Glutaric Acidemia Type II Panel

Summary and Pricing

Test Method

Exome Sequencing with CNV Detection
Test Code Test Copy Genes Gene CPT Codes Copy CPT Codes
10127 ETFA 81479,81479 Order Options and Pricing
ETFB 81479,81479
ETFDH 81479,81479
Test Code Test Copy Genes Panel CPT Code Gene CPT Codes Copy CPT Code Base Price
10127Genes x (3)81479 81479 $890 Order Options and Pricing

Pricing Comments

We are happy to accommodate requests for testing single genes in this panel or a subset of these genes. The price will remain the list price. If desired, free reflex testing to remaining genes on panel is available. Alternatively, a single gene or subset of genes can also be ordered via our PGxome Custom Panel tool.

An additional 25% charge will be applied to STAT orders. STAT orders are prioritized throughout the testing process.

For Reflex to PGxome pricing click here.

Turnaround Time

18 days on average for standard orders or 14 days on average for STAT orders.

Once a specimen has started the testing process in our lab, the most accurate prediction of TAT will be displayed in the myPrevent portal as an Estimated Report Date (ERD) range. We calculate the ERD for each specimen as testing progresses; therefore the ERD range may differ from our published average TAT. View more about turnaround times here.

Targeted Testing

For ordering sequencing of targeted known variants, go to our Targeted Variants page.

EMAIL CONTACTS

Genetic Counselors

Geneticist

Clinical Features and Genetics

Clinical Features

Glutaric acidemia (GA) type II, also known as multiple acyl-CoA dehydrogenase deficiency (MADD), is an inherited disorder of fatty acid and amino acid oxidation. GA type II is caused by defects in one of three genes (ETFA, ETFB or ETFDH). Clinical and biochemical features are not typically useful in distinguishing which gene is affected in GA type II patients. Three sub-categories of GA type II are recognized, each of which is based on severity and presentation of clinical symptoms. (Frerman and Goodman 2014).

Patients in the first group present within the first 48 hours of life with severe hypoketotic hypoglycemia, hypotonia, metabolic acidosis, possibly hepatomegaly and a “sweaty feet” odor similar to that observed in isovaleric acidemia patients, and multiple congenital anomalies, such as dysplastic kidneys, facial dysmorphism, rocker bottom feet, abdominal wall defects and abnormal external genitalia. Such patients typically die within the first week of life (Olsen et al. 2003; Schiff et al. 2006; Frerman and Goodman 2014; Xi et al. 2014).

Patients in the second group present similarly to those in the first group, but without congenital anomalies. If these patients survive beyond the first week of life, they typically succumb within the first few months, often due to cardiomyopathy (Olsen et al. 2003; Schiff et al. 2006; Frerman and Goodman 2014; Xi et al. 2014).

The patients in the third group have a more mild form of GA type II, with onset anywhere from infancy to adulthood. Clinical presentation also varies widely in this group, and may include vomiting, hypoglycemia, metabolic acidosis, hepatomegaly, progressive lipid storage proximal myopathy and exercise intolerance. Symptoms in the third group often present in an episodic manner, making biochemical analysis challenging as abnormalities may be detectable only during periods of metabolic crisis (Olsen et al. 2003; Schiff et al. 2006; Frerman and Goodman 2014; Xi et al. 2014).

In all GA type II patients, generalized aminoacidemia and aminoaciduria, hyperammonemia and metabolic acidosis may be observed. Increased levels of sarcosine in both the serum and urine are common in those with mild, later onset GA type II. Biochemically, GA type II can be distinguished from GA type I based on the presence of 2-hydroxyglutaric acid (3-hydroxyglutaric acid is present in GA type I patients) (Frerman and Goodman 2014).

To date, no effective treatments are available for patients with the severe, infantile onset forms of GA type II. Some patients with the mild, later onset form have been shown to respond well to riboflavin, glycine and L-carnitine supplementation, as well as to dietary restriction of fat and protein (Olsen et al. 2007; Wen et al. 2013; Frerman and Goodman 2014). The majority of patients reported with the late-onset, riboflavin responsive form of GA type II have had defects in the ETFDH gene (Olsen et al. 2007; Wen et al. 2010; Cornelius et al. 2012; Wen et al. 2013).

Genetics

Glutaric acidemia type II is an autosomal recessive disorder caused by pathogenic variants in the ETFA, ETFB or ETFDH genes. To date, approximately 130 causative variants have been reported in the ETFDH gene, and nearly 40 causative variants have been reported between both the ETFA and ETFB genes (Human Gene Mutation Database). The majority of reported pathogenic variants are missense, although nonsense, regulatory, and splicing variants, as well as small deletions, insertions, duplications and indels have been reported, as has one gross deletion in ETFDH (Human Gene Mutation Database; Wen et al. 2010). The variants are spread throughout these genes.

The ETFA and ETFB genes encode the α- and β-subunits, respectively, of the electron transfer flavoprotein (ETF). ETFDH encodes the electron transfer flavoprotein-ubiquinone oxidoreductase (ETF-QO). The ETF protein is found in the mitochondrial matrix as a heterodimer, comprised of one subunit each of α- and β-monomers. ETF accepts electrons from at least 12 other flavoprotein dehydrogenases, then transfers them to the mitochondrial respiratory chain via the electron transfer flavoprotein-ubiquinone oxidoreductase (ETF-QO), which is located in the inner mitochondrial membrane. Clinical symptoms observed in ETFA, ETFB or ETFDH deficient patients are due to a disruption of electron transfer to the respiratory chain (Cornelius et al. 2012; Frerman and Goodman 2014).

