Inborn errors of metabolism (IEM) cause significant morbidity and mortality when left untreated. Urine organic acid (UOA) analysis is often a first-line investigation when an IEM is suspected. UOAs are usually qualitatively analyzed via the current gold standard, GC-EI-MS (Gas Chromatography-Electron Impact-Mass Spectroscopy). The Agilent 7890 GC in tandem with the Waters’ Xevo TQ-S MS contains an easily interchangeable LC-ESI (liquid chromatography-electrospray Ionization) and GC-APCI (Atmospheric Pressure Chemical Ionization) instrument set-up, while maintaining accuracy and sensitivity in both LC and GC applications. Utilizing this novel GC-APCI instrument, this project aims to develop and validate a new UOA method for clinical use. Furthermore, utilizing the machine’s MRM mode would increase sensitivities thus allowing for hopefully quantitative analysis. Chemical standards and patient urine samples were extracted via a liquid-liquid ether extraction and derivatized with BSTFA for proper GC elution. Results were compared on the current gold standard GC-EI-MS instrument and the new GC-APCI-MS instrument. Initial instrument suitability and method setup was then optimized. Source moisture levels were modified to explore the wet proton transfer and the dry charge transfer mechanism using [M+H]+ and [M+*]+ ion peak ratios, respectively. Elution times and APCI ion mass spectra profiles of UOA metabolites of interest were identified from full scan mode in preparation for MRM mode analysis. Exploration into the wet and dry mode settings of the APCI source determined that the former induced via methanol had greater peak areas and signal-to-noise ratios. Suitable MRMs were determined for clinically relevant organic acids from which a quantitative assay was developed for methyl malonic acid and several other compounds. The Waters’ Xevo TQ-S micro with Agilent 7890 GC demonstrated promising GC-APCI-MS detection of urine organic acids. With clear avenues for future work, the APCI technique hints at great benefits for biochemical genetic laboratories. / Thesis / Master of Science (MSc) / Inborn errors of metabolism (IEM) are a class of genetic diseases that when left untreated, cause reduced quality of life and sometimes death in newborns. Urine organic acid (UOA) analysis is used for detection using an instrument called GC-EI-MS (Gas Chromatography Electron Impact Mass Spectroscopy). This project explores how a new instrument, the Agilent 7890 GC and the Waters’ Xevo TQ-S MS, can detect these genetic diseases using a technique called APCI (Atmospheric Pressure Chemical Ionization) while still being accurate and sensitive. UOAs are isolated from urine and run through the new machine. When compared to the currently used technique, results were promising but further optimization is needed. Using the new machine, various UOA compounds that were elevated and/or decreased in newborns with genetics diseases were identified and quantified. With clear avenues for future work, the APCI technique can greatly improve newborn diagnosis of IEMs.

La plupart des conditions détectées par le dépistage néonatal sont reliées à l'une des enzymes qui dégradent les acyls-CoA mitochondriaux. Le rôle physiopathologique des acyls-CoA dans ces maladies est peu connue, en partie parce que les esters liés au CoA sont intracellulaires et les échantillons tissulaires de patients humains ne sont généralement pas disponibles. Nous avons créé une modèle animal murin de l'une de ces maladies, la déficience en 3-hydroxy-3-methylglutaryl-CoA lyase (HL), dans le foie (souris HLLKO). HL est la dernière enzyme de la cétogenèse et de la dégradation de la leucine. Une déficience chronique en HL et les crises métaboliques aigües, produisent chacune un portrait anormal et distinct d'acyls-CoA hépatiques. Ces profils ne sont pas prévisibles à partir des niveaux d'acides organiques urinaires et d'acylcarnitines plasmatiques. La cétogenèse est indétectable dans les hépatocytes HLLKO. Dans les mitochondries HLLKO isolées, le dégagement de 14CO2 à partir du [2-14C]pyruvate a diminué en présence de 2-ketoisocaproate (KIC), un métabolite de la leucine. Au test de tolérance au pyruvate, une mesure de la gluconéogenèse, les souris HLLKO ne présentent pas la réponse hyperglycémique normale. L'hyperammoniémie et l'hypoglycémie, des signes classiques de plusieurs erreurs innées du métabolisme (EIM) des acyls-CoA, surviennent de façon spontanée chez des souris HLLKO et sont inductibles par l'administration