Advances in Newborn Screening for Lysosomal Disorders: From Laboratory Screening to Diagnosis

A special issue of International Journal of Neonatal Screening (ISSN 2409-515X).

Deadline for manuscript submissions: 30 April 2026 | Viewed by 2898

Special Issue Editors


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Guest Editor
1. Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
2. Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
Interests: lysosomal storage diseases; mucopolysaccharidoses; newborn screening
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Guest Editor
Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY 12201-2002, USA
Interests: newborn screening; lysosomal storage disorders; Krabbe disease; genetics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Due to the rapid proliferation of disease-modifying therapies for lysosomal disorders, there is increasing interest in newborn screening for these relatively common genetic disorders. It is clear that treatment is most effective when initiated early in the course of these progressive diseases; however, for most of these diseases, lengthy diagnostic delays are commonly seen. For some, such as infantile Krabbe disease and late-infantile metachromatic leukodystrophy, treatment is only effective during the presymptomatic period. In the United States, four lysosomal disorders (Pompe disease, mucopolysaccharidosis type I and II, and Krabbe disease) have been added to the Recommended Uniform Screening Panel (RUSP), and newborn screening is now widespread for these disorders. In other parts of the world, and in some states in the US, pilot or universal screening is ongoing for MPS IVA, VI and VII, Fabry disease, Gaucher disease, and metachromatic leukodystrophy. For many of these disorders, issues such as the frequent diagnosis of late-onset forms, the complexity of phenotype prediction, and pseudodeficiency must be addressed. The education of laboratory personnel, health care providers, and families is critically important in mitigating the potential negative psychological impacts of newborn screening, avoiding overtreatment, and insuring optimal outcomes for screened infants.

The Special Issue of International Journal of Neonatal Screening, “Advances in Newborn Screening for Lysosomal Disorders: From Laboratory Screening to Diagnosis”, will focus on laboratory methodology, approaches to the diagnostic confirmation of the various disorders, the prediction of phenotypes and prognosis, newborn screening experiences across the globe, and the short- and long-term follow-up of newborns identified with various lysosomal disorders. The time is right for this Special Issue, and we thank all contributing authors in advance.

Prof. Dr. Barbara K. Burton
Dr. Joseph Orsini
Guest Editors

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Keywords

  • krabbe disease
  • metachromatic leukodystrophy
  • pompe disease
  • mucopolysaccharidosis type I and II
  • MPS IVA, VI and VII
  • fabry disease
  • gaucher disease
  • lysosomal disorders
  • newborn screening

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Published Papers (3 papers)

