Survey on serum protein electrophoresis and recommendations for standardised reporting.

INTRODUCTION: Serum protein electrophoresis (SPE) is a well-established laboratory technique. However, reporting of results varies considerably between laboratories. The variation in reporting can cause confusion to the clinician with a potential of adversely impacting patient care. The purpose of the survey was to find out the variation in reporting and to prepare recommendations to the Malaysian laboratories based on the survey to reduce both the variation in reporting between laboratories and the risk of misinterpretation of reports. MATERIALS AND METHODS: To determine the extent of variation in reporting of protein electrophoresis results questionnaires were distributed to the pathologists of various laboratories in Malaysia regarding the method, quantification of paraprotein concentrations and immunoglobulin assays, and information regarding current laboratory electrophoresis practices. RESULTS: Variation was found in the following reporting practices: (a) screening protocol; (b) reporting of serum albumin; (c) numerical reporting of protein fractions and paraprotein; (d) co-migration of a paraprotein with a normal serum protein; (e) reporting of multiple paraprotein bands (f) appearance of small abnormal band and oligoclonal bands and (g) communication about of interferences. CONCLUSION: The pathologists of the country made recommendations on the reporting of protein electrophoresis. Harmonised reporting will reduce inconsistency, variation in reporting, improve the quality of the report and most importantly improve patient care.

A national audit of estimated glomerular filtration rate and proteinuria and the MACD CKD task force recommendations.

INTRODUCTION: The Malaysian Association of Clinical Biochemists (MACB) established a Task Force for Chronic Kidney Disease. A survey was undertaken by the Task Force on the reporting of estimated glomerular filtration rate (eGFR) and urine albumin by hospital laboratories in Malaysia in both the government and private sectors. MATERIALS AND METHODS: An e-mail invitation to participate in an online survey was sent to hospital laboratories in Malaysia (n=140). Questions regarding methods for measuring creatinine, equations for calculating eGFR, eGFR reporting, the terminology used in reporting urine albumin, types of samples and the cut-off values used for normal albuminuria. RESULTS: A total of 42/140 (30%) laboratories answered the questionnaire. The prevalent method used for serum creatinine measurement was the Jaffé method (88.1%) traceable to isotope-dilution mass spectrometry. eGFR was reported along with serum creatinine by 61.9% of laboratories while 33.3% of laboratories report eGFR on request. The formula used for eGFR reporting was mainly MDRD (64.3%) and results were reported as exact numbers even when the eGFR was <60 ml/min/1.73m2. The term microalbumin is still used by 83.3% of laboratories. There is a large heterogeneity among the labs regarding the type of sample recommended for measuring urine albumin, reference interval and reporting units. CONCLUSION: It is evident that the laboratory assessment of chronic kidney disease in Malaysia is not standardised. It is essential to provide a national framework for standardised reporting of eGFR and urine albumin. Recommendations developed by the MACB CKD Task Force, if adopted by all laboratories, will lead to a reduction in this variability.

Calculation of free and bioavailable vitamin D and its association with bone mineral density in Malaysian women.

INTRODUCTION: Low 25-hydroxyvitamin D [25(OH)D] levels have not been consistently associated with bone mineral density (BMD). It has been suggested that calculation of the free/bioavailable 25(OH)D may correlate better with BMD. We examined this hypothesis in a cohort of Malaysian women. MATERIALS AND METHODS: A cross-sectional study of 77 patients with rheumatoid arthritis (RA) and 29 controls was performed. Serum 25(OH)D was measured using the Roche Cobas E170 immunoassay. Serum vitamin D binding protein (VDBP) was measured using a monoclonal enzyme-linked immunosorbent assay (ELISA). Free/bioavailable 25(OH)D were calculated using both the modified Vermuelen and Bikle formulae. RESULTS: Since there were no significant differences between RA patients and controls for VDBP and 25(OH)D, the dataset was analysed as a whole. Calculated free 25(OH)D by Vermeulen was strongly correlated with Bikle (r = 1.00, p < 0.001). A significant positive correlation was noted between measured total 25(OH)D with free/bioavailable 25(OH)D (r = 0.607, r = 0.637, respectively, p < 0.001). Median free/bioavailable 25(OH)D values were significantly higher in Chinese compared with Malays and Indians, consistent with their median total 25(OH)D. Similar to total 25(OH)D, the free/bioavailable 25(OH)D did not correlate with BMD. CONCLUSION: In this first study of a multiethnic female Malaysian population, free/bioavailable 25(OH)D were found to reflect total 25(OH)D, and was not superior to total 25(OH)D in its correlation with BMD. Should they need to be calculated, the Bikle formula is easier to use but only calculates free 25(OH)D. The Vermuelen formula calculates both free/bioavailable 25(OH)D but is more complex to use.

