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Dijkstra AM, de Blaauw P, van Rijt WJ, Renting H, Maatman RGHJ, van Spronsen FJ, Maase RE, Schielen PCJI, Derks TGJ, Heiner-Fokkema MR. Important Lessons on Long-Term Stability of Amino Acids in Stored Dried Blood Spots. Int J Neonatal Screen 2023; 9:34. [PMID: 37489487 PMCID: PMC10366855 DOI: 10.3390/ijns9030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
Residual heel prick Dried Blood Spots (DBS) are valuable samples for retrospective investigation of inborn metabolic diseases (IMD) and biomarker analyses. Because many metabolites suffer time-dependent decay, we investigated the five-year stability of amino acids (AA) in residual heel prick DBS. In 2019/2020, we analyzed 23 AAs in 2170 residual heel prick DBS from the Dutch neonatal screening program, stored from 2013-2017 (one year at +4 °C and four years at room temperature), using liquid chromatography mass-spectrometry. Stability was assessed by AA changes over the five years. Hydroxyproline could not be measured accurately and was not further assessed. Concentrations of 19 out of the remaining 22 AAs degraded significantly, ranked from most to least stable: aspartate, isoleucine, proline, valine, leucine, tyrosine, alanine, phenylalanine, threonine, citrulline, glutamate, serine, ornithine, glycine, asparagine, lysine, taurine, tryptophan and glutamine. Arginine, histidine and methionine concentrations were below the limit of detection and were likely to have been degraded within the first year of storage. AAs in residual heel prick DBS stored at room temperature are subject to substantial degradation, which may cause incorrect interpretation of test results for retrospective biomarker studies and IMD diagnostics. Therefore, retrospective analysis of heel prick blood should be done in comparison to similarly stored heel prick blood from controls.
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Affiliation(s)
- Allysa M Dijkstra
- Section of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Pim de Blaauw
- Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Willemijn J van Rijt
- Section of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Hanneke Renting
- Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Ronald G H J Maatman
- Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Francjan J van Spronsen
- Section of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Rose E Maase
- Centre for Health Protection, Dutch National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands
| | - Peter C J I Schielen
- Centre for Population Screening, Dutch National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands
| | - Terry G J Derks
- Section of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - M Rebecca Heiner-Fokkema
- Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
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van Rijt WJ, Schielen PCJI, Özer Y, Bijsterveld K, van der Sluijs FH, Derks TGJ, Heiner-Fokkema MR. Instability of Acylcarnitines in Stored Dried Blood Spots: The Impact on Retrospective Analysis of Biomarkers for Inborn Errors of Metabolism. Int J Neonatal Screen 2020; 6:ijns6040083. [PMID: 33147805 PMCID: PMC7712882 DOI: 10.3390/ijns6040083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022] Open
Abstract
Stored dried blood spots (DBS) can provide valuable samples for the retrospective diagnosis of inborn errors of metabolism, and for validation studies for newborn blood spot screening programs. Acylcarnitine species are subject to degradation upon long-term storage at room temperature, but limited data are available on the stability in original samples and the impact on acylcarnitine ratios. We analysed complete acylcarnitine profiles by flow-injection tandem mass spectrometry in 598 anonymous DBS stored from 2013 to 2017, at +4 °C during the first year and thereafter at room temperature. The concentrations of C2-, C3-, C4-, C5-, C6-, C8-, C10:1-, C10-, C12:1-, C12-, C14:1-, C14-, C16:1-, C16-, C18:2-, C18:1-, C18-, C5OH+C4DC-, C18:1OH-, and C16DC-carnitine decreased significantly, whereas a positive trend was found for free carnitine. Only the C4/C8-, C8/C10-, C14:1/C10- and C14:1/C16-carnitine ratios appeared robust for the metabolite instability. The metabolite instability may provoke the wrong interpretation of test results in the case of retrospective studies and risk the inaccurate estimation of cut-off targets in validation studies when only stored control DBS are used. We recommend including control DBS in diagnostic, retrospective cohort studies, and, for validation studies, we recommend using fresh samples and repeatedly re-evaluating cut-off targets.
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Affiliation(s)
- Willemijn J. van Rijt
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (W.J.v.R.); (T.G.J.D.)
| | - Peter C. J. I. Schielen
- Reference Laboratory for Neonatal Screening, Centre for Health Protection, National Institute for Public Health and the Environment, 3721 BA Bilthoven, The Netherlands;
| | - Yasemin Özer
- Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (Y.Ö.); (K.B.); (F.H.v.d.S.)
| | - Klaas Bijsterveld
- Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (Y.Ö.); (K.B.); (F.H.v.d.S.)
| | - Fjodor H. van der Sluijs
- Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (Y.Ö.); (K.B.); (F.H.v.d.S.)
| | - Terry G. J. Derks
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (W.J.v.R.); (T.G.J.D.)
| | - M. Rebecca Heiner-Fokkema
- Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (Y.Ö.); (K.B.); (F.H.v.d.S.)
