Newborn screening for galactosemia: ultramicro assay for galactose-1-phosphate-uridyltransferase activity

Copper Single-Atom Nanozyme Mimicking Galactose Oxidase with Superior Catalytic Activity and Selectivity

Due to the low stability and high cost of some natural enzymes, nanozymes have been developed as enzyme-imitating nanomaterials. Single-atom nanozymes are a class of nanozymes with metal centers that mimic the structure of metal-based natural enzymes. Herein, Cu-N-C single-atom nanozyme (SAN) is synthesized with excellent peroxidase- and enhanced oxidase-like activities to mimic the action of natural galactose oxidase. Cu-SAN demonstrates stereospecific activity akin to that of natural galactose oxidase by oxidizing D-galactose and primary alcohol but not L-Galactose or other carbohydrates. The SAN can catalyze the oxidation of galactose in the presence of oxygen, producing hydrogen peroxide as a sub-product. The produced hydrogen peroxide then oxidizes 3,3',5,5'-tetramethylbenzidine catalyzed by the SAN, yielding the typical blue product. The relationship between absorbance and galactose concentration is linear in the 1-60 µm range with a detection limit as low as 0.23 µm. This strategy can be utilized in the diagnosis of galactosemia disorder and detection of galactose in some dairy and other commercial products. DFT calculations clarify the high activity of the Cu sites in the POD-like reaction and explain the selectivity of the Cu-SAN oxidase-like reaction toward D-galactose.

Single-atom Nanozymes for Biomedical Applications： Recent Advances and Challenges

Nanozymes have received extensive attention in the fields of sensing and detection, medical therapy, industry, and agriculture thanks to the combination of the catalytic properties of natural enzymes and the physicochemical properties of nanomaterials, coupled with superior stability and ease of preparation. Despite the promise of nanozymes, conventional nanozymes are constrained by their oversized size and low catalytic capacity in sophisticated practical application environments. single-atom nanozymes (SAzymes) were characterized as nanozymes with high catalytic efficiency by uniformly distributed single atoms as catalysis sites, thus effectively addressing the defects of conventional nanozymes. This paper reviews the activity improvement scheme and catalytic mechanism of SAzymes and highlights the latest research progress of SAzymes in the fields of biomedical sensing and therapy. Eventually, the challenges and future directions of SAzymes are discussed in this paper.

Voltammetric Determination of Phenylalanine Using Chemically Modified Screen-Printed Based Sensors

This paper describes the sensitive properties of screen-printed carbon electrodes (SPCE) modified by using three different electroactive chemical compounds: Meldola’s Blue, Cobalt Phthalocyanine and Prussian Blue, respectively. It was demonstrated that the Prussian Blue (PB) modified SPCE presented electrochemical signals with the highest performances in terms of electrochemical process kinetics and sensitivity in all the solutions analyzed. PB-SPCE was demonstrated to detect Phe through the influence it exerts on the redox processes of PB. The PB-SPCE calibration have shown a linearity range of 0.33–14.5 µM, a detection limit (LOD) of 1.23 × 10−8 M and the standard deviation relative to 3%. The PB-SPCE sensor was used to determine Phe by means of calibration and standard addition techniques on pure samples, on simple pharmaceutical samples or on multicomponent pharmaceutical samples. Direct determination of the concentration of 4 × 10−6–5 × 10−5 M Phe in KCl solution showed that the analytical recovery falls in the range of 99.75–100.28%, and relative standard deviations in the range of 2.28–3.02%. The sensors were successfully applied to determine the Phe in pharmaceuticals. The validation of the method was performed by using the FTIR, and by comparing the results obtained by PB-SPCE in the analysis of three pharmaceutical products of different concentrations with those indicated by the producer.

