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Maharjan AS, Wyness SP, Ray JA, Willcox TL, Seiter JD, Genzen JR. Detection and characterization of estradiol (E2) and unconjugated estriol (uE3) immunoassay interference due to anti-bovine alkaline phosphatase (ALP) antibodies. Pract Lab Med 2019; 17:e00131. [PMID: 31538105 PMCID: PMC6745434 DOI: 10.1016/j.plabm.2019.e00131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/17/2019] [Accepted: 08/26/2019] [Indexed: 11/15/2022] Open
Abstract
Objectives Competitive immunoenyzmatic assays for estradiol (E2) and unconjugated estriol (uE3) on UniCel DxI 800 Access immunoassay systems (Beckman Coulter) utilize bovine alkaline phosphatase (ALP) for amplification. In these assays, rare 'IND' error flags indicate that a relative light unit (RLU) raw result is past the high or low end of the calibration curve but cannot be differentiated from an instrument error or analytical interference. The present studies were conducted to establish a protocol to identify analytical interference and to characterize its mechanism when present. Design and methods Matrix and recovery studies were conducted to establish a protocol for interference identification. Spiking experiments with inactivated calf intestinal ALP were performed to determine whether interference could be blocked. Commercial anti-ALP antibodies (Abs) were spiked into human serum to model assay interference. Three E2 immunoassays which do not include ALP as a reagent component (cobas e602, Roche; Centaur XP, Siemens; ARCHITECT i2000SR, Abbott) were tested for comparative purposes. Results 1:2 dilution of specimen into Access Sample Diluent A (Beckman) differentiated IND error flags due to true low results (e.g. less than the analytical measurement range; AMR) from those due to assay interference. Interferences were reduced by pre-incubation with inactivated ALP and could be replicated by spiking with commercial anti-ALP Abs. Conclusions Patient anti-bovine ALP Abs can cause interference on DxI 800 E2 and uE3 assays. This model can be used to investigate interference risk with other ALP-dependent assays.
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Key Words
- ALP, alkaline phosphatase
- AMR, analytical measurement range
- Alkaline phosphatase
- Analytical systems
- CLIA, Clinical Laboratory Improvement Amendments
- E2, estradiol
- Endocrinology
- IND, indeterminate ‘no value’ error flag
- Immunoassay
- Interference
- MoM, multiple of the median
- PBS, phosphate buffered saline
- RLU, relative light unit
- ddH2O, demineralized distilled water
- uE3, unconjugated estriol
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Affiliation(s)
- Anu S. Maharjan
- Department of Pathology, University of Utah, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Sara P. Wyness
- ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Julie A. Ray
- ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Tanya L. Willcox
- ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
| | | | - Jonathan R. Genzen
- Department of Pathology, University of Utah, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
- ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
- ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
- Corresponding author. University of Utah, Department of Pathology, ARUP Laboratories, 500 Chipeta Way, Mail Code 115, Salt Lake City, UT, 84108, USA.
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Dreyer FE, Abdulrahman GO, Waring G, Hinshaw K. Placental steroid sulphatase deficiency: an approach to antenatal care and delivery. Ann Saudi Med 2018; 38:445-449. [PMID: 30531180 PMCID: PMC6302985 DOI: 10.5144/0256-4947.2018.445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Placental steroid sulphatase deficiency (SSD) is an X-linked inborn error of metabolism. Congenital X-linked ichthyosis (XLI) is a genetic disorder of keratinisation caused by steroid sulphatase (STS) deficiency, which results in a scaling skin condition in male infants shortly after birth. It may be associated with failed induction of labor and prolonged labor leading to cesarean delivery due to 'cervical dystocia'. We present two cases of congenital ichthyosis. Thorough counselling of women with a previously affected pregnancy during the antenatal period should include discussion about mode of delivery and a critical review of the complexities of prenatal diagnosis in this condition. We propose a clinical management pathway to offer women with a previous pregnancy affected by this rare condition. SIMILAR CASES PUBLISHED: Less than 50 cases reported.
