bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical significance of lipoprotein size and risk for coronary atherosclerosis
Authors: Roheim P S , Asztalos B F
Published: January 2020

Correlation between coronary heart disease and lipoprotein size and composition is well documented. Within the low-density lipoprotein (LDL) family the small LDL particles are associated with increased risk of coronary heart disease. These particles also have increased apolipoprotein (apo) B content. The appearance of these small LDL particles is the manifestation of complex alteration of plasma lipoprotein metabolism. The LDL size is influenced by genetic, endocrine, and environmental factors. Within the high-density lipoprotein (HDL) family the decrease of larger HDL2 particles is associated with coronary heart disease. HDLs can also be separated according to their apoprotein composition into particles containing lipoprotein (Lp)A-I only and particles containing LpA-I and LpA-II. Most studies have shown that the concentration of LpA-I-only particles decreases in coronary heart disease. HDLs are remodeled in the circulation and this remodeling continues in vitro after the blood is taken. Therefore adequate preservation of blood samples is necessary.
Atherogenic nature of triglycerides, postprandial lipidemia, and triglyceride-rich remnant lipoproteins
Authors: Zilversmit D B
Published: January 2020

In addition to low-density lipoproteins, plasma chylomicrons and very-low-density lipoproteins (VLDL) contribute to atherogenesis. When triglyceride-rich particles bind to arterial endothelium and to deendothelialized areas, locally present lipoprotein lipase initiates triglyceride hydrolysis and decreases the size of the adhering particles. Additional changes in composition are brought about by the exchange of lipids between chylomicron/VLDL remnants and the cholesteryl ester-rich low- and high-density lipoproteins. These exchanges are mediated by lipid transfer proteins in plasma. Animal studies with doubly labeled lipoproteins show that the size of lipoprotein particles determines their rate of entering the artery and contributes to the formation of lesions. This model supports epidemiologic studies that have identified plasma triglycerides as a risk factor for atherogenesis. The model for a causal role of pre- and postprandial triglyceride-rich lipoproteins in atherogenesis suggests that measuring them may improve the assessment of cardiovascular risk factors.
Prostate-specific antigen in milk of lactating women
Authors: Yu H , Diamandis E P
Published: January 2020

Prostate-specific antigen (PSA) is believed to be a highly specific marker for normal and cancerous prostatic tissue. We recently found that 30-40% of breast tumors produce PSA. Other data from our group suggest that normal breast can also produce PSA under conditions of stimulation by steroid hormones. In addition, we detected PSA in amniotic fluid. Here we report the presence of PSA in breast milk of lactating women. PSA concentrations in breast milk were quite variable, ranging from < 0.01 microgram/L in 4 of 38 milks to 350 micrograms/L; the median was 0.47 microgram/L. PSA concentration in breast milk was not correlated with mother's age or the sex of the newborn. It did tend to decrease with increasing time postdelivery, but was still detectable 2 weeks postdelivery. PSA in milk was equally measurable by a highly sensitive PSA assay based on time-resolved fluorometry and by the IMx automated PSA method. As confirmed by Western blot analysis, PSA in milk was present predominantly in its 33-kDa form; the PSA-alpha 1-antichymotrypsin complex (100 kDa) was also present but its concentration was < 25% of total PSA. We conclude that the female breast can produce PSA and that PSA is secreted into the milk during lactation; however, the biological role of PSA in milk is unknown. These and other data presented by our group suggest that PSA, a serine protease, may play a role in control of growth in mammary and other tissues through regulation of growth factors, cytokines, and growth-factor-binding proteins.
A molecular protocol for diagnosing myotonic dystrophy
Authors: Guida M , Marger R S , Papp A C , Snyder P J , Sedra M S , Kissel J T , Mendell J R , Prior T W
Published: January 2020

Myotonic dystrophy (DM) is an autosomal dominant genetic disease caused by an unstable CTG repeat sequence in the 3' untranslated region of the myotonin protein kinase gene. The CTG repeat is present 5-30 times in the normal population, whereas DM patients have CTG expansions of 50 to several thousand repeats. The age of onset of the disorder and the severity of the phenotype is roughly correlated with the size of the CTG expansion. We developed a molecular protocol for the diagnosis of DM based on an initial polymerase chain reaction screen to detect normal-sized alleles and small expansions, followed by an improved Southern protocol to detect larger expansions.
Apolipoprotein AI, AII, and AIV isoforms in plasma determined by automated isoelectric focusing with PhastSystem and immunofixation
Authors: Schaefer J R , Hackler R , Brand S , Schwarz S , Kleine T O , Steinmetz A
Published: January 2020

Distinct genetic variants of apolipoprotein (apo) AI have been shown to influence concentrations of high-density lipoprotein (HDL) cholesterol. The genetic polymorphism of apo AIV may modulate HDL-cholesterol, plasma triglycerides, and lipoprotein(a) concentrations. There is evidence for an antagonizing role of apo AII in reverse cholesterol transport. Since genetic polymorphisms and variants of these apolipoproteins are detectable by isoelectric focusing (IEF), we developed a rapid and easy automated method for IEF analysis of apos AI, AII, and AIV on self-made or commercially available gels, using the PhastSystem. Diluted plasma or serum samples (1 microL) are applied automatically onto the gel and IEF is carried out for 35-45 min. Afterwards, the apo A bands are precipitated by specific polyclonal antibodies and visualized by automated silver staining. This rapid procedure is suitable as a routine or screening method for IEF analysis of these major HDL apolipoproteins.
Continuous-flow assay with immobilized enzymes for determining of inorganic phosphate in serum
Authors: Luque de Castro M D , Quiles R , Fernández-Romero J M , Fernández E
Published: January 2020