Peroxidase-like activity of Fe-N-C single-atom nanozyme based colorimetric detection of galactose

Single atom nanozymes are the artificial enzymes with enzyme-like activity, which have attracted a great deal attention in recent years due to their unique merits such as remarkable stability, excellent atom utilization and low cost. Herein, a convenient and sensitive colorimetric strategy was developed for the sensing of galactose based on Fe-N-C single-atom nanozyme (Fe-SAzyme). The Fe-SAzyme was prepared through "isolation-pyrolysis" method that exhibited intrinsic peroxidase mimicking activity, which can quickly catalyze the oxidation of 3,3',5,5'-tetramethylbenzidine (TMB) to produce blue-colored oxTMB in the presence of hydrogen peroxide (H₂O₂). Galactose can be oxidized by galactose oxidase (Gal Ox) to generate H₂O₂, and Fe-SAzyme can be utilized for quantitative colorimetric detection of galactose. A good linearity between absorbance and the galactose concentration in the range of 50-500 μM was obtained with a detection limit of (LOD) 10 μM. The Fe-SAzyme based colorimetric strategy offered a rapid, convenient and economic way for galactose quantification detection, which could be used as an alternative method for galactosemia diagnosis.

Microchip in situ electrosynthesis of silver metallic oxide clusters for ultra-FAST detection of galactose in galactosemic newborns' urine samples

This work describes for the first time the coupling of microfluidic chips (MC) to electrosynthetized silver metallic oxide clusters (AgMOCs). As an early demonstration of this novel approach, the ultrafast detection of galactose in galactosemic newborns' urine samples is proposed. AgMOCs were in situ electrosynthetized on integrated microchip platinum electrodes using a double pulse technique and characterized in full using scanning electronic microscopy (SEM), energy dispersive X-ray spectroscopy (EDX), X-ray photoelectron spectroscopy (XPS) and electrochemical techniques revealing the presence of silver oxides and electrocatalysis towards galactose as a galactosemia biomarker. Galactose detection in galactosemic newborns' urine samples proceeded in less than 30 s, differentiating between ill and healthy urine samples and requiring negligible urine sample consumption. The significance of the newborns' urine samples confirmed the analytical potency of the MC-AgMOCs approach for future implementation of screening for rare disease diagnosis such as galactosemia.

Peroxidase-like activity of 2',7'-difluorofluorescein and its application for galactose detection

The peroxidase-like activity of 2',7'-difluorofluorescein (DFF), was investigated using 3,3',5,5'-tetramethylbenzidine (TMB) as a chromogenic substrate in the presence of H₂O₂. DFF could catalyze oxidization of TMB by H₂O₂ to produce a blue colored oxidation product. Effect of various reaction conditions, such as pH, temperature, H₂O₂ concentration and reaction time on the catalytic activity of DFF was studied. The peroxidase-like activity of DFF was found to follow Michaelis-Menten kinetics, and its catalysis accorded with ping-pong mechanism. The calculated kinetic parameters (K_cat) of DFF catalysis showed higher peroxidase-like activity than fluorescein and 2',7'-dichlorofluorescein (DCF). According to the radical capture and electron spin resonance (ESR) spectroscopy results, we confirmed that hydroxyl radical (•OH) is the active specie of catalytic process. It is known that the oxidation of galactose by galactose oxidase (GAOx) enzyme leads to the formation of H₂O₂, the H₂O₂ released in this reaction was consequently quantified using DFF as peroxides mimics and TMB as the chromogen. Thus, a combination of above two reactions was exploited to establish a method for galactose detection. Under the optimum conditions, the linear range of this method was from 10 μM to 20 mM with the detection limit down to 3 μM. Moreover, the developed method was applied to detect galactose in urine samples. Our work will facilitate the utilization of DFF intrinsic peroxidase-like activity in medical diagnostics and biotechnology.

