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Deleanu C, Nicolescu A. NMR Spectroscopy in Diagnosis and Monitoring of Methylmalonic and Propionic Acidemias. Biomolecules 2024; 14:528. [PMID: 38785935 PMCID: PMC11117674 DOI: 10.3390/biom14050528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Although both localized nuclear magnetic resonance spectroscopy (MRS) and non-localized nuclear magnetic resonance spectroscopy (NMR) generate the same information, i.e., spectra generated by various groups from the structure of metabolites, they are rarely employed in the same study or by the same research group. As our review reveals, these techniques have never been applied in the same study of methylmalonic acidemia (MMA), propionic acidemia (PA) or vitamin B12 deficiency patients. On the other hand, MRS and NMR provide complementary information which is very valuable in the assessment of the severity of disease and efficiency of its treatment. Thus, MRS provides intracellular metabolic information from localized regions of the brain, while NMR provides extracellular metabolic information from biological fluids like urine, blood or cerebrospinal fluid. This paper presents an up-to-date review of the NMR and MRS studies reported to date for methylmalonic and propionic acidemias. Vitamin B12 deficiency, although in most of its cases not inherited, shares similarities in its metabolic effects with MMA and it is also covered in this review.
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Affiliation(s)
- Calin Deleanu
- “Costin D. Nenitescu” Institute of Organic and Supramolecular Chemistry, Spl. Independentei 202-B, RO-060023 Bucharest, Romania
- “Petru Poni” Institute of Macromolecular Chemistry, Aleea Grigore Ghica Voda 41-A, RO-700487 Iasi, Romania
| | - Alina Nicolescu
- “Costin D. Nenitescu” Institute of Organic and Supramolecular Chemistry, Spl. Independentei 202-B, RO-060023 Bucharest, Romania
- “Petru Poni” Institute of Macromolecular Chemistry, Aleea Grigore Ghica Voda 41-A, RO-700487 Iasi, Romania
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Victoria Zhang Y, Garg U. Mass Spectrometry in Clinical Laboratory: Applications in Therapeutic Drug Monitoring and Toxicology. Methods Mol Biol 2024; 2737:1-13. [PMID: 38036805 DOI: 10.1007/978-1-0716-3541-4_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Mass spectrometry (MS) coupled with liquid chromatography (LC) or gas chromatography (GC) has been proven to be a powerful platform in research and specialized clinical laboratories for decades. In clinical laboratories, it is used for compound identification and quantification. Due to the ability to provide specific identification, high sensitivity, and simultaneous analysis of multiple analytes (>100) in recent years, application of MS in routine clinical laboratories has increased significantly. Although MS is used in many laboratory areas, therapeutic drug monitoring, drugs of abuse, and clinical toxicology remain the primary focuses of the field. Due to rapid increase in the number of prescription drugs and drugs of abuse (e.g., novel psychoactive substances), clinical laboratories are challenged with developing new MS assays to meet the clinical needs of the patients. We are here to present "off-the-shelf" and "ready-to-use" protocols of recent developments in new assays to help the clinical laboratory community adopt the technology and analysis for the betterment of patient care.
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Affiliation(s)
- Y Victoria Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA
| | - Uttam Garg
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, USA.
- University of Missouri School of Medicine, Kansas City, MO, USA.
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Staretz-Chacham O, Damseh NS, Daas S, Abu Salah N, Anikster Y, Barel O, Dumin E, Fattal-Valevski A, Falik-Zaccai TC, Hershkovitz E, Josefsberg S, Landau Y, Lerman-Sagie T, Mandel H, Rock R, Rostami N, Saraf-Levy T, Shaul Lotan N, Spiegel R, Tal G, Ulanovsky I, Wilnai Y, Korman SH, Almashanu S. Hereditary orotic aciduria identified by newborn screening. Front Genet 2023; 14:1135267. [PMID: 36999056 PMCID: PMC10043439 DOI: 10.3389/fgene.2023.1135267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/27/2023] [Indexed: 03/15/2023] Open
Abstract
Introduction: Hereditary orotic aciduria is an extremely rare, autosomal recessive disease caused by deficiency of uridine monophosphate synthase. Untreated, affected individuals may develop refractory megaloblastic anemia, neurodevelopmental disabilities, and crystalluria. Newborn screening has the potential to identify and enable treatment of affected individuals before they become significantly ill.Methods: Measuring orotic acid as part of expanded newborn screening using flow injection analysis tandem mass spectrometry.Results: Since the addition of orotic acid measurement to the Israeli routine newborn screening program, 1,492,439 neonates have been screened. The screen has identified ten Muslim Arab newborns that remain asymptomatic so far, with DBS orotic acid elevated up to 10 times the upper reference limit. Urine organic acid testing confirmed the presence of orotic aciduria along with homozygous variations in the UMPS gene.Conclusion: Newborn screening measuring of orotic acid, now integrated into the routine tandem mass spectrometry panel, is capable of identifying neonates with hereditary orotic aciduria.
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Affiliation(s)
- Orna Staretz-Chacham
- Metabolic Clinic, Pediatric Division, Soroka University Medical Center, Ben Gurion University, Beer- Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel
- Institute for Rare Diseases, Soroka University Medical Center, Ben Gurion University, Beer- Sheva, Israel
- *Correspondence: Orna Staretz-Chacham, ,
| | - Nadirah S. Damseh
- Faculty of Medicine, Al-Quds University, Palestinian National Authority, Abu Deis, Palestine
| | - Suha Daas
- National Newborn Screening Program, Public Health Services, Ministry of Health, Ramat-Gan, Israel
| | - Nasser Abu Salah
- Department of Neonatology, Red Crescent Society Hospital, Jerusalem, Israel
- School of Medicine, Hebrew University School of Medicine, Jerusalem, Israel
| | - Yair Anikster
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Metabolic Disease Unit, Sheba Medical Center Tel-Hashomer, Edmond and Lily Safra Children’s Hospital, Ramat Gan, Israel
| | - Ortal Barel
- Genomics Unit, The Center for Cancer Research, Sheba Medical Center, Ramat Gan, Israel
| | - Elena Dumin
- Metabolic Laboratory, Sheba Medical Center, Ramat Gan, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Aviva Fattal-Valevski
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Tel Aviv Sourasky Medical Center, Dana Children Hospital, Pediatric Neurology Institute, Tel Aviv, Israel
| | - Tzipora C. Falik-Zaccai
- Galilee Medical Center, Institute of Human Genetics, Naharia, Israel
- The Azrieli Faculty of Medicine, Bar Ilan, Safed, Israel
| | - Eli Hershkovitz
- Metabolic Clinic, Pediatric Division, Soroka University Medical Center, Ben Gurion University, Beer- Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel
- Pediatric D Department, Soroka Medical Center, Beer Sheva, Israel
| | | | - Yuval Landau
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Metabolic Disease Unit, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Tally Lerman-Sagie
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Magen Center for Rare Diseases-Metabolic, Neurogenetic, Wolfson Medical Center, Holon, Israel
| | - Hanna Mandel
- Metabolic Unit, Department of Genetics, Rebecca Sieff Hospital, Safed, Israel
| | - Rachel Rock
- National Newborn Screening Program, Public Health Services, Ministry of Health, Ramat-Gan, Israel
| | - Nira Rostami
- National Newborn Screening Program, Public Health Services, Ministry of Health, Ramat-Gan, Israel
| | - Talya Saraf-Levy
- National Newborn Screening Program, Public Health Services, Ministry of Health, Ramat-Gan, Israel
| | - Nava Shaul Lotan
- Department of Genetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronen Spiegel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Pediatrics B, Metabolic Service, Emek Medical Center, Afula, Israel
- Emek Medical Center, Institute for Rare Diseases, Afula, Israel
| | - Galit Tal
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Rambam Medical Center, Metabolic Clinic, Ruth Rappaport Children’s Hospital, Haifa, Israel
| | - Igor Ulanovsky
- National Newborn Screening Program, Public Health Services, Ministry of Health, Ramat-Gan, Israel
| | - Yael Wilnai
- Tel Aviv Sourasky Medical Center, Genetic Institute, Tel Aviv, Israel
| | - Stanley H. Korman
- Rambam Medical Center, Metabolic Clinic, Ruth Rappaport Children’s Hospital, Haifa, Israel
- Shaare Zedek Medical Center, Wilf Children’s Hospital, Jerusalem, Israel
| | - Shlomo Almashanu
- National Newborn Screening Program, Public Health Services, Ministry of Health, Ramat-Gan, Israel
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Introduction to Mass Spectrometry for Bimolecular Analysis in a Clinical Laboratory. Methods Mol Biol 2022; 2546:1-12. [PMID: 36127573 DOI: 10.1007/978-1-0716-2565-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Mass spectrometry is a technique that identifies analytes based on mass-to-charge (m/z) ratio and structural fragments. Although this technique has been used in research and specialized clinical laboratories for decades, only in recent years has mass spectrometry become popular in routine clinical laboratories. Mass spectrometry, especially when coupled with gas chromatography or liquid chromatography, provides very specific and often sensitive analysis of many analytes. Other advantages of mass spectrometry include simultaneous analysis of multiple analytes (>100) and generally limited requirement for specialized reagents. Commonly measured analytes by mass spectrometry include metabolites, drugs, hormones, and proteins.
