Clinica Chimica Acta 494 (2019) 106–111 Contents lists available at ScienceDirect Clinica Chimica Acta journal homepage: www.elsevier.com/locate/cca Expanded newborn screening for inherited metabolic disorders and genetic characteristics in a southern Chinese population T ⁎ ⁎ Yiming Lina, Quanzhi Zhenga, Tianwen Zhengb, Zhenzhu Zhenga, Weihua Lina, , Qingliu Fua, a Neonatal Disease Screening Center, Quanzhou Maternal and Children's Hospital, 700 Fengze Street, Quanzhou, Fujian Province 362000, China b Department of Pediatrics, Quanzhou Maternal and Children's Hospital, 700 Fengze Street, Quanzhou, Fujian Province 362000, China ARTICLE INFO ABSTRACT Keywords: To evaluate the incidence, disease spectrum, and genetic characteristics of inherited metabolic disorders (IMDs) Expanded newborn screening of newborns in Quanzhou area, China. We analyze the expanded newborn screening results of IMDs detected by Inherited metabolic disorders tandem mass spectrometry (MS/MS) during 5 years. Suspected positive patients were diagnosed through next- Tandem mass spectrometry generation sequencing and validated by Sanger sequencing. In addition, multiplex ligation-dependent probe Fatty acid oxidation disorder amplification technology has also been applied to assist in diagnosis of diseases with deletion or duplication Mutation mutations. A total of 364,545 newborns were screened, 130 IMDs were identified yielding an incidence of 1:2804. In addition, 9 cases of maternal disorders were also identified by our MS/MS newborn screening pro- gram. There were 42 newborns with amino acid disorders (1:8680), 39 with organic acid disorders (1:9347), and 49 with fatty acid oxidation disorders (1:7440). Unlike other studies, our study indicated that fatty acid oxi- dation disorder has the highest proportion (37.7%), particularly primary carnitine deficiency (PCD) with in- cidence up to 1:10,126 was the most common disorder in the region. The recurrent mutations of relatively common diseases like PCD, phenylalanine hydroxylase deficiency, short-chain acyl-CoA dehydrogenase defi- ciency, citrin deficiency, glutaric acidemia type I, isobutyryl-CoA dehydrogenase deficiency, and multiple acyl- CoA dehydrogenase deficiency in this region were also clearly elucidated. Therefore, our data indicated that IMDs are never uncommon in Quanzhou, the disease spectrum and genetic backgrounds were clearly elucidated, contributing to the treatment and prenatal genetic counseling of these disorders in this region. 1. Introduction a considerable number of diseases. Newborn screening (NBS) is a va- luable preventive health measure for early diagnosis, which has been Inherited metabolic disorders (IMDs) are a group of genetic dis- shown to be diagnostically effective and economically efficient. In orders caused by defective enzymes, cofactors, or transporters in me- particular, the introduction of tandem mass spectrometry (MS/MS) tabolic pathways. Many IMDs have serious consequences to the affected technology enabled the simultaneous determination and quantification neonate, including lethargy, irreversible mental retardation, physical of several amino acids and acylcarnitines in a single test [1]. Conse- handicaps, coma, and even death. Albeit individually rare, IMDs are quently, MS/MS has been applied wildly for the screening of IMDs that collectively numerous. If early accurate diagnosis was made, many of include disorders of amino acids, organic acidurias, and fatty acid these severe complications can be prevented or significantly reduced in oxidiation disorders [2]. In China, MS/MS based NBS was launched in Abbreviations: IMD, Inherited metabolic disorder; NBS, Newborn screening; MS/MS, Tandem mass spectrometry; DBS, Dried blood spot; NGS, Next-generation sequencing; PCR, Polymerase chain reaction; MLPA, Multiplex ligation-dependent probe amplification; NKH, Non-ketotic hyperglycinemia; PA, Propionic academia; PPV, Positive predictive value; PAHD, Phenylalanine hydroxylase deficiency; CD, Citrin deficiency; UCD, Urea cycle disorder; BH4D, tetrahydrobiopterin deficiency; MAT I/III, Methionine adenosyltransferase I/III; OTCD, Ornithine carbamoyltransferase deficiency; SBCADD, Short/branched chain acyl-CoA dehydrogenase defi- ciency; GA-I, Glutaric acidemia type I; IBDHD, Isobutyryl-CoA dehydrogenase deficiency; 3-MCCD, 3-methylcrotonyl CoA carboxylase dedicency; IVA, Isovaleric acidemia; MMA, Methylmalonic academia; FAODs, Fatty acid oxidation disorders; PCD, Primary carnitine deficiency; MADD, Multiple acyl-CoA dehydrogenase deficiency; SCADD, Short-chain acyl-CoA dehydrogenase deficiency; VLCADD, Very-long-chain acyl-CoA dehydrogenase deficiency; CPT-I, Carnitine palmitoyl transferase-I deficiency; PTPS, 6-Pyruvoyl-tetrahydropterin synthase; LSM, Lipid storage