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Clinical Immunology and Biochemistry > Inborn Errors of Metabolism > Flashcards

Inborn Errors of Metabolism Flashcards

1
Q

What is the function of an enzyme?

A

An enzyme catalyses a reaction with a substrate

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2
Q

Define Inborn Errors of Metabolism

A

A genetically inherited metabolic defect, which results in deficient enzyme production or synthesis of an abnormal enzyme

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3
Q

How do single gene defects cause IEM?

A

Single gene defects result in abnormalities in the synthesis or catabolism of proteins, carbohydrates, or fats

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4
Q

How can IEM be exacerbated?

A

The onset and severity may be exacerbated by environmental factors, such as diet and intercurrent illness

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5
Q

What are the categories of IEM?

A 
Disorders of protein metabolism 
Disorders of carbohydrate metabolism c
Lysosomal storage disorders 
Fatty acid oxidation defects 
Mitochondrial disorders 
Peroxisomal disorders
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6
Q

Give examples of disorders of protein metabolism

A

Amino acidopathies
Organic acidopathies
Urea cycle defects

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7
Q

Give examples of disorders of carbohydrate metabolism

A 
Carbohydrate intolerance disorders
Glycogen storage disorders
Disorders of gluconeogenesis and glycogenolysis
Galactosemia
Hereditary fructose intolerance
Fructosuria
Pyruvate Metabolism Disorders
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8
Q

Are IEM’s common or rare?

A

Rare

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9
Q

Give examples of Pyruvate Metabolism Disorders

A

Pyruvate dehydrogenase complex deficiency

Pyruvate caroboxylase absence

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10
Q

Give examples of Amino Acid Metabolism Disorders

A

PKU
Tyrosinemia
Homocystinuria

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11
Q

What is a key symptom of IEM?

A

Failure to thrive

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12
Q

Why is identifying IEM early key?

A

If you can identify conditions early in a child’s life, there may be treatments available

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13
Q

What is involved in the conventional approach to diagnosing IEM?

A

Conventional approaches to diagnosing and monitoring IEM’s rely on biochemical analysis of metabolites, hormones or certain proteins
- e.g. for diagnosis of congenital adrenal hyperplasia, 17-hydroxyprogesterone is measured

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14
Q

What are the screening programme principles?

A 
Used before patient shows overt disease symptoms
Method available
Clearly defined disorder
Appreciable frequency
Advantage of early diagnosis to allow treatment or prenatal diagnosis
Low false positive rate
Low false negative rate
Benefits outweigh the costs
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15
Q

What are the Wilson Criteria for Screening?

A

Clinically and biochemically well-defined disorder
Known incidence in populations relevant to the UK
Disorder associated with significant morbidity or mortality
Effective treatment available
Period before onset during which intervention improves outcome
Ethical, safe, simple and robust screening test
Cost-effectiveness of screening

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16
Q

Give examples of Population Screening Programmes

A 
Antenatal (carrier analysis)
Thalassemia*
Sickle Cell
Tay-Sachs*
Cystic Fibrosis

Neonatal
Phenylketonuria
Hypothyroidism

*Anlalysed in some countries/certain ethnic groups successfully

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17
Q

What conditions are tested for in the UK Neonatal Screening Programme?

A 
Sickle Cell Anemia 
Thalassemia
Phenylketonuria
Cystic fibrosis
Congenital Hypothyroidism
Medium Chain acyl-CoA Dehydrogenase (MCAD)
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18
Q

Other than early treatment, what benefit can come from screening for IEM’s?

A

The parents may have a recessive condition.

The results from the screening test may mean that the parents decide not to have any more children

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19
Q

What are the Prenatal Diagnosis Criteria?

A 
Parents with a previously affected child
High risk groups
Severe disorder
There is no available treatment
Early treatment advantageous
Reliable test
20
Q

What methods are used for prenatal screening and diagnosis?

A 
Ultrasound screening
Mother’s markers
Amniocentesis
Chorionic Villus Sampling (transcervical, transabdominal)
Fetal Blood Sampling (cordocentesis)
21
Q

How is ultrasound screening used for prenatal screening and diagnosis?

A

Abnormality checks

22
Q

When is ultrasound screening used for prenatal screening and diagnosis?

A
  • If pregnant woman has a high alpha-fetoprotein level

- Family history of birth defects

23
Q

Give an example of how is mother’s markers are used for prenatal screening and diagnosis?

A

Alpha-fetoprotein (high level indicates spina bifida)

24
Q

When is amniocentesis performed?

A

15 and 17 weeks of pregnancy

25
Q

When is Chorionic Villus Sampling performed?

A

10-12 weeks of pregnancy

26
Q

What is the function of Chorionic Villus Sampling?

A

DNA analysis, for example for CF

27
Q

How is Fetal Blood Sampling (cordocentesis) performed?

A

Small needle is inserted into the site where the cord joins the placenta
Blood is cultured for foetal karyotype analysis

28
Q

Hurler Syndrome

A

Autosomal Recessive

Biochemical Test

29
Q

Hemophilia A

A

X Linked

DNA/Biochemical Test

30
Q

Ornithine carbamoyltransferase

A

Autosomal Recessive

Biochemical Test

31
Q

Lesch-Nyhan syndrome

A

X Linked

Biochemical Test

32
Q

How is a definitive diagnosis made?

