High Risk Stratified Neonatal Screening

OBJECTIVES

To ascertain the proportion of neonates and infants presenting with suspicion of an inborn error of metabolism in the centers identified by ICMR for newborn screening.

METHODS

A set of red flag signs suggestive IEM were listed by the Taskforce members. The age group was limited to one year as it was understood that most of the small molecules with a severe phenotype would present before the age of one year. Further investigations were tandem mass spectrometry, gas chromatography mass spectrometry and high performance liquid chromatography.

RESULTS

A total of 851 babies with an index of suspicion were investigated using a combination of these modalities. The yield from this sample was 31.7%, better than reported in literature owing to a more specific inclusion criteria. Methylmalonic acidemia followed by Propionic acidemia were the most common organic acidemias, while maple syrup urine disease and classic citrullinemia were the common aminoacidopathies.

CONCLUSIONS

If all the sick care neonatal unit patients would undergo high risk stratified screening, the likely benefit of the high end technologies currently available in India would become apparent. Though this is not the opportune moment to start the expanded screening program in the country, none of the neonates admitted for any of these errors should be bereft of the diagnosis. This has implications not only for the index case but for its impact on the family's reproductive decisions. The Task Force consitituted by the Indian Council of Medical Research definitely feels that the high risk expanded screening program should be implemented for the sick newborns getting admitted in the Neonatal Intensive Care Units or the Sick Care Newborn Units.

Alternative Cell Sources to Adult Hepatocytes for Hepatic Cell Therapy

Adult hepatocyte transplantation is limited by scarce availability of suitable donor liver tissue for hepatocyte isolation. New cell-based therapies are being developed to supplement whole-organ liver transplantation, to reduce the waiting-list mortality rate, and to obtain more sustained and significant metabolic correction. Fetal livers and unsuitable neonatal livers for organ transplantation have been proposed as potential useful sources of hepatic cells for cell therapy. However, the major challenge is to use alternative cell sources for transplantation that can be derived from reproducible methods. Different types of stem cells with hepatic differentiation potential are eligible for generating large numbers of functional hepatocytes for liver cell therapy to treat degenerative disorders, inborn hepatic metabolic diseases, and organ failure. Clinical trials are designed to fully establish the safety profile of such therapies and to define target patient groups and standardized protocols.