Clinical Sensitivity - Sequencing with CNV PGxome

Although the sensitivity of this test panel is currently unknown, most variants reported for the three genes in this panel are of the type which can be detected using direct sequencing methods and thus analytical sensitivity is expected to be high. Based on reported patient data, the detection rates for pathogenic variants in the three genes in this panel are approximately as follows: In the ETFA gene, pathogenic variants were detected in 23 of 26 studied alleles, for an overall detection rate of ~88% (Schiff et al. 2006); in the ETFB gene, pathogenic variants were detected in 16 of 18 studied alleles, for an overall detection rate of ~88% (Curcoy et al. 2003; Olsen et al. 2003; Schiff et al. 2006; Yotsumoto et al. 2008); in the ETFDH gene, pathogenic variants were detected on 64 of 70 studied alleles, for an overall detection rate of ~90% (Goodman et al. 2002; Olsen et al. 2007).

To date, only a single gross deletion has been reported in the ETFDH gene (Wen et al. 2010), and no gross deletions or duplications have been reported in the ETFA or ETFB genes. It should be noted, however, that most studies of glutaric acidemia type II patients that included ETFA, ETFB and/or ETFDH sequence analysis have not been reported to have included deletion and duplication testing. Therefore, the clinical sensitivity of this test is currently difficult to estimate.

Testing Strategy

This test is performed using Next-Gen sequencing with additional Sanger sequencing as necessary.

This panel provides 100% coverage of all coding exons of the genes plus 10 bases of flanking noncoding DNA in all available transcripts along with other non-coding regions in which pathogenic variants have been identified at PreventionGenetics or reported elsewhere. We define coverage as ≥20X NGS reads or Sanger sequencing.

Since this test is performed using exome capture probes, a reflex to any of our exome based tests is available (PGxome, PGxome Custom Panels).

Indications for Test

Individuals with a positive newborn screening result for glutaric acidemia type II are good candidates for this test, as are individuals that exhibit biochemical and clinical symptoms of GA type II.

Genes

Official Gene Symbol OMIM ID
ETFA 608053
ETFB 130410
ETFDH 231675
Inheritance Abbreviation
Autosomal Dominant AD
Autosomal Recessive AR
X-Linked XL
Mitochondrial MT

Disease

Name Inheritance OMIM ID
Glutaric Aciduria, Type 2 AR 231680

Related Test

Name
PGxome®

Citations

  • Cornelius N. et al. 2012. Human Molecular Genetics. 21: 3435-48. PubMed ID: 22611163
  • Curcoy A. et al. 2003. Molecular Genetics and Metabolism. 78: 247-9. PubMed ID: 12706375
  • Frerman F.E. and Goodman S.I. 2014. Defects of Electron Transfer Flavoprotein and Electron Transfer Flavoprotein-Ubiquinone Oxidoreductase: Glutaric Acidemia Type II. In: Valle D, Beaudet A.L., Vogelstein B, et al., editors. New York, NY: McGraw-Hill. OMMBID.
  • Goodman SI. et al. 2002. Molecular Genetics and Metabolism. 77: 86-90. PubMed ID: 12359134
  • Human Gene Mutation Database (HGMD).
  • Olsen R.K. et al. 2003. Human Mutation. 22: 12-23. PubMed ID: 12815589
  • Olsen R.K. et al. 2007. Brain. 130: 2045-54. PubMed ID: 17584774
  • Schiff M. et al. 2006. Molecular Genetics and Metabolism. 88: 153-8. PubMed ID: 16510302
  • Wen B. et al. 2010. Journal of Neurology, Neurosurgery, and Psychiatry. 81: 231-6. PubMed ID: 19758981
  • Wen B. et al. 2013. Molecular Genetics and Metabolism. 109: 154-60. PubMed ID: 23628458
  • Xi J. et al. 2014. Journal of Inherited Metabolic Disease. 37: 399-404. PubMed ID: 24357026
  • Yotsumoto Y. et al. 2008. Molecular Genetics and Metabolism. 94: 61-7. PubMed ID: 18289905

Ordering/Specimens

Ordering Options

We offer several options when ordering sequencing tests. For more information on these options, see our Ordering Instructions page. To view available options, click on the Order Options button within the test description.

myPrevent - Online Ordering

  • The test can be added to your online orders in the Summary and Pricing section.
  • Once the test has been added log in to myPrevent to fill out an online requisition form.

Requisition Form

  • A completed requisition form must accompany all specimens.
  • Billing information along with specimen and shipping instructions are within the requisition form.
  • All testing must be ordered by a qualified healthcare provider.

For Requisition Forms, visit our Forms page


Specimen Types

Specimen Requirements and Shipping Details

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ORDER OPTIONS

View Ordering Instructions

1) Select Test Type


2) Select Additional Test Options

STAT and Prenatal Test Options are not available with Patient Plus.

No Additional Test Options are available for this test.

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