A 12-month, longitudinal, intervention study examining a tablet protein substitute preparation in the management of tyrosinemia

Abstract

Protein substitutes (PS) without tyrosine (Tyr) and phenylalanine (Phe), are an essential source of synthetic protein in the treatment of tyrosinemia (HT). In the UK, the only available protein substitutes for HT are Tyr/ Phe free amino acid liquid or powders or formulations based on glycomacropeptide (CGMP). A tablet Tyr/ Phe free amino acid supplement (AAT) has now been introduced. The aim of this two-part prospective, longitudinal intervention study was to assess the efficacy, acceptability, and tolerance of AAT in children aged >8 years with HTI. Part 1: was a 28-day acceptability/ tolerance study, part 2, was a 12-month extension study examining efficacy of AAT. Anthropometry and blood Tyr/ Phe were assessed. All subjects were taking NTBC [2-(2-nitro-4-triflourothybenzoyl) cyclohexane-1, 3-dione] with a Tyr restricted diet. Eight subjects with HTI were recruited 4 boys, and 4 girls with a median age of 14.3y (range 10.4–17.3); 3 were Caucasian and 5 of Pakistani origin. The median (range) protein equivalent from PS was 60 g/d (50–60), natural protein 20 g/d (15–30), and NTBC 30 mg/d (25–80). No subjects were taking Phe supplements. Five (63%) subjects completed part 1, with 4 taking all their PS requirements as AAT. Subjects reported AAT were tasteless and had no odour. No adverse gastrointestinal symptoms were recorded, with two reporting improvements in abdominal discomfort. At 12 months, 4 subjects had a non-significant decrease in blood Tyr/ Phe compared to the 12 months pre-treatment. Median blood Tyr (μmol/ L) pre-intervention was 500 (320–590); and at 12 months, 450 (290–530). Median blood Phe (μmol/L) pre-intervention was 40 (30–40); and at 12 months 30 (30–50). Median height z scores remained unchanged, but there was a small decrease in weight z score (pre-study weight − 0.1 (−1.4 to1.1), 12 m − 0.3 (−1.4 to 1.3) and BMI (pre- study BMI 0.2 (−2 to 1.4), and 12 m, −0.1 (−2.5 to 1.5)).

Conclusion

AAT were useful for some adolescents with HTI who struggled with the taste and volume of conventional powdered and liquid PS.