de KIC. Une charge en KIC augmente le niveau d'acyls-CoA reliés à la leucine et diminue le niveau d'acétyl-CoA. Les mitochondries des hépatocytes des souris HLLKO traitées avec KIC présentent un gonflement marqué. L'hyperammoniémie des souris HLLKO répond au traitement par l'acide N-carbamyl-L-glutamique. Ce composé permet de contourner une enzyme acétyl-CoA-dépendante essentielle pour l’uréogenèse, le N-acétylglutamate synthase. Ceci démontre un mécanisme d’hyperammoniémie lié aux acyls-CoA. Dans une deuxième EIM des acyls-CoA, la souris SCADD, déficiente en déshydrogénase des acyls-CoA à chaînes courtes. Le profil des acyls-CoA hépatiques montre un niveau élevé du butyryl-CoA particulièrement après un jeûne et après une charge en triglycérides à chaîne moyenne précurseurs du butyryl-CoA. / Most conditions detected by expanded newborn screening result from deficiency of one of the enzymes that degrade acyl-CoA esters in mitochondria. The role of acyl-CoAs in the pathophysiology of these disorders is poorly understood, in part because CoA esters are intracellular and samples are not generally available from human patients. We created a mouse model of one such condition, deficiency of 3-hydroxy-3-methylglutaryl-CoA lyase (HL), in liver (HLLKO mice). HL catalyses a reaction of ketone body synthesis and of leucine degradation. Chronic HL deficiency and acute crises each produced distinct abnormal liver acyl-CoA patterns, which would not be predictable from levels of urine organic acids and plasma acylcarnitines. In HLLKO hepatocytes, ketogenesis was undetectable. Measures of Krebs cycle flux diminished following incubation of HLLKO mitochondria with the leucine metabolite 2-ketoisocaproate (KIC). HLLKO mice also had suppression of the normal hyperglycemic response to a systemic pyruvate load, a measure of gluconeogenesis. Hyperammonemia and hypoglycemia, cardinal features of many inborn errors of acyl-CoA metabolism, occurred spontaneously in some HLLKO mice and were inducible by administering KIC. KIC loading also increased levels of several leucine-related acyl-CoAs and reduced acetyl-CoA levels. Ultrastructurally, hepatocyte mitochondria of KIC-treated HLLKO mice show marked swelling. KIC-induced hyperammonemia improved following administration of carglumate (N-carbamyl-L-glutamic acid), which bypasses an acetyl-CoA-dependent reaction essential for urea cycle function, thus demonstrating an acyl-CoA-related mechanism for this complication. In a second animal model of an inborn error of acyl-CoA metabolism, short chain acyl-CoA dehydrogenase (SCAD)-deficient mice, the main finding in liver acyl-CoAs is increased butyryl-CoA, particularly during fasting or after enteral loading with medium chain triglyceride precursor of butyryl-CoA.

La plupart des conditions détectées par le dépistage néonatal sont reliées à l'une des enzymes qui dégradent les acyls-CoA mitochondriaux. Le rôle physiopathologique des acyls-CoA dans ces maladies est peu connue, en partie parce que les esters liés au CoA sont intracellulaires et les échantillons tissulaires de patients humains ne sont généralement pas disponibles. Nous avons créé une modèle animal murin de l'une de ces maladies, la déficience en 3-hydroxy-3-methylglutaryl-CoA lyase (HL), dans le foie (souris HLLKO). HL est la dernière enzyme de la cétogenèse et de la dégradation de la leucine. Une déficience chronique en HL et les crises métaboliques aigües, produisent chacune un portrait anormal et distinct d'acyls-CoA hépatiques. Ces profils ne sont pas prévisibles à partir des niveaux d'acides organiques urinaires et d'acylcarnitines plasmatiques. La cétogenèse est indétectable dans les hépatocytes HLLKO. Dans les mitochondries HLLKO isolées, le dégagement de 14CO2 à partir du [2-14C]pyruvate a diminué en présence de 2-ketoisocaproate (KIC), un métabolite de la leucine. Au test de tolérance au pyruvate, une mesure de la gluconéogenèse, les souris HLLKO ne présentent pas la réponse hyperglycémique normale. L'hyperammoniémie et l'hypoglycémie, des signes classiques de plusieurs erreurs innées du métabolisme (EIM) des acyls-CoA, surviennent de façon spontanée chez des souris HLLKO et sont inductibles par l'administration de KIC. Une charge en KIC augmente le niveau d'acyls-CoA reliés à la leucine et diminue le niveau d'acétyl-CoA. Les mitochondries des hépatocytes des souris HLLKO traitées avec KIC présentent un gonflement marqué. L'hyperammoniémie des souris HLLKO répond au traitement par l'acide