Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-16T19:41:42Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_NathanaJamilleMezzomo.pdf: 2403536 bytes, checksum: a811beb07b8f995e286c3f3f76fad6bd (MD5) / Made available in DSpace on 2018-08-16T19:41:42Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_NathanaJamilleMezzomo.pdf: 2403536 bytes, checksum: a811beb07b8f995e286c3f3f76fad6bd (MD5) Previous issue date: 2015-03-27 / Phenylketonuria (PKU) is an inborn error of phenylalanine (Phe) metabolism caused by a deficiency of hepatic phenylalanine hydroxylase enzyme (EC 1.14.16.1 - PAH), which converts Phe tyrosine (Tyr), resulting in hyperphenylalaninemia. Excess Phe compromises the developing brain of affected individuals. Considering the creatine energy and neuroprotective substance, the aim of use it in liposomal form was to increase its concentration in the brain and evaluate parameters of energy metabolism, oxidative stress and behavioral usually changed by excess Phe in PKU patients or hyperphenylalaninemia (HPA) animals. Also, check whether the administrations of nanoparticles could affect non-PAH rats parameters, thus evaluating a neurotoxic action. The ethanol injection method for production of liposomes containing creatine allowed the formation of nanoscale particles with pH around the saline, with an average size of 236.44 nm, a polydispersity index below 0.3, mean zeta potential of -23.9 mV, encapsulation efficiency of 33.65% and creatine content of 93%. The HPA alter the activity of cytosolic and mitochondrial fractions of creatine kinase (CK) in the cerebral cortex and the hippocampus in the mitochondrial fraction, however, did not affect the activity of pyruvate kinase (PK) and adenilato kinase (AK) the analyzed brain structures. The administration of liposomes containing creatine (LCr) possibly prevented the alterations of cytosolic and mitochondrial CK activity in the cerebral cortex of the HPA group. Induction HPA did not change the oxidative stress parameters evaluated in the brain cortex and hippocampus. However, administration of LCr in animals non-HPA, increased levels of GSH antioxidant and superoxide dismutase activity (SOD) and in contrast, stimulated an increased of dihydrodichlorofluorescein oxidation (DCFH) in cerebral cortex. The blank liposomes (LBr) also increased the reduced glutathione (GSH) content in the cerebral cortex. Associated with these results, one can also check the cerebral impairment of the HPA animals through the reduced brain mass, open field test, tail suspension and elevated zero maze. The administration of LCr the HPA animals can partially prevent changes in enzyme activity, as well as the number of rearings improved open field test and the number of head-dipping of the elevated zero maze test. In short, we believe that the LCr may have crossed the blood-brain barrier, since its effects were differentiated administration of free creatine (Cr), thus preventing changes caused by Phe administration on behavioral tests and enzyme activity energy metabolism in the cortex and hippocampus. / A fenilcetonúria (PKU) é um erro inato do metabolismo do aminoácido fenilalanina (Phe) provocado pela deficiência da enzima hepática fenilalanina hidroxilase (EC 1.14.16.1 - PAH), que converte Phe em tirosina (Tyr), resultando em hiperfenilalaninemia. O excesso de Phe compromete o desenvolvimento cerebral dos indivíduos afetados. Considerando a creatina uma substância energética e neuroprotetora, o objetivo de utilizá-la na forma lipossomal foi o de aumentar sua concentração no cérebro e avaliar parâmetros do metabolismo energético, do estresse oxidativo e comportamentais, normalmente alterados pelo excesso de Phe em pacientes PKU ou em animais com hiperfenilalaninemia (HPA). Além de verificar se as administrações das nanopartículas poderiam afetar os parâmetros de ratos não-HPA, avaliando dessa forma uma ação neurotóxica. O método de injeção de etanol utilizado para a produção dos lipossomas contendo creatina permitiu a formação de partículas nanométricas com pH próximo ao da salina, com tamanho médio de 236,44 nm, índice de polidispersão abaixo de 0,3, potencial zeta médio de -23,9 mV, eficiência de encapsulação de 33,65 % e teor de 93 %. A HPA alterou a atividade das frações citosólica e mitocondrial da creatinacinase (CK) no córtex cerebral e na fração mitocondrial no hipocampo, porém, não afetou a atividade da piruvatoquinase (PK) e adenilatoquinase (AK) nas estruturas cerebrais estudadas. A administração de lipossomas contendo creatina (LCr), possivelmente preveniu as alterações da atividade da CK citosólica e mitocondrial no córtex cerebral dos grupo HPA. A indução a HPA não alterou os parâmetros de estresse oxidativo avaliados no córtex cerebral e hipocampo. No entanto, a administração de LCr nos animais não-HPA, aumentou os níveis do antioxidante