Measurement of sialic acid in serum and urine: clinical applications and limitations

Surface-enhanced Raman spectroscopy as effective tool for detection of sialic acid as cancer biomarker

Sialic acid, a negatively charged nine-carbon monosaccharide, is mainly located at the terminal end of glycan chains on glycoproteins and glycolipids of cell surface and most secreted proteins. Elevated levels of sialylated glycans have been known as a hallmark in numerous cancers. As a result, sialic acid acts as a useful and accessible cancer biomarker for early cancer detection and monitoring the disease development during cancer treatment which is crucial in elevating the survival rate. The detection of sialic acid has been done by many tools including surface-enhanced Raman spectroscopy (SERS) which gained incredible attention due to its high selectivity and sensitivity. However, currently, comprehensive reviews of sialic acid detection and imaging as a cancer biomarker using SERS are still lacking. Here, we present the significant breakthroughs in SERS-based detection of sialic acid levels on cells, tissues, and body fluids due to the presence of cancer, different cancer metastasis stages, and in response to the external stimuli. This review covers the SERS substrate and novel SERS strategies, using lectin, boronic acid, metabolic glycan labelling and label-free methods, for sialic acid detection as cancer biomarker. The remaining challenges to detect sialic acid and prospect of future development of SERS for other carbohydrate-based cancer biomarker, for instance fucose, are also discussed.

Evaluation of Systemic Inflammation Before and After Standard Anti-tuberculosis Treatment in Patients With Active Pulmonary Tuberculosis and Diabetes Mellitus

Background Diabetes mellitus (DM) is a common comorbidity of active pulmonary tuberculosis (APTB) that increases the risk of treatment failure during anti-tuberculosis chemotherapy. Evaluating systemic inflammatory response could help determine differences in response to treatment between APTB patients and those with APTB and DM. Methodology To explore changes in systemic inflammation, measured by a set of inflammatory mediators in subjects with APTB and TBDM before and after six months of anti-tuberculosis chemotherapy, 30 APTB and nine TBDM subjects underwent cytokine testing, including interleukin (IL)-6, IL-8, IL-10, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and transforming growth factor-beta 1 (TGF-β1) by enzyme-linked immunosorbent assay, C-reactive protein by nephelometry, and sialic acid by colorimetric assay at baseline and following six months of standard anti-tuberculosis treatment. Sputum smear microscopy or molecular biology (Xpert MTB/RIF) was used for diagnosis, and sputum smear microscopy was performed monthly during the treatment of the patient with pulmonary tuberculosis to evaluate his evolution. Principal component analysis examined changes in the inflammatory status. Results Both groups showed negative sputum smear microscopy in the sixth month after starting anti-tuberculosis chemotherapy. TGF-β1 was found to be significantly higher in subjects with TBDM before treatment compared to APTB patients (p<0.001), and systemic inflammation continued only in TBDM subjects after treatment (accumulation and persistence of inflammatory mediators like IL-6, IL-8, IL-10, IFN-γ, TNF-α, TGF-β1, C-reactive protein, and sialic acid in blood). On the other hand, the mediators IFN-γ, C-reactive protein, and total sialic acid were found to be most influential in distinguishing pre- and post-treatment inflammatory response in subjects with APTB without DM. Conclusions Inflammatory mediators analyzed in combination, including IFN-γ, CRP, and total sialic acid, may be useful in evaluating the systemic inflammatory response in subjects with APTB and TBDM before and after anti-tuberculosis treatment. Determining these mediators revealed persistent systemic inflammation in TBDM subjects after six months of standard tuberculosis treatment, despite negative sputum smear microscopy results and good glycemic control. This suggests a need for inflammation-modulating therapies during tuberculosis control. Finally, monitoring sputum smear microscopy results alongside the determination of proposed inflammatory mediators (IFN-γ, CRP, and total sialic acid) are effective in evaluating the response to anti-tuberculosis treatment in APTB subjects without DM, warranting further investigation.

Lysosomal storage disorders identified in adult population from India: Experience of a tertiary genetic centre and review of literature

Lysosomal storage disorders (LSDs) in adults have milder phenotype and variable age at presentation. Several studies have described the phenotype, genotype and treatment outcomes for adult-onset LSDs like Gaucher, Fabry, Pompe disease and others. We describe the first systematic study on the occurrence of LSDs in an adult population from India. It describes, the key clinical signs seen in these patients and those from literature review that can aid in early detection. Of 2102 biochemically diagnosed LSDs cases, 32 adult patients were identified with LSDs. Based on the clinical suspicion, screening test and enzyme study was carried out. Twenty-two patients were subjected to a genetic study to identify the causative variant in a respective gene. Of the 32 adult patients, we observed a maximum percentage of 37.5% (n = 12) cases with Gaucher disease, followed by 13% (n = 4) with Fabry disease. We found 10% of cases with MPS IVA and MPS I, and 9% cases with Pompe. Single case of adult mucolipidosis III and two cases each of Type 1 Sialidosis, Niemann-Pick disease B and metachromatic leukodystrophy were identified. We observed two common variants p.Leu483Pro and p.Ala487Thr in the GBA1 gene in 23% of Indian patients with adult Gaucher disease. No common variants were observed in other aforementioned LSDs. Study identified 50% of Fabry patients and 4% of Gaucher patients diagnosed at our centre to be adults. The prevalence of adult Pompe patients was low (3.4%) as compared to 80% reported in the Caucasian population. Adult LSDs such as, MPS III, GM1/GM2 gangliosidosis and Krabbe disease were not identified in our cohort.

Free urinary sialic acid levels may be elevated in patients with pneumococcal sepsis

OBJECTIVES

Urine free sialic acid (UFSA) is an important diagnostic biomarker for sialuria (GNE variants) and infantile sialic acid storage disease/Salla disease (SLC17A5 variants). Traditionally, UFSA has been measured using specific single-plex methodology in relatively small cohorts of patients with clinical symptoms suggestive of these disorders. The use of multiplex tandem mass spectrometry urine screening (UMSMS) has meant that UFSA can be measured semi-quantitatively in a much larger cohort of patients being investigated for suspected metabolic disorders. We hypothesised that the neuraminidase of Streptococcus pneumoniae may release free sialic acid from endogenous sialylated glycoconjugates and result in increased UFSA levels.

