Test Code MPS3W Mucopolysaccharidosis III, Four-Enzyme Panel, Leukocytes
Shipping Instructions
For optimal isolation of leukocytes, it is recommended the specimen arrive refrigerated within 6 days of collection to be stabilized. Collect specimen Monday through Thursday only and not the day before a holiday. Specimen should be collected and packaged as close to shipping time as possible.
Necessary Information
1. Patient's age is required.
2. Reason for testing is required.
Specimen Required
Container/Tube:
Preferred: Yellow top (ACD solution B)
Acceptable: Yellow top (ACD solution A) or lavender top (EDTA)
Specimen Volume: 6 mL
Collection Instructions: Send whole blood specimen in original tube. Do not aliquot.
Forms
1. New York Clients-Informed consent is required. Document on the request form or electronic order that a copy is on file. The following documents are available:
-Informed Consent for Genetic Testing (T576)
-Informed Consent for Genetic Testing-Spanish (T826)
2. Biochemical Genetics Patient Information (T602)
3. If not ordering electronically, complete, print, and send a Biochemical Genetics Test Request (T798) with the specimen.
Useful For
Supporting the biochemical diagnosis of mucopolysaccharidoses types IIIA, IIIB, IIIC, IIID
This test is not useful for carrier detection.
Special Instructions
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
MPS III (Four) Panel, WBCSpecimen Type
Whole Blood ACDSpecimen Minimum Volume
5 mL
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Whole Blood ACD | Refrigerated (preferred) | 6 days | |
Ambient | 6 days |
Reject Due To
Gross hemolysis | Reject |
Clinical Information
Mucopolysaccharidosis III (MPS III; Sanfilippo syndrome) is caused by reduced or absent activity of 1 of 4 enzymes involved in heparan sulfate degradation. Patients with MPS III uniformly excrete heparan sulfate resulting in similar clinical phenotypes and are further classified as type A, B, C, or D based upon the specific enzyme deficiency. MPS III is characterized by severe central nervous system (CNS) degeneration but only mild physical disease. Such disproportionate involvement of the CNS is unique among the MPS. Onset of clinical features, most commonly behavioral problems and delayed development, usually occurs between 2 and 6 years of age in a child who previously appeared normal. Severe neurologic degeneration occurs in most patients by 6 to 10 years of age accompanied by a rapid deterioration of social and adaptive skills with death generally occurring by their 20s. The occurrence of MPS III varies by subtype with types A and B being the most common and types C and D being very rare. The collective incidence is approximately 1 in 58,000 live births. This assay detects all MPSIII types (MPS IIIA, IIIB, IIIC, and IIID).
A diagnostic workup for MPS typically also includes GAG determination in urine (MPSQU / Mucopolysaccharides Quantitative, Random, Urine) or blood (MPSBS / Mucopolysaccharidosis, Blood Spot, or MPSER / Mucopolysaccharides Quantitative, Serum) and molecular genetic analysis of the relevant gene(s). For MPS III, a molecular panel is available that includes SGSH, NAGLU, GNS, HGSNAT (CGPH / Custom Gene Panel, Hereditary, Next-Generation Sequencing, Varies; specify Gene List ID: IEMCP-7YM613).
Reference Values
HEPARAN-N-SULFATASE:
>0.13 nmol/hour/mg protein
N-ACETYL-ALPHA-D-GLUCOSAMINIDASE:
>0.09 nmol/hour/mg protein
HEPARAN-ALPHA-GLUCOSAMINIDE N-ACETYLTRANSFERASE:
>0.24 nmol/hour/mg protein
N-ACETYLGLUCOSAMINE-6-SULFATASE:
>0.03 nmol/hour/mg protein
An interpretive report will be provided.
Interpretation
Abnormal results are not sufficient to establish a diagnosis of a particular disease. To verify a preliminary diagnosis based on this assay, additional biochemical or molecular genetic analyses are required.
When abnormal results are detected, a detailed interpretation is given, including an overview of the results and of their significance, a correlation to available clinical information, elements of differential diagnosis, recommendations for additional biochemical testing and in vitro confirmatory studies (enzyme assay, molecular analysis), and a phone number to reach one of the laboratory directors in case the referring physician has additional questions.
Cautions
Individuals with pseudodeficiency alleles can show reduced enzyme activity.
Carrier status (heterozygosity) for these conditions cannot be reliably detected.
Enzyme levels may be normal in individuals receiving enzyme replacement therapy or who have undergone hematopoietic stem cell transplant.
Method Description
Leukocytes are incubated with four cocktail mixes: 1) substrate and internal standard (IS) for iduronate 2-sulfatase, heparan N-sulfatase, alpha-N-acetylglucosaminidase, N-acetylgalactosamine-sulfate, beta-galactosidase, arylsulfatase B, beta-glucuronidase, and tripeptidyl peptidase 1; 2) substrate and IS for acetyl-CoA:alpha-glucosaminide N-acetyltransferase; 3) substrate and IS for N-acetylglucosamine-6-sulfatase; and 4) substrate and IS for palmitoyl-protein thioesterase 1 in 96-well plates. Following overnight incubation, the plates are combined and purified by liquid-liquid extraction. The extracts are evaporated, reconstituted with mobile phase, and analyzed by tandem mass spectrometry.(Unpublished Mayo method)
Day(s) Performed
Preanalytical processing: Monday through Saturday
Testing performed: Tuesday
Report Available
8 to 15 daysSpecimen Retention Time
WBC homogenate: 1 monthPerforming Laboratory
Mayo Clinic Laboratories in RochesterTest Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
82657
LOINC Code Information
Test ID | Test Order Name | Order LOINC Value |
---|---|---|
MPS3W | MPS III (Four) Panel, WBC | 104072-4 |
Result ID | Test Result Name | Result LOINC Value |
---|---|---|
BG767 | Reason for Referral | 42349-1 |
618456 | Heparan-N-sulfatase | 24086-1 |
618457 | N-acetyl-alpha-D-glucosaminidase | 24092-9 |
618458 | Heparan-alpha-glucosaminide N-acetyltransferase | 24044-0 |
618459 | N-acetylglucosamine-6-sulfatase | 24098-6 |
618460 | Interpretation | 59462-2 |
618455 | Reviewed By | 18771-6 |