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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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Bota B, Ward V, Lamoureux M, Santander E, Ducharme R, Hawken S, Potter BK, Atito R, Nyamanda B, Munga S, Otieno N, Chakraborty S, Saha S, Stringer JS, Mwape H, Price JT, Mujuru HA, Chimhini G, Magwali T, Chakraborty P, Darmstadt GL, Wilson K. Unlocking the global health potential of dried blood spot cards. J Glob Health 2022; 12:03027. [PMID: 35841606 PMCID: PMC9288235 DOI: 10.7189/jogh.12.03027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Brianne Bota
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Victoria Ward
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Emeril Santander
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Robin Ducharme
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Beth K Potter
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Raphael Atito
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Bryan Nyamanda
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Stephen Munga
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Nancy Otieno
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | | | - Samir Saha
- Child Health Research Foundation, Mirzapur, Bangladesh
| | - Jeffrey Sa Stringer
- Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, North Carolina, USA.,UNC Global Projects Zambia, Lusaka, Zambia
| | | | - Joan T Price
- Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, North Carolina, USA.,UNC Global Projects Zambia, Lusaka, Zambia
| | - Hilda Angela Mujuru
- Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe
| | - Gwendoline Chimhini
- Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe
| | - Thulani Magwali
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Gary L Darmstadt
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada.,Bruyere Research Institute, Ottawa, Ontario
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3
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Hawken S, Murphy MSQ, Ducharme R, Bota AB, Wilson LA, Cheng W, Tumulak MAJ, Alcausin MML, Reyes ME, Qiu W, Potter BK, Little J, Walker M, Zhang L, Padilla C, Chakraborty P, Wilson K. External validation of machine learning models including newborn metabolomic markers for postnatal gestational age estimation in East and South-East Asian infants. Gates Open Res 2021; 4:164. [PMID: 34104876 PMCID: PMC8160452 DOI: 10.12688/gatesopenres.13131.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Postnatal gestational age (GA) algorithms derived from newborn metabolic profiles have emerged as a novel method of acquiring population-level preterm birth estimates in low resource settings. To date, model development and validation have been carried out in North American settings. Validation outside of these settings is warranted. Methods: This was a retrospective database study using data from newborn screening programs in Canada, the Philippines and China. ELASTICNET machine learning models were developed to estimate GA in a cohort of infants from Canada using sex, birth weight and metabolomic markers from newborn heel prick blood samples. Final models were internally validated in an independent sample of Canadian infants, and externally validated in infant cohorts from the Philippines and China. Results: Cohorts included 39,666 infants from Canada, 82,909 from the Philippines and 4,448 from China. For the full model including sex, birth weight and metabolomic markers, GA estimates were within ±5 days of ultrasound values in the Canadian internal validation (mean absolute error (MAE) 0.71, 95% CI: 0.71, 0.72), and within ±6 days of ultrasound GA in both the Filipino (0.90 (0.90, 0.91)) and Chinese cohorts (0.89 (0.86, 0.92)). Despite the decreased accuracy in external settings, our models incorporating metabolomic markers performed better than the baseline model, which relied on sex and birth weight alone. In preterm and growth-restricted infants, the accuracy of metabolomic models was markedly higher than the baseline model. Conclusions: Accuracy of metabolic GA algorithms was attenuated when applied in external settings. Models including metabolomic markers demonstrated higher accuracy than models using sex and birth weight alone. As innovators look to take this work to scale, further investigation of modeling and data normalization techniques will be needed to improve robustness and generalizability of metabolomic GA estimates in low resource settings, where this could have the most clinical utility
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Affiliation(s)
- Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Malia S Q Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robin Ducharme
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - A Brianne Bota
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lindsay A Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Wei Cheng
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ma-Am Joy Tumulak
- Newborn Screening Reference Centre, University of the Philippines Manila, Manila, Philippines
| | | | - Ma Elouisa Reyes
