Standardizing plasma protein measurements worldwide: a challenging enterprise.

The need for harmonizing laboratory results is particularly intense in the field of quantitative protein assays in consideration of the clinical impact of specific protein measurements and their relevance in monitoring disease. We report the efforts made by the Committee on Plasma Proteins of the IFCC Scientific Division to achieve worldwide comparability in plasma protein results. We focus on the production of reference materials and the methods applied throughout their production process. Particularly, the recent characterization of ERM-DA470k/IFCC and ERM-DA472/IFCC has demonstrated that it is possible to reproduce the earlier established procedures and thereby maintain standardization. Plasma protein reference materials have had a substantial impact in improving the harmonization of patient protein results that should translate into better patient care.

Protein standardization V: value transfer. A practical protocol for the assignment of serum protein values from a Reference Material to a Target Material.

We present a practical protocol for the assignment of values to serum proteins in a Target Material using a Reference Material. This protocol is based on the model of Direct Value Transfer between serum matrices and is intended to improve the value assignment of commercial calibrators using the Reference Material CRM 470 (now labeled ERM-DA 470) or similar reference materials. The procedure describes the general as well as the practical principles involved in the value assignment (with examples). The practical transfer protocol is based on multiple assays of 6 dilutions of the Reference Material and 6 dilutions of the Target Material. The transfer protocol requires several measurements a day repeated on several days, an important prerequisite being that all reconstitutions and dilutions are controlled by weighing thus reducing uncertainty in the transfer. In open systems that allow the use of the Reference Material as calibrator and the Target Material as samples, the proportionality of the two materials (the presence or absence of matrix effects) can now be directly assessed by evaluating a single regression plot. If no matrix effects are found, the regression line will pass through zero with a slope equal to the ratio of the concentrations of the two materials. In closed systems, the dedicated commercial calibrator has to be used as such; the Reference Material and the Target Material are now assayed as samples against this calibrator. Two regression plots are therefore obtained; if no matrix effects are present among the two materials and the calibrator, both the Reference and Target Materials will show zero intercepts, and the ratio of the two slopes will equal the ratio of the concentrations.

Reference intervals for serum proteins: similarities and differences between adult Caucasian and Asian Indian males in Yorkshire, UK.

The aim of this study was to investigate similarities and differences in the distribution of serum concentrations of nine proteins in two racial groups (Caucasian and Asian Indian) of adult males living in the same geographical area (Leeds, Bradford, UK) for at least two generations. This is part of a larger study to determine the need for separating reference intervals for racial and ethnic groups worldwide. The distributions of concentrations for all proteins evaluated in the Indians fit In-Gaussian distributions, indicating probable homogeneity. However, for the Caucasians, the distributions for alpha1-antitrypsin and possibly haptoglobin were not In-Gaussian. In the former case, this is undoubtedly due to the number of Caucasians with lower-concentration phenotypes (Pi MS and MZ). Although haptoglobin differences may be due to genetic variants as well, this is not a complete explanation. In addition, the Indians have lower serum concentrations of orosomucoid (alpha1-acid glycoprotein), as has been reported by others. It is apparent that for some proteins, including alpha1-antitrypsin, orosomucoid, and possibly haptoglobin, the populations show differences that require the use of separate reference intervals. In addition to genetic influences, environmental differences cannot be ruled out as partial causes for some of the differences noted.

Commutability of the CRM 470 C-reactive protein value in the Dade Behring N High Sensitivity CRP assay.

Certified Reference Material 470 (CRM 470) demonstrates commutability with both the manufacturer's calibrator and with dilutions of serum pools in the Dade Behring N High Sensitivity assay for C-reactive protein (CRP). Both regression and back calibration show similar nonlinearity for all materials, largely due to the method of calibration curve fitting used in this assay. Significant differences in values among the currently available commercial assays can be largely overcome by using appropriate calibration curve fitting and the recommended value transfer protocol, which includes a minimum of two assay runs on each of at least 3 separate days, with weight correction of all reconstitutions and dilutions. An initial weight-corrected dilution should be made each day because of the relatively high level of CRP in CRM 470. In our opinion, the degree of nonlinearity, imprecision, and differences in values in currently available assays renders the use of fixed clinical decision cut-points questionable for high-sensitivity CRP. An alternative approach is suggested.