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Affiliation(s)
- Frieda-Elsje Dreyer
- Frieda Elsje Dreyer, Department of Obstetrics and Gynaecology,, Sunderland Royal Hospital,, Sunderland SR4 7TP, United Kingdom, T: +44 0191 565 6256, , ORCID: http://orcid.org/0000-0002.0997-9919
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Gibbins KJ, Reddy UM, Saade GR, Goldenberg RL, Dudley DJ, Parker CB, Thorsten V, Pinar H, Bukowski R, Hogue CJ, Silver RM. Smith-Lemli-Opitz Mutations in Unexplained Stillbirths. Am J Perinatol 2018; 35:936-939. [PMID: 29433144 PMCID: PMC6060008 DOI: 10.1055/s-0038-1626705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive syndrome caused by a defect in cholesterol biosynthesis with mutations in 7-dehydrocholesterol reductase (DHCR7). A total of 3% of Caucasians carry DHCR7 mutations, theoretically resulting in a homozygote frequency of 1/4000. However, SLOS occurs in only 1/20,000 to 60,000 live births. Our objective was to assess DHCR7 mutations in unexplained stillbirths. STUDY DESIGN Prospective, multicenter, population-based case-control study of all stillbirths and a representative sample of live births enrolled in five geographic areas. Cases with stillbirth due to obstetric complications, infection, or aneuploidy, and those with poor quality deoxyribonucleic acid (DNA) were excluded. DNA was extracted from placental tissue stored at -80°C, and exons 3 to 9 of the DCHR7 gene were amplified, purified, and subjected to bidirectional sequencing to identify mutations. RESULTS One-hundred forty four stillbirths were unexplained and had adequate DNA for analysis. Nine stillbirths of 139 (6.5%) had a single mutation in one allele in coding exons 3 to 9 of DHCR7 (Table 1). One case (0.7%) was a compound heterozygote for mutations in exons 3 to 9 of DHCR7; this fetus had no clinical or histologic features of SLOS. CONCLUSION We detected SLOS mutations in only 0.7% of stillbirths. This does not support a strong association between unrecognized DHCR7 mutations and stillbirth.
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Affiliation(s)
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | | | | | | | | | | | - Halit Pinar
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Akcan N, Serakıncı N, Turkgenc B, Bundak R, Bahceciler N, Temel SG. A Novel TBX19 Gene Mutation in a Case of Congenital Isolated Adrenocorticotropic Hormone Deficiency Presenting with Recurrent Respiratory Tract Infections. Front Endocrinol (Lausanne) 2017; 8:64. [PMID: 28458651 PMCID: PMC5394421 DOI: 10.3389/fendo.2017.00064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/23/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Congenital isolated adrenocorticotropic hormone deficiency (CIAD) is a rare disease characterized by low adrenocorticotropic hormone (ACTH) and cortisol levels. To date, recurrent pulmonary infections in infancy have not been reported as an accompanying symptom of CIAD. CASE PRESENTATION A 7-year-old boy was hospitalized nine times for recurrent lower respiratory tract infections. The results of all tests for the possible causes of wheezing were within the normal limits. His ACTH and cortisol levels were persistently low. All other pituitary hormone levels, and adrenal ultrasound and pituitary magnetic resonance imaging results, were normal. Molecular analyses confirmed the diagnosis of CIAD by identifying compound heterozygosity for two mutations in the TBX19 gene. The first was a novel frameshift c.665delG variant in exon 4 of the TBX19 gene, leading to premature termination that was predicted to result in a non-functional truncated protein. The second was a nonsense C-to-T transition in exon 6 of the TBX19 gene, resulting in an arg286-to-ter mutation (dbSNP: rs74315376). Both parents were heterozygous for one of the mutations. CONCLUSION Here, we presented a new mutation in the TBX19 gene in a patient with CIAD who presented with recurrent respiratory tract infections. This expands the mutation spectrum in this disorder. To conclude, adrenal insufficiency should be considered in patients with unexplained recurrent infections to prevent a delay in diagnosis.
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Affiliation(s)
- Nese Akcan
- Faculty of Medicine, Department of Pediatric Endocrinology, University of Near East, Nicosia, Cyprus
| | - Nedime Serakıncı
- Faculty of Medicine, Department of Medical Genetics, University of Near East, Nicosia, Cyprus
| | - Burcu Turkgenc
- Genetic Diagnostic Center, University of Acıbadem, Istanbul, Turkey
| | - Ruveyde Bundak
- Faculty of Medicine, Department of Pediatric Endocrinology, University of Kyrenia, Kyrenia, Cyprus
| | - Nerin Bahceciler
- Faculty of Medicine, Department of Pediatric Allergy and Immunology, University of Near East, Nicosia, Cyprus
| | - Sehime G. Temel
- Faculty of Medicine, Department of Histology and Embryology, University of Near East, Nicosia, Cyprus
- Faculty of Medicine, Department of Histology and Embryology, University of Uludag, Bursa, Turkey
- *Correspondence: Sehime G. Temel,
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Liaugaudienė O, Benušienė E, Domarkienė I, Ambrozaitytė L, Kučinskas V. X-linked ichthyosis: differential diagnosis of low maternal oestriol level. J OBSTET GYNAECOL 2014; 34:737-9. [PMID: 24960317 DOI: 10.3109/01443615.2014.925857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- O Liaugaudienė
