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Licensed Unlicensed Requires Authentication Published by De Gruyter November 13, 2020

Evaluation of the efficiency of serum biotinidase activity as a newborn screening test in Turkey

  • Mujgan Ercan ORCID logo EMAIL logo , Emiş Deniz Akbulut , Ozlem Oz , Nurgul Ataş , Meryem Karaca and Fatma Meriç Yılmaz



Biotinidase Deficiency (BD) is an autosomal recessive metabolic disorder. However, the relationship between genotype and biochemical phenotype has not been completely elucidated yet. But still, some mutations are accepted to be associated with profound or partial deficiency. We aimed to evaluate the results of biochemical enzyme activity in accordance with the presence of genetic mutations and investigate the correlation between genotype and biochemical phenotype together in the study.


This retrospective study was carried out using data from medical records of 133 infants detected by the newborn screening followed by serum biotinidase activity (BA) detection with semi-quantitative colorimetric method. Mutation analysis was performed to confirm the diagnosis. In addition, the expected biochemical phenotype based on the known mutant alleles were compared with the observed biochemical phenotype.


When confirmed with mutation analysis results, the diagnostic sensitivity and specificity of serum BA with spectrophotometric method was 93.1% and 95.1%, respectively. In 93.98% of the cases conformity was observed between the biochemical phenotype and the genotype. The c.1330 G>C(p.D444H) and c.470 G>A (p.Arg157His) were the most common allelic variants with frequencies of 63.69% and 33.75%, respectively.


The diagnostic test is supposed to have a high sensitivity to identify asymptomatic BD patients. Apparently healthy cases with almost normal enzyme activity and a variant allele in the genetic analysis were reported to present symptoms under stress conditions, which should be kept in mind. This study can be accepted as an informative report as it may contribute to the literature in terms of the allelic frequency and determination of the relation between genotype and biochemical phenotype. Also, method verification including the assessment of possible effects of non-genetic factors on BA according to the certain mutation types is warranted.

Corresponding author: Dr. Mujgan Ercan, Department of Biochemistry, Faculty of Medicine, Harran University, Mardin Yolu 22 Km Osmanbey Kampüsü, 63300 Sanliurfa, Turkey, Phone: + 90 414 318 30 00, Fax: + 90 414 318 3192, E-mail:

  1. Research funding: None declared.

  2. Author contributions: Author Ercan M, Akbulut ED, Oz O, Ataş N and Karaca M have given substantial contributions to the conception or the design of the manuscript. Ercan M and Karaca M were responsible for enzyme activity testing and for interpretation of the DBS screening testing. Oz O was responsible for the molecular analysis and for interpretation of the genetic variants. All authors have participated to drafting the manuscript, author Yılmaz FM revised it critically. All authors read and approved the final version of the manuscript.

  3. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.


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Received: 2020-06-25
Accepted: 2020-10-10
Published Online: 2020-11-13
Published in Print: 2021-01-27

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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