Carbamylated hemoglobin and carbamylated plasma protein in hemodialyzed patients.

The carbamylation reaction in vivo involves the nonenzymatic, covalent attachment of isocyanic acid, the spontaneous dissociation product of urea, to proteins. Carbamylated proteins have been proposed as markers of uremia and indicators of uremic control. However, the utility of measuring carbamylated proteins has not been investigated adequately. Therefore, this study was done to determine the relationship between the carbamylation of long-lived protein (hemoglobin) with that of short-lived proteins (plasma proteins) in hemodialyzed patients. Significantly higher carbamylated hemoglobin (CHb; 157 +/- 40 microg valine hydantoin/g Hb) and carbamylated protein (CTP; 0.117 +/- 0.011 absorbance/mg protein) concentrations were found in hemodialyzed patients (N = 13) as compared to normal individuals (N = 9, 53 +/- 20 microg valine hydantoin/g Hb and 0.08 +/- 0.01 absorbance/mg protein, respectively). A high correlation was found between CHb and CTP concentrations (r = 0.87, P < 0.0001), demonstrating a strong relationship between these two different half-lived proteins. A six-month longitudinal study of seven hemodialyzed patients showed that the between subject correlations were significant for CHb versus CTP as well as CHb versus pre-dialysis urea. Correlations were not significant for CTP versus pre-dialysis urea or Kt/V, nor CHb versus Kt/V. Carbamylated hemoglobin fluctuated the most over this time period (30.1% +/- 20.2%), pre-dialysis urea and CTP varied less (18.3% +/- 13.4% and 14.9% +/- 7.5%, respectively), and Kt/V varied the least (6.3% +/- 3.3%). Within subject correlations were not significant between any two tests. It is unclear whether the lack of correlations found is real or a function of the small sample size. However, these data do show that CHb and CTP are positively associated and reflect the degree of urea exposure in the blood, but their usefulness for patients on maintenance hemodialysis is not clear.

Carbamylation of erythrocyte membrane proteins: an in vitro and in vivo study.

OBJECTIVES: To establish the degree of erythrocyte membrane protein carbamylation in uremic and nonuremic patients, and to characterize the in vitro binding of cyanate to the individual proteins of the cytoskeletal matrix. DESIGN AND METHODS: For in vivo studies, erythrocyte ghosts were digested with proteinase K and the released peptides colorimetrically assayed for carbamylation, using the diacetyl monoxime reagent, and quantitated using homocitrulline. For in vitro studies, erythrocyte ghosts were incubated with [14C] cyanate, and the membrane proteins separated by SDS-PAGE. Cyanate incorporation was quantitated by liquid scintillation counting and imaging densitometry of the excised bands. RESULTS: Erythrocytes from uremic patients were found to have a greater level of carbamylation than those from nonuremic patients (47.09 +/- 7.80 and 25.89 +/- 6.92 nmol homocitrulline/mg proteolyzed protein released, respectively). In vitro incorporation of [14C] cyanate into membrane protein followed the sequence: spectrin > ankyrin > Band 4.1 > Band 3 > actin > Band 7. CONCLUSIONS: The increased level of erythrocyte membrane protein carbamylation in uremic compared to nonuremic patients may lead to membrane destabilization and contribute to the decreased erythrocyte survival time observed in uremia.

Low-density lipoprotein binding assay using the calf adrenocortical low-density lipoprotein receptor.

The low-density lipoprotein (LDL) receptor was purified to a semipure solubilized form from calf adrenocortical tissue. This receptor was found to be a suitable substitute for the human LDL receptor for studying human LDL binding. The apparent dissociation constant of the receptor from calf adrenocortical cells, using human LDL as the ligand, was found to be 8.8 +/- 1.0 micrograms 125I-LDL/mL, similar to that reported for the human LDL receptor (4-10 micrograms LDL/mL). The calf adrenocortical LDL receptor demonstrated specificity toward human lipoprotein fractions that was identical with that of the human LDL receptor. A competitive binding assay was optimized using the semipurified solubilized calf adrenocortical receptor. This facilitated the study of nonenzymatically glycosylated human LDL by a binding assay that is much simpler and faster than previous studies, which used intact cultured cells. The present assay requires only a 1-h incubation of LDL with the receptor and a simple filtration procedure to remove unbound LDL. Using the present assay, it was shown that nonenzymatic glycosylation of LDL on the order of what is seen in diabetics, that is, modification of 2-5% of lysine residues, caused a decreased ability of the LDL to bind to the receptor.