An automated method for the determination of inorganic phosphate based on flow-injection analysis and on the use of immobilized enzymes is reported. The method features a linear range between 0.1 and 20 mumol/L with a CV < 2.1% and 3.4% for the within-run and between-run studies, respectively, and a sampling throughput of 40 h-1. The sensitivity of the method makes a 1:250 dilution of the serum samples feasible, thus making undetectable the interferences from analytes commonly present in serum. The method shows an excellent correlation with conventional automated analyzers based on the same enzymatic reaction (Hitachi, r = 0.988) but with the catalyst in solution, and with the Kodak Ektachem method (r = 0.974) based on the use of dry reagents and formation of the phosphomolybdo heteropolyacid.
Highly sensitive and specific HPLC with fluorometric detection for determination of plasma epinephrine and norepinephrine applied to kinetic studies in humans
Authors: Willemsen J J , Ross H A , Jacobs M C , Lenders J W , Thien T , Swinkels L M , Benraad T J
Published: January 2020

An HPLC separation method combined with fluorometric detection was extended to enable simultaneous assessment of plasma 3H-labeled and endogenous epinephrine (E) and norepinephrine (NE). Forearm fractional extraction (FFE) of 3H-labeled E and NE and of endogenous E was measured in 40 healthy volunteers who were receiving a continuous infusion of 3H-labeled E and NE. Concentrations of arterial and venous E were 26.8 +/- 1.95 (mean +/- SE) and 6.8 +/- 0.75 ng/L, respectively. Arterial and venous NE and dopamine (DA) were also measured, with respective values of 140.7 +/- 8.5 and 192.1 +/- 15.1 for NE, and 13.1 +/- 0.78 and 11.3 +/- 0.70 ng/L for DA. The FFE of 3H-labeled E was slightly but significantly higher (0.790 +/- 0.016) than the that of either 3H-labeled NE or endogenous E (0.748 +/- 0.0146 and 0.745 +/- 0.0185, respectively; P < 0.001), the correlations being highly significant (r = 0.80, P < 0.001) in both cases. The small difference between the FFE of E and of 3H-labeled E allows the calculation of the apparent spillover of E. However, this spillover was negligible compared with forearm NE spillover (0.0112 +/- 0.0031 vs 1.369 +/- 0.128 ng/L per minute. The high sensitivity of this measurement of venous E widens the possibilities for studying E kinetics under physiological conditions.
Subclass typing of IgG paraproteins by immunofixation electrophoresis
Authors: Klouche M , Bradwell A R , Wilhelm D , Kirchner H
Published: January 2020

We present a simple method for subclass typing of IgG paraproteins, with which we have demonstrated a large number of paraproteins that were undetected by conventional immunofixation techniques. The types and distribution of IgG subclass paraproteins were analyzed in 92 human sera in which IgG paraproteins had been demonstrated. The IgG subclass paraproteins were separated by agarose gel electrophoresis rapidly and simply and then typed with the use of sheep anti-human monospecific IgG1-IgG4 antibodies. In 24 of the sera analyzed, IgG subclass typing revealed 25 additional monoclonal bands that were not detected by conventional immunofixation electrophoresis with anti-IgG antisera. Most of these belonged to a different subclass type. The overall subclass frequencies were 68% IgG1, 13% IgG2, 16% IgG3, and 3% IgG4. The distribution of paraprotein subclasses, however, was different in monoclonal gammopathies of undetermined significance in which more IgG3 was shown, whereas in non-Hodgkin lymphomas the number of IgG2 paraproteins was greater than expected; this finding may have diagnostic and prognostic significance.
Generation and characterization of monoclonal antibodies to human type-5 tartrate-resistant acid phosphatase: development of a specific immunoassay of the isoenzyme in serum
Authors: Chamberlain P , Compston J , Cox T M , Hayman A R , Imrie R C , Reynolds K , Holmes S D
Published: January 2020

We have characterized four monoclonal antibodies (mAbs) to the purple ("tartrate-resistant," band 5) acid phosphatase of the human osteoclast (TRAP) and used these to develop a specific serum immunoassay. All four mAbs are of high affinity (Ka = 1-5 x 10(8) L/mol) with a very fast Kassoc (0.2-2.0 x 10(5) L mol-1 s-1) and a moderate Kdissoc (1-3 x 10(-3) s). Two of the mAbs were selected to develop a time-resolved fluorescence immunoassay to measure serum concentrations of TRAP. The mean serum immunoreactive TRAP in a group of healthy premenopausal women and men was 3.7 +/- 1.8 micrograms/L (mean +/- SD) and 3.5 +/- 1.6 micrograms/L, respectively. Significantly higher concentrations of TRAP were found in postmenopausal women (6.3 +/- 2.3 micrograms/L) and in eight patients with Gaucher disease (19.3 +/- 4.7 micrograms/L). Further studies are required to investigate the value of serum TRAP as a marker of bone resorption.
Diagnosis of premature rupture of membranes with an improved alpha-fetoprotein monoclonal antibody kit
Authors: Kishida T , Hirao A , Matsuura T , Katamine T , Yamada H , Sagawa T , Fujimoto S
Published: January 2020