N-carbamyl-L-glutamique. Ce composé permet de contourner une enzyme acétyl-CoA-dépendante essentielle pour l’uréogenèse, le N-acétylglutamate synthase. Ceci démontre un mécanisme d’hyperammoniémie lié aux acyls-CoA. Dans une deuxième EIM des acyls-CoA, la souris SCADD, déficiente en déshydrogénase des acyls-CoA à chaînes courtes. Le profil des acyls-CoA hépatiques montre un niveau élevé du butyryl-CoA particulièrement après un jeûne et après une charge en triglycérides à chaîne moyenne précurseurs du butyryl-CoA. / Most conditions detected by expanded newborn screening result from deficiency of one of the enzymes that degrade acyl-CoA esters in mitochondria. The role of acyl-CoAs in the pathophysiology of these disorders is poorly understood, in part because CoA esters are intracellular and samples are not generally available from human patients. We created a mouse model of one such condition, deficiency of 3-hydroxy-3-methylglutaryl-CoA lyase (HL), in liver (HLLKO mice). HL catalyses a reaction of ketone body synthesis and of leucine degradation. Chronic HL deficiency and acute crises each produced distinct abnormal liver acyl-CoA patterns, which would not be predictable from levels of urine organic acids and plasma acylcarnitines. In HLLKO hepatocytes, ketogenesis was undetectable. Measures of Krebs cycle flux diminished following incubation of HLLKO mitochondria with the leucine metabolite 2-ketoisocaproate (KIC). HLLKO mice also had suppression of the normal hyperglycemic response to a systemic pyruvate load, a measure of gluconeogenesis. Hyperammonemia and hypoglycemia, cardinal features of many inborn errors of acyl-CoA metabolism, occurred spontaneously in some HLLKO mice and were inducible by administering KIC. KIC loading also increased levels of several leucine-related acyl-CoAs and reduced acetyl-CoA levels. Ultrastructurally, hepatocyte mitochondria of KIC-treated HLLKO mice show marked swelling. KIC-induced hyperammonemia improved following administration of carglumate (N-carbamyl-L-glutamic acid), which bypasses an acetyl-CoA-dependent reaction essential for urea cycle function, thus demonstrating an acyl-CoA-related mechanism for this complication. In a second animal model of an inborn error of acyl-CoA metabolism, short chain acyl-CoA dehydrogenase (SCAD)-deficient mice, the main finding in liver acyl-CoAs is increased butyryl-CoA, particularly during fasting or after enteral loading with medium chain triglyceride precursor of butyryl-CoA.

Tesis por compendio / [EN] Carbamoyl phosphate synthetase 1 (CPS1), a 1462-residue mitochondrial enzyme, catalyzes the entry of ammonia into the urea cycle, which converts ammonia, the neurotoxic waste product of protein catabolism, into barely toxic urea. The urea cycle inborn error and rare disease CPS1 deficiency (CPS1D) is inherited with mendelian autosomal recessive inheritance, being due to CPS1 gene mutations (>200 mutations reported), and causing life-threatening hyperammonemia. We have produced recombinantly human CPS1 (hCPS1) in a baculovirus/insect cell expression system, isolating the enzyme in active and highly purified form, in massive amounts. This has allowed enzyme crystallization for structural studies by X-ray diffraction (an off-shoot of the present studies). This hCPS1 production system allows site-directed mutagenesis and enzyme characterization as catalyst (activity, kinetics) and as protein (stability, aggregation state, domain composition). We have revealed previously unexplored traits of hCPS1 such as its domain composition, the ability of glycerol to replace the natural and essential CPS1 activator N-acetyl-L-glutamate (NAG), and the hCPS1 protection (chemical chaperoning) by NAG and by its pharmacological analog N-carbamyl-L-glutamate (NCG). We have exploited this system to explore the effects on the activity, kinetic parameters and stability/folding of the enzyme, and to test the disease-causing nature, of mutations identified in patients with CPS1 deficiency (CPS1D). These results, supplemented with those obtained with other non-clinical mutations, have provided novel information on the functions of three non-catalytic domains of CPS1. We have introduced three CPS1D-associated mutations and one trivial polymorphism in the glutaminase-like domain of CPS1, supporting a stabilizing and an activity-enhancing function of this non-catalytic domain. Two mutations introduced into the bicarbonate phosphorylation domain have shed light on bicarbonate binding and have directly