Introduction: Hyperphenylalaninemia (HPA) is a metabolic disorder classified into phenylalanine-4-hydroxylase (PAH) and non-PAH deficiency.
The latter is produced by mutations in genes involved in the tetrahydrobiopterin (BH4) biosynthesis pathway and DNAJC12 pathogenetic variants. The
BH4 metabolism, including de novo biosynthesis involved genes (i.e., guano-
sine 5′-triphosphate cyclohydrolase I (GTPCH/GCH1), sepiapterin reductase
(SR/SPR), 6-pyruvoyl-tetrahydropterin synthase (PTPS/PTS)), and two genes
that play roles in cofactor regeneration pathway (i.e., dihydropteridine reductase
(DHPR/QDPR) and pterin-4α- carbinolamine dehydratase (PCD/PCBD1)). The
subsequent systemic hyperphenylalaninemia and monoamine neurotransmitter
deficiency lead to neurological consequences. The high rate of consanguineous
marriages in Iran substantially increases the incidence of BH4 deficiency
Methods: We utilized the Sanger sequencing technique in this study to investigate 14 Iranian patients with non-PAH deficiency. All affected subjects in this
study had HPA and no mutation was detected in their PAH gene
Results: We successfully identified six mutant alleles in BH4-deficiency-
associated genes, including three novel mutations: one in QDPR, one in PTS, and
one in the PCBD1 gene, thus giving a definite diagnosis to these patients.
Conclusion: In this light, appropriate patient management may follow. The clinical effect of reported variants is essential for genetic counseling and prenatal
diagnosis in the patients' families and significant for the improvement of precision medicine.