Novel test and its automation for the determination of erythrocyte acetylcholinesterase and its application to organophosphate exposure.

BACKGROUND: Because of the lack of a problem-free, reliable method for determination of erythrocyte acetylcholinesterase (AChE), we developed a simple kinetic method, which we found to be both reliable and suitable for automation in the routine clinical laboratory. METHODS: Acetylthiocholine, used as substrate, is hydrolysed by acetylcholinesterase to yield acetate and thiocholine. Thiocholine reacts with dichlorophenolindophenol, a blue coloured compound, which is reduced to a colourless product, producing a linear decrease in absorption at 606 nm. If required, this assay can also be run at 600 nm with equally acceptable results. RESULTS: The method was automated on the Synchron LX20 multianalyser (Beckman Instruments) and blood samples of 80 patients with clinically symptomatic organophosphate poisoning and 153 normal controls were evaluated. Acetylcholinesterase values were in the range of 0-14 UgHb(-1) in cases of organophosphate poisoning, in contrast with normal controls, who had AChE values of 24.4--37.9 UgHb(-1). No overlap was found between AChE values of controls and poisoned cases. Intra- and inter-assay coefficients of variation were 1.68 and 3.71%, respectively. CONCLUSION: The method we propose for measurement of AChE was found to be simple, reliable and easily automatable in the routine clinical laboratory.

Spontaneous oxidation of methionine: effect on the quantification of plasma methionine levels.

Plasma methionine (Met), methionine sulfoxide (MSO), and total Met concentrations were determined by reversed-phase chromatography and fluorescence detection after automated precolumn derivatization with an o-phthalic aldehyde mercaptoethanol reagent. Addition of pure, MSO-free L-Met to plasma samples resulted in the anticipated linear increase in plasma Met concentrations, but simultaneously effected a dose-dependent, linear increase in MSO levels. In contrast, the addition of pure L-MSO to plasma samples rendered linear calibration curves for MSO, while the Met concentration remained constant. A strong buffering effect against the spontaneous or hydrogen peroxide induced oxidation of Met to MSO was observed in plasma samples. This protective effect could be neutralized by preincubating the plasma samples with sodium azide. The addition of relatively low concentrations of red cell lysates to plasma samples, prior to hydrogen peroxide oxidation, strongly inhibited the conversion of Met to MSO. Plasma samples from 127 healthy female volunteers were analyzed: MSO concentrations (mean, 3.6 +/- 2.1 microM) exhibited a weak positive correlation (r = 0.352) with Met levels (mean, 21.3 +/- 6.1 microM) but, after the exclusion of two probable outliers from the data set, no correlation was observed. Our results suggest that plasma Met concentrations should be corrected for oxidative losses incurred during storage, sample processing and because of the action of a variety of in situ oxidants, present in plasma, in order to obtain a reliable estimate of the methionine status of an individual.

Adenosine deaminase isoenzymes in typhoid fever.

The activity of serum adenosine deaminase and its isoenzymes (ADA1 and ADA2) was measured in the sera of 55 patients with clinically diagnosed typhoid fever, 46 of whom were seropositive for Salmonella typhi infection. At presentation 95% of the serologically positive patients had increased serum adenosine deaminase activity. The increase in activity was greater than that of other frequently measured enzymes. Isoenzyme ADA2 accounted for 84% of the activity, indicating a monocyte/macrophage origin. Results show that in patients with typhoid fever, serum adenosine deaminase, particularly its isoenzyme ADA2, may be regarded as a marker for monocyte/macrophage activation and could be valuable in diagnosis.

Significance of adenosine deaminase activity and its isoenzymes in tuberculous effusions.

Adenosine deaminase (ADA) activity is increased in effusions caused by certain clinical conditions including tuberculosis and bacterial infections. In this study, the ADA isoenzyme patterns in tuberculous and parainfective effusions were investigated to determine the isoenzyme responsible for this increase in activity. Fifty-one tuberculous effusions and six parainfective effusions were investigated. All effusions had increased ADA activity (median values of 126 and 127 units/L, respectively). In the tuberculous effusions, ADA2 isoenzyme was found to be primarily responsible for total activity, with a median contribution of 88 percent. The ADA1 (both ADA1m and ADA1c isoenzymes) was the major isoenzyme in the parainfective effusions with a median contribution of 70 percent. The ADA2 isoenzyme activity most likely reflects monocyte-macrophage turnover or activity, while ADA1 probably originates from lymphocytes or neutrophils. It is therefore essential to determine the isoenzyme profile when interpreting ADA activity levels in effusions. The measurement of the individual isoenzymes will enhance the diagnostic utility of ADA activity determinations in pleural effusions.