METHODS

We conducted a retrospective review of clinical records of patients who were identified as having S. pneumoniae infection and who also had UMSMS at the time of their acute infection.

RESULTS

We identified three cases of increased UFSA detected by UMSMS screening that were secondary to S. pneumoniae sepsis. Additional testing ruled out genetic causes of increased UFSA in the first patient. All three patients had overwhelming sepsis with multiorgan dysfunction which was fatal. Glycosylation abnormalities consistent with the removal of sialic acid were demonstrated in serum transferrin patterns in one patient.

CONCLUSIONS

We have demonstrated in a retrospective cohort that elevation of UFSA levels have been observed in cases of S. pneumoniae sepsis. This expands our knowledge of UFSA as a biomarker in human disease. This research demonstrates that infection with organisms with neuraminidase activity should be considered in patients with unexplained increases in UFSA.

SARS-CoV-2 Attacks in the Brain: Focus on the Sialome

The epidemiological observations suggest that respiratory and gastrointestinal symptoms caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) are accompanied by short- and long-term neurological manifestations. There is increasing evidence that the neuroinvasive potential of SARS-CoV-2 is closely related to its capacity to interact with cell membrane sialome. Given the wide expression of sialylated compounds of cell membranes in the brain, the interplay between cell membrane sialoglycans and the virus is crucial for its attachment and cell entry, transport, neuronal damage and brain immunity. Here, we focus on the significance of the brain sialome in the progress of coronavirus disease 2019 (COVID-19) and SARS-CoV-2-induced neuropathology.

Dissemination of Mycobacterium tuberculosis is associated to a SIGLEC1 null variant that limits antigen exchange via trafficking extracellular vesicles

The identification of individuals with null alleles enables studying how the loss of gene function affects infection. We previously described a non-functional variant in SIGLEC1, which encodes the myeloid-cell receptor Siglec-1/CD169 implicated in HIV-1 cell-to-cell transmission. Here we report a significant association between the SIGLEC1 null variant and extrapulmonary dissemination of Mycobacterium tuberculosis (Mtb) in two clinical cohorts comprising 6,256 individuals. Local spread of bacteria within the lung is apparent in Mtb-infected Siglec-1 knockout mice which, despite having similar bacterial load, developed more extensive lesions compared to wild type mice. We find that Siglec-1 is necessary to induce antigen presentation through extracellular vesicle uptake. We postulate that lack of Siglec-1 delays the onset of protective immunity against Mtb by limiting antigen exchange via extracellular vesicles, allowing for an early local spread of mycobacteria that increases the risk for extrapulmonary dissemination.

Sialic Acid-Siglec Axis as Molecular Checkpoints Targeting of Immune System: Smart Players in Pathology and Conventional Therapy

The sialic acid-based molecular mimicry in pathogens and malignant cells is a regulatory mechanism that leads to cross-reactivity with host antigens resulting in suppression and tolerance in the immune system. The interplay between sialoglycans and immunoregulatory Siglec receptors promotes foreign antigens hiding and immunosurveillance impairment. Therefore, molecular targeting of immune checkpoints, including sialic acid-Siglec axis, is a promising new field of inflammatory disorders and cancer therapy. However, the conventional drugs used in regular management can interfere with glycome machinery and exert a divergent effect on immune controlling systems. Here, we focus on the known effects of standard therapies on the sialoglycan-Siglec checkpoint and their importance in diagnosis, prediction, and clinical outcomes.

The lysosomal disease caused by mutant VPS33A

A rare lysosomal disease resembling a mucopolysaccharidosis with unusual systemic features, including renal disease and platelet dysfunction, caused by the defect in a conserved region of the VPS33A gene on human chromosome 12q24.31, occurs in Yakuts-a nomadic Turkic ethnic group of Southern Siberia. VPS33A is a core component of the class C core vacuole/endosome tethering (CORVET) and the homotypic fusion and protein sorting (HOPS) complexes, which have essential functions in the endocytic pathway. Here we show that cultured fibroblasts from patients with this disorder have morphological changes: vacuolation with disordered endosomal/lysosomal compartments and-common to sphingolipid diseases-abnormal endocytic trafficking of lactosylceramide. Urine glycosaminoglycan studies revealed a pathological excess of sialylated conjugates as well as dermatan and heparan sulphate. Lipidomic screening showed elevated β-D-galactosylsphingosine with unimpaired activity of cognate lysosomal hydrolases. The 3D crystal structure of human VPS33A predicts that replacement of arginine 498 by tryptophan will de-stabilize VPS33A folding. We observed that the missense mutation reduced the abundance of full-length VPS33A and other components of the HOPS and CORVET complexes. Treatment of HeLa cells stably expressing the mutant VPS33A with a proteasome inhibitor rescued the mutant protein from degradation. We propose that the disease is due to diminished intracellular abundance of intact VPS33A. Exposure of patient-derived fibroblasts to the clinically approved proteasome inhibitor, bortezomib, or inhibition of glucosylceramide synthesis with eliglustat, partially corrected the impaired lactosylceramide trafficking defect and immediately suggest therapeutic avenues to explore in this fatal orphan disease.

