Test ID: AAQP
Amino Acids, Quantitative, Plasma

Evaluating patients with possible inborn errors of metabolism

May aid in evaluation of endocrine disorders, liver diseases, muscle diseases, neoplastic diseases, neurological disorders, nutritional disturbances, renal failure, and burns

Quantitative Analysis by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Includes quantitation of the following amino acids: taurine, threonine, serine, asparagine, glutamic acid, glutamine, proline, alanine, citrulline, alpha-amino-n-butyric acid, valine, cystine, methionine, isoleucine, leucine, tyrosine, phenylalanine, beta-alanine, ornithine, lysine, histidine, argininosuccinic acid, allo-isoleucine, arginine, phosphoserine, phosphoethanolamine, hydroxyproline, glycine, aspartic acid, ethanolamine, sarcosine, 1-methylhistidine, 3-methylhistidine, carnosine, anserine, homocitruline, alpha-aminoadipic acid, gamma-amino-n-butyric acid, beta-aminoisobutyric acid, hydroxylysine, cystathionine, and tryptophan.

Collection Container/Tube:

Preferred: Green top (sodium heparin)

Acceptable: EDTA, PST, lithium heparin

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL

Collection Instructions:

1. Fasting (4 hours or more in infants).

2. Spin down promptly.

Additional Information: 

1. Patient's age is required.

2. Include family history, clinical condition (asymptomatic or acute episode), diet, and drug therapy information.

Forms: If not ordering electronically, submit a Biochemical Genetics Request Form (Supply T439) with the specimen.

Amino acids are the basic structural units that comprise proteins, and are found throughout the body. Many inborn errors of amino acid metabolism, including phenylketonuria and tyrosinemia, which affect amino acid transport and/or metabolism have been identified. Amino acid disorders can manifest at any time in a person's life, but most become evident in infancy or early childhood. These disorders result in the accumulation or the deficiency of 1 or more amino acids in biological fluids which leads to the clinical signs and symptoms of the particular amino acid disorder.

The clinical presentation is dependent upon the specific amino acid disorder. In general, affected patients may experience failure to thrive, neurologic symptoms, digestive problems, dermatologic findings, and physical and cognitive delays. If not diagnosed and treated promptly, amino acid disorders can result in mental retardation and death.  

Treatment for amino acid disorders involves very specific dietary modifications. Nonessential amino acids are synthesized by the body, while essential amino acids are not and must be obtained through an individual’s diet. Therapeutic diets are coordinated and closely monitored by a dietician and/or physician. They are structured to provide the necessary balance of amino acids with particular attention to essential amino acids and those which accumulate in a particular disorder. Patients must pay close attention to the protein content in their diet and generally need to supplement with medical formulas and foods. Dietary compliance is monitored by periodic analysis of amino acids.

In addition, amino acid analysis may have clinical importance in the evaluation of several acquired conditions including endocrine disorders, liver diseases, muscle diseases, neoplastic diseases, neurological disorders, nutritional disturbances, renal failure, and burns.

When abnormal results are detected, a detailed interpretation is given, including an overview of the results and of their significance, a correlation to available clinical information, elements of differential diagnosis, recommendations for additional biochemical testing, and in vitro confirmatory studies (enzyme assay, molecular analysis), name and phone number of key contacts who may provide these studies at Mayo or elsewhere, and a phone number to reach one of the laboratory directors in case the referring physician has additional questions.

Reference values are for fasting patients.

Amino acids. In The Metabolic and Molecular Bases of Inherited Disease. Eighth edition. Edited by CR Scriver, AL Beaudet, WS Sly, et al. New York, McGraw-Hill, Inc. 2001, pp 1667-2105

Quantitative analysis of amino acids (AA) is performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) by labeling amino acids present in plasma, urine, and CSF with aTRAQ Reagent 121. Samples are dried and reconstituted with aTRAQ Reagent 113-labeled Standard Mix. Amino acids are separated and detected by LC-MSMS (API 3200). The concentrations of AA are established by comparison of their ion intensity (121-labeled amino acids) to that of their respective internal standards (113-labeled amino acids). Chromatography is performed using a C18 (150x4.6mm) column and total analysis time is 18 minutes.(Lacey JM, Casetta B, Daniels SB, et al: Amino acid quantitation in plasma, urine and CSF by iTRAQ Reagent Amino Acid Analysis Kit and MS/MS. J Am Soc Mass Spec 2008;19[5]:S97)

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