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Padilla CD, Therrell BL, Alcausin MMLB, Chiong MAD, Abacan MAR, Reyes MEL, Jomento CM, Dizon-Escoreal MTT, Canlas MAE, Abadingo ME, Posecion JEWC, Abarquez CG, Andal AP, Elizaga ALG, Halili-Mendoza BC, Otayza MPVK, Millington DS. Successful Implementation of Expanded Newborn Screening in the Philippines Using Tandem Mass Spectrometry. Int J Neonatal Screen 2022; 8:ijns8010008. [PMID: 35225931 PMCID: PMC8883932 DOI: 10.3390/ijns8010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/23/2021] [Accepted: 01/12/2022] [Indexed: 11/29/2022] Open
Abstract
Newborn bloodspot screening (NBS) began as a research project in the Philippines in 1996 and was mandated by law in 2004. The program initially included screening for five conditions, with a sixth added in 2012. As screening technology and medical knowledge have advanced, NBS programs in countries with developed economies have also expanded, not only in the number of newborns screened but also in the number of conditions included in the screening. Various approaches have been taken regarding selection of conditions to be screened. With limited resources, low- and middle-income countries face significant challenges in selecting conditions for screening and in implementing sustainable screening programs. Building on expansion experiences in the U.S. and data from California on Filipinos born and screened there, the Philippine NBS program has recently completed its expansion to include 29 screening conditions. This report focuses on those conditions detectable through tandem mass spectrometry. Expanded screening was implemented in a stepwise fashion across the seven newborn screening laboratories in the Philippines. A university-based biochemical genetics laboratory provides confirmatory testing. Follow-up care for confirmed cases is monitored and provided through the NBS continuity clinics across the archipelago. Pre-COVID-19 pandemic, the coverage was 91.6% but dropped to 80.4% by the end of 2020 due to closure of borders between cities, provinces, and islands.
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Affiliation(s)
- Carmencita D. Padilla
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (M.E.L.R.); (C.M.J.); (M.T.T.D.-E.); (M.A.E.C.); (M.E.A.)
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines; (M.A.D.C.); (M.A.R.A.)
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines
- Correspondence:
| | - Bradford L. Therrell
- National Newborn Screening and Global Resource Center, Austin, TX 78759, USA;
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Maria Melanie Liberty B. Alcausin
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (M.E.L.R.); (C.M.J.); (M.T.T.D.-E.); (M.A.E.C.); (M.E.A.)
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines; (M.A.D.C.); (M.A.R.A.)
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines
| | - Mary Anne D. Chiong
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines; (M.A.D.C.); (M.A.R.A.)
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines
- Department of Biochemistry, Molecular Biology and Nutrition, Faculty of Medicine and Surgery, University of Santo Tomas, Manila 1008, Philippines
| | - Mary Ann R. Abacan
- Department of Pediatrics, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines; (M.A.D.C.); (M.A.R.A.)
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines
| | - Ma. Elouisa L. Reyes
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (M.E.L.R.); (C.M.J.); (M.T.T.D.-E.); (M.A.E.C.); (M.E.A.)
| | - Charity M. Jomento
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (M.E.L.R.); (C.M.J.); (M.T.T.D.-E.); (M.A.E.C.); (M.E.A.)
| | - Maria Truda T. Dizon-Escoreal
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (M.E.L.R.); (C.M.J.); (M.T.T.D.-E.); (M.A.E.C.); (M.E.A.)
| | - Margarita Aziza E. Canlas
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (M.E.L.R.); (C.M.J.); (M.T.T.D.-E.); (M.A.E.C.); (M.E.A.)
| | - Michelle E. Abadingo
- Newborn Screening Reference Center, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines; (M.M.L.B.A.); (M.E.L.R.); (C.M.J.); (M.T.T.D.-E.); (M.A.E.C.); (M.E.A.)
| | | | - Conchita G. Abarquez
- Newborn Screening Center—Mindanao, Southern Philippine Medical Center, Davao 8000, Philippines;
| | - Alma P. Andal
- Newborn Screening Center—Southern Luzon, Daniel O. Mercado Medical Center, Tanauan 4232, Philippines;
| | - Anna Lea G. Elizaga
- Newborn Screening Center—National Institutes of Health, Quezon 1101, Philippines;
| | - Bernadette C. Halili-Mendoza
- Newborn Screening Center—Central Luzon, Angeles University Foundation Medical Center, Angeles 2009, Philippines;
| | - Maria Paz Virginia K. Otayza
- Newborn Screening Center—Northern Luzon, Mariano Marcos Memorial Hospital and Medical Center, Batac 2906, Philippines;
| | - David S. Millington
- Department of Pediatrics, Duke University School of Medicine, Durham, NC 27708, USA;
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Yavuz E, Irak K, Çelik ÖY, Bolacali M, Ergiden Y, Gürgöze S. Determination of the Relationship of Serum Amino Acid Profile with Sex and Body Weight in Healthy Geese by Liquid Chromatography-Tandem Mass Spectrometry. BRAZILIAN JOURNAL OF POULTRY SCIENCE 2022. [DOI: 10.1590/1806-9061-2021-1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- E Yavuz
- International Center for Livestock Research and Training, Turkey
| | | | | | | | - Y Ergiden
- International Center for Livestock Research and Training, Turkey
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Queijo C, Lemes A, Queiruga G. 25 Years of Newborn Screening in Uruguay. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2021. [DOI: 10.1590/2326-4594-jiems-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - A. Lemes
- Banco de Prevision Social, Uruguay
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Lotz-Havla AS, Röschinger W, Schiergens K, Singer K, Karall D, Konstantopoulou V, Wortmann SB, Maier EM. Fatal pitfalls in newborn screening for mitochondrial trifunctional protein (MTP)/long-chain 3-Hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency. Orphanet J Rare Dis 2018; 13:122. [PMID: 30029694 PMCID: PMC6053800 DOI: 10.1186/s13023-018-0875-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/11/2018] [Indexed: 12/31/2022] Open
Abstract
Background Mitochondrial trifunctional protein (MTP) and long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency are long-chain fatty acid oxidation disorders with particularly high morbidity and mortality. Outcome can be favorable if diagnosed in time, prompting the implementation in newborn screening programs. Sporadic cases missed by the initial screening sample have been reported. However, little is known on pitfalls during confirmatory testing resulting in fatal misconception of the diagnosis. Results We report a series of three patients with MTP and LCHAD deficiency, in whom diagnosis was missed by newborn screening, resulting in life-threatening metabolic decompensations within the first half year of life. Two of the patients showed elevated concentrations of primary markers C16-OH and C18:1-OH but were missed by confirmatory testing performed by the maternity clinic. A metabolic center was not consulted. Confirmatory testing consisted of analyses of acylcarnitines in blood and organic acids in urine, the finding of normal excretion of organic acids led to rejection and underestimation of the diagnosis, respectively. The third patient, a preterm infant, was not identified in the initial screening sample due to only moderate elevations of C16-OH and C18:1-OH and normal secondary markers and analyte ratios. Conclusion Our observations highlight limitations of newborn screening for MTP/LCHAD deficiency. They confirm that analyses of acylcarnitines in blood and organic acids in urine alone are not suitable for confirmatory testing and molecular or functional analysis is crucial in diagnosing MTP/LCHAD deficiency. Mild elevations of primary biomarkers in premature infants need to trigger confirmatory testing. Our report underscores the essential role of specialized centers in confirming or ruling out diagnoses in suspicious screening results.
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Affiliation(s)
- Amelie S Lotz-Havla
- Department of Inborn Errors of Metabolism, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Lindwurmstr. 4, 80337, Munich, Germany
| | - Wulf Röschinger
- Becker and colleagues laboratory, Fuehrichstr. 70, 81671, Munich, Germany
| | - Katharina Schiergens
- Department of Inborn Errors of Metabolism, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Lindwurmstr. 4, 80337, Munich, Germany
| | - Katharina Singer
- Department of Inborn Errors of Metabolism, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Lindwurmstr. 4, 80337, Munich, Germany
| | - Daniela Karall
- Clinic for Pediatrics, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Saskia B Wortmann
- Department of Pediatrics, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020, Salzburg, Austria
| | - Esther M Maier
- Department of Inborn Errors of Metabolism, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Lindwurmstr. 4, 80337, Munich, Germany.
