Showing papers in "Clinical Chemistry in 1990"

Determination of inorganic nitrate in serum and urine by a kinetic cadmium-reduction method.

Abstract: Nitrate in serum and urine was assayed by a modification of the cadmium-reduction method; the nitrite produced was determined by diazotization of sulfanilamide and coupling to naphthylethylene diamine. After samples were deproteinized with Somogyi reagent, the nitrate was reduced by Cu-coated Cd in glycine buffer at pH 9.7 (2.5 to 3 g of Cd granules for a 4-mL reaction mixture). The reduction followed pseudo-first-order reaction kinetics, a convenient time interval for assay being 75 to 90 min. Maximum reduction (85%) occurred at about 2 h. Detection limits in urine or serum were 2 to 250 mumol/L. This method does not require the reaction to go to completion, does not require expensive reagents or equipment, and can assay several samples simultaneously. Repeated assays of two serum pools gave CVs of 9.0% and 4.7% for nitrate concentrations of 31.4 and 80.2 mumol/L, respectively (n = 20 each). The mean concentration of nitrate was 1704.0 +/- 1294 (SD) mumol/L (n = 21) in untimed normal urine, 81.8 +/- 50.1 mumol/L in serum of 38 renal dialysis patients, and 51.2 +/- 26.4 mumol/L in serum of 38 controls.

Radioimmunoassay of the carboxyterminal propeptide of human type I procollagen.

Abstract: Type I collagen is the most abundant collagen type in soft tissues and the only type found in mineralized bone. We established a rapid equilibrium radioimmunoassay for the carboxyterminal propeptide of human type I procollagen (PICP), to be used as an indicator of the synthesis of type I collagen. We isolated type I procollagen from the medium of primary cultures of human skin fibroblasts, digested the protein with highly purified bacterial collagenase, and purified PICP by lectin-affinity chromatography, gel filtration, and ion-exchange separation on HPLC. The purity of the protein was verified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and by N-terminal amino acid sequencing of its component chains. The final radioimmunoassay was established with polyclonal rabbit antibodies. Material antigenically related to PICP is readily detected in human serum. There is only one form of the serum antigen, its molecular size and affinity to the antibodies being similar to those of the isolated propeptide. Intra- and interassay CVs are 3% and 5%, respectively. Preliminary reference intervals for healthy adults (18 to 61 years of age) are 38-202 micrograms/L for men and 50-170 micrograms/L for women: in men the concentration is inversely related to age. The serum antigen is stable during storage and after repeated thawing.

Estimating low-density lipoprotein cholesterol by the Friedewald equation is adequate for classifying patients on the basis of nationally recommended cutpoints.

Abstract: We compared low-density lipoprotein cholesterol (LDL) values obtained by the Friedewald formula--i.e., total cholesterol minus high-density lipoprotein (HDL) cholesterol minus very-low-density lipoprotein (VLDL) cholesterol (estimated as triglyceride divided by 5)--with those obtained by lipoprotein fractionation, using 4736 specimens. When triglycerides were less than 2.0 g/L, greater than 90% of estimated LDL cholesterol values were acceptable, within +/- 10% of measured values. At triglyceride concentrations of 2.0-4.0 g/L and 4.0-6.0 g/L, only 72% and 39%, respectively, of the estimates were acceptable. LDL values derived from an alternative formula, estimating VLDL as triglycerides divided by 6, were even less accurate. Nevertheless, the use of estimated LDL for risk classification based on the National Cholesterol Education Program Adult Treatment Panel cutpoints of 1.30 and 1.60 g/L was considered acceptable. At triglyceride concentrations less than or equal to 5.0 g/L, 88% of classifications based on estimated LDL (using triglycerides divided by 5) were concordant with those by measured LDL. Eleven percent of classifications were shifted across one cutpoint, evenly distributed between high and low. Fewer than 1% of classifications, all with Type III hyperlipoproteinemia, were misclassified two cutpoints high. Refinements in the estimation model did not substantially improve LDL estimation or concordance of risk classification.

