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Test Code MISC2MAYOGALTP Galactose-1-Phosphate Uridyltransferase Biochemical Phenotyping, Erythrocytes

Reporting Name

Gal-1-Phos Urdyltrns Phenotype,RBC

Useful For

Determining the biochemical phenotype for galactosemia when enzymatic and molecular results are incongruent

Additional Tests

Test ID Reporting Name Available Separately Always Performed
GALT Gal-1-P Uridyltransferase, RBC Yes Yes

Testing Algorithm

A quantitative galactose-1-phosphate uridyltransferase (GALT) level is used in addition to the isoelectric focusing for accurate interpretation. If recent GALT test results are not provided, GALT testing will be automatically performed at an additional charge. However, if previous GALT results are provided, GALT testing will be cancelled and not charged.

 

See Galactosemia Testing Algorithm in Special Instructions.

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Whole Blood EDTA


Ordering Guidance


The preferred test to evaluate for possible diagnosis of galactosemia, routine carrier screening, and follow-up of abnormal newborn screening results is GCT / Galactosemia Reflex, Blood.

 

For monitoring of dietary compliance, order GAL1P / Galactose-1-Phosphate, Erythrocytes.



Necessary Information


Patient's age is required.

 

A quantitative galactose-1-phosphate uridyltransferase level (GALT / Galactose-1-Phosphate Uridyltransferase, Blood) is required for accurate interpretation.

 

Biochemical Genetics Patient Information (T602) is recommended, but not required, to be filled out and sent with the specimen to aid in the interpretation of test results.



Specimen Required


Multiple whole blood tests for galactosemia can be performed on 1 specimen. Prioritize order of testing when submitting specimens. See Galactosemia-Related Test List in Special Instructions for a list of tests that can be ordered together.

 

Container/Tube: Lavender top (EDTA)

Specimen Volume: 3 mL


Specimen Minimum Volume

2 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Whole Blood EDTA Refrigerated (preferred) 28 days
  Ambient  14 days

Reference Values

An interpretative report will be provided.

Day(s) Performed

Thursday

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

82664

82775

LOINC Code Information

Test ID Test Order Name Order LOINC Value
GALTP Gal-1-Phos Urdyltrns Phenotype,RBC 33780-8

 

Result ID Test Result Name Result LOINC Value
80341 Gal-1-Phos Urdyltrns Phenotype,RBC 33780-8
34524 Reviewed By 18771-6

Clinical Information

Galactosemia is an autosomal recessive disorder that results from a deficiency of any 1 of the 4 enzymes catalyzing the conversion of galactose to glucose: galactose-1-phosphate uridyltransferase (GALT), galactokinase (GALK), uridine diphosphate galactose-4-epimerase (GALE), and galactose mutarotase (GALM). GALT deficiency is the most common cause of galactosemia and is often referred to as classic galactosemia. The complete or near-complete deficiency of GALT enzyme is life-threatening if left untreated. Complications in the neonatal period include failure to thrive, liver failure, sepsis, and death.

 

Galactosemia is treated by a galactose-restricted diet, which allows for rapid recovery from the acute symptoms and a generally good prognosis. Despite adequate treatment from an early age, individuals with galactosemia remain at increased risk for developmental delays, speech problems, and abnormalities of motor function. Female patients with galactosemia are at increased risk for premature ovarian failure. Based upon reports by newborn screening programs, the frequency of classic galactosemia in the United States is approximately 1 in 30,000, although literature reports range from 1 in 10,000 to 1 in 60,000 live births.

 

Duarte-variant galactosemia (compound heterozygosity for the Duarte variant, N314D and a classic variant) is generally associated with higher levels of enzyme activity (5%-20%) than classic galactosemia (<5%); however, this may be indistinguishable by newborn screening assays. Previously, it was unknown whether children with Duarte-variant galactosemia were at an increased risk for adverse developmental outcomes due to milk exposure and were often treated with a low galactose diet during infancy. More recently, the outcomes data suggest a lack of evidence for developmental complications due to milk exposure, therefore treatment recommendations remain controversial. The Los Angeles variant, which consists of N314D and a second variant, L218L, is associated with higher levels of GALT enzyme activity than the Duarte-variant allele.