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Age-Related Reference Intervals for Blood Amino Acids in Thai Pediatric Population Measured by Liquid Chromatography Tandem Mass Spectrometry. J Nutr Metab 2018; 2018:5124035. [PMID: 29854440 PMCID: PMC5960525 DOI: 10.1155/2018/5124035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/19/2018] [Accepted: 02/28/2018] [Indexed: 01/21/2023] Open
Abstract
Background Age, race, and analytic method influence levels of blood amino acids, of which reference intervals are required for the diagnosis and management of inherited metabolic disorders. Objectives To establish age-specific reference intervals for blood amino acids in Thai pediatric population measured by liquid chromatography tandem mass spectrometry (LC-MS/MS). Methods A cross-sectional study of 277 healthy children from birth to 12 years was conducted. Anthropometric, clinical, and dietary information were recorded. Dried blood spots on a filtered paper were used for measurement by derivatized LC-MS/MS. Factors that might affect amino acids such as fasting time and dietary intake were analyzed using quantile regression analysis. Results Levels of thirteen blood amino acids were reported as median and interval from 2.5th–97.5th percentiles. Compared with those of Caucasian, most blood amino acid levels of Thai children were higher. Compared with a previous study using HPLC in Thai children, many amino acid levels are different. Glycine, alanine, leucine/isoleucine, and glutamic acid sharply decreased after birth. Citrulline, arginine, and methionine stayed low from birth throughout childhood, whereas phenylalanine was at middle level and slightly increased during preadolescence. Conclusion Reference intervals of age-specific blood amino acids using LC-MS/MS were established in the Thai pediatric population. They diverge from previous studies, substantiating the recommendation that, for the optimal clinical practice, age-specific reference intervals of amino acids should be designated for the particular population and analysis method.
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Beger RD, Dunn W, Schmidt MA, Gross SS, Kirwan JA, Cascante M, Brennan L, Wishart DS, Oresic M, Hankemeier T, Broadhurst DI, Lane AN, Suhre K, Kastenmüller G, Sumner SJ, Thiele I, Fiehn O, Kaddurah-Daouk R. Metabolomics enables precision medicine: "A White Paper, Community Perspective". Metabolomics 2016; 12:149. [PMID: 27642271 PMCID: PMC5009152 DOI: 10.1007/s11306-016-1094-6] [Citation(s) in RCA: 366] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/08/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION BACKGROUND TO METABOLOMICS Metabolomics is the comprehensive study of the metabolome, the repertoire of biochemicals (or small molecules) present in cells, tissues, and body fluids. The study of metabolism at the global or "-omics" level is a rapidly growing field that has the potential to have a profound impact upon medical practice. At the center of metabolomics, is the concept that a person's metabolic state provides a close representation of that individual's overall health status. This metabolic state reflects what has been encoded by the genome, and modified by diet, environmental factors, and the gut microbiome. The metabolic profile provides a quantifiable readout of biochemical state from normal physiology to diverse pathophysiologies in a manner that is often not obvious from gene expression analyses. Today, clinicians capture only a very small part of the information contained in the metabolome, as they routinely measure only a narrow set of blood chemistry analytes to assess health and disease states. Examples include measuring glucose to monitor diabetes, measuring cholesterol and high density lipoprotein/low density lipoprotein ratio to assess cardiovascular health, BUN and creatinine for renal disorders, and measuring a panel of metabolites to diagnose potential inborn errors of metabolism in neonates. OBJECTIVES OF WHITE PAPER—EXPECTED TREATMENT OUTCOMES AND METABOLOMICS ENABLING TOOL FOR PRECISION MEDICINE We anticipate that the narrow range of chemical analyses in current use by the medical community today will be replaced in the future by analyses that reveal a far more comprehensive metabolic signature. This signature is expected to describe global biochemical aberrations that reflect patterns of variance in states of wellness, more accurately describe specific diseases and their progression, and greatly aid in differential diagnosis. Such future metabolic signatures will: (1) provide predictive, prognostic, diagnostic, and surrogate markers of diverse disease states; (2) inform on underlying molecular mechanisms of diseases; (3) allow for sub-classification of diseases, and stratification of patients based on metabolic pathways impacted; (4) reveal biomarkers for drug response phenotypes, providing an effective means to predict variation in a subject's response to treatment (pharmacometabolomics); (5) define a metabotype for each specific genotype, offering a functional read-out for genetic variants: (6) provide a means to monitor response and recurrence of diseases, such as cancers: (7) describe the molecular landscape in human performance applications and extreme environments. Importantly, sophisticated metabolomic analytical platforms and informatics tools have recently been developed that make it possible to measure thousands of metabolites in blood, other body fluids, and tissues. Such tools also enable more robust analysis of response to treatment. New insights have been gained about mechanisms of diseases, including neuropsychiatric disorders, cardiovascular disease, cancers, diabetes and a range of pathologies. A series of ground breaking studies supported by National Institute of Health (NIH) through the Pharmacometabolomics Research Network and its partnership with the Pharmacogenomics Research Network illustrate how a patient's metabotype at baseline, prior to treatment, during treatment, and post-treatment, can inform about treatment outcomes and variations in responsiveness to drugs (e.g., statins, antidepressants, antihypertensives and antiplatelet therapies). These studies along with several others also exemplify how metabolomics data can complement and inform genetic data in defining ethnic, sex, and gender basis for variation in responses to treatment, which illustrates how pharmacometabolomics and pharmacogenomics are complementary and powerful tools for precision medicine. CONCLUSIONS KEY SCIENTIFIC CONCEPTS AND RECOMMENDATIONS FOR PRECISION MEDICINE Our metabolomics community believes that inclusion of metabolomics data in precision medicine initiatives is timely and will provide an extremely valuable layer of data that compliments and informs other data obtained by these important initiatives. Our Metabolomics Society, through its "Precision Medicine and Pharmacometabolomics Task Group", with input from our metabolomics community at large, has developed this White Paper where we discuss the value and approaches for including metabolomics data in large precision medicine initiatives. This White Paper offers recommendations for the selection of state of-the-art metabolomics platforms and approaches that offer the widest biochemical coverage, considers critical sample collection and preservation, as well as standardization of measurements, among other important topics. We anticipate that our metabolomics community will have representation in large precision medicine initiatives to provide input with regard to sample acquisition/preservation, selection of optimal omics technologies, and key issues regarding data collection, interpretation, and dissemination. We strongly recommend the collection and biobanking of samples for precision medicine initiatives that will take into consideration needs for large-scale metabolic phenotyping studies.
