The mitochondrial-targeted reactive species scavenger JP4-039 prevents sulfite-induced alterations in antioxidant defenses, energy transfer, and cell death signaling in striatum of rats

Sulfite oxidase (SO) deficiency is a disorder caused either by isolated deficiency of SO or by defects in the synthesis of its molybdenum cofactor. It is characterized biochemically by tissue sulfite accumulation. Patients present with seizures, progressive neurological damage, and basal ganglia abnormalities, the pathogenesis of which is not fully established. Treatment is supportive and largely ineffective. To address the pathophysiology of sulfite toxicity, we examined the effects of intrastriatal administration of sulfite in rats on antioxidant defenses, energy transfer, and mitogen-activated protein kinases (MAPK) and apoptosis pathways in rat striatum. Sulfite administration decreased glutathione (GSH) concentration and glutathione peroxidase, glucose-6-phosphate dehydrogenase, glutathione S-transferase, and glutathione reductase activities in striatal tissue. Creatine kinase (CK) activity, a crucial enzyme for cell energy transfer, was also decreased by sulfite. Superoxide dismutase-1 (SOD1) and catalase (CAT) proteins were increased, while heme oxygenase-1 (HO-1) was decreased. Additionally, sulfite altered phosphorylation of MAPK by decreasing of p38 and increasing of ERK. Sulfite further augmented the content of GSK-3β, Bok, and cleaved caspase-3, indicating increased apoptosis. JP4-039 is a mitochondrial-targeted antioxidant that reaches higher intramitochondrial levels than other traditional antioxidants. Intraperitoneal injection of JP4-039 before sulfite administration preserved activity of antioxidant enzymes and CK. It also prevented or attenuated alterations in SOD1, CAT, and HO-1 protein content, as well as changes in p38, ERK, and apoptosis markers. In sum, oxidative stress and apoptosis induced by sulfite injection are prevented by JP4-039, identifying this molecule as a promising candidate for pharmacological treatment of SO-deficient patients.

Prenatal counseling in heterozygotes for ornithine transcarbamylase deficiency

X-linked ornithine transcarbamylase deficiency (OTCD) often leads to fatal neonatal hyperammonemia in affected males (hemizygotes). In prenatal management of subsequent pregnancies, families carrying female fetuses are often reassured of the low risk of clinically overt disease. We suggest that such reassurance may be misleading. While OTCD heterozygotes may show no symptoms or only mild protein intolerance, the clinical course in a fraction of children can include manifestations similar to those in affected males. We present three cases of symptomatic and previously undiagnosed OTCD heterozygotes to illustrate the potential severity of this condition. Significant improvement in function and growth followed diagnosis and treatment; however, two of the three children remain significantly developmentally delayed. While a quantitative risk estimate cannot be derived from these data, the cases are indicative of an adverse outcome in manifesting heterozygotes. Accordingly, OTCD carrier families should be counseled regarding the possibility of significant hyperammonemia, neurologic deficit, and the need for pharmacologic and dietary intervention in their heterozygote daughters.

Screening for defects of branched-chain amino acid metabolism

Screening for defects of branched-chain amino acid metabolism is a sequential process involving clinical evaluation of the patient, plasma carnitine determination, urinary organic acid analysis, and enzyme studies in cultured or isolated peripheral cells. This report will summarize clinical and metabolite features and enzymological methods available for the diagnosis of the more common defects of branched-chain amino acid metabolism, including isovaleryl-CoA dehydrogenase deficiency, 3-methylcrotonyl-CoA carboxylase deficiency, 3-methylglutaconic aciduria due to 3-methylglutaconyl-CoA hydratase deficiency and other less well characterized defects, 3-hydroxy-3-methylglutaryl-CoA lyase deficiency, and 2-methylacetoacetyl-CoA thiolase deficiency. Newer enzymatic methodologies utilizing NaH14CO3 fixation coupled assays are described which allow for the estimation of six enzyme activities in the catabolic pathways of L-leucine and L-isoleucine catabolism. These coupled assays facilitate the rapid identification of five of the six enzyme abnormalities described above. Their ease of use should allow them to be implemented in any laboratory which screens for inborn errors of metabolism.

