1
|
Succoio M, Sacchettini R, Rossi A, Parenti G, Ruoppolo M. Galactosemia: Biochemistry, Molecular Genetics, Newborn Screening, and Treatment. Biomolecules 2022; 12:biom12070968. [PMID: 35883524 PMCID: PMC9313126 DOI: 10.3390/biom12070968] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 12/16/2022] Open
Abstract
Galactosemia is an inborn disorder of carbohydrate metabolism characterized by the inability to metabolize galactose, a sugar contained in milk (the main source of nourishment for infants), and convert it into glucose, the sugar used by the body as the primary source of energy. Galactosemia is an autosomal recessive genetic disease that can be diagnosed at birth, even in the absence of symptoms, with newborn screening by assessing the level of galactose and the GALT enzyme activity, as GALT defect constitutes the most frequent cause of galactosemia. Currently, galactosemia cannot be cured, but only treated by means of a diet with a reduced content of galactose and lactose. Although the diet is able to reverse the neonatal clinical picture, it does not prevent the development of long-term complications. This review provides an overview of galactose metabolism, molecular genetics, newborn screening and therapy of galactosemia. Novel treatments for galactosemia currently being investigated in (pre)clinical studies and potentially able to prevent long-term complications are also presented.
Collapse
Affiliation(s)
- Mariangela Succoio
- CEINGE-Biotecnologie Avanzate s.c.ar.l., 80145 Naples, Italy; (M.S.); (R.S.)
| | - Rosa Sacchettini
- CEINGE-Biotecnologie Avanzate s.c.ar.l., 80145 Naples, Italy; (M.S.); (R.S.)
| | - Alessandro Rossi
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (A.R.); (G.P.)
| | - Giancarlo Parenti
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (A.R.); (G.P.)
- Telethon Institute of Genetics and Medicine (TIGEM), 80078 Pozzuoli, Italy
| | - Margherita Ruoppolo
- CEINGE-Biotecnologie Avanzate s.c.ar.l., 80145 Naples, Italy; (M.S.); (R.S.)
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
- Correspondence:
| |
Collapse
|
2
|
Sartippour MR, Doroudian R, Frampton G, Lorey F, Helmer G, Ho T, Bhandal A. Identification of galactose-1-phosphate uridyl transferase gene common mutations in dried blood spots. Clin Chim Acta 2014; 436:298-302. [DOI: 10.1016/j.cca.2014.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 06/07/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
|
3
|
Adam BW, Chafin DL, De Jesús VR. Stabilities of hemoglobins A and S in dried blood spots stored under controlled conditions. Clin Biochem 2013; 46:1089-1092. [PMID: 23701845 PMCID: PMC4557610 DOI: 10.1016/j.clinbiochem.2013.05.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/02/2013] [Accepted: 05/06/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aimed to measure separately the contributions of heat and humidity to changes in levels of hemoglobins A and S in dried-blood-spot (DBS) samples. DESIGN AND METHODS We stored paired sets of DBSs at 37°C for predetermined intervals in low-humidity and high-humidity environments. Hemoglobin A and S levels of all samples in each complete set were measured in a single high performance liquid chromatography run. RESULTS During the one-month storage intervals, both hemoglobin species lost about 35% of initial levels in low-humidity storage and almost all of initial levels in high-humidity storage. CONCLUSIONS Minimizing both humidity and temperature in the transportation and storage environments of DBS samples is essential to maintaining the integrity of the hemoglobin tetramer molecules.
Collapse
Affiliation(s)
- Barbara W Adam
- Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Atlanta, GA 30341, USA.
| | - Dana L Chafin
- Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Atlanta, GA 30341, USA
| | - Victor R De Jesús
- Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Atlanta, GA 30341, USA
| |
Collapse
|
4
|
Adam BW, Hall EM, Sternberg M, Lim TH, Flores SR, O'Brien S, Simms D, Li LX, De Jesus VR, Hannon WH. The stability of markers in dried-blood spots for recommended newborn screening disorders in the United States. Clin Biochem 2011; 44:1445-50. [PMID: 21963384 PMCID: PMC4557772 DOI: 10.1016/j.clinbiochem.2011.09.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 09/12/2011] [Accepted: 09/13/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aimed to measure separately the contributions of heat and humidity to changes in levels of 34 markers of inborn disorders in dried-blood-spot (DBS) samples. DESIGN AND METHODS We stored paired sets of DBSs at 37°C for predetermined intervals in low-humidity and high-humidity environments. Marker levels of all samples in each complete sample set were measured in a single analytic run. RESULTS During the 30 ± 5 day studies, galactose-1-phosphate uridyltransferase and biotinidase lost almost 65% of initial activities in low-humidity storage; most of the degradation in 27 other markers was attributable to adverse effects of high-humidity storage; seven markers in DBSs stored at high humidity lost more than 90% of initial levels by the end of the study and 4 of the 7 lost more than 50% of initial levels within the first week of storage. CONCLUSIONS Minimizing both humidity and temperature in DBS transportation and storage environments is essential to maintaining sample integrity.