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Affiliation(s)
- Richard D. Beger
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079 USA
| | - Warwick Dunn
- School of Biosciences, Phenome Centre Birmingham and Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Michael A. Schmidt
- Advanced Pattern Analysis and Countermeasures Group, Research Innovation Center, Colorado State University, Fort Collins, CO 80521 USA
| | - Steven S. Gross
- Department of Pharmacology, Weill Cornell Medical College, New York, NY 10021 USA
| | - Jennifer A. Kirwan
- School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Marta Cascante
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Universitat de Barcelona, Av Diagonal 643, 08028 Barcelona, Spain
- Institute of Biomedicine of Universitat de Barcelona (IBUB) and CSIC-Associated Unit, Barcelona, Spain
| | | | - David S. Wishart
- Departments of Computing Science and Biological Sciences, University of Alberta, Edmonton, AB Canada
| | - Matej Oresic
- Turku Centre for Biotechnology, University of Turku, Turku, Finland
| | - Thomas Hankemeier
- Division of Analytical Biosciences and Cluster Systems Pharmacology, Leiden Academic Centre for Drug Research, Leiden University & Netherlands Metabolomics Centre, Leiden, The Netherlands
| | | | - Andrew N. Lane
- Center for Environmental Systems Biochemistry, Department Toxicology and Cancer Biology, Markey Cancer Center, Lexington, KY USA
| | - Karsten Suhre
- Department of Physiology and Biophysics, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Gabi Kastenmüller
- Institute of Bioinformatics and Systems Biology, Helmholtz Center Munich, Oberschleißheim, Germany
| | - Susan J. Sumner
- Discovery Sciences, RTI International, Research Triangle Park, Durham, NC USA
| | - Ines Thiele
- University of Luxembourg, Luxembourg Centre for Systems Biomedicine, Campus Belval, Esch-Sur-Alzette, Luxembourg
| | - Oliver Fiehn
- West Coast Metabolomics Center, UC Davis, Davis, CA USA
- Biochemistry Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rima Kaddurah-Daouk
- Psychiatry and Behavioral Sciences, Duke Internal Medicine and Duke Institute for Brain Sciences and Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Box 3903, Durham, NC 27710 USA
| | - for “Precision Medicine and Pharmacometabolomics Task Group”-Metabolomics Society Initiative
- Division of Systems Biology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079 USA
- School of Biosciences, Phenome Centre Birmingham and Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- Advanced Pattern Analysis and Countermeasures Group, Research Innovation Center, Colorado State University, Fort Collins, CO 80521 USA
- Department of Pharmacology, Weill Cornell Medical College, New York, NY 10021 USA
- School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Universitat de Barcelona, Av Diagonal 643, 08028 Barcelona, Spain
- Institute of Biomedicine of Universitat de Barcelona (IBUB) and CSIC-Associated Unit, Barcelona, Spain
- UCD Institute of Food and Health, UCD, Belfield, Dublin Ireland
- Departments of Computing Science and Biological Sciences, University of Alberta, Edmonton, AB Canada
- Turku Centre for Biotechnology, University of Turku, Turku, Finland
- Division of Analytical Biosciences and Cluster Systems Pharmacology, Leiden Academic Centre for Drug Research, Leiden University & Netherlands Metabolomics Centre, Leiden, The Netherlands
- School of Science, Edith Cowan University, Perth, Australia
- Center for Environmental Systems Biochemistry, Department Toxicology and Cancer Biology, Markey Cancer Center, Lexington, KY USA
- Department of Physiology and Biophysics, Weill Cornell Medical College in Qatar, Doha, Qatar
- Institute of Bioinformatics and Systems Biology, Helmholtz Center Munich, Oberschleißheim, Germany
- Discovery Sciences, RTI International, Research Triangle Park, Durham, NC USA
- University of Luxembourg, Luxembourg Centre for Systems Biomedicine, Campus Belval, Esch-Sur-Alzette, Luxembourg
- West Coast Metabolomics Center, UC Davis, Davis, CA USA
- Biochemistry Department, King Abdulaziz University, Jeddah, Saudi Arabia
- Psychiatry and Behavioral Sciences, Duke Internal Medicine and Duke Institute for Brain Sciences and Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Box 3903, Durham, NC 27710 USA
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11
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Ho G, Ueda K, Houben RFA, Joa J, Giezen A, Cheng B, van Karnebeek CDM. Metabolic Diet App Suite for inborn errors of amino acid metabolism. Mol Genet Metab 2016; 117:322-7. [PMID: 26748688 DOI: 10.1016/j.ymgme.2015.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND An increasing number of rare inborn errors of metabolism (IEMs) are amenable to targeted metabolic nutrition therapy. Daily adherence is important to attain metabolic control and prevent organ damage. This is challenging however, given the lack of information of disorder specific nutrient content of foods, the limited availability and cost of specialty products as well as difficulties in reliable calculation and tracking of dietary intake and targets. OBJECTIVES To develop apps for all inborn errors of amino acid metabolism for which the mainstay of treatment is a medical diet, and obtain patient and family feedback throughout the process to incorporate this into subsequent versions. METHODS & RESULTS The Metabolic Diet App Suite was created with input from health care professionals as a free, user-friendly, online tool for both mobile devices and desktop computers (http://www.metabolicdietapp.org) for 15 different IEMs. General information is provided for each IEM with links to useful online resources. Nutrient information is based on the MetabolicPro™, a North American food database compiled by the Genetic Metabolic Dietitians International (GMDI) Technology committee. After user registration, a personalized dashboard and management plan including specific nutrient goals are created. Each Diet App has a user-friendly interface and the functions include: nutrient intake counts, adding your own foods and homemade recipes and, managing a daily food diary. Patient and family feedback was overall positive and specific suggestions were used to further improve the App Suite. DISCUSSION The Metabolic Diet App Suite aids individuals affected by IEMs to track and plan their meals. Future research should evaluate its impact on patient adherence, metabolic control, quality of life and health-related outcomes. The Suite will be updated and expanded to Apps for other categories of IEMs. Finally, this Suite is a support tool only, and does not replace medical/metabolic nutrition professional advice.
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Affiliation(s)
- Gloria Ho
- Division of Biochemical Diseases, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Keiko Ueda
- Division of Biochemical Diseases, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | | | | | - Alette Giezen
- Division of Biochemical Diseases, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Barbara Cheng
- Division of Biochemical Diseases, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Clara D M van Karnebeek
- Division of Biochemical Diseases, BC Children's Hospital, University of British Columbia, Vancouver, Canada; Department of Pediatrics, Centre for Molecular Medicine & Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
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12
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Abstract
Inborn errors of metabolism are single gene disorders resulting from the defects in the biochemical pathways of the body. Although these disorders are individually rare, collectively they account for a significant portion of childhood disability and deaths. Most of the disorders are inherited as autosomal recessive whereas autosomal dominant and X-linked disorders are also present. The clinical signs and symptoms arise from the accumulation of the toxic substrate, deficiency of the product, or both. Depending on the residual activity of the deficient enzyme, the initiation of the clinical picture may vary starting from the newborn period up until adulthood. Hundreds of disorders have been described until now and there has been a considerable clinical overlap between certain inborn errors. Resulting from this fact, the definite diagnosis of inborn errors depends on enzyme assays or genetic tests. Especially during the recent years, significant achievements have been gained for the biochemical and genetic diagnosis of inborn errors. Techniques such as tandem mass spectrometry and gas chromatography for biochemical diagnosis and microarrays and next-generation sequencing for the genetic diagnosis have enabled rapid and accurate diagnosis. The achievements for the diagnosis also enabled newborn screening and prenatal diagnosis. Parallel to the development the diagnostic methods; significant progress has also been obtained for the treatment. Treatment approaches such as special diets, enzyme replacement therapy, substrate inhibition, and organ transplantation have been widely used. It is obvious that by the help of the preclinical and clinical research carried out for inborn errors, better diagnostic methods and better treatment approaches will high likely be available.
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13
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Abstract
Mass spectrometry (MS) is a technique that can identify analytes on the basis of mass-to-charge (m/z) ratio. Although this technique has been used in research and specialized clinical laboratories for decades, however, in recent years, MS has been increasingly used in routine clinical laboratories. MS, especially when coupled to gas chromatography or liquid chromatography, provides very specific and often sensitive analysis of many analytes. Other advantages of MS include simultaneous analysis of multiple analytes (>100) and generally without need for specialized reagents. Commonly measured analytes by MS include drugs, hormones, and proteins.
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Affiliation(s)
- Uttam Garg
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA.
- University of Missouri School of Medicine, Kansas City, MO, USA.
| | - Yan Victoria Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA
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14
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Garg U, Zhang YV. Mass Spectrometry in Clinical Laboratory: Applications in Therapeutic Drug Monitoring and Toxicology. Methods Mol Biol 2016; 1383:1-10. [PMID: 26660168 DOI: 10.1007/978-1-4939-3252-8_1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mass spectrometry (MS) has been used in research and specialized clinical laboratories for decades as a very powerful technology to identify and quantify compounds. In recent years, application of MS in routine clinical laboratories has increased significantly. This is mainly due to the ability of MS to provide very specific identification, high sensitivity, and simultaneous analysis of multiple analytes (>100). The coupling of tandem mass spectrometry with gas chromatography (GC) or liquid chromatography (LC) has enabled the rapid expansion of this technology. While applications of MS are used in many clinical areas, therapeutic drug monitoring, drugs of abuse, and clinical toxicology are still the primary focuses of the field. It is not uncommon to see mass spectrometry being used in routine clinical practices for those applications.
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Affiliation(s)
- Uttam Garg
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO, USA.
| | - Yan Victoria Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA
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15
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Rogers GW, Nadanaciva S, Swiss R, Divakaruni AS, Will Y. Assessment of fatty acid beta oxidation in cells and isolated mitochondria. ACTA ACUST UNITED AC 2014; 60:25.3.1-19. [PMID: 24865647 DOI: 10.1002/0471140856.tx2503s60] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fatty acid beta oxidation is a major pathway of energy metabolism and occurs primarily in mitochondria. Drug-induced modulation of this pathway can cause adverse effects such as liver injury, or be beneficial for treating heart failure, type 2 diabetes, and obesity. Hence, in vitro assays that are able to identify compounds that affect fatty acid oxidation are of value for toxicity assessments, as well as for efficacy assessments. Here, we describe two high-throughput assays, one for assessing fatty acid oxidation in cells and the other for assessing fatty acid oxidation in isolated rat liver mitochondria. Both assays measure fatty acid-driven oxygen consumption and can be used for rapid and robust screening of compounds that modulate fatty acid oxidation.