glutationa reduzida (GSH) e a atividade da superóxido dismutase (SOD) e em contrapartida, estimularam uma maior oxidação de diclodihidrofluoresceína (DCFH) em córtex cerebral. Os lipossomas brancos (LBr) também elevaram a concentração de GSH no córtex cerebral. Associado a esses resultados, pode-se também verificar o comprometimento cerebral dos animais HPA por meio da redução da massa cerebral, testes de campo aberto, suspensão da cauda e labirinto zero elevado. A administração de LCr nos animais HPA, pode prevenir parcialmente alterações das atividades enzimáticas, assim como melhorou o número de levantamentos do teste de campo aberto e o número de espiadas do teste labirinto zero elevado. Em suma, acreditamos que os LCr possam ter atravessado a barreira sangue-cérebro, uma vez que seus efeitos foram diferenciados da administração da creatina livre (Cr), conseguindo prevenir alterações causadas pela administração de Phe sobre o testes comportamentais e a atividade de enzimas do metabolismo energético do córtex e hipocampo.

Objective: The objective of this thesis was to estimate the impact on newborn screening (NBS) results of changing screening technology from tandem mass spectrometry (MS/MS) to an approach using targeted next-generation sequencing (T-NGS) and MS/MS in parallel. Methods: We integrated results of an analysis of MS/MS screening data for phenylketonuria (PKU) and medium-chain acyl-CoA dehydrogenase (MCAD) deficiency; and a query of genetic compendia for variants of genes associated with the two disorders. Results: The introduction of T-NGS into NBS may reduce nearly 80% of false positives that are generated using the current screening approach. Based on estimated NBS results, T-NGS may be applied using a second-tier approach, which may improve specificity while maintaining sensitivity at its current level. Discussion: T-NGS may enhance the performance of NBS for PKU by improving specificity when used as a second tier test, but may be limited by feasibility and cost under current circumstances. Future studies should consider the cost-effectiveness of T-NGS for all infants undergoing NBS.

No description available.

This study set out to express, purify and characterize twelve ammonia lyase enzymes for potential application as a supplement to a treatment of an inborn error of metabolism disease. The DNA sequence for two wild-type ammonia lyases, three modified ammonia lyases and seven resurrected ancestral ammonia lyases had been synthesized and cloned in vectors. These were transformed into Escherichia coli, expressed, purified using immobilized metal affinity chromatography and size exclusion chromatography and characterized. Ten of the enzymes were successfully expressed and purified. All enzymes had a higher turnover number with substrate 1 than with substrate 2. The wild-types showed the highest catalytic turnover and one of them displayed substrate cooperativity. The modified enzymes were inactive. Some ancestral enzymes were active and had decreasing kcat with age. A promising ancestral enzymes was found that showed a kcat of 2,85 s-1 with substrate 1 and 1,82 s-1 with substrate 2. The ancestral enzymes had a lower Km with substrate 2 compared to substrate 1, while one of the wild-types had a higher Km with substrate 2 than with substrate 1, indicating that the substrate affinity has switched. The ancestral enzymes had increased thermostability compared to the wild-types which increased with age. Ranging from a +7C increase in melting temperature with the youngest ancestral enzyme to +10,7C with the oldest tested enzyme, comparing with one of the wild-types. The promising ancestral enzyme displayed a higher stability than the wild-types during long term incubation in 37_C and 25_C, since it did not become prone to aggregation,it did not show visible degradation on SDS-PAGE and it retained the highest activity following incubation. It was also demonstrated that neither wild-types nor the promising ancestral enzyme were stable in a simulated gut environment. The promising ancestral enzyme and one of the wild-types degraded substrate 1 and 2 in serum. Using the resurrection of ancestral sequences a promising enzyme has been produced and characterized, displaying properties that are desired in therapeutic enzymes. The enzyme did not aggregate or become prone to aggregation over time, it was thermostable, it was active in serum and had acceptable catalytic properties. For therapeutic application of the ancestral enzyme, immunogenicty should be analyzed in silico and in vitro followed by further investigation in vivo. / Målet med denna studie var att uttrycka, rena och karaktärisera tolv ammonia lyase enzymer, för potentiell användning som komplement till en behandling utav en sjukdom, som tillhör sjukdomsgruppen medfödda ämnesomsättningsrubbningar. DNA sekvensen för