Evaluation of lipid-bound sialic acid (LSA) as a tumor marker

The objective of this study is the evaluation of serum levels of lipid-bound sialic acid (LSA) as a of marker cancer. This is a case-control study, and the levels of LSA were determined with blinded duplicates of cases and controls. Histologic verification of all cancer cases was used to confirm the diagnosis. The study included 135 patients with cancer (breast carcinoma, head and neck squamous cell carcinoma, lung cancer and gastrointestinal cancer) and 95 controls (57 normal subjects and 38 with chronic non-malignant diseases). Marker determination was done by the spectrophotometric procedure of Katopodis with resorcinol. The mean LSA level in the 57 healthy individuals was 15.09 mg/dl (95% C.I., 13.51-16.67), in the entire control group of 95 non-tumoral individuals it was 19.21 mg/dl (17.18-21.24), and in the 135 cancer patients it was 26.64 mg/dl (24.42-28.87). There was a statistically significant difference between patients with chronic non-tumoral diseases and healthy individuals (p<0.001) and also between cancer patients and healthy individuals (p<0.001), but not between cancer patients and patients with chronic non-tumoral diseases (p>0.05). The mean LSA serum values related to tumor site were (mg/dl): breast cancer, 21.49; gastrointestinal tumors, 28.45; head and neck cancer, 28.61 and lung cancer, 32.54. The means according to clinical stage were: complete remission, 18.50, significantly higher than the healthy controls (p<0.05); local disease, 23.50 (p<0.01); locoregional disease, (p<0.05); local disease, 23.50 (p < 0.01); locoregional disease, 27.21 (p < 0.001); metastatic disease, 34.49 (p < 0.001), and relapses, 20.87 (p<0.05). When comparing patients with clinically active cancer with healthy persons, the estimated cutoff value was 19.1 mg/dl, with a sensitivity of 74.7% and a specificity of 74.7%. We conclude that LSA values increase in cases of clinically active cancer and decrease in complete remission. LSA is of great value as a tumor marker in the diagnosis of disease extent.

Serum Sialic Acid Level Is Significantly Associated with Nonalcoholic Fatty Liver Disease in a Nonobese Chinese Population: A Cross-Sectional Study

BACKGROUND/AIM

To investigate the association between serum sialic acid (SA) levels and nonalcoholic fatty liver disease (NAFLD) in a nonobese Chinese population.

METHODS

A cross-sectional study was performed among the 5916 adults who took their annual health examinations at International Health Care Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, from December 2013 to November 2014.

RESULTS

A total of 693 (11.71%) subjects fulfilled the diagnostic criteria of NAFLD, and NAFLD patients had significantly higher serum SA levels than controls (P < 0.001). The prevalence of NAFLD was positively associated with serum SA levels (P for trend <0.001). Serum sialic acid levels are significantly associated with features of metabolic syndrome (Ps < 0.01). Multivariate logistic regression analysis showed that serum SA level was significantly associated with risk for NAFLD (odds ratio: 1.018, 95%; confidence interval: 1.007-1.030; P = 0.002).

CONCLUSIONS

Our results suggest for the first time that NAFLD patients had higher serum SA level than controls, and increased serum SA level is significantly associated with risk for NAFLD in a large nonobese Chinese population.

Serum sialic acids levels according to the severity of liver cirrhosis

BACKGROUND

The sialylation of serum proteins and lipids changes in liver diseases of different etiologies and could change the total sialic acid (TSA), lipid-bound SA (LSA), and free SA (FSA) levels in the sera. However, little is known of the relationship of serum SAs concentrations and the severity of liver disease. Therefore, the aim of this study was to investigate the SAs concentrations (TSA, LSA, and FSA) in liver cirrhosis in relation with the severity of liver disease.

METHODS

Tested group consisted of 91 consecutive patients suffering from liver cirrhosis. For each patient, the Child-Pugh score was calculated. TSA and LSA were determined by the enzymatic method on microplate reader, and FSA using the thiobarbituric method.

RESULTS

Among the SA forms, only the serum FSA level in liver cirrhosis appears to be different according to the severity of liver damage evaluated by the Child-Pugh score. It was the highest in score C, and was higher than that in scores B and A. The elevated levels of FSA significantly positively correlated with the Child-Pugh score.

CONCLUSION

In conclusion, the sialylation of serum proteins and lipids changes in liver cirrhosis, but only the serum concentrations of FSA are stage-related and reflect the severity of liver disease.

Modulation of Fourier transform infrared spectra and total sialic acid levels by selenium during 1,2 dimethylhydrazine-induced colon carcinogenesis in rats

The present study investigated the modulatory potential of selenium supplementation, if any, on Fourier transform infrared (FTIR) spectra in brush border membranes (BBM) of colons and on serum total sialic acid as well as lipid bound sialic acid during 1,2 dimethyl hydrazine (DMH)-induced colorectal carcinogenesis in rats. The FTIR spectra of BBM from the colons of DMH-treated rats revealed a significant increase in the lipid contents but showed a significant decline in the protein contents. Further, decrease in the collagen as well as creatine contents was also noticed in the colons of DMH-treated rats. Supplementation with selenium appreciably restored protein as well as collagen contents and resulted in decreased lipids levels in the colons of DMH-treated rats. Interestingly, a significant increase in the levels of total sialic acid in serum of DMH-treated rats was observed which, however, got moderated significantly upon selenium supplementation. Moreover, no significant changes were observed in the levels of lipid bound sialic acid in all the treated groups as compared to controls. In conclusion, the present study suggested that supplementation of selenium act as a chemopreventive agent and delays considerably the process of colon carcinogenesis.

Salivary lipid peroxidation and total sialic acid levels in smokers and smokeless tobacco users as Maraş powder

Maraş powder (MP), a different type of smokeless tobacco (ST) and prepared from a tobacco of species Nicotiana rustica Linn, is widely used in Turkey. We aimed to investigate the effects of MP on salivary total sialic acid (TSA) and malondialdehyde (MDA) levels and to compare these parameters in smokers and MP users (MPUs). The salivary TSA and MDA concentrations were significantly higher in the smokers and MPU than those of control subjects and also in MPU than that of smokers. We have also observed that as the number of cigarettes consumed and MP amount increases, TSA and MDA levels increase too. In smokers, MDA values were significantly correlated with the number of cigarettes smoked and the duration of smoking. In MPU, both MDA and TSA levels were significantly correlated with the duration of MP use and the amount of daily consumed MP. We have concluded increased salivary TSA and MDA levels associated in MPU and smokers. Results can help to evaluate harmful effects of these habits. It is important to point out that bigger change in the measured parameters has been observed for MP use. This observation may be an important indication of harmful effects of ST use as MP.

