1. Untargeted metabolomics as an unbiased approach to the diagnosis of inborn errors of metabolism of the non-oxidative branch of the pentose phosphate pathway.
- Author
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Shayota BJ, Donti TR, Xiao J, Gijavanekar C, Kennedy AD, Hubert L, Rodan L, Vanderpluym C, Nowak C, Bjornsson HT, Ganetzky R, Berry GT, Pappan KL, Sutton VR, Sun Q, and Elsea SH
- Subjects
- Adult, Biomarkers blood, Carbohydrate Metabolism, Inborn Errors blood, Carbohydrate Metabolism, Inborn Errors metabolism, Carbohydrate Metabolism, Inborn Errors pathology, Child, Child, Preschool, Chromatography, Liquid, Female, Humans, Infant, Male, Mass Spectrometry, Metabolism, Inborn Errors blood, Metabolism, Inborn Errors metabolism, Metabolism, Inborn Errors pathology, Metabolomics, Pentose Phosphate Pathway genetics, Transaldolase blood, Transaldolase metabolism, Transketolase blood, Transketolase deficiency, Young Adult, Carbohydrate Metabolism, Inborn Errors genetics, Metabolism, Inborn Errors genetics, Transaldolase deficiency, Transaldolase genetics, Transketolase genetics
- Abstract
Inborn errors of metabolism (IEM) involving the non-oxidative pentose phosphate pathway (PPP) include the two relatively rare conditions, transketolase deficiency and transaldolase deficiency, both of which can be difficult to diagnosis given their non-specific clinical presentations. Current biochemical testing approaches require an index of suspicion to consider targeted urine polyol testing. To determine whether a broad-spectrum biochemical test could accurately identify a specific metabolic pattern defining IEMs of the non-oxidative PPP, we employed the use of clinical metabolomic profiling as an unbiased novel approach to diagnosis. Subjects with molecularly confirmed IEMs of the PPP were included in this study. Targeted quantitative analysis of polyols in urine and plasma samples was accomplished with chromatography and mass spectrometry. Semi-quantitative unbiased metabolomic analysis of urine and plasma samples was achieved by assessing small molecules via liquid chromatography and high-resolution mass spectrometry. Results from untargeted and targeted analyses were then compared and analyzed for diagnostic acuity. Two siblings with transketolase (TKT) deficiency and three unrelated individuals with transaldolase (TALDO) deficiency were identified for inclusion in the study. For both IEMs, targeted polyol testing and untargeted metabolomic testing on urine and/or plasma samples identified typical perturbations of the respective disorder. Additionally, untargeted metabolomic testing revealed elevations in other PPP metabolites not typically measured with targeted polyol testing, including ribonate, ribose, and erythronate for TKT deficiency and ribonate, erythronate, and sedoheptulose 7-phosphate in TALDO deficiency. Non-PPP alternations were also noted involving tryptophan, purine, and pyrimidine metabolism for both TKT and TALDO deficient patients. Targeted polyol testing and untargeted metabolomic testing methods were both able to identify specific biochemical patterns indicative of TKT and TALDO deficiency in both plasma and urine samples. In addition, untargeted metabolomics was able to identify novel biomarkers, thereby expanding the current knowledge of both conditions and providing further insight into potential underlying pathophysiological mechanisms. Furthermore, untargeted metabolomic testing offers the advantage of having a single effective biochemical screening test for identification of rare IEMs, like TKT and TALDO deficiencies, that may otherwise go undiagnosed due to their generally non-specific clinical presentations., Competing Interests: Declaration of Competing Interest BJS, VRS, QS, JX, and SHE are employees of Baylor College of Medicine. CG is an employee of Baylor Genetics. Baylor Genetics generates genetic testing revenue in a partnership with Baylor College of Medicine. ADK and KLP are employees of Metabolon, Inc. and, as such, have affiliations with or financial involvement with Metabolon, Inc. HTB is a consultant for Millennium Therapeutics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the article apart from those disclosed., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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