Glycated calmodulin from platelets as an index of glycemic control.

In an effort to test whether a significant fraction of calmodulin would become glycated within the life span of the platelet (10-14 days), we monitored the kinetics of calmodulin glycation in vitro. Under the conditions we used, the fraction of glycated calmodulin reached a maximum (approximately 21%) within 10 days. We then extended the studies to human subjects. The intraplatelet concentrations of calmodulin and glycated calmodulin from age-matched type I diabetic subjects were monitored by a combination of m-aminophenylboronate affinity chromatography and enzyme-linked immunosorbent assay. The results indicate that the concentrations of total intraplatelet calmodulin (nonglycated plus glycated) were not dependent on the glycemic state of the subjects. Data from control and diabetic subjects showed a poor correlation between the concentrations of glycohemoglobin and of glycated calmodulin. However, a better correlation was obtained when glycated calmodulin concentrations were compared with those of serum fructosamine. The fraction of glycated calmodulin in the control population (7.71% +/- 0.75%) was significantly (P < 0.05) different from that of the diabetic population (21.6% +/- 1.26%). Given that the clinical role of the fructosamine assay remains controversial, estimation of glycated calmodulin in platelets might be useful as a short time-window index of glycemic control.

Glutathione metabolic enzyme activities in diabetic platelets as a function of glycemic control.

Type 1 diabetic subjects categorized on the basis of the glycated haemoglobin content of their blood (low less than 7%; medium, greater than 7% and less than 11%; high, greater than 11%) were analyzed for total intraplatelet GSH as well as for the steady-state kinetic parameters (apparent KM and apparent Vmax) of some glutathione metabolic enzymes including glutathione reductase, glutathione peroxidase, gamma-glutamyltrans-peptidase and glutathione-S-transferase. This study indicates that intraplatelet GSH content of subjects with low glycated-haemoglobin is approximately 2-fold higher than those with medium glycated-haemoglobin. There was no further decrease in intraplatelet-GSH in subjects with high glycated-haemoglobin. The kinetic parameters of the platelet-enzymes studied (glutathione reductase, gamma-glutamyltranspeptidase and glutathione-S-transferase) were essentially independent of the glycation state of the subject. However, the apparent KM of glutathione peroxidase was approximately 4-fold higher in the subjects with high glycated-haemoglobin, in comparison to low subjects. This decrease in affinity could possibly result from the susceptibility of this enzyme to non-enzymatic glucosylation as purified samples of glutathione peroxidase incubated in vitro with glucose showed similar increases in apparent KM. These results are discussed in terms of the potential contribution of glutathione peroxidase impairment, to the hyperaggregability of the diabetic platelet.

Determination of non-enzymatically glycated apolipoprotein A1.

A procedure for the quantitation of non-enzymatically glycated apolipoprotein A1 (GApoA1) was developed and optimized. Glycated total protein was separated from plasma using m-aminophenyl-boronate affinity chromatography. Apolipoprotein A1 present in the glycated and non-glycated fractions of each sample was determined by rate nephelometry, and the percent glycated apo A1 calculated. The measuring range of the assay was 0.5-8.0% GApoA1. The within- and between-run CV's were less than 5.2 and 7.9%, respectively, and recoveries were greater than 92%. Free glucose did not affect the results. In a group of female non-insulin diabetic subjects the mean GApoA1 was 3.8 +/- 1.6% (mean +/- SD). In non-diabetic subjects the mean level of GApoA1 was 2.1 +/- 0.8% (mean +/- SD).

Colorimetric determination of non-enzymatically glycated albumin.

A colorimetric method was developed for the determination of nonenzymatically glycated albumin and adapted to a Flexigem centrifugal analyzer. Albumin was separated from serum or plasma using Sepharose-blue dextran affinity chromatography. The stable ketoamine linkage in glycated albumin reduced a tetrazolium salt to its colored formazan. Glycated human serum albumin was used as the standard and optimum conditions for the assay were established. Recovery of glycated albumin was quantitative. The coefficients of variation for within-run and day-to-day precision were 4.6% and 8.5%, respectively. The labile aldimine fraction, lipemia, icterus, hemolysis and type of anticoagulant used did not affect the results. The non-diabetic reference interval for this method was 7.9-11.6% glycated albumin, and normal and diabetic populations can be clearly discriminated (p less than 0.005). Values obtained with this method correlated well with a thiobarbituric acid assay (r = 0.974) but less so with those for glycated hemoglobin (r = 0.35).

