RESUMO
Neonatal screening of medium-chain acyl-CoA dehydrogenase deficiency (MCADD) is of major importance due to the significant morbidity and mortality in undiagnosed patients. MCADD screening has been performed routinely in Galicia since July 2000, and until now 199,943 newborns have been screened. We identified 11 cases of MCADD, which gives an incidence of 1/18,134. During this period, no false negative screens have been detected. At diagnosis, all identified newborns were asymptomatic. Our data showed that octanoylcarnitine (C8) and C8/C10 ratio are the best markers for screening of MCADD. C8 was increased in all patients and C8/C10 was increased in all but one patient.The common mutation, c.985A > G, was found in homozygosity in seven newborns and in compound heterozygosity in three, while one patient did not carry the common mutation at all. In addition, two novel mutations c.245G > C (p.W82S) and c.542A > G (p.D181G) were identified. Ten of the 11 identified newborns did not experience any episodes of decompensation. The patient with the highest level of medium chain acylcarnitines at diagnosis, who was homozygous for the c.985A > G mutation, died at the age of 2 years due to a severe infection.This is the first report of the results from neonatal screening for MCADD in Spain. Our data provide further evidence of the benefits of MCADD screening and contribute to better understanding of this disease.
RESUMO
The response to tetrahydrobiopterin (BH4) in patients with phenylalanine hydroxylase (PAH, EC 1.14.16.1) deficiency (OMIM 261600) has been widely reported. Here we report results of the BH4 loading test (20 mg/kg per day) in a group of 36 patients with PAH deficiency and phenotype of mild hyperphenylalaninaemia (HPA), mild phenylketonuria (PKU) or classic PKU. The patients ranged from neonates aged 7-15 days, detected in the Newborn Screening Programme for PKU in the population of Galicia (NW Spain), to adults aged up to 32 years who had been receiving a low-phenylalanine (Phe) diet for a period of years. Ten of the 36 patients showed a reduction of more than 30% in plasma Phe levels within 24 h of BH4 loading (ranging from 33.7% to 90.2%, mean 59.2%, SD 19.8%). All the patients with mild HPA (100%) showed a positive response; 57% of patients with mild PKU (4 of 7) showed a positive response. Of particular interest were positive responses in two patients with classic PKU, and in one patient with mutations of the phenylalanine hydroxylase (PAH) gene that have not to date been reported to be BH4-responsive (p.S303A and p.G46S). BH4 treatment (5-8 mg/kg per day) was commenced in 9 of the 10 BH4-responsive patients. The observed responses to treatment argue for application of the BH4 loading test in all patients with HPA or PKU, independently of genotype, phenotype or age.
Assuntos
Biopterinas/análogos & derivados , Dieta com Restrição de Proteínas , Fenilalanina/sangue , Fenilcetonúrias/diagnóstico , Fenilcetonúrias/tratamento farmacológico , Adulto , Biopterinas/uso terapêutico , Humanos , Recém-Nascido , Mutação , Seleção de Pacientes , Fenilalanina Hidroxilase/genética , Fenilalanina Hidroxilase/metabolismo , Fenilcetonúrias/dietoterapia , Fenilcetonúrias/metabolismo , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
The purpose of the present paper is to develop an easy and quick in vitro method to compare copper availability from breast milk and infant formulas. This study focuses on the differences caused by the use of pH 2.0 (adult gastric pH) or pH 5.0 (newborn gastric pH) in the first stage of the enzymolysis. pH affects Cu solubility, a possible estimator of the availability. Selection of a digestor, times of enzymolysis, centrifugation parameters, and Cu determination by ETAAS were discussed as well. Percentage of Cu solubility was larger from breast milk (gastric pH 2.0, 65.3 +/- 14.0 vs 40.0 +/- 13.9%; gastric pH 5.0, 61.2 +/- 16.5 vs 26.6 +/- 10.3%), but the soluble content was larger from infant formulas for both pHs (gastric pH 2.0, 245.3 +/- 82.1 vs 113.0 +/- 103.4 ng mL(-1); gastric pH 2.0, 169.3 +/- 76.9 vs 75.3 +/- 21.9 vs ng mL(-1)).