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16
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Ma YY, Wu TF, Liu YP, Wang Q, Li XY, Ding Y, Song JQ, Shi XY, Zhang WN, Zhao M, Hu LY, Ju J, Wang ZL, Yang YL, Zou LP. Two compound frame-shift mutations in succinate dehydrogenase gene of a Chinese boy with encephalopathy. Brain Dev 2014; 36:394-8. [PMID: 23849264 DOI: 10.1016/j.braindev.2013.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 06/05/2013] [Accepted: 06/05/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate respiratory chain complex II deficiency resulted from mutation in succinate dehydrogenase gene (SDH) encoding complex II subunits in China. METHODS An 11-year-old boy was admitted to our hospital. He had a history of progressive psychomotor regression and weakness since the age of 4years. His cranial magnetic resonance imaging revealed focal, bilaterally symmetrical lesions in the basal ganglia and thalamus, indicating mitochondrial encephalopathy. The activities of mitochondrial respiratory chain enzymes I-V in peripheral leukocytes were determined via spectrophotometry. Mitochondrial DNA and the succinate dehydrogenase A (SDHA) gene were analyzed by direct sequencing. RESULTS Complex II activity in the leukocytes had decreased to 33.07nmol/min/mg mitochondrial protein (normal control 71.8±12.9); the activities of complexes I, III, IV and V were normal. The entire sequence of the mitochondrial DNA was normal. The SDHA gene showed two heterozygous frame-shift mutations: c.G117G/del in exon 2 and c.T220T/insT in exon 3, which resulted in stop codons at residues 56 and 81, respectively. CONCLUSIONS We have described the first Chinese case of mitochondrial respiratory chain complex II deficiency, which was diagnosed using enzyme assays and gene analysis. Two novel, compound, frame-shift mutations, c.G117G/del in exon 2 and c.T220T/insT in exon 3 of the SDHA gene, were found in our patient.
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Affiliation(s)
- Yan-Yan Ma
- Department of Pediatrics, Chinese Liberation Army General Hospital, Beijing, PR China
| | - Tong-Fei Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, PR China
| | - Yu-Peng Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, PR China
| | - Qiao Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, PR China
| | - Xi-Yuan Li
- Department of Pediatrics, Peking University First Hospital, Beijing, PR China
| | - Yuan Ding
- Department of Pediatrics, Peking University First Hospital, Beijing, PR China
| | - Jin-Qing Song
- Department of Pediatrics, Peking University First Hospital, Beijing, PR China
| | - Xiu-Yu Shi
- Department of Pediatrics, Chinese Liberation Army General Hospital, Beijing, PR China
| | - Wei-Na Zhang
- Department of Pediatrics, Chinese Liberation Army General Hospital, Beijing, PR China
| | - Meng Zhao
- Department of Pediatrics, Chinese Liberation Army General Hospital, Beijing, PR China
| | - Ling-Yan Hu
- Department of Pediatrics, Chinese Liberation Army General Hospital, Beijing, PR China
| | - Jun Ju
- Department of Pediatrics, Chinese Liberation Army General Hospital, Beijing, PR China
| | | | - Yan-Ling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, PR China.
| | - Li-Ping Zou
- Department of Pediatrics, Chinese Liberation Army General Hospital, Beijing, PR China.
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17
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Abstract
The multifaceted field of metabolomics has witnessed exponential growth in both methods development and applications. Owing to the urgent need, a significant fraction of research investigations in the field is focused on understanding, diagnosing and preventing human diseases; hence, the field of biomedicine has been the major beneficiary of metabolomics research. A large body of literature now documents the discovery of numerous potential biomarkers and provides greater insights into pathogeneses of numerous human diseases. A sizable number of findings have been tested for translational applications focusing on disease diagnostics ranging from early detection, to therapy prediction and prognosis, monitoring treatment and recurrence detection, as well as the important area of therapeutic target discovery. Current advances in analytical technologies promise quantitation of biomarkers from even small amounts of bio-specimens using non-invasive or minimally invasive approaches, and facilitate high-throughput analysis required for real time applications in clinical settings. Nevertheless, a number of challenges exist that have thus far delayed the translation of a majority of promising biomarker discoveries to the clinic. This article presents advances in the field of metabolomics with emphasis on biomarker discovery and translational efforts, highlighting the current status, challenges and future directions.
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Affiliation(s)
- G A Nagana Gowda
- Northwest Metabolomics Research Center, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98109, USA
| | - D Raftery
- Northwest Metabolomics Research Center, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98109, USA; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
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18
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Ma YY, Wu TF, Liu YP, Wang Q, Li XY, Song JQ, Shi XY, Zhang WN, Zhao M, Hu LY, Yang YL, Zou LP. Heterogeneity of six children and their mothers with mitochondrial DNA 3243 A>G mutation. ACTA ACUST UNITED AC 2013; 24:297-302. [DOI: 10.3109/19401736.2012.760071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Forman J, Coyle F, Levy-Fisch J, Roberts P, Terry S, Legge M. Screening criteria: the need to deal with new developments and ethical issues in newborn metabolic screening. J Community Genet 2012; 4:59-67. [PMID: 23055099 PMCID: PMC3537969 DOI: 10.1007/s12687-012-0118-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 09/12/2012] [Indexed: 11/30/2022] Open
Abstract
Newborn metabolic screening is the most widespread application of screening technology and provides the most comprehensive application of genetics in health services, where the Guthrie blood spot cards allow screening for metabolic diseases in close to 100 % of all newborn babies. Despite over 40 years of use and significant benefits to well in excess of 100,000 children worldwide, there is remarkably little consensus in what conditions should be screened for and response to new advances in medicine relating to programme expansion. In this article, the international criteria for newborn metabolic screening are considered, and we propose that these criteria are poorly developed in relation to the baby, its family and society as a whole. Additionally, the ethical issues that should inform the application of screening criteria are often not developed to a level where a consensus might easily be achieved. We also consider that when family interests are factored in to the decision-making process, they have a significant influence in determining the list of diseases in the panel, with countries or states incorporating family and societal values being the most responsive. Based on our analysis, we propose that decision criteria for metabolic screening in the newborn period should be adapted to specifically include parent and family interests, community values, patients’ rights, duties of government and healthcare providers, and ethical arguments for action in the face of uncertainty.
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Affiliation(s)
- John Forman
- New Zealand Organisation for Rare Disorders (NZORD), PO Box 38-538, Wellington Mail Centre, 5045, Wellington, New Zealand,
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20
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Ma YY, Wu TF, Liu YP, Wang Q, Li XY, Zhang Y, Song JQ, Wang YJ, Yang YL. Mitochondrial respiratory chain enzyme assay and DNA analysis in peripheral blood leukocytes for the etiological study of Chinese children with Leigh syndrome due to complex I deficiency. ACTA ACUST UNITED AC 2012; 24:67-73. [PMID: 22947169 DOI: 10.3109/19401736.2012.717932] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mitochondrial respiratory chain complex I enzyme deficiency is the most commonly seen mitochondrial respiratory chain disorder. Although screening and diagnostic methods are available overseas, clinically feasible diagnostic methods have not yet been established in China. In this study, four Chinese boys with Leigh syndrome due to complex I deficiency were diagnosed by mitochondrial respiratory chain enzyme assay and DNA analysis using peripheral blood leukocytes. Four patients were admitted at the age of 5-14 years because of unexplained progressive neuromuscular symptoms, including motor developmental delay or regression, weakness, and seizures. Their cranial magnetic resonance imaging revealed typical finding as Leigh syndrome. Peripheral leukocyte mitochondrial respiratory chain complex I activities were found decreased to 9.6-33.1 nmol/min/mg mitochondrial protein(control 44.0 ± 5.4 nmol/min/mg). The ratios of complex I to citrate synthase activity were also decreased (8.9-19.8% in patients vs. control 48 ± 11%). Three mtDNA mutations were identified from three out of four patients, supporting the diagnosis of complex I deficiency. Point mutations m.10191T>C in mitochondrial ND3 gene, m.13513G>A in ND5 gene and m.14,453G>A in ND6 gene were detected in three patients.