Continuous-flow analysis of ammonia in perchloric acid supernate of blood or plasma using an ammonia-selective electrode.

A simple automated method for the estimation of ammonia in perchloric acid supernate of blood or plasma using an ion-selective electrode (Orion Ammonia-selective electrode, Model 95-10) is described. The reliability of the proposed method has been checked against an ion-exchange resin procedure, which has been chosen as a standard procedure. Regression equation and correlation coefficient for the proposed method are y = 0.7 X + 10 and 0.945, respectively, as compared with the chosen standard method. Within-run and between-run precision are 2.1% and 3.5% respectively. The average percent recovery is 97.5% and a tentative range is 13-73 microgram/dl (9-52 micronmol/l) ammonia nitrogen.

Assessment of the EMIT-(TM) technique as a screening test for opiates and methadone for a methadone maintenance clinic and its calibration by Bayesian statistics.

1. The performance of the semi-quantitative enzyme multiplied immunoassay technique (EMIT, Syva Corp.) for opiates and methadone has been examined as a screening procedure of urine samples from a methadone maintenance programme. The predictive value model that is based upon Bayesian statistics was used to determine screening levels for the EMIT assays. 2. With a predictive value of a negative result of 100%, the EMIT opiate assay can be used to show the absence of the indicated drugs, while positive results can be confirmed by a non-immunological technique. A screening level of 1.0 micrograms/ml for the opiate assay, conforms to this model. 3. The EMIT methadone assay was shown to have a predictive value of a negative result of 28% with respect to thin-layer chromatographic (TLC) results. This discrepancy between EMIT and TLC can not be explained by sensitivity alone. The manufacturer's recommended 0.5 micrograms/ml cutoff has been used therefore for the methadone assay.

Pulmonary surfactant and amniotic fluid insulin.

Immunoreactive insulin was measured in 66 amniotic fluid samples and the level compared to two indices of pulmonary surfactant activity, namely, lecithin sphingomyelin ratio and lecithin palmitic acid. An apparent inverse relation between lecithin and insulin was demonstrated after 34-35 weeks' gestation. These results tend to support the hypothesis that insulin can inhibit lecithin synthesis.

Quantitative histological changes in isoproterenol induced cardiac growth.

In female rats daily injections of isoproterenol (0.3 mg/kg) produced a 40% myocardial growth within 10 days. Approximately 75% of the total growth was associated with increased muscle fiber size. The number of nuclei in muscle tissue was not affected while the nuclear population in the interstitial tissue was significantly increased.

Fetal lung maturity, as assessed by gas-liquid chromatographic determination of phospholipid palmitic acid in amniotic fluid.

We describe a new and specific method for measurement of lecithin palmitic acid in amniotic fluid. Dipalmitoyl lecithin, the major alveolar surfactant, has previously been estimated by measuring the lecithin-sphingomyelin ratio, total lecithin, total phospholipid phosphorus, and (or) total palmitic acid. Our method is more specific for estimation of dipalmitoyl lecithin, because nonphospholipid sources of palmitic acid are removed by solvent extraction. Using a hexane/2-propanol/sulfuric acid system, we obviated the major interferences from triglycerides and free fatty acids. The palmitic acid derived from the phospholipid fraction is measured by gas-liquid chromatography of its methyl ester. No contribution appears to be made by sphingomyelin palmitic acid--probably owing to the mild hydrolysis conditions. The measured palmitic acid therefore appears to be derived from lecithins, principally dipalmitoyl lecithin. The value for palmitic acid determined by this method correlates well with the lecithin-sphingomyelin ratio and total phospholipid phosphorus. Infants are unlikely to develop respiratory distress syndrome when the measured palmitic acid in amniotic fluid exceeds 8.0 mg/liter, which corresponds to an lecithin-sphingomyelin ratio of 2.0.

Simultaneous determination of serum cholesterol and triglycerides after preliminary column chromatography.

An isopropanolic extract of serum can be made suitable for the simultaneous estimation of cholesterol and triglycerides by passing it through a commercially-available chromatographic column containing activated metallic oxides in which alumina predominates. No centrifugation step nor phase separation is required. Use of the purified extract allows existing methods to be simplified and shortened without loss of reproducibility or stability. Results compare well with those obtained by traditional methods.