Genetic Strip Mining

My first lesson on neonatal screening made a dramatic impression on me. I was a student at BCIT in 1985 and it was during a lecture in clinical chemistry the PKU test was explained to me. Before this test had been developed, thousands of newborns each year were destined to be warehoused in state run facilities for the mentally impaired with no hope of any sort of normal life. The lecturer had worked in that time frame to see firsthand these patients.
So what happened to change this?
In 1934 Dr. Asbjorn Folling of Norway observed that certain mentally retarded patients smelt strange. Giving in to his curiosity, he discovered the source of the odour was phenylacetic acid present in the patient’s urine. From his observations, Folling concluded that the mental retardation resulted from genetics and diet. Since the source of the phenylacetic acid was from a chemical called phenylketone, and it was present in the urine, the disease was called phenylketonuria (PKU).
So the next step in treating the disease was to determine how this all caused mental retardation in what appeared to be healthy newborns. The answer was that these infants were lacking an enzyme called phenylalanine hydroxylase which breaks down an essential amino acid called phenylanine . Without this enzyme, there is a build up phenylanine levels in the blood, resulting in elevated levels of phenylanine which are harmful to the central nervous system and if left untreated, lead to brain damage. Unable to properly break down the phenylanine, it is then converted to phenylacetic acid, which is then excreted into the urine.
In 1951 Horst Bickel, a German professor, developed a protein drink without any phenylanine in it, allowing for a infant with PKU to receive proper nutrition. Then in 1958, Robert Guthrie developed a way for testing for PKU that was simple and inexpensive. All it involved was placing a few drops of blood on a piece of filter paper. Eight years later in 1966, hospitals began screening for PKU.
In 1986, that was a very powerful message. Laboratory technologists could improve a patient’s outcome with a very simple test. Families were spared the bitter burden of institutionalizing a child.
Since this first neonatal screening, other tests have been included, such as genetic screening for cystic fibrosis and sickle cell anemia.
Unfortunately now events have occurred that have challenged just not PKU testing be done, but all neonatal screening.
In the four decades since the first PKU screening, genetic testing has grown exponentially. A person’s entire genome can be determined from a single drop of blood. Parents are concerned that blood stored on a PKU card can be used to determine that child’s genetic information, and be kept in a private data base. There is an expectation of privacy that blood samples from the millions of PKU cards collected is not turned into some huge ‘genetic strip mine,’ as researchers and private companies take advantage of this huge pool of DNA.
Parents cannot let fear prevent them from having their infants screened for disease. At the same time researcher’s have to be allowed to do research at a molecular level to help with disease diagnosis and treatment. The millions of PKU cards stored in hospitals world wide make a tempting target.
It is for the good of the newborn that government makes newborn screening mandatory, and it is also good that researchers try to find a treatments and cures for disease. In a historical perspective, did the doctor mentioned earlier, Dr. Folling, have to get permission to begin those groundbreaking experiments that led to the discovery of PKU? What if he had been denied that opportunity to find out why those patients had strange smelling urine, how many millions of patients would have had negative outcomes?
True, there has to be a limit to who has access to stored genetic material, whether it be dried blood on filter paper to tissue biopsies from a cancer patient. It is time for politicians to become not only involved, but informed.
What would my solution be? Earlier I used the term ‘genetic strip mining.’ Treat all stored genetic material as a public resource, and any company that develops that resource pay a royalty to the government for that material. Respect of patient’s privacy is paramount
These are interesting times. But we can’t let fear prevent us from making sure children of every generation have a chance to overcome the challenges they face in this business we call life, including the DNA they are born with.