Abstract
Glutaryl-CoA dehydrogenase (GCDH) deficiency is a rare neurometabolic disorder that is considered treatable if patients are identified before the onset of acute encephalopathic crises. To allow early identification of affected individuals, tandem mass spectrometry-based newborn screening for GCDH deficiency has been started in Germany in 1999. We prospectively followed neonatally screened patients (n = 38) and compared the neurologic outcome with patients from a historical cohort (n = 62). In the majority of neonatally screened children, the onset of encephalopathic crises has been prevented (89%), whereas acute encephalopathic crises or progressive neurologic impairment was common in the historical cohort. Neonatal screening in combination with intensive management is effective – even assuming ascertainment bias in the historical cohort. Similar proportions of commonest mutations and biochemical phenotypes (high and low excretors) were found in neonatally screened and historical patients. However, potential predictor variables for mild clinical phenotypes are not yet known and thus a selection of these patients by newborn screening is not excluded. No patient was known to be missed by newborn screening from 1999 to 2005. In conclusion, this study confirms that newborn screening for GCDH deficiency in combination with intensive management is beneficial.
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Abbreviations
- 3-OH-GA:
-
3-hydroxyglutaric acid
- C5DC:
-
glutarylcarnitine
- GA:
-
glutaric acid
- GCDH:
-
glutaryl-CoA dehydrogenase (EC 1.3.99.7)
- GC/MS:
-
gas chromatography/mass spectrometry
- MS/MS:
-
tandem mass spectrometry
- NBS:
-
newborn screening
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Acknowledgements
These authors are indebted for the patients and their families for their participation and trust, particularly the German parents group “Glutaric aciduria e.V.” (URL: www.glutarazidurie.de) which was instrumental for this study. We are grateful to B. Assmann, R. Brackmann, A. M. Das, F. Lagler, O. Hendricks, E. Mayatepek, T. Marquardt, A. Muntau, W. Röschinger, A. Schulze, B. Schwahn, K. Ullrich, and U. Wendel for reports on patients and fruitful discussions. We thank J. G. Okun, D. Kohlmüller, C.-D. Langhans, P. Feyh, and S. Exner-Camps for excellent technical support of organic acid analysis and acylcarnitine profiling, and E. Christensen (Copenhagen, Denmark) for GCDH enzyme analysis. We are grateful to K. Kromeyer-Hauschild for providing LMS values. We thank A. Schulze (president, Deutsche Gesellschaft für Neugeborenenscreening) for providing the numbers of screened newborns in Germany.
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This study was supported by a grant from the German Federal Ministry of Education and Sciences (BMBF # 01GM0305) and a grant from the “Kindness for Kids” Foundation, Munich, Germany – both to S. K. and G. F. H.
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Kölker, S., Garbade, S., Boy, N. et al. Decline of Acute Encephalopathic Crises in Children with Glutaryl-CoA Dehydrogenase Deficiency Identified by Newborn Screening in Germany. Pediatr Res 62, 357–363 (2007). https://doi.org/10.1203/PDR.0b013e318137a124
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DOI: https://doi.org/10.1203/PDR.0b013e318137a124
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