Abstract
Biotinidase deficiency is a rare inherited metabolic disorder that can cause severe neurological symptoms. To prevent severe clinical presentations, it was included in the Dutch neonatal screening programme in 2007. Since then the number of cases detected has been high. This study set out to describe the incidence of the disease, the clinical and demographic characteristics of the neonates identified and the type of mutations found. In the south-western Netherlands, 304 982 neonates were screened between 2007 and 2012; and 92 were identified for further testing. Confirmatory testing revealed 6 (7%) with a profound biotinidase deficiency (<10% enzyme activity), 44 (48%) with a partial deficiency (10–30%) and 42 (46%) with normal activity (>30%). All six patients whose profound deficiency was confirmed had enzyme activities below 15% on neonatal screening. Mutation analysis was performed in 61 neonates: 5 ‘profound’, 35 ‘partial’ and 21 ‘normal’. All five ‘profound’ cases had two severe mutations. Comparison with the northern Netherlands showed that the frequency and types of mutation were representative for the Netherlands as a whole. The most common mutation detected was c.[1330G>C] (p.(Asp444His); 34%), which is considered to be mild, followed by three severe mutations c.[1368A>C], c.[1595C>T] and c.[1330G>C;511G>A]. Seven new mutations were identified. We conclude that neonatal screening for profound biotinidase produces a high number of false positives. Biotinidase deficiency was profound in less than 10% of cases identified. As biotinidase activity lay below 15% on neonatal screening in all such cases, the screening threshold might be reduced to 15%.
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Acknowledgements
The National Advisory Board Neonatal Screening for Metabolic Diseases (ANS-MZ). We thank Mrs IH van Veen-Hof for technical assistance.
Author contributions
MW conceived the study, and RW, MK, MW, JS and AvdP participated in its design. RW, MW, WO and KN collected clinical information. WO, FV and KN were responsible for enzyme activity testing and interpretation. EK was responsible for the processing and interpretation of the DBS screening results. RvM and JS were responsible for the molecular analysis and for interpretation of the genetic variants. KN was responsible for isolation and shipment of the materials of the UMCG cohort. FvS had oversight of the UMCG cohort and contributed discussion points around the screening debate. RW, MK, AvdP and MW were involved in the interpretation of all results. RW and MK drafted the manuscript. MK, MW and AvdP oversaw the stages of revision and editing. MW takes responsibility for the content of the manuscript, including the data and analysis. All authors helped to interpret the results and read and approved the final manuscript.
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Wiltink, R., Kruijshaar, M., van Minkelen, R. et al. Neonatal screening for profound biotinidase deficiency in the Netherlands: consequences and considerations. Eur J Hum Genet 24, 1424–1429 (2016). https://doi.org/10.1038/ejhg.2016.65
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DOI: https://doi.org/10.1038/ejhg.2016.65