 

In general, molecular genetic analysis with a panel of common variants (GALMP / Galactosemia, GALT Gene, Variant Panel, Varies (24 variant panel) is typically performed to determine the specific genotype. If the enzymatic and molecular results are incongruent, biochemical phenotyping and/or molecular sequence analysis (GALZ / Galactosemia, GALT Gene, Full Gene Analysis, Varies) may be beneficial to help clarify results to determine a treatment strategy and recurrence risks.

 

See Galactosemia Testing Algorithm in Special Instructions for additional information.

Interpretation

An interpretive report will be provided.

 

See Galactosemia Testing Algorithm in Special Instructions for additional information.

Method Description

Isoelectric focusing is used to resolve the isoenzymes of galactose-1-phosphate uridyltransferase (GALT). The band patterns, when used in conjunction with a quantitative GALT result, can be used to predict the GALT phenotype of an individual.

 

In isoelectric focusing, a pH gradient is established across an agarose gel by adding a select mixture of amphoteric molecules to the gel and applying an electric field to the gel. Each protein (isoenzyme) has its own unique isoelectric point, a pH at which the net charge of the protein is equal to zero. Therefore, if a protein is applied to the gel, it will migrate through the pH gradient in the gel until it reaches its isoelectric point. There the protein will stop and "focus" into distinct bands.

 

In this procedure, a red blood cell hemolysate is focused on a 5% agarose gel containing ampholytes of a 5 to 7 pH range. The isoenzyme bands are then visualized by applying a substrate mixture that results in a series of reactions (shown below). The final product, reduced nicotinamide adenine dinucleotide phosphate (NADPH), is stained a blue-violet color when it reacts with phenazine methosulfate and 3-(4-5 dimethylthiazol-2-yl) I-2,5-diphenyltetrazolium bromide.(Shin YS, Niedermeier HP, Endres W, et al: Agarose gel isoelectrofocusing of UDP-galactose pyrophosphorylase and galactose-1-phosphate uridyltransferase: developmental aspect of UDP-galactose pyrophosphorylase. Clin Chim Acta 1987;166:27-35, modified to acrylamide as described by Leclerc P, Forest JC: Electrophoretic determination of isoamylases in serum with commercially available reagents. Clin Chem 1982;28:37-40; Cowan T, Pasquali M: Laboratory investigations of inborn errors of metabolism. In: Sarafoglou K, Hoffman GF, Roth KS, eds. Pediatric Endocrinology and Inborn Errors of Metabolism. 2nd ed. McGraw-Hill; 2017:1139-1158).

 

 

GALT

 

Gal-1-P + UDP-Glu

------------->

UDP-Gal + Glu-1-P

 

Phosphoglucomutase

 

Glu-1-P + Glu-1-6 diP

------------->

Glu-1-6 diP + Glu-6-P

 

Glu-6-P-Dehydrogenase

 

Glu-6-P + NADP

------------->

Ribose-5-P + CO2 + NADPH

NADPH + MTT + PMS

------------->

Blue Violet Stain

Report Available

8 to 15 days

Reject Due To

Gross hemolysis Reject

Method Name

GALTP: Isoelectric Focusing
GALT: Enzyme Reaction followed by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

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 in Special Instructions:

-Informed Consent for Genetic Testing (T576)

-Informed Consent for Genetic Testing-Spanish (T826)

2. Biochemical Genetics Patient Information (T602) is recommended, see Special Instructions.

3. If not ordering electronically, complete, print, and send a Biochemical Genetics Test Request (T798) with the specimen.

Secondary ID

80341