- Newborn Screening Reference Centre, University of the Philippines Manila, Manila, Philippines
| | - Wenjuan Qiu
- Pediatric Endocrinology and Genetic Metabolism, XinHua Hospital, Shanghai, Shanghai, China
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Mark Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Better Outcomes Registry & Network, Ottawa, Canada
| | - Lin Zhang
- Department of Gynecology and Obsetrics, XinHua Hospital, Shanghai, Shanghai, China.,MOE-Shanghai Key Lab of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Carmencita Padilla
- Department of Pediatrics, University of the Philippines Manila, Manilla, Philippines.,Institute of Human Genetics, National Institutes of Health, University of Philippines Manila, Manila, Philippines
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottowa, Ottowa, ON, Canada.,Bruyère Research Institute, Ottowa, ON, Canada
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Bota AB, Ward V, Hawken S, Wilson LA, Lamoureux M, Ducharme R, Murphy MSQ, Denize KM, Henderson M, Saha SK, Akther S, Otieno NA, Munga S, Atito RO, Stringer JSA, Mwape H, Price JT, Mujuru HA, Chimhini G, Magwali T, Mudawarima L, Chakraborty P, Darmstadt GL, Wilson K. Metabolic gestational age assessment in low resource settings: a validation protocol. Gates Open Res 2021; 4:150. [PMID: 33501414 PMCID: PMC7801859 DOI: 10.12688/gatesopenres.13155.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 11/20/2022] Open
Abstract
Preterm birth is the leading global cause of neonatal morbidity and mortality. Reliable gestational age estimates are useful for quantifying population burdens of preterm birth and informing allocation of resources to address the problem. However, evaluating gestational age in low-resource settings can be challenging, particularly in places where access to ultrasound is limited. Our group has developed an algorithm using newborn screening analyte values derived from dried blood spots from newborns born in Ontario, Canada for estimating gestational age within one to two weeks. The primary objective of this study is to validate a program that derives gestational age estimates from dried blood spot samples (heel-prick or cord blood) collected from health and demographic surveillance sites and population representative health facilities in low-resource settings in Zambia, Kenya, Bangladesh and Zimbabwe. We will also pilot the use of an algorithm to identify birth percentiles based on gestational age estimates and weight to identify small for gestational age infants. Once collected from local sites, samples will be tested by the Newborn Screening Ontario laboratory at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada. Analyte values will be obtained through laboratory analysis for estimation of gestational age as well as screening for other diseases routinely conducted at Ontario's newborn screening program. For select conditions, abnormal screening results will be reported back to the sites in real time to facilitate counseling and future clinical management. We will determine the accuracy of our existing algorithm for estimation of gestational age in these newborn samples. Results from this research hold the potential to create a feasible method to assess gestational age at birth in low- and middle-income countries where reliable estimation may be otherwise unavailable.
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Affiliation(s)
- A. Brianne Bota
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Victoria Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen Hawken
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Lindsay A. Wilson
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Robin Ducharme
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Malia S. Q. Murphy
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
| | - Kathryn M. Denize
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Matthew Henderson
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Samir K. Saha
- Child Health Research Foundation, Mizapur, Bangladesh
| | - Salma Akther
- Child Health Research Foundation, Mizapur, Bangladesh
| | - Nancy A. Otieno
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Stephen Munga
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | - Raphael O. Atito
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, Kenya
| | | | | | - Joan T. Price
- Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Hilda Angela Mujuru
- Department of Paediatrics and Child Health, University of Zimbabwe, Avondale, Zimbabwe
| | - Gwendoline Chimhini
- Department of Paediatrics and Child Health, University of Zimbabwe, Avondale, Zimbabwe
| | - Thulani Magwali
- Department of Obstetrics and Gynaecology, University of Zimbabwe, Avondale, Zimbabwe
| | - Louisa Mudawarima
- Department of Paediatrics and Child Health, University of Zimbabwe, Avondale, Zimbabwe
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Gary L. Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Bruyère Research Institute, Otttawa, Canada
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5