- Centre for Medical Genetics, Vilnius University Hospital Santariskiu Klinikos , Vilnius , Lithuania
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Gruchy N, Bigot N, Jeanne Pasquier C, Read MH, Odent S, Galera P, Leporrier N. Involvement and alteration of the Sonic Hedgehog pathway is associated with decreased cholesterol level in trisomy 18 and SLO amniocytes. Mol Genet Metab 2014; 112:177-82. [PMID: 24742993 DOI: 10.1016/j.ymgme.2014.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/24/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Trisomy 18 and Smith-Lemli-Opitz syndrome are two polymalformative conditions in which a cholesterol defect has been noted. When they occur prenatally, they are associated with a decreased maternal unconjugated estriol (uE(3)) level. Cholesterol plays an essential role in the Sonic Hedgehog pathway, allowing Shh protein maturation leading to its maximal activity. Many malformations in these two syndromes occur in Shh dependent tissues. We thus sought to assess whether a cholesterol defect could affect the Shh pathway and explain some of the observed malformations. MATERIALS AND METHODS We selected 14 cases of trisomy 18 and 3 cases of SLO in which the maternal uE(3) level was decreased and reported malformations were observed after fetopathological examination. We correlated the number of malformations with maternal uE(3) level. We then carried out cholesterol concentrations in separate culture media consisting of trisomy 18, SLO and control amniocytes. Finally, we analyzed the Shh pathway by testing the gene expression of several Shh components: GLI transcription factors, BMP2, BMP4, TGFβ1, COL1A1 and COL1A2. RESULTS AND DISCUSSION There was an inverse correlation between phenotypic severity and maternal uE(3) levels in SLO and trisomy 18. The cholesterol levels in the amniocyte culture media were correlated with maternal uE3 levels and were significantly lower in T18 and SLO amniocytes, reflecting cholesterol defects. There was an alteration in the Shh pathway since expression of several genes was decreased in T18 and SLO amniocytes. However, these cholesterol defects were not solely responsible for the altered Shh pathway and the malformations observed.
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Affiliation(s)
- N Gruchy
- Laboratoire de cytogénétique prénatale, service de Génétique, avenue Côte de Nacre, CHU Caen, UFR médecine, 14033 Caen cedex 9, France.
| | - N Bigot
- Laboratoire "Microenvironnement cellulaire et pathologie" (MILPAT) EA 4652, UFR Médecine Caen, avenue Côte de Nacre, 14033 Caen cedex 9, France.
| | - C Jeanne Pasquier
- Service d'Anatomie pathologique, CHU Caen, UFR Médecine, 14033 Caen cedex 9, France.
| | - M H Read
- Service de biochimie métabolique, CHU Caen, UFR Médecine, 14033 Caen cedex 9, France.
| | - S Odent
- Génétique des pathologies liées au développement, CNRS, UMR6290, UFR Médecine, Rennes, France.
| | - P Galera
- Laboratoire "Microenvironnement cellulaire et pathologie" (MILPAT) EA 4652, UFR Médecine Caen, avenue Côte de Nacre, 14033 Caen cedex 9, France.
| | - N Leporrier
- Laboratoire de cytogénétique prénatale, service de Génétique, avenue Côte de Nacre, CHU Caen, UFR médecine, 14033 Caen cedex 9, France.
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Schreyer-Shafir N, Sukenik-Halevy R, Tepper R, Arnon S, Litmanovitch I, Eliakim A, Pommeranz A, Ludman MD, Raas-Rothschild A. Prenatal bilateral adrenal calcifications, hypogonadism, and nephrotic syndrome: beyond Wolman disease. Prenat Diagn 2014; 34:608-11. [PMID: 24777844 DOI: 10.1002/pd.4344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/12/2014] [Accepted: 02/18/2014] [Indexed: 11/06/2022]
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Elias PM, Williams ML, Choi EH, Feingold KR. Role of cholesterol sulfate in epidermal structure and function: lessons from X-linked ichthyosis. Biochim Biophys Acta Mol Cell Biol Lipids 2013; 1841:353-61. [PMID: 24291327 DOI: 10.1016/j.bbalip.2013.11.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 11/13/2013] [Accepted: 11/20/2013] [Indexed: 02/07/2023]
Abstract
X-linked ichthyosis is a relatively common syndromic form of ichthyosis most often due to deletions in the gene encoding the microsomal enzyme, steroid sulfatase, located on the short area of the X chromosome. Syndromic features are mild or unapparent unless contiguous genes are affected. In normal epidermis, cholesterol sulfate is generated by cholesterol sulfotransferase (SULT2B1b), but desulfated in the outer epidermis, together forming a 'cholesterol sulfate cycle' that potently regulates epidermal differentiation, barrier function and desquamation. In XLI, cholesterol sulfate levels my exceed 10% of total lipid mass (≈1% of total weight). Multiple cellular and biochemical processes contribute to the pathogenesis of the barrier abnormality and scaling phenotype in XLI. This article is part of a Special Issue entitled The Important Role of Lipids in the Epidermis and their Role in the Formation and Maintenance of the Cutaneous Barrier. Guest Editors: Kenneth R. Feingold and Peter Elias.