We developed a new kit for detecting alpha-fetoprotein (AFP) in leaked amniotic fluid (Eur J Obstet Gynecol Reprod Biol 1995;58:67-72). Later, we developed an improved AFP kit utilizing the same AFP monoclonal antibody. We compared this improved AFP test with the nitrazine test for 137 patients. The nitrazine test correctly diagnosed 62.1% of the cases, but the improved AFP kit diagnosed 98.0% for < 37 weeks of gestation (P < 0.001). The nitrazine test showed a specificity of 58.3%, whereas the AFP kit showed a 100% rate for detecting > or = 37 weeks of gestation (P < 0.01). The reaction time with the AFP kit is 90 s. This study has confirmed a high clinical efficacy of the improved AFP test kit as a method of diagnosis of premature rupture of fetal membranes.
Citrate in urine determined with a new citrate lyase method
Authors: Petrarulo M , Facchini P , Cerelli E , Marangella M , Linari F
Published: January 2020

An enzyme-spectrophotometric method to determine citrate in biological fluids is proposed, based on citrate lyase-catalyzed and phenylhydrazine reactions. The enzyme converts citrate into oxaloacetate, which, in the presence of phenylhydrazine, is transformed into the corresponding phenylhydrazone. The ultraviolet-absorbing product is determined by absorbance measurement at 330 nm. The method is more precise and twice as sensitive as the traditional citrate lyase method and, because it does not require the use of additional enzymes and coenzymes, is cheaper and simpler. Mean analytical recovery of citrate averaged 100.7% +/- 2.2%, imprecision (CV) of the assay for citrate at 0.96 mmol/L (urine) was 2.0%, and the lower limit of quantification was 0.08 mmol/L. Results correlated well with those by both ion-chromatographic and traditional citrate lyase methods.
Reliability of salivary testosterone measurements: a multicenter evaluation
Authors: Dabbs J M , Campbell B C , Gladue B A , Midgley A R , Navarro M A , Read G F , Susman E J , Swinkels L M , Worthman C M
Published: January 2020

The reliability of salivary testosterone assays was evaluated by nine laboratories in four countries. Each laboratory used its own RIA procedures to assay samples from a set of 100 male and 100 female subjects. Agreement among the laboratories on mean scores was within the range reported by Read (Ann N Y Acad Sci 1993; 694: 161-76). Overall agreement on individual scores, as indicated by the intraclass correlation coefficient computed within subjects across laboratories, was r = 0.87 for men and r = 0.78 for women. Mean agreement between each laboratory and the combined set of all other laboratories (via Fisher's Z-transformation) was r = 0.61 for men and r = 0.58 for women. We take these latter values to be the best estimates of the average reliability of laboratories in their ordering of individual samples.
Analyzer-dependent differences in results for ionized calcium, ionized magnesium, sodium, and pH
Authors: Hristova E N , Cecco S , Niemela J E , Rehak N N , Elin R J
Published: January 2020

We compared two ion-selective analyzers (AVL 988-4 and NOVA CRT) for determining ionized calcium (iCa2+), ionized magnesium (iMg2+), sodium (Na+), and pH in serum specimens from healthy and diseased individuals. For assays of three levels of protein-based control materials, total imprecision (CV) was < 3% for all analytes except iMg2+ (< or = 6.5% on NOVA, and < or = 4.9% on AVL). We found a significant difference between the analyzers (P < 0.001) for the mean iMg2+ concentration in patients but no significant correlation (r = 0.253) between the analyzers for iMg2+ in specimens from healthy volunteers, even though the mean iMg2+ concentration did not differ significantly between these groups. The reference interval (central 95 percentiles) for iMg2+ with AVL (0.44-0.60 mmol/L) was contained within that of NOVA (0.39-0.64 mmol/L). The AVL gave higher values for iCa2+ (P < 0.001) and lower values for pH (P < 0.001) in specimens from normal volunteers and patients. The mean value for Na+ in patients' samples was significantly higher by the NOVA (P < 0.01) than by the AVL analyzer. Thus, we found significant differences between these two analyzers for all four analytes.
Calcium ion binding to clinically relevant chemical modifications of human serum albumin
Authors: Vorum H , Fisker K , Otagiri M , Pedersen A O , Kragh-Hansen U
Published: January 2020

Calcium binding to glycated, penicilloylated, acetylated, and normal defatted human serum albumin as well as to mercapt- and nonmercaptalbumin was studied by equilibrium dialysis of radioactive Ca2+. Binding was quantified by five Scatchard constants [ni = 1, (i = 1-4) and n5 = 10]. Glycation resulted in increased k1- and k2-values and unchanged k3-k5-values, whereas penicilloylation increased all five association constants. The increments were greater the more pronounced the modification, and the enhancements caused by penicilloylation were, for the same degree of modification, greater than those produced by glycation. In contrast, acetylation by acetylsalicylate did not affect calcium binding. Likewise, binding to mercapt- and nonmercaptalbumin was the same, a finding showing that the thiol group of cysteine 34 is not important for calcium binding. D-Glucose and penicillin G are known to react with lysine residues of albumin, and the enhancement of binding resulting from glycation or penicilloylation is probably brought about by unspecific electrostatic effects, possibly supplemented by conformational changes of the protein molecule. The relative importance of the three domains of human serum albumin for calcium binding is discussed.
Variation in measurement of prostate-specific antigen: importance of method and lot variability
Authors: Wener M H , Daum P R , Brawer M K
Published: January 2020