Collapse
Affiliation(s)
- B W Adam
- Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Frómeta A, Reyes ECG, Castells E, Tejeda Y, Almenares P, Pérez PL. Quantitative ultramicrotest for newborn screening of galactosemia in Cuba. J Perinat Med 2011; 39:77-81. [PMID: 21171942 DOI: 10.1515/jpm.2010.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To describe a simple, rapid, quantitative ultramicrotest (UMTEST) based on the fluorometric method introduced by Fujimura et al. adapted to an Ultra Micro Analytic System (SUMA) for the detection of total galactose (GAL) in dried blood specimens. METHODS The assay uses 3 mm discs of dried blood on Whatman 903 filter paper and small volumes of each reagent. A methanol/acetone/water solution is used for deproteination, and a specially designed 96-well polystyrene opaque ultramicroplates, with a maximum capacity of 30 μL per well, are used for the reading. RESULTS The UMTEST GAL is completed in 2 h, with measuring range of 0.28-3.92 mmol/L. The intra- and inter-assay coefficients of variation were 2.3%-8.9% and 6.8%-11.1%, respectively, depending on the total GAL concentrations. Percentage recovery ranged from 97.7% to 103%. Limit of detection and limit of quantitation were 0.06 and 0.16 mmol/L, respectively. The mean GAL concentration, in 2510 dried blood samples from the National Neonatal Screening Program was 0.23 mmol/L. Our assay showed high concordance correlations with the commercially available ICN Immuno-Chem™ GAL-MW EA kit. CONCLUSIONS The analytical performance characteristics of this assay is suitable for mass newborn screening of galactosemia in Cuba.
Collapse
Affiliation(s)
- Amarilys Frómeta
- Department of Neonatal Screening, Immunoassay Center, 134 Street and 25 Avenue, P.O. Box 6653, Cubanacán, Playa, Havana, Cuba
| | | | | | | | | | | |
Collapse
|
6
|
|
7
|
Cui Y, Barford JP, Renneberg R. Amperometric determination of phosphoglucomutase activity with a bienzyme screen-printed biosensor. Anal Biochem 2006; 354:162-4. [PMID: 16647031 DOI: 10.1016/j.ab.2006.03.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2006] [Revised: 03/21/2006] [Accepted: 03/23/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Yue Cui
- Department of Chemical Engineering and Department of Chemistry, Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong.
| | | | | |
Collapse
|
8
|
Easley CJ, Jin LJ, Presto Elgstoen KB, Jellum E, Landers JP, Ferrance JP. Capillary electrophoresis with laser-induced fluorescence detection for laboratory diagnosis of galactosemia. J Chromatogr A 2003; 1004:29-37. [PMID: 12929958 DOI: 10.1016/s0021-9673(03)00767-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Galactosemia, a metabolic disorder associated with the intolerance to dietary galactose due to an inherited enzymatic deficiency, is indicated by heightened levels of galactose in urine (galactosuria). In this report, capillary electrophoresis (CE) with laser-induced fluorescence detection was evaluated for its ability to screen urinary carbohydrates, particularly galactose. Neonatal urine samples with normal and abnormal levels of galactose were analyzed with galactose concentrations quantitated relative to urinary creatinine concentrations to account for variable urinary dilution. Analysis of nine samples by CE in a single-blind manner defined four as negative (normal) and five as positive for galactosuria with galactose levels as high as 146.8 +/- 5.9 mM. Galactosuria was correlated with clinical galactosemia diagnoses for four of the positive samples, while the remaining positive was associated with a patient diagnosed with Hurler's syndrome.
Collapse
Affiliation(s)
- Christopher J Easley
- University of Virginia, Department of Chemistry, McCormick Road, Charlottesville, VA 22904, USA
| | | | | | | | | | | |
Collapse
|
9
|
Item C, Hagerty BP, Mühl A, Greber-Platzer S, Stöckler-Ipsiroglu S, Strobl W. Mutations at the galactose-1-p-uridyltransferase gene in infants with a positive galactosemia newborn screening test. Pediatr Res 2002; 51:511-6. [PMID: 11919338 DOI: 10.1203/00006450-200204000-00018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Newborn screening for galactosemia yields a high number of false-positive results. Confirmatory DNA testing for unknown galactosemia mutations on the initial positive sample using novel techniques of mutation detection tenders itself to reduce the recall rate. The potential benefits of confirmatory DNA testing, however, could be offset by the detection of a high percentage of galactosemia carriers, Duarte/galactosemia compound heterozygotes, and infants with benign sequence changes in the galactose-1-phosphate uridyltransferase (GALT) gene among infants with a positive biochemical screening test. Our aim was to determine the frequency and allelic distribution of all sequence changes in the GALT gene in 110 newborns with a positive total galactose screening test among 43,688 Austrian newborns screened consecutively. We found that only 20 of the 110 probands carried at least one known or novel candidate galactosemia mutation (one galactosemia homozygote, 7 Duarte/galactosemia compounds, 12 carriers) as judged by denaturing gradient gel electrophoresis and cleavage fragment length polymorphism analysis. Four novel galactosemia candidate mutations (Q9H, A46fsdelCAGCT, M129T, L342I) were identified. Sixty-seven probands had no detectable sequence changes and 23 carried only the benign Duarte or Los Angeles variant alleles or silent mutations. We conclude that a rapid and automatable confirmation test for unknown GALT mutations, e.g. on a high-density oligonucleotide array basis, has the potential to lower the recall rate of galactosemia screening in our population by about five-fold from 0.25 to 0.046%. Further research, however, will be required before the development of such a test can be advocated.
