Referred Work

Preferred Sample Type

Alpha Amino Adipic Semialdehyde (AASA, ASA)

Suitable Specimen Types

  • Plain Spot Urine
> 1 mL

Specimen Transport

Send frozen.

Sample Processing in Laboratory


Sample Stability

Freeze on arrival in laboratory

Alpha Amino Adipic Semialdehyde (AASA, ASA)

General Information

Pyridoxine-dependent epilepsy (PDE MIM 266100) is an autosomal recessive disease caused by mutations in the alpha-aminoadipic semialdehyde dehydrogenase (ALDH7A1 – antiquitin) gene located on chromosome 5q31. Alpha-aminoadipic semialdehyde (AASA) dehydrogenase is involved in the cerebral lysine degradation pathway. Deficiency of the enzyme leads to the accumulation of AASA and piperideine- 6-carboxylate (P6C), elevated levels of which can be detected in urine, plasma, and CSF of affected patients. Patients usually present with neonatal seizures that are unresponsive to conventional anti-convulsant therapy, but which can be controlled by treatment with pyridoxine (vitamin B6). Less commonly, later-onset cases present during the second and third years of life. Patients also display varying degrees of developmental delay, which may, in part, be independent of the timing of pyridoxine therapy.

In affected patients, P6C inactivates pyridoxalphosphate (PLP), the active vitamer of pyridoxine, leading to severe PLP deficiency. As PLP is a cofactor of various enzymes in the CNS, seizures in PDE are most probably due to perturbation in the metabolism of cerebral amino acids and neurotransmitters. Pyridoxine is a precursor of PLP and it can therefore reduce the effect of PLP deficiency in PDE patients.

(Taken from

Measurement of AASA is performed by Proteomic and Diagnostic Services at UCL. 


Patient Preparation

None required.


UCL require > 1 mL of a random urine which can be posted to them without special precautions if it will arrive within 16 hours of dispatch.  However, AASA is particularly susceptible to breakdown when unfrozen, if the transfer will take longer than 16 hours, all samples should be sent on dry-ice and should not be scheduled to arrive at ICH at the weekend. Please make sure the sample is not too dilute as it makes quantitation difficult and analysis may need repeating.

Reference Range

Provided by referral laboratory.

The laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital form part of the services provided by University Hospitals Birmingham and are UKAS (United Kingdom Accreditation Service) accredited to the ISO 15189:2012 standard. For a list of accredited tests and other information please visit the UKAS website using the following link:

  • Heartlands, Good Hope and Solihull Hospital pathology laboratories are a UKAS accredited medical laboratory No.8217
  • United Kingdom Health Security Agency laboratory is a UKAS accredited medical laboratory No.8213

Tests not appearing on the UKAS Schedule of Accreditation currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.

For further test information, please visit the test database:

Protection of personal information - Laboratory Medicine comply with the Trust Data Protection policy and have procedures in place to allow the Directorate and its employees to comply with the Data Protection act  1998 and associated best practice and guidance.

For further information contact Louise Fallon, Quality Manager, 0121 424 1235