Systematic overestimation of human serum albumin by capillary zone electrophoresis method due to monoclonal immunoglobulin interferences

Excreted albumin of diabetic microalbuminuria cases exhibits pseudo esterase activity: A new way to explore microalbuminuria, perhaps with more information

BACKGROUND

Microalbuminuria is associated with several clinical conditions of public health concern. Particularly in diabetic patients, there is routine microalbuminuria screening to understand whether the renal complication has progressed to the microalbuminuria stage or not. Therefore, microalbuminuria detection is a matter of considerable interest. For such detection, the clinical labs rely on immunochemical methods. Nevertheless, the immunochemical methods are believed to be less sensitive for the purpose. So, the need arises for continuous research in the field. We believe that pseudoesterase activity of the excreted albumin in microalbuminuria cases is a potential target. This aspect is investigated here and it is shown that the excreted albumin in diabetic microalbuminuria cases retains its pseudoesterase activity, unlike the overt albuminuria cases.

METHODS

The cases of diabetic nephropathy and healthy controls were included in the study. The patients were divided into diabetic controls microalbuminuria, and overt albuminuria group considering the albumin to creatinine ratio (ACR). The urinary proteins of the cases were isolated by centrifugation. The obtained protein pellet was then checked for pseudoesterase activity by electrophoretic and fluorescence-based methods. The CD spectroscopy and LC-MS study was carried out to show the suitability of the substrate for the detection of albumin pseudoesterase activity. To further, understand the structure-function relation, molecular docking studies were carried out.

RESULTS

From the CD and LC-MS study the suitability of the used substrate was confirmed. The electrophoretic and fluorescence study showed that the protein of the microalbuminuria group retained the pseudoesterase activity whereas the same is lost in the overt albuminuria group. The molecular docking studies indicated that a change in albumin structure may result in a change in its pseudoesterase activity.

CONCLUSION

The urinary protein of diabetic microalbuminuria cases exhibits pseudoesterase activity. It distinguishes the excreted protein in the diabetic albuminuria group and the overt albuminuria group. This is the first study that showed the retention of pseudoesterase property in excreted albumin. Further, in this study a simple test is developed that distinguishes the excreted albumin in the microalbuminuria group and overt albuminuria group.

Reliability of albumin bromocresol green colorimetric method and clinical impact

Measuring plasma albumin is a common and important laboratory test. We compared the results obtained with the bromocresol green (BCG) colorimetric, immunoturbidimetric (IT), and capillary electrophoresis (CE) methods and evaluated the clinical reliability of the colorimetric test. Samples from 320 patients including 227 patients with hypoalbuminemia (albumin levels <35 g/L) were analyzed. Results were compared between different patient groups. The BCG method indicated significantly higher plasma albumin levels than the CE and IT methods, especially in patients with elevated C-reactive protein, alpha-1 globulin (a1G), and alpha-2 globulin (a2G) values. A significant proportion of patients with mild hypoalbuminemia tested using the BCG method (albBCG) and were classified as severely hypoalbuminemic (albumin <20 g/L) when switching to the CE or IT method (albCE and albIT). These patients had elevated a1G and/or a2G levels. This change of result implied an additional indication for albumin replacement therapy. The BCG method significantly overestimates albumin levels in patients with inflammation and hypoalbuminemia, which may lead to inappropriate therapeutic decisions.

Analytical interference on measurement of immunoglobulins in monoclonal gammopathy

Monoclonal gammopathy has been reported to interfere with several laboratory measurement results. We investigated potential interference in monoclonal gammopathy on immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM) concentrations using three different routine chemistry instruments: Alinity (Abbott Laboratories), Cobas 8000 (Roche Diagnostics) and Optilite (Binding Site) at the Department of Clinical Biochemistry, Aalborg University Hospital, Denmark. Blood samples collected from 216 patients with known monoclonal gammopathy were analyzed on Alinity, Cobas and Optilite. Diagnoses were ascertained from clinical records. Scatter plots with Passing-Bablok regression were used to investigate associations between concentrations of IgA, IgG and IgM measured with each of the different instruments. Furthermore, comparison of IgG analyses on Alinity, Optilite and Cobas according to monoclonal IgM concentration was explored with Bland-Altman plots. A total of 81 patients were identified with IgM type monoclonal gammopathy and 8 of these patients (10%) had analytical interference as reflected by more than 25% decrease in the level of IgG measured on Alinity as compared to Optilite and Cobas. All blood samples with interference on IgG measurement using Alinity were from patients with lymphoplasmacytic lymphoma/Waldenströms macroglobulinemia and all of them had monoclonal IgM concentrations above 10 g/L. This study identified a source of interference from IgM monoclonal gammopathy on IgG measurement performed using Alinity. The interferences caused falsely low results of IgG which is important to recognize to ensure proper patient management.

