RESUMO
BACKGROUND: Serum and urinary protein electrophoresis play an important role in the identification of monoclonal gammopathy. Recently, capillary electrophoresis (CE) has been adapted in many clinical laboratories because of several advantages such as short turnaround time, automation, and high reproducibility. However, there have been unsolved concerns for the concordance between conventional gel and automated capillary electrophoresis methods for protein separation in clinical specimens. In this study, we investigated the diagnostic performance of both methods for detecting monoclonal (M) protein. METHODS: From February 2012 to August 2015, a total of 3,013 CE tests were performed in our hospital. Among these cases, we reconfirmed results of CE (Capillary 2, Sebia, Lysse, France) with those of conventional agarose gel electrophoresis (GE) (Hydragel 4IF, Sebia, Lisses, France) in 28 specimens from 24 patients with newly diagnosed monoclonal gammopathy (group 1). In addition, 22 cases from 15 patients with previously diagnosed monoclonal gammopathy presenting indeterminate or suspicious results on CE (group 2) were also reconfirmed with GE. RESULTS: We compared the results between the two electrophoresis methods in two different groups of patients with newly diagnosed discrete monoclonal peaks vs. pre-existing monoclonal gammopathy with obscure results in follow-up courses. In group 1, agreement rate was 100% (28/28) and there was no discrepant result between these two electrophoresis methods. In contrast, group 2 showed 86.4% (19/22) agreement rate and 0.67 Cohen's kappa value (95% confidence interval, 0.51 - 1.02). CONCLUSIONS: According to our results, both electrophoresis methods can be used with the same level of assurance at the time of initial diagnosis for monoclonal gammopathy. However, in patients with previously diagnosed monoclonal gammopathy in follow-up course after appropriate treatments, discordant results can be observed due to the reduced amount of M proteins. Therefore, we suggest that some ambiguous cases with very small amounts of M components require a combination of both CE and GE methods for accurate interpretation to confirm the presence of M proteins.
Assuntos
Serviços de Laboratório Clínico/normas , Eletroforese em Gel de Ágar/métodos , Eletroforese Capilar/métodos , Paraproteinemias/diagnóstico , Eletroforese em Gel de Ágar/estatística & dados numéricos , Eletroforese Capilar/estatística & dados numéricos , Humanos , Proteínas do Mieloma/análise , Paraproteinemias/sangue , Paraproteinemias/urina , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
To investigate the sequence types (STs) and fluoroquinolone resistance related mutations among ciprofloxacin (CIP)-non-susceptible extended-spectrum ß-lactamase (ESBL)-producing E. coli isolated from Korean patients from 2006-2008. The prevalence of fluoroquinolone resistance-determining region (QRDR) mutations in gyrA, gyrB, parC, and parE and plasmid-mediated quinolone resistance (PMQR) genes were also studied. Multilocus sequence typing (MLST) was performed to identify STs. The most common ST was ST131 (33/51, 64.7%). All isolates, except one isolate, showed three mutations at codons 83 (S83L) and 87 (S87N) in gyrA and 80 (S80I) in parC The prevalence of ST131 in our hospital was much higher than reported in other Asian studies during a similar time period. The mutations found in ST131 were concordant with other studies.
