RT Journal Article SR Electronic T1 Experience of a 2-year spinal muscular atrophy NBS pilot study in Italy: towards specific guidelines and standard operating procedures for the molecular diagnosis JF Journal of Medical Genetics JO J Med Genet FD BMJ Publishing Group Ltd SP jmg-2022-108873 DO 10.1136/jmg-2022-108873 A1 Emanuela Abiusi A1 Alessandro Vaisfeld A1 Stefania Fiori A1 Agnese Novelli A1 Serena Spartano A1 Maria Vittoria Faggiano A1 Teresa Giovanniello A1 Antonio Angeloni A1 Giovanni Vento A1 Roberta Santoloci A1 Francesca Gigli A1 Adele D'Amico A1 Simonetta Costa A1 Alessia Porzi A1 Mara Panella A1 Chiara Ticci A1 Marta Daniotti A1 Michele Sacchini A1 Ilaria Boschi A1 Enrico Bertini A1 Antonio Lanzone A1 Giancarlo Lamarca A1 Maurizio Genuardi A1 Marika Pane A1 Maria Alice Donati A1 Eugenio Mercuri A1 Francesco Danilo Tiziano A1 , YR 2022 UL http://jmg.bmj.com/content/early/2022/11/22/jmg-2022-108873.abstract AB Background Spinal muscular atrophy (SMA) is due to the homozygous absence of SMN1 in around 97% of patients, independent of the severity (classically ranked into types I–III). The high genetic homogeneity, coupled with the excellent results of presymptomatic treatments of patients with each of the three disease-modifying therapies available, makes SMA one of the golden candidates to genetic newborn screening (NBS) (SMA-NBS). The implementation of SMA in NBS national programmes occurring in some countries is an arising new issue that the scientific community has to address. We report here the results of the first Italian SMA-NBS project and provide some proposals for updating the current molecular diagnostic scenario.Methods The screening test was performed by an in-house-developed qPCR assay, amplifying SMN1 and SMN2. Molecular prognosis was assessed on fresh blood samples.Results We found 15 patients/90885 newborns (incidence 1:6059) having the following SMN2 genotypes: 1 (one patient), 2 (eight patients), 2+c.859G>C variant (one patient), 3 (three patients), 4 (one patient) or 6 copies (one patient). Six patients (40%) showed signs suggestive of SMA at birth. We also discuss some unusual cases we found.Conclusion The molecular diagnosis of SMA needs to adapt to the new era of the disease with specific guidelines and standard operating procedures. In detail, SMA diagnosis should be felt as a true medical urgency due to therapeutic implications; SMN2 copy assessment needs to be standardised; commercially available tests need to be improved for higher SMN2 copies determination; and the SMN2 splicing-modifier variants should be routinely tested in SMA-NBS.Data sharing not applicable as no datasets generated and/or analysed for this study.