confirmed the importance of this domain for NAG binding to the distant (in the sequence) C-terminal CPS1 domain. The introduction of 18 CPS1D-associated missense mutations mapping in a clinically highly eloquent central non-catalytic domain have proven the disease-causing nature of most of these mutations while showing that in most of the cases they trigger enzyme misfolding and/or destabilization. These results, by proving an important role of this domain in the structural integration of the multidomain CPS1 protein, have led us to call this domain the Integrating Domain. Finally, we have examined the effects of eight CPS1D-associated mutations, of one trivial polymorphism and of five non-clinical mutations, all of them mapping in the C-terminal domain of the enzyme where NAG binds, whereas we have re-analyzed prior results with another four clinical and five non-clinical mutations affecting this domain. We have largely confirmed the pathogenic nature of the clinical mutations, predominantly because of decreased activity, in many cases due to hampered NAG binding. A few mutations had substantial negative effects on CPS1 stability/folding. Our analysis reveals that NAG activation begins with a movement of the final part of the ß4-¿4 loop of the NAG site. Transmission of the activating signal to the phosphorylation domains involves helix ¿4 from this domain and is possibly transmitted by the mutually homologous loops 1313-1332 and 778-787 (figures are residue numbers) belonging, respectively, to the carbamate and bicarbonate phosphorylation domains. These two homologous loops are called from here on Signal Transmission Loops. / [ES] La carbamil fosfato sintetasa 1 (CPS1), una enzima mitocondrial, cataliza la entrada del amonio en el ciclo de la urea, que convierte esta neurotoxina derivada del catabolismo de las proteínas en urea, mucho menos tóxica. El déficit de CPS1 (CPS1D) es un error innato del ciclo de la urea, una enfermedad rara autosómica recesiva, que se debe a mutaciones en el gen CPS1 (>200 mutaciones descritas) y que cursa con hiperamonemia. Hemos producido CPS1 humana recombinante (hCPS1) en un sistema de expresión de células de insecto y baculovirus, y la hemos aislado en forma activa, muy pura y en cantidad elevada. Este sistema de producción de hCPS1 permite la realización de mutagénesis dirigida y la caracterización de la enzima como catalizador (actividad, cinética) y como proteína (estabilidad, estado de agregación y composición de dominios). Hemos revelado características de la hCPS1 antes no exploradas como es la composición de dominios, la capacidad que tiene el glicerol para reemplazar al activador natural y esencial de la CPS1, N-acetil-L-glutamato (NAG), y la protección de la hCPS1 por NAG y por su análogo farmacológico N-carbamil-L-glutamato (NCG) (chaperonas químicas). Hemos utilizado este sistema para explorar los efectos en actividad, parámetros cinéticos y estabilidad/plegamiento de la enzima, y para comprobar la naturaleza patogénica de mutaciones identificadas en pacientes con CPS1D. Estos resultados, junto con los obtenidos con otras mutaciones no clínicas, han aportado información novedosa sobre tres de los dominios no catalíticos de CPS1. Las observaciones realizadas tras introducir en el dominio de tipo glutaminasa de la enzima tres mutaciones asociadas a CPS1D y un polimorfismo trivial, apoyan la contribución de este dominio no catalítico a la estabilidad y a aumentar la actividad de la enzima. Dos mutaciones introducidas en el dominio de fosforilación de bicarbonato han arrojado luz sobre el modo de unión del bicarbonato (un sustrato). Los resultados de estas mutaciones también han confirmado la contribución de este dominio para la unión de NAG, cuyo sitio de unión se encuentra en el dominio C-terminal de CPS1, bastante alejado (en la secuencia) del dominio de fosforilación de bicarbonato. Además, hemos introducido 18 mutaciones de cambio de sentido asociadas a CPS1D, las cuales están localizadas en un dominio no catalítico, central y de elevada elocuencia clínica. Estos resultados han demostrado la naturaleza patogénica de estas mutaciones, ya que en la mayoría de los casos estas mutaciones producen un mal plegamiento o/y desestabilización de la enzima. Debido a que estos resultados han puesto de manifiesto el importante papel de este dominio en la integración estructural de la proteína multidominio CPS1, lo hemos llamado Dominio Integrador. Finalmente, hemos examinado los efectos de 8 mutaciones asociadas