två vild-typammonia lyaser, tre modifierade ammonia lyaser och sju återuppväckta ammonia lyaser hade blivit syntetiserade och klonade i vektorer. E.coli celler blev transformerade med vektorerna, vilka uttryckte enzymerna, som renades med hjälp av immobilized metal affinity chromatography och gelfiltrering och karaktäriserades. Tio utav enzymerna kunde uttryckas och renas. Alla enzymer hade högre katalytisk omsättning av substrat 1 än substrat 2. Vildtyperna hade högst kcat med båda substrat och en utav dem uppvisade substratsammarbete. De modifierade enzymerna var inaktiva. Några av de återuppväckta ammonia lyaserna var aktiva och kcat minskade med ålder. Ett av de återuppväckta enzymerna var lovande och hade ett kcat värde av 2,85 s-1 med substrat 1 och 1,82 s-1 med substrat 2. De återuppväckta enzymerna hade ett lägre Km värde för substrat 2 än substrat 1, jämfört med en utav vildtyperna som hade ett högre Km värde för substrat 2 än substrat 1, vilket indikerar ett skifte i substrataffinitet. De återuppväckta enzymerna var mer termostabilia än vild-typerna och termostabiliteten ökar med ålder. Ökningen i smälttemperatur låg i spannet av +7C för de yngsta återuppväckta enzymerna till + 10,7C för det äldsta testade återuppväckta enzymet, vid jämförelse med en utav vild-typerna. Det lovande återuppväckta enzymet demonstrerade även en högre stabilitet än vild-typerna under långtidsinkubering, eftersom den inte blev benägen att aggregera, den uppvisade ingen nedbrytning på SDS-PAGE och den behöll högst aktivitet efter inkubering. Det bevisades även att varken vild-typerna eller det lovande återuppväckta enzymet var stabila i en simulerad magsäcksmiljö. Både det lovande återuppväckta enzymet och en av vild-typerna bröt ner substrat 1 och 2 i serum. Genom att återuppväcka sekvenser kunde ett lovande enzym produceras och karaktäriseras, vilket uppvisade egenskaper som är eftertraktade i terapeutiska enzymer. Enzymet aggregerade ej, det blev inte benäget att aggregera över tid, det var termostabilt, det var aktivt i serum och hade acceptabla katalytiska egenskaper. För terapeutisk applikation av det återuppväckta enzymet, borde analys av dess immunogenicitet utföras in silico och in vitro följt av vidare undersökning in vivo.

Introdução: A Doença da Urina do Xarope do Bordo (DXB) é um Erro Inato do Metabolsimo (EIM), causada pela deficiência da atividade do complexo enzimático desidrogenase dos L-cetoácidos de cadeia ramificada (CACR). O programa público brasileiro de triagem neonatal não inclui o diagnóstico e o tratamento da DXB. Objetivo: Caracterizar aspectos relacionados ao diagnóstico e ao tratamento de pacientes brasileiros com DXB. Metodologia: Estudo retrospectivo. Os pacientes foram identificados a partir dos registros de laboratório considerado referência nacional para o diagnóstico de DXB, e de contato com demais serviços nacionais de referência em genética médica. O diagnóstico foi realizado entre 1992-2011. Os dados analisados foram obtidos a partir da revisão de prontuários. Resultados: Oitenta e três pacientes, oriundos de 75 famílias, foram incluídos no estudo (mediana de idade= 3 anos; IQ25- 75= 0,57-7). A mediana da idade de início dos sintomas foi de 10 dias (IQ= 5-30), enquanto que a mediana da idade ao diagnóstico foi de 60 dias (IQ= 29-240, p= 0,001). Apenas três (3,6%) pacientes foram diagnosticados antes de desenvolverem manifestações clínicas. A comparação entre os pacientes com (n=12) e sem (n=71) diagnóstico precoce mostrou que o mesmo associa-se com a presença de história familiar positiva e diminuição da prevalência de manifestações clínicas ao diagnóstico, mas não com melhor resultado; além disso, a maioria desses diagnósticos foi realizada entre 2002-2011 (n= 10/12). Considerando a amostra total, 98,8% dos pacientes apresentam atraso de desenvolvimento neuropsicomotor. Conclusão: Os pacientes com DXB são diagnosticados tardiamente no Brasil, de forma que as complicações associadas a esta condição não são prevenidas. Entretanto, existem indícios de que está havendo um melhora gradual desse panorama desde a última década. Os nossos dados indicam que o diagnóstico precoce dessa condição, mesmo que em fase sintomática, associa-se a um melhor prognóstico do paciente. Sugere-se a elaboração de políticas públicas específicas para doenças raras no país. / Introduction: Maple syrup urine disease (MSUD) is an Inborn Errors of Metabolism, is caused by a deficiency in activity of the branched-chain L-keto acid dehydrogenase complex. The Brazilian neonatal screening program does not include the diagnosis and treatment of MSUD. Objective: To draw a profile of aspects related to the diagnosis and treatment of Brazilian patients who received. Methods: In this retrospective study, patients were identified through a search of records from a national reference laboratory for the