Characterization of the second conserved domain in the heme uptake protein HtaA from Corynebacterium diphtheriae.

HtaA is a heme-binding protein that is part of the heme uptake system in Corynebacterium diphtheriae. HtaA contains two conserved regions (CR1 and CR2). It has been previously reported that both domains can bind heme; the CR2 domain binds hemoglobin more strongly than the CR1 domain. In this study, we report the biophysical characteristics of HtaA-CR2. UV-visible spectroscopy and resonance Raman experiments are consistent with this domain containing a single heme that is bound to the protein through an axial tyrosine ligand. Mutants of conserved tyrosine and histidine residues (Y361, H412, and Y490) have been studied. These mutants are isolated with very little heme (≤5%) in comparison to the wild-type protein (~20%). Reconstitution after removal of the heme with butanone gave an alternative form of the protein. The HtaA-CR2 fold is very stable; it was necessary to perform thermal denaturation experiments in the presence of guanidinium hydrochloride. HtaA-CR2 unfolds extremely slowly; even in 6.8M GdnHCl at 37°C, the half-life was 5h. In contrast, the apo forms of WT HtaA-CR2 and the aforementioned mutants unfolded at much lower concentrations of GdnHCl, indicating the role of heme in stabilizing the structure and implying that heme transfer is effected only to a partner protein in vivo.

A Library of Rare α1-Antitrypsin (AAT) Variant Phenotypes to Aid in the Diagnosis of AAT Deficiency.

OBJECTIVES: α1-Antitrypsin (AAT) deficiency is a hereditary disorder due to defective production of the serine protease inhibitor, AAT, which can cause lung and liver diseases. Severity of disease depends particularly on the phenotypic representation of AAT variants in the patient. METHODS: In this study, we present determination of seven common and nine rare variant phenotypes of AAT using pediatric samples collected in Texas Children's Hospital to address the knowledge gap in the identification of rare variants. We tested 16 different AAT variants that had been stored in a -80 °C freezer over the years to add to the reference library of AAT variants. The gold-standard isoelectric focusing electrophoresis method was used for analysis and interpretation of AAT variants. Each variant was inspected visually by comparing multiple bands, unique to phenotypic identity, with a previously identified pattern. RESULTS: Seven common M, S, and Z variants were identified as M1M1, M2M2, M1M2, MS, SS, SZ, and ZZ. Nine rare variants were identified as FM, FS, FZ, PM, XM, YM, IM, TS, and EP. These were interpreted independently and in a blinded manner by an experienced technologist and two clinical chemists from two different institutions. CONCLUSIONS: Our results add to the reference library to identify the rare variant phenotypes of AAT protein. This report will guide clinical laboratories for proper assessment of rare variants and in turn contribute to accurate diagnosis and management of AAT deficiency.

Multiple calibrator measurements improve accuracy and stability estimates of automated assays.

OBJECTIVES: The effects of combining multiple calibrations on assay accuracy (bias) and measurement of calibration stability were investigated for total triiodothyronine (TT3), vitamin B12 and luteinizing hormone (LH) using Beckman Coulter's Access 2 analyzer. METHODS: Three calibration procedures (CC1, CC2 and CC3) combined 12, 34 and 56 calibrator measurements over 1, 2, and 3 days. Bias was calculated between target values and average measured value over 3 consecutive days after calibration. Using regression analysis of calibrator measurements versus measurement date, calibration stability was determined as the maximum number of days before a calibrator measurement exceeded 5% tolerance limits. RESULTS: Competitive assays (TT3, vitamin B12) had positive time regression slopes, while sandwich assay (LH) had a negative slope. Bias values for TT3 were -2.49%, 1.49%, and -0.50% using CC1, CC2 and CC3 respectively, with calibrator stability of 32, 20, and 30 days. Bias values for vitamin B12 were 2.44%, 0.91%, and -0.50%, with calibrator stability of 4, 9, and 12 days. Bias values for LH were 2.26%, 1.44% and -0.29% with calibrator stability of >43, 39 and 36 days. Measured stability was more consistent across calibration procedures using percent change rather than difference from target: 26 days for TT3, 12 days for B12 and 31 days for LH. CONCLUSIONS: Averaging over multiple calibrations produced smaller bias, consistent with improved accuracy. Time regression slopes in percent change were unaffected by number of calibration measurements but calibrator stability measured from the target value was highly affected by the calibrator value at time zero.