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Affiliation(s)
- Yan Yan Ma
- Department of Pediatrics, Peking University First Hospital , No. 1, Xi-an-men Road, Xicheng District, Beijing 100034 , P.R. China
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Moore T, Le A, Cowan TM. An improved LC-MS/MS method for the detection of classic and low excretor glutaric acidemia type 1. J Inherit Metab Dis 2012; 35:431-5. [PMID: 22005781 DOI: 10.1007/s10545-011-9405-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 09/20/2011] [Accepted: 09/22/2011] [Indexed: 11/26/2022]
Abstract
Glutaric acidemia type I (GA1) is associated with elevated glutarylcarnitine (C5DC), typically measured as its butylester by acylcarnitine profile analysis using tandem mass spectrometry (MS/MS) and the precursor-product ion pair of m/z 388-85. This method neither distinguishes between C5DC and its isomer 3-hydroxydecanoylcarnitine (C10-OH) nor reliably detects the low-excretor variant of GA1, leading to both false-positive and false-negative results when testing for GA1. To overcome these limitations, we developed an LC-MS/MS method that discriminates C5DC from C10-OH by the use of precursor-product ion pairs specific for butylated C5DC (m/z 388-115) and underivatized C10-OH (m/z 332-85). The C5DC method was validated over the linearity range of 0.025-20 μM with a lower limit of quantification (LOQ) of 0.025 μM. Excellent precision and accuracy were also observed. We tested plasma samples from 10 patients with confirmed GA1 (including 3 with the low-excretor variant), 21 patients with mild elevations of C5DC or C10-OH by routine acylcarnitine analysis for which GA1 ultimately was excluded, and 29 normal controls. By using the m/z 388-115 ion pair, all cases of GA1, including the low-excretor variant, were reliably distinguished from normal controls. By using the m/z 388-85 pair, patients with ambiguous elevations of C5DC or C10-OH demonstrated clearly elevated levels of C10-OH (m/z 332-85) but normal C5DC (m/z 388-115), confirming that the apparent elevation of C5DC is due to interference by C10-OH. Our method results in excellent detection of GA1, including the low-excretor variant, and also provides a means to discriminate C5DC and C10-OH in follow-up testing and routine acylcarnitine studies.
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Affiliation(s)
- Tereza Moore
- Department of Pathology, Stanford University, 3375 Hillview Avenue, Palo Alto, CA 94303, USA
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Tu W, He J, Dai F, Wang X, Li Y. Impact of inborn errors of metabolism on admission in a neonatal intensive care unit--a prospective cohort study. Indian J Pediatr 2012; 79:494-500. [PMID: 21660401 DOI: 10.1007/s12098-011-0464-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To estimate the incidence of Inborn errors of metobolism (IEM) in Neonatal intensive care unit (NICU) using tandem mass spectrometry and to determine the impact that these disorders have on NICU resources. METHODS During the period of study, 724 (81% eligible cases) dried blood filter-paper samples were collected from a NICU. The samples were analysed using tandem mass spectrometry. The diagnosis was further confirmed through clinical symptoms and by gas chromatography-mass spectrometry. The results were also confirmed by clinical follow-up of all positive patients in an overall interval of 1 year. The mean observation period was 11 months per neonate. RESULTS In total, 22 cases were screen positive and 8 cases of inborn errors of metabolism were detected. The incidence of IEM in the population of patients admitted to the authors' NICU was 1.1%. The most common inborn error found was methylmalonic acidemia (3 cases, 37.5%), and all of the cases needed aggressive treatment and invasive mechanical ventilation. There were two cases of Tyrosinemia type 1, one case each of Maple Syrup Urine Disease, Propionic Acidemia, and Multiple Acyl-CoA dehydrogenase deficiency (MADD). Five of the eight patients required invasive mechanical ventilation. The median length of NICU stay was 3 days (1~7 days) and early therapeutic intervention was effective for four of them and other four patients (50%) died. CONCLUSIONS The incidence of IEM in NICU was 1.1%, indicating an underestimation of the incidence of metabolic disorders prior to implementing screening. Most patients with IEM in the NICU required invasive mechanical ventilation and the mortality was increased due to underlying IEM.
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Affiliation(s)
- Wenjun Tu
- Center for Clinical Laboratory Development, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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23
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Klein NP, Aukes L, Lee J, Fireman B, Shapira SK, Slade B, Baxter R, Summar M. Evaluation of immunization rates and safety among children with inborn errors of metabolism. Pediatrics 2011; 127:e1139-46. [PMID: 21482602 DOI: 10.1542/peds.2010-3706] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children with inherited metabolic disorders are a potential high-risk group for vaccine-preventable diseases, yet information regarding immunization rates and vaccine safety within this population is limited. METHODS Using Northern California Kaiser Permanente's electronic medical record, we identified children with inborn errors of metabolism from 1990 to 2007. We assessed immunization rates among infants with inborn errors of metabolism born at Northern California Kaiser Permanente matched to healthy infants (1 to 20), comparing both vaccines received by 2 years of age and age at vaccination. We assessed postvaccination adverse events among children up to 18 years old with inborn errors of metabolism, separately comparing emergency-department visits and hospitalizations during postvaccine days 0 to 30 (primary) and days 0 to 14 (secondary). RESULTS Comparing infants with inborn errors of metabolism (n = 77) versus matched control subjects (n = 1540), similar proportions were up to date for vaccines at 2 years of age, and there was no evidence of delay in receipt of recommended vaccines during the first year. Vaccination of children with inborn errors of metabolism (n = 271) was not associated with any significant increase in emergency-department visits or hospitalizations during the 30 days after vaccination. Secondary analyses suggested that there may be increased rates of hospitalizations 2 weeks after vaccination for the sickest 1- to 4-year-old children. CONCLUSIONS Children with inborn errors of metabolism at Northern California Kaiser Permanente received vaccines on the same immunization schedule as healthy infants. Immunization was not associated with increased risk for serious adverse events during the month after vaccination, providing overall reassurance that routine vaccination of children with inborn errors of metabolism does not result in adverse effects.
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Affiliation(s)
- Nicola P Klein
- Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, 16th Floor, Oakland, CA 94612, USA.
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The National Austrian Newborn Screening Program – Eight years experience with mass spectrometry. Past, present, and future goals. Wien Klin Wochenschr 2010; 122:607-13. [DOI: 10.1007/s00508-010-1457-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 08/18/2010] [Indexed: 01/16/2023]
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Gowda GAN, Zhang S, Gu H, Asiago V, Shanaiah N, Raftery D. Metabolomics-based methods for early disease diagnostics. Expert Rev Mol Diagn 2009; 8:617-33. [PMID: 18785810 DOI: 10.1586/14737159.8.5.617] [Citation(s) in RCA: 454] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The emerging field of metabolomics, in which a large number of small-molecule metabolites from body fluids or tissues are detected quantitatively in a single step, promises immense potential for early diagnosis, therapy monitoring and for understanding the pathogenesis of many diseases. Metabolomics methods are mostly focused on the information-rich analytical techniques of NMR spectroscopy and mass spectrometry (MS). Analysis of the data from these high-resolution methods using advanced chemometric approaches provides a powerful platform for translational and clinical research and diagnostic applications. In this review, the current trends and recent advances in NMR- and MS-based metabolomics are described with a focus on the development of advanced NMR and MS methods, improved multivariate statistical data analysis and recent applications in the area of cancer, diabetes, inborn errors of metabolism and cardiovascular diseases.
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Affiliation(s)
- G A Nagana Gowda
- Department of Chemistry, Purdue University, 560 Oval Drive, West Lafayette, IN 47907, USA.
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la Marca G, Malvagia S, Casetta B, Pasquini E, Donati MA, Zammarchi E. Progress in expanded newborn screening for metabolic conditions by LC-MS/MS in Tuscany: update on methods to reduce false tests. J Inherit Metab Dis 2008; 31 Suppl 2:S395-404. [PMID: 18956250 DOI: 10.1007/s10545-008-0965-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 08/22/2008] [Accepted: 08/28/2008] [Indexed: 11/25/2022]
Abstract
We report on our 6-year experience of expanded newborn screening by tandem mass spectrometry in Tuscany (Italy), the first Italian Region to screen all newborns for more than 40 inborn errors of metabolism: organization, diseases observed and updates on methods to reduce false-positive and false-negative tests are described. Blood collection is recommended between 48 and 72 h of life. Blood spots are sent daily by courier to laboratory. When a positive result occurs, two subsequent procedures are followed: for disorders with possible acute metabolic decompensation, the baby is immediately recalled and clinical examinations and confirmatory tests are performed; for the other disorders, the nursery provides for a second blood spot. If the test is positive, clinical examinations and confirmatory tests are performed. In both cases, if confirmatory tests are positive, a treatment and a follow-up programme are started. Up to now, spots from 160 000 infants have been analysed and 80 affected patients have been identified (disorders of amino acids, organic acids and fatty acids metabolism). We describe adjustments to cut-off values, the introduction of a second-tier test for propionic acidaemia and for methylmalonic aciduria, the inclusion of succinylacetone in the panel of metabolites, and protocols for premature infants and for newborns on parenteral nutrition or transfused. These changes resulted in a reduction in recalls from 1.37% to 0.32% and consequently of working time and parental stress. Avoiding false-negatives by using more specific markers and minimizing the false-positive rate with second-tier testing is important for a successful newborn screening programme.