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Bota AB, Ward V, Hawken S, Wilson LA, Lamoureux M, Ducharme R, Murphy MSQ, Denize KM, Henderson M, Saha SK, Akther S, Otieno NA, Munga S, Atito RO, Stringer JSA, Mwape H, Price JT, Mujuru HA, Chimhini G, Magwali T, Mudawarima L, Chakraborty P, Darmstadt GL, Wilson K. Metabolic gestational age assessment in low resource settings: a validation protocol. Gates Open Res 2020. [DOI: 10.12688/gatesopenres.13155.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Preterm birth is the leading global cause of neonatal morbidity and mortality. Reliable gestational age estimates are useful for quantifying population burdens of preterm birth and informing allocation of resources to address the problem. However, evaluating gestational age in low-resource settings can be challenging, particularly in places where access to ultrasound is limited. Our group has developed an algorithm using newborn screening analyte values derived from dried blood spots from newborns born in Ontario, Canada for estimating gestational age within one to two weeks. The primary objective of this study is to validate a program that derives gestational age estimates from dried blood spot samples (heel-prick or cord blood) collected from health and demographic surveillance sites and population representative health facilities in low-resource settings in Zambia, Kenya, Bangladesh and Zimbabwe. We will also pilot the use of an algorithm to identify birth percentiles based on gestational age estimates and weight to identify small for gestational age infants. Once collected from local sites, samples will be tested by the Newborn Screening Ontario laboratory at the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, Canada. Analyte values will be obtained through laboratory analysis for estimation of gestational age as well as screening for other diseases routinely conducted at Ontario’s newborn screening program. For select conditions, abnormal screening results will be reported back to the sites in real time to facilitate counseling and future clinical management. We will determine the accuracy of our existing algorithm for estimation of gestational age in these newborn samples. Results from this research hold the potential to create a feasible method to assess gestational age at birth in low- and middle-income countries where reliable estimation may be otherwise unavailable.
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Grecsó N, Zádori A, Szécsi I, Baráth Á, Galla Z, Bereczki C, Monostori P. Storage stability of five steroids and in dried blood spots for newborn screening and retrospective diagnosis of congenital adrenal hyperplasia. PLoS One 2020; 15:e0233724. [PMID: 32470014 PMCID: PMC7259505 DOI: 10.1371/journal.pone.0233724] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/11/2020] [Indexed: 12/25/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) is a severe inherited disorder of cortisol biosynthesis that is potentially lethal or can seriously affect quality of life. For the first time, we aimed to assess the stability of 21-deoxycortisol (21Deox), 11-deoxycortisol (11Deox), 4-androstenedione (4AD), 17-hydroxyprogesterone (17OHP) and cortisol (Cort), diagnostic for CAH, in dried blood spots (DBSs) during a 1 year storage at different temperatures. Spiked DBS samples were stored at room temperature, 4 °C, -20 °C or -70 °C, respectively and analyzed in triplicates using liquid chromatography–tandem mass spectrometry at Weeks 0, 1, 2, 3 and 4, Month 6 and Year 1. Analyte levels within ±15% vs the baseline were considered stable. Our observations show that 21Deox, 4AD and 17OHP were not significantly changed for 1 year even at room temperature at either analyte levels. In contrast, Cort required storage at 4 °C, -20 °C or -70 °C for long-term stability, being significantly decreased at room temperature from Month 6 (p<0.01) in both the 30(60) nM and the 90(180) nM samples. 11Deox was significantly decreased at room temperature at Year 1 (p<0.01) and only in the 30(60) nM samples. Thus, all biomarkers were stable for up to 1 year at 4 °C, -20 °C or -70 °C and at least for 4 weeks at room temperature. These findings have implications for analyses of stored DBS samples in 2nd-tier assays in newborn screening and for retrospective CAH studies.
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Affiliation(s)
- Nóra Grecsó
- Metabolic and Newborn Screening Laboratory, Department of Pediatrics, University of Szeged, Szeged, Hungary
- * E-mail:
| | - Anita Zádori
- Metabolic and Newborn Screening Laboratory, Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Ilona Szécsi
- Metabolic and Newborn Screening Laboratory, Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Ákos Baráth
- Metabolic and Newborn Screening Laboratory, Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Zsolt Galla
- Metabolic and Newborn Screening Laboratory, Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Csaba Bereczki
- Metabolic and Newborn Screening Laboratory, Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Péter Monostori
- Metabolic and Newborn Screening Laboratory, Department of Pediatrics, University of Szeged, Szeged, Hungary
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