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A Roadmap for Potential Improvement of Newborn Screening for Inherited Metabolic Diseases Following Recent Developments and Successful Applications of Bivariate Normal Limits for Pre-Symptomatic Detection of MPS I, Pompe Disease, and Krabbe Disease. Int J Neonatal Screen 2022; 8:ijns8040061. [PMID: 36412587 PMCID: PMC9680456 DOI: 10.3390/ijns8040061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
The mucopolysaccharidoses (MPS), Pompe Disease (PD), and Krabbe disease (KD) are inherited conditions known as lysosomal storage disorders (LSDs) The resulting enzyme deficiencies give rise to progressive symptoms. The United States Department of Health and Human Services' Recommended Uniform Screening Panel (RUSP) suggests LSDs for inclusion in state universal newborn screening (NBS) programs and has identified screening deficiencies in MPS I, KD, and PD NBS programs. MPS I NBS programs utilize newborn dried blood spots and assay alpha L-iduronidase (IDUA) enzyme to screen for potential cases. Glycosaminoglycans (GAGs) offer potential as a confirmatory test. KD NBS programs utilize galactocerebrosidase (GaLC) as an initial test, with psychosine (PSY) activity increasingly used as a confirmatory test for predicting onset of Krabbe disease, though with an excessive false positive rate. PD is marked by a deficiency in acid α-glucosidase (GAA), causing increased glycogen, creatine (CRE), and other biomarkers. Bivariate normal limit (BVNL) methods have been applied to GaLC and PSY activity to produce a NBS tool for KD, and more recently, to IDUA and GAG activity to develop a NBS tool for MPS I. A BVNL tool based on GAA and CRE is in development for infantile PD diagnosis. Early infantile KD, MPS I, and PD cases were pre-symptomatically identified by BVNL-based NBS tools. This article reviews these developments, discusses how they address screening deficiencies identified by the RUSP and may improve NBS more generally.
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Abstract
OBJECTIVE The purpose of our study was to understand the healthcare burden and incidence of Krabbe disease (Krabbe). METHODS Retrospective analysis of Krabbe patients identified October 1, 2015 through December 31, 2020, ages birth through age 3, evaluated in two national databases. We estimated point prevalence and incidence from year 2016 data. RESULTS We identified 98 unique Krabbe patients with 736 visits including 260 were inpatient admissions. Total healthcare charges were $51.5 million dollars. We determined a point prevalence of 34 68 Krabbe patients in 2016 ages 0 3 years. This estimates a birth incidence of ~1 in 310,000 live births. Significance: Krabbe disease patients had over $51 million in health care charges and hundreds of hospitalizations. Estimated prevalence and birth incidence is similar to rates observed from newborn screening. Our findings show the tremendous health impacts of Krabbe disease, and provide guidance for efforts in screening and treatment planning.
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Affiliation(s)
| | | | - Bradley J. Barney
- Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joshua L. Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine; Primary Children’s Center for Personalized Medicine, Primary Children’s Hospital, Salt Lake City, Utah
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Langan TJ, Jalal K, Barczykowski AL, Carter RL, Stapleton M, Orii K, Fukao T, Kobayashi H, Yamaguchi S, Tomatsu S. Development of a newborn screening tool for mucopolysaccharidosis type I based on bivariate normal limits: Using glycosaminoglycan and alpha-L-iduronidase determinations on dried blood spots to predict symptoms. JIMD Rep 2020; 52:35-42. [PMID: 32154058 PMCID: PMC7052686 DOI: 10.1002/jmd2.12093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/26/2019] [Accepted: 12/11/2019] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Current newborn screening (NBS) for mucopolysaccharidosis type I (MPSI) has very high false positive rates and low positive predictive values (PPVs). To improve the accuracy of presymptomatic prediction for MPSI, we propose an NBS tool based on known biomarkers, alpha-L-iduronidase enzyme activity (IDUA) and level of the glycosaminoglycan (GAG) heparan sulfate (HS). METHODS We developed the NBS tool using measures from dried blood spots (DBS) of 5000 normal newborns from Gifu Prefecture, Japan. The tool's predictive accuracy was tested on the newborn DBS from these infants and from seven patients who were known to have early-onset MPSI (Hurler's syndrome). Bivariate analyses of the standardized natural logarithms of IDUA and HS levels were employed to develop the tool. RESULTS Every case of early-onset MPSI was predicted correctly by the tool. No normal newborn was incorrectly identified as having early-onset MPSI, whereas 12 normal newborns were so incorrectly identified by the Gifu NBS protocol. The PPV was estimated to be 99.9%. CONCLUSIONS Bivariate analysis of IDUA with HS in newborn DBS can accurately predict early MPSI symptoms, control false positive rates, and enhance presymptomatic treatment. This bivariate analysis-based approach, which was developed for Krabbe disease, can be extended to additional screened disorders.