A Decade of Development in Immunoassay Methodology

Abstract: Immunoassays are now very widely used in the clinical laboratory, either because no other type of assay system is feasible or because they are often the most effective and suitable of the possible analytical methods. The last decade has seen the development and refinement of many new immunoassay reagents and systems. The major trend has been away from liquid-phase assays involving radioisotopic labels, towards fast homogeneous or solid-phase assays capable of operation anywhere; and towards precise and reliable nonisotopic, automated or semi-automated laboratory assays, often with detection limits measured in pico- or attomoles. The use of monoclonal antibodies is now widespread, and the methodologies of labels and of solid-phase components are much more sophisticated. New assay formulations, novel homogeneous systems, immunosensors, free-analyte assays, the importance of thorough validation and of interfering substances, and future trends are discussed.

Lipoprotein(a) is an independent risk factor for myocardial infarction at a young age.

Abstract: We quantified lipoprotein(a) [Lp(a)] immunochemically in young (less than 46 y) male survivors of myocardial infarction and in age-matched controls recruited from participants of the Prospective Cardiovascular Munster (PROCAM) study. We further determined apolipoprotein E polymorphism and measured triglycerides, total cholesterol, high- and low-density lipoprotein cholesterol (HDL and LDL), and apolipoproteins AI, AII, and B in the serum of these subjects. Lp(a) concentrations in serum were not correlated with other well-recognized risk factors for early myocardial infarction such as apolipoproteins AI and B, LDL cholesterol, and HDL cholesterol. Apolipoprotein E polymorphism did not affect Lp(a) concentrations, but had a major influence on apolipoprotein B concentration. Lp(a) concentrations were not influenced by age. Our data suggest that (a) an increased concentration of Lp(a) constitutes an independent risk factor for early myocardial infarction and (b) the concentrations of Lp(a) and LDL cholesterol (apolipoprotein B) in serum are under separate metabolic control.

On dividing reference data into subgroups to produce separate reference ranges.

Abstract: We consider statistical criteria for partitioning a reference database to obtain separate reference ranges for different subpopulations. Using general formulas relating population variances, sample sizes, and the normal deviate test for the significance of the difference between two subgroup means, we show that partitioning into separate ranges produces little reduction in between-person variability, even when the differences between means are highly significant statistically. However, when there is a clear physiological basis for distinguishing between certain subgroups, simulation studies show that partitioning may be necessary to obtain reference limits that cut off the desired proportions of low and high values in each subgroup. Guidelines based on these results are provided to help decide whether separate ranges should be obtained for a given analyte.

Calculated values for low-density lipoprotein cholesterol in the assessment of lipid abnormalities and coronary disease risk

Abstract: Low-density lipoprotein (LDL) cholesterol concentrations are most commonly estimated by the formula LDL cholesterol = total cholesterol - [triglycerides (TG)/5 + high-density lipoprotein cholesterol], although alternative factors such as TG/6 have also been used. Using standardized, automated, enzymatic lipid assays, we analyzed 4797 plasma samples from normal and dyslipidemic adults, to compare LDL cholesterol concentrations obtained after ultracentrifugation with those calculated by several such methods (i.e., TG/4-TG/8). or TG concentrations less than or equal to 0.50 g/L, TG/4 agreed best with the direct assay; for TG of 0.51-2.00 g/L, TG/4.5 was best; and for TG of 2.01-4.00 g/L, TG/5 was best. Differences in estimated values were generally small, however. At TG greater than 4.00 g/L, none of the factors tested allowed a reliable estimate of LDL cholesterol. When TG were less than or equal to 4.00 g/L, 86% of estimated LDL cholesterol values were properly classified according to National Cholesterol Education Program cutpoints when the factor TG/5 was used. We conclude that a convenient direct method for measuring LDL cholesterol is needed but, until one is available, use of the factor TG/5 will assure that most individuals with TG less than or equal to 4.00 g/L, as measured in a standardized laboratory, can be reasonably well classified for risk of coronary artery disease.