Biochemical genetics of methylglyoxal dehydrogenases in the laboratory rat (Rattus norvegicus).

A genetic locus controlling the electrophoretic mobility of a methylglyoxal dehydrogenase (EC 1.2.1.23) in the rat is described. The locus, designated Mgd1, is expressed in liver and kidney. Inbred rat strains have fixed either allele Mgd1a or allele Mgd1b. Codominant expression is observed in heterozygotes, providing evidence for a tetrameric enzyme structure. Backcross progenies showed the expected 1:1 segregation ratio, and there is evidence that Mgd1 is linked to Pep3 and Fh1 on chromosome 13. There is also evidence for two additional methylglyoxal dehydrogenases: Mgd2, present in liver and kidney, and Mgd3, present only in heart.

The influence of porphyrogenic drugs on the glyoxalase enzymes.

A variety of drugs, known to induce acute attacks in porphyric patients has been found to inhibit the glyoxalase pathway. Glyoxalase I is competitively inhibited by sulphadimidine, oxytetracycline, chloramphenicol, etc. Allylisopropyl acetamide (AIA) seems to inhibit glyoxalase II. This inhibition could play a contributing role in the overproduction of porphyrins in porphyria and thus help explain the mechanism of induction of porphyric attacks. The results indicate, that the Heme pathway and the glyoxalase cycle are closely connected.

An enzymatic assay of inorganic phosphate in serum using nucleoside phosphorylase and xanthine oxidase.

We have developed a new enzymatic assay for the determination of inorganic phosphate (Pi) in serum, using nucleoside phosphorylase (NP) and xanthine oxidase (XOD). Pi and inosine react to form hypoxanthine and ribose-1-phosphate. The hypoxanthine is oxidized to xanthine, which is further oxidized to uric acid. In these two reactions 2,6-dichlorophenol-indophenol (DCIP) is reduced to a colourless compound and the decrease in colour is measured spectrophotometrically at 600 nm. The assay is automated with an RA-XT analyser. The precision of the automated assay is acceptable (C.V. < 3.5%) and results are accurate and linear across a range of values from 0.2-2.5 mmol/l. The assay correlates well with molybdate methods carried out on SMAC III and RA-XT analysers (r values 0.99 and 0.98, respectively), and seems to be less prone to non-specific sample interference than the usual RA-XT method. The enzymatic assay described seems to be suitable for the routine determination of serum Pi.

Kinetic determination of serum adenosine deaminase.

A new kinetic method for the determination of serum adenosine deaminase (EC 3.5.4.4) is described, with adenosine as the substrate and nucleoside phosphorylase and xanthine oxidase as the reaction enzymes. Inosine is produced, which is converted to hypoxanthine. The hypoxanthine is oxidized to xanthine, which is further oxidized to uric acid. In these two reactions, blue 2,6-dichlorophenolindophenol is reduced to a colorless compound and the decrease in color is measured spectrophotometrically at 606 nm. The assay was automated by using a Cobas Mira analyzer. The automated assay had a CV of < 7%, and the calibration curve was linear from 10 to 120 U/L. The assay correlates well with an established method, based on detection of liberated NH3 with Berthelot's reaction. The reference interval (mean +/- 2 SD) was 14-34 U/L (mean 24 U/L, n = 84). The enzymatic method described is easily automated and seems to be suitable for the routine determination of adenosine deaminase in serum.

Intrafamilial variability in the clinical expression of familial hypercholesterolemia: importance of risk factor determination for genetic counselling.

A specific mutation in the low-density lipoprotein receptor (LDLR) gene causes familial hypercholesterolemia (FH) in about 60% of Afrikaner FH heterozygotes. Molecular diagnosis of this so-called FH Afrikaner-1 mutation was performed in a family with the disease. One individual did not develop coronary heart disease (CHD) by age 84, despite having the FH Afrikaner-1 mutation, while his son who inherited the same gene, developed CHD before age 50 and had to undergo bypass surgery. All the sibs in the third generation inherited the defective LDLR gene allele. This variation in clinical presentation creates a counselling dilemma. It also raises questions about the effect of diet and life style, and the possibility of other genes either contributing to the severity of the disease, or protecting against high lipid levels in plasma. An investigation of the influence of selected factors on the clinical expression of the FH Afrikaner-1 mutation in this family indicated that it was especially the elevated apolipoprotein (a) levels, in addition to low levels of high density lipoprotein cholesterol and raised triglyceride and apolipoprotein B levels, that were associated with a greater risk of developing CHD. These findings are thus in accordance with the view that the severity of CHD in FH patients is not only determined by nature of the gene defect, but is also influenced by other risk factors.