Protective effect of L-carnitine and coenzyme Q10 on CCl₄-induced liver injury in rats

This study provides an information about the mechanisms of liver injury induced by CCl(4), and determines the influence of administration of L-carnitine or/and CoQ10 as prophylactic agents against CCl(4) deteriorative effect. The study was carried out on 80 adult male albino rats divided into eight groups, 10 animals each, as follows: four normal groups (control, treated with L-carnitine, treated with CoQ10, and treated with a combination of Lcarnitine and CoQ10) and four liver injury groups treated with CCl(4) (control, treated with L-carnitine, treated with CoQ10, and treated with a combination of L-carnitine and CoQ10). Liver injury was induced by s.c. injection of a single dose of CCl(4) (1 ml/kg). L-carnitine (50 mg/kg/day) was given i.p. for four successive days 24 hours before CCl(4) injection, and CoQ10 (200 mg/kg) was given as a single i.p. dose 24 hours before CCl(4) injection. Animals were sacrificed 24 hours after CCl(4) injection, blood samples were withdrawn and liver tissue samples were homogenized. The levels of the following parameters were determined: hepatic reduced glutathione, serum ALT and AST, hepatic lipid peroxides, hepatic vitamin C, hepatic and serum total protein, serum albumin, serum sialic acid, serum nitrite, and serum and hepatic total LDH activities and LDH isoenzymes. The obtained data revealed that CCl(4) injection produced a significant decrease in reduced glutathione content, vitamin C, total protein and albumin levels. However, there was a significant increase in serum ALT and AST activities, lipid peroxides, sialic acid, nitric oxide, serum and hepatic total LDH activities. On the other hand, groups treated with L-carnitine or/and CoQ10 prior to CCl(4) injection showed an improvement in most parameters when compared with cirrhotic control group. It has been concluded that L-carnitine and coenzyme Q10 have a pronounced prophylactic effect against liver damage induced by halogenated alkanes such as carbon tetrachloride.

Lipid-bound sialic acid in alcoholics participates in increased level of total sialic acid

Serum total sialic acid (TSA) concentration is a sensitive marker of excessive alcohol consumption and is the sum of protein-bound sialic acid, lipid-bound sialic acid (LSA), and free sialic acid. The LSA is the fraction of SA attached to gangliosides that are transported in the blood by the lipoproteins. In this article, the effect of chronic alcohol consumption on the serum levels of LSA was evaluated. The objective of the study was to understand the mechanism of elevated serum TSA concentration during alcohol abuse. Additionally, the association of LSA with serum lipid profile was tested. For this purpose, the levels of LSA, TSA, lipids, lipoproteins, and apolipoproteins (apos) in the sera of 106 alcoholics were measured. The serum level of LSA in alcohol abusers was significantly elevated. This increase was because of the elevated level of LSA in patients drinking alcohol up to 2 days before sampling. The elevated level of LSA positively correlated with TSA, and also with biochemical indices of hepatocellular injury such as aspartate aminotransferase and gamma-glutamyltransferase, but did not correlate with any lipids, apos, and lipoproteins. The increase in LSA level is not related with the status of serum lipid profile but is related to the liver status estimated by the biochemical markers of liver cell damage. On the basis of our results, we conclude that the elevated level of LSA in alcohol abusers contributes to an increase in the serum concentration of TSA, and contrary to TSA, is affected by the status of liver cells.

Effect of Neem (Azadirchta indica) on serum glycoprotein contents of rats administered 1,2 dimethylhydrazine

The present study was designed to investigate the effects of aqueous Azadirchta Indica leaf extract (AAILE) on serum glycoprotein contents and tumor incidence rate in colon of rats subjected to Dimethylhydrazine (DMH) treatment. Forty rats were divided equally and randomly into four groups viz., Group I (normal control), Group II (DMH-treated), Group III (AAILE) and Group IV (DMH + AAILE treated). Group II and IV animals were injected subcutaneously every week with DMH (30 mg/kg b.wt.) for two durations of 10 and 20 weeks. AAILE was given orally three times a week on alternate days (100 mg/kg b.wt.) to animals belonging to groups III and IV. Blood samples were drawn from all the animals by ocular vein puncture every month for the estimation of Total Sialic Acid (TSA) and Lipid Bound Sialic Acid (LSA), which served as markers for the cancer. No incidence of tumor was recorded in the animals given DMH treatment for 10 weeks. However, DMH treatment for 20 weeks showed 100% tumor incidence. Animals treated with DMH for both the time durations showed a significant increase in the levels of TSA in comparison to normal control, which however were decreased significantly following AAILE supplementation. There was no significant difference between LSA levels of DMH-treated animals and normal controls. The present study suggested that supplementation of AAILE in cancer-bearing animals attenuates considerably the molecular events that initiate the development of tumors.

Serum free sialic acid as a marker of alcohol abuse

BACKGROUND

Previous studies have shown that serum total sialic acid (TSA) concentration significantly increases during alcohol abuse. Chronic ethanol consumption impairs glycosylation of many proteins. The increased desialylation rate of serum glycoproteins is one of the effects of alcohol abuse. The aim of this study was to investigate the diagnostic value of free sialic acid (FSA) as a marker of alcohol abuse.

METHODS

We determined serum FSA concentrations in the group of 156 alcoholic subjects and 35 healthy control subjects by means of a modification of the thiobarbituric acid method. The alcoholic group was divided into subgroups according to their history of abuse.

RESULTS

The FSA concentration was significantly higher in alcoholic subjects than in healthy controls. The subjects who consumed alcohol for longer than a week showed significantly higher FSA level than those who consumed alcohol for a shorter period. The serum FSA concentration was significantly higher in alcoholic subjects with elevated markers of liver dysfunction. The diagnostic accuracy of FSA was high, although it did not differ from TSA, and was limited by its low sensitivity.

CONCLUSIONS

This study shows that FSA concentration in the sera of alcoholic subjects is increased. The low diagnostic sensitivity is accompanied by high specificity, however the accuracy is high and similar to the accuracy of TSA. Free sialic acid does not seem to be a better marker of alcohol abuse than TSA and current markers.

Sialic acid: a novel marker of cardiovascular disease?

The global burden posed by cardiovascular disease (CVD), due to a rising incidence of known risk factors, underlines an urgent need to identify other potential risk factors. Sialic acid (SA), an abundant terminal monosaccharide of glycoconjugates, is a possible risk factor for CVD. Although large-scale epidemiological surveys have shown that serum total sialic acid (TSA) is positively associated with mortality from coronary artery disease (CAD) and stroke, studies investigating the correlation between serum TSA and the severity of atherosclerosis are conflicting. Clinical and epidemiological studies indicate that serum TSA is a marker of a sustained inflammatory response in CVD, rather than causal in nature. Data also indicates ethnic variation in baseline TSA. This article reviews current methods for determining serum TSA and evidence supporting serum TSA as a risk factor for CVD. Potential mechanisms for this role are examined. The use of serum TSA as a marker of atherosclerotic disease is evaluated.

