Fecal contamination in urine amino acid screening: artifactual cause of hyperaminoaciduria

Profiling of amino acids in body fluids and tissues by means of liquid chromatography

The needs of urgent diagnoses and the needs emerging from acute forms of diseases have directed progress in amino acid profiling to modern, rapid, automated analyses that can be done at reasonable cost. The first step in this direction was the short programmes of classical ion-exchange chromatography. At the beginning of this review we attempted to survey methods of sample preparation and sample treatment, as these are frequently neglected stages where artefacts or erroneous results may arise. There are basically the following approaches in amino acid profiling by liquid chromatographic techniques. For preliminary screening of a large number of samples in clinical routine planar procedures are the methods of choice, as they allow large numbers of samples to be handled with minimum effort and at very reasonable cost. For more precise profiling, particularly where quantitative data are essential, one can choose between some of the modern procedures for separating underivatized amino acids using modern equipment for cation-exchange chromatography, by making use of a stepped series of lithium citrate buffers with ninhydrin, o-phthalaldehyde or 4-fluoro-7-nitrobenzo-2,1,3-oxadiazole detection. Ninhydrin detection is preferred in those situations where the demands on sensitivity are not high. Where, however, only small amounts of samples are available or high sensitivity is required, one of the latter two methods is preferred. The o-phthalaldehyde procedure is not suitable for the detection of secondary amines and, if these are of interest, then diazole derivatization is to be preferred. At present, however, the ninhydrin and o-phthalaldehyde detection procedures are the most popular. The other choice is to use one of the sophisticated HPLC systems equipped with fluorescence detection and to separate amino acids as derivatives. Here o-phthalaldehyde and 4-fluoro-7-nitrobenzo-2,1,3-oxadiazole derivatives offer the most versatile possibilities. Automation and computerization have penetrated both categories of liquid column separation and are applied to automated sample delivery, automated and computerized gradient formation and quantitation of the data obtained. The tables of metabolic disorders of amino acids and the roles of different amino acids in these disorders should provide preliminary information for clinical chemists.

Difficulties and pitfalls in the interpretation of screening tests for the detection of inborn errors of metabolism

A review of factors which may be responsible for false positive and false negative results in a screening program for the detection of inborn errors of metabolism is presented. Administration of medication, dietary therapy, chemical treatment of specimens, delay in analysis, hypersensitivity of procedures utilized, interfering metabolites and inadequate metabolic development or enzymatic maturation in the patient may all produce results resembling an actual inborn error of metabolism. Inadequate nutritional intake prior to procurement of specimen and loss of material during analytical procedures may produce false negative results. As well, certain less severe variants of inborn errors may present in an unusual manner or may only present during periods of stress to the patient. These factors are discussed in relation to the performance of a metabolic screening program. It is suggested that these progrms should be performed by specialized, central laboratories experienced in the complexities of detection of inborn errors of metabolism.