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Newborn screening for biotinidase deficiency has identified children with profound biotinidase deficiency (less than 10% of mean normal activity) and about an equal number of children with partial biotinidase deficiency (10 to 30% of mean normal activity). Partial biotinidase deficiency was initially considered a variant without clinical consequences until one child, during an episode of gastroenteritis, developed symptoms of biotinidase deficiency that resolved with biotin therapy. Biochemical and immunologic characterization of biotinidase was performed in sera from 23 children with partial biotinidase deficiency from 19 families and 18 of their parents. As expected, all patients had cross-reacting material in their serum. Patients with partial biotinidase deficiency can be classified into six distinct biochemical phenotypes on the basis of the number of isoforms and the distribution frequency of the isoforms. Kinetic studies were performed on samples from 17 of the patients and were found to be normal in all cases. The patient with partial deficiency who became symptomatic has an isoform profile that is not different from 10 other asymptomatic, partially deficient children. The parents had normal isoform patterns. The isoform patterns observed in the patients with partial biotinidase deficiency were not different from those of the profoundly deficient patients who had cross-reacting material.

Biochemical and Immunologic Characterization of Serum Biotinidase in Partial Biotinidase