Assuntos
Cobre/farmacocinética , Fórmulas Infantis , Leite Humano , Disponibilidade Biológica , Centrifugação , Cobre/análise , Humanos , Concentração de Íons de Hidrogênio , Lactente , Solubilidade , UltracentrifugaçãoRESUMO
BACKGROUND: Conditions not directly related to copper nutriture, such as pregnancy, infections and inflammation, which increase serum copper concentration even during copper deprivation, may be expected to conceal changes in copper status. It has been suggested that the specific enzymatic activity of ceruloplasmin (activity per unit mass of enzyme protein) may be a sensitive indicator of copper status and is not affected by factors such as hormones or sex. In this study, we investigated the behaviour of specific oxidase activity of ceruloplasmin and the copper/ceruloplasmin ratio in pregnant women. METHODS: Copper, immunoreactive ceruloplasmin and its oxidase activity were determined in serum from 52 women in the last trimester of normal pregnancy, and in 50 control women of similar age living in the same area and who were not taking oral contraceptives. The results are expressed as mean+/-S.E.M. RESULTS: In the group of pregnant women, significantly higher serum levels of copper, ceruloplasmin and its oxidase activity were found than in the control group (p < 0.001). In both groups, a high correlation was found between these biochemical variables (r > or =0.905, p < 0.001). However, in the group of pregnant women the specific oxidase activity for ceruloplasmin (364.4+/-3.3 vs. 407.5+/-3.8 U/g) and the copper/ceruloplasmin ratio (2.82+/-0.03 vs. 3.19+/-0.04 microg/mg) were significantly lower than in the control group (p < 0.001). CONCLUSIONS: Although pregnancy accelerates the rate of ceruloplasmin protein synthesis and release with an increase of serum copper, the decrease in specific oxidase activity of circulating ceruloplasmin would be an indicator of the degree of depletion of the mother's copper deposits in order to deal with the foetus' needs.
Assuntos
Ceruloplasmina/metabolismo , Cobre/sangue , Gravidez/metabolismo , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Distribuição Normal , Terceiro Trimestre da GravidezRESUMO
This method will allow the determination of bound copper to low relative molecular mass compounds in milk. The milk whey obtained by ultracentrifugation was submitted to fractionation by size exclusion chromatography (SEC) on a TSK-Gel2000 (Toso Haas) column with a mobile phase of 0.2 M NH4NO3 + NH3, pH 6.7. Fractions of effluent corresponding to the protein peaks were collected and the copper content was determined by ETAAS. The method was sensitive (LOD 0.4 microgram l-1 and LOQ 1.5 micrograms l-1 in the fraction; LOQ 7.5-22.5 micrograms l-1 referred to the milk sample and depended on fraction volume) and precise (RSD +/- 10%). Media sample recoveries from the column were 101.2%. Cu was predominantly present in fractions corresponding to relative molecular mass 76 and 15 kDa of breast milk while copper was mostly found in fractions corresponding to 14 and 38 kDa of cow's milk-based infant formulae; moreover, copper was eluted in the relative molecular mass region < 6 kDa.
Assuntos
Cobre/análise , Alimentos Infantis/análise , Leite Humano/química , Cromatografia Líquida de Alta Pressão/métodos , Humanos , Lactente , Recém-Nascido , Espectrofotometria Atômica/métodosRESUMO
Size exclusion chromatography (SEC) and flame atomic absorption spectroscopy (FAAS) were used for the separation of metal-containing species in milk whey. After milk ultracentrifugation, the sample was injected into a TSK-Gel G2000 glass column and eluted with 0.2M NH4NO3-NH3, pH 6.7. Low molecular weight proteins were fractionated, and the fractions were characterized by molecular weight. Zinc distributions were obtained by FAAS using a high performance nebulizer. The method was very sensitive (limit of detection = 2.6 x 10(-3) microg/mL; limit of quantitation = 8.9 x 10(-3) microg/mL) and precise (RSDs < or =10%). This method was applied to the determination of Zn in binding compounds in breast milk whey and in commercial cow's milk-based formulas. Distribution patterns were different. The presence of Zn in most fractions in breast milk was most significant, whereas in infant formulas Zn was detected only in fractions of molecular weight <5 kDa and in the highest molecular weight peak.
Assuntos
Cromatografia em Gel/métodos , Alimentos Infantis/análise , Proteínas do Leite/análise , Leite Humano/química , Espectrofotometria Atômica/métodos , Zinco/análise , Calibragem , Humanos , Indicadores e Reagentes , Lactente , Peso Molecular , Sensibilidade e EspecificidadeRESUMO
Forty adult patients (30 women and 10 men) with rheumatoid arthritis (RA), treated with nonsteroidal anti-inflammatory drugs, were studied. Serum levels of immunoreactive ceruloplasmin, oxidase activity of the ceruloplasmin and total copper, as well as the specific oxidase activity (enzyme activity per unit of mass) and the copper/immunoreactive ceruloplasmin relationship were significantly higher in the group of patients than in the healthy control group (p < 0.001). However, no significant difference was found for the concentration of non-ceruloplasmin copper between both groups. A statistically significant negative correlation was obtained for the concentration of serum thiobarbituric acid-reacting substances with the immunoreactive ceruloplasmin and its oxidase activity in the group of patients (p < 0.005). These results suggest that in RA increases of serum copper are produced at the expense of the fraction linked to the ceruloplasmin, diminishing the proportion of apoceruloplasmin and other forms poor in copper. Although the increase in the serum concentration of ceruloplasmin might offer an additional safeguard against oxidative stress. it does not appear to have a beneficial effect upon the activity of the illness as evaluated by means the biological inflammation markers C-reactive protein, erythrocyte sedimentation rate and sialic acid.
