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Incidence of Inborn Errors of Metabolism by Expanded Newborn
Original Article Journal of Inborn Errors of Metabolism & Screening 2016, Volume 4: 1–8 Incidence of Inborn Errors of Metabolism ª The Author(s) 2016 DOI: 10.1177/2326409816669027 by Expanded Newborn Screening iem.sagepub.com in a Mexican Hospital Consuelo Cantu´-Reyna, MD1,2, Luis Manuel Zepeda, MD1,2, Rene´ Montemayor, MD3, Santiago Benavides, MD3, Hector´ Javier Gonza´lez, MD3, Mercedes Va´zquez-Cantu´,BS1,4, and Hector´ Cruz-Camino, BS1,5 Abstract Newborn screening for the detection of inborn errors of metabolism (IEM), endocrinopathies, hemoglobinopathies, and other disorders is a public health initiative aimed at identifying specific diseases in a timely manner. Mexico initiated newborn screening in 1973, but the national incidence of this group of diseases is unknown or uncertain due to the lack of large sample sizes of expanded newborn screening (ENS) programs and lack of related publications. The incidence of a specific group of IEM, endocrinopathies, hemoglobinopathies, and other disorders in newborns was obtained from a Mexican hospital. These newborns were part of a comprehensive ENS program at Ginequito (a private hospital in Mexico), from January 2012 to August 2014. The retrospective study included the examination of 10 000 newborns’ results obtained from the ENS program (comprising the possible detection of more than 50 screened disorders). The findings were the following: 34 newborns were confirmed with an IEM, endocrinopathies, hemoglobinopathies, or other disorders and 68 were identified as carriers. Consequently, the estimated global incidence for those disorders was 3.4 in 1000 newborns; and the carrier prevalence was 6.8 in 1000. Moreover, a 0.04% false-positive rate was unveiled as soon as diagnostic testing revealed negative results. -
EXTENDED CARRIER SCREENING Peace of Mind for Planned Pregnancies
Focusing on Personalised Medicine EXTENDED CARRIER SCREENING Peace of Mind for Planned Pregnancies Extended carrier screening is an important tool for prospective parents to help them determine their risk of having a child affected with a heritable disease. In many cases, parents aren’t aware they are carriers and have no family history due to the rarity of some diseases in the general population. What is covered by the screening? Genomics For Life offers a comprehensive Extended Carrier Screening test, providing prospective parents with the information they require when planning their pregnancy. Extended Carrier Screening has been shown to detect carriers who would not have been considered candidates for traditional risk- based screening. With a simple mouth swab collection, we are able to test for over 419 genes associated with inherited diseases, including Fragile X Syndrome, Cystic Fibrosis and Spinal Muscular Atrophy. The assay has been developed in conjunction with clinical molecular geneticists, and includes genes listed in the NIH Genetic Test Registry. For a list of genes and disorders covered, please see the reverse of this brochure. If your gene of interest is not covered on our Extended Carrier Screening panel, please contact our friendly team to assist you in finding a gene test panel that suits your needs. Why have Extended Carrier Screening? Extended Carrier Screening prior to pregnancy enables couples to learn about their reproductive risk and consider a complete range of reproductive options, including whether or not to become pregnant, whether to use advanced reproductive technologies, such as preimplantation genetic diagnosis, or to use donor gametes. -
Inherited Metabolic Disease
