Methylmalonic acid in amniotic fluid and maternal urine as a marker for neural tube defects / 华中科技大学学报（医学）（英德文版）

To evaluate the implication of methymalonic acid (MMA) in the early diagnosis of neural tube defects (NTD), a quantitative assay for MMA was established by using gas chromatography-mass spectrometry with stable isotope of MMA as an internal standard. Amniotic fluid and maternal urine MMA concentration, maternal serum folate, red blood cell folate and vitamin B12 levels were measured in the middle term of NTD-affected and normal pregnancies. Amniotic fluid and maternal urine MMA concentrations in the middle term of NTD affected pregnancies (1.4 +/- 0.9 micromol/L, and 22.1 +/- 12.6 nmol/micromol creatinine) were significantly higher than that of normal pregnancies (1.0 +/- 0. 4 micromol/L, and 2.5 +/- 1.1 nmol/micromol creatinine). There was no significant difference between normal and NTD pregnancies for serum folate, red blood cell folate and vitamin B12 levels. The results suggested that MMAs in amniotic fluid and maternal urine are sensitive markers for early diagnosis of NTD. Vitamin B12 is an active cofactor involved in the remethylation of homocycteine and its deficiency is an independent risk factor for NTD. MMA is a specific and sensitive marker for intracellular vitamin B12 deficiency. This study suggests that it is necessary to monitor the vitamin B12 deficiency and advocates vitamin B12 supplementation with folate prevention program.

Detección de aciduria metilmalónica mediante pruebas de tamizaje metabólico / Detection of methylmalonic aciduria by means of metabolic screening

La búsqueda de aciduria metilmalónica es uno de los procedimientos en el Programa de Detección de Errores Congénitos del Metabolismo que se realiza en varias unidades del IMSS en Monterrey, Nuevo León, para estudiar muestras procedentes de personas con sospecha de enfermedad metabólica genética. De un total de 2100 exámenes realizados en pacientes pediátricos, cinco resultaron positivos mediante la prueba del color y en todos ellos se corroboró la presencia del ácido metilmalónico mediante cromatografía A1 de celusosa. Aunque no se obtuvo diagnóstico de precisión, es probable que más de una forma del padecimiento exista en nuestro medio. Debido a la gravedad de este defecto, a la posibilidad del manejo médico y la conveniencia del asesoramiento genético en las familias portadoras, se justifica este tipo de detección en las unidades pediátricas o de atención materno-infantil.