A whole genome methylation analysis of systemic lupus erythematosus: hypomethylation of the IL10 and IL1R2 promoters is associated with disease activity.

The etiology of systemic lupus erythematosus (SLE) involves a complex interaction of genetic and environmental factors. Investigations have shown that environmentally driven epigenetic changes contribute to the etiology of SLE. Here, we hypothesize that aberrant DNA methylation may contribute to the activation of the immune machinery and trigger lupus disease activity. A whole genome methylation array was applied to investigate the DNA methylation changes between 12 pairs of active SLE patients and healthy controls. The results were further confirmed in 66 SLE patients, 102 healthy controls. The methylation statuses of the IL10 and IL1R2 genes were significantly reduced in the SLE patient samples relative to the healthy controls (age-adjusted odds ratios, 64.2 and 16.9, respectively, P<0.0001). There was a trend toward SLE patients having hypomethylated IL10 and IL1R2 genes accompanied by greater disease activity. We observed that the methylation degree of IL10 and IL1R2 genes were reduced in the rheumatoid arthritis (RA) patients as well but the hypomethylation change was more significant in IL1R2 genes than in the IL10 genes in RA patients. This study demonstrated that DNA hypomethylation might be associated with SLE. Hypomethylated IL10 and IL1R2 genes may provide potential epigenetic markers as clinical predictors for autoimmune diseases.

Secretion profiles of venom alkaloids in Solenopsis geminata (Hymenoptera: Formicidae) in Taiwan.

Solenopsis geminata (F.) was introduced into southern Taiwan decades ago and has continued to threaten the residents. Although the venom compositions of various fire ant species have been studied, the effects of environmental cues on the secretion pattern have received relatively little attention in an area with subtropical climate and high humidity, such as Taiwan. This study characterizes the effects of temperature and season on the venom compositions of S. geminata in Taiwan. Pure venom was sampled by using a microcapillary pipette and immersing the whole ant in hexane and subjected to gas chromatography-mass spectrometry analysis. The results showed that the ratio of cis C(11) to trans C(11) alkaloids in major workers was significantly higher than that in minor workers. No significant differences could be found in either the relative alkaloids content or the ratio of cis C(11) to trans C(11) alkaloids in venom of minor workers while rearing at four temperature conditions. Nevertheless, the ratio of cis C(11) to trans C(11) alkaloids in the venom of minor workers was the highest in spring and the lowest in winter. The results also showed that the body length, abdomen length, head length, head width, and venom volume differed significantly between major workers and minor workers of S. geminata. The venom volumes of these two castes were positively correlated with their body sizes.

Effect of treatment with 4-hydroxyandrostenedione on the peripheral conversion of androstenedione to estrone and in vitro tumor aromatase activity in postmenopausal women with breast cancer.