diagnosis of MSUD and through contact with other medical genetics services across Brazil. A diagnosis of MSUD between 1992 and 2011. Data were collected by means of a chart review. Results: Eighty-three patients from 75 families were enrolled in the study (median age 3 years; interquartile range, 0.57–7). Median age at onset of symptoms was 10 days (IQR 5–30), whereas median age at diagnosis was 60 days (IQR 29–240, p=0.001). Only three (3.6%) patients were diagnosed before the onset of clinical manifestations. A comparison between patients with (n=12) and without (n=71) an early diagnosis show that early diagnosis is associated with the presence of positive familial history and decreased prevalence of clinical manifestations at the time of diagnosis, but not with a better outcome. Overall, 98.8% of patients have some psychomotor or neurodevelopmental delay. Conclusion: In Brazil, patients with MSUD receive a late diagnosis and show neurological compromise and poor survival even with an early diagnosis. We suggest that specific public policies for rare diseases should be developed and implemented in the country.

Introdução: A Doença da Urina do Xarope do Bordo (DXB) é um Erro Inato do Metabolsimo (EIM), causada pela deficiência da atividade do complexo enzimático desidrogenase dos L-cetoácidos de cadeia ramificada (CACR). O programa público brasileiro de triagem neonatal não inclui o diagnóstico e o tratamento da DXB. Objetivo: Caracterizar aspectos relacionados ao diagnóstico e ao tratamento de pacientes brasileiros com DXB. Metodologia: Estudo retrospectivo. Os pacientes foram identificados a partir dos registros de laboratório considerado referência nacional para o diagnóstico de DXB, e de contato com demais serviços nacionais de referência em genética médica. O diagnóstico foi realizado entre 1992-2011. Os dados analisados foram obtidos a partir da revisão de prontuários. Resultados: Oitenta e três pacientes, oriundos de 75 famílias, foram incluídos no estudo (mediana de idade= 3 anos; IQ25- 75= 0,57-7). A mediana da idade de início dos sintomas foi de 10 dias (IQ= 5-30), enquanto que a mediana da idade ao diagnóstico foi de 60 dias (IQ= 29-240, p= 0,001). Apenas três (3,6%) pacientes foram diagnosticados antes de desenvolverem manifestações clínicas. A comparação entre os pacientes com (n=12) e sem (n=71) diagnóstico precoce mostrou que o mesmo associa-se com a presença de história familiar positiva e diminuição da prevalência de manifestações clínicas ao diagnóstico, mas não com melhor resultado; além disso, a maioria desses diagnósticos foi realizada entre 2002-2011 (n= 10/12). Considerando a amostra total, 98,8% dos pacientes apresentam atraso de desenvolvimento neuropsicomotor. Conclusão: Os pacientes com DXB são diagnosticados tardiamente no Brasil, de forma que as complicações associadas a esta condição não são prevenidas. Entretanto, existem indícios de que está havendo um melhora gradual desse panorama desde a última década. Os nossos dados indicam que o diagnóstico precoce dessa condição, mesmo que em fase sintomática, associa-se a um melhor prognóstico do paciente. Sugere-se a elaboração de políticas públicas específicas para doenças raras no país. / Introduction: Maple syrup urine disease (MSUD) is an Inborn Errors of Metabolism, is caused by a deficiency in activity of the branched-chain L-keto acid dehydrogenase complex. The Brazilian neonatal screening program does not include the diagnosis and treatment of MSUD. Objective: To draw a profile of aspects related to the diagnosis and treatment of Brazilian patients who received. Methods: In this retrospective study, patients were identified through a search of records from a national reference laboratory for the diagnosis of MSUD and through contact with other medical genetics services across Brazil. A diagnosis of MSUD between 1992 and 2011. Data were collected by means of a chart review. Results: Eighty-three patients from 75 families were enrolled in the study (median age 3 years; interquartile range, 0.57–7). Median age at onset of symptoms was 10 days (IQR 5–30), whereas median age at diagnosis was 60 days (IQR 29–240, p=0.001). Only three (3.6%) patients were diagnosed before the onset of clinical manifestations. A comparison between patients with (n=12) and without (n=71) an early diagnosis show that early diagnosis is associated with the presence of positive familial history and decreased prevalence of clinical manifestations at the time of diagnosis, but not with a better outcome. Overall, 98.8% of patients have some psychomotor or neurodevelopmental delay. Conclusion: In Brazil, patients with MSUD receive a late diagnosis and show neurological compromise and poor survival even with an early diagnosis. We suggest that specific public policies for rare diseases should be developed and implemented in the country.