Serum total sialic acid levels in smokers and users of smokeless tobacco in form of oral powder (Maraş powder)

Smokeless tobacco (ST) is widely used as chewing tobacco and as oral snuff in the world. Also, in Kahramanmaraş, a city in Southern Turkey, ST used as 'oral powder' or 'Maraş Powder' is consumed widely instead of cigarette smoking. The aim of this study was to search the effect of ST use on serum total sialic acid (TSA) and to compare the serum TSA levels in smokers and ST users. The study was performed at the Department of Chemistry-Biochemistry, University of Kahramamaraş Sutcu Imam, Turkey, in 2003. Serum samples obtained from smokers (Group I), Maraş powder users (Group II), and healthy control subjects (Group III) who were nonsmokers and nonusers ST. Individuals who were smokers and ST users were classified into subgroups with respect to amount of consumed cigarette or oral powder. Serum TSA was measured with the Denny's colorimetric method. The TSA concentrations were significantly higher in the sera of smokers (p < 0.001) and Maraş powder users (p < 0.001) than those of control subjects. The mean serum TSA level was found to be lowest in the control group and highest in the Maraş Powder users. But, there was no significant difference in serum TSA levels between smokers and Maraş powder users (p > 0.05). We can conclude from the results obtained that serum TSA was affected by ST use as seen in smokers. This finding may be an indication of harmful effects of ST use as Maraş powder as well as cigarette smoking.

Quantification of Free Sialic Acid in Urine by HPLC–Electrospray Tandem Mass Spectrometry: A Tool for the Diagnosis of Sialic Acid Storage Disease

Background: Sialic acid storage diseases (SSDs) are severe autosomal recessive neurodegenerative disorders caused by a transport defect across the lysosomal membrane, which leads to accumulation of sialic acid in tissues, fibroblasts, and urine. Defective free sialic acid transport can be established by quantification of free sialic acid in urine.

Methods: Urine sample size was adjusted to the equivalent of 100 nmol of creatinine. After addition of 2-keto-3-deoxy-d-glycero-d-galactonononic acid as internal standard, samples were diluted with water to an end volume of 250 μL. We used 10 μL for HPLC–tandem mass spectrometric analysis in the negative electrospray ionization mode, monitoring transitions m/z 308.3→m/z 86.9 (sialic acid) and m/z 267.2→m/z 86.9 (internal standard). The overall method was validated and studied for ion suppression, interfering compounds, and pH effects. Samples from controls (n = 72) and SSD patients (n = 3) were analyzed.

Results: The limit of detection was 3 μmol/L. Intraassay imprecision (CV; n = 10) was 6%, 3%, and 2% at 30, 130, and 1000 mmol/mol creatinine, respectively; corresponding interassay CV (n = 10) were 5%, 5%, and 2%. Recovery was 109% (100–1000 mmol/mol creatinine). The mean (SD) [range] excretion rates (mmol/mol creatinine) were 31.3 (16.6) [0.7–56.9] at 0–1 year (n = 20), 21.2 (9.8) [6.3–38.3] at 1–3 years (n = 15), 14.4 (8.2) [1.7–32.9] at 3–10 years (n = 25), and 4.6 (2.6) [0–9.8] above age 10 years (n = 12). SSD patients 1.2, 3.9, and 12 years of age had concentrations of 111.5, 54.2, and 36.1 mmol/mol creatinine, respectively.

Conclusions: The HPLC-tandem MS method for free sialic acid in urine is more rapid, accurate, sensitive, selective, and robust than earlier methods and may serve as a candidate reference method for free sialic acid in diagnosis of SSD.

The role and potential of sialic acid in human nutrition

Sialic acids are a family of nine-carbon acidic monosaccharides that occur naturally at the end of sugar chains attached to the surfaces of cells and soluble proteins. In the human body, the highest concentration of sialic acid (as N-acetylneuraminic acid) occurs in the brain where it participates as an integral part of ganglioside structure in synaptogenesis and neural transmission. Human milk also contains a high concentration of sialic acid attached to the terminal end of free oligosaccharides, but its metabolic fate and biological role are currently unknown. An important question is whether the sialic acid in human milk is a conditional nutrient and confers developmental advantages on breast-fed infants compared to those fed infant formula. In this review, we critically discuss the current state of knowledge of the biology and role of sialic acid in human milk and nervous tissue, and the link between sialic acid, breastfeeding and learning behaviour.

Determination of free N-acetylneuraminic acid in urine by high-performance liquid chromatography using 3-[(1-[[4-(5,6-dimethoxy-1-oxoisoindolin-2-yl)-2-methoxyphenyl]sulfonyl]pyrrolidin-2-yl)carbonylamino]phenylboronic acid as a fluorescent labeling reagent

A highly sensitive high-performance liquid chromatography (HPLC) method for the determination of urinary N-acetylneuraminic acid (NeuAc) using 3-[(1-[[4-(5,6-dimethoxy-1-oxoisoindolin-2-yl)-2-methoxyphenyl]sulfonyl]pyrrolidin-2-yl)carbonylamino]phenylboronic acid as a fluorescent labeling reagent was developed. The labeling reaction was carried out at 30 degrees C for 30 min in the presence of pyridine. The derivative was monitored at Ex 314 nm and Em 388 nm. The detection limit of NeuAc was about 48 fmol per injection. The relative standard deviations of within-day and between-day precisions were 2.6-3.3 and 1.7-3.3%, respectively. Urine diluted 10 times with distilled water was analyzed by employing the standard-addition method. The concentrations were 8-89 nmol/mg creatinine (30+/-28 nmol/mg creatinine, n=9).