The effect of treatment with the aromatase inhibitor, 4-hydroxyandrostenedione (4-OHA) on the peripheral conversion of androstenedione to estrone has been examined in eight postmenopausal women with advanced breast cancer. Before treatment conversion of androstenedione to estrone ([p]AEIBB) ranged from 0.81 to 3.7% and was almost completely inhibited after treatment with 4-OHA (two doses of 500 mg i.m. with an interval of 12 days between doses). Transfer constants were also measured by the urinary method ([p]AEIBU) for some subjects and decreased from 2.3 +/- 0.52% to 0.24 +/- 0.11% after treatment, a mean reduction of 90%. Mean plasma concentration of estradiol (37.4 +/- 16.6 pmol/liter) and estrone (99.0 +/- 32.2 pmol/liter) decreased significantly (P less than 0.01) to 15.7 +/- 4.6 pmol/liter and 52.4 +/- 8.9 pmol/liter, respectively, after treatment. Aromatase and DNA polymerase alpha (a marker of cell proliferation) activities were measured in seven samples of breast tumor tissue obtained before and after treatment. For three samples there was a marked (67 +/- 17%) decrease in tumor aromatase activity after treatment, for two, little change occurred, while tumor aromatase activity in the other two samples appeared to be resistant to the effect of 4-OHA. The correlation between tumor aromatase and DNA polymerase alpha activities (r = 0.45) failed to reach a significant level.

Prognostic significance of NPM1 mutation-modulated microRNA-mRNA regulation in acute myeloid leukemia.

Distinct microRNA (miRNA) and mRNA signatures were reported in nucleophosmin (NPM1)-mutated acute myeloid leukemia (AML). However, it remains unknown whether the mutation participates in the dynamic interaction between miRNA and mRNA. In this study, we aimed to investigate the role of NPM1 mutation in modulating miRNA-mRNA regulation (MMR). From the sample-paired miRNA/mRNA microarrays of 181 de novo AML patients, we found that MMR was dynamic and could be affected by NPM1 mutation. By a systematic framework, we identified 493 NPM1 mutation-modulated MMR pairs, where the strength of MMR was significantly attenuated in patients carrying NPM1 mutations, compared to those with wild-type NPM1. These miRNAs/mRNAs were associated with pathways implicated in cancer and known functions of NPM1 mutation. Such modulation of MMR was validated in two independent cohorts as well as in cells with different NPM1 mutant burdens. Furthermore, we showed that the regulatory strength of nine MMR pairs could predict patients' outcomes. Combining these pairs, a scoring system was proposed and shown to predict survival in discovery and validation data sets, independent of other known prognostic factors. Our study provides novel biological insights into the role of NPM1 mutation as a modulator of MMR, based on which a novel prognostic marker is proposed in AML.

Overnight excretion of urinary catecholamines and metabolites in the detection of pheochromocytoma.

The detection and diagnosis of pheochromocytoma are highly dependent on the biochemical confirmation of excessive catecholamine release by the tumor. As the reliability of baseline plasma catecholamines in the detection of pheochromocytoma is questionable, assessment of the excretion rates of catecholamines or metabolites in 24-h urine collections remains the mainstay of initial biochemical investigation. However, diagnostic difficulties can arise from incomplete collection of 24-h specimens or equivocal increases in catecholamines due to stress. To investigate the diagnostic validity of shorter collection times for the biochemical detection of this tumor, we measured the excretion of catecholamines and metabolites after sleep, a period associated with decreased sympathetic activity. Overnight catecholamines, metanephrines, and 4-hydroxy-3-methoxymandelic acid (HMMA) levels were measured in 16 patients with histologically confirmed pheochromocytomas, 166 patients with hypertension, and 24 normotensive subjects. All measurements were performed by high performance liquid chromatography with electrochemical detection. Overnight excretion of norepinephrine in the tumor group (range, 86-1552 nmol/mmol creatinine) was significantly different (P <0.001) from that in the nontumor group (14-63 nmol/mmol creatinine). Autonomous secretion of norepinephrine was evident in all urine collections, including a patient with a predominantly epinephrine-secreting tumor. Overnight normetanephrine levels displayed a similar excretion pattern (P < 0.001), whereas overnight epinephrine and metanephrine levels were normal in 10 of the 16 patients with pheochromocytoma. In contrast, HMMA excretion in overnight urine collections was highly variable, with only 6 of the 16 patients in the tumor group having consistently elevated excretion. In the other 10 patients, overnight HMMA excretion showed a high intravariability. The measurement of catecholamines and total metanephrines after sleep is a viable approach for the exclusion of pheochromocytoma, as overnight urine collections completely differentiated patients with pheochromocytoma from hypertensive patients. Compared to 24-h results, overnight urinary norepinephrine levels provided a better diagnostic sensitivity and specificity (100% sensitivity and 98% specificity compared with 88% and 82%). Sleep urine samples simplify the collection protocol while avoiding the effects of stress and exercise.