Clinical and laboratory approach for the diagnosis of galactosaemia in Africa.

A new method free from haemoglobin interference is described to measure erythrocyte galactose-l-phosphate uridyltransferase(GALT) activity levels. Since haemoglobin is removed by acid denaturation and precipitation with chloroform, only a simple photometer is required to assay GALT activity, implying that this method can be performed even when only basic laboratory facilities are available. Using this method, four infants have been found to suffer from galactosaemia due to GALT deficiency. Three children had very low, but still measurable GALT activities (< 1.0 mumol glucose-l-phosphate formed/gHb/hr) while one child had no detectable erythrocyte GALT activity. Compared to the other three children, this latter infant was seriously ill and required intensive care treatment before the diagnosis of galactosaemia was made. These results confirm the existence of different GALT variants in galactosaemia, in which the variant with zero activity has the most serious clinical sequelae if not appropriately treated.

Chicken eggshell porphyrins and the glyoxalase pathway: its possible physiological role.

1. The plasma 4,5-dioxovaleric acid (DOVA) levels of two different breeds of chicken were determined and found to be higher in the group with a higher porphyrin eggshell content. 2. The erythrocyte and uterus glyoxalase II activity, investigated by means of a new spectrophotometric method, was found to be significantly higher in the group with a low porphyrin eggshell content. 3. A comparative genetic study of two chicken populations, one with white and one with dark eggshells, showed different gene frequencies for the glyoxalase I polymorphism. 4. An interpretation of these data suggests that the glyoxalase pathway may be involved in the metabolism of early porphyrin precursors.

Serum adenosine deaminase: isoenzymes and diagnostic application.

Human adenosine deaminase (ADA; EC 3.5.4.4) consists of three isoenzymes: ADA1, ADA1+CP, and ADA2. We developed an electrophoretic technique to distinguish between these three isoenzymes. The isoenzyme pattern was studied in tissue and cell homogenates, as well as in serum from normal subjects and from patients with increased serum ADA who had either hepatitis, infectious mononucleosis, tuberculosis, pneumonia, rheumatoid arthritis, or acute lymphoblastic leukemia (ALL). The highest ADA activity was found in lymphocytes and monocytes. ADA2 could be detected only in monocytes (18% of total ADA activity). It was also the predominant isoenzyme in the sera of controls and all disease groups, except for ALL--the only condition evaluated that is not of an inflammatory nature. We conclude that serum ADA reflects monocyte/macrophage activity or turnover in most diseases studied. The exception is ALL, where serum ADA most probably originates from lymphocyte precursors.

Ethnic immunity to coronary heart disease?

Dietary fat intake is often regarded as a major determinant of coronary heart disease (CHD) rate and it has been deemed unnecessary to invoke racial or other factors to explain the differences in CHD rates among different ethnic groups. Despite a high prevalence of CHD risk factors such as hypertension, obesity, and smoking, CHD remains a rarity in westernized black Africans. Cord blood total cholesterol (TC), low density lipoprotein cholesterol (LDLC) and apolipoprotein B (apo B) levels were measured and found to be respectively 12.1%, 18.3% and 22.4% lower in black neonates when compared to white neonates. These differences were again studied in a group of young black African males and a comparable group of age-matched whites who had been exposed to the same environment and western diet for at least 2 years. Although the body mass indices and serum albumin concentrations in the adult males were not significantly different, serum levels of TC, LDLC and apo B were 10.7%, 18.7% and 39.7% lower in the blacks, respectively. Furthermore, high density lipoprotein cholesterol (HDLC) and Apolipoprotein AI were 20.2% and 9.5% higher, homocysteine 45.6% lower and coagulation factor VII 26.6% lower in the adult black Africans. It is concluded that blacks are biochemically less responsive to an atherogenic diet than whites and these differences are already present at birth.

The prevalence of homocysteinemia and hypercholesterolemia in angiographically defined coronary heart disease.