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Affiliation(s)
- G la Marca
- Meyer Children's Hospital, Metabolic Unit, Florence, Italy.
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Gu H, Pan Z, Duda C, Mann D, Kissinger C, Rohde C, Raftery D. 1H NMR study of the effects of sample contamination in the metabolomic analysis of mouse urine. J Pharm Biomed Anal 2007; 45:134-140. [PMID: 17707608 DOI: 10.1016/j.jpba.2007.06.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Revised: 06/26/2007] [Accepted: 06/29/2007] [Indexed: 01/30/2023]
Abstract
Nuclear magnetic resonance (NMR) spectroscopy was used to evaluate and optimize the strategy for collecting mouse urine samples. A series of normal urine samples and those mixed with folate-deficient food, turkey or mouse fecal particles were analyzed using principal component analysis (PCA). The metabolic profile of urine mixed with folate-deficient food was found to be extremely different than that of clean urine. Changes in the urine composition caused by mixing with turkey or feces are relatively small as judged by the output of PCA. As a result, turkey may be considered as an applicable food source for obtaining uncontaminated urine samples for metabolomics-based research.
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Affiliation(s)
- Haiwei Gu
- Department of Physics, Purdue University, 525 Northwestern Avenue, West Lafayette, IN 47907, United States
| | - Zhengzheng Pan
- Department of Chemistry, Purdue University, 560 Oval Drive, West Lafayette, IN 47907, United States
| | - Chester Duda
- BASi, Inc. 2701 Kent Avenue, West Lafayette, IN 47906, United States
| | - Doug Mann
- BASi, Inc. 2701 Kent Avenue, West Lafayette, IN 47906, United States
| | - Candice Kissinger
- BASi, Inc. 2701 Kent Avenue, West Lafayette, IN 47906, United States
| | - Candace Rohde
- BASi, Inc. 2701 Kent Avenue, West Lafayette, IN 47906, United States
| | - Daniel Raftery
- Department of Chemistry, Purdue University, 560 Oval Drive, West Lafayette, IN 47907, United States.
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Cipriano LE, Rupar CA, Zaric GS. The cost-effectiveness of expanding newborn screening for up to 21 inherited metabolic disorders using tandem mass spectrometry: results from a decision-analytic model. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2007; 10:83-97. [PMID: 17391418 DOI: 10.1111/j.1524-4733.2006.00156.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVES In 2005, in Ontario, Canada, newborns were only screened for phenylketonuria (PKU) and hypothyroidism. Tandem mass spectrometry (MS/MS) has since been implemented as a new screening technology because it can screen for PKU and many other diseases simultaneously. We estimated the cost-effectiveness of using this technology to expand the Ontario newborn screening program to screen for each disease independently and for hypothetical bundles of up to 21 metabolic diseases. METHODS We constructed a decision-analytic model to estimate the incremental costs and life-years of survival that can be gained by screening or changing screening technologies. Costs and health benefits were estimated for a cohort of babies born in Ontario in 1 year. Secondary sources and expert opinion were used to estimate the test characteristics, disease prevalence, treatment effectiveness, disease progression rates, and mortality. The London Health Sciences Centre Case Costing Initiative, the Ontario Health Insurance Plan Schedule, and the Ontario Drug Benefits plan formulary were used to estimate costs. RESULTS Changing screening technologies, from the Guthrie test to MS/MS, for PKU detection had an incremental cost of $5,500,000 per life-year (LY) gained. We identified no diseases for which the incremental cost of screening for just that disease was less than $100,000 per LY gained. The incremental costs of screening ranged from $222,000 (HMG-CoA lyase deficiency) to $142,500,000 (glutaric acidemia type II) per LY gained. Screening for a bundle of diseases including PKU and the 14 most cost-effective diseases to screen for cost less than $70,000 per LY gained, and the incremental cost-effectiveness of adding each of the 14 diseases to the bundle was less than $100,000 per LY gained. The incremental cost of adding the 15th most cost-effective disease was $309,400 per LY gained. CONCLUSIONS Early diagnosis and treatment of metabolic disease is important to reduce disease severity and delay or prevent the onset of the disease. Screening at birth reduces the morbidity, mortality, and social burden associated with the irreversible effects of disease on the population. Our analysis suggests that the cost-efficiencies gained by using MS/MS to screen for bundles of diseases rather than just one disease are sufficient to warrant consideration of an expanded screening program. It is, however, not cost-effective to screen for all diseases that can be screened for using this technology.
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Affiliation(s)
- Lauren E Cipriano
- Richard Ivey School of Business, University of Western Ontario, London, ON, Canada
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Corso G, Paglia G, Garofalo D, D'Apolito O. Neutral loss analysis of amino acids by desorption electrospray ionization using an unmodified tandem quadrupole mass spectrometer. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2007; 21:3777-3784. [PMID: 17972274 DOI: 10.1002/rcm.3280] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A new method to analyze free amino acids using desorption electrospray ionization (DESI) has been implemented. The method is based on the neutral loss mode determination of underivatized amino acids using a tandem quadrupole mass spectrometer equipped with an unmodified atmospheric interface. Qualitative and quantitative optimization of DESI parameters, including ESI voltage, solvent flow rate, angle of collection and incidence, gas flow and temperatures, was performed for amino acids detection. The parameters for DESI analysis were evaluated using a mixture of valine, leucine, methionine, phenylalanine and tyrosine standards. A few microliters of this mixture were deposited on a slide, dried and analyzed at a flow rate of 2 microL/min. The optimal ionization response was obtained using laboratory glass slides and an equivalent solution of water/methanol doped with 2% of formic acid. The method specificity was evaluated by comparing product ion spectra and neutral loss analysis of amino acids obtained either by DESI or by electrospray ionization flow injection analysis (ESI-FIA). To evaluate the quantitative response on amino acids analyzed by DESI, calibration curves were performed on amino acid standard solutions spiked with a fixed amount of labelled amino acids. The method was also employed to analyze free amino acids from blood spots, after a rapid solvent extraction without other sample pretreatment, from positive and negative subjects. The method enables one to analyze biological samples and to discriminate healthy subjects from patients affected by inherited metabolic diseases. The intrinsic high-throughput analysis of DESI represents an opportunity, because of its potential application in clinical chemistry, for the expanded screening of some inborn errors of metabolism.
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Affiliation(s)
- Gaetano Corso
- Clinical Biochemistry, Department of Biomedical Sciences, Faculty of Medicine, University of Foggia, Viale L. Pinto 1, 71100 Foggia, Italy.
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Pan Z, Gu H, Talaty N, Chen H, Shanaiah N, Hainline BE, Cooks RG, Raftery D. Principal component analysis of urine metabolites detected by NMR and DESI–MS in patients with inborn errors of metabolism. Anal Bioanal Chem 2006; 387:539-49. [PMID: 16821030 DOI: 10.1007/s00216-006-0546-7] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 05/11/2006] [Indexed: 10/24/2022]
Abstract
Urine metabolic profiles of patients with inborn errors of metabolism were examined with nuclear magnetic resonance (NMR) and desorption electrospray ionization mass spectrometry (DESI-MS) methods. Spectra obtained from the study of urine samples from individual patients with argininosuccinic aciduria (ASA), classic homocystinuria (HCY), classic methylmalonic acidemia (MMA), maple syrup urine disease (MSUD), phenylketonuria (PKU) and type II tyrosinemia (TYRO) were compared with six control patient urine samples using principal component analysis (PCA). Target molecule spectra were identified from the loading plots of PCA output and compared with known metabolic profiles from the literature and metabolite databases. Results obtained from the two techniques were then correlated to obtain a common list of molecules associated with the different diseases and metabolic pathways. The combined approach discussed here may prove useful in the rapid screening of biological fluids from sick patients and may help to improve the understanding of these rare diseases.