Relationship between basic fibroblast growth factor and transforming growth factor-beta 2 in breast cyst fluid.

Women with "apocrine" breast cysts (usually having intracystic Na/K < 3) may have a higher risk of developing breast cancer than women with breast cysts lined by flattened epithelium (usually having intracystic Na/K > 3). In this study the concentrations of basic fibroblast growth factor (bFGF), a potent mitogen, and transforming growth factor-beta 2 (TGF-beta 2), which exerts a growth inhibitory effect on epithelial cell types, were measured in breast cyst fluid and their relationship studied. Both growth factors were measured by "sandwich" enzyme immunometric assays. The concentrations of both bFGF and TGF-beta 2 were significantly higher (P < 0.001) in the Na/K > 3 group (median 444 fmol/L, range: < 56 fmol/L-7,890 fmol/L, n = 23 and median 1,776 pmol/L, range: 20.4 pmol/L-5,000 pmol/L, n = 19 respectively) than in the Na/K < 3 group (median < 56 fmol/L, range: < 56 fmol/L-2,722 fmol/L, n = 21 and median 176 pmol/L, range: 12 pmol/L-1,940 pmol/L, n = 23 respectively). Significantly positive correlations were found between bFGF and TGF-beta 2 (rS = 0.496, n = 37, P = 0.002), bFGF and Na/K (rS = 0.599, n = 44, P < 0.001) and TGF-beta 2 and Na/K (rS = 0.521, n = 42, P < 0.001). The significantly higher concentrations of the growth inhibitory TGF-beta 2 in the Na/K > 3 cyst group may provide an explanation for the lower risk of breast cancer which has been observed in this group of women. The role of bFGF in mammary carcinogenesis is unclear as lower levels of this growth factor are present in breast cancer tissue and breast cancer cell lines than in normal breast tissue and cell lines. The positive correlation between bFGF and TGF-beta 2 may indicate regulation by a common factor or that one of these growth factors may regulate the production of the other. This is the subject of further study.

Endothelin-like immunoreactivity in human breast cyst fluid.

Immunoreactive endothelin has been detected in 21 of 43 samples of breast cyst fluid (21 cases; 3.5 +/- 0.6 pmol/l, mean +/- SEM. Other 22 cases; not detectable, less than 0.5 pmol/l). Fast protein liquid chromatographic analysis of the immunoreactive endothelin of pooled breast cyst fluid showed two immunoreactive peaks; one in the void volume and the other in the position of endothelin-1. It is probable that endothelin-1 is produced by the epithelial cells lining breast cysts, but significance of the presence of endothelin-1 in breast cyst fluid remains to be elucidated.

The locus of enterocyte effacement pathogenicity island of enteropathogenic Escherichia coli encodes secretion functions and remnants of transposons at its extreme right end.

The locus of enterocyte effacement (LEE) is necessary for enteropathogenic Escherichia coli to cause characteristic attaching and effacing lesions in host cells. To determine whether sequences at the extreme right end of the LEE downstream of the espB gene are required for attaching and effacing, we constructed a mutant with an omega-interposon insertion immediately downstream of espB. This mutant is incapable of attaching and effacing, of secreting EspA and EspB and of inducing tyrosine phosphorylation of host cell proteins. These phenotypes are restored by a plasmid containing the extreme right end of the LEE. The nucleotide sequence of this region reveals a relatively low G+C content, remnants of transposons, and several open reading frames. The predicted products of these open reading frames include a potential chaperone, a potential component of the secretion apparatus, and a hypothetical peptide with proline rich repeats reminiscent of several eukaryotic proteins. These data indicate that the extreme right end of the LEE is required for attaching and effacing and reveal information relevant to the origin and function of the LEE.