Differential Electroimmunoassay of Human LpA-I Lipoprotein Particles on Ready-to-Use Plates

Abstract: We describe a method for directly measuring LpA-I lipoprotein particles containing apolipoprotein A-I (apo A-I) not associated with apolipoprotein A-II (apo A-II), by differential electroimmunoassay of plasma on ready-to-use plates. Lipoprotein particles containing both apo A-I and apo A-II (LpA-I:A-II) are retained close to the wells when a very high excess of anti-apo A-II is used as compared with anti-apo A-I, whereas the LpA-I particles migrate and react with anti-apo A-I. The method is specific, rapid, and precise. Within- and between-run CVs at three concentrations (high, medium, and low) ranged between 1.51% and 2.72% and 3.01% and 4.56%, respectively. Analytical recovery of isolated LpA-I was from 93% to 115%. Results correlate well with those obtained by two-phase electroimmunoassay, enzyme-linked differential-antibody immunosorbent assay, and immunoaffinity chromatography coupled to enzyme-linked immunosorbent assay. The average normolipidemic concentration of LpA-I was 600 mg/L in 45 women and 490 mg/L in 40 men (P less than 0.0001).

Factors affecting the concentrations of ferritin in serum in a healthy Australian population.

Abstract: We measured by different techniques the ferritin concentration in serum in two large asymptomatic Australian population samples: 1367 bank employees and 601 insurance corporation employees. Ethanol intake, diet, the frequency of blood donation, smoking and exercise habits, and past medical history were documented. The median concentration of ferritin in serum varied according to age and sex, but was generally higher than in previously reported populations under age 65 years. Results for the two population samples were in close agreement. Apart from the blood donation status, the most important factors influencing the concentration of ferritin in serum were ethanol intake in men and diet in women. Heavy ethanol intake was associated with increased values, even among men without evidence of liver disease. We conclude that the reference range for ferritin concentration in serum in the Australian population should be significantly increased and should be related to age as well as sex. This study emphasizes the need to determine local reference ranges for ferritin concentrations in serum.

Cytokines in disease.

Abstract: Cytokines are peptides used by immune and inflammatory cells to communicate with each other and to control the milieu interieur in which they operate. Recent evidence suggests that they are of immense importance in controlling the local and systemic events of the immune response, inflammation, hemopoiesis, healing, and the systemic response to injury. Many of them can now be measured by immunoassay, and the role of such measurements in the diagnosis and management of disease is actively under investigation. Similarly, the availability of recombinant DNA techniques to produce cytokines in almost unlimited quantities is leading to new and exciting therapeutic applications.

Spontaneous decay of oxidized ascorbic acid (dehydro-L-ascorbic acid) evaluated by high-pressure liquid chromatography.

Abstract: We applied high-pressure liquid chromatography to assess the decomposition of the oxidized form of vitamin C, dehydro-L-ascorbic acid. We selected experimental conditions that might represent a wide variety of clinical and research procedures. Decay of dehydro-L-ascorbic acid proceeded much more rapidly at high pH (7-8) than at low pH (3-5) and was more rapid at 37 or 45 degrees C than at 0 or 23 degrees C. When evaluated at pH 6.6, the percent decay was somewhat more rapid from an initial concentration of 1000 mumol/L than at 5-10 mumol/L. The analytical procedure (HPLC) provided useful information about the rate of decay under various conditions. This may facilitate future biological and clinical studies that require a distinction between the oxidized and reduced forms of vitamin C.