Equivalence between Hybritech Tandem and Abbott IMx PSA methods have been reported by some but not all previous investigators. To determine reasons for these differing conclusions, we measured serum PSA with three different lots each of IMx and Tandem-E kits. Overall, mean IMx results were significantly lower than Tandem-E results; however, for selected sera, the IMx results were consistently higher than the Tandem-E results. Lot-to-lot differences for the IMx method were significantly greater than those with the Tandem-E method. Most IMx/Tandem-E lot-to-lot comparisons had linear regression slopes that differed significantly from 1.0, but some did not. Conclusions concerning the equivalence of the IMx and the Tandem-E methods can be influenced both by variations in the proportions of free PSA in sera in tested populations and by lot-to-lot differences in the IMx method.
Enzymatic method for determining ketone body ratio in arterial blood
Authors: Uno S , Takehiro O , Tabata R , Ozawa K
Published: January 2020

We have developed a new, sensitive, and rapid method for measuring the ketone body concentration in arterial blood and determining the arterial blood ketone body ratio. The procedure involves the sequential use of the enzymes 3-hydroxybutyrate dehydrogenase (3-HBDH; EC 1.1.1.30) and NADH oxidase, followed by a color-generating reaction with the hydrogen peroxide produced by the oxidase reaction. The amount of oxidized chromogen produced is proportional to the 3-hydroxybutyrate (3-HBA) concentration. The acetoacetate (AcAc) concentration is obtained after complete conversion of the AcAc to 3-HBA, in the presence of 3-HBDH. The total 3-HBA concentration is measured and then subtracted from the total ketone body concentration to give the AcAc concentration. This procedure may be applied to plasma samples and the absorbance change measured with an automated chemistry analyzer. Ketone body concentration may be determined over the range 0 to 400 mumol/L. The analysis takes approximately 12 min and requires only 30 microL of plasma.
Lipid peroxidation and antioxidants as biomarkers of tissue damage
Authors: Gutteridge J M
Published: January 2020

Disturbance of the balance between the production of reactive oxygen species such as superoxide; hydrogen peroxide; hypochlorous acid; hydroxyl, alkoxyl, and peroxyl radicals; and antioxidant defenses against them produces oxidative stress, which amplifies tissue damage by releasing prooxidative forms of reactive iron that are able to drive Fenton chemistry and lipid peroxidation and by eroding away protective sacrificial antioxidants. The body has a hierarchy of defense strategies to deal with oxidative stress within different cellular compartments, and superimposed on these are gene-regulated defenses involving the heat-shock and oxidant stress proteins.
Induced gene transcription: implications for biomarkers
Authors: Sewall C H , Bell D A , Clark G C , Tritscher A M , Tully D B , Vanden Heuvel J , Lucier G W
Published: January 2020

Numerous xenobiotics regulate cellular functions by altering transcription of target genes. Use of sensitive and specific biomarkers based on gene transcript levels may help clarify the shape of the dose-response curve in the low-dose region associated with human exposures to environmental concentrations of chemicals. We have quantified gene transcription induced by 2,3,7,8-tetrachlorodibenzo-p-dioxin in both animal models and humans with the use of Northern analysis and PCR-based methods. In addition, we describe a rapid and sensitive in vitro assay that we have used to screen chemicals and biological samples for their ability to alter gene transcription. Whereas some of the endpoints in our studies such as cytochrome P-450 1A1 are predictive indicators of exposure and dose, other gene responses such as growth factors are more complex and represent a critical event, progression, or adaptation to a pathological alteration. In conclusion, measurement of toxicant-induced gene transcription will contribute to the usefulness of biomarkers in addressing issues of human health and environmentally induced disease.
Markers of neurotoxicity: from behavior to autoantibodies against brain proteins
Authors: Evans H L
Published: January 2020

Evidence of potentially neurotoxic exposures may be obtained in peripheral indicator media, but molecular or cellular evidence of neurotoxic effects has not been as readily available, primarily because the nervous system of living humans is beyond the reach of direct measures. Although there is limited evidence that molecular changes in the blood can provide information about neurotoxicity, several new approaches are being investigated. One is that the immune system may preserve evidence of damage to the nervous system. Debris from damaged cells in the nervous system may present as antigens, giving rise to autoantibodies, which may be detectable in blood for a long time after injury. Progress will depend on more control experiments and clarification of confounding variables. Validation of new molecular markers must go hand in hand with documentation of impaired function, most commonly measured as behavioral or neurophysiological changes. These noninvasive markers will be measured with greater sensitivity and precision, thanks to innovative computer technology. The practical advantages of the new markers may be as important as their contribution to our understanding of the mechanisms by which the nervous system defends against chemical insult.
Manifestations of chemically induced liver damage
Authors: Batt A M , Ferrari L
Published: January 2020

Possible liver damage induced by chemicals or drugs must be detected early during drug development or industrial exposure, although damage is still difficult to predict, especially when immunotoxicity is involved. Liver toxicity may result from cytolysis, steatosis, cholestasis, phospholipidosis, or vascular lesions, most the outcome of a disadvantageous balance between chemicals or metabolites vs protective mechanisms, resulting from chemical dosage, genetic factors, or the immunoallergic status of the patient. Drug metabolism, lipid peroxidation, and thiol oxidation are frequently involved in liver toxicities. Classical guidelines in toxicology propose many methods for liver toxicity assessment: histology; chemical changes in hepatic tissue (lipids, glutathione, enzymes); physiological changes in biosynthesis (proteins, glycoproteins); excretion function (fructose); drug metabolism; and concentrations of related enzymes (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase) in blood. In vitro studies in human or animal hepatocytes or tumor-derived cell lines are useful in detecting hepatocellular lesions by cell viability, glutathione concentration, amount of lactate dehydrogenase released, cellular ATP, morphology (blebs), and drug metabolism.
Development of a marker of estrogenic exposure in human serum
Authors: Sonnenschein C , Soto A M , Fernandez M F , Olea N , Olea-Serrano M F , Ruiz-Lopez M D
Published: January 2020

