Elevated mannose levels detected by gas-liquid chromatography in hydrolysates of serum from rats and humans with candidiasis

HPLC for simultaneous quantification of free mannose and glucose concentrations in serum: use in detection of ovarian cancer

Background: Abnormal levels of monosaccharides in blood have been linked to tumorigenesis. In this study, a novel high-performance liquid chromatography (HPLC) method was established for the simultaneous determination of free mannose and glucose in the serum. Methods: The serum was directly derivatized by 1-phenyl-3-methyl-5-pyrazolone under alkaline conditions using L-rhamnose as an internal standard. The chromatographic separation was then performed on a Poroshell EC-C18 chromatographic column (4.6 × 100 mm, particle size 2.7 μm, Agilent) with gradient elution using NH4Ac-HAc and acetonitrile as the mobile phases. The method was thereafter validated according to international guidelines. The serum samples obtained from 200 healthy individuals and 200 ovarian cancer (OC) patients were analyzed for free mannose and glucose. Results: The method was found to be reproducible for quantification within 20 min and included online sample purification. The method displayed excellent linearity in the concentration range (for mannose: 0.5-500 μg/mL; glucose: 0.5-1500 μg/mL). The precision, recovery, and stability met the FDA bioanalytical method validation acceptance criteria. Overall, the measurement of glucose content by HPLC correlated well with the different enzymatic methods. Ovarian cancer mannose levels in the serum were significantly higher in the advanced stage (61.22 μmol/L, p < 0.0001) than those in healthy volunteers and early-stage patients (44.51 μmol/L versus 50.09 μmol/L, p < 0.0001). The AUC for the ratio of serum free glucose to mannose (G/M) was 0.98 (p < 0.0001), with a sensitivity of 91.46% and a specificity of 98.50%, which served as a biomarker for OC diagnosis. Conclusion: We report a simple, repeatable, and attractive analytical method by HPLC, which can be used for quantitative estimation of free mannose and glucose simultaneously in human serum. Our results indicate that the serum level of mannose could be used as a potential biomarker of ovarian cancer.

Systemic candidiasis in babies with retinopathy of prematurity

Fifteen premature babies developed systemic candidiasis during the administration of intravenous hyperalimentation in the Beilinson Neonatal Intensive Care Unit. Candida albicans was found in the blood cultures of all the babies and in the urine cultures of 66.7% of them. Repeated funduscopic examinations revealed no evidence of septic embolization in the retinal or choroidal circulation. It should be noted that acute retinopathy of prematurity (ROP) grade 2 or 3 was found in all the babies.

Comparison of antibody, antigen, and metabolite assays in rat models of systemic and gastrointestinal candidiasis

We compared serial measurements of antibodies to mannan and to a cytoplasmic antigen (enzyme-linked immunosorbent assays), detection of mannan and an unidentified candidal antigen (latex agglutination), and assays of mannose and arabinitol (gas chromatographic assay of per-O-acetylated aldonitrile derivatives). In a high-inoculum intravascular-infection model, antimannan assays were consistently positive beginning on day 2 postinoculation, anti-cytoplasmic antigen assays followed the same time course but were less sensitive, mannan was detected in all samples beginning on day 2 postinoculation, and serum mannose concentrations peaked on day 3 postinoculation and were less sensitive than mannan detection. Other assays were not useful. In a lower-inoculum intravascular-infection model, the antibody assays became positive after a similar interval and remained positive for 28 days, with antimannan again being the more sensitive. Mannan and mannose tests were positive in week 1 postinoculation only, with mannan detection being the more sensitive. In a gastrointestinal-colonization model, antimannan assays become positive after 2 weeks of colonization, whereas anti-cytoplasmic antigen and mannan tests remained negative. In a model of gastrointestinal colonization followed by invasive infection produced by induction of neutropenia, only mannan detection was diagnostically useful. These data, comparing this panel of modern serodiagnostic techniques in controlled models of clinically relevant syndromes of candidiasis, enhance understanding of previous efforts in serodiagnosis of candidiasis and provide a foundation for further prospective studies in patients.

Candida endocarditis: report of four cases

Four patients who developed left-sided endocarditis due to infection with Candida species are reported. Three of them had had previous prosthetic valve replacement, and the fourth one developed endocarditis on a normal valve following pancreaticoduodenectomy. The difficulties presented in diagnosis and management are discussed.