Spurious capillary zone electrophoresis pattern in hypercholesterolemic dogs

Capillary zone electrophoresis (CZE) is a relatively new serum protein electrophoresis method with higher resolution than other electrophoretic techniques. Hypercholesterolemic dogs exhibit a peculiar CZE pattern. Specifically, they have a shoulder or peak immediately next to the albumin peak. We investigated the prevalence of this spurious peak in hypercholesterolemic dogs and its correlation with the serum cholesterol concentration. Moreover, possible discrepancies between the CZE and spectrophotometric (bromocresol green [BCG] method) albumin concentrations in those animals were evaluated, as well as the accuracy in measuring albumin by a different CZE fractionation system. We retrospectively enrolled 500 hypercholesterolemic and normotriglyceridemic dogs. Each electrophoretic curve was inspected visually to identify a spurious peak (prevalence of 68.8%). We chose 120 dogs to further investigate the albumin concentration; CZE albumin was significantly higher than measured using the BCG method. A weak but significant correlation (r = 0.412; p <0.0001) was observed between the magnitude of the spurious peak and the serum cholesterol concentration. Finally, the significant difference between CZE and BCG albumin measurement disappeared (p = 0.92) when the spurious peak was considered as α1-globulins instead of albumin.

Serum Protein Electrophoretic in Children

Serum protein electrophoresis is a simple, reliable, and specific method used for separation of serum proteins. This study consisted to detect, at pediatric cases, pathological profiles of serum proteins by capillary electrophoresis and interpret any anomalies. The study was performed on 81 sera collected from pediatric subjects admitted at the Abderrahim Harouchi Children's Hospital in Casablanca. Study results revealed 72 specific pathological electrophoretic patterns for acute and chronic inflammatory response (35 children), hypogammaglobulinemia (3), polyclonal hypergammaglobulinemia (23), hypoalbuminemia (5), agammaglobulinemia (1), and other medical conditions (2). No cases of alpha-1-antitrypsin deficiency and nephrotic syndrome by electrophoresis were highlighted. Serum protein electrophoresis in children is recommended as a diagnostic technique for increasing the accuracy of the diagnosis in acute, subacute, and chronic inflammatory diseases, liver disease, and cases of immunodeficiency.

Protein electrophoresis of non-traditional species: A review

EPH has been demonstrated to be a useful tool in companion animals while providing an opportunity to characterize globulinemias, including paraproteinemia. In EPH of non-traditional species, these same applications are important, but the primary use is to gauge the acute-phase and humoral immune responses. This includes the valid quantitation of albumin as well as the examination of fractions reflective of increases in acute-phase reactants and immunoglobulins. Agarose gel EPH and, more recently, capillary zone EPH have been applied to samples from these species. Performing these analyses provides special challenges in the placement of fraction delimits, generation of RIs, and interpretation of results. Recommended as part of routine bloodwork, EPH can also provide key results that are helpful in clinical and field-based health assessments as well as in prognostication.

Electrochemical Immunosensing of ST2: A Checkpoint Target in Cancer Diseases

A magnetic beads (MB)-involved amperometric immunosensor for the determination of ST2, a member of the IL1 receptor family, is reported in this work. The method utilizes a sandwich immunoassay and disposable screen-printed carbon electrodes (SPCEs). Magnetic immunoconjugates built on the surface of carboxylic acid-microsized magnetic particles (HOOC-MBs) were used to selectively capture ST2. A biotinylated secondary antibody further conjugated with a streptavidin peroxidase conjugate (Strep-HRP) was used to accomplish the sandwiching of the target protein. The immune platform exhibits great selectivity and a low limit of detection (39.6 pg mL⁻¹) for ST2, allowing the determination of soluble ST2 (sST2) in plasma samples from healthy individuals and patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) in only 45 min once the immunoconjugates have been prepared. The good correlation of the obtained results with those provided by an ELISA kit performed using the same immunoreagents demonstrates the potential of the developed strategy for early diagnosis and/or prognosis of the fatal PDAC disease.