The deleterious, disruptive effects of estrogen mimics on the endocrine system were discovered after the compounds were released into the environment. Their chemical structure does not obviously resemble that of steroid hormones; hence, their estrogenic effects were totally unexpected. In addition to occupational exposures, environmental estrogens may have played a role in decreasing the quantity and quality of human semen during the last 50 years and in increasing the incidences of testicular cancer and cryptorchidism in men and breast cancer in women and men in industrialized countries. Testing the environmental estrogen hypothesis will require developing appropriate biomarkers of exposure and measuring these biomarkers at developmental points where exposure is critical. We report the ongoing development of a method to extract and separate xenoestrogens from ovarian estrogens with human serum as a source, followed by determination of xenoestrogen concentration by a bioassay. We also critically assess bioassays currently available to measure the cumulative effect of xenoestrogens, e.g., (a) the E-SCREEN assay, which measures the proliferative effect of estrogens on their target cells, and (b) the induction by estrogens of specific gene products, such as progesterone receptor and pS2.
Susceptibility of plasma to ferrous iron/hydrogen peroxide-mediated oxidation: demonstration of a possible Fenton reaction
Authors: Agil A , Fuller C J , Jialal I
Published: January 2020

The aim of our study was to evaluate a model system by using iron in the peroxidation of plasma. Lipid peroxidation was monitored by fluorometric measurement of lipid peroxides (LPO). Plasma coincubated with Fe2+ and H2O2 had a 268% increase in plasma LPO after 1 h. The optimum concentrations were 0.42 mmol/L Fe2+ and 0.73 mol/L H2O2. Coincubation of plasma with these concentrations of Fe2+ and H2O2 separately resulted in no increase in plasma LPO. The increase in plasma LPO after oxidation with Fe2+/H2O2 was paralleled by a decrease in plasma polyunsaturated fatty acids, an increase in the relative electrophoretic mobility of low-density lipoprotein (LDL), and decreases in apolipoprotein (apo) B-100 and apo A-I immunoreactivity. In vitro oxidation of LDL and high-density lipoprotein separately with this system produced increases of LPO of 246% and 128%, respectively. LPO formation in plasma was inhibited by catalase, desferrioxamine, and mannitol, but not by superoxide dismutase. Hydroxyl radical generation with Fe2+/H2O2 was evidenced by fragmentation of deoxyribose. We conclude that the Fe2+/H2O2 system, possibly by a Fenton reaction mechanism, resulted in significant plasma oxidation. This model system may be useful for examining lipid peroxidation in clinical investigations.
Immunoseparation method for measuring low-density lipoprotein cholesterol directly from serum evaluated
Authors: McNamara J R , Cole T G , Contois J H , Ferguson C A , Ordovas J M , Schaefer E J
Published: January 2020

Low-density lipoprotein (LDL) cholesterol can not be calculated from other lipid measurements when samples are obtained from nonfasting individuals or when triglycerides are > or = 4.0 g/L. We have evaluated a direct LDL cholesterol assay for analyzing 115 fresh serum samples obtained from fasting and nonfasting dyslipidemic patients with triglycerides < or = 35.85 g/L, who were receiving diet and (or) drug treatments. Results were highly correlated with those by ultracentrifugation (r = 0.97), with a mean/median bias of -2.9%/0.7% (-0.001/0.010 g/L) and an absolute bias of 9.5%/6.4% (0.119/0.090 g/L). The assay correctly classified LDL cholesterol concentrations < 1.30 g/L 81% of the time, 1.30-1.60 g/L 76% of the time, and > or = 1.60 g/L 94% of the time. Precision studies provided within- and between-run CVs in the range of 1.2-3.8% and 2.0-5.1%, respectively. Our data indicate that this assay is an accurate method for measuring LDLC directly from fresh serum obtained from fasting or nonfasting subjects with a wide range of triglyceride values.
Role of a central laboratory in implementing national cholesterol education panel guidelines in rural practices: model system for managed care
Authors: Reed R G , Fong S Y , Pearson T A
Published: January 2020

We describe the use of a central laboratory to identify patients who may be candidates for a hypercholesterolemia treatment program and to direct their referral into this program. The laboratory, providing service for 16 medical practices in a rural area of upstate New York, served as the entry point to the treatment program for those patients with serum cholesterol > or = 5.18 mmol/L. This treatment program, designed to follow the National Cholesterol Education Program Adult Treatment Panel Guidelines, was provided by the lipid referral center staff, including a registered dietitian and a lipid specialist. After introduction of this program, 52% of eligible patients received nutritional counseling for hypercholesterolemia, compared with only 29% in usual care settings. This program represents an enhanced role for laboratories in the implementation of treatment protocols typical of those adopted by managed care networks.
Interlaboratory/intermethod differences in functional sensitivity of immunometric assays of thyrotropin (TSH) and impact on reliability of measurement of subnormal concentrations of TSH
Authors: Spencer C A , Takeuchi M , Kazarosyan M , MacKenzie F , Beckett G J , Wilkinson E
Published: January 2020

