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Bekri S, Bley A, Brown HA, Chanson C, Church HJ, Gelb MH, Hong X, Janzen N, Kasper DC, Mechtler T, Morton G, Murko S, Oliva P, Tebani A, Wu THY. Higher precision, first tier newborn screening for metachromatic leukodystrophy using 16:1-OH-sulfatide. Mol Genet Metab 2024; 142:108436. [PMID: 38552449 DOI: 10.1016/j.ymgme.2024.108436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 05/08/2024]
Abstract
Newborn screening (NBS) for metachromatic leukodystrophy (MLD) is based on first-tier measurement of sulfatides in dried blood spots (DBS) followed by second-tier measurement of arylsulfatase A in the same DBS. This approach is very precise with 0-1 false positives per ∼30,000 newborns tested. Recent data reported here shows that the sulfatide molecular species with an α-hydroxyl, 16‑carbon, mono-unsaturated fatty acyl group (16:1-OH-sulfatide) is superior to the original biomarker 16:0-sulfatide in reducing the number of first-tier false positives. This result is consistent across 4 MLD NBS centers. By measuring 16:1-OH-sulfatide alone or together with 16:0-sulfatide, the estimated false positive rate is 0.048% and is reduced essentially to zero with second-tier arylsulfatase A activity assay. The false negative rate is predicted to be extremely low based on the demonstration that 40 out of 40 newborn DBS from clinically-confirmed MLD patients are detected with these methods. The work shows that NBS for MLD is extremely precise and ready for deployment. Furthermore, it can be multiplexed with several other inborn errors of metabolism already tested in NBS centers worldwide.
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Affiliation(s)
- Soumeya Bekri
- Hospital Charles Nicolle, UNIROUEN INSERM U1245, CHU Rouen, Referral Center for Lysosomal Diseases, Department of Metabolic Biochemistry, 76000 Rouen, France..
| | - Annette Bley
- Department of Pediatrics, University Medical Center, Hamburg Eppendorf, Hamburg, Germany
| | - Heather A Brown
- Willink Biochemical Genetics Laboratory, Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | | | - Heather J Church
- Willink Biochemical Genetics Laboratory, Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Michael H Gelb
- Dept. of Chemistry, University of Washington, Seattle, WA 98195, USA.
| | - Xinying Hong
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nils Janzen
- Screening-Laboratory Hannover, Hannover 30430, Germany; Department of Clinical Chemistry, Hannover Medical School, Hannover, Germany; Centre for Children and Adolescents, Kinder- and Jugenbrankenhaus Auf der Bult, Hannover, Germany
| | | | | | - Georgina Morton
- ArchAngel MLD Trust, 506 Betula House, North Wharf Road, London W1 2DT, UK
| | - Simona Murko
- Newborn Screening and Metabolic Laboratory, Department of Pediatrics, University Medical Center Eppendorf, Hamburg, Germany
| | | | - Abdellah Tebani
- Hospital Charles Nicolle, UNIROUEN INSERM U1245, CHU Rouen, Referral Center for Lysosomal Diseases, Department of Metabolic Biochemistry, 76000 Rouen, France
| | - Teresa H Y Wu
- Willink Biochemical Genetics Laboratory, Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK.
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Schwarz M, Skrinjar P, Fink MJ, Kronister S, Mechtler T, Koukos PI, Bonvin AMJJ, Kasper DC, Mikula H. A click-flipped enzyme substrate boosts the performance of the diagnostic screening for Hunter syndrome. Chem Sci 2020; 11:12671-12676. [PMID: 34094461 PMCID: PMC8163285 DOI: 10.1039/d0sc04696e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/23/2020] [Indexed: 11/23/2022] Open
Abstract
We report on the unexpected finding that click modification of iduronyl azides results in a conformational flip of the pyranose ring, which led to the development of a new strategy for the design of superior enzyme substrates for the diagnostic assaying of iduronate-2-sulfatase (I2S), a lysosomal enzyme related to Hunter syndrome. Synthetic substrates are essential in testing newborns for metabolic disorders to enable early initiation of therapy. Our click-flipped iduronyl triazole showed a remarkably better performance with I2S than commonly used O-iduronates. We found that both O- and triazole-linked substrates are accepted by the enzyme, irrespective of their different conformations, but only the O-linked product inhibits the activity of I2S. Thus, in the long reaction times required for clinical assays, the triazole substrate substantially outperforms the O-iduronate. Applying our click-flipped substrate to assay I2S in dried blood spots sampled from affected patients and random newborns significantly increased the confidence in discriminating between these groups, clearly indicating the potential of the click-flip strategy to control the biomolecular function of carbohydrates.