Evaluation of serum sialic acid, sialyltransferase and sialoproteins in oral cavity cancer

OBJECTIVE

Altered glycosylation of glycoconjugates is among the important molecular changes that accompany malignant transformation. The aim of our study was to investigate clinical usefulness of circulatory levels of sialic acid, sialoproteins and sialyltransferase for early diagnosis and management of oral cavity cancer (OC) patients.

MATERIALS AND METHODS

Blood samples collected from 210 untreated OC patients, 100 patients with oral precancerous conditions (OPC) and 100 healthy males. OC patients were followed after initiation of anticancer treatment and 394 follow-up samples were also collected. Serum sialic acid levels were measured spectrophotometrically. Sialyltransferase activity was analysed using radioassay. Alpha 2-6 sialoproteins were isolated using lectin affinity chromatography.

RESULTS

Serum levels of free, protein bound and total sialic acid as well as their ratio with total proteins were significantly elevated in untreated OC patients compared with healthy individuals, patients with OPC as well as complete responders (CR). Levels of the markers were comparable between untreated OC patients and non-responders. We observed positive correlation between serum levels of the markers and extent of malignant disease. Serum sialyltransferase activity showed significant elevations in OC patients compared with the controls (P<0.001), patients with OPC (P<0.05) and CR (P<0.05). Higher sialic acid levels in OC patients at the time of diagnosis showed poor survival. The changes in serum proteins with terminal alpha 2-6 sialic acid correlated well with the alterations in the levels of sialic acid forms and sialyltransferase activity.

CONCLUSION

Our results confirmed the elevations in sialic acid and sialyltransferase levels in OC patients and suggested potential utility of these parameters in prognostication and treatment monitoring of this neoplasm. The alterations in these parameters in circulation were in accordance with the changes in alpha 2-6 sialylated proteins.

Serum total sialic acid in cholangiocarcinoma patients: an ROC curve analysis

OBJECTIVES

This study was undertaken to establish the diagnostic utility of serum total sialic acid (TSA) for patients with cholangiocarcinoma (CCA).

DESIGN AND METHODS

Serum TSA was determined in 89 histologically confirmed CCA patients, 38 with benign hepatobiliary diseases (BHD) and 43 healthy persons. To check whether the test could adequately discriminate between these groups, complete statistical Receiver Operating Characteristic (ROC) curves were analyzed.

RESULTS

The mean value of serum TSA in CCA patients (2.75 +/- 0.67 mmol/L) was significantly higher than that in the BHD (2.33 +/- 0.69 mmol/L p < 0.002) and healthy persons (1.89 +/- 0.46 mmol/L p < 0.001) groups. The areas under the ROC curves were 0.6699 and 0.8558, respectively. A cut-off value of 2.33 mmol/L discriminated between the CCA, BHD and healthy groups with a sensitivity of 71.9% and a positive predictive value range of 80 to 89%.

CONCLUSION

Determination of TSA yielded high diagnostic values for differentiating between CCA, BHD and healthy persons. The determination of serum TSA would be most useful as an adjunct diagnosis rather than an early detection and screening tool because of the apparent nonspecificity of SA to a given disease.

Serum Sialic Acid in a Random Sample of the General Population

Background: The serum sialic acid (SA) concentration has been reported to be a potentially useful but nonspecific disease marker. We wanted to study which factors influence SA concentration in a well-characterized healthy population.

Methods: SA was determined in 97 women and 96 men with a colorimetric Warren method.

Results: The mean ± SD concentrations of SA were 634 ± 109 (95% confidence interval, 612–656) and 630 ± 106 (95% confidence interval, 608–651) mg/L for women and men, respectively. The serum SA showed a significant positive association with body mass index and with systolic and diastolic blood pressure among both women and men. SA also correlated significantly with the use of contraceptive pills and age among women and with smoking among men.

Conclusions: Our study suggests that SA does not increase with age in men but appears to increase with female menopause. The strong positive association with blood pressure may explain why SA predicts cardiovascular mortality.

Occurrence of sialic acids in healthy humans and different disorders

Sialic acid (SA), N-acetylated derivatives of neuraminic acid, play a central role in the biomedical functioning of humans. The normal range of total sialic acid (TSA) level in serum/plasma is 1.58-2.22 mmol L-1, the free form of SA only constituting 0.5-3 mumol L-1 and the lipid-associated (LSA) forms 10-50 mumol L-1. Notably, considerably higher amounts of free SA are found in urine than in serum/plasma (approximately 50% of the total SA). In inherited SA storage diseases such as Salla's disease, SA levels are elevated many times over, and their determination during clinical investigation is well established. Furthermore, a number of reports describe elevated SA levels in various other diseases, tentatively suggesting broader clinical utility for SA markers. Increased SA concentrations have been reported during inflammatory processes, probably resulting from increased levels of richly sialylated acute-phase glycoproteins. A connection between increased SA levels and elevated stroke and cardiovascular mortality risk has also been reported. In addition, SA levels are slightly increased in cancer, positively correlating with the degree of metastasis, as well as in alcohol abuse, diabetes, chronic renal failure and chronic glomerulonephritis. Several different mechanisms are assumed to underlie the elevated SA concentrations in these disorders. The apparent non-specificity of SA to a given disease limits the potential clinical usefulness of SA determination. In addition, some non-pathological factors, such as aging, pregnancy and smoking, may cause changes in SA concentrations. The absolute increases in SA levels are also rather small (save those in inherited SA storage disorders); this further limits the clinical potential of SA as a marker. Tentatively, SA markers might serve as adjuncts, when combined with other markers, in disease screening, disease progression follow-up, and in the monitoring of treatment response. To become clinically useful, however, the existing SA determination assays need to be considerably refined to reduce interferences, to be specific for certain SA forms, and to be more easy to use.

