Monoclonal free light chain detection and quantification: Performances and limits of available laboratory assays

The detection and quantification of immunoglobulin free light chains in serum and urine is recommended for the diagnosis and monitoring of monoclonal gammopathies according to the guidelines of the International Myeloma Working Group (IMWG). Several tests are currently available in the clinical laboratory to detect and quantify free light chains but although quality, efficiency, and effectiveness have been improved, the results are still variable and poorly harmonized and standardized. The present review article wants to analyze these aspects, with a keen eye on techniques, such as mass spectrometry, that could replace in the practical clinical laboratory the current methods including Bence-Jones protein assay and free light chain immunoassays.

Effect of industrial processing and storage procedures on oxysterols in milk and milk products

Oxysterols are products of enzymatic and/or chemical cholesterol oxidation. While some of the former possess broad antiviral activities, the latter mostly originate from the deterioration of the nutritional value of foodstuff after exposure to heat, light, radiation and oxygen, raising questions about their potential health risks. We evaluated the presence of selected oxysterols in bovine colostrum and monitored the evolution of their cholesterol ratio throughout an entire industrial-scale milk production chain and after industrially employed storage procedures of milk powders. We report here for the first time the presence of high levels of the enzymatic oxysterol 27-hydroxycholesterol (27OHC) in concentrations of antiviral interest in bovine colostrum (87.04 ng mL^-1) that decreased during the first postpartum days (56.35 ng mL^-1). Of note, this oxysterol is also observed in milk and milk products and is not negatively affected by industrial processing or storage. We further highlight an exponential increase of the non-enzymatic oxysterols 7β-hydroxycholesterol (7βOHC) and 7-ketocholesterol (7KC) in both whole (WMPs) and skimmed milk powders (SMPs) during prolonged storage, confirming their role as reliable biomarkers of cholesterol oxidation over time: after 12 months, 7βOHC reached in both SMPs and WMPs amounts that have been found to be potentially toxic in vitro (265.46 ng g^-1 and 569.83 ng g^-1, respectively). Interestingly, industrial processes appeared to affect the generation of 7βOHC and 7KC differently, depending on the presence of fat in the product: while their ratios increased significantly after skimming and processing of skimmed milk and milk products, this was not observed after processing whole milk and milk cream.

Haemodynamic characteristics and blood pressure evolution of hypertension subtypes in young to middle age adults

Aim

The prognostic significance of different hypertension subtypes in young hypertensives, in particular of isolated systolic hypertensives (ISHs) is still debated. The aim of the present study was to investigate clinical and haemodynamic characteristics and blood pressure (BP) evolution of different hypertension subtypes in young stage I hypertensives.

Methods

We investigated 1206 young subjects from the HARVEST study: 81 normotensives (NTs), 146 ISHs, 281 isolated diastolic hypertensives (IDHs) and 698 systolic-diastolic hypertensives (SDHs) according to office BP values at baseline. Data on baseline haemodynamic and metabolic characteristics, BP and heart rate changes during follow-up (mean 7 years) were collected. ANCOVA analysis was used for all comparisons adjusting for age and sex.

Results

Males were more frequent among ISHs (90.4%) compared to other categories (70.4, 67.3, 71.5% among NTs, IDHs, SHDs). Moreover, ISHs were younger compared to the others (25.6±6.6 years, p<0.001) and thinner compared to SDHs (24.6±.2.6 vs 25.8±3.6 kg/m2, p=0.028). Heart rate was higher among ISHs (75.7±9.4 bpm) and SDHs (75.8±9.7) compared to other categories (p<0.001). Metabolic characteristics were not significantly different among groups. ISHs were more active in sports (55.5%) and drank less alcohol compared to others (p<0.001, p=0.05 respectively). Systolic white coat effect was higher among ISH (17.6±12.4 mmHg) compared to others (p<0.001), as was cardiac output ISH (6.3±1.2 ml/min) compared to NTs and IDHs (p<0.001); Peripheral resistances were similar in ISHs and NTs and were lower than in IDHs and SDHs (p<0.001). Small and large artery compliance was higher, central systolic BP and augmentation index were lower among NTs and ISHs compared to IDHs and SDHs, even if these differences were not statistically significant. During follow-up systolic BP decreased (−7.6±14.4 mmHg) among ISHs, while it increased among NTs and IDHs (p<0.001). Heart rate decreased in all categories but to a higher extent among ISHs (−3.8±10.9 bpm) and SDHs (−3.4±10.8 bpm) (p=0.002 vs others). Changes in diastolic BP were similar among ISHs and NTs and higher than those observed among IDHs and SDHs (p<0.001). The percent of patients who started pharmacological treatment during follow-up was 70.6% among SDHs, 54.1% among IDHs, 41.1% among ISHs, and 39.5% among NTs (p<0.001).