Selective screening for amino acid disorders

The analysis of amino acids is the most frequently applied technique in the selective screening of inborn errors of metabolism. When urine is used as a starting material, simple techniques such as thin-layer chromatography or high-voltage electrophoresis is preferred as a first approach. The quantitative analysis requires instrumentation, usually an amino acid analyser. Both plasma and urine are needed for establishing renal transport defects. Apart from the accumulation of the 'usual' amino acids, the presence of unusual amino acids may be of diagnostic significance. Furthermore the finding of decreased plasma concentrations of specific amino acids may pinpoint several inherited defects. No amino acid screening procedure is complete without the availability of an organic acid and a purine/pyrimidine analytical system, both yielding important additional diagnostic information. Considerable clinical problems may occur in subjects with a decreased tolerance to protein amino acids without being homozygous for any inherited defect. Examples of these disorders that need further studies are homocysteinaemia associated with vascular disease and carriers of ornithine transcarbamylase deficiency.

[Biochemical diagnosis and mass screening for hereditary amino acid disorders]

During the past 50 years, the development of both organic and analytical chemistry has greatly contributed to the discovery of new hereditary amino acid disorders. As a result, more than 80 new amino acid disorders have been discovered. More recently, the development of protein chemistry has made it easily to investigate the biochemical basis of these disorders. In this paper we present the status of biochemical diagnosis as well as mass-screening for amino acid disorders. The result of neonatal mass-screening for 4 amino acid disorders (PKU, MSUD, homocystinuria and histidinemia) from 1977 to 1990 revealed that the incidence of PKU is extremely rare in Japan when compared to European Countries, and the incidence of MSUD and homocystinuria are also less common in Japan. On the other hand, the incidence of histidinemia is higher in Japan than in Europe, however, a follow up study of more than 1,500 patients showed almost all cases developed normally without any dietary treatment.

Prospective treatment of urea cycle disorders

We present a diagnostic and therapeutic protocol designed to prevent clinical expression of inborn errors of urea synthesis in the neonatal period, and discuss the long-term developmental outcome of survivors. The families of 32 infants, among 43 identified prenatally as being at risk for a urea cycle disorder, chose to have their infants treated according to a diagnostic and therapeutic protocol, beginning at birth. The therapy was effective in avoiding neonatal hyperammonemic coma and death in seven patients with carbamoyl phosphate synthetase deficiency, argininosuccinate synthetase deficiency, and argininosuccinate lyase deficiency. When treated prospectively, five of eight patients with ornithine transcarbamylase deficiency avoided severe hyperammonemia and survived the neonatal period. Two patients with carbamoyl phosphate synthetase deficiency and two with ornithine transcarbamylase deficiency have subsequently died; three additional patients with the latter disorder have received orthotopic liver transplants. Our experience suggests that these surviving patients have had a more favorable neurologic outcome than patients rescued from neonatal hyperammonemic coma. However, all of them require a burdensome medical regimen and may have handicaps that include impairment of development and recurrent episodes of hyperammonemia. Further, those with deficiency of carbamoyl phosphate synthetase or ornithine transcarbamylase have a high mortality rate.

Screening for inborn errors of amino acid metabolism

Early diagnosis and treatment may prevent brain damage and mental retardation in young infants with inborn errors of amino acid metabolism. The abnormal blood and urinary amino acids and their metabolites are listed in two separate tables in association with each disorder to aid laboratories in making a diagnosis during screening. Because of recent developments and discoveries, more detailed descriptions and diagnostic approaches in phenylketonuria (PKU) variants and urea cycle deficiencies are also presented. The test procedures routinely used for screening inherited metabolic disorders are also described. These include five simple chemical tests to detect excessive metabolites and amino acids; a one dimensional thin layer chromatography (TLC) to screen urine for abnormal amino acid patterns; a two-dimensional TLC for semiquantitative identification of amino acids in both urine and blood; and a high performance liquid chromatographic (HPLC) method for quantitative identification of amino acids. In addition, both one- and two-dimensional chromatographies run on small thin layer cellulose plates, are introduced, modifications which save a great deal of time, labor, and reagents. A new automated HPLC system is introduced for the quantitation of both primary and secondary amino acids; the sensitivity and speed of this system is especially useful for screening large numbers of physiological fluids. It is recommended that both the urine and blood from the same patients be screened to ensure that a diagnosis is not overlooked.