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Affiliation(s)
- Peter M Elias
- Dermatology Service, Department of Veterans Affairs Medical Center, and Department of Dermatology, University of California, San Francisco, CA USA.
| | - Mary L Williams
- Departments of Dermatology and Pediatrics, University of California, San Francisco, CA USA
| | - Eung-Ho Choi
- Department of Dermatology, Yonsei University, Wonju College of Medicine, Wonju, South Korea
| | - Kenneth R Feingold
- Medical Service, Department of Veterans Affairs Medical Center, and Department of Medicine, University of California, San Francisco, CA, USA
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Craig WY, Palomaki G, Roberson M, Haddow JE. Further insights into implications of undetectable or very low unconjugated estriol in maternal serum during the second trimester. Prenat Diagn 2011; 31:616-8. [PMID: 21472738 DOI: 10.1002/pd.2754] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 03/15/2011] [Accepted: 03/15/2011] [Indexed: 12/13/2022]
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Álvarez Sánchez B, Capote FP, Jiménez JR, Luque de Castro M. Automated solid-phase extraction for concentration and clean-up of female steroid hormones prior to liquid chromatography–electrospray ionization–tandem mass spectrometry: An approach to lipidomics. J Chromatogr A 2008; 1207:46-54. [DOI: 10.1016/j.chroma.2008.08.085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 08/10/2008] [Accepted: 08/14/2008] [Indexed: 11/17/2022]
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Abstract
Recent insights into the Smith-Lemli-Opitz syndrome. The Smith-Lemli-Opitz syndrome (SLOS) is an autosomal recessive multiple congenital anomaly/mental retardation disorder caused by an inborn error of post-squalene cholesterol biosynthesis. Deficient cholesterol synthesis in SLOS is caused by inherited mutations of 3beta-hydroxysterol-Delta7 reductase gene (DHCR7). DHCR7 deficiency impairs both cholesterol and desmosterol production, resulting in elevated 7DHC/8DHC levels, typically decreased cholesterol levels and, importantly, developmental dysmorphology. The discovery of SLOS has led to new questions regarding the role of the cholesterol biosynthesis pathway in human development. To date, a total of 121 different mutations have been identified in over 250 patients with SLOS who represent a continuum of clinical severity. Two genetic mouse models have been generated which recapitulate some of the developmental abnormalities of SLOS and have been useful in elucidating the pathogenesis. This mini review summarizes the recent insights into SLOS genetics, pathophysiology and potential therapeutic approaches for the treatment of SLOS.
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Affiliation(s)
- H Yu
- Corresponding authors: Hongwei Yu, Shailesh Patel, Division of Endocrinology, Metabolism and Nutrition, Medical College of Wisconsin, 9200 West, Wisconsin Avenue, Milwaukee, WI 53226, USA, Tel.: +1 414 456 6801; fax: +1 414 456 6210; e-mail: ,
| | - SB Patel
- Corresponding authors: Hongwei Yu, Shailesh Patel, Division of Endocrinology, Metabolism and Nutrition, Medical College of Wisconsin, 9200 West, Wisconsin Avenue, Milwaukee, WI 53226, USA, Tel.: +1 414 456 6801; fax: +1 414 456 6210; e-mail: ,
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Ilagan JG, Stamilio DM, Ural SH, Macones GA, Odibo AO. Abnormal multiple marker screens are associated with adverse perinatal outcomes in cases of intrauterine growth restriction. Am J Obstet Gynecol 2004; 191:1465-9. [PMID: 15507984 DOI: 10.1016/j.ajog.2004.05.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if abnormal multiple marker screens (MMS) are associated with adverse perinatal outcomes in intrauterine growth restriction (IUGR) pregnancies. STUDY DESIGN This was a case control study of IUGR pregnancies (birth weight <10th percentile for gestational age [GA]) delivered in our unit over 6 years. Cases were compared with controls for the association between abnormal MMS and adverse perinatal outcomes (APO). RESULTS Of the 261 IUGR pregnancies, 39 (16%) had at least 1 APO. An elevated HCG was significantly associated with an APO (OR 2.6, 95% CI 1.1-6.4). A low uE3 was also associated with an APO (OR 5.5, 95% CI 2.2-14). The association between an elevated AFP and APO was not statistically significant (OR 1.6, 95% CI, 0.6-4.6). CONCLUSION An elevated HCG and low uE3 were associated with APO in cases of IUGR. This information could be useful in identifying a subset of IUGR cases deserving closer surveillance.
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Affiliation(s)
- John G Ilagan
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA, USA
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