Determination of sialic acids in biological fluids using reversed-phase ion-pair high-performance liquid chromatography

A simple, rapid and sensitive reversed-phase ion-pair high-performance liquid chromatographic method for the determination of N-acetylneuraminic acid and 2-deoxy-2,3-dehydro-N-acetylneuraminic acid in biological fluids is described. Determination of N-acetylneuraminic acid released by acidic hydrolysis, in serum, urine and saliva, and 2-deoxy-2,3-dehydro-N-acetylneuraminic acid in urine, without hydrolysis, was accomplished by injecting the sample without derivatization, into the chromatograph. Measurements were carried out isocratically within 6 min using a C18 column and a mobile phase of aqueous solution of triisopropanolamine, as ion-pair reagent, 60 mM, pH 3.5 at room temperature with UV absorbance detection. The present method is reported for the first time for the determination of sialic acids in biological fluids. Recoveries in serum, urine and saliva ranged from 90 to 102% and the limits of detection were 60 nM and 20 nM for the two sialic acids, respectively. The method has been applied to normal and pathological sera from patients with breast, stomach, colon, ovarian and cervix cancers, to normal urine and urine from patient with sialuria and to normal saliva.

Salivary sialic acid, protein, salivary flow rate, pH, buffering capacity and caries indices in subjects with Down's syndrome

OBJECTIVES

The aim of this study was to compare salivary sialic acid, protein, salivary flow rate, pH and buffering capacity and caries indices between subjects with Down's Syndrome and healthy controls.

METHODS

Unstimulated mixed saliva was collected from 26 Down's syndrome subjects and 25 healthy subjects of age range 6-24 years. Total protein was determined by the method of Lowry and total sialic acid using Ehrlich reagent. Laemmli SDS-polyacrylamide gel electrophoresis was also carried out.

RESULTS

Buffering capacity and pH were quite similar for both groups. For permanent dentition subjects pH was significantly higher (P = 0.03) in the Down's syndrome group. The salivary flow rate of the Down's syndrome subjects was significantly lower (P < 0.01) than that of healthy controls and the Down's syndrome subjects' salivary protein and sialic acid levels were significantly higher (P < 0.001). The ratios of total sialic acid to total protein were significantly higher (P < 0.001) in the Down's syndrome group. However, salivary sialic acid expectoration rates, a means of compensating for flow rate differences, were significantly lower (P = 0.01) in the Down's syndrome subjects than in controls. Electrophoresis revealed no significant differences between the protein bands of the groups. There were no significant differences in caries indices between groups, even when compensated for age, nor in the salivary parameters within groups between sexes.

CONCLUSIONS

Total salivary sialic acid in Down's syndrome subjects, higher in terms of levels but lower in terms of expectoration rates, was significantly different from that of controls of similar caries indices.

Total serum sialic acid is a general disease marker rather than a specific tumour marker in dogs

The aim of the present study was to examine the levels of total sialic acid (TSA) in serum of clinically healthy dogs and dogs with various diseases to evaluate the usefulness of TSA as a tumour marker. TSA levels in clinically healthy dogs were not different between sexes, but pregnant and lactating dogs had higher mean (+/- standard deviation (SD)) TSA levels than clinically healthy female dogs (642 +/- 78 vs. 495 +/- 73 mg/l, P < 0.001). Eighty-eight dogs with different tumours (54 malignant and 34 benign tumours of different tissues) had higher mean TSA levels than 148 clinically healthy dogs (675 +/- 143 vs. 498 +/- 75 mg/l, P < 0.01). Fifty dogs with other diseases excluding tumours (skin, urinary system, and gastrointestinal diseases, pyometra, other inflammatory diseases, and Cushing's syndrome) had slightly higher TSA levels than the tumour-bearing dogs (730 +/- 159 mg/l, P = 0.02). TSA levels in dogs with malignant tumours did not differ from dogs with benign tumours (682 +/- 144 vs. 664 +/- 142 mg/l, P = 0.73). A receiver-operating characteristic (ROC) plot revealed a maximum sensitivity and specificity combination of 69% and 91% (TSA cut-off concentration 595 mg/l) in distinguishing between healthy dogs and dogs with tumours. When evaluating TSA measurements to distinguish dogs with other diseases from dogs with tumours, a maximum sensitivity and specificity combination of 50% and 75% was found (cut-off concentration 761 mg/l). WHO staging of mammary tumours revealed an increase in TSA levels with increasing stage (P < 0.0001, rs, = 0.62). In conclusion, the nonspecificity of increases makes TSA determinations unsuitable as a tumour marker. TSA levels seem instead to be a general disease marker. Whether serial TSA measurements could be used in the follow-up of dogs operated for malignant tumours should be further investigated.

Sialic acid content of LDL in coronary artery disease: no evidence of desialylation in subjects with coronary stenosis and increased levels in subjects with extensive atherosclerosis and acute myocardial infarction: relation between desialylation and in vitro peroxidation

We recently showed that sialic acid content of LDL was not a marker of early cardiovascular disease (Arterioscler Thromb Vasc Biol. 1995;15:334-339). Here, we investigated this parameter in patients with advanced coronary artery disease (CAD). We first examined 100 patients having undergone coronary angiography. The distribution of LDL sialic acid values was very similar in subjects with no coronary stenosis (31.3+/-3.7 nmol/mg LDL protein, mean+/-SD) and those with > or = 75% stenosis in at least one main coronary artery or > or = 50% stenosis in at least two main coronary arteries (32.1+/-5.5 nmol/mg LDL protein). In contrast, LDL sialic acid content was significantly increased in patients with both coronary stenosis and peripheral arterial atherosclerotic lesions compared with those with either no lesion or only one or the other type of lesion. We then examined LDL sialic acid content in 20 patients with acute myocardial infarction. LDL sialic acid content was significantly higher (35.9+/-3.2 nmol/mg LDL protein) than that in the CAD(-) control group. These data suggest that LDL sialic acid content increases with the extension of atherosclerosis and its progression to acute complications. To explain the discordance with Orekhov and coworkers (Atherosclerosis. 1991;86:153-161), who showed that LDL sialic acid content in patients with advanced CAD was lower than that in healthy subjects, we studied the time courses of sialic acid, TBARS, and vitamin E levels in LDL dialyzed in different experimental conditions. A continuous decrease in both sialic acid and vitamin E levels and an increase in TBARS levels were observed in LDL samples containing less than 1 mmol/L EDTA, the intensity and rapidity of which varied with the EDTA concentration in the buffer. Our data support the idea that desialylation may result from in vitro peroxidation of LDL.