a CPS1D, de un polimorfismo trivial y de 5 mutaciones no clínicas, todas localizadas en el dominio C-terminal de la enzima, donde se une NAG. Además, hemos reanalizado resultados anteriores con otras 4 mutaciones clínicas y 5 no clínicas afectando a este dominio. Hemos confirmado el carácter patogénico de las mutaciones clínicas, las cuales predominantemente causan una disminución en la actividad enzimática, en muchos casos debida a que la unión de NAG se encuentra obstaculizada. Unas pocas mutaciones mostraron efectos negativos en la estabilidad/plegamiento de CPS1. Nuestros análisis revelan que la activación por el NAG empieza con un movimiento de la parte final del bucle ß4-¿4 del sitio de NAG. La transmisión de la señal activadora a los dominios de fosforilación implica a la hélice ¿4 de este dominio y posiblemente se transmite a través de los bucles homólogos 1313-1332 y 778-787 (numeración de residuos) pertenecientes, respectivamente, a los dominios de fosforilación de carbamato y bicarbonato. Por ello, hemos llamado a ambos bucles Bucles de / [CA] La carbamil fosfat sintetasa 1 (CPS1), un enzim mitocondrial, catalitza l'entrada d'amoni en el cicle de la urea, que convertix l'amoni, producte neurotòxic del catabolisme de les proteïnes, en urea, una molècula molt poc tòxica. El dèficit de CPS1 (CPS1D) és un error innat del cicle de la urea, una malaltia rara autosòmica recessiva, que es deu a mutacions en el gen CPS1 (>200 mutacions descrites) i que cursa amb hiperamonièmia. Hem produït CPS1 humana recombinant (hCPS1) en un sistema d'expressió de cèl·lules d'insecte i baculovirus, i l'hem aïllada en forma activa, molt pura i en gran quantitat. Això ha permés la cristal·lització de l'enzim per a estudis estructurals amb difracció de raios-X (treball no inclòs en esta tesi Aquest sistema de producció de hCPS1 permet la realització de mutagènesi dirigida i la caracterització de l'enzim com a catalitzador (activitat, cinètica) i com a proteïna (estabilitat, estat d'agregació i composició de dominis). Hem revelat característiques de la hCPS1 no explorades abans com és la composició de dominis, la capacitat que té el glicerol per a reemplaçar l'activador natural i essencial de CPS1, N-acetil-L-glutamat (NAG), i la protecció de la hCPS1 per NAG i pel seu anàleg farmacològic N-carbamil-L-glutamat (NCG) (xaperones químiques) . Hem utilitzat aquest sistema per a explorar els efectes en l'activitat, els paràmetres cinètics i l'estabilitat/plegament de l'enzim, i per a comprovar la naturalesa patogènica de mutacions identificades en pacients amb CPS1D. Aquestos resultats, junt amb els obtinguts amb altres mutacions no clíniques, han aportat informació nova sobre tres dels dominis no catalítics de la CPS1. Les observacions, després d'introduir tres mutacions associades a CPS1D i un polimorfisme trivial en el domini tipus glutaminasa de CPS1, recolzen la contribució d'aquest domini no catalític a l'estabilitat i a l'optimització de l'activitat enzimàtica. Dues mutacions introduïdes en el domini de fosforilació de bicarbonat han esclarit el mode d'unió de bicarbonat. Els resultats d'aquestes mutacions també han confirmat la contribució d'aquest domini per a la unió de NAG, el lloc d'unió de la qual es troba en el domini C-terminal de CPS1, prou allunyat (en la seqüència) del domini de fosforilació de bicarbonat. A més, hem introduït 18 mutacions de canvi de sentit associades a CPS1D, les quals estan localitzades en un domini no catalític, central i d'elevada eloqüència clínica. Aquestos resultats han demostrat la naturalesa patogènica d'aquestes mutacions, ja que, en la majoria dels casos produïxen un mal plegament o/i desestabilització de l'enzim. Pel fet que aquestos resultats han posat de manifest l'important paper d'aquest domini en la integració estructural de la proteïna multidomini CPS1, l'hem anomenat Domini Integrador. Finalment, hem examinat els efectes de huit mutacions associades a CPS1D, un polimorfisme trivial i cinc mutacions no clíniques, totes elles localitzades en el domini C-terminal de l'enzim, on s'unix NAG. A més, hem reanalitzat resultats anteriors amb altres quatre mutacions clíniques i cinc no clíniques que afecten aquest domini. Hem confirmat el caràcter patogènic de les mutacions clíniques, les quals predominantment causen una disminució en l'activitat enzimàtica, en molts casos pel fet que la unió de NAG es troba obstaculitzada. Unes poques mutacions van mostrar efectes negatius substancials en l'estabilitat/plegament de