Inherited metabolic disease Dr Neil W Hopper SRH Areas for discussion • Introduction to IEMs • Presentation • Initial treatment and investigation of IEMs • Hypoglycaemia • Hyperammonaemia • Other presentations • Management of intercurrent illness • Chronic management Inherited Metabolic Diseases • Result from a block to an essential pathway in the body's metabolism. • Huge number of conditions • All rare – very rare (except for one – 1:500) • Presentation can be non-specific so index of suspicion important • Mostly AR inheritance – ask about consanguinity Incidence (W. Midlands) • Amino acid disorders (excluding phenylketonuria) — 18.7 per 100,000 • Phenylketonuria — 8.1 per 100,000 • Organic acidemias — 12.6 per 100,000 • Urea cycle diseases — 4.5 per 100,000 • Glycogen storage diseases — 6.8 per 100,000 • Lysosomal storage diseases — 19.3 per 100,000 • Peroxisomal disorders — 7.4 per 100,000 • Mitochondrial diseases — 20.3 per 100,000 Pathophysiological classification • Disorders that result in toxic accumulation – Disorders of protein metabolism (eg, amino acidopathies, organic acidopathies, urea cycle defects) – Disorders of carbohydrate intolerance – Lysosomal storage disorders • Disorders of energy production, utilization – Fatty acid oxidation defects – Disorders of carbohydrate utilization, production (ie, glycogen storage disorders, disorders of gluconeogenesis and glycogenolysis) – Mitochondrial disorders – Peroxisomal disorders IMD presentations • ? IMD presentations • Screening – MCAD, PKU • Progressive unexplained neonatal -
Amino Acid Disorders 105
AMINO ACID DISORDERS 105 Massaro, A. S. (1995). Trypanosomiasis. In Guide to Clinical tions in biological fluids relatively easy. These Neurology (J. P. Mohrand and J. C. Gautier, Eds.), pp. 663– analyzers separate amino acids either by ion-ex- 667. Churchill Livingstone, New York. Nussenzweig, V., Sonntag, R., Biancalana, A., et al. (1953). Ac¸a˜o change chromatography or by high-pressure liquid de corantes tri-fenil-metaˆnicos sobre o Trypanosoma cruzi in chromatography. The results are plotted as a graph vitro: Emprego da violeta de genciana na profilaxia da (Fig. 1). The concentration of each amino acid can transmissa˜o da mole´stia de chagas por transfusa˜o de sangue. then be calculated from the size of the corresponding O Hospital (Rio de Janeiro) 44, 731–744. peak on the graph. Pagano, M. A., Segura, M. J., DiLorenzo, G. A., et al. (1999). Cerebral tumor-like American trypanosomiasis in Most amino acid disorders can be diagnosed by acquired immunodeficiency syndrome. Ann. Neurol. 45, measuring the concentrations of amino acids in 403–406. blood plasma; however, some disorders of amino Rassi, A., Trancesi, J., and Tranchesi, B. (1982). Doenc¸ade acid transport are more easily recognized through the Chagas. In Doenc¸as Infecciosas e Parasita´rias (R. Veroesi, Ed.), analysis of urine amino acids. Therefore, screening 7th ed., pp. 674–712. Guanabara Koogan, Sa˜o Paulo, Brazil. Spina-Franc¸a, A., and Mattosinho-Franc¸a, L. C. (1988). for amino acid disorders is best done using both South American trypanosomiasis (Chagas’ disease). In blood and urine specimens. Occasionally, analysis of Handbook of Clinical Neurology (P. -
Alkaptonuria.Pdf
Alkaptonuria Description Alkaptonuria is an inherited condition that causes urine to turn black when exposed to air. Ochronosis, a buildup of dark pigment in connective tissues such as cartilage and skin, is also characteristic of the disorder. This blue-black pigmentation usually appears after age 30. People with alkaptonuria typically develop arthritis, particularly in the spine and large joints, beginning in early adulthood. Other features of this condition can include heart problems, kidney stones, and prostate stones. Frequency This condition is rare, affecting 1 in 250,000 to 1 million people worldwide. Alkaptonuria is more common in certain areas of Slovakia (where it has an incidence of about 1 in 19, 000 people) and in the Dominican Republic. Causes Mutations in the HGD gene cause alkaptonuria. The HGD gene provides instructions for making an enzyme called homogentisate oxidase. This enzyme helps break down the amino acids phenylalanine and tyrosine, which are important building blocks of proteins. Mutations in the HGD gene impair the enzyme's role in this process. As a result, a substance called homogentisic acid, which is produced as phenylalanine and tyrosine are broken down, accumulates in the body. Excess homogentisic acid and related compounds are deposited in connective tissues, which causes cartilage and skin to darken. Over time, a buildup of this substance in the joints leads to arthritis. Homogentisic acid is also excreted in urine, making the urine turn dark when exposed to air. Learn more about the gene associated with Alkaptonuria • HGD Inheritance This condition is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. -