Clinically relevant interassay precision profiles for thyrotropin (thyroid-stimulating hormone; TSH) were constructed with human serum pools measured over 4-8 weeks by six immunometric assays, in at least two different reagent lots. Functional sensitivities (the concentration at which the interassay CV is < or = 20%) were determined in four to eight clinical laboratories plus the respective manufacturer's laboratory. These studies revealed that the manufacturer's stated functional sensitivity limit is rarely duplicated in clinical practice. Loss of specificity (indicated by artifactually high values) was seen with some methods when used to measure certain unrefrigerated low-TSH sera. Measurement of TSH in four human serum pools (TSH < 0.05-0.25 mIU/L) by 16 different methods (each in at least eight UK or US laboratories) showed that some methods could not reliably distinguish subnormal from normal TSH values. Better pool rankings and fewer misclassifications of low-TSH sera as "normal" were seen with use of assays capable of "third-generation" functional sensitivity (0.01-0.02 mIU/L) than with assays with "second-generation" functional sensitivity (0.1-0.2 mIU/L). Because inter- and intramethod differences in functional sensitivity negatively impact the diagnostic accuracy and cost-effectiveness of a TSH-centered thyroid-testing strategy, laboratories should independently establish an assay's functional sensitivity by a clinically relevant protocol. Moreover, manufacturers should assess functional sensitivity more realistically and improve the robustness of assays to ensure that their performance potential is consistently met in clinical practice.
Mutation screening of the codon 3500 region of the apolipoprotein B gene by denaturing gradient-gel electrophoresis
Authors: Nissen H , Hansen P S , Faergeman O , Hørder M
Published: January 2020

Familial defective apolipoprotein B (FDB) is a clinical condition resembling familial hypercholesterolemia. The underlying genetic defects are mutations in the apolipoprotein B-100 (apo B-100) gene. Two mutations (Arg3500 --> Gln and Arg3531 --> Cys) are known to date. We designed a denaturing gradient-gel electrophoresis (DGGE) technique to detect sequence variations in codons 3456-3553 of the apo B-100 gene. In 46 heterozygous FDB patients with the predominant codon 3500 mutation, a uniform four-band DGGE pattern was seen, whereas 57 non-FDB patients showed the uniform single-band pattern expected in normal homozygotes. The recently described codon 3531 mutation and a previously unpublished Arg --> Pro mutation in codon 3480 showed unique DGGE patterns, allowing unambiguous differentiation of the three mutations. The DGGE method thus both detects known FDB mutations and screens for other mutations in codons 3456-3553 of the low-density lipoprotein receptor binding region of apo B-100; it can be used as a first-line screening method for FDB.
Determination of alpha-amylase activity: methods comparison and commutability study of several control materials
Authors: Gubern G , Canalias F , Gella F J
Published: January 2020

Six different methods for alpha-amylase determination were compared by assaying human serum samples covering a wide range of alpha-amylase values. All the methods studied use as substrate a maltooligosaccharide with a chromophore group at the reducing end; some are chemically blocked at the nonreducing end. Intermethod comparison by regression and correspondence analyses showed significant differences for two methods. The commutability of 12 commercial control materials containing alpha-amylase was also assessed by the different methods in comparison with human serum specimens containing the pancreatic and salivary isoenzymes. We also studied the behavior of pancreatic and salivary materials prepared in our laboratory. Control materials with alpha-amylase of non-human origin were not commutable with the enzyme in human sera and should not be used for intermethod calibration.
Discriminant function based on serum analytes differentiates hepatocarcinoma from secondary liver neoplasia
Authors: Castaldo G , Oriani G , Cimino L , Topa M , Budillon G , Salvatore F , Sacchetti L
Published: January 2020

Hepatocellular carcinoma (HC) is often difficult to distinguish from secondary liver neoplasia (SLN) by physical and imaging diagnostic procedures alone. To this aim we have extended and improved a laboratory approach based on a serum lactate dehydrogenase isoenzyme ratio (LD4:LD5) by adding the carcinoembryonic antigen: alpha-fetoprotein ratio, alkaline phosphatase, and serum iron concentrations to obtain a highly efficient discriminant function. In two successive cohorts, for a total of 102 patients, all histologically diagnosed, with a prevalence of HC vs SLN of 3:1, we correctly classified 96% of cases (100% of SLN cases). Subsequent verification with the jackknife reallocation statistical algorithm confirmed these results. In conclusion, this discriminant function based on simple laboratory assays of a few analytes is an important tool in solving a diagnostic dilemma in cases of liver neoplasia.
International normalized ratio for prothrombin times in patients taking oral anticoagulants: critical difference and probability of significant change in consecutive measurements
Authors: Lassen J F , Brandslund I , Antonsen S
Published: January 2020

To determine when a change in serial measurements of prothrombin time in patients receiving oral anticoagulant therapy (ACT) is a statistically significant biological change necessitating dose adjustment, one must know the size of the "critical difference" in statistical terms (i.e., probabilities). In a cohort of 32 ACT patients at pharmacological steady-state, we studied the within-subject total variation of prothrombin time, expressed as International Normalized Ratio (INR), over 6 months. The total within-subject variation (CV) of INR was 10.1%. The corresponding critical differences required for significance of change in serial INR results was 0.7 at a therapeutic target of 2.5 INR and 1.0 at a therapeutic target of 3.5 INR. The data presented allow generation of objective criteria for monitoring ACT patients and deciding dose adjustments. We recommend that estimations of critical differences for significant change of INR in ACT patients should be based on results obtained in the specific clinic investigated to mirror the routine total variation of INR measurements they obtain.
Catecholamine interference with enzymatic determination of nonesterified fatty acids in two commercially available test kits
Authors: Carr R E , Humphreys S M , Frayn K N
Published: January 2020

