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Resumen Los desórdenes congénitos de la glicosilación son un grupo de desórdenes genéticos de herencia, generalmente autosómica y recesiva. Descriptos por primera vez por Jaeken en 1980, comprenden defectos en la N- y O-glicosilación de proteínas y de lípidos. Los pacientes con defectos de N-glicosilación muestran un amplio espectro de manifestaciones clínicas, con alto compromiso neurológico. Por esta razón, se hace necesaria la implementación de una metodología que ayude en el diagnóstico. El Laboratorio de Pesquisa Neonatal incorporó el isoelectroenfoque de transferrina como método de screening y, posteriormente, secuenciación del gen PMM2 como método confirmatorio para las muestras con screening alterado. Se presentan, en este trabajo, la experiencia y los resultados obtenidos entre noviembre de 2017 y diciembre de 2018, los que permitieron establecer un algoritmo de trabajo que impactó positivamente en el diagnóstico de estos pacientes.
Abstract Congenital disorders of glycosylation are a group of genetic, autosomal and recessive diseases, first reported by Jaeken in 1980. These include defects in N- and O-glycosilation of proteins and lipids. Most N-glycosylation defects are multi-organ diseases with neurological involvement. Therefore, the implementation of a screening methodology is necessary to contribute in the diagnosis. Newborn Screening Laboratory included the transferrin isoelectrofocusing as a screening method and, subsequently, PMM2 gene sequencing as a confirmatory method for samples with altered screening. The present study shows the experience and results obtained between November 2017 and December 2018, which made it possible to establish an algorithm that positively impacted in the diagnosis of these patients.
Resumo Os defeitos congênitos da glicosilação (CDG) são um grupo de doenças genéticas, autossômicas e recessivas.Descritos pela primeira vez por Jaeken em 1980, eles incluem na N- e O- glicosilação de proteínas e lipídios.Pacientes com defeitos da N-glicosilação mostram um amplo espectro de manifestações clínicas, com alto comprometimento neurológico. Por esse motivo, a implementação de uma metodologia necessária para contribuirno diagnóstico. O Laboratório de Pesquisa Neonatal incorporou isoeletro-enfoque da transferrina (IEF)como método de screening e posterior sequenciamento do gene PMM2 como método confirmatório para asamostras que apresentaram triagem alterada. Neste trabalho, são apresentadas as experiências e resultadosobtidos entre novembro de 2017 e dezembro de 2018, que permitiram estabelecer um algoritmo de trabalhoque teve um impacto positivo no diagnóstico desses pacientes.
Assuntos
Anormalidades Congênitas , GlicosilaçãoRESUMO
Abstract In the 1960s Guthrie conceived the idea of preventing congenital disease using dried blood spot samples on filter paper to detect them through biochemical tests and then be able to treat environmental factors in time to avoid the devastating effect of the diseases. Uruguay started in 1994 with the detection of congenital hypothyroidism in umbilical cord blood. In 2007 it was extended to Phenylketonuria and Congenital Adrenal Hyperplasia, starting with dried blood spot sample. In 2008, with the incorporation of Mass Spectrometry, a pilot program was started for the detection of aminoacidopathies, beta-oxidation defects and organic acidemias disorders. In the following years, the program expanded to more diseases, reaching a total of 25 disorders that could be detected, 5 of them are investigated on a mandatory basis and others in pilot program. During the 25-year of experience, 974277 umbilical cord blood samples were analyzed and since 2007: 532684 dried blood spot samples. 613 true positive congenital disorders were identified. The coverage has been greater than 98% and the repetition rate for insufficient samples less than 1.9%.
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Abstract Introduction: Newborn Screening Program (NBS) in Uruguay includes congenital hypothyroidism (CHT), phenylketonuria (PKU), congenital adrenal hyperplasia (CAH), cystic fibrosis (CF), medium chain acyl-CoA dehydrogenase deficiency (MCADD), and Congenital Hearing Loss (CHL). Objetives: This study describe the epidemiological characteristics of newborns with abnormal neonatal screening tests diagnosed by blood drop and otoacoustic emissions in Uruguay. Results: Cases with abnormal NBS tests (399 newborns; 0.17%) were compared to the newborns with normal tests in the same period (239,240). Prevalence rates (per 10,000 livebirths) were 10.00 for CHL; 3.70 for CH; 1.20 for CF; 0.59 for CAH; 0.54 for PKU; 0.13 for MCADD. The Department of Artigas had the highest rate of abnormal tests. Lower maternal education, less prenatal care, increased prematurity rate and neonatal depression were more frequent in in mothers whose children had CHL. Conclusions: This is the first study evaluating the characteristics of newborns with abnormal screening in Uruguay. Because these results may impact the planning of health services, data transmission between clinical care and public health systems is needed to improve both follow-up and management.
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Las hemoglobinopatías son los trastornos monogénicos más frecuentes y son causa de importante morbilidad y mortalidad en el mundo. En enero de 2013 el Laboratorio de Pesquisa Neonatal comenzó un programa piloto destinado a conocer la incidencia de estas patologías en la población uruguaya, orientado a disminuir su impacto mediante un tratamiento precozmente instituido. En este trabajo se presentan los resultados encontrados mediante el plan piloto de pesquisa neonatal de hemoglobinopatías entre enero de 2013 y diciembre de 2014. Durante este período se procesaron muestras de sangre en papel de filtro tomadas a las 40 h de vida de todos los recién nacidos dentro del territorio uruguayo. Se analizaron mediante HPLC-CE (Variant Nbs, BIORAD). Se encontró una incidencia de 1/26.000 casos patológicos y 1/180 portadores. La incidencia de portadores encontrados por departamento concuerda con la tasa de población afrodescendiente estimada en el último censo.
Hemoglobinopathies are the most frequent monogenic disorder and cause an important worldwide morbidity and mortality. In January 2013, the Newborn Screening Laboratory started a Pilot Program with the objective to know the incidence of these diseases in the Uruguayan population, in order to decrease the impact of these pathologies with implementation of early treatment. The Newborn Screening Pilot Program for Hemoglobinopathies is presented in this paper through the results obtained during the January 2013 to December 2014. During this period, dried blood spots taken from all newborns within 40 hrs. of life in Uruguay were processed. The samples were analyzed with HPLC-CE (Vaniant Nbs, BIORAD). An incidence of 1/26,000 for pathologic cases and 1/180 carriers for some hemoglobin variants was found. The incidence of carriers found by department correlates with the afro descendant population rate from the last census.
As hemoglobinopatias são as doenças monogênicas mais frequentes e causam significativa morbidade e mortalidade em todo o mundo. Em janeiro de 2013, o Laboratório de Pesquisa Neonatal iniciou um programa piloto objetivando conhecer a incidência dessas doenças na população uruguaia, encaminhado a reduzir seu impacto através de tratamento instituído precocemente. Neste trabalho são apresentados os resultados achados pelo programa piloto de triagem neonatal das hemoglobinopatias entre janeiro de 2013 e dezembro de 2014. Durante este período foram processadas amostras de sangue em papel de filtro, coletadas nas primeiras 40 horas de vida de todos os recém-nascidos, dentro do território uruguaio. Elas foram analisadas por HPLC-CE (Variant Nbs, BIORAD). A incidência encontrada foi de 1/26.000 casos patológicos e 1/180 portadores. A incidência de portadores encontrados por departamento está de acordo com a taxa de população afrodescendente estimada no último censo.