Tetrahydrobiopterin Loading Test in Hyperphenylalaninemia
003 1-399819113005-0435$03.00/0 PEDIATRIC RESEARCH Vol. 30, No. 5, 1991 Copyright 0 199 1 International Pediatric Research Foundation, Inc. Pr~ntc.d in U.S. A Tetrahydrobiopterin Loading Test in Hyperphenylalaninemia ALBERT0 PONZONE, ORNELLA GUARDAMAGNA, SILVIO FERRARIS, GIOVANNI B. FERRERO, IRMA DIANZANI, AND RICHARD G. H. COTTON InstiflifeofPediatric Clinic(A.P., O.G., S.F., G.B.F., I.D.], University of Torino, 10126 Torino, Italy and Olive Miller Laboratory [R.G.H.C.],Murdoch Institute, Royal Children's Hospital, Vicroria,Australia 3052 ABSTRACT. Some cases of primary hyperphenylalanine- PKU to describe some cases clinically unresponsive to a Phe- mia are not caused by the lack of phenylalanine hydroxyl- restricted diet and later shown to be due to BH4 deficiency ase, but by the lack of its cofactor tetrahydrobiopterin. ( 1-4). These patients are not clinically responsive to a phenylal- By analyzing all the essential components of the complex anine-restricted diet, but need specific substitution therapy. hydroxylation system of aromatic amino acids, it became appar- Thus, it became necessary to examine all newborns ent that a defect in the BH4 recycling enzyme DHPR (EC screened as positive with the Guthrie test for tetrahydro- 1.66.99.7) and two defects in BH4 synthetic pathway enzymes, biopterin deficiency. Methods based on urinary pterin or guanosine triphosphate cyclohydrolase I (EC 3.5.4.16) and 6- on specific enzyme activity measurements are limited in PPH4S, may lead to cofactor deficiency resulting in HPA and in their availability, and the simplest method, based on the impaired production of dopamine and serotonin (5-7). -
Amino Acid Disorders
471 Review Article on Inborn Errors of Metabolism Page 1 of 10 Amino acid disorders Ermal Aliu1, Shibani Kanungo2, Georgianne L. Arnold1 1Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 2Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA Contributions: (I) Conception and design: S Kanungo, GL Arnold; (II) Administrative support: S Kanungo; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: E Aliu, GL Arnold; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Georgianne L. Arnold, MD. UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Suite 1200, Pittsburgh, PA 15224, USA. Email: [email protected]. Abstract: Amino acids serve as key building blocks and as an energy source for cell repair, survival, regeneration and growth. Each amino acid has an amino group, a carboxylic acid, and a unique carbon structure. Human utilize 21 different amino acids; most of these can be synthesized endogenously, but 9 are “essential” in that they must be ingested in the diet. In addition to their role as building blocks of protein, amino acids are key energy source (ketogenic, glucogenic or both), are building blocks of Kreb’s (aka TCA) cycle intermediates and other metabolites, and recycled as needed. A metabolic defect in the metabolism of tyrosine (homogentisic acid oxidase deficiency) historically defined Archibald Garrod as key architect in linking biochemistry, genetics and medicine and creation of the term ‘Inborn Error of Metabolism’ (IEM). The key concept of a single gene defect leading to a single enzyme dysfunction, leading to “intoxication” with a precursor in the metabolic pathway was vital to linking genetics and metabolic disorders and developing screening and treatment approaches as described in other chapters in this issue. -
European Conference on Rare Diseases