Total serum homocysteine and cholesterol levels were determined in 163 male patients with typical angina who were subjected to coronary angiography. The prevalence of homocysteinemia in coronary heart disease (CHD) was 41.9%. Serum homocysteine levels were significantly elevated (p less than 0.05) in patients with major occlusion in two or three coronary arteries. Furthermore, the prevalence of homocysteinemia correlated positively (p less than 0.05) with the number of coronary vessels that were occluded. The prevalence of hypercholesterolemia was 34.9%, but, in contrast to homocysteinemia, no graded strength of association with the number of stenotic coronary arteries could be demonstrated. The results suggest that homocysteinemia may contribute significantly to the development of coronary heart disease.

Relationship between maternal and neonatal vitamin B6 metabolism: perspectives from enzyme studies.

Enzymes involved in vitamin B6 metabolism, i.e., pyridoxal kinase, pyridoxamine (pyridoxine) 5'-phosphate oxidase, and pyridoxal 5'-phosphate phosphatase, were assayed in hemolysates prepared from cord, maternal, and control blood samples. Mean cord and control pyridoxamine (pyridoxine) 5'-phosphate oxidase activities were significantly higher than maternal activities (p less than 0.001 and p less than 0.05, respectively). A significant correlation (p less than 0.001) was observed between maternal and cord vitamin B6-metabolizing enzymes. Cord pyridoxal 5'-phosphate levels correlated significantly with maternal pyridoxal 5'-phosphate levels (p less than 0.001) and with cord pyridoxal kinase activity (p less than 0.05). Maternal pyridoxal 5'-phosphate levels appear to be the most important factor determining fetal vitamin B6 status.

High-performance liquid chromatographic assay of human lymphocyte kynureninase activity levels.

Human lymphocyte kynureninase activity was assessed in homogenized cells by determination of 3-hydroxyanthranilic acid production as a function of time after addition of the substrate, 3-hydroxykynurenine. The product, 3-hydroxyanthranilic acid, was determined by isocratic high-performance liquid chromatography and fluorescence detection. Mean (+/- S.D.) lymphocyte kynureninase activity in a group (n = 12) of vitamin B6-deficient men was 5.04 +/- 0.81 pmol 3-hydroxyanthranilic acid formed per mg protein per min, which was significantly (p = 0.005) lower than the 6.69 +/- 1.70 pmol 3-hydroxyanthranilic acid formed per mg protein per min in men with a normal vitamin B6 status. This indicates that lymphocyte kynureninase activity is depressed during a vitamin B6 deficiency.

Rapid high-performance liquid chromatographic assay for total homocysteine levels in human serum.

A rapid, isocratic high-performance liquid chromatographic (HPLC) method is described for the determination of total homocysteine levels in human serum. Prior to reversed-phase HPLC analysis, the serum thiols were derivatized with SBD-F (ammonium 7-fluorobenzo-2-oxa-1,3-diazole-4-sulphonate), a thiolspecific fluorogenic probe which is commercially available. Retention of SBD-homocysteine was sensitive to pH, and a mobile phase pH of 2.1 ensured baseline separation of serum thiols within 6 min. The method is simple, sensitive, reproducible (between-run coefficient of variation of 6.6%) and very suitable for routine determination of serum homocysteine levels in a clinical pathology laboratory.

Relationship between vitamin B-6 status and elevated pyridoxal kinase levels induced by theophylline therapy in humans.

Theophylline administration to seven healthy male volunteers resulted in a rapid and significant decline in both plasma and erythrocyte pyridoxal-5'-phosphate levels. Total erythrocyte pyridoxal kinase levels increased during 15 wk of theophylline treatment from a mean initial activity of 19.23 +/- 5.03 (mean +/- SD) to 62.64 +/- 11.59 nmol pyridoxal-5'-phosphate formed/(g hemoglobin.h). Although plasma pyridoxal levels remained normal, the threefold increase in total erythrocyte pyridoxal kinase activity levels did not normalize plasma and erythrocyte pyridoxal-5'-phosphate levels. Pyridoxal-5'-phosphate hydrolysis was not affected by theophylline therapy. Increased pyridoxal oxidation was confirmed by elevated urinary 4-pyridoxic acid excretion after 15 wk of theophylline treatment. Mean erythrocyte alanine aminotransferase activity declined by 70%, and aspartate aminotransferase activity declined by 50%, indicating that decreased availability of pyridoxal-5'-phosphate can have widespread metabolic consequences. We conclude that the effect of theophylline on vitamin B-6 metabolism is not transitory and cannot be overcome by elevated intracellular levels of pyridoxal kinase. However, pyridoxine supplementation (10 mg/d for 1 wk) normalized indices of vitamin B-6 status and reversed the downward trend in both alanine aminotransferase and aspartate aminotransferase activity levels.