We present evidence that catecholamines, which are commonly used to stimulate lipolysis in adipose tissue in vitro, interfere with the enzymatic determination of non-esterified fatty acid (NEFA) in two commercially available kits. Measurement of a 100 mumol/L standard with the Wako "NEFA C" test kit was 60% inhibited by 100 mumol/L norepinephrine and was completely inhibited by 100 mumol/L isoproterenol or by 1 mmol/L norepinephrine or epinephrine. Measurement with the Boehringer Mannheim "Free Fatty acids, Half-micro test" was completely inhibited by 100 mumol/L norepinephrine and was also affected by concentrations as low as 0.1 mumol/L. We propose that this effect is due to the catecholamines interfering with a step common to the two kits, the generation of hydrogen peroxide and oxidation of a chromagen; furthermore, this interference appears to be stoichiometric. We also give details of an alternative in-house method, which does not depend on the generation of hydrogen peroxide and is not affected by catecholamines.
Decreased amino acid uptake by erythrocytes during postoperative sepsis
Authors: Roberts N B , Wilkes R
Published: January 2020

We describe a patient with postoperative sepsis associated with reduced ability to transport amino acids into erythrocytes. Administration of amino acid infusion showed no effect on plasma or red blood cell concentrations of the amino acids during the sepsis period. However, when the site of sepsis was removed, patient recovery was associated with marked increases of all amino acids, particularly in the red blood cells. The case illustrates the potential of red blood cells as a marker of amino acid utilization and demonstrates the association of sepsis with effects on cellular uptake.
On-line computer pharmacokinetics program: lessons learned from its failure
Authors: Baer D M , Kotschi M L
Published: January 2020

Decision support computer technology (DST) embedded in laboratory or hospital information systems has great potential but has rarely been successful. Through studying a pharmacokinetic program that automatically extracted data without requiring manual data entry, we have identified several barriers to the successful implementation of DST. Manual data entry is a major barrier, but so is the entry of erroneous data such as heights, weights, drug dosing times, and specimen collection times. In such a system, unanticipated changed modes of clinical practice and software changes in the system's component modules can be incompatible with the decision-support program, necessitating software revisions. We also noted that clinicians increased their ordering of laboratory tests and changes in drug doses but without improvement in patients' outcomes. This suggests that information output from the program can be misinterpreted by clinicians. In summary, DST programs should be validated in an actual working environment.
Four agglutination assays evaluated for measurement of von Willebrand factor (ristocetin cofactor activity)
Authors: Ermens A A , de Wild P J , Vader H L , van der Graaf F
Published: January 2020

The concentration of von Willebrand factor (vWf) in patients' plasma can be determined by measuring the ristocetin cofactor activity (vWf R:Co). However, this vWf R:Co assay is time consuming, which limits its routine use. Several commercial vWf R:Co tests, based on agglutination of lyophilized fixed platelets, are available. We evaluated the slide tests and aggregometer assays from Behring and Organon Teknika and compared them with the classic vWf R:Co aggregometer method. The within-run and between-run precisions of the two slide tests were better than those of the aggregometer methods. The correlation studies between the four commercial assays and the classic aggregation method were based on 23 plasma samples (range: 15-450% vWf R:Co). The correlation coefficients, which ranged from 0.923 to 0.950, did not differ significantly (P > 0.1). All four commercial assays gave significantly lower vWf R:Co values than the classic aggregation method (P < 0.01). We conclude that commercially available fixed platelets can be used for the rapid measurement of vWf R:Co with a slide test. The use of the aggregometer is time consuming and may result in a lower precision.
Smith-Lemli-Opitz syndrome diagnosed by using time-of-flight secondary-ion mass spectrometry
Authors: Seedorf U , Fobker M , Voss R , Meyer K , Kannenberg F , Meschede D , Ullrich K , Horst J , Benninghoven A , Assmann G
Published: January 2020

We describe a rapid and sensitive method involving time-of-flight secondary-ion mass spectrometry (TOF-SIMS) for specific laboratory diagnosis of the Smith-Lemli-Opitz syndrome, which is characterized by massive (approximately 1000-fold) accumulation of the biosynthetic cholesterol precursor 7-dehydrocholesterol. Minute amounts of blood (1-50 microL) were extracted with n-hexane, and aliquots were analyzed by TOF-SIMS. 7-Dehydrocholesterol and its isomers were detected at 491.3 mass units ([M + 107Ag]+) and cholesterol at 495.3 mass units ([M + 109Ag]+). Quantitation of 7-dehydrocholesterol and cholesterol was achieved after saponification and addition of stigmasterol as internal standard. Whereas 7-dehydrocholesterol and isomeric dehydrocholesterol were not detectable in controls, the patients revealed concentrations ranging between 0.84 and 1.25 mmol/L. Comparison with results obtained by gas chromatography indicated that quantitation by TOF-SIMS yielded the sum of 7-dehydrocholesterol, isomeric dehydrocholesterol II, and sterol III, the latter two also being increased in the patients. Consistent with quantitation by gas chromatography, the cholesterol concentrations in the patients ranged between 1.54 and 2.12 mmol/L (controls: 6.10 +/- 1.37 mmol/L).
6 alpha-biotinylated estrone: novel tracer in competitive chemiluminescence immunoassay of estrone in serum
Authors: Luppa P , Hauck S , Schwab I , Birkmayer C , Hauptmann H
Published: January 2020