Sialic acid concentration in serum and tissue of endometrial cancer patients

Serum total sialic acid (TSA) level was determined in the group of 45 patients with endometrial neoplasia. Moreover, the sialic acid content in 23 surgically obtained tumor tissue specimens has been estimated. The mean value of serum total sialic acid level of the cancer patients (2.38 mmol/l) was significantly higher (P < 0.0001) than the sialic acid level in the control group (1.52 mmol/l). The elevation of serum total sialic acid level was associated with the burden of the tumor (2.30 mmol/l and 2.68 mmol/l for stages I and II + III, respectively). Tissue sialic acid content showed no significant differences between early and advanced clinical stage of the disease.

Determination of the novel sialic acid analog GG167 (GR121167X) in human urine by liquid chromatography: direct injection with column switching

GG167 is a novel compound which selectively inhibits viral neuraminidase and has demonstrated activity against influenza A and B. A liquid chromatography (LC) method for the determination of GG167 in human urine has been developed and validated. The method allows direct injection of urine (7 microliters) using LC column switching followed by UV detection. Initial chromatography is performed using a Nucleosil-Diol column (7 microns, 250 mm x 4.6 mm), eluted with 20 mM phosphate buffer (pH 2.5):acetonitrile (18:82, v/v) at 2.0 ml min-1. GG167 is "heart-cut" to a Spherisorb-SCX column (5 microns, 100 mm x 4.6 mm) and eluted with 35 mM phosphate buffer (pH 2.5):acetonitrile (50:50, v/v) at 1.5 ml min-1 for final separation. GG167 is detected by UV absorbance at lambda = 238 nm. UV detection and peak shape are enhanced at pH < 2.5. The quantitation range of the assay is 0.3-100 micrograms ml-1. The method has demonstrated sufficient ruggedness to be used in support of GG167 clinical trials.

Plasma and urine sialic acid in non-insulin dependent diabetes mellitus

Urinary excretions of albumin, glycosaminoglycans (GAGS), total sialic acid (TSA), and lipid associated sialic acid (LASA) were measured in 78 non-insulin dependent diabetic patients (NIDDM) and 28 healthy subjects. TSA excretion was significantly higher in normoalbuminuric and microalbuminuric diabetic subjects than the control subjects and TSA excretion was correlated with urinary albumin excretion rate (AER). In normoalbuminuric diabetics, the duration of diabetes correlated significantly with both sialicaciduria and albuminuria. Although serum TSA levels were significantly higher in both diabetic groups than the control subjects, there was no correlation between serum and urinary TSA levels.

Evaluation of the sialic acid content of LDL as a marker of coronary calcification and extracoronary atherosclerosis in asymptomatic hypercholesterolemic subjects. PCVMETRA Group

Recent studies have shown that the sialic acid content of LDL isolated from patients with angiographically demonstrated advanced coronary atherosclerosis is lower than that of LDL isolated from healthy subjects. These observations raise the question as to whether LDL sialic acid content could be used as an early marker of atherosclerosis. We screened for carotid, aortic, and femoral plaques by ultrasonography and for coronary calcifications by ultrafast computed tomography in 160 hypercholesterolemic subjects free of cardiovascular disease to investigate the relation between LDL sialic acid content and the prevalence of these early atherosclerotic lesions. LDL sialic acid values varied from 19.6 to 46.6 nmol/mg LDL protein (33.9 +/- 4.4, mean +/- SD) in the whole population, but the distribution was very similar: (1) in subjects with no plaque (34.1 +/- 4.9) relative to those with one or several plaques at one (34.2 +/- 4.4), two (33.0 +/- 3.6), or three (34.8 +/- 3.4) different arterial sites; (2) in subjects with (33.9 +/- 3.7) and without (34.1 +/- 4.8) coronary calcification; and (3) in subjects with both extracoronary and coronary lesions (33.8 +/- 3.9) relative to those with no arterial lesions (34.2 +/- 4.5). LDL sialic acid content was not related to sex, age, body mass index, smoking, blood pressure, or serum total cholesterol and lipoprotein(a) levels but correlated negatively with serum triglyceride levels (P < .001). These results suggest that LDL sialic acid content is not a discriminant marker of early atherosclerosis in asymptomatic hypercholesterolemic subjects.

Evaluation of an automated spectrophotometric assay for the determination of total sialic acid in canine serum

This study validates an automated enzymatic assay using the Cobas Fara (Roche) centrifugal analyser, which offers a reliable measurement of the total sialic acid concentration in canine serum as assessed by evaluating the precision and accuracy. Data are presented on the biological variation in the total serum sialic acid concentration. Measurements of total serum sialic acid concentration appear to be useful in distinguishing dogs with neoplastic disorders from clinically healthy dogs.

Monitoring the acute phase response to vaso-occlusive crisis in sickle cell disease

AIMS

To identify suitable acute phase proteins as objective markers of tissue ischaemia during painful vaso-occlusive crises in sickle cell disease.

METHODS

The prodromal and established phases of 14 vaso-occlusive crises were studied longitudinally in 10 patients with sickle cell anaemia. Automated solid phase enzyme immunoassays were used to measure the fast responding acute phase proteins C-reactive protein and serum amyloid A protein. Slower responding glycoproteins (fibrinogen, orosomucoid, sialic acid and concanavalin-A binding) were measured in parallel.

RESULTS

C-reactive protein and serum amyloid A protein increased early in crisis, sometimes within the early (prodromal) phase. Crises that resolved within 24 hours in hospital showed a minor and transient rise compared with crises that required treatment for four days or more. In eight crises treated by patients at home the acute phase response ranged from minor to a level consistent with extensive tissue ischaemia.

CONCLUSIONS

Sensitive enzyme immunoassays for C-reactive protein and serum amyloid A protein are of potential value for monitoring the onset of tissue ischaemia in sickle cell crisis and for confirming subsequent resolution.

Tumours of the central nervous system and serum sialic acid concentration in men and women

In a population-based study serum sialic acid level was examined in relation to subsequent development of central nervous system (CNS) tumours (229 cases). Significantly increased sialic acid concentration was found in men with a malignant CNS tumour diagnosed within 8 years of analysis, compared with corresponding matched controls. These findings suggest that the tumour existed at the time of examination which is supported by a negative linear association between sialic acid level and the time from screening to tumour diagnosis.