Tay-Sachs disease: an improved, fully-automated method for heterozygote identification by tear beta-hexosaminidase assay

Experiences in molecular-based prenatal screening for Ashkenazi Jewish genetic diseases

Multiple-option prenatal carrier testing in the Ashkenazi Jewish community for three and now eight disorders has been readily accepted in this prenatal, health-oriented and knowledgeable population. Counseling of screenees concerning the nature (severity, treatability, etc.), inheritance, and frequencies of each disorder was essential for informed test choices and future reproductive decision making. The value of couple testing for a group of disorders when 1 in about 6 would be found to be a carrier of at least one disease was emphasized. These studies identified issues of education, confidentiality, posttest anxiety, and self-esteem that must be continuously addressed in the Ashkenazi population. However, an important value of these studies is that they provide a framework for the development of mass carrier screening programs in the general population or in specific segments of the population with similar demographic characteristics and in more diverse prenatal populations.

Gaucher type I (Ashkenazi) disease: a new method for heterozygote detection using a novel fluorescent natural substrate

A new acid beta-glucosidase assay for the detection of heterozygotes for Gaucher Type I disease has been developed using isolated lymphocytes as enzyme source and a novel fluorescent natural substrate, NBD-glucosyl ceramide. The procedure for optimal heterozygote discrimination was established by systematic evaluation of the effect of various solubilization techniques, detergent concentrations, pH, enzyme sources and artificial vs. natural substrates. A pilot screening study indicated the feasible application of this assay for heterozygote detection in the high-risk Ashkenazi Jewish population.

Clinical biochemistry of tears

The composition of tear fluid as it exists in the conjunctival fornix and in the precorneal tear film is of a complicated nature. The precorneal tear film is a physically inhomogenous system, produced by the lacrimal glands, the accessory lacrimal glands and the goblet cells of the conjunctiva and the Meibomian glands of the lid margin. The method of collection is crucial for the quantity and concentration of a great number of different compounds that have been demonstrated in tears. A survey is given of the literature concerning tears as they are composed of proteins, enzymes, lipids, metabolites, electrolytes and drugs, the latter secreted during therapy. Clinical applications of the determination of several compounds for diagnosis or for monitoring drug therapy are summarized.

Radioimmunoassay and heat denaturation enzyme assay for the detection of Tay-sachs heterozygotes during pregnancy

Tay-Sachs disease results from a loss of activity of hexosaminidase A (HEXA) in body tissues and fluids. Heterozygotes for the disease are usually identified by their relatively low ratio of heat-labile HEX A to total hexosaminidase. During pregnancy an intermediate isoenzyme (HEX I) increases in activity in serum and obscures the heterozygote status. HEX I dose not increase in leucocytes, tears and other body tissues but because of technical difficulties in these assays we examined the feasibility of using a radioimmunoassay for HEX A. By univariate analysis, the heat denaturation assay gave a lower cost of misclassification for non-pregnant normals while RIA did so for pregnant normals. A combination of both tests led to reduced cost of misclassification compared to either alone. Bayesian analysis of bivariate gaussian density functions for heat denaturation and for radioimmunoassay of HEX isoenzymes was employed to calculate misclassification frequencies. Among the parameters examined, HEX A measured by RIA and % HEX A by heat-denaturation assay were the two having the best discriminatory power.

Assay of ganglioside GM2-N-acetyl-beta-D-galactosaminidase activity in human fibroblasts employing the natural activator protein--diagnosis of variant forms of GM2 gangliosidosis

The physiological activator protein for the degradation of ganglioside GM2 by hexosaminidase A has been employed to assess the capability of cultured human fibroblast extracts to catalyze this ganglioside. This method permits a more reliable diagnosis of the different variants of GM2 gangliosidoses than the methods hitherto used. These either rely on artificial substrates or, when natural substrates are used, on detergents. Our method avoids a number of possible sources of error introduced by the unphysiological detergents, such as alteration of the isoenzymes' substrate specificity or inactivation of the enzymes. The range of application of the new method is discussed.