Introdução: A Doença da Urina do Xarope do Bordo (DXB) é um Erro Inato do Metabolsimo (EIM), causada pela deficiência da atividade do complexo enzimático desidrogenase dos L-cetoácidos de cadeia ramificada (CACR). O programa público brasileiro de triagem neonatal não inclui o diagnóstico e o tratamento da DXB. Objetivo: Caracterizar aspectos relacionados ao diagnóstico e ao tratamento de pacientes brasileiros com DXB. Metodologia: Estudo retrospectivo. Os pacientes foram identificados a partir dos registros de laboratório considerado referência nacional para o diagnóstico de DXB, e de contato com demais serviços nacionais de referência em genética médica. O diagnóstico foi realizado entre 1992-2011. Os dados analisados foram obtidos a partir da revisão de prontuários. Resultados: Oitenta e três pacientes, oriundos de 75 famílias, foram incluídos no estudo (mediana de idade= 3 anos; IQ25- 75= 0,57-7). A mediana da idade de início dos sintomas foi de 10 dias (IQ= 5-30), enquanto que a mediana da idade ao diagnóstico foi de 60 dias (IQ= 29-240, p= 0,001). Apenas três (3,6%) pacientes foram diagnosticados antes de desenvolverem manifestações clínicas. A comparação entre os pacientes com (n=12) e sem (n=71) diagnóstico precoce mostrou que o mesmo associa-se com a presença de história familiar positiva e diminuição da prevalência de manifestações clínicas ao diagnóstico, mas não com melhor resultado; além disso, a maioria desses diagnósticos foi realizada entre 2002-2011 (n= 10/12). Considerando a amostra total, 98,8% dos pacientes apresentam atraso de desenvolvimento neuropsicomotor. Conclusão: Os pacientes com DXB são diagnosticados tardiamente no Brasil, de forma que as complicações associadas a esta condição não são prevenidas. Entretanto, existem indícios de que está havendo um melhora gradual desse panorama desde a última década. Os nossos dados indicam que o diagnóstico precoce dessa condição, mesmo que em fase sintomática, associa-se a um melhor prognóstico do paciente. Sugere-se a elaboração de políticas públicas específicas para doenças raras no país. / Introduction: Maple syrup urine disease (MSUD) is an Inborn Errors of Metabolism, is caused by a deficiency in activity of the branched-chain L-keto acid dehydrogenase complex. The Brazilian neonatal screening program does not include the diagnosis and treatment of MSUD. Objective: To draw a profile of aspects related to the diagnosis and treatment of Brazilian patients who received. Methods: In this retrospective study, patients were identified through a search of records from a national reference laboratory for the diagnosis of MSUD and through contact with other medical genetics services across Brazil. A diagnosis of MSUD between 1992 and 2011. Data were collected by means of a chart review. Results: Eighty-three patients from 75 families were enrolled in the study (median age 3 years; interquartile range, 0.57–7). Median age at onset of symptoms was 10 days (IQR 5–30), whereas median age at diagnosis was 60 days (IQR 29–240, p=0.001). Only three (3.6%) patients were diagnosed before the onset of clinical manifestations. A comparison between patients with (n=12) and without (n=71) an early diagnosis show that early diagnosis is associated with the presence of positive familial history and decreased prevalence of clinical manifestations at the time of diagnosis, but not with a better outcome. Overall, 98.8% of patients have some psychomotor or neurodevelopmental delay. Conclusion: In Brazil, patients with MSUD receive a late diagnosis and show neurological compromise and poor survival even with an early diagnosis. We suggest that specific public policies for rare diseases should be developed and implemented in the country.