Vertically-Oriented and Shape-Tailored Electrocatalytic Metal Nanowire Arrays for Enzyme-Free Galactosemia Rapid Diagnosis

Metallic catalytic nanowires such as nickel and copper nanowires (NWs) for electrochemical detection of carbohydrates involved in metabolic rare diseases are proposed. NWs were electrodeposited using a polycarbonate membrane template, which was cut with the desired shape, stuck in double-sided adhesive tape, pasted into a non-conductive substrate and in situ removed. This simple and versatile approach allowed to obtain NWs vertically oriented (v-NWs), which are contained in the double-sided adhesive tape, becoming highly versatile. The high specific surface of working electrode in which the transduction is supported exclusively by the nanomaterial yielded a high analytical performance [extremely low fouling for galactose (RSD<2 %; n=25)]. Likewise, v-NWs exhibited a superior analytical performance with respect to commercial sputtered thick-film electrodes showing also a clear advantage related with the price, as well as with non-need clean room facilities. The analytical potency of the new approach was clearly demonstrated towards the fast and reliable diagnosis of galactosemia using precious newborn urine samples compared to standard clinical diagnosis. These results revealed new opportunities for future enzyme-free diagnosis and development of future point-of-care applications.

Selective Screening for Metabolic Disorders in the Slovenian Pediatric Population

Background

Inborn errors of metabolism (IEM) are disorders with a block in the metabolic pathway caused by a genetic defect of a specific enzyme. Although each of these diseases is quite rare, as a group they account for a significant proportion of newborn and childhood morbidity and mortality. Early diagnosis is important to prevent complications or even death of the child. Selective screening is an important diagnostic tool for the diagnosis of IEM.

Methods

In Slovenia, symptomatic patients with suspected IEM are referred to the University Children’s Hospital Ljubljana. Techniques used for selective screening are gas chromatography-mass spectrometry, ion exchange chromatography-post-column derivatization, liquid chromatography-tandem mass spectrometry and isoelectric focusing. Fluorimetric method is used for enzyme activity measurement.

Results

There are 168 patients with amino and organic acidemias, 5 patients with disorders in fatty acids metabolism, 1 patient with a congenital disorder of glycosylation, 42 patients with Fabry disease (of which 37 are adult) and 20 patients with Gaucher disease (of which 18 are adult) in the Slovenian Register for Rare Diseases.

Conclusions

In Slovenia, management of patients with IEM is centralized at the University Children’s Hospital, with the exception of adult patients with Fabry and Gaucher disease. The team work is well organized with close cooperation between the laboratory and pediatricians specialized in metabolic disorders. According to the known frequencies of IEM from the literature, we would expect more positive results than obtained. To evaluate these results, we are planning to perform a pilot study on expanded newborn screening.

Determination of EDTA in dried blood samples by tandem mass spectrometry avoids serious errors in newborn screening

Newborn screening programs use whole blood dried on filter paper as the standard specimen. Metabolites are reasonably stable and can easily be sent to screening laboratories by regular mail. The recommended sample collection procedure is to spot native blood without anticoagulants onto the filter paper, because anticoagulants can interfere with the different laboratory methods. However, visual examination of the blood spots cannot always detect contamination. In this study, whole blood was drawn by venous puncture from a healthy volunteer, spiked with the corresponding metabolites and EDTA, and spotted onto filter paper. TSH and 17alpha-hydroxyprogesterone were determined by time resolved fluoroimmunoassays with the AutoDelfia system. Total galactose, biotinidase activity, and galactose-1-phosphate uridyltransferase activity were measured photometrically or fluorometrically. Succinyl acetone was estimated indirectly through the inhibition of porphobilinogen synthase activity (PBGS assay). EDTA, amino acids, and acylcarnitines were converted to the corresponding butyl esters, after extraction with methanol, and analysed by LC-MS/MS. EDTA contamination gives falsely elevated 17-OHP values and falsely reduced TSH and PBGS values. The inclusion of an EDTA determination in routine screening revealed that at least 0.06% of newborn screening samples were contaminated with EDTA. In conclusion, non-conformity during the pre-analytical phase is a source of false positive and false negative screening results. Determination of EDTA from NBS blood spots can reliably identify these samples and prevent screening errors.

