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Test ID: ANAT    
Alpha-N-Acetylglucosaminidase, Fibroblasts

Useful For Suggests clinical disorders or settings where the test may be helpful

Diagnosis of Sanfilippo syndrome, type B (mucopolysaccharidoses, type IIIB)

Genetics Test Information Provides information that may help with selection of the correct test or proper submission of the test request

Diagnostic enzyme assay for Sanfilippo syndrome, type B.

Testing Algorithm Delineates situation(s) when tests are added to the initial order. This includes reflex and additional tests.

When this test is ordered, a fibroblast culture and cryopreservation for biochemical studies will always be performed at an additional charge. However, for multiple lysosomal enzyme assays on a patient utilizing fibroblast culture, only 1 culture is required regardless of the number of enzyme assays ordered. If viable cells are not obtained within 10 days, client will be notified.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

The mucopolysaccharidoses (MPS) are a group of disorders caused by the deficiency of any of the enzymes involved in the stepwise degradation of dermatan sulfate, heparan sulfate, keratan sulfate, or chondroitin sulfate (glycosaminoglycans or GAG). Accumulation of GAG in lysosomes interferes with normal functioning of cells, tissues, and organs, resulting in the clinical features observed in MPS disorders.


Sanfilippo syndrome (MPS type III) is an autosomal recessive MPS with 4 recognized types (A-D). Each type is caused by a deficiency in 1 of 4 enzymes involved in the degradation of heparan sulfate resulting in its lysosomal accumulation. Though biochemically different, the clinical presentation of all types is indistinguishable. Sanfilippo syndrome is characterized by severe central nervous system (CNS) degeneration, but other symptoms seen in MPS, such as coarse facial features and skeletal involvement, tend to be milder. Onset of clinical features usually occurs between 2 and 6 years in a child who previously appeared normal. The presenting symptoms are most commonly developmental delay and severe behavioral problems. Severe neurologic degeneration occurs in most patients by 6 to 10 years of age, accompanied by a rapid deterioration of social and adaptive skills. Death generally occurs by age 20, though individuals with an attenuated phenotype may have a longer life expectancy. Although there is no cure for Sanfilippo syndrome, research of therapies has included bone marrow transplantation, enzyme replacement, and gene replacement.


Sanfilippo syndrome type B is caused by mutations in NAGLU. Diagnostic testing of the coding region of this gene is available as a clinical assay (MP3BZ / Mucopolysaccharidosis IIIB, Full Gene Analysis).

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

> or =0.05 nmol/min/mg protein

Interpretation Provides information to assist in interpretation of the test results

Deficiency of alpha-N-acetylglucosaminidase is diagnostic for Sanfilippo syndrome type B.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

The preferred specimen type for diagnosing Sanfilippo syndrome type B is serum (ANAS / Alpha-N-Acetylglucosaminidase, Serum); however, if fibroblasts are readily available, ANAT / Alpha-N-Acetylglucosaminidase, Fibroblasts can also be used to diagnose this disorder.


This assay detects Sanfilippo syndrome type B only. The 3 other types of Sanfilippo syndrome (A, C, and D) must be ruled-out independently.


This assay will not identify carrier status for Sanfilippo syndrome type B.


Interfering factors include lack of viable cells, bacterial contamination, failure to transport tissue in an appropriate media, excessive transport time, and exposure of the specimen to temperature extremes (freezing or >30 degrees C).

Clinical Reference Provides recommendations for further in-depth reading of a clinical nature

1. Heron B, Mikaeloff Y, Froissart R, et al: Incidence and natural history of mucopolysaccharidosis type III in France and comparison with United Kindgom and Greece. Am J Med Genet A 2011;155A(1):58-68

2. Neufeld EF, Muenzer J: The Mucopolysaccharidoses. In: The Online Metabolic and Molecular Bases of Inherited Disease. Edited by D Valle, AL Beaudet, B Vogelstein B, et al: New York, NY: McGraw-Hill; 2014 Available at http://ommbid.mhmedical.com/content.aspx?bookid=971&Sectionid=62642135. Accessed May 04, 2015

3. Valstar MJ, Bruggenwirth HT, Olmer R, et al: Mucopolysaccharidosis type IIIB may predominantly present with an attenuated clinical phenotype. J Inherit Metab Dis 2010;33:759-767

Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test