Epidermal growth factor and oestradiol in human breast cyst fluid.

Gross cystic breast disease is a common condition in women. Women with apocrine breast cysts (breast cyst fluid Na+/K+ less than 3) may be at higher risk of breast cancer than women who have cysts lined by flattened epithelium (Na+/K+ greater than or equal to 3). Breast cyst fluid concentrations of epidermal growth factor were significantly higher in the low electrolyte ratio group than in the high electrolyte ratio group (356.2 ng/ml vs 104.1 ng/ml, P less than 0.0003). A negative correlation was obtained between intracystic epidermal growth factor concentrations and Na+/K+ (rs = -0.666, P less than 0.001). No significant difference was found between the total oestradiol concentrations in the two cyst groups. However, the unbound oestradiol concentrations on a limited number of samples were significantly higher in the low electrolyte ratio group than in the high electrolyte ratio group (P less than 0.05). The higher concentrations of EGF in cyst fluid with Na+K+ less than 3 may explain why women with apocrine breast cysts may be at increased risk of developing breast cancer.

Relationships between oestrogen-inducible proteins, oestradiol and electrolyte ratio in breast cyst fluid.

Women who have breast cysts with intracystic Na+/K+ < 3 may have a higher risk of developing breast cancer than women who have breast cysts with intracystic Na+/K+ > 3. In this study wide-ranging intracystic concentrations of cathepsin D and pS2 (oestrogen inducible proteins/polypeptides) as well as oestradiol were found. The concentrations of cathepsin D and oestradiol were significantly higher in the low electrolyte ratio cyst group than in the high electrolyte ratio cyst group. No significant difference was found between pS2 concentrations in the two groups. The significantly higher intracystic concentrations of cathepsin D, a mitogenic lysosomal endopeptidase and oestradiol in the low electrolyte ratio group may partly provide an explanation for the higher risk of breast cancer which has been observed in this group of women.

Insulin-like growth factor binding protein-3 in breast cyst fluid: relationships with insulin-like growth factors I and II and transforming growth factor-beta 1 and 2.

Women who have palpable breast cysts with intracystic Na/K > 3 may have a lower risk of developing breast cancer than those with intracystic Na/K < 3. In this study significantly higher concentrations of insulin-like growth factor-binding protein-3 (IGFBP-3), insulin-like growth factors I and II (IGF-I, IGF-II) and transforming growth factor-beta 2 (TGF-beta2) were found in the Na/K > 3 sub-group. No difference was found in transforming-growth factor-beta 1 (TGF-beta1) levels between the two sub-groups of breast cysts. A positive correlation was obtained for IGFBP-3 and TGF-beta1 in the Na/ K > 3 sub-group consistent with reports that TGF-beta1 may regulate the production of IGFBP-3. Equimolar amounts of total IGFs and IGFBP-3 in breast cyst fluid imply that most, if not all, of these IGFs are protein-bound. The significantly higher concentrations of TGF-beta2 in the Na/K > 3 sub-group may partly explain the lower risk of breast cancer in this group of women.

Effect of breast cyst fluid on oestrogen 17-oxidoreductase activity in MCF-7 breast cancer cells.

Breast cyst fluid (BCF) was found to stimulate oestrogen 17-oxidoreductase activity in the reductive direction, i.e., conversion of oestrone (E1) to oestradiol (E2), in MCF-7 breast cancer cells. Dialysis of BCF revealed that this property of BCF was present in both dialysed BCF and dialysate, implying that both high and low mol. wt. substances were responsible for stimulating E1 to E2 conversion. Gel filtration of dialysed BCF revealed that the high mol. wt. substances responsible for the stimulation of E1 to E2 conversion had mol. wts. of approximately 11 kD and 68 kD. This property of BCF would serve to increase the concentration of E2, a steroid which may play a role in mammary carcinogenesis.

In vitro metabolism or testosterone by breast microcysts.