We describe the development and validation of a labeled-hapten competitive immunoassay for determining total estrone in serum. For the hapten tracer we use the 6 alpha-biotinylated estrone derivative, 3-hydroxyestra-1,3,5(10)-trien-17-one 6 alpha-N-(epsilon-biotinyl)aminocaproamide (Bio-E1). A specific polyclonal rabbit anti-estrone antibody is indirectly bound via an immobilized donkey anti-rabbit antibody on microtiter plate wells. The amount of Bio-E1 bound is then measured with streptavidin-horseradish peroxidase conjugate, whereby the enzyme activity is quantified by an enhanced chemiluminometric method. For the assay, serum samples were extracted with solid-phase extraction cartridges. The assay dynamic range was 93-7400 pmol/L estrone, with a lower detection limit of 55 pmol/L. An interassay imprecision (CV) of 12-14%, a recovery rate between 80% and 110%, and a dilution linearity are demonstrated. Estrone serum concentrations were measured in healthy men and women and in women with polycystic ovary syndrome. Comparing the assay with a nonextraction RIA, we found an acceptable correlation for samples from 143 subjects of either sex. This enzyme immunoassay with biotin as the primary label and enhanced chemiluminescence signaling detection performs well for determining total estrone in serum and is readily adaptable to assays for other steroid hormones.
Behavior of frozen serum pools and lyophilized sera in an external quality-assessment scheme
Authors: Ferrero C A , Carobene A , Ceriotti F , Modenese A , Arcelloni C
Published: January 2020

To further improve analytical accuracy in clinical chemistry, proficiency testing needs amelioration in the quality of materials tested and in target value assignment. To obtain information on the actual state-of-the-art in the Lombardy region of Italy, and to examine the behavior of different types of control materials (fresh-frozen human sera and lyophilized materials), we developed the following experimental design. Two human serum pools and two lyophilized sera were distributed to 32 laboratories for determination of glucose, creatinine, cholesterol, sodium, potassium, and gamma-glutamyltransferase (gamma-GT). Each analyte was measured in triplicate on each of 3 days. Target values for the controls were obtained with Reference Methods. The results show a good intralaboratory precision for every component but some accuracy problems for glucose, creatinine, cholesterol, and gamma-GT. Lyophilized materials showed some commutability problems for glucose, electrolytes, and gamma-GT, mainly with dry chemistry technology.
Multiple mechanisms account for genomic instability and molecular mutation in neoplastic transformation
Authors: Coleman W B , Tsongalis G J
Published: January 2020

Neoplastic cells typically possess numerous genomic mutations and chromosomal aberrations, including point mutations, gene amplifications and deletions, and replication errors. Acquisition of such genomic instability may represent an early step in the process of carcinogenesis. Proteins involved in DNA replication, DNA repair, cell cycle progression, and others are all components of complex overlapping biochemical pathways that function to maintain cellular homeostasis. Therefore, mutational alteration of genes encoding proteins involved in these cellular processes could contribute to genomic instability. Loss of normal cellular mechanisms that guard against genomic mutation and the ensuing genomic instability might lead to accumulation of multiple stable mutations in the genome of affected cells, perhaps resulting in neoplastic transformation when some critical number of transformation-related target genes become damaged. Thus, interactions of fundamental cellular processes play significant roles in sustaining cellular normality, and alteration of any of these homeostatic processes could entrain cells to the progressive genomic instability and phenotypic evolution characteristic of carcinogenesis. Here, we discuss possible molecular mechanisms governing DNA mutation and genomic instability in genetically normal cells that might account for the acquisition of genomic instability in somatic cells, leading to the development of neoplasia. These include (a) molecular alteration of genes encoding DNA repair enzymes, (b) molecular alteration of genes responsible for cell-cycle control mechanisms, and (c) direct molecular alteration of dominantly transforming cellular protooncogenes. We also discuss normal cellular processes involved with DNA replication and repair that can contribute to the mutational alteration of critical genes: e.g., slow repair of damaged DNA in specific genes, and the timing of normal gene-specific replication.
Biological variation and the effect of fasting and halothane anesthesia on plasma glutathione S-transferase concentrations
Authors: Ray D C , Aldridge L M , Spens H J , Drummond G B , Howie A F , Beckett G J
Published: January 2020

Using a specific RIA, we have investigated in patients and volunteers whether fasting, diminished hepatic clearance, hemoconcentration, or within-day biological variation might be responsible for the transient increases in plasma glutathione S-transferase (GST) concentration observed after anesthesia. GST concentration was measured in 44 healthy volunteers after an overnight fast and at 3, 6, and 24 h after the fasting sample. The concentration was significantly lower at 3 and 6 h after than in the fasting sample (P = 0.0019 and P = 0.015, respectively). The change in GST concentration caused by fasting was examined in 30 subjects by comparing pre- and postfasting values. Fasting had no significant effect on GST concentration overall (P = 0.4721), but two individuals showed a marked increase in GST concentration after fasting overnight. In a separate study of 10 patients, plasma amylase activity and plasma concentrations of GST and albumin were measured immediately before and 3 h after induction of halothane anesthesia. Although GST concentration was increased at 3 h in each of the 10 patients, plasma amylase activity and plasma albumin concentration were significantly decreased in all patients (P = 0.002). Apparently, increases in GST concentration after anesthesia do not result from incidental factors.