Development of a simple method for the analysis of phenylalanine in dried blood spot using tandem mass spectrometry

Phenylketonuria (PKU), inborn error of metabolism, results from phenylalanine hydroxylase deficiency. PKU leads to neurological manifestations, intellectual disability, and mental disorders. Treatment depends on phenylalanine-restricted diet. Diagnosis and follow-up of PKU depends on blood phenylalanine level. The development of bacterial inhibition assay was the first routine screening test for PKU. ELISA and amino acids analyzers methods were then developed. Tandem mass spectrometry was introduced for newborn screening from dried blood spot in the late 1990s. Since then, several methods were developed, starting from using HPLC column followed by direct injection in mass spectrometer by analyte derivatization and use of external and internal standards. Kits are available for neonatal screening without derivatization using internal standards for quantitation. Due to high PKU incidence in Egypt, it is important to continuously ameliorate the methods for neonatal diagnosis and follow-up. External standards as dried blood spots were prepared according to the previously described procedures. These standards were evaluated for phenylalanine concentration using ELISA kit. Analysis of samples was done with a single-step elution from dried blood spot followed by 1-min mass spectrometry analysis. Validation was done according to US FDA and other related guidelines. Fifty samples were analyzed by ELISA and another 126 samples were analyzed by mass spectrometer kit. All these samples were analyzed by the developed method and no statistically significant difference was observed. New simple method is developed for phenylalanine quantitation in dried blood spot using tandem mass spectrometry. This method is cost and time effective.