Identification of mucopolysaccharidosis I heterozygotes based on biochemical characteristics of L-iduronidase from dried blood spots.

BACKGROUND: Mucopolysaccharidosis I (MPS I) is a genetic disorder caused by deficiency of L-iduronidase (IDUA) activity. Heterozygote screening is a highly requested service by risk families; however, determination of IDUA activity alone is not sufficient to discriminate between heterozygotes and normal individuals because a significant overlap occurs between them. The aim of this study was to characterize the enzyme eluted from heterozygote's dried blood samples and determine if there are differences with that of normal individuals. METHODS: We determined Km, Vmax and the thermal stability of the enzyme at 50 °C. RESULTS: Vmax from heterozygotes (7.28 ± 2.72 µmol/l blood/h) was significantly different than the obtained in controls (10.52 ± 2.05 µmol/l blood/h), while their Km were similar: 0.633 ± 0.339 mmol/l and 0.672 ± 0.246 mmol/l, respectively. After a 12 h pre-incubation period, IDUA activity in controls was significantly lower compared to heterozygotes. CONCLUSIONS: IDUA eluted from dried blood spots of heterozygotes differs from that of controls in terms of Vmax and thermal stability. These parameters can be used as an important tool for the detection of carriers for MPS I. This is the first report describing a differential behavior of these parameters for a lysosomal enzyme obtained from dried blood.

Optimization of enzymatic diagnosis for mucopolysaccharidosis I in dried blood spots on filter paper.

OBJECTIVES: The aim of this study was to validate an ultramicroassay with a reduced interference of hemoglobin for the enzymatic diagnosis of mucopolysaccharidosis I in dried blood spots on filter paper. DESIGN AND METHODS: A matrix of dried blood was incorporated within the calibration system. In addition, trichloroacetic acid was added to precipitate hemoglobin. Linearity, precision, accuracy and limits of detection and quantification were determined and α-l-iduronidase activity was obtained from 6 patients, 9 heterozygotes, 25 healthy adults and 500 neonates. RESULTS: The ultramicroassay was linear, precise (coefficients of variation less than 10%) and accurate (recovery between 91 and 98%). The interference of hemoglobin was decreased within the hematocrit range of clinical interest: 35-55%. CONCLUSIONS: This ultramicroassay increases in 2.5 times the difference between healthy individuals and patients with respect to the reference assay; optimizing enzymatic quantification and confirmatory biochemical diagnosis for mucopolysaccharidosis I.

Mucopolysaccharidosis type I: current knowledge on its pathophysiological mechanisms.

Mucopolysaccharidosis type I is one of the most frequent lysosomal storage diseases. It has a high morbidity and mortality, causing in many cases severe neurological and somatic damage in the first years of life. Although the clinical phenotypes have been described for decades, and the enzymatic deficiency and many of the mutations that cause this disease are well known, the underlying pathophysiological mechanisms that lead to its development are not completely understood. In this review we describe and discuss the different pathogenic mechanisms currently proposed for this disease regarding its neurological damage. Deficiency in the lysosomal degradation of heparan sulfate and dermatan sulfate, as well as its primary accumulation, may disrupt a variety of physiological and biochemical processes: the intracellular and extracellular homeostasis of these macromolecules, the pathways related to gangliosides metabolism, mechanisms related to the activation of inflammation, receptor-mediated signaling, oxidative stress and permeability of the lysosomal membrane, as well as alterations in intracellular ionic homeostasis and the endosomal pathway. Many of the pathogenic mechanisms proposed for mucopolysaccharidosis type I are also present in other lysosomal storage diseases with neurological implications. Results from the use of methods that allow the analysis of multiple genes and proteins, in both patients and animal models, will shed light on the role of each of these mechanisms and their combination in the development of different phenotypes due to the same deficiency.

Estudio de las enzimas lisosomales N-acetil-a-D-glucosaminidasa y arilsulfatasa A en adultos cubanos / Assay of lysosomal N-acetyl-a-D-glucosaminidase and arylsulfatase A activities in Cuban adults

El objetivo de este estudio fue determinar, en una muestra de individuos cubanos, un rango preliminar de valores normales de actividad específica de N-acetil- a-D-glucosaminidasa y arilsulfatasa A, enzimas deficientes en la mucopolisacaridosis tipo III B y la leucodistrofia metacromática, respectivamente. Se realizó una investigación de corte transversal, en muestras de sangre de 38 individuos adultos. Se realizó la extracción de los leucocitos y se determinó la actividad específica de las enzimas por métodos espectrofotométricos. Todos los participantes fueron caracterizados desde el punto de vista clínico como sanos para ambas enfermedades. Se obtuvieron valores medios de actividad específica de N-acetil-a-D-glucosaminidasa y arilsulfatasa A de 1,52±0,30 y 121,37±20,14 nmol/mg/h, respectivamente. No se encontraron diferencias significativas en relación a las características étnicas para ninguna de las dos enzimas (p<0,05). Este constituye el primer estudio cubano en el cual se publican rangos de actividad específica para estas enzimas en individuos cuya condición de sanos y no relacionados familiarmente con la enfermedad ha sido clínicamente demostrada. El análisis de un mayor número de muestras permitirá establecer los puntos de corte que dotarán al diagnóstico bioquímico de estas enfermedades de una mayor confiabilidad.

The aim of this study was to determine, in a sample of Cuban individuals, a preliminary range of normal values of N-acetyl-a-D-glucosaminidase and arylsulfatase A activity, enzymes that are deficient in mucopolysaccharidosis type III B and metachromatic leukodystrophy, respectively. A cross-sectional research was conducted. Blood samples were obtained out of 38 adult individuals. The leucocytes were extracted and the specific enzymatic activity was assayed by spectrophotometric methods. All participants were characterized from the clinical point of view as healthy for both diseases. Average values of N-acetyl-a-D-glucosaminidase and arylsulfatase A specific activities of 1.52 ± 0.30 and 121.37 ± 20.14 nmol/mg/h, respectively were obtained. There were no significant differences related to ethnicity for any of the two enzymes (p <0.05). This is the first Cuban study in which ranges of activity for these enzymes have been reported in healthy individuals whose healthy and non-familiarly related with the disease status have been clinically demonstrated. The analysis of more samples will establish the cutoff points that will increase the reliability of the biochemical diagnosis of these diseases.