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Affiliation(s)
- Zhengzheng Pan
- Department of Chemistry, Purdue University, 560 Oval Drive, West Lafayette, IN 47907, USA
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Garg U, Dasouki M. Expanded newborn screening of inherited metabolic disorders by tandem mass spectrometry: Clinical and laboratory aspects. Clin Biochem 2006; 39:315-32. [PMID: 16563365 DOI: 10.1016/j.clinbiochem.2005.12.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Revised: 12/15/2005] [Accepted: 12/20/2005] [Indexed: 11/27/2022]
Abstract
Newborn screening started in the 1960s for the purpose of identifying phenylketonuric patients to begin early intervention and to prevent mental retardation in these patients. Soon thereafter, screening programs expanded to include additional genetic disorders added individually one at a time. In the 1980s, tandem mass spectrometry (MS/MS) was introduced in clinical laboratories, and in the 1990s, the technique was used for newborn screening. Unlike measuring one analyte at a time, MS/MS allows measurement of >40 analytes, in a few minutes with the use of a single assay. Currently, MS/MS is being used for the identification of several amino acid, organic acid and fatty acid disorders. Several states in the United States and many other countries are using MS/MS in newborn screening. However, there is a significant disparity among different newborn screening programs for disorders being screened by MS/MS and many other challenges are faced by the expanded newborn screening. It is anticipated that in the future the use of MS/MS in newborn screening will expand both at the analyte and geographic levels. Clinicians and laboratory scientists should become familiar with MS/MS, disorders being screened in their patients' population and the future of this emerging technology.
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Affiliation(s)
- Uttam Garg
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
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Carducci C, Santagata S, Leuzzi V, Carducci C, Artiola C, Giovanniello T, Battini R, Antonozzi I. Quantitative determination of guanidinoacetate and creatine in dried blood spot by flow injection analysis-electrospray tandem mass spectrometry. Clin Chim Acta 2006; 364:180-7. [PMID: 16197934 DOI: 10.1016/j.cca.2005.06.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Revised: 06/16/2005] [Accepted: 06/17/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Guanidinoacetate (GAA) and creatine (Cr) are reliable biochemical markers of primary creatine disorders. The aim of this study was to develop and validate a method for the determination of GAA and Cr in dried blood spot through the use of stable isotope dilution and flow injection analysis (FIA)-ESI-MS/MS. METHODS Dried blood spots were extracted using methanol-water solution containing D3-Cr. After evaporation and formation of butyl esters, samples were analyzed using multiple reaction monitoring mode (m/z 174.2-->101.1 for GAA, 188.3-->90.1 for Cr and 191.3-->93.1 for D3-Cr). RESULTS The analysis was very fast (1 min). The detection limits were 0.34 micromol/l of blood and 0.30 micromol/l of blood for Cr and GAA, respectively, and the response was linear over the range 0.25-12.5 micromol/l of blood for GAA and 3.57-624.7 micromol/l of blood for Cr. Recovery range was 93-101% for Cr and 94-105% for GAA and between-run CVs were 5.3% for GAA and 4.5% for Cr. Ion suppression effect was also studied. The method was applied to spots obtained from two patients affected by GAMT deficiency, four patients affected by AGAT deficiency (including a newborn) as well as 282 healthy subjects. CONCLUSIONS The detection of GAA in dried blood spot by FIA-ESI-MS/MS is a highly reliable and high throughput method for the diagnosis of GAMT and AGAT deficiencies and a possible tool for newborn screening of both these tractable disorders.
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Affiliation(s)
- Claudia Carducci
- Dipartimento di Medicina Sperimentale e Patologia, Università di Roma La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy.
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Abstract
Since the beginning of newborn screening for metabolic and other disorders in 1964, advances in the understanding of the disorders identified and development of new methods of testing newborn screening blood spots have contributed to improved health in children. Pediatricians and others involved in the health care of infants must be able to participate in the assessment and confirmatory testing of infants who have an abnormal test result and in the care of infants identified with a disorder. Expansion in the technology and number of disorders identified has complicated this process. As more and a greater variety of disorders are tested for and identified, a crucial collaborative role has emerged for the newborn screening programs and their public health professionals, the tertiary care specialists in the disorders and the primary care clinicians who comprise the medical home of the infants identified. This collaboration needs to provide prompt results of the newborn screening tests, expeditious and expert confirmatory testing and an effective care plan for the affected infant to realize the benefits of treatment for children with otherwise devastating disorders.
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Affiliation(s)
- Margretta R Seashore
- Department of Genetics, Yale University School of Medicine, New Haven, CT 06520-8005, USA.
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Allard P, Grenier A, Korson MS, Zytkovicz TH. Newborn screening for hepatorenal tyrosinemia by tandem mass spectrometry: analysis of succinylacetone extracted from dried blood spots. Clin Biochem 2004; 37:1010-5. [PMID: 15498530 DOI: 10.1016/j.clinbiochem.2004.07.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2004] [Revised: 07/19/2004] [Accepted: 07/22/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To develop a method for the determination of succinylacetone (SA) in dried blood spots (DBS) using tandem mass spectrometry (MS/MS). METHODS SA was extracted from DBS with an acetonitrile and water solution (80:20 by volume) containing formic acid and hydrazine hydrate (both at 0.1% by volume), and analyzed by MS/MS with a total run time per sample under 2 min. The reference range for SA in newborns was determined by analyzing a control group of 3199 DBS. SA was also measured in stored newborn specimens from three patients diagnosed clinically with hepatorenal tyrosinemia (HT). RESULTS The within-run precision was <or=7.4% and total precision was <or=12.2% on blood spots fortified with SA at 2, 10, and 50 micromol/L. The limit of quantitation was 1 micromol/L and the calibration was linear from 1 to 50 micromol/L. A comparison of SA analysis of this MS/MS method with an established enzyme assay indirectly quantitating SA by inhibition of delta-aminolevulinic acid dehydratase demonstrated a strong correlation. The reference range in the control group of unaffected newborn was determined to be <2 micromol/L, while SA in retrieved DBS from HT patients was significantly elevated, measuring 46.7, 36.5, and 23.2 micromol/L. CONCLUSIONS We report a simple method that can be used for screening HT in newborns. Based on our limited experience, a 2 micromol/L cutoff could result in up to 100% sensitivity and specificity.
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Affiliation(s)
- Pierre Allard
- Division of Genetics, Tufts-New England Medical Center, and Tufts University School of Medicine, Boston, MA 02111, USA.
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Li Y, Brockmann K, Turecek F, Scott CR, Gelb MH. Tandem mass spectrometry for the direct assay of enzymes in dried blood spots: application to newborn screening for Krabbe disease. Clin Chem 2004; 50:638-40. [PMID: 14981030 DOI: 10.1373/clinchem.2003.028381] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yijun Li
- Department of Chemistry, University of Washington, Seattle 98195, USA
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McConkie-Rosell A, Spiridigliozzi GA. “Family Matters”: A Conceptual Framework for Genetic Testing in Children. J Genet Couns 2004; 13:9-29. [DOI: 10.1023/b:jogc.0000013379.90587.ef] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sigauke E, Rakheja D, Kitson K, Bennett MJ. Carnitine palmitoyltransferase II deficiency: a clinical, biochemical, and molecular review. J Transl Med 2003; 83:1543-54. [PMID: 14615409 DOI: 10.1097/01.lab.0000098428.51765.83] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Congenital deficiency of carnitine palmitoyltransferase (CPT) II has been known for at least 30 years now, and its phenotypic variability remains fascinating. Three distinct clinical entities have been described, the adult, the infantile, and the perinatal, all with an autosomal recessive inheritance pattern. The adult CPT II clinical phenotype is somewhat benign and requires additional external triggers such as high-intensity exercise before the predominantly myopathic symptoms are elicited. The perinatal and infantile forms involve multiple organ systems. The perinatal disease is the most severe form and is invariably fatal. The introduction of mass spectrometry to analyze blood acylcarnitine profiles has revolutionized the diagnosis of fatty acid oxidation disorders including CPT II deficiency. Its use in expanded neonatal screening programs has made presymptomatic diagnosis a reality. An increasing number of mutations are being identified in the CPT II gene with a distinct genotype-phenotype correlation in most cases. However, clinical variability in some patients suggests additional genetic or environmental modifiers. Herein, we present a new case of lethal perinatal CPT II deficiency with a rare missense mutation, R296Q (907G>A) associated with a previously described 25-bp deletion on the second allele. We review the clinical features, the diagnostic protocol including expanded neonatal screening, the treatment, and the biochemical and molecular basis of CPT II deficiency.
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Affiliation(s)
- Ellen Sigauke
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
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Current literature in journal of mass spectrometry. JOURNAL OF MASS SPECTROMETRY : JMS 2003; 38:235-244. [PMID: 12577291 DOI: 10.1002/jms.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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