title: NMR-Based Screening for Inborn Errors of Metabolism: Initial Results from a Study on Turkish Neonates.
abstract: Approximately 1 in 400 neonates in Turkey is affected by inherited metabolic diseases. This high prevalence is at least in part due to consanguineous marriages. Standard screening in Turkey now covers only three metabolic diseases (phenylketonuria, congenital hypothyroidism, and biotinidase deficiency). Once symptoms have developed, tandem-MS can be used, although this currently covers only up to 40 metabolites. NMR potentially offers a rapid and versatile alternative.We conducted a multi-center clinical study in 14 clinical centers in Turkey. Urine samples from 989 neonates were collected and investigated by using NMR spectroscopy in two different laboratories. The primary objective of the present study was to explore the range of variation of concentration and chemical shifts of specific metabolites without clinically relevant findings that can be detected in the urine of Turkish neonates. The secondary objective was the integration of the results from a healthy reference population of neonates into an NMR database, for routine and completely automatic screening of congenital metabolic diseases.Both targeted and untargeted analyses were performed on the data. Targeted analysis was aimed at 65 metabolites. Limits of detection and quantitation were determined by generating urine spectra, in which known concentrations of the analytes were added electronically as well as by real spiking. Untargeted analysis involved analysis of the whole spectrum for abnormal features, using statistical procedures, including principal component analysis. Outliers were eliminated by model building. Untargeted analysis was used to detect known and unknown compounds and jaundice, proteinuria, and acidemia. The results will be used to establish a database to detect pathological concentration ranges and for routine screening.
authors.affiliation: Institut für Biomedizinische Analytik und NMR-Imaging GmbH (INFAI), Gottfried Hagen-Str. 60-62, 51105, Köln, Germany, sa@infai.de.
authors.forename: Sitke
authors.initials: S
authors.lastname: Aygen
authors.forename: Ulrich
authors.initials: U
authors.lastname: Dürr
authors.forename: Peter
authors.initials: P
authors.lastname: Hegele
authors.forename: Johannes
authors.initials: J
authors.lastname: Kunig
authors.forename: Manfred
authors.initials: M
authors.lastname: Spraul
authors.forename: Hartmut
authors.initials: H
authors.lastname: Schäfer
authors.forename: David
authors.initials: D
authors.lastname: Krings
authors.forename: Claire
authors.initials: C
authors.lastname: Cannet
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.forename: Birk
authors.initials: B
authors.lastname: Schütz
authors.forename: Selda F H
authors.initials: SF
authors.lastname: Bülbül
authors.forename: H Ibrahim
authors.initials: HI
authors.lastname: Aydin
authors.forename: S Umit
authors.initials: SU
authors.lastname: Sarıcı
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yalaz
authors.forename: Rahmi
authors.initials: R
authors.lastname: Ors
authors.forename: Resit
authors.initials: R
authors.lastname: Atalan
authors.forename: Oğuz
authors.initials: O
authors.lastname: Tuncer