EUROPEAN CONFERENCE ON RARE DISEASES Luxembourg 21-22 June 2005 EUROPEAN CONFERENCE ON RARE DISEASES Copyright 2005 © Eurordis For more information: www.eurordis.org Webcast of the conference and abstracts: www.rare-luxembourg2005.org TABLE OF CONTENT_3 ------------------------------------------------- ACKNOWLEDGEMENTS AND CREDITS A specialised clinic for Rare Diseases : the RD TABLE OF CONTENTS Outpatient’s Clinic (RDOC) in Italy …………… 48 ------------------------------------------------- ------------------------------------------------- 4 / RARE, BUT EXISTING The organisers particularly wish to thank ACKNOWLEDGEMENTS AND CREDITS 4.1 No code, no name, no existence …………… 49 ------------------------------------------------- the following persons/organisations/companies 4.2 Why do we need to code rare diseases? … 50 PROGRAMME COMMITTEE for their role : ------------------------------------------------- Members of the Programme Committee ……… 6 5 / RESEARCH AND CARE Conference Programme …………………………… 7 …… HER ROYAL HIGHNESS THE GRAND DUCHESS OF LUXEMBOURG Key features of the conference …………………… 12 5.1 Research for Rare Diseases in the EU 54 • Participants ……………………………………… 12 5.2 Fighting the fragmentation of research …… 55 A multi-disciplinary approach ………………… 55 THE EUROPEAN COMMISSION Funding of the conference ……………………… 14 Transfer of academic research towards • ------------------------------------------------- industrial development ………………………… 60 THE GOVERNEMENT OF LUXEMBOURG Speakers ……………………………………………… 16 Strengthening cooperation between academia -
Screening for Inherited Metabolic Disease in Wales Using Urine-Impregnated Filter Paper
Arch Dis Child: first published as 10.1136/adc.50.4.264 on 1 April 1975. Downloaded from Archives of Disease in Childhood, 1975, 50, 264. Screening for inherited metabolic disease in Wales using urine-impregnated filter paper D. M. BRADLEY From the Department of Medicine, Welsh National School of Medicine, Heath Park, Cardiff Bradley, D. M. (1975). Archives of Disease in Childhood, 50, 264. Screening for inherited metabolic disease in Wales using urine-impregnated filter paper. Urine specimens from 135 295 infants have been collected on filter paper and tested for 7 abnormal urinary constituents using spot tests and paper chromato- graphy. The method has detected 5 infants with phenylketonuria, 4 with histidinae- mia, 5 with cystinuria, 5 with diabetes mellitus, and one with alcaptonuria. Transient abnormalities such as tyrosyluria, generalized aminoaciduria, cystinuria, and glyco- suria have been noted. 2 phenylketonuric infants failed to excrete a detectable quantity of o-hydroxyphenylacetic acid at the time of testing. The findings show that the detection of this compound in urine is an unreliable method of screening for phenylketonuria. Early detection of phenylketonuria became Method essential when it was found that the severe mental Collection of urine specimens. The recom- retardation associated with this disorder could be mended time of testing is between the 10th and 14th prevented by introducing a low phenylalanine diet day of life. In practice, 53% of all specimens are in the first months of life (Bickel, Gerrard, and collected by the 14th day, rising to 98% by the 28th Hickmans, 1953). The Medical Research Council day (Table I). -
Living with Classical Homocystinuria
Living with Classical Homocystinuria This brochure will help you understand what classical homocystinuria is, how it affects your body, and how you can manage your condition A few words about this brochure What is homocystinuria? Has your doctor diagnosed you or your child You may have heard the word “homocystinuria” with homocystinuria (HO-mo-SIS-tin-YUR- for the first time when your doctor talked to ee-uh)? There are three types of genetic you about possibly having this condition. disorders that cause homocystinuria. Each Homocystinuria is a rare disorder involving type has a different cause and different the amino acid homocysteine (HO-mo-SIS- health issues. This brochure will talk about teen). Amino acids are building blocks that your classical homocystinuria. The information body uses to make proteins. Homocystinuria will help you understand classical occurs when there is a buildup of the amino acid homocystinuria and how you can manage homocysteine in your blood and urine. your condition. High levels of homocysteine can be harmful to your body. You may be reading this brochure because you have classical homocystinuria or Why is there homocysteine because your child or a sibling or a friend in your body? has it. Or perhaps you’re a healthcare professional. Please note the brochure It starts with the foods you eat. Your body addresses “you,” but it’s understood that makes homocysteine from another amino acid “you,” the reader, may not have classical called methionine (meh-THIGH-uh-neen). Most homocystinuria yourself. foods contain some methionine. But high-protein foods such as meat, fish, eggs, or cheese tend to have the most methionine. -