Serum beta-hexosaminidases in pregnancy

Serum contains several hexosaminidase forms. Two, HEX A and HEX B, migrate in both DEAE cellulose and isoelectric focussing systems like their tissue counterparts. A major group of serum hexosaminidases migrate in an intermediate position. These forms, collectively named HEX 1, increase during pregnancy and obscure carrier detection for Tay-Sachs and Sandhoff's disease. Using DEAE-cellulose chromatography, HEX A, I, and B, can be clearly separated. In normals, activity ratios of A/B are 4.03 +/- 1.33. During pregnancy the ratio falls slightly to 3.01 +/- 1.08. In Tay-Sachs heterozygotes the ratio is only 1.08 +/- 0.35 and falls during early pregnancy to 0.53 +/- 0.23. In Sandhoff heterozygotes the DEAE chromatograms appear normal with higher than normal A/B ratios but in sera, from both pregnant and nonpregnant carriers, the HEX B and HEX I forms are 50% heat labile. During pregnancy, serum can be used as a reliable source of HEX for heterozygote identification for both Sandhoff's and Tay-Sachs disease.

Inborn errors of lysosomal catabolism--principles of heterozygote detection

Carriers of an inborn error of lysosomal catabolism can be recognized, as they have enzyme levels approximately half those of normal individuals. Of the various tissues readily available for assay, plasma and leukocytes and, in some situations, tears are preferred. Although mixed leukocytes have proved satisfactory in Tay-Sachs screening programs, purified preparations of granulocytes or lymphocytes will allow better discrimination in most situations. Enzymes are assayed relative to some other reference parameter which must be a constant or highly correlated with test enzyme activity. In the two mass screening programs in operation, beta-hexosaminidase A and alpha-mannosidase have both been assayed relative to total beta-hexosaminidase activity. Carrier detection is particularly important in X-linked diseases. The techniques used mostly involve hair roots or fibroblasts and depend on random inactivation of the X chromosome. In the mucolipidoses II and III, in which there are a number of deficient enzymes in cells, carriers may be identified on the basis of the ratio of beta-hexosaminidase I1 and I2 to total hexosaminidase.

Biochemistry and genetics of gangliosidoses

The gangliosidoses comprise an-ever increasing number of biochemically and phenotypically variant diseases. In most of them an autosomal recessive inherited deficiency of a lysosomal hydrolase results in the fatal accumulation of glucolipids (predominantly in the nervous tissue) and of oligosaccharides. The structure, substrate specificity, immunological properties of and genetic studies on the relevant glycosidases, ganglioside GM1 beta-galactosidase and beta-hexosaminidase isoenzymes, are reviewed in this paper. Contrary to general expectation, only a poor correlation is observed between the severity of the disease and residual activity of the defective enzyme when measured with synthetic or natural substrates in the presence of detergents. For the understanding of variant diseases and for their pre- and postnatal diagnosis, the necessity of studying the substrate specificity of normal and mutated enzymes under conditions similar to the in vivo situation, e.g., with natural substrates in the presence of appropriate activator proteins, is stressed. The possibility that detergents may have adverse affects on the substrate specificity of the enzymes is discussed for the beta-hexosaminidases. The significance of activator proteins for the proper interaction of lipid substrates and water-soluble hydrolases is illustrated by the fatal glycolipid storage resulting from an activator protein deficiency in the AB variant of GM2-gangliosidosis. Recent somatic complementation studies have revealed the existence of a presumably post-translational modification factor necessary for the expression of ganglioside GM1 beta-galactosidase activity. This factor is deficient in a group of variants of GM1-glangliosidosis. Among the possible reasons for the variability of enzyme activity levels in heterozygotes and patients, allelic mutations, formation of hybrid enzymes, and the existence of patients as compound heterozygotes are discussed. All these may result in the production of mutant enzymes with an altered specificity for a variety of natural substrates.

Beta-hexosaminidase activities in tears and plasma, diphosphoglycerate in blood of diabetic patients

In a study on 10 normal controls, 7 pregnant women and 16 diabetic patients, beta-hexosaminidase in tears and 2,3-diphosphoglycerate in blood were investigated for possible use as index for diabetic retinopathy during pregnancy. Tears were used as source for beta-hexosaminidase because the concentration in plasma and the isoenzyme pattern are affected by the occurrence of a placentar isoenzyme in pregnancy. It has been found that in diabetes the concentration of beta-hexosaminidase in plasma may be elevated, but that it remains unchanged in tears and that there is no correlation between the plasma and tear values in all individuals. Neither beta-hexosaminidase in tears nor 2,3-diphosphoglycerate in blood appears as indicator for the onset or development of diabetic retinopathy.