- Correspondence:
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Li W, Tse FLS. Dried blood spot sampling in combination with LC-MS/MS for quantitative analysis of small molecules. Biomed Chromatogr 2010; 24:49-65. [DOI: 10.1002/bmc.1367] [Citation(s) in RCA: 456] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Fingerhut R, Ensenauer R, Röschinger W, Arnecke R, Olgemöller B, Roscher AA. Stability of Acylcarnitines and Free Carnitine in Dried Blood Samples: Implications for Retrospective Diagnosis of Inborn Errors of Metabolism and Neonatal Screening for Carnitine Transporter Deficiency. Anal Chem 2009; 81:3571-5. [DOI: 10.1021/ac8022235] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ralph Fingerhut
- Laboratory Becker, Olgemöller and Colleagues, Munich, Germany, and Research Center, Department of Biochemical Genetics and Molecular Biology, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Regina Ensenauer
- Laboratory Becker, Olgemöller and Colleagues, Munich, Germany, and Research Center, Department of Biochemical Genetics and Molecular Biology, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Wulf Röschinger
- Laboratory Becker, Olgemöller and Colleagues, Munich, Germany, and Research Center, Department of Biochemical Genetics and Molecular Biology, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Ralf Arnecke
- Laboratory Becker, Olgemöller and Colleagues, Munich, Germany, and Research Center, Department of Biochemical Genetics and Molecular Biology, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Bernhard Olgemöller
- Laboratory Becker, Olgemöller and Colleagues, Munich, Germany, and Research Center, Department of Biochemical Genetics and Molecular Biology, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Adelbert A. Roscher
- Laboratory Becker, Olgemöller and Colleagues, Munich, Germany, and Research Center, Department of Biochemical Genetics and Molecular Biology, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität, Munich, Germany
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Lindner M, Ho S, Fang-Hoffmann J, Hoffmann GF, Kölker S. Neonatal screening for glutaric aciduria type I: strategies to proceed. J Inherit Metab Dis 2006; 29:378-82. [PMID: 16763905 DOI: 10.1007/s10545-006-0284-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Accepted: 03/01/2006] [Indexed: 11/26/2022]
Abstract
Acute encephalopathic crisis in glutaric aciduria type I results in an unfavourable disease course and poor outcome, dominated by dystonia, feeding problems, seizures and reduced life expectancy. A conditio sine qua non for the prevention of irreversible brain damage is timely diagnosis and start of therapy, i.e. before the onset of neurological disease. As there are no specific clinical signs or symptoms that allow a reliable detection of these patients before the manifestation of encephalopathic crises, neonatal screening programmes for glutaric aciduria type I have been established in some countries using analysis of glutarylcarnitine in dried blood spots by tandem mass spectrometry. This article summarizes recent strategies, pitfalls and shortcomings of mass screening for glutaric aciduria type I, focusing on the relevant risk of missing patients with a mild biochemical phenotype (i.e. low excretors). Furthermore, it evaluates a binary strategy--using glutarylcarnitine as primary variable and glutarylcarnitine/acylcarnitine ratios as secondary variable--to improve the diagnostic sensitivity and specificity of neonatal screening for glutaric aciduria type I. An optimization of diagnostic as well as therapeutic procedures must be achieved before screening for glutaric aciduria type I can be regarded as reliable and beneficial for all patients.
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Affiliation(s)
- M Lindner
- Department of General Pediatrics, Division of Metabolic Diseases, University Children's Hospital Heidelberg, Im Neuenheimer Feld 153, D-69120, Heidelberg, Germany.
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Gallagher RC, Cowan TM, Goodman SI, Enns GM. Glutaryl-CoA dehydrogenase deficiency and newborn screening: retrospective analysis of a low excretor provides further evidence that some cases may be missed. Mol Genet Metab 2005; 86:417-20. [PMID: 16183314 DOI: 10.1016/j.ymgme.2005.08.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Revised: 08/11/2005] [Accepted: 08/15/2005] [Indexed: 11/21/2022]
Abstract
Glutaryl-CoA dehydrogenase deficiency (GA-I) is associated with the onset of irreversible, disabling dystonia between 3 and 18 months of age. Presymptomatic identification and treatment can prevent the devastating disability associated with this disorder. We report the retrospective analysis of the newborn blood spot of an affected child with a low excretor phenotype. The level of glutarylcarnitine was below the newborn screening program cut-off. This suggests that some cases of GA-I may be missed by newborn screening by tandem mass spectrometry.
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Affiliation(s)
- Renata C Gallagher
- Department of Pediatrics, Division of Genetics, Stanford University School of Medicine, Stanford, CA, USA
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