Abstract The mitochondrial oxidative phosphorylation system is composed of five multisubunit enzyme complexes. Complex I is the first and largest of these, containing 46 subunits, seven encoded by mitochondrial DNA (mtDNA) and the rest by nuclear DNA. Isolated complex I deficiency is a major cause of metabolic errors in infancy and childhood, presenting as encephalomyopathies or multisystem disorders. Due to the bigenomic origin of complex I, the genetic causes of these defects can be either mitochondrial or nuclear. The object of the present work was to identify the underlying genetic cause in cases of children with complex I deficiency and to obtain more information on the structurally and functionally important sites of complex I subunits. The complete coding region of mtDNA was analysed by conformation-sensitive gel electrophoresis and subsequent sequencing. In addition, nine nuclear genes encoding conserved subunits of complex I were sequenced. The structural and functional consequences of the new sequence variants were further elucidated using mutagenesis of homologous residue in bacterial NDH-1 or by studying complex I assembly and expression in patient cell lines. Analysis of the mtDNA coding region in 50 children revealed four definitely pathogenic mutations, 3460G>A, 10191T>C, 11778G>A and 14487T>C, in seven patients. In addition, two novel mtDNA base pair substitutions were identified, 3866T>C in a patient with muscle weakness and short stature and 4681T>C in a patient with Leigh syndrome. The latter mutation causes a Leu71Pro amino acid exchange in the ND2 subunit. Cybrid clones harbouring this mutation retained the complex I defect, and reduced amounts of fully assembled complex I were detected in patient cell lines. The 3866T>C mutation leads to a Ile187Thr amino acid substitution in the ND1 subunit, and functional studies of the homologous amino acid substitution in E. coli showed that this had an effect on the assembly or stability of the NDH-1 holoenzyme. Sequencing of the nine nuclear-encoded complex I genes revealed only one novel base pair substitution with pathogenic potential. Further studies are needed, however, to establish the role of the Arg18Cys substitution in the mitochondrial leading peptide of the TYKY subunit. The above findings emphasize the contribution of mtDNA mutations to the aetiology of pediatric patients with complex I deficiency. Furthermore, two LHON primary mutations were identified in the present cohort of patients, although the clinical signs differed considerably from the classical symptoms of LHON. This suggests that the phenotype caused by primary LHON mutations is more variable than has so far been thought.

The role of biological markers (biomarkers) in public health, pediatric medicine and clinical toxicology cannot be understated. Clinically validated biomarkers used in newborn screening (NBS) serve to detect individuals at risk for a disease in the population, pre-symptomatically diagnose affected neonates early in life and/or accurately predict disease progression and treatment responses to therapy. However, there is urgent need for the discovery of more specific biomarkers that can improve screening accuracy in a high throughput, cost-effective yet ethical manner. The major objectives of this thesis were to develop innovative nontargeted metabolite profiling methodologies based on multisegment injection-capillary electrophoresis-mass spectrometry (MSI-CE-MS) for early detection of treatable genetic diseases, as well as comprehensive surveillance of drugs of abuse (DoA) in high risk subjects. Chapter II introduces a multiplexed MSI-CE-MS strategy for confirmatory testing of known biomarkers for various inborn errors of metabolism from a dried blood spot (DBS) that was rigorously validated using proficiency test specimens from Centres for Disease Control and Prevention (CDC) and authentic neonatal samples from Newborn Screening Ontario (NSO) with quality assurance. Additionally, MSI-CE-MS together with temporal signal pattern recognition revealed for the first time a novel class of pathognomonic marker elevated in galactosemia, namely N-galactated amino acids. Chapter III describes an untargeted metabolomic study to discover biomarkers of cystic fibrosis (CF) to reduce the high false positive rate and widespread carrier identification by current two-tiered NBS algorithms that rely on genetic testing. A panel of metabolites from retrospective DBS specimens, including several amino acids, ophthalmic