New developments in the diagnosis of opportunistic fungal infection

This review considers recent developments in the diagnosis of aspergillosis, candidosis and cryptococcosis and discusses the prospects for routine application of a number of novel methods. The introduction of lysis-centrifugation and radiometric methods for blood culture has improved the diagnosis of deep candidosis, but the value of these methods for the diagnosis of aspergillosis has not yet been determined. Recent developments in serological diagnosis have included the evaluation of newly discovered antigens of Candida albicans in an attempt to distinguish colonization from significant infection. Antigen detection, an established method for the diagnosis of cryptococcosis, has also been evaluated and appears promising for the diagnosis of aspergillosis and candidosis. Another promising approach has been the use of gas-liquid chromatography to detect fungal metabolites in serum and other host fluids.

Capillary gas chromatographic profiling of urinary, plasma and erythrocyte sugars and polyols as their trimethylsilyl derivatives, preceded by a simple and rapid prepurification method

A capillary gas chromatographic method for the profiling of trimethylsilylated mono- and disaccharides and polyols in urine, plasma and unwashed and washed erythrocytes is described. The prepurification method is based on the moderate inhibition of the derivatization experienced in the presence of physiological amounts of inorganic salts and the relative stability of the formed trimethylsilylethers towards treatment with water and dilute hydrochloric acid. Series to series quality control data for 31 sugars/polyols in a pooled urine are given. The method was used to establish age-dependent concentrations of 18 sugars/polyols in urines of 72 control persons on a free diet. Gas chromatographic profiles and quantitative data obtained from urines of pediatric patients with galactosemia treated with a diet low in lactose and galactose, type 1 hereditary tyrosinemia treated with a diet low in phenylalanine and tyrosine, and a neurological disorder with a high calorie gastric drip feeding, are presented and discussed. Examples of the profiling of sugars/polyols in the plasma, unwashed and washed erythrocytes of a healthy adult, and the plasma of a newborn with galactosemia prior to treatment, are given.

Enzymatic fluorometric method for the determination of D-arabinitol in serum by initial rate analysis

We describe a new, simple, fluorometric assay for D-arabinitol in serum. The method is based on oxidation of D-arabinitol by D-arabinitol dehydrogenase (EC 1.1.1.11), with the concomitant reduction of NAD. The initial rate of NAD reduction, which is proportional to the D-arabinitol content of serum, can be measured with a recording spectrofluorometer. Sensitivity, specificity, recovery and reproducibility experiments gave satisfactory results. The proposed method is suitable for clinical use, and may be helpful in the diagnosis of invasive candidiasis.

Comparison of enzyme immunoassay and gas-liquid chromatography for the rapid diagnosis of invasive candidiasis in cancer patients

Three proposed quantitative markers for candidiasis, arabinitol, mannose, and mannan in serum, are compared in 50 normal blood donors and 38 high-risk patients, 23 with and 15 without invasive candidiasis. Arabinitol concentrations in serum, the arabinitol/creatinine ratio, and mannose concentrations in serum were significantly greater in the 15 patients without candidiasis than in the normal blood donors (P less than 0.05). The sensitivities and specificities were 26 and 87% for arabinitol, 13 and 93% for the arabinitol/creatinine ratio, and 39 and 87% for mannose. On the other hand, mannan concentrations in serum were less than 1 ng/ml in normal blood donors and patients without candidiasis (P = 0.344), and the sensitivity and specificity were 65 and 100%, respectively. Of 23 patients with proven or probable candidiasis, 16 had mannan levels in serum greater than the mean + 2 standard deviations (0.46 ng/ml) for the 15 controls. In 16 patients with invasive candidiasis and positive blood cultures for the Candida spp., only 13 had elevated levels of at least one of the three markers. The arabinitol/creatinine ratio, the mannose level, and the mannan level became elevated an average of 4 days before, 1 day before, and on the same day that the blood cultures were drawn, respectively. Conversely, mannan was detected in the sera of six of seven patients with invasive candidiasis and negative blood cultures. We conclude that the best approach to diagnosing invasive candidiasis involves obtaining blood cultures and carrying out serial assays for mannan in serum.

Antigenic variability of Candida albicans

The concepts of modern biology lead us to think that all structures are liable to continual changes. Ultrastructural and biochemical methods have been able to objectify such a dynamic in Candida albicans, an opportunistic yeast. A broad analysis of antigens is a reliable way to study the antigenic variations which concern this organism. Numerous information on somatic and metabolic antigens of C. albicans is available at the moment. Paradoxically, if one accepts studies dealing with dimorphism, very few works have shown antigenic variability of this species or investigated the mechanisms involved in such a variability. The few approaches done in this way tend to prove that it may be possible to link together the expression of particular antigens and the behavior of the yeast, particularly when it acts as a pathogen.

