Succinylacetone as primary marker to detect tyrosinemia type I in newborns and its measurement by newborn screening programs

• Published in: Molecular genetics and metabolism 2014-09, Vol.113 (1-2), p.67-75
• Main Authors: De Jesús, Víctor R., Adam, Barbara W., Mandel, Daniel, Cuthbert, Carla D., Matern, Dietrich
• Format: Article
• Language: English
• Subjects: Biomarkers - blood; Dried Blood Spot Testing - methods; Dried Blood Spot Testing - standards; Heptanoates - blood; HHS Secretary's (Discretionary) Advisory Committee on Heritable Disorders in Newborns and Children; Humans; Infant, Newborn; Neonatal Screening - methods; Neonatal Screening - standards; Newborn screening; Quality Control; Reproducibility of Results; Succinylacetone; Tandem Mass Spectrometry; Tyrosine; Tyrosinemia type I; Tyrosinemias - blood; Tyrosinemias - diagnosis; US Recommended Uniform Screening Panel
• ISSN: 1096-7192; 1096-7206
• DOI: 10.1016/j.ymgme.2014.07.010

Tyrosinemia type I (TYR I) is caused by autosomal recessive fumarylacetoacetate hydrolase deficiency and is characterized by development of severe liver disease in infancy and neurologic crises. If left untreated, most patients die of liver failure in the first years of life. Intervention with medication is effective when initiated during the first month of life. This improvement in the treatment of TYR I patients influenced the decision to include TYR I in the US Secretary of the Department of Health and Human Services' (HHS) Recommended Uniform Screening Panel. However, while tyrosine is routinely measured in newborn screening (NBS) by tandem mass spectrometry (MS/MS), elevated tyrosine levels are not specific to TYR I. To improve the specificity of NBS for TYR I, several assays were developed to measure succinylacetone (SUAC) in dried blood spots (DBS). SUAC is a pathognomonic marker of TYR I, and its detection by NBS MS/MS is possible. This review of the current status of NBS for TYR I in the US is the result of discussions at the HHS Secretary's (Discretionary) Advisory Committee on Heritable Disorders in Newborns and Children about the inconsistent implementation of effective NBS for TYR I in the US. We sought to understand the different TYR I screening practices in US NBS programs. Results indicate that 50 out of 51 NBS programs in the US screen for TYR I, and a successful SUAC performance evaluation scheme is available from the Centers for Disease Control and Prevention. Programmatic and methodological barriers were identified that prevent widespread adoption of SUAC measurements in NBS laboratories. However, since SUAC detection is currently the best approach to NBS for TYR I, a further delay of the addition of SUAC measurement into NBS procedures is discouraged. SUAC measurement should improve both the false positive and false negative rate in NBS for TYR I thereby yielding the desired benefits for affected patients at no expense to the overall population served. •Inconsistent newborn screening (NBS) for Tyrosinemia type I (TYR I) is addressed.•Succinylacetone (SUAC) but not tyrosine is a pathognomonic biomarker of TYR I.•SUAC can be measured by several NBS methods.•SUAC is currently the most effective NBS marker for TYR I.•SUAC should be measured by NBS laboratories to improve specificity for TYR I.