acid and an unknown peptide, allowed for differentiation of asymptomatic CF neonates from screen-positive yet unaffected carriers and transient hypertrypsinogenemic cases. Chapter IV develops and validates a high throughput MSI-CE-MS assay for rapid screening for DoA and their metabolites in human urine with improved specificity and broad spectrum coverage as compared to classic targeted immunoassays. This method can also applied to ensure compliance, drug efficacy and patient safety while detecting for potential substitution or adulteration when using high resolution MS/MS. In summary, this thesis contributes an innovative methodology and data workflow for biomarker discovery for improved neonatal screening of rare genetic diseases in the population, which was also applied for more effective drug surveillance strategies in public health given the alarming worldwide opioid crisis. / Thesis / Doctor of Philosophy (PhD)

Introdução: A Doença da Urina do Xarope de Bordo é uma doença hereditária do metabolismo dos aminoácidos de cadeia ramificada, de caráter autossômico recessivo. O diagnóstico precoce é fundamental na prevenção da deterioração neurológica, que se dá pela ausência da implementação do tratamento nutricional adequado. Objetivo: Realizar triagem das mutações em todos os éxons dos três genes envolvidos na Doença da Urina do Xarope de Bordo (BCKDHA, BCKDHB e DBT) através do sequenciamento gênico direto e correlacionar com a heterogeneidade fenotípica. Métodos: Estudo clínico transversal com pacientes chilenos diagnosticados com Doença da Urina do Xarope de Bordo. A genotipagem foi realizada com produtos purificados de reação em cadeia da polimerase (PCR) de DNA.Foi realizada análise in silico das substituições de nucleotídeos através dos softwares MutPred® v1.2, Polyphen-2® - Polymorphism Phenotyping v2 e SIFT®. As características clínicas dos pacientes foram fornecidas pela equipe de nutrição do Instituto de Nutrição e Tecnologia da Universidade de Chile (INTA). Foi realizado um teste exato de Fisher no grupo de pacientes portadores da mutação mais prevalente na amostragem, a I214K com a intenção de avaliar o grau de correlação entre algumas variáveis clínicas e genéticas para verificar a possibilidade de se estabelecer uma relação fenótipo/genótipo. Resultados: Dos 18 pacientes 88% apresentaram mutação no gene BCKDHB, 1 pacientes 5% apresentou mutação no gene BCKDHA e 1 (5%) paciente apresentou mutação no gene DBT. Foram encontradas um total de 8 mutações na amostra e 4 novas mutações (50%). Não se pode afirmar que há correlação de nenhuma das variáveis clínicas com os genótipos encontrados nessa amostragem. Conclusão: Este estudo reportou 4 novas mutações em pacientes portadores de DXB na população chilena, o que pode ajudar em futuros diagnósticos genéticos da doença. Se a DXB fosse diagnosticada de forma mais rápida, na triagem neonatal, talvez fosse possível estabelecer uma relação genótipo-fenótipo de forma mais eficiente / Introduction: Maple Syrup Urine Disease (MSUD) is an autossomal recessive hereditary disease of the branched-chain amino acid metabolism. Early diagnosis is essential in preventing neurological deterioration, which occurs due to inadequate nutritional implametation treatment. Purpose: Screen mutations in all exons from the three genes involved in MSUD (BCKDHA, BCKDHB and DBT) through direct gene sequencing and correlation with phenotypic heterogeneity. Methods: A cross-sectional study with Chilean patients diagnosed with Maple Syrup Urine Disease. Genotyping was performed using purified polymerase chain reaction (PCR) DNA. Nucleotide substitutions In Silico analysis was performed using MutPred® v1.2, Polyphen-2® - Polymorphism Phenotyping v2 and SIFT® softwares. Patients clinical characteristics were provided by the nutrition team from Chile University, Nutriton and Technology Institute (INTA). Results: Of the 18 patients, 88% presented mutation in BCKDHB gene, 1 patient had mutation in BCKDHA gene and 1 patient (5%) presented a mutation in DBT gene. A total of 8 mutations in the sample and 4 new mutations (50%) were found. It can not be affirmed that there is correlation between clinical variables and genotypes in this sample. Conclusion: This study reported 4 new mutations in patients with MSUD in Chilean population, which may help in future genetic diagnosis. If MSUD was diagnosed more rapidly in neonatal screening, it might be possible to establish a genotype-phenotype relationship more efficiently