Assuntos
Ciprofloxacina/farmacologia , Farmacorresistência Bacteriana/genética , Infecções por Escherichia coli/epidemiologia , Escherichia coli/isolamento & purificação , Fluoroquinolonas/farmacologia , Genes Bacterianos , Tipagem de Sequências Multilocus/métodos , Antibacterianos/farmacologia , Estudos Epidemiológicos , Escherichia coli/genética , Infecções por Escherichia coli/genética , Infecções por Escherichia coli/microbiologia , Hospitais Universitários , Humanos , Testes de Sensibilidade Microbiana , Mutação , Prognóstico , República da Coreia/epidemiologia , Atenção Terciária à Saúde , beta-Lactamases/metabolismoRESUMO
BACKGROUND: We investigated mutations in the quinolone resistance-determining region (QRDR) of ciprofloxacinnonsusceptible extended-spectrum ï¢-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae by a statistical analysis. METHODS: We collected 97 clinical isolates of ciprofloxacin-nonsusceptible ESBL-producing E. coli (55 strains) and K. pneumoniae (42 strains) from a tertiary-care university hospital in Seoul, Republic of Korea, between 2006 and 2008. The QRDR of the gyrA, gyrB, parC, and parE genes were amplified by PCR and sequenced. RESULTS: Most E. coli isolates (53/55; 96.4%) with a minimum inhibitory concentration of ≥ 64 mg/L against ciprofloxacin had double mutations in gyrA (Ser-83ï®Leu and Asp-87ï®Asn) and at least one mutation in parC (Ser-80 ï®Ile or Glu-84ï®Val), with or without one in parE. Fifty E. coli (90.9%) isolates had a mutation in parE, of which Ile-529ï®Leu (70.9%) was the most frequent. However, we could not find statistically significant variables in increasing ciprofloxacin resistance in E. coli isolates. Thirty-six K. pneumoniae isolates (36/42; 85.7%) had at least one mutation in gyrA, gyrB, or parC, and the mutation in gyrA might have been associated with plasmid-mediated quinolone-resistance (PMQR). Ser-80ï®Ile in parC and aac(6')-Ib-cr in the K. pneumoniae isolates were significantly associated with an increased MIC of ciprofloxacin by ordinal logistic regression analysis. CONCLUSIONS: The Ser-80ï®Ile in parC and aac(6')-Ib-cr in K. pneumoniae are supposed to play an important role in increased ciprofloxacin resistance, but statistically significant variables could not be found in E. coli isolates in the present study.
Assuntos
Escherichia coli , Klebsiella pneumoniae , Mutação , Antibacterianos , Ciprofloxacina , DNA Girase , DNA Topoisomerase IV , Farmacorresistência Bacteriana , Humanos , Testes de Sensibilidade Microbiana , República da CoreiaAssuntos
Cirrose Hepática Alcoólica , Ásia , Eletroforese Capilar , Humanos , Isoformas de Proteínas , TransferrinaRESUMO
The inhibin-α gene was identified as a tumor suppressor gene in the gonads and adrenal glands by functional studies using knockout mice. Methylation of CpG sites within the regulatory regions of tumor suppressor gene is frequently associated with their transcriptional silencing. We investigated epigenetic modifications, changes in loss of heterozygosity (LOH), and mutation of the inhibin-α gene, and regulation of transcriptional expression in response to inhibitors of DNA methylation (5-aza-2'-deoxycytidine, 5-AzaC) in human lymphoid (Jurkat, Molt-4, Raji, and IM-9) and myeloid (HL-60, Kasumi-1, and K562) leukemia cells. The inhibin-α promoter was hypermethylated in lymphoid (Molt-4 and Raji) and myeloid (HL-60 and Kasumi-1) leukemia cells. Inhibin-α gene mutations differed significantly between lymphoid (heterozygote) and myeloid (homozygote) leukemia cells. LOH in the inhibin-α gene was detected in lymphoid and myeloid leukemia cells, with the exception of Jurkat cells. Treatment with 5-AzaC, a demethylating agent, resulted in increased inhibin-α mRNA and protein levels in most of the cell lines. Also, 5-AzaC treatment inhibited cell proliferation and induced apoptosis. Taken together, our results reveal that the inhibin-α gene is transcriptionally silenced in human leukemia cells and that reactivation is suppressed by a demethylating agent. In addition, mutations in, and expression levels of, the inhibin-α gene differed between human lymphoid and myeloid leukemia cells.