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Research

16 pages, 1147 KB  
Article
Umbilical Cord Blood Sampling for Newborn Screening of Pompe Disease and the Detection of a Novel Pathogenic Variant and Pseudodeficiency Variants in an Asian Population
by Fook-Choe Cheah, Sharifah Azween Syed Omar, Jasmine Lee, Zheng Jiet Ang, Anu Ratha Gopal, Wan Nurulhuda Wan Md Zin, Beng Kwang Ng, Shu-Chuan Chiang and Yin-Hsiu Chien
Int. J. Neonatal Screen. 2025, 11(3), 74; https://doi.org/10.3390/ijns11030074 - 3 Sep 2025
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Abstract
Pompe disease is an autosomal recessive metabolic disorder caused by acid alpha-glucosidase (GAA) deficiency. The use of umbilical cord blood (UCB) for newborn screening (NBS) of Pompe disease, compared to heel-prick sampling, has not been widely studied. This study compared GAA activity in [...] Read more.
Pompe disease is an autosomal recessive metabolic disorder caused by acid alpha-glucosidase (GAA) deficiency. The use of umbilical cord blood (UCB) for newborn screening (NBS) of Pompe disease, compared to heel-prick sampling, has not been widely studied. This study compared GAA activity in UCB from term newborns with peripheral or heel-prick blood samples obtained on days 1, 2, and 3 after birth. Enzyme assays were performed using UPLC-MS/MS. Sanger sequencing was conducted in infants with low GAA activity to identify pathogenic variants. Among 4091 UCB samples analyzed over 18 months, the mean GAA activity was 10.04 ± 5.95 μM/h, higher in females than males [Median (IQR): 9.83 (5.45) vs. 9.08 (4.97) μM/h, respectively, p < 0.001], and similar across ethnicities. GAA levels in UCB and Day 3 heel-prick samples were comparable. A GAA cut-off value of 1.54 μM/h (0.1% of study population) identified one infant (0.024% prevalence) with a novel bi-allelic variant—c.2005_2010del (p.Pro669_Phe670del) and c.1123C>T (p.Arg375Cys), and 12 infants with non-pathogenic pseudodeficiency alleles. This study supports GAA measurement in UCB as a viable alternative for NBS, with enzyme activity remaining stable for up to 72 h post-collection. Larger-scale multicenter nationwide studies are warranted to confirm this prevalence in our population. Full article
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9 pages, 250 KB  
Article
Novel Phenotypic Insights into the IDS c.817C>T Variant in Mucopolysaccharidosis Type II from Newborn Screening Cohorts
by Éliane Beauregard-Lacroix, Caitlin Menello, Madeline Steffensen, Hsiang-Yu Lin, Chih-Kuang Chuang, Shuan-Pei Lin and Can Ficicioglu
Int. J. Neonatal Screen. 2025, 11(3), 68; https://doi.org/10.3390/ijns11030068 - 26 Aug 2025
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Abstract
Mucopolysaccharidosis (MPS) type II, or Hunter syndrome, is an X-linked lysosomal storage disorder caused by a deficiency of iduronate-2-sulfatase. Glycosaminoglycan (GAG) accumulation leads to progressive multisystemic involvement, with coarse facial features, hepatosplenomegaly, short stature, recurrent upper respiratory infections, hearing loss, hernias, dysostosis multiplex, [...] Read more.
Mucopolysaccharidosis (MPS) type II, or Hunter syndrome, is an X-linked lysosomal storage disorder caused by a deficiency of iduronate-2-sulfatase. Glycosaminoglycan (GAG) accumulation leads to progressive multisystemic involvement, with coarse facial features, hepatosplenomegaly, short stature, recurrent upper respiratory infections, hearing loss, hernias, dysostosis multiplex, joint contractures, and cardiac valve disease. Individuals with the neuronopathic form of the disease also have central nervous system (CNS) involvement with developmental delay and progressive cognitive decline. Enzyme replacement therapy (ERT), idursulfase, is the only FDA-approved treatment for MPS II. MPS II was added to the Recommended Uniform Screening Panel (RUSP) in the United States in 2022, and screening is ongoing in several other countries, including Taiwan. Here, we report seven individuals from four families identified through newborn screening sharing the same IDS variant: c.817C>T, p.Arg273Trp. Confirmatory testing demonstrated low iduronate-2-sulfatase activity level and elevated GAGs in every individual, but they had no signs or symptoms of MPS II. They were aged 8 months to 60 years old according to the most recent assessment and all remained asymptomatic. ERT was not initiated for any of them. Our findings suggest that the IDS c.817C>T variant is associated with abnormal biochemical findings but no clinical phenotype of MPS II. Newborn screening will likely identify additional cases and provide a better understanding of the clinical significance of this variant. Full article
13 pages, 2448 KB  
Article
Analysis of the Effect of Demographic Variables on Lysosomal Enzyme Activities in the Missouri Newborn Screening Program
by Lacey Vermette, Jon Washburn and Tracy Klug
Int. J. Neonatal Screen. 2025, 11(2), 48; https://doi.org/10.3390/ijns11020048 - 19 Jun 2025
Cited by 1 | Viewed by 838
Abstract
Newborn screening laboratories are increasingly adding lysosomal storage disorders (LSDs), such as Mucopolysaccharidosis I (MPS I) and Pompe disease, to their screening panels. Without newborn screening, LSDs are frequently diagnosed only after the onset of symptoms; late detection can lead to profound and [...] Read more.
Newborn screening laboratories are increasingly adding lysosomal storage disorders (LSDs), such as Mucopolysaccharidosis I (MPS I) and Pompe disease, to their screening panels. Without newborn screening, LSDs are frequently diagnosed only after the onset of symptoms; late detection can lead to profound and irreversible organ damage and mortality. While screening of these disorders has accelerated over the past five years, there is little published information regarding the potential correlation of demographic variables (age at sample collection, birthweight, gestational age, gender, etc.) with lysosomal enzyme activity. The Missouri State Public Health Laboratory prospectively screened more than 475,000 newborns for MPS I, Pompe disease, Gaucher disease, and Fabry disease between 15 January 2013 and 15 May 2018. This report investigates trends between several demographic variables and activities of four lysosomal enzymes: α-L-iduronidase (IDUA), acid α-glucosidase (GAA), acid β-glucocerebrosidase (GBA), and acid α-galactosidase (GLA). This information provides a valuable resource to newborn screening laboratories for the implementation of screening for lysosomal storage disorders and the establishment of screening cutoffs. Full article
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