Comparison of serum mannan, arabinitol, and mannose in experimental disseminated candidiasis

Concentrations of arabinitol, mannose, and mannan in serum have independently been reported to be elevated in patients with invasive candidiasis. These three marker substances were compared in a rabbit model. Twelve rabbits, immunosuppressed with cortisone, were infected intravenously with Candida albicans 3181A. Six uninfected control animals also received cortisone, and four rabbits were neither infected nor immunosuppressed. Blood samples, drawn from 2 days before to 14 days after infection, were assayed for serum mannan by sandwich enzyme immunoassay, antibodies to mannan by indirect enzyme immunoassay, arabinitol and mannose by gas-liquid chromatography, and serum creatinine. Serum mannan, negative before infection, peaked in all infected animals 4 days after infection (mean, 18 ng/ml) and decreased thereafter. Significant increases (2 standard deviations greater than mean in normals) in arabinitol, the arabinitol/creatinine ratio, and mannose were found in 12, 8, and 12 of the infected rabbits, respectively, but also in all 6 uninfected animals receiving cortisone. Only serum mannan was specific in this immunosuppressed rabbit model.

Identification and molecular weight characterization of antigens from Candida albicans that are recognized by human sera

Antigenic components in the cytoplasmic extract of Candida albicans were examined after fractionation by concanavalin A-Sepharose and DEAE-Sephacel ion-exchange chromatography. Fractions from the DEAE column were tested by fused rocket immunoelectrophoresis for their reactivity with antibodies in the sera of 20 patients with disseminated candidiasis. Three groups of fractions (regions A, B, and C) from the DEAE column were defined by their reactivity with these sera. Immunoblot analysis with 20 human sera identified 18 antigenic components in regions A, B, and C. Region A contained nine antigens, region B contained four antigens, and region C contained five antigens. Region A contained an antigen with an apparent molecular weight of 48,000 that was recognized by 7 of 10 sera from patients with disseminated candidiasis. Immunoprecipitation experiments with labeled proteins from region A and 51 human sera also demonstrated the presence of a major antigen whose apparent molecular weight is 48,000 to 52,000. The 48- to 52-kilodalton protein is an abundant protein in region A and is the most frequently recognized protein by antibodies in the sera of patients with disseminated candidiasis. Patients with disseminated candidiasis had significantly higher levels of antibody (immunoglobulin G) (P less than 0.001) directed against the 48- to 52-kilodalton protein than did patients with noninvasive forms of candidiasis, patients with other fungal infections, or normal, healthy persons.

Evaluation of serum arabinitol as a diagnostic test for candidiasis

Gas-liquid chromatography was used to quantitate the arabinitol concentration in the sera of patients with candidiasis and in that of control patients. Serum arabinitol was elevated in 59% (n = 34) of patients with Candida sepsis, in 39% (n = 38) with Candida colonization, in 14% (n = 62) with bacterial sepsis, and in 0% (n = 11) of normal persons. The above patients were subsequently divided on the basis of renal function. Of those with decreased renal function, serum arabinitol was elevated in 89, 92, and 50% of patients with Candida sepsis, Candida colonization, and bacterial sepsis, respectively. Of those with normal renal function, serum arabinitol was elevated in only 23 and 14% of patients with Candida sepsis and Candida colonization, respectively. When serum arabinitol/creatine ratios were calculated for patients with both increased arabinitol and increased creatinine, elevated ratios were obtained in 69, 36, and 0% of patients with Candida sepsis, Candida colonization, and bacterial sepsis, respectively.

Nonculture techniques using blood specimens for the diagnosis of infectious disease

Recent technological advances have increased the use of blood as a source for diagnosis of local and systemic infectious diseases. Traditionally, viable organisms may be cultured from the blood and others identified microscopically. The ability to detect microbial products by physicochemical, bioactivity, and antigenic techniques and the ability to detect specific immunoglobulin M (IgM) responses to infection improve our diagnostic capabilities but also present new problems in determining clinical relevance. The diagnostic use and reproducibility of new tests should be verified by comparative clinical field testing before implementation.

Simultaneous determination of arabinitol and mannose by gas-liquid chromatography in experimental candidiasis

A method is described for the simultaneous quantitation of D-arabinitol and D-mannose in serum by gas-liquid chromatography as an aid for the diagnosis of disseminated candidiasis. Both variables were observed as per-O-acetylated aldononitrile derivatives in each chromatographic run of sera from immunosuppressed rabbits experimentally infected with Candida albicans 3181A.