Assuntos
Metilação de DNA , Epigênese Genética , Regulação Neoplásica da Expressão Gênica , Inibinas/genética , Leucemia Linfoide/genética , Leucemia Mieloide/genética , Apoptose/efeitos dos fármacos , Azacitidina/análogos & derivados , Azacitidina/farmacologia , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Ilhas de CpG/genética , Metilação de DNA/efeitos dos fármacos , Decitabina , Inibidores Enzimáticos/farmacologia , Inativação Gênica , Humanos , Perda de Heterozigosidade , Mutação , Regiões Promotoras Genéticas , RNA Mensageiro/metabolismoAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cromossomos Humanos Par 12 , Cromossomos Humanos Par 3 , Fusão Gênica , Rearranjo Gênico , Leucemia Mieloide Aguda/genética , Proteína do Locus do Complexo MDS1 e EVI1/genética , Proteínas Proto-Oncogênicas c-ets/genética , Proteínas Repressoras/genética , Translocação Genética , Deleção Cromossômica , Cromossomos Humanos Par 7/genética , Predisposição Genética para Doença , Humanos , Cariotipagem , Leucemia Mieloide Aguda/induzido quimicamente , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex , Fenótipo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Variante 6 da Proteína do Fator de Translocação ETSAssuntos
Síndromes Mielodisplásicas/diagnóstico , Complicações Hematológicas na Gravidez/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Adulto , Feminino , Humanos , Síndromes Mielodisplásicas/sangue , Síndromes Mielodisplásicas/genética , Regressão Neoplásica Espontânea , Parto , Valor Preditivo dos Testes , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/genética , Complicações Neoplásicas na Gravidez/sangue , Complicações Neoplásicas na Gravidez/genética , Recidiva , Fatores de RiscoAssuntos
Infecções por Bacteroides/diagnóstico , Bacteroides/genética , Chaperonina 60/genética , DNA Girase/genética , DNA Bacteriano/genética , RNA Ribossômico 16S/genética , Ribotipagem/métodos , Análise de Sequência de DNA , Antibacterianos/uso terapêutico , Bacteroides/classificação , Bacteroides/efeitos dos fármacos , Infecções por Bacteroides/sangue , Infecções por Bacteroides/tratamento farmacológico , Infecções por Bacteroides/microbiologia , Infecções por Bacteroides/transmissão , Feminino , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Resultado do TratamentoAssuntos
Aerococcaceae/genética , Bacteriemia/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , RNA Ribossômico 16S/genética , Aerococcaceae/isolamento & purificação , Idoso de 80 Anos ou mais , DNA Bacteriano/análise , DNA Bacteriano/isolamento & purificação , Feminino , Humanos , República da Coreia , Análise de Sequência de DNA/métodosAssuntos
Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Vancomicina , Antibacterianos/uso terapêutico , Humanos , Linezolida , Meticilina , Resistência a Meticilina , Oxazolidinonas/uso terapêutico , Pneumonia Estafilocócica/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacosAssuntos
Transfusão de Eritrócitos , Sistema do Grupo Sanguíneo Rh-Hr/genética , Imunoglobulina rho(D)/sangue , Adenocarcinoma/sangue , Adenocarcinoma/cirurgia , Povo Asiático/genética , Doadores de Sangue , Deleção de Genes , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Neoplasias da Próstata/sangue , Neoplasias da Próstata/cirurgia , População BrancaAssuntos
Bacteriemia/diagnóstico , Proteínas de Bactérias/genética , Corynebacterium/genética , RNA Ribossômico 16S/genética , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Proteínas de Bactérias/metabolismo , Proteína C-Reativa/análise , Cateteres Venosos Centrais , Corynebacterium/isolamento & purificação , Farmacorresistência Bacteriana Múltipla , Humanos , Masculino , Pessoa de Meia-Idade , RNA Ribossômico 16S/metabolismoRESUMO
AIM: Although the etiology of plasma cell dyscrasia is poorly understood, there is evidence for immune dysregulation or sustained immune stimulation playing a pivotal role in the pathogenesis of these diseases, including chronic infection and autoimmune disorders. In this study, we report four autoimmune disease cases where monoclonal gammopathy (MG) was incidentally found during follow-up. METHODS: We retrospectively reviewed the medical charts and laboratory test results in the following four cases: neuromyelitis optica, Kikuchi disease, Sjögren syndrome and ankylosing spondylosis. RESULTS: The four patients were older than 55 years and the male-to-female ratio was 2 : 2. The autoimmune disease in each case developed differently because two patients had coincidental detection of MG, whereas MG was detected 2 years and 10 years after diagnosis in the other two patients. The amount of M-components in the blood for two cases was ≤ 1 g/dL. For the other two subjects, M-components were ≥ 3 g/dL. CONCLUSION: A high prevalence of MG of undetermined significance (MGUS) has been noted in a series of patients with immune disorders, suggesting a possible association with MG. Further studies should focus on determining how MG relates to various clinical information and laboratory parameters, such as disease duration, disease activity and higher sedimentation rate. In the future, we also need to identify which stimuli, such as cytokine types and levels, can induce lymphocyte clonal transformation and the production of monoclonal antibodies.