myopathies; C2, Aceylcarnitine; C3, Propionylcarnitine; C5, Isovalerylcarnitine/2-methylbutyrylcarnitine; C5DC, Glutarylcarnitine; C5OH, 3-Hydroxyisovalerylcarnitine/3-hydroxy-2-methylbutyrylcarnitine; C0, Free carni- tine; C8, Octanoylacrnitine; C10, Decanoylcarnitine; C12, Dodecanoylcarnitine; C14, Myristoylcarnitine ⁎ Corresponding authors. E-mail addresses: [email protected] (W. Lin), [email protected] (Q. Fu). https://doi.org/10.1016/j.cca.2019.03.1622 Received 15 March 2019; Accepted 20 March 2019 Available online 21 March 2019 0009-8981/ © 2019 Published by Elsevier B.V. Y. Lin, et al. Clinica Chimica Acta 494 (2019) 106–111 2004 and the average incidence of IMDs was 1:3795 in a pilot study [3]. Table 1 However, subsequent studies have shown that the incidence and disease Positive cases detected by MS/MS newborn screening. ff spectrum of IMDs varied greatly in di erent regions of China, especially Disorders Positive Frequency between the south and north. The expanded NBS program in- cases corporating MS/MS for newborns was begun in Quanzhou since Jan- uary 2014. Herein, we report our five-year experience with MS/MS Amino acid disorders 42 1:8680 Phenylalanine hydroxylase deficiency (PAHD) 14 1:26,039 expanded NBS, which include the incidence, disease spectrum, and Citrin deficiency (CD) 10 1:36,455 genetic characteristics of IMDs. Tetrahydrobiopterin deficiency (BH4D) 4 1:91,136 Non-ketotic hyperglycinemia (NKH) 3 1:121,515 2. Materials and methods Methionine adenosyltransferase I/III (MAT I/III) 3 1:121,515 deficiency Hyperprolinemia 1 1:364,545 2.1. Newborn screening Urea cycle disorders 7 1:52,078 Citrullinemia type I (CTLN1) 2 1:182,273 In total, 364,545 infants (209,136 males and 155,409 females) born Argininosuccinate layse deficiency (ASLD) 2 1:182,273 fi in Quanzhou, China, between January 2014 to November 2018 were Ornithine transcarbamylase de ciency (OTCD) 2 1:182,273 Carbamoylphosphate synthetase deficiency (CPSD) 1 1:364,545 enrolled for expanded NBS by MS/MS. Blood samples were collected by Organic acid disorders 39 1:9347 heel stick and spotted on Whatman 903 filter paper. Blood collection for Short/branched chain acyl-CoA dehydrogenase 12 1:30,379 NBS is recommended between 3 and 7 days of life. Dried blood spot deficiency (SBCADD) (DBS) samples were delivered by cold-chain transportation to the NBS Glutaric acidemia type I (GA-I) 7 1:52,078 fi center of Quanzhou Maternity and Children's Hospital within 5 days. Isobutyryl-CoA dehydrogenase de ciency (IBDHD) 6 1:60,758 ™ 3-methylcrotonyl CoA carboxylase dedicency (3- 5 1:72,909 DBS samples were pre-processed following the instruction of NeoBase MCCD) non-derivatized MS/MS kit (PekinElmer, USA), then an ACQUITY TQD Isovaleric acidemia (IVA) 4 1:91,136 mass spectrometer (Waters, Milford, MA, USA) was used to analyze Methylmalonic academia (MMA) 3 1:121,515 amino acids and aclycarnitines in DBS samples. The cutoff values were Propionic academia (PA) 2 1:182,273 Fatty acid oxidation disorders 49 1:7440 initially set by reference to the worldwide collaborative project and Primary carnitine deficiency (PCD) 36 1:10,126 other screening centers [4,5], and were adjusted over time as the Multiple acyl-CoA dehydrogenase deficiency 5 1:72,909 number of samples increased. Newborns with clear aberrant initial (MADD) screening results were immediately referred to confirmatory tests, in- Short-chain acyl-CoA dehydrogenase deficiency 4 1:91,136 cluding biochemical and genetic analysis. Newborns with mild initial (SCADD) Very-long-chain acyl-CoA dehydrogenase deficiency 3 1:121,515 screening results were recalled for repeated test, if the second test was (VLCAD) still positive, the patient was referred to confirmatory tests. This study Carnitine palmitoyl transferase-I deficiency (CPT I) 1 1:364,545 was approved by the Ethical Committee of Quanzhou Maternity and Total numbers 130 1:2804 Children's Hospital. Written informed consents were obtained from all Total numbers including materal disorders 139 1:2623 the infants' patients. clinical symptoms. Only patients diagnosed by genetic analysis were 2.2. Genetic analysis included in this study. Genetic analysis was performed by Genuine Diagnostics Company (Hangzhou, Zhejiang, China). Briefly, DBS or peripheral whole blood of 3. Results suspected positive patients were referred to laboratory, and genomic DNA was extracted using Qiagen Blood DNA mini kits (Qiagen, Hilden, 3.1. Newborn screening Germany) according to the manufacturer's protocol. DNA samples of the probands were quantified using a Qubit® dsDNA HS Assay Kit Among the 364,545 screened newborns, 4897 newborns were sus- fi (Invitrogen, Carlsbad, CA, USA) and then were taken for next-genera- pected positive in the rst screening, yielding a positive ratio of 1.34%. tion sequencing (NGS). The target