Consensus Document: Hawk's Cay Meeting on Therapeutic Drug Monitoring of Cyclosporine

Abstract: The optimal measurement method and clinical application of the therapeutic drug monitoring of cyclosporine remain uncertain. At a workshop held at Hawk's Cay, FL, from January 14 to January 17, 1990, 57 scientists presented their latest research findings, either in formal papers or as discussants. Lively debate and discussion followed presentation of extant and new methodologies for drug measurements as well as multicenter validation studies: applications of trough-concentration monitoring in renal, hepatic, and bone-marrow transplants as well as in autoimmune disease; and alternative pharmacokinetic approaches to guide cyclosporine therapy. The process of inducing and maintaining optimal immunosuppression to facilitate graft success is a complex and often challenging task, requiring the combined expertise of multiple disciplines. Thus, the assembly of four of the groups essential to the transplant process--clinicians, laboratory scientists, the pharmaceutical company, and the manufacturers of cyclosporine measurement kits--provided a unique opportunity to evaluate therapeutic drug monitoring issues facing the transplant field. Here we present the major conclusions reached at the meeting, brief discussions of the study data on which they are based, and a summary of unresolved problems that will require further rigorous investigations. The Consensus Document was reviewed by all the workshop participants before we submitted this final manuscript.

Abbott TDx monoclonal antibody assay evaluated for measuring cyclosporine in whole blood.

Abstract: We report here the evaluation of the Abbott TDx assay with a monoclonal antibody for selectively quantifying cyclosporine (CsA) in whole blood. Over the clinically relevant concentration ranges, results with this assay demonstrated within- and between-run CVs of less than 2.5% and 5%, respectively; sensitivity of 25 micrograms/L; good analytical recovery (100.3%); and linearity with whole-blood specimens. The percentage cross-reactivity of the major CsA metabolites varied from 15.3% for AM9 (M-1), 8.2% for AM1 (M-17), and 3.7% for AM4N (M-21), to less than 3% for the other metabolites tested. Results with the TDx assay (y) correlated well with those by the Sandimmune selective RIA (x; Sandoz) with blood specimens from 44 renal-transplant recipients (n = 44, x= 187.3, y = 198.9, y = 5.49 + 1.03x, r = 0.987). The TDx values were on average 24% higher than those by HPLC (x') with the same patients' specimens (n = 44, x' = 159.9, y = 198.9, y = 15.9 + 1.14x', r = 0.967). We conclude that the Abbott TDx monoclonal antibody assay provides a rapid, precise, and accurate means for quantifying CsA in whole blood.

The unique lipoprotein(a): properties and immunochemical measurement.

Abstract: Lipoprotein (a) [Lp(a)] represents a class of lipoprotein particles defined by the presence of apolipoprotein(a), a unique glycoprotein linked by a disulfide bond to apolipoprotein B-100 to form a single macromolecule. Apolipoprotein(a) is formed by three different structural domains having high amino acid sequence homology with plasminogen. One of the domains, called kringle 4, is present in multiple copies, the number of which varies and is genetically determined. This accounts for the size heterogeneity of apolipoprotein(a) and thus of Lp(a). Because high concentrations of Lp(a) are associated with atherosclerotic cardiovascular and cerebrovascular disease and may inhibit fibrinolysis, interest in measuring Lp(a) has increased considerably, leading to a rapid development of commercially available immunoassays for the measurement of Lp(a) in human plasma. However, the immunochemical measurement of Lp(a) has several peculiar problems in addition to those encountered by the measurements of other apolipoproteins. The major problems that need to be carefully evaluated are (a) the structural complexity and heterogeneity of Lp(a), (b) the homology of apolipoprotein(a) with plasminogen, (c) the lack of standardization of the methods, and (d) the lack of a common means of expressing the Lp(a) values.

Setting analytical goals for random analytical error in specific clinical monitoring situations.

