i n e been treated during the last 30 through a of hydroxylase inhibitor (26-27)...