Potassium ion ionization of desorbed species (K+IDS): a rapid method for the screening of urine for organic acidemias

A new desorption/ionization mass spectrometric technique, K+ ionization of desorbed species (K+IDS), is evaluated as a rapid method for differentiating various organic acidemias, conditions in which excessive levels of organic acid metabolites are present in plasma or urine as a result of some inborn error of metabolism. This method requires no derivatization of the isolated organic acids, unlike that required for gas chromatographic and gas chromatographic/mass spectrometric analyses. 'Batch' mass spectrometric analysis is achieved by deposition of the complex organic acid mixture (from urine) onto a K+IDS probe. Rapid heating results in the emission of alkali ions (Na+ or K+) from a thermionic emitter and the intact desorption of analyte. Subsequent gas-phase addition produces a mass spectrum showing alkali ion adducts of the components, providing molecular weight and relative concentration information. This rapid desorption/ionization technique requires no matrix, and analysis times are exceedingly short relative to those required in gas chromatographic/mass spectrometric analyses. Results suggest that differential diagnosis of some of the more commonly occurring organic acidemias (e.g. isovaleric acidemia, maple syrup urine disease, etc.) may be made.

Mass screening of urea cycle diseases: a new mass screening method of hyperornithinemia by using two coupling enzymes

We devised a new microfluorometric mass screening method for determining ornithine in only one blood disc of 3 mm in diameter (blood of 2-3 microliters) by use of two coupling enzymes, ornithine aminotransferase and delta'-pyrroline-5-carboxylate reductase. We could apply this method to some cases of gyrate atrophy of the choroid and retina. Our method can be applied in range of 0 to 12-16 nmoles or about 54.8 mg% or about 4 mM ornithine in blood. Ornithine values by our method were well correlated with those by an amino acid analyser.

Health economic analysis of the Swedish neonatal metabolic screening programme. A method of optimizing routines

A benefit-cost analysis was carried out to optimize the routines for neonatal metabolic screening. The basis of the study was provided by results of the Swedish neonatal screening programme from 1965 to 1979. During this period over one million infants were screened by the Guthrie test for phenylketonuria and galactosaemia, and for limited periods also for tyrosinaemia, homocystinuria and histidinaemia. The benefit-cost ratio was calculated for combinations of different screening tests, recall routines, and varying degrees of coverage. The largest benefit-cost ratio was obtained with combined screening for phenylketonuria and galactosaemia, using a borderline blood phenylalanine level of 0.50 mmol/L in the Guthrie test for phenylketonuria. However, the inaccuracy of this test necessitated the use of a lower blood phenylalanine level of 0.25 mmol/L and the acceptance of a lower benefit-cost ratio. An increase in the present 98% coverage of newborns by the screening programme was found to be an effective means of improving the benefit-cost ratio in the present programme.

Urine screening for aminoacidopathies: is it beneficial? Results of a long-term follow-up of cases detected bny screening one millon babies

One million 6-week-old infants were screened for aminoacidurias and the long-term follow-up analyzed to assess the benefits of the screening program. Apart from phenylketonuria, now normally detected by blood screening at five days, the most frequent abnormalities identified were cystinuria, histidinemia, Hartnup disease, and iminoglycinuria. Other disorders occurred less frequently than 1:100,000. Early diagnosis provided unequivocal clinical benefit only for phenylketonuria. There was probable benefit to patients with cystinuria, homocystinuria, argininosuccinic aciduria, and to some patients with Hartnup disease. However, benefit of early diagnosis in these disorders, of which the combined incidence was 1:10,000, was not clear-cut; for example, in 68 cystinuric children, four had already developed renal stones despite close medical supervision and a regimen of increased fluid intake to the limits of tolerance. No patient detected with any other condition benefited, either because the condition appeared benign and was not treated, or because the disorder was serious or lethal and there was a bad outcome despite early diagnosis and treatment. Existing urine screening programs should explore the incidence and clinical significance of further biochemical abnormalities detectable in the newborn infant, but there is no indication at present for the initiation of new urine screening programs designed to detect only aminoacidurias.