Heme-bound SiaA from Streptococcus pyogenes: Effects of mutations and oxidation state on protein stability.

The protein SiaA (HtsA) is part of a heme uptake pathway in Streptococcus pyogenes. In this report, we present the heme binding of the alanine mutants of the axial histidine (H229A) and methionine (M79A) ligands, as well as a lysine (K61A) and cysteine (C58A) located near the heme propionates (based on homology modeling) and a control mutant (C47A). pH titrations gave pKa values ranging from 9.0 to 9.5, close to the value of 9.7 for WT SiaA. Resonance Raman spectra of the mutants suggested that the ferric heme environment may be distinct from the wild-type; spectra of the ferrous states were similar. The midpoint reduction potential of the K61A mutant was determined by spectroelectrochemical titration to be 61±3mV vs. SHE, similar to the wild-type protein (68±3mV). The addition of guanidine hydrochloride showed two processes for protein denaturation, consistent with heme loss from protein forms differing by the orientation of the heme in the binding pocket (the half-life for the slower process ranged from less than half a day to two days). The ease of protein unfolding was related to the strength of interaction of the residues with the heme. We hypothesize that kinetically facile but only partial unfolding, followed by a very slow approach to the completely unfolded state, may be a fundamental attribute of heme trafficking proteins. Small motions to release/transfer the heme accompanied by resistance to extensive unfolding may preserve the three dimensional form of the protein for further uptake and release.

Evaluation of the Lipid Interference for Siemens BN ProSpec Cystatin C Assay Using Pediatric Samples.

Endogenous interferents (lipids, hemoglobin and bilirubin) are a common cause of pre-analytical laboratory errors. We evaluated the effect of lipemia on Siemens cystatin C assay using pediatric samples. Lipemic samples were prepared by adding various concentrations of triglycerides into low and high cystatin C sample pools. Cystatin C concentrations were then measured on Siemens BN ProSpec analyzer and change of the analyte concentrations was determined. Low and high cystatin C sample pools were not affected by additions of lower lipid concentrations (150, 500 and 750 mg/dL), while the negative bias of <10% was seen with additions of higher lipid concentrations (1000 and 1500 mg/dL). Our results suggest that the BN ProSpec assay is a good alternative for cystatin C measurements in our pediatric population with no major interference from lipemia.

Heme Binding by Corynebacterium diphtheriae HmuT: Function and Heme Environment.

The heme uptake pathway (hmu) of Corynebacterium diphtheriae utilizes multiple proteins to bind and transport heme into the cell. One of these proteins, HmuT, delivers heme to the ABC transporter HmuUV. In this study, the axial ligation of the heme in ferric HmuT is probed by examination of wild-type (WT) HmuT and a series of conserved heme pocket residue mutants, H136A, Y235A, and M292A. Characterization by UV-visible, resonance Raman, and magnetic circular dichroism spectroscopies indicates that H136 and Y235 are the axial ligands in ferric HmuT. Consistent with this assignment of axial ligands, ferric WT and H136A HmuT are difficult to reduce while Y235A is reduced readily in the presence of dithionite. The FeCO Raman shifts in WT, H136A, and Y235A HmuT-CO complexes provide further evidence of the axial ligand assignments. Additionally, these frequencies provide insight into the nonbonding environment of the heme pocket. Ferrous Y235A and the Y235A-CO complex reveal that the imidazole of H136 exists in two forms, one neutral and one with imidazolate character, consistent with a hydrogen bond acceptor on the H136 side of the heme. The ferric fluoride complex of Y235A reveals the presence of at least one hydrogen bond donor on the Y235 side of the heme. Hemoglobin utilization assays showed that the axial Y235 ligand is required for heme uptake in HmuT.

Validation of the procalcitonin (PCT) assay: Experience in a pediatric hospital.