Breast microcysts are considered to be a normal findings in the adult female breast without any increased risk of developing carcinomatous change. Breast cysts fluid contains steroid but not studies have been reported on the ability of breast microcysts to metabolise steroid hormones. It was, therefore, the aim of this study to identify the metabolites formed on incubation of radiolabelled testosterone with microcysts. In all instances dihydrotestosterone and androstenedione were formed. Oestrogens were not identified. Tis study, therefore, provides evidence for th presence of 5-alpha-reductase and 17-oxidoreductase enzyme systems in breast microcysts.

In vivo conversion of norethisterone to ethynyloestradiol in perimenopausal women.

The extent to which norethisterone is converted to ethynyloestradiol is controversial. To investigate the conversion of norethisterone to ethynyloestradiol we have used a double isotope infusion technique to measure the conversion in vivo. The use of acids or bases was precluded to prevent possible artefactual formation of phenolic metabolites of norethisterone. Transfer constants for the conversion of norethisterone to ethynyloestradiol in two perimenopausal women were 2.26 and 2.34% as measured in blood and 2.27 and 0.38% in urine. Results from this study show that a small but significant proportion of norethisterone is converted to ethynyloestradiol in vivo.

Biochemical detection of phaeochromocytoma: should we still be measuring urinary HMMA?

AIMS: To compare the diagnostic value of biochemical tests in the detection of phaeochromocytoma. METHODS: Urinary catecholamines and metabolites were measured by high performance liquid chromatography in the initial 24 hour collections from 31 patients with histologically confirmed phaeochromocytoma. Results were compared with values from 50 patients investigated for the possible presence of a phaeochromocytoma but in whom an alternative diagnosis was later established. RESULTS: The diagnostic sensitivity for the measurement of normetadrenaline (NMT) (97%) was greater than any other single factor. Use of a combined noradrenaline and adrenaline value in preference to individual values increased the sensitivity of free catecholamines to 97%. Urinary 4-hydroxy-3-methoxymandelic acid (HMMA) showed a much lower sensitivity for the detection of phaeochromocytoma (81%). An increased excretion of either noradrenaline, adrenaline, or combined catecholamines was found in all 31 patients. CONCLUSIONS: A combination of biochemical tests improves the detection of phaeochromocytoma. The measurement of urinary free catecholamines or metadrenalines, or both, is better than HMMA estimation. It is recommended that the practice of using only HMMA measurements for the biochemical detection of phaeochromocytoma should be abandoned.

Effect of transforming growth factor beta 2 on oestrogen metabolism in the MCF-7 breast cancer cell line.

Transforming growth factor beta (TGF-beta) is a multifunctional regulator of cellular growth and differentiation in many cell types and has a growth inhibitory effect on mammary epithelial cells. The TGF-beta 2 isoform has been shown to be present in high concentrations in breast cyst fluid and might have a protective role in breast cancer. In addition, oestrogens play an important role in breast cancer development, and oestrone sulphate (E1S) might be the main source of active oestrogens in the breast. The aim of this study was to assess the effect of TGF-beta 2 on oestrogen synthesis in an attempt to understand the mechanism by which TGF-beta 2 may exert a protective effect in breast cancer. In this study, higher concentrations of TGF-beta 2 significantly inhibited the conversion of E1S to oestrone (E1) and the conversion of E1 to the potent oestrogen, oestradiol (E2). TGF-beta 2 did not have any effect on MCF-7 cell growth or on E2 to E1 conversion. In conclusion, TGF-beta 2 might exert a protective role in breast cancer by reducing the amount of active oestrogens present in the breast.

Pseudohyperphosphataemia in patients with multiple myeloma.

The phosphate concentrations were measured in 41 patients who had multiple myeloma with paraproteinaemia using four different methods to compare the incidence of pseudohyperphosphataemia. The direct acid/molybdate method produced the highest number of anomalous results. The erroneously high phosphate concentration was attributable to the presence of turbidity in the reaction mixture. No association was found between paraprotein type and occurrence of turbidity. The direct acid/molybdate method was unreliable in patients with serum paraproteins and should therefore not be used for the measurement of phosphate concentration in such patients.