Method for interpreting tandem mass spectrometry data for clinical diagnosis
First Claim
1. A method comprising steps of:
- acquiring mass spectral data from a sample that has been derived from the blood of a patient, wherein said data includes values comprised of a propionyl carnitine concentration (C3) and a molar ratio of propionyl carnitine and acetyl carnitine (C3/C2) or a molar ratio of propionyl carnitine and palmitoyl carnitine (C3/C16);
comparing said values, respectively, with a C3 flag threshold and a C3/C2 flag threshold or a C3/C16 flag threshold;
identifying whether or not there is an elevation of any of said values above any of said flag thresholds; and
interpreting said sample as being normal for propionic acidemia, provided there is no said elevation of any of said values.
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Abstract
A method for interpreting data that is produced after a group of amino acids and acylcarnitines are derivatized from blood spots taken from newborn babies and scanned by a tandem mass spectrometer. Concentration levels of each metabolite, which are directly proportional to the butyl ester fragment after derivatization, are compared to threshold flags for determining a significance of any deviation of the metabolite relative to the flag threshold. The threshold flags are diagnostic limits to the data retrieved from each blood spot. The data includes metabolite concentrations and molar ratios of metabolites with other metabolites. Samples are labeled normal for a disease if the concentration of any of the metabolite concentrations or molar ratio concentration do not deviate from the flag threshold, but, in contrast, the sample must be further evaluated if a value is elevated or deficient to some degree. Thus, as each metabolite fragments at a different mass to charge value (m/z), corresponding data is compared to the respective flag thresholds for determining a next course of action that must be taken to ultimately assist a physician in the diagnosis of a genetic disorder resulting from an elevation or deficiency of the metabolite particular for that disorder.
23 Citations
123 Claims
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1. A method comprising steps of:
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acquiring mass spectral data from a sample that has been derived from the blood of a patient, wherein said data includes values comprised of a propionyl carnitine concentration (C3) and a molar ratio of propionyl carnitine and acetyl carnitine (C3/C2) or a molar ratio of propionyl carnitine and palmitoyl carnitine (C3/C16); comparing said values, respectively, with a C3 flag threshold and a C3/C2 flag threshold or a C3/C16 flag threshold; identifying whether or not there is an elevation of any of said values above any of said flag thresholds; and interpreting said sample as being normal for propionic acidemia, provided there is no said elevation of any of said values. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18)
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19. A method comprising steps of:
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acquiring mass spectral data from a sample that has been derived from the blood of a patient, wherein said data includes values comprised of a glutaryl carnitine concentration (C5DC) and optionally a molar ratio of glutaryl carnitine and palmitoyl carnitine (C5DC/C16); comparing said values, respectively, with a C5DC flag threshold and optionally a C5DC/C16 flag threshold; identifying whether or not there is an elevation of any of said values above any of said flag thresholds; and interpreting said sample as being normal for glutaric acidemia, provided there is no said elevation of any of said values. - View Dependent Claims (20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36)
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37. A method comprising steps of:
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acquiring mass spectral data from a sample that has been derived from the blood of a patient, wherein said data includes values comprised of a leucine+isoleucine concentration (leu+ile) and, a valine concentration (val) and optionally one or more of a molar ratio of leucine+isoleucine and phenylalanine (leu+ile/phe), and a molar ratio of leucine+isoleucine and alanine (leu+ile/ala); comparing said values, respectively, with a leu+ile flag threshold and a val flag threshold and optionally one or more of a leu+ile/phe flag threshold and a leu+ile/ala flag threshold; identifying whether or not there is an elevation of any of said values above any of said flag thresholds; and interpreting said sample as being normal for maple syrup urine disease (MSUD), provided there is no said elevation of any of said values. - View Dependent Claims (38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 69, 70, 71)
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55. A method comprising steps of:
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acquiring mass spectral data from a sample that has been derived from the blood of a patient, wherein said data includes values comprised of a leucine+isoleucine concentration (leu+ile) and a molar ratio of leucine+isoleucine and alanine (leu+ile/ala); and comparing said values, respectively, with a leu+ile flag threshold and a leu+ile/ala flag threshold; identifying whether or not there is an elevation of any of said values above any of said flag thresholds; and interpreting said sample as being normal for maple syrup urine disease (MSUD), provided there is no said elevation of any of said values. - View Dependent Claims (56, 57, 58, 59)
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60. A method comprising steps of:
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acquiring mass spectral data from a sample that has been derived from the blood of a patient, wherein said data includes values comprised of a leucine+isoleucine concentration (leu+ile), a molar ratio of leucine+isoleucine and phenylalanine (leu+ile/phe), and a molar ratio of leucine+isoleucine and alanine (leu+ile/ala); and comparing said values, respectively, with a leu+ile flag threshold, a leu+ile/phe flag threshold, and a leu+ile/ala flag threshold; identifying whether or not there is an elevation of any of said values above any of said flag thresholds; and interpreting said sample as being normal for maple syrup urine disease (MSUD), provided there is no said elevation of any of said values.
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61. A method comprising steps of:
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acquiring mass spectral data from a sample that has been derived from the blood of a patient, wherein said data includes values comprised of an octanoyl carnitine concentration (C8) and one or more of a molar ratio of octanoyl carnitine and palmitoyl carnitine (C8/C16), a hexanoyl carnitine concentration (C6), a decanoyl carnitine concentration (C10;
1), and a decanoyl carnitine concentration (C10);comparing said values, respectively, with one or more of a C8 flag threshold and one or more of a C8/C16 flag threshold, a C6 flag threshold, a C10;
1 flag threshold, and a C10 flag threshold;identifying whether or not there is an elevation of any of said values above any of said flag thresholds; and interpreting said sample as being normal for medium-chain acyl-coenzyme A dehydrogenase (MCAD) deficiency, provided there is no said elevation of any of said values. - View Dependent Claims (62, 63, 64, 65, 66, 67, 68, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81)
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82. A method comprising steps of:
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acquiring mass spectral data from a sample that has been derived from the blood of a patient, wherein said data includes values comprised of one or more of a saturated myristoyl carnitine concentration (C14), an unsaturated myristoyl carnitine concentration (C14;
1), and a molar ratio of myristoyl carnitine and palmitoyl carnitine (C14;
1/C16);comparing said values, respectively, with one or more of a C14 flag threshold, a C14;
1 flag threshold, and a C14;
1/C16 flag threshold;identifying whether or not there is an elevation of any of said values above any of said flag thresholds; and interpreting said sample as being normal for VLCAD, provided there is no said elevation of any of said values. - View Dependent Claims (83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104)
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105. A method comprising steps of:
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acquiring mass spectral data from a sample that has been derived from the blood of a patient, wherein said data includes values comprised of one or more of a hydroxyisovalerylcarnitine concentration (C5OH) and a tiglylcarnitine concentration (C5;
1);comparing said values, respectively, with one or more of a C5OH flag threshold and a C5;
1 flag threshold;identifying whether or not there is an elevation of any of said values above any of said flag thresholds; and interpreting said sample as being normal for crotonyl co-A carboxylase deficiency, provided there is no said elevation of any of said values. - View Dependent Claims (106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123)
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Specification