OBJECTIVES: Procalcitonin (PCT) is a potential early biomarker used to differentiate sepsis from systemic inflammation. Serial PCT measurement is useful in reducing the duration of antibiotic exposure without increasing treatment failure. Our aim was to establish and evaluate an automated quantitative PCT assay at Texas Children's Hospital. METHODS: We validated the analytical and clinical performance of the automated miniVIDAS B.R.A.H.M.S PCT® assay (BioMerieux®, France) at Texas Children's Hospital. Analytical performance parameters included precision, linearity, accuracy, correlation, and effect of different common interferents (free Hb, bilirubin, triglyceride and rheumatoid factor). Also, the interference of high calcitonin (CT) on PCT assay was tested. We performed clinical correlation of PCT to blood culture, WBC counts and CRP in sepsis patients. RESULTS: The PCT assay showed good precision with %CV of <5% for intra-assay and %CV of 6.5% for inter-assay precision. The assay was linear across the measurement range (0.05µg/L-200µg/L). Correlation studies showed a good correlation (r>0.9). No significant effects on PCT levels were seen with common interferents however, calcitonin concentrations of 1000ng/L or more showed cross-reactivity with PCT values. Fourteen (78%) out of the total eighteen patients with positive blood culture, showed median PCT concentrations greater than the cut-off values of 0.15µg/L. CONCLUSION: The miniVIDAS PCT assay can be used for diagnostic purposes in clinical laboratories. We envision that serial PCT monitoring along with clinical correlation will be beneficial in critically ill patients.

Assessment of liver function tests on Piccolo Xpress point of care chemistry analyzer in a pediatric hospital.

OBJECTIVES: Point of care testing (POCT) contributes to diagnosis and monitoring with fast testing time and easily performed assays. We evaluated the Abaxis Piccolo Xpress point of care chemistry analyzer using the Liver Panel Plus discs for our pediatric patient population at Texas Children's Hospital. DESIGN AND METHODS: Analytical performance was evaluated for precision and linearity using quality control materials and commercially available verification samples. Comparison studies were performed between Piccolo Xpress analyzer and Vitros 5600 analyzer using patient samples. Interference studies were carried out using nine different patient pool sera. Lipemia interference was removed using LipoClear for severely lipemic sample pools. RESULTS: Precision of all tests was excellent (CVs<5% for all measured analytes except TBIL). All assays were linear and accurate within the allowable total error. Comparison studies showed that three analytes (amylase, GGT and TBIL) had statistically significant bias. Interference study results did not exceed the total allowable error for hemoglobin (<150 mg/dL), bilirubin (<15 mg/dL) and lipemia (<400 mg/dL except ALT, GGT and TP). LipoClear treatment removed lipemia interference for all analytes except total protein. CONCLUSIONS: The Piccolo Xpress chemistry analyzer showed an acceptable analytical performance for precision, linearity and interference from common substances. Increased bias for three analytes in comparison studies could be due to different methodologies.

Evaluation of Beckman Coulter DxI 800 immunoassay system using clinically oriented performance goals.

OBJECTIVES: We evaluated the analytical performance of 24 immunoassays using the Beckman Coulter DxI 800 immunoassay systems at Mayo Clinic, Rochester, MN for trueness, precision, detection limits, linearity, and consistency (across instruments and reagent lots). METHODS: Clinically oriented performance goals were defined using the following methods: trueness-published desirable accuracy limits, precision-published desirable biologic variation; detection limits - 0.1 percentile of patient test values, linearity - 50% of total error, and consistency-percentage test values crossing key decision points. Local data were collected for precision, linearity, and consistency. Data were provided by Beckman Coulter, Inc. for trueness and detection limits. RESULTS: All evaluated assays except total thyroxine were within the proposed goals for trueness. Most of the assays met the proposed goals for precision (86% of intra-assay results and 75% of inter-assay results). Five assays had more than 15% of the test results below the minimum detection limits. Carcinoembryonic antigen, total thyroxine and free triiodothyronine exceeded the proposed goals of ±6.3%, ±5% and ±5.7% for dilution linearity. All evaluated assays were within the proposed goals for instrument consistency. Lot-to-lot consistency results for cortisol, ferritin and total thyroxine exceeded the proposed goals of 3.3%, 11.4% and 7% at one medical decision level, while vitamin B12 exceeded the proposed goals of 5.2% and 3.8% at two decision levels. CONCLUSIONS: The Beckman Coulter DxI 800 immunoassay system meets most of these proposed goals, even though these clinically focused performance goals represent relatively stringent limits.