A

A definitive diagnosis may be made from screening tests but may also need:

  • Specific Enzyme analysis
  • May be necessary to biopsy tissues (eg liver/muscle)
  • DNA testing, if 1st tier work is inconclusive
33
Q

Phenylketonuria

A

Caused by mutation at 12q22-24.1
AR disorder
Heel stick (Guthrie test) - ~5 days old
24-48 hrs old
Incidence - 1 in 12,000 (1 in 6000 in UK, 1 in 200,000 in Japan
Caused by low levels of phenylalanine hydroxylase
F>Y
Phenylalanine accumulation results in a child with severe mental retardation
Treatment: low protein diet with amino acid supplement is an effective treatment

34
Q

Cystic Fibrosis

A

Mutation in CFTR gene (7q31.2) - causes alteration in chloride pump that uses ATP

Cystic fibrosis 1 per 1600 people of European descent
Carrier frequency up to 5% (Northern Europeans)

DF508 very common in UK, but multiple mutations make genetic analysis problematic

Autosomal Recessive

DNA Test

35
Q

How common is Medium Chain Acyl-CoA dehydrogenase (MCAD)?

A

1 in 10,000 babies

36
Q

Congenital Hypothyroidism

A

1 in 4,000 babies
Defects of thyroxine synthesis
Thyroxine deficiency - can cause cretinism

37
Q

Hereditary Haemachromatosis

A

Carrier frequency up to 10% (Northern Europeans)
Treatable disorder of iron metabolism
Mutations in HFE, a HLA class 1 -like gene
HFE gene at 6p21.3
No clinical features during childhood
Penetrance must be considered if mutation found
Gradual iron accumulation leads to complications
85% of patients are homozygous for a single mutation C28Y

38
Q

Tay-Sachs Disease

A

Tay-Sachs disease, a heritable metabolic disorder commonly associated with Ashkenazi Jews

Autosomal recessive disease caused by mutations in both alleles of a gene (HEXA) on chromosome 15. HEXA codes for the alpha subunit of the enzyme β-hexosaminidase A.
This enzyme is found in lysosomes, organelles that break down large molecules for recycling by the cell.

Normally, β-hexosaminidase A helps to degrade a lipid called GM2 ganglioside, but in Tay-Sachs individuals, the enzyme is absent or present only in very reduced amounts, allowing excessive accumulation of the GM2 ganglioside in neurons.

The progressive neurodegeneration seen in the varied forms of Tay-Sachs depends upon the speed and degree of GM2 ganglioside accumulation, which in turn is dependent upon the level of functional β-hexosaminidase A present in the body.

39
Q

Give examples of other IEMs

A 
Maple Syrup Urine Disease (MSUD)
Homocystinuria (pyridoxine unresponsive)
Glutaric Aciduria Type I (GA1)
Isovaleric Acidaemia (IVA)
Long-chain 3-hydroxyacyl CoA dehydrogenase deficiency (LCHADD; includes trifunctional protein deficiency)
40
Q

What are the benefits of DNA testing over Biochemical testing for IEMs?

A

Detection of multiple potential mutations
Identification of multiple genes simultaneously
(BUT sensitivity of DNA testing must be as good as current biochemical testing)
PCR can show selective allele amplification

41
Q

What are the cons of DNA testing over Biochemical testing for IEMs?

A

Cost of transferral to DNA testing would be expensive

42
Q

How could DNA testing be of benefit as an adjunct to conventional testing?

A

Mutation identification could clarify borderline cases
Prediction of phenotype severity
Facilitates DNA-based prenatal diagnosis in a future pregnancy
Identify family members that are trait carriers

43
Q

What are the potential problems with DNA testing as an adjunct to conventional testing?

A

Penetrance needs to be considered if mutation found
Heterozygote analysis
- education and counseling would be necessary
- insurance issues, workplace discrimination

44
Q

What is involved in genetic counselling?

A

Formal genetic counseling for affected families

  • patient prognosis
  • recurrence risk
  • possibility of prenatal diagnosis
  • screening of other family members
45
Q

What is Tandem Mass Spectrometry?

A

Tandem mass spectrometry is a procedure used in medical laboratories consisting of two mass spectrometers in series connected by a chamber known as a collision cell.

The sample to be examined is essentially sorted and weighed in the first mass spectrometer, then broken into pieces in the collision cell, and a piece or pieces sorted and weighed in the second mass spectrometer.

Tandem mass spectrometry is used in newborn screening to detect molecules such as amino acids (the building blocks of proteins) and fatty acids

46
Q

Why is Tandem Mass Spectrometry important in detecting IEMs?

A

In inherited metabolic diseases, specific enzymes that facilitate the breakdown of amino acids or conversion of fat to energy, do not function.
If a particular enzyme is not functioning, the breakdown of a compound by this enzyme does not occur.In other instances, products are not produced that are important for cell function.
Because the compound cannot be metabolised, it will accumulate in the blood and tissues.
The tandem mass spectrometer, by measuring the amounts of the specific compounds present, can identify whether there is too much in the blood, which may suggest which condition a patient is suffering from (other tests may be required to confirm)

Clinical Immunology and Biochemistry (14 decks)

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