Evidence of cataplerosis in a patient with neonatal classical galactosemia presenting as citrin deficiency

Classical galactosemia is an autosomal recessive disorder caused by a deficiency of the enzyme galactose-1-phosphate uridyltransferase. Undoubtedly, some of the short term complications are linked to the toxic effects of the accumulated abnormal metabolites (galactose-1-phosphate and galactitol). However, the physiopathology of neonatal liver failure remains unclear. We report the case of a 7-week-old girl who was first diagnosed with liver failure, hypoprotidaemia, ascites and generalized edemas. High citrulline (293 micromol/L), on initial plasma amino acid, suggested the diagnosis of citrin deficiency. As the citric acid cycle intermediates were non-detectable (oxoglutarate, succinate and citrate), a cataplerotic state was suspected. As a result, citrate (as an anaplerotic treatment) induced a clear improvement in her liver function. Four weeks later, this patient was switched to a galactose-free formula (as recommended in citrin deficiency with galactosemia) and her pathological status returned to normal. Citrin deficiency was later ruled out by molecular biology studies; then we reintroduced a galactose-containing formula which re-evoked rapidly vomiting, galactose aversion and hepatic cytolysis and the diagnosis of classical galactosemia was established. Our case clearly shows that cataplerosis could play a role in the pathophysiology of the neonatal liver disease observed in classical galactosemia.

Biotinidase determination in serum and dried blood spots--high sensitivity fluorimetric ultramicro-assay

A miniaturized quantitative biotinidase assay has been developed using biotin 6-amidoquinoline as substrate and the 100-fold enhanced fluorescence of 6-amidoquinoline measured using apolar solvents. Amidoquinoline is measured after deproteinization by ethanol/acetone using individual standardisation and solvent resistant microtiter plates. The assay was optimized for end point determinations of biotinidase activities in serum and for newborn screening using dried blood spots. Serum activities obtained are closely correlated with values obtained using a quantitative validation method (r=0.96). Analytical sensitivity is around 2% of the mean activity (7.01+/-1.92 nmol/min/ml, mean+/-SD) of a healthy control population. With dried blood spots, a close correlation with values obtained using the Wallac-test kit (r=0.92) was found. Biotinidase activities of a healthy population of 651 newborns amount to 0.2429+/-0.07 nmol/min/ml blood. The analytical sensitivity is close to 1% of the mean activity.

Quantitative Beutler Test for Newborn Mass Screening of Galactosemia Using a Fluorometric Microplate Reader

Background: The Beutler enzyme spot test is an effective assay for newborn mass screening of galactosemia, but it is qualitative and relies on visual interpretation. We describe a quantitative, instrumental modification of the assay.

Methods: We modified the macroscopic visual Beutler enzyme spot test by adding extraction of blood components from filter paper, deproteinization with acetone-methanol, and quantification and recording by a fluorescent microplate reader and personal computer. All handling was performed in microplates. The measurement time was 90 min.

Results: Fluorescence intensity (FI) of healthy controls correlated with hematocrit and galactose-1-phosphate uridyltransferase (GALT) activity. Patients with GALT deficiency were distinguished clearly from healthy subjects and heterozygous carriers by FI. FI decreased to 75% of the initial activity after storage at 25 °C for 3 days and to 40% after storage at 37 °C for 7 days. Screening of 46 742 newborns yielded 1 false-positive result (in a heterozygous carrier), 1 patient with glucose-6-phosphate dehydrogenase deficiency, and no apparent false negatives as judged by concurrent measurements of galactose and galactose-1-phosphate.

Conclusions: The quantitative Beutler test can provide precise GALT activity in newborn mass screening, and can take into consideration the influence of high temperature and humidity, duration between sampling and testing, and anemia. This method is clinically useful, simple, automated, and highly reliable for newborn mass screening of galactosemia.