Conclusions

ISHs had increased cardiac output and white coat effect and lower peripheral resistances compared to other hypertension subtypes while distensibility parameters did not differ significantly among groups. The percent of patients who developed hypertension needing treatment was lower among ISHs than other hypertensives. This was due to a favourable time course of BP during follow-up. Longer follow-ups are needed to confirm the lower risk profile of ISH of the young

Funding Acknowledgement

Type of funding source: None

P5467Gender related differences in the clinical significance of elevated pulse pressure in the young. Results from the HARVEST study

Background

Elevated pulse pressure (PP) is a well known cardiovascular risk factor in the elderly. Whether PP is a harbinger of adverse outcome also in young individuals is still a matter of debate. Moreover, the prognostic significance of elevated PP in the young seems to differ according to gender. Recently, we showed that PP was a predictor of adverse outcome only in young women while in men PP even had a protective effect.

Aim

The aim of the present study was to identify clinical, metabolic and haemodynamic characteristics associated with high PP in young hypertensive adults and to investigate whether these associations differed according to gender.

Methods

We investigated 1207 young stage I hypertensives (878 males) from the HARVEST Study, a long-term observational study involving 17 centres in the North-East of Italy. Mean age was 33.1±8.5 years and BP 145.5±10.6/93.5±5.7 mmHg. At the baseline patients underwent office and ambulatory blood pressure measurements and biochemical analyses and were followed at 6-month intervals until they developed hypertension requiring pharmacological treatment. For the analysis patients were divided into PP tertiles. All comparisons between males and females were tested with age-adjusted two-way ANCOVA using PP and sex as predictors.

Results

PP was 52.8±11.4 mmHg in men and 49.4±9.4 mmHg in women (p<0.001). Metabolic data did not differ between the two genders. Echocardiographic stroke volume was higher in men than women (82.1±15.7 ml vs 70.8±16.4 ml, p<0.001). No between-sex difference was found for peripheral resistance. Twenty-four-hour urinary norepinephrine/creatinine was higher in women than men (68.2±59.6 vs 54.4±66.5 mcg/mg, p=0.023), whereas no difference was found for epinephrine. Stratification by PP tertile showed that men in the top tertile were younger and had lower BMI than those in the bottom tertile (p<0.001 and p=0.002), while the opposite trend was found for women (p<0.001 and p=0.002) with a significant PP-sex interaction (p<0.001 for both). Heart rate and systolic white coat effect progressively increased across PP tertiles in both genders (p<0.001 for both). Glucose and triglycerides increased with increasing PP among women while the opposite was found for men, with a significant trend for glucose (p=0.025). At the end of follow-up (mean 7.9 years) females in the top PP tertile presented higher systolic BP (p=0.004), diastolic BP (p=0.071) and heart rate (<0.001), compared to males of the corresponding tertile.

Conclusions

Young hypertensive women were characterized by increased sympathetic activity whereas men showed a hyperkinetic state. High PP was associated with greater BMI and worse metabolic profile in women, and with better metabolic data in men. This different pathogenetic background may account for the worse time-course of isolated systolic hypertension in women compared to men shown by previous studies.

Acknowledgement/Funding

None

3q aberration and monosomy 7 in ANLL presenting with high platelet count and diabetes insipidus

Diabetes insipidus and thrombocytosis were presenting symptoms in a case of adult ANLL-M1. Cytogenetic investigations revealed a typical 3q rearrangement, i.e. inv(3)(q21q26). A subclone with monosomy 7 was also found and documented by FISH analysis. Correlations between clinical/hematological features and cytogenetic/FISH results are discussed.