Abstract
Newborn screening was implemented in the 1960s with screening for phenylketonuria (PKU). In the same decade, it became possible to screen for classical galactosemia, a rare autosomal recessive inherited disorder, which is potentially life threatening if not treated. While newborn screening for PKU has become almost universal, galactosemia is included only in a minority of European newborn screening programs. The major arguments why galactosemia is excluded from newborn screening programs are that the disease can be diagnosed clinically, there is a high rate of false positives and long-term complications are common despite early diagnosis.
Here, we report how we have decreased the number of false-positive galactosemia recalls to less than 0.01%, using a two-tier test strategy. All samples are tested with the Beutler blood spot test, a method that measures galactose-1-phosphate uridyltransferase activity. Samples with less than ≤15% activity are tested for galactose with a galactose dehydrogenase test (the rapid GAL-DH test), which catalyzes the oxidation of galactose and the reduction of NAD+ to NADH that is estimated visually by fluorescence under UV-light. Both tests are semiquantitative.
With this strategy, screening for galactosemia is inexpensive, does not demand a heavy workload, and has a low false-positive re-call rate. The incidence of classical galactosemia in Sweden is 1/100,000, which is lower than the reported incidence in other European countries. Despite this, newborn screening for galactosemia has never been questioned.
Concise sentence: Screening for galactosemia using well-established methods to reduce the false-positive rate.
Competing interests: None declared.
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Abbreviations
- DG:
-
Duarte galactosemia
- G-1-P:
-
Galactose-1-phosphate
- Gal:
-
Galactose
- GAL-DH:
-
Galactose dehydrogenase
- GALE:
-
Galactose epimerase
- GALK:
-
Galactokinase
- GALT:
-
Galactose-1-phosphate uridyltransferase
- NBS:
-
Newborn screening
- PKU:
-
Phenylketonuria
References
Beutler E, Baluda MC (1966) A simple spot screening test for galactosemia. J Lab Clin Med 68:137–141
Coman DJ, Murray DW, Byrne JC, Rudd PM, Bagaglia PM, Doran PD, Treacy EP (2010) Galactosemia, a single gene disorder with epigenetic consequences. Pediatr Res 67:286–292
Fernhoff PM (2010) Duarte galactosemia: how sweet is it? Clin Chem 56:1045–1046
Ficicioglu C, Thomas N, Yager C, Gallagher PR, Hussa C, Mattie A, Day-Salvatore DL, Forbes BJ (2008) Duarte (DG) galactosemia: a pilot study of biochemical and neurodevelopmental assessment in children detected by newborn screening. Mol Genet Metab 95:206–212
Ficicioglu C, Hussa C, Gallagher PR, Thomas N, Yager C (2010) Monitoring of biochemical status in children with Duarte galactosemia: utility of galactose, galactitol, galactonate, and galactose 1-phosphate. Clin Chem 56:1177–1182
Freer DE, Ficicioglu C, Finegold D (2010) Newborn screening for galactosemia: a review of 5 years of data and audit of a revised reporting approach. Clin Chem 56:437–444
Gitzelmann R, Bosshard NU (1995) Partial deficiency of galactose-1-phosphate uridyltransferase. Eur J Pediatr 154:S40–S44
Goppert F (1917) Galaktosurie nach Milchzuckergabe bei angeborenem, familiaerem chronishen Leberleiden Klin Wschr 54:473–477
Guthrie R, Susi A (1963) A simple phenylalanine method for detecting phenylketonuria in large populations of newborn infants. Pediatrics 32:338–343
Isselbacher KJ, Andersson EP, Kurahashi K, Kalckar HM (1956) Congenital galactosemia, a single enzymatic block in galactose metabolism. Science 123:635–636
Jeong JS, Yoon HR, Hong SP (2007) Development of a new diagnostic method for galactosemia by high-performance anion-exchange chromatography with pulsed amperometric detection. J Chromatogr A 1140:157–162
Powell KK, Van Naarden BK, Singh RH, Shapira SK, Olney RS, Yeargin-Allsopp M (2009) Long-term speech and language developmental issues among children with Duarte galactosemia. Genet Med 11:874–879
Waggoner DD, Buist NR, Donnell GN (1990) Long-term prognosis in galactosaemia: results of a survey of 350 cases. J Inherit Metab Dis 13:802–818
Acknowledgements
This work was supported by grants from the Karolinska Institute Research Foundation.
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Communicated by: Rodney Pollitt.
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Ohlsson, A., Guthenberg, C., von Döbeln, U. (2011). Galactosemia Screening with Low False-Positive Recall Rate: The Swedish Experience. In: JIMD Reports - Case and Research Reports, 2011/2. JIMD Reports, vol 2. Springer, Berlin, Heidelberg. https://doi.org/10.1007/8904_2011_59
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DOI: https://doi.org/10.1007/8904_2011_59
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