Abstract: Strategies abound for the setting of analytical goals in clinical chemistry. Many, especially those more recently proposed for particular clinical situations, are concerned with tests used in diagnosis. We suggest a general theory for the setting of goals in situations that specifically involve the monitoring of individuals. Goals are calculated from the formula CVA less than [(delta c 2/2Z2)-CVB2]1/2, where CVA is the analytical imprecision (as coefficient of variation, CV); delta c is the percentage change in serial results that is considered clinically significant; Z is the Z-statistic, which depends only on the probability selected for statistical significance; and CVB is the average inherent within-subject biological variation (as CV). Examples given show applications in hematology and in monitoring diabetes mellitus, chronic renal failure, and hepatitis. The derived goals are for total random analytical error (imprecision and intermittent systematic variation), and provide objective criteria that should be achieved in practice. The effect of analytical variability on both variability in test results and the probability that a stated change can be considered significant should be calculated whether or not the goals are attained.

Immunoradiometric assay of parathyrin with polyclonal and monoclonal region-specific antibodies.

Abstract: In this immunoradiometric assay (IRMA) of parathyrin (PTH) a polyclonal anti-amino-PTH(1-34) is the capture antibody and a radiolabeled monoclonal anti-hPTH(44-68) is the second antibody. Gel filtration of serum from a hyperparathyroid patient yielded only a single peak of PTH, corresponding to the elution position of synthetic PTH(1-84). Healthy elderly individuals (ages 78 +/- 5 y, mean +/- SD, n = 45) had PTH concentrations (21 +/- 13 ng/L) not significantly higher than those from healthy younger (38 +/- 11 y) adults (20 +/- 8 ng/L, n = 94). Assay results agreed well with those obtained with a carboxyl-terminal PTH assay both in normal subjects (r = 0.63, P less than 0.001) and in patients with primary hyperparathyroidism (r = 0.59, P less than 0.001). Both assays equally discriminated patients with surgically confirmed primary hyperparathyroidism from normal individuals, but the PTH(1-84) IRMA also allowed a nearly absolute discrimination between normal subjects and patients with primary hypoparathyroidism (undetectable serum PTH in 18 of 21 cases) and secondary hypoparathyroidism (caused by hypercalcemia that was caused by a malignant tumor, PTH 1.3 +/- 1.3 ng/L, n = 32). Moreover, the PTH(1-84) IRMA is more sensitive (detection limit in serum, 0.8 ng/L) and easier and quicker to perform than the carboxyl-terminal assay.

Interference by human anti-mouse antibody in two-site immunoassays.

Abstract: Studies with goat and rabbit anti-mouse antibody, as models of human anti-mouse antibody (HAMA), have shown that several of the commonly used two -site immunoassays (e.g., for CA-125, carcinoembryonic antigen, choriogonadotropin, lutropin, hepatitis B surface antigen, thyrotropin) are susceptible to interference by this type of bridging heterophile antibody. In most cases the interference can be blocked by incubation with mouse IgG. We studied HAMA interference in an assay of hepatitis B surface antigen by using HAMA-positive sera from a transplant patient given OKT3 and from a cancer patient given CYT-103 (modified antibody B72.3). The HAMA interference attributable to the OKT3 could be blocked by incubation with mouse IgG at room temperature. In contrast, the interference caused by the B72.3-induced HAMA could be blocked by prolonged incubation with high concentrations of the B72.3 antibody at 4 degrees C. A limited survey of 50 hospital patients selected without conscious bias revealed two HAMA-positive patients, only one of whom was known to have been exposed to mouse immunoglobulin. HAMA interferences are currently a minor problem in routine laboratory medicine, but the increasing use of diagnostic and therapeutic products involving mouse-origin monoclonal antibodies will make the detection and elimination of HAMA interferences an important part of laboratory practice in the future.

Sensitive salivary estradiol assay for monitoring ovarian function.