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Affiliation(s)
- Thomas J. Langan
- Department of Neurology, School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew York
| | - Kabir Jalal
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNew York
| | - Amy L. Barczykowski
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNew York
| | - Randy L. Carter
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNew York
| | - Molly Stapleton
- Skeletal Dysplasia Research Lab, Nemours/Alfred I. DuPont Hospital for ChildrenWilmingtonDelaware
- Department of Biological SciencesUniversity of DelawareNewarkDelaware
| | - Kenji Orii
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
| | - Toshiyuki Fukao
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
| | | | | | - Shunji Tomatsu
- Skeletal Dysplasia Research Lab, Nemours/Alfred I. DuPont Hospital for ChildrenWilmingtonDelaware
- Department of Biological SciencesUniversity of DelawareNewarkDelaware
- Department of Pediatrics, Graduate School of MedicineGifu UniversityGifuJapan
- Department of PediatricsShimane UniversityShimaneJapan
- Department of PediatricsThomas Jefferson UniversityPhiladelphiaPennsylvania
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Langan TJ, Barczykowski A, Jalal K, Sherwood L, Allewelt H, Kurtzberg J, Carter RL. Survey of quality of life, phenotypic expression, and response to treatment in Krabbe leukodystrophy. JIMD Rep 2019; 47:47-54. [PMID: 31240167 PMCID: PMC6498827 DOI: 10.1002/jmd2.12033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/27/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To develop a quality of life (QOL) survey for Krabbe disease (KD), and to thereby improve understanding of its phenotypic expression and response to treatment. METHODS The survey, the Leukodystrophy Quality of Life Assessment (LQLA) and the Vineland Adaptive Behavior Scales were co-administered to 33 patients or their caretakers. These included the phenotypes of early infantile KD (EIKD; 0-6 months old at onset), late infantile cases (LIKD; 7-12 months old at onset), and cases that emerged after 12 months old, late onset (LOKD). The sample included cases with and without stem cell transplantation (SCT). Reliability and concurrent validity were assessed for overall and subscale scores. Analysis of variance tested differences in QOL between phenotypes and transplant groups (none, pre-, post-symptom). RESULTS Good concurrent validity with the Vineland was shown for total, communication, daily activity, social, and motor scales and good reliability was observed. LOKD cases had better communication skills than either EIKD or LIKD and better overall QOL than EIKD. Analyses of individual items showed that communication items, mostly, contributed significantly to phenotype differences. Presymptomatic SCT significantly improved QOL compared to postsymptomatic SCT or no treatment. Presymptomatically treated patients had near-normal total scores. CONCLUSIONS The LQLA is valid and reliable. Despite small sample size, phenotypic demarcation was determined to be due mainly to differences in communication skills. There was a relative enhancement of QOL in LOKD patients, and in those who had presymptomatic SCT. These results apply to the current controversy about recommendations for newborn screening for this condition.
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Affiliation(s)
- Thomas J. Langan
- Department of Neurology, School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew York
| | - Amy Barczykowski
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNew York
| | - Kabir Jalal
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNew York
| | - Laura Sherwood
- Department of Neurology, School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew York
| | - Heather Allewelt
- Department of PediatricsDuke University School of MedicineDurhamNorth Carolina
| | - Joanne Kurtzberg
- Department of PediatricsDuke University School of MedicineDurhamNorth Carolina
| | - Randy L. Carter
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloNew York
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Development of a newborn screening tool based on bivariate normal limits: using psychosine and galactocerebrosidase determination on dried blood spots to predict Krabbe disease. Genet Med 2018; 21:1644-1651. [DOI: 10.1038/s41436-018-0371-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/07/2018] [Indexed: 11/08/2022] Open
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Abstract
PURPOSE OF REVIEW The leukodystrophies, typically considered incurable neurodegenerative disorders, are often diagnosed after irreversible central and peripheral nervous system injury has occurred. Early recognition of these disorders is imperative to enable potential therapeutic interventions. This article provides a summary of the symptoms of and diagnostic evaluation for leukodystrophies, along with the currently available therapies and recent advances in management. RECENT FINDINGS The leukodystrophies are a rapidly expanding field because of advances in neuroimaging and genetics; however, recognition of the clinical and biochemical features of a leukodystrophy is essential to accurately interpret an abnormal MRI or genetic result. Moreover, the initial symptoms of leukodystrophies may mimic other common pediatric disorders, leading to a delay in the recognition of a degenerative disorder. SUMMARY This article will aid the clinician in recognizing the clinical features of leukodystrophies and providing accurate diagnosis and management.
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Sidhu R, Mikulka CR, Fujiwara H, Sands MS, Schaffer JE, Ory DS, Jiang X. A HILIC-MS/MS method for simultaneous quantification of the lysosomal disease markers galactosylsphingosine and glucosylsphingosine in mouse serum. Biomed Chromatogr 2018; 32:e4235. [PMID: 29516569 PMCID: PMC5992066 DOI: 10.1002/bmc.4235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 01/20/2023]
Abstract
Deficiencies of galactosylceramidase and glucocerebrosidase result in the accumulation of galactosylsphingosine (GalSph) and glucosylsphingosine (GluSph) in Krabbe and Gaucher diseases, respectively. GalSph and GluSph are useful biomarkers for both diagnosis and monitoring of treatment effects. We have developed and validated a sensitive, accurate, high-throughput assay for simultaneous determination of the concentration of GalSph and GluSph in mouse serum. GalSph and GluSph and their deuterated internal standards were extracted by protein precipitation in quantitative recoveries, baseline separated by hydrophilic interaction chromatography and detected by positive-ion electrospray mass spectrometry in multiple reaction monitoring mode. Total run time was 7 min. The lower limit of quantification was 0.2 ng/mL for both GalSph and GluSph. Sample stability, assay precision and accuracy, and method robustness were demonstrated. This method has been successfully applied to measurement of these lipid biomarkers in a natural history study in twitcher (Krabbe) mice.