Assuntos
Artrite Reumatoide/enzimologia , Ceruloplasmina/metabolismo , Adulto , Artrite Reumatoide/sangue , Cobre/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Especificidade por Substrato , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismoRESUMO
In a study of 50 full-term newborns, we found serum levels of ceruloplasmin, its oxidase activity and specific oxidase activity (activity per unit mass of enzyme protein) which were significantly lower than in adult subjects (p<0.001). A significant correlation was obtained between the specific oxidase activity of the neonatal ceruloplasmin and the transferrin/alpha-fetoprotein ratio (p<0.01), which reflects the maturity of the fetal hepatocyte through its ability to synthesise fetal- and non-fetal-associated proteins. The lower specific oxidase activity of the ceruloplasmin in newborns would be due to a higher relative proportion of apoprotein, and/or other molecular forms with a poor copper content in the oxidase sites. This could be due to an inability to transfer copper into a common intracellular pool for holoceruloplasmin synthesis and biliary copper excretion. A high interindividual variability was found for the specific oxidase activity of the neonatal ceruloplasmin, and in the newborns with higher levels of ceruloplasmin this, from a catalytic point of view, is more similar to the adult form.
Assuntos
Ceruloplasmina/análise , Sangue Fetal/química , Adolescente , Adulto , Fatores Etários , Cobre/sangue , Feminino , Humanos , Imunodifusão , Técnicas Imunoenzimáticas , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nefelometria e Turbidimetria , Oxirredutases/sangue , Valores de Referência , Fatores Sexuais , Espectrofotometria Atômica , Transferrina/análise , alfa-Fetoproteínas/análiseRESUMO
Speciation of iron in milk was carried out by high performance liquid chromatography (HPLC) and electrothermal atomic absorption spectrometry (ETAAS). Milk whey was obtained and low molecular weight protein separation was performed by size exclusion chromatography (SEC) with a TSK Gel SW glass guard (Waters) pre-column and a TSK-Gel G2000 glass (Toso Haas) column. After studying water as a possible mobile phase, this mobile phase was carefully selected in order to avoid alterations of the sample and to make subsequent iron determination in the protein fractions easier by ETAAS. The proposed method is sensitive (limit of detection [LOD] and LOQ 1.4 and 4.7 microg l(-1), respectively) and precise (relative standard deviation [RSD]<10%). Iron is principally found in the proteins of 3 and 76 kDa in breast milk, and it is irregularly distributed in infant formulas.
RESUMO
BACKGROUND: Aluminum toxicity is well documented and contamination of milk formulas has been implicated as the source of accumulation in bone and brain tissues. The purpose of the current study was to evaluate the aluminum contents of human milk, cow's milk, and infant formulas. METHODS: Aluminum contents were determined by atomic absorption spectrometry in samples of human milk in the colostrum, intermediate, and mature stages; infant formulas from eight manufacturers; and various types and brands of commercially available cow's milk. RESULTS: Mean aluminum concentration was lowest in human milk (23.4 +/- 9.6 microg/l), and did not differ significantly between colostrum, intermediate-stage and mature-stage milk. Mean aluminum concentration was 70 microg/l in cow's milk, and 226 microg/l in reconstituted infant formulas. Aluminum concentrations in infant formulas differed markedly among manufacturers; concentration in milk from one of the manufacturers was particularly high (mean, 551 microg/l; range, 302-1149 microg/l). These values are for milk reconstituted with aluminum-free water under laboratory conditions; formulas prepared with tap water in the University Hospital's infant-feeding unit had even higher aluminum content. Experiments showed that aluminum concentration in the high-aluminum milk could be reduced by more than 70% at the manufacturing stage, by using low aluminum components. CONCLUSIONS: The results of the present study support the recommendations for infant formula manufacturers to strive to reduce aluminum concentration in their products.
Assuntos
Alumínio/análise , Alimentos Infantis/análise , Leite Humano/química , Leite/química , Animais , Manipulação de Alimentos/métodos , Embalagem de Alimentos , Humanos , Lactente , Recém-Nascido , Espectrofotometria AtômicaRESUMO
Chromium was measured by Electrothermal Atomic Absorption Spectrometry in human milk, cow's milk, and infant formulas. The mean levels found were 1.56, 0.83, and 4.84 (13%) micrograms/L, respectively. According to our data, the daily intake for the Spanish neonates is lower than the Recommended Dietary Allowances (RDAs) (10-40 micrograms/d) for this element.