Abstract: Measurement of steroids in saliva has excited interest because of the numerous potential clinical applications; noninvasive, convenient sampling; and apparently accurate reflection of the concentrations of physiologically active unbound steroid in the circulation. Although assays of saliva for several steroid hormones are available and widely used, assays for salivary estradiol are not, primarily because of methodological limitations. By modifying a commercially available kit for serum estradiol, our laboratory has developed a procedure that is sensitive, highly specific, and reliable for measuring salivary estradiol. Assay sensitivity is 0.5 fmol (0.14 pg; sample concentration 1.3 pmol/L) with a mean interassay CV of 10.8% at low concentrations. Clinical studies showed that values for serum and saliva are highly correlated (P less than 0.001), and demonstrated reliable detection of estradiol peaks during normal ovulatory cycles in serial samples from 15 women. Salivary estradiol peaked at 5.4 (SD 1.9) pmol/L on cycle day 14.4 (SD 3.2), 1.2 (SD 0.8) days before ovulation detected by ultrasound. This assay may be particularly helpful in investigating ovarian function and free estradiol in women at various stages of the reproductive cycle.

Triglyceride measurements: a review of methods and interferences.

Abstract: The National Cholesterol Education Program has emphasized the need to identify individuals at risk for coronary artery disease (CAD). Because increased triglycerides may be a risk factor for CAD and because triglycerides are used to estimate concentrations of low-density lipoprotein (LDL) cholesterol, which has definitely been shown to be a risk factor for CAD, it is important that reliable results be obtained. Many methods are available for measuring triglyceride concentrations in serum or plasma, but there is no definitive method that confirms the reliability of any of these procedures. Accuracy and precision guidelines are extremely difficult to determine, owing to broad biological variability both within and among individuals. Here, we review the major triglyceride quantification methods in the literature, some of the potential interference problems, and the limitations regarding standardization that should be addressed when establishing such guidelines.

Canadian Consensus Meeting on cyclosporine monitoring: report of the consensus panel.

Abstract: The Bureau of Drug Research, Health Protection Branch I the Government of Canada, requested of the transplant nd clinical chemistry professional groups that a consensus leeting be held, to develop a “state-of-the-art” consensus aper on cyclosporune (CsA) monitoring. The often confusg scientific literature on CsA monitoring, created largely s a result of the use of different nonspecific and specific iethods for measurement of CsA, the use of different ample matrices in which the drug is measured, and the aried criteria used for defining renal toxicity or rejection ad led to this request. In response, the Canadian Society of linical Chemists in conjunction with the Canadian Translant Society planned and organized the Canadian Consenus Meeting, which was held at Minaki, Ontario, May 11 rough 13, 1990. Twenty-one scientists representing the linical, methodological, and pharmacological aspects of sA presented to 72 attendees the latest research data on iechanisnis of the immunosuppressive and nephrotoxic ctivity of CsA; immunosuppressive and nephrotoxic activies of the major human metabolites of CsA; distribution of sA between blood plasma, blood cells, and tissues; specific iethods for measuring CsA; the impact on clinical outcome I adjusting CsA dosage on the basis of results of monitorig the parent drug concentration in whole blood; CsA harmacokinetics; and methods for detecting rejection. izsed on a detailed consideration of all data pertinent to se therapeutic drug monitoring of CsA, a set of recommenations was developed, as requested by the Canadian Iealth Protection Branch, by a consensus panel consisting I the nine individuals who co-authored this paper. At the nclusion of the meeting these recommendations and the tionale for them were presented for critical review to all ho attended the meeting. During the conference there was considerable debate gardung the following: (a) the appropriateness of one mple matrix over another (whole blood, plasma, serum,

Rapid and simultaneous determination of lactulose and mannitol in urine, by HPLC with pulsed amperometric detection, for use in studies of intestinal permeability.