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Affiliation(s)
- Rohini Sidhu
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Christina R. Mikulka
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110
| | - Hideji Fujiwara
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Mark S. Sands
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110
| | - Jean E. Schaffer
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Daniel S. Ory
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
| | - Xuntian Jiang
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110
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Zhao J, Ma Y. Optimal pseudolikelihood estimation in the analysis of multivariate missing data with nonignorable nonresponse. Biometrika 2018; 105:479-486. [PMID: 30799873 PMCID: PMC6373018 DOI: 10.1093/biomet/asy007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Indexed: 11/13/2022] Open
Abstract
Tang et al. (2003) considered a regression model with missing response, where the missingness mechanism depends on the value of the response variable and hence is nonignorable. They proposed three pseudolikelihood estimators, based on different treatments of the probability distribution of the completely observed covariates. The first assumes the distribution of the covariate to be known, the second estimates this distribution parametrically, and the third estimates the distribution nonparametrically. While it is not hard to show that the second estimator is more efficient than the first, Tang et al. (2003) only conjectured that the third estimator is more efficient than the first two. In this paper, we investigate the asymptotic behaviour of the third estimator by deriving a closed-form representation of its asymptotic variance. We then prove that the third estimator is more efficient than the other two. Our result can be straightforwardly applied to missingness mechanisms that are more general than that in Tang et al. (2003).
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Affiliation(s)
- Jiwei Zhao
- Department of Biostatistics, State University of New York at Buffalo, 719 Kimball Tower, Buffalo, New York, U.S.A
| | - Yanyuan Ma
- Department of Statistics, Pennsylvania State University, University Park, Pennsylvania, U.S.A
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Ficicioglu C. New tools and approaches to newborn screening: ready to open Pandora's box? Cold Spring Harb Mol Case Stud 2017; 3:a001842. [PMID: 28487886 PMCID: PMC5411690 DOI: 10.1101/mcs.a001842] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The landscape of newborn screening (NBS) is changing as new tools are developed. We must acknowledge that NBS is a very important and extraordinarily positive initiative especially for rare and serious inherited disorders; however, lessons learned from current NBS should guide the future of NBS as we enter the era of “omics” that will expand NBS for many other genetic disorders. In this article, I will first discuss new tools such as genomics and metabolomics for NBS. I will then turn to assessing how best to take advantage of new technical developments while considering the best interests of patients and the success of newborn screening.
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Affiliation(s)
- Can Ficicioglu
- Children's Hospital of Philadelphia (CHOP), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Langan TJ, Barcykowski AL, Dare J, Pannullo EC, Muscarella L, Carter RL. Evidence for improved survival in postsymptomatic stem cell-transplanted patients with Krabbe's disease. J Neurosci Res 2016; 94:1189-94. [PMID: 27638603 PMCID: PMC5484586 DOI: 10.1002/jnr.23787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 11/08/2022]
Abstract
Krabbe's disease (KD) is a severe neurodegenerative disorder affecting white matter in the brain and peripheral nerves. Transplantation of hematopoietic stem cells (HSCT), although not curative, has been shown to extend survival and alleviate neurodevelopmental symptoms when treatment precedes the onset of symptoms. Existing evidence, although not tested statistically, seems clearly to show that postsymptomatic transplantation does not improve neurodevelopmental outcomes. The impact of postsymptomatic HSCT treatment on survival, however, is an open question. This study uses a KD registry to examine the effect of HSCT on survival of symptomatic KD patients. Sixteen transplanted patients were matched by age of onset to 68 nontransplanted patients. The potential confounding effect of age of onset was, therefore, avoided. To quantify the effect of HSCT over time, we used Cox regression analysis, and we observed a sustained and nearly 2.2-fold risk of death from KD in patients who were not transplanted relative to those who were transplanted (one-tailed P = 0.0365; 95% lower bound = 1.07). The improvement of survival resulting from HSCT did not appear to depend on the age of symptom onset. Thus, these results establish a long-term, quantitative benefit of HSCT even in patients who are already experiencing symptoms. They also provide a benchmark for improved survival that can be used for potential new treatments for KD. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Thomas J Langan
- Hunter James Kelly Research Institute, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
| | - Amy L Barcykowski
- Hunter James Kelly Research Institute, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Jonathan Dare
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Erin C Pannullo
- Hunter James Kelly Research Institute, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Leah Muscarella
- Hunter James Kelly Research Institute, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Randy L Carter
- Hunter James Kelly Research Institute, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Biostatistics, Population Health Observatory, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
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