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Affiliation(s)
- Markus Schwarz
- Institute of Applied Synthetic Chemistry, TU Wien Getreidemarkt 9 1060 Vienna Austria
- ARCHIMED Life Science GmbH Leberstraße 20 1110 Vienna Austria
| | - Philipp Skrinjar
- Institute of Applied Synthetic Chemistry, TU Wien Getreidemarkt 9 1060 Vienna Austria
| | - Michael J Fink
- Department of Chemistry and Chemical Biology, Harvard University 12 Oxford Street Cambridge MA 02138 USA
| | - Stefan Kronister
- Institute of Applied Synthetic Chemistry, TU Wien Getreidemarkt 9 1060 Vienna Austria
| | - Thomas Mechtler
- ARCHIMED Life Science GmbH Leberstraße 20 1110 Vienna Austria
| | - Panagiotis I Koukos
- Bijvoet Centre for Biomolecular Research, Faculty of Science - Chemistry, Utrecht University Padualaan 8 3584CH Utrecht The Netherlands
| | - Alexandre M J J Bonvin
- Bijvoet Centre for Biomolecular Research, Faculty of Science - Chemistry, Utrecht University Padualaan 8 3584CH Utrecht The Netherlands
| | - David C Kasper
- ARCHIMED Life Science GmbH Leberstraße 20 1110 Vienna Austria
| | - Hannes Mikula
- Institute of Applied Synthetic Chemistry, TU Wien Getreidemarkt 9 1060 Vienna Austria
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Wiesinger T, Mechtler T, Schwarz M, Xie X, Grosse R, Nieves Cobos P, Kasper D, Lukacs Z. Investigating the suitability of high-resolution mass spectrometry for newborn screening: identification of hemoglobinopathies and β-thalassemias in dried blood spots. ACTA ACUST UNITED AC 2020; 58:810-816. [DOI: 10.1515/cclm-2019-0832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/23/2019] [Indexed: 11/15/2022]
Abstract
AbstractA fast and reliable method for the determination of hemoglobinopathies and thalassemias by high-resolution accurate mass spectrometry (HRAM/MS) is presented. The established method was verified in a prospective clinical study (HRAM/MS vs. high-pressure liquid chromatography [HPLC]) of 5335 de-identified newborn samples from the Hamburg area. The analytical method is based on a dual strategy using intact protein ratios for thalassemias and tryptic digest fragments for the diagnosis of hemoglobinopathies. Due to the minimal sample preparation and the use of flow injection, the assay can be considered as a high-throughput screening approach for newborn screening programs (2 min/sample). Using a simple dried blood spot (DBS) extraction (tryptic digest buffer), the following results were obtained: (1) a carrier incidence of 1:100 newborns (35 FAS, nine FAC, eight FAD and two FAE), and (2) no homozygous affected patient was detected. Using the HRAM/MS protocol, an unknown Hb mutation was identified and confirmed by genetic testing. In addition to greater specificity toward rare mutations and β-thalassemia, the low price/sample (1–2€) as well as an automated data processing represent the major benefits of the described HRAM/MS method.
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Affiliation(s)
| | | | | | | | - Regine Grosse
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulina Nieves Cobos
- Newborn Screening and Metabolic Diagnostics Unit, Center of Diagnostics, University Medical Center Hamburg, Hamburg, Germany
| | | | - Zoltan Lukacs
- Newborn Screening and Metabolic Diagnostics Unit, Center of Diagnostics, University Medical Center Hamburg, Hamburg, Germany
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Nowak A, Mechtler T, Kasper DC, Desnick RJ. Correlation of Lyso-Gb3 levels in dried blood spots and sera from patients with classic and Later-Onset Fabry disease. Mol Genet Metab 2017; 121:320-324. [PMID: 28663131 DOI: 10.1016/j.ymgme.2017.06.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/16/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fabry disease (FD), an X-linked lysosomal storage disorder, results from the deficient activity of α-galactosidase A (α-Gal A) and the accumulation of its substrates, globotriaosylceramide (Gb3) and its deacylated derivative, globotriaosyl-sphingosine (Lyso-Gb3). Here, we compared the levels of Lyso-Gb3 in dried blood spots (DBS) and sera in affected males and heterozygotes with the "Classic" and "Later-Onset" phenotypes. METHODS The Lyso-Gb3 concentrations in DBS and sera from 56 FD patients were determined by highly sensitive electrospray ionization liquid chromatography tandem mass spectrometry. RESULTS The serum Lyso-Gb3 levels in 18 and 5 affected males with the Classic and Later-Onset phenotypes, were 61±38 and 14±12ng/mL, respectively. Lyso-Gb3 levels in 30 females from Classic families and three females from Later-Onset families were 10±5.4 and 2.4±1.0ng/mL, respectively. The linear regression model with serum Lyso-Gb3 as the dependent variable and DBS Lyso-Gb3 an independent variable was described by the function y=-1.83+1.68∗x and showed a high coefficient of determination, R2=0.976. The overall correlation between the Lyso-Gb3 levels in DBS and sera was high (R=0.99; p<0.001). CONCLUSION DBS provides a convenient, sensitive, and reproducible source to measure Lyso-Gb3 levels for diagnosis, initial phenotypic assignment, and therapeutic monitoring in patients with Fabry disease.
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Affiliation(s)
- Albina Nowak
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Thomas Mechtler
- ARCHIMED Life Science, Leberstrasse 20, 1110 Vienna, Austria.
| | - David C Kasper
- ARCHIMED Life Science, Leberstrasse 20, 1110 Vienna, Austria.
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA.
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Berger A, Altiok I, Mechtler T, Langgartner M, Böhm J, Herkner K, Pollak A, Kasper D. Adaption of the Roche Septifast system for the early detection of neonatal sepsis in very low birthweight infants. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Berger A, Mechtler T, Langgartner M, Böhm J, Witt A, Pollak A, Kasper D. The bacterial load of Ureaplasma parvum inamniotic fluid is correlated with an increased intrauterine inflammatoryresponse. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Berger A, Kasper D, Mechtler T, Witt A, Herkner K, Pollak A. Strong association between in utero exposure to Ureaplasma spp. and development of bronchopulmonary dysplasia in preterm infants. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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