The PAH Gene, Phenylketonuria, and a Paradigm Shift
HUMAN MUTATION 28(9), 831^845, 2007 WILEY 200TH ANNIVERSARY TRIBUTE ARTICLE The PAH Gene, Phenylketonuria, and a Paradigm Shift Charles R. Scriver1–4Ã 1Department of Human Genetics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; 2Department of Biochemistry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; 3Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; 4Department of Biology, Faculty of Science, McGill University, Montreal, Quebec, Canada Communicated by Johannes Zschocke ‘‘Inborn errors of metabolism,’’ first recognized 100 years ago by Garrod, were seen as transforming evidence for chemical and biological individuality. Phenylketonuria (PKU), a Mendelian autosomal recessive phenotype, was identified in 1934 by Asbjo¨rn Fo¨lling. It is a disease with impaired postnatal cognitive development resulting from a neurotoxic effect of hyperphenylalaninemia (HPA). Its metabolic phenotype is accountable to multifactorial origins both in nurture, where the normal nutritional experience introduces L-phenylalanine, and in nature, where mutations (4500 alleles) occur in the phenylalanine hydroxylase gene (PAH) on chromosome 12q23.2 encoding the L-phenylalanine hydroxylase enzyme (EC 1.14.16.1). The PAH enzyme converts phenylalanine to tyrosine in the presence of molecular oxygen and catalytic amounts of tetrahydrobiopterin (BH4), its nonprotein cofactor. PKU is among the first of the human genetic diseases to enter, through newborn screening, the domain of public health, and to show a treatment effect. This effect caused a paradigm shift in attitudes about genetic disease. The PKU story contains many messages, including: a framework on which to appreciate the complexity of PKU in which phenotype reflects both locus-specific and genomic components; what the human PAH gene tells us about human population genetics and evolution of modern humans; and how our interest in PKU is served by a locus-specific mutation database (http://www.pahdb.mcgill.ca; last accessed 20 March 2007). -
Molecular Patterns Behind Immunological and Metabolic Alterations in Lysinuric Protein Intolerance
MOLECULAR PATTERNS BEHIND IMMUNOLOGICAL AND METABOLIC ALTERATIONS IN LYSINURIC PROTEIN INTOLERANCE Johanna Kurko TURUN YLIOPISTON JULKAISUJA – ANNALES UNIVERSITATIS TURKUENSIS Sarja - ser. D osa - tom. 1220 | Medica - Odontologica | Turku 2016 University of Turku Faculty of Medicine Institute of Biomedicine Department of Medical Biochemistry and Genetics Turku Doctoral Programme of Molecular Medicine (TuDMM) Supervised by Adjunct Professor Juha Mykkänen, Ph.D Professor Harri Niinikoski, MD, Ph.D Research Centre of Applied and Department of Paediatrics and Preventive Cardiovascular Medicine Adolescent Medicine University of Turku Turku University Hospital Turku, Finland University of Turku Turku, Finland Reviewed by Adjunct Professor Risto Lapatto, MD, Ph.D Adjunct Professor Outi Monni, Ph.D Department of Paediatrics Research Programs’ Unit and Institute of Helsinki University Hospital Biomedicine University of Helsinki University of Helsinki Helsinki, Finland Helsinki, Finland Opponent Adjunct Professor Päivi Saavalainen, Ph.D Research Programs Unit University of Helsinki Helsinki, Finland The originality of this thesis has been checked in accordance with the University of Turku quality assurance system using the Turnitin OriginalityCheck service. ISBN 978-951-29-6399-7 (PRINT) ISBN 978-951-29-6400-0 (PDF) ISSN 0355-9483 (PRINT) ISSN 2343-3213 (ONLINE) Painosalama Oy - Turku, Finland 2016 ‘Nothing has such power to broaden the mind as the ability to investigate systematically and truly all that comes under thy observation in life.’ Marcus