Abstract: The lactulose/mannitol dual sugar absorption test is a non-invasive test of intestinal permeability. Its widespread use has been limited by the difficulties of analysis for carbohydrates in urine at low concentrations. We describe a "high-pressure" liquid-chromatographic method for determining lactulose and mannitol in urine, in which anion-exchange chromatography and pulsed amperometric detection are used. Sample preparation is simple and fast, and lactulose and mannitol and the internal standards arabinose and cellobiose are well resolved within 15 min. Analytical response of the method is linear with concentrations to 3 g/L, and one can detect as little as 0.3 mg of lactulose per liter of urine. Analytical recovery was between 90% and 107% for all sugars analyzed, and there was good agreement with results by a gas-chromatographic method (r = 0.993 lactulose, 0.984 mannitol). The method may potentially be applied to the study of other carbohydrates present in biological fluids at low concentrations.

Serum angiotensin-converting enzyme in healthy and sarcoidotic children: comparison with the reference interval for adults.

Abstract: Angiotensin-converting enzyme (ACE) was measured in serum of 187 healthy children between the ages six months and 18 years. Results were pooled for five-year age intervals and compared with the reference values for adults that we previously determined [Clin Chem 1986;32:884-6). Results for each age group were also studied as a function of sex. Children had higher ACE activities in serum than did adults (P less than 0.001), but these activities were age-related only from age four to 18 years. Adolescents showed sex-related differences, with higher serum ACE activities in boys than in girls (P less than 0.05). Both sex- and age-related differences may be related to a steroid hormonal regulation of ACE biosynthesis. We also verified that children with sarcoidosis (n = 20) had significantly increased serum ACE activity. Such physiological variations in serum ACE activity must be taken into account for diagnosing sarcoidosis in children, for following the course of the disease, and for evaluating the accuracy of therapy.

Immunological assays of apolipoproteins in plasma: methods and instrumentation.

Abstract: A number of immunological techniques--radioimmunoassay, enzyme-linked immunosorbent assay (ELISA), electroimmunoassay, radial immunodiffusion, and a variety of immunoprecipitin assays--have been used to quantify apolipoproteins in plasma. This paper outlines their technical details and discusses their major advantages and drawbacks. The most sensitive procedures, RIAs and ELISAS, are best suited to quantifying those apoproteins found in low concentration in plasma. Immunoturbidimetric assays, on the other hand, which are readily automated, are being widely used to quantify apolipoproteins A-I and B. Apolipoprotein quantification is complicated by the interaction of the proteins with lipids, which can often mask their antigenic determinants. This problem may be circumvented by pretreatment of the samples, by selection of appropriate standards, or by the use of polyclonal or monoclonal antibodies that interact with permanently exposed epitopes on the lipoproteins' surfaces. Our proposed methods for measurement of the individual apolipoproteins give consideration to these approaches.

Preanalytical Increase of Ammonia in Blood Specimens from Healthy Subjects

Abstract: The course and magnitude of spontaneous increase in ammonia concentration in plasma on standing were investigated with EDTA-treated blood specimens from 36 healthy subjects with use of a sensitive and precise enzymic method. Over 90 min, the rates of increase were virtually constant at fixed temperature. The mean (and SE) rates at 0, 20, and 37 degrees C were 3.9 (0.23), 5.2 (0.23), and 25.2 (0.59) mumol/L per hour, respectively. At these temperatures, the plasma contributed at most 7%, 15%, and 10%, respectively, to the formation of ammonia in whole blood. In view of the medical needs and the measured rates of ammonia increase, an interval of 15 min between blood sampling and the start of centrifugation may be tolerated at a specimen temperature of 0 degree C. Rates of ammonia increase showed significant correlations with erythrocyte and platelet count as well as with the plasma activities of gamma-glutamyltransferase (EC 2.3.2.2) and alanine aminotransferase (EC 2.6.1.2).

Age and sex distribution of alkaline phosphatase isoenzymes by agarose electrophoresis.