Collapse
Affiliation(s)
- Chike Item
- Department of Pediatrics, University of Vienna, Austria
| | | | | | | | | | | |
Collapse
|
10
|
Fujimoto A, Okano Y, Miyagi T, Isshiki G, Oura T. Quantitative Beutler Test for Newborn Mass Screening of Galactosemia Using a Fluorometric Microplate Reader. Clin Chem 2000. [DOI: 10.1093/clinchem/46.6.806] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background: The Beutler enzyme spot test is an effective assay for newborn mass screening of galactosemia, but it is qualitative and relies on visual interpretation. We describe a quantitative, instrumental modification of the assay.
Methods: We modified the macroscopic visual Beutler enzyme spot test by adding extraction of blood components from filter paper, deproteinization with acetone-methanol, and quantification and recording by a fluorescent microplate reader and personal computer. All handling was performed in microplates. The measurement time was 90 min.
Results: Fluorescence intensity (FI) of healthy controls correlated with hematocrit and galactose-1-phosphate uridyltransferase (GALT) activity. Patients with GALT deficiency were distinguished clearly from healthy subjects and heterozygous carriers by FI. FI decreased to 75% of the initial activity after storage at 25 °C for 3 days and to 40% after storage at 37 °C for 7 days. Screening of 46 742 newborns yielded 1 false-positive result (in a heterozygous carrier), 1 patient with glucose-6-phosphate dehydrogenase deficiency, and no apparent false negatives as judged by concurrent measurements of galactose and galactose-1-phosphate.
Conclusions: The quantitative Beutler test can provide precise GALT activity in newborn mass screening, and can take into consideration the influence of high temperature and humidity, duration between sampling and testing, and anemia. This method is clinically useful, simple, automated, and highly reliable for newborn mass screening of galactosemia.
Collapse
Affiliation(s)
- Akie Fujimoto
- Osaka City Environment and Public Health Association, Osaka 541-0055, Japan
| | - Yoshiyuki Okano
- Department of Pediatrics, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Tomiko Miyagi
- Osaka City Environment and Public Health Association, Osaka 541-0055, Japan
| | - Gen Isshiki
- Department of Pediatrics, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Toshiaki Oura
- Osaka City Environment and Public Health Association, Osaka 541-0055, Japan
| |
Collapse
|
11
|
Rhode H, Elei E, Taube I, Podskarbi T, Horn A. Newborn screening for galactosemia: ultramicro assay for galactose-1-phosphate-uridyltransferase activity. Clin Chim Acta 1998; 274:71-87. [PMID: 9681599 DOI: 10.1016/s0009-8981(98)00052-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An enzymatically optimized, miniaturized (20 microl) fluorimetric assay of galactose-1-phosphate-uridyltransferase using dried blood spots for newborn screening is presented. The Beutler reaction principle has been adapted to the microtiter plate technology and acetone/methanol was used for complete deproteinization. A special ultramicro multiwell screening plate resistant to organic solvents has been developed and employed. The assay is simple, sensitive and inexpensive, due to small reagent volumes and the low prices of ultramicro screening plates. The reaction is linear with galactose-1-phosphate-uridyltransferase activity up to 120 min of incubation time. It shows low imprecision and good correlation to a quantitative validation test. For standardization the use of plate means or medians of activity or fluorescence values is proposed. Individual blank measurement prevents false negative assessments.
Collapse
Affiliation(s)
- H Rhode
- Institute of Biochemistry, Medical Faculty, Friedrich Schiller University, Jena, Germany.
| | | | | | | | | |
Collapse
|
12
|
McCabe ER. Lessons for newborn screening from the Armed Forces DNA Identification Laboratory. BIOCHEMICAL MEDICINE AND METABOLIC BIOLOGY 1992; 48:177-8. [PMID: 1476785 DOI: 10.1016/0885-4505(92)90063-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|