Tandem mass spectrometry for the
multiplex and quantitative analysis
of enzyme activities in dried blood spots on newborn screening cards
has emerged as a powerful technique for early assessment of lysosomal
storage diseases. Here we report the design and process-scale synthesis
of substrates for the enzymes α-l-iduronidase, iduronate-2-sulfatase,
and N-acetylgalactosamine-4-sulfatase that are used
for newborn screening of mucopolysaccharidosis types I, II, and VI.
The products contain a bisamide unit that is hypothesized to readily
protonate in the gas phase, which improves detection sensitivity by
tandem mass spectrometry. The products contain a benzoyl group, which
provides a useful site for inexpensive deuteration, thus facilitating
the preparation of internal standards for the accurate quantification
of enzymatic products. Finally, the reagents are designed with ease
of synthesis in mind, thus permitting scale-up preparation to support
worldwide newborn screening of lysosomal storage diseases. The new
reagents provide the most sensitive assay for the three lysosomal
enzymes reported to date as shown by their performance in reactions
using dried blood spots as the enzyme source. Also, the ratio of assay
signal to that measured in the absence of blood (background) is superior
to all previously reported mucopolysaccharidosis types I, II, and
VI assays.