Abstract: We separated isoenzymes of alkaline phosphatase (ALP; EC 3.1.3.1) in 1383 sera of normal individuals (ages 4-65 years) by agarose electrophoresis with the Isopal system (Analis). As expected, the predominant isoenzyme in children was of bone origin, and almost all (99%) of the children had low activities of a second bone fraction, "bone variant" ALP. The "bone variant" disappeared after age 17 in girls and after age 20 in boys. The highest (median) bone ALP activity was reached at age 9 to 10 in girls and at age 13 to 14 in boys, followed by a gradual decline in girls and a steep decline in boys. During adulthood, activity of the bone fraction was constant and no significant differences were observed between sexes, neither for bone nor for liver ALP activity. The latter remained almost unchanged throughout life. We observed no high-Mr ALP activity in children, whereas sera from 60% of the adults contained low activities of high-Mr ALP. Intestinal ALP (soluble form) and "intestinal variant" ALP (hydrophobic form) were frequently present, in 21% and 37% of all samples, respectively. No significant differences were observed between age groups and sexes for the intestinal isoenzymes.

Manganese content of the cellular components of blood.

Abstract: We measured the manganese content of whole blood, plasma, platelets, mononucleated cells, polymorphonucleated cells, and erythrocytes. Platelets and blood cells were separated from whole blood by use of discontinuous gradients of colloidal polyvinylpyrrolidone-coated silica (Percoll), and their manganese content was measured by Zeeman graphite furnace atomic absorption spectrophotometry, after digestion with nitric acid and hydrogen peroxide. Erythrocytes account for about 66% of the manganese in whole blood, whereas the "buffy coat"--platelets and leukocytes--accounts for about 30%. The "buffy coat" components turn over more rapidly than do erythrocytes, so their manganese content may better indicate the body's manganese status.

Apolipoprotein E polymorphism determined by restriction enzyme analysis of DNA amplified by polymerase chain reaction: convenient alternative to phenotyping by isoelectric focusing.

Abstract: Three common alleles determine six apolipoprotein E (apo E) phenotypes that are associated with variations in serum cholesterol in the population. This genetic variation results from single nucleotide alterations at two DNA loci encoding the amino acid residues 112 and 158 of apo E. We compared results of apo E phenotyping carried out by isoelectric focusing with those of apo E genotyping accomplished by direct DNA analysis. In the latter, the target DNA was amplified by the polymerase chain reaction (PCR) and subsequently analyzed by digestion with the restriction enzyme Hha I, followed by polyacrylamide gel electrophoresis of the cleavage products. With one exception, these two techniques yielded similar results from all 40 samples tested. In addition, a rare variant form of apo E (phenotype E1) was analyzed separately and incorrectly diagnosed as E2 by the Hha I digestion method; the anticipated mutation in the codon 127 was, however, confirmed by demonstration of a new Taq I restriction site in this variant gene. These data confirm that the common isoforms of apo E usually arise from genetic variation of the codons 112 and 158 and demonstrate the feasibility of the PCR technique in apo E genotyping.

Rapid purification of human DNA from whole blood for potential application in clinical chemistry laboratories.

Abstract: A simple, rapid method for isolating human DNA has been developed, which can be routinely used in clinical chemistry laboratories. The entire procedure takes less than 90 min, and as many as 12 blood samples can be handled in one cycle. One milliliter of EDTA-treated blood is lysed and centrifuged to yield a nuclear fraction. The nuclear pellet is treated with sodium dodecyl sulfate/urea and phenol/chloroform to remove contaminating proteins, then the crude DNA extract is purified by use of a Sephadex G-25 spin-column. Typical 260 nm/280 nm absorbance ratio (used to assess purity) and yield for DNA so purified were 1.84 and 24.5 micrograms/mL, respectively. Within- and between-day CVs for recovery of DNA from pooled blood were 8% and 11% respectively. Such DNA preparations were found quite suitable for digestion by a variety of restriction endonucleases and for restriction fragment length polymorphism analysis. We are using this method to isolate DNA from whole blood of myocardial infarction patients for studies on the apolipoprotein B gene.