CPS1. Les nostres anàlisis revelen que l'activació de NAG comença amb un moviment de la part final del bucle ß4-¿4 del lloc de NAG. La transmissió del senyal activadora als dominis de fosforilació involucra l'hèlix ¿4 d'aquest domini i es transmet, possiblement, a través dels bucles homòlegs 1313-1332 i 778-787 (numeració dels residus), pertanyents, respectivament, als dominis de fosforilació de carbamato i bicarbonat. Per això, hem anomenat a ambd / Díez Fernández, C. (2015). USING RECOMBINANT HUMAN CARBAMOYL PHOSPHATE SYNTHETASE 1 (CPS1) FOR STUDYING THIS ENZYME'S FUNCTION, REGULATION, PATHOLOGY AND STRUCTURE [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/52855 / Compendio

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.

Newborn screening programs measure analyte levels in neonatal blood spots to identify individuals at high risk of disease. Carnitine and acylcarnitine levels are primary markers used in the detection of fatty acid oxidation disorders. These analytes may be influenced by certain pre/perinatal or newborn screening related factors. The primary objective of this study was to explore the association between these characteristics and levels of blood carnitines and acylcarnitines in the newborn population. The study was composed of two parts: a systematic review and a clinical database analysis of existing newborn screening data. The systematic review results suggested considerable variability across studies in the presence and directionality of associations between analyte levels and birth weight, gestational age, age at time of blood spot collection, type of sample, and storage time. Sex was not significantly associated with carnitine or acylcarnitine levels in neonatal blood. We identified a need to more fully investigate a potential interaction between gestational age and birth weight in regard to analyte levels. The secondary data analyses indicated a statistically significant relationship between analyte levels and all perinatal / infant and newborn screening related factors of interest, but effect sizes were generally small. The interaction between gestational age and birth weight was significant in all models; when further explored through graphical analysis with conditional means, extremely premature neonates stood out as having distinct analyte patterns in relation to birth weight. Variation in the ratio of total acylcarnitine to free carnitine was better accounted for by the perinatal and newborn factors than was variation in any individual carnitine or acylcarnitine, indicating that proportions of carnitine and acylcarnitines may be more important in understanding an individual’s metabolic functioning than individual analyte levels. A low proportion of variation was explained in all multivariate models, supporting the use of universal algorithms in newborn screening and suggesting the need for further large scale empirical research targeted at previously unaccounted for perinatal factors such as birth stress.

Indiana University-Purdue University Indianapolis (IUPUI) / Multiple sclerosis (MS) is a disabling disease that afflicts an estimated two million people worldwide. The disease is characterized by degradation of the myelin sheath that insulates neurons of the central nervous system manifesting as a heterogeneous collection of symptoms. Two enzymes, protein arginine deaminases type 2 and 4 (PAD2 and PAD4) have been implicated to play an etiologic role in demyelination and neurodegeneration by catalyzing a post-translational modification of arginine peptide residues to citrulline. The pathogenesis of MS is poorly understood, though vitamin D deficiency is a well-associated risk factor for developing the disorder. Using the experimental autoimmune encephalomyelitis (EAE) model of MS we demonstrate vitamin D treatment to attenuate over-expression of PAD 2 and 4 in the brain and spine during EAE. In addition, we identify two molecules produced by peripheral immune cells, IFNɣ and IL-6, as candidate signaling molecules that induce PAD expression in the brain. We demonstrate vitamin D treatment to inhibit IFNɣ mediated up regulation of PAD2 and PAD4 both directly within the brain and by modulating PAD-inducing cytokine production by infiltrating immune cells. These results provide neuroprotective rational for the supplementation of vitamin D in MS patients. More importantly, these results imply an epigenetic link between vitamin D deficiency and the pathogenesis of MS that merits further investigation.