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Block DR, Lasho MA, Donato LJ, Meeusen JW. Establishing hemolysis, icterus, and lipemia interference limits for body fluid chemistry analytes measured on the Roche cobas instrument. Am J Clin Pathol 2024:aqae040. [PMID: 38709595 DOI: 10.1093/ajcp/aqae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/16/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES The aims of this study were to (1) establish the maximum allowable interference limits for hemolysis, lipemia, and icterus for chemistry analytes tested in body fluid samples and (2) assess the effectiveness of serial dilution to mitigate spectral interferences. METHODS Residual body fluids from clinically ordered testing were mixed (<10% by volume) with stock solutions of interferent (spiked) and compared with a control spiked with an equal volume of 0.9% saline. The analytes were measured on the Roche cobas c501 instrument. Difference and percentage difference were calculated and compared with allowable total error limits. A subset of samples were serially diluted with 0.9% saline. Mean (SD) difference and percentage difference were calculated. RESULTS The interference thresholds were lower than the package insert for lactate dehydrogenase, cholesterol, triglycerides, and total protein for hemolysis; amylase, cholesterol, and total protein for icterus; and albumin for lipemia. Only cholesterol and triglyceride results returned to baseline upon dilution of icteric samples. CONCLUSIONS Interference thresholds in body fluids were lower than blood for 6 analytes. Diluting interferences that surpass these limits does not produce reliable results that are comparable to the baseline results before spiking in the interferent.
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Affiliation(s)
- Darci R Block
- 1 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Michael A Lasho
- 1 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Leslie J Donato
- 1 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
| | - Jeffrey W Meeusen
- 1 Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, US
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Wang Q, Meeusen JW. Clinical Impacts of Implementing the 2021 Race-Free Chronic Kidney Disease Epidemiology Collaboration Estimated Glomerular Filtration Rate. J Appl Lab Med 2024; 9:586-598. [PMID: 38366867 DOI: 10.1093/jalm/jfad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/01/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) has become incorporated into multiple clinical management situations. Historically, equations included a Black race coefficient, which lacked biological plausibility and created potential to exacerbate health disparities. A new equation created in 2021 changed the weighting of age, sex, and creatinine by modeling against a diverse cohort and removing the Black race coefficient. CONTENT A variety of clinical outcomes including kidney disease risk stratification, medication dosing, patient eligibility for clinical trials, and kidney donation are impacted by implementation of the new equation. Nearly 2 years after its initial publication, many studies have reported on observed analytical performance of the 2021 eGFR determined as diagnostic concordance and percentage of estimates within 30% of measured GFR. Additionally, the potential clinical impacts following adoption of the new eGFR among different patient populations has also been reported. Here we review these studies with a focus on assessing the data associated with the transition from 2009 to 2021 Chronic Kidney Disease Epidemiology Collaboration equations. SUMMARY The reported interindividual variation in eGFR performance is significantly larger than any potential benefit derived from race coefficients. Both the 2021 eGFR and the 2009 eGFR analytical performance fall short of the validation cohort performance in most cohorts. However, the 2021 analytical is similar or better than the 2009 eGFR in most cohorts. Implementing the 2021 eGFR will remove a systematic overestimation of kidney function among Black patients.
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Affiliation(s)
- Qian Wang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, United States
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, United States
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Seehusen KE, Remaley AT, Sampson M, Meeusen JW, Larson NB, Decker PA, Killian JM, Takahashi PY, Roger VL, Manemann SM, Lam R, Bielinski SJ. Discordance Between Very Low-Density Lipoprotein Cholesterol and Low-Density Lipoprotein Cholesterol Increases Cardiovascular Disease Risk in a Geographically Defined Cohort. J Am Heart Assoc 2024; 13:e031878. [PMID: 38591325 DOI: 10.1161/jaha.123.031878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/08/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Clinical risk scores are used to identify those at high risk of atherosclerotic cardiovascular disease (ASCVD). Despite preventative efforts, residual risk remains for many individuals. Very low-density lipoprotein cholesterol (VLDL-C) and lipid discordance could be contributors to the residual risk of ASCVD. METHODS AND RESULTS Cardiovascular disease-free residents, aged ≥40 years, living in Olmsted County, Minnesota, were identified through the Rochester Epidemiology Project. Low-density lipoprotein cholesterol (LDL-C) and VLDL-C were estimated from clinically ordered lipid panels using the Sampson equation. Participants were categorized into concordant and discordant lipid pairings based on clinical cut points. Rates of incident ASCVD, including percutaneous coronary intervention, coronary artery bypass grafting, stroke, or myocardial infarction, were calculated during follow-up. The association of LDL-C and VLDL-C with ASCVD was assessed using Cox proportional hazards regression. Interaction between LDL-C and VLDL-C was assessed. The study population (n=39 098) was primarily White race (94%) and female sex (57%), with a mean age of 54 years. VLDL-C (per 10-mg/dL increase) was significantly associated with an increased risk of incident ASCVD (hazard ratio, 1.07 [95% CI, 1.05-1.09]; P<0.001]) after adjustment for traditional risk factors. The interaction between LDL-C and VLDL-C was not statistically significant (P=0.11). Discordant individuals with high VLDL-C and low LDL-C experienced the highest rate of incident ASCVD events, 16.9 per 1000 person-years, during follow-up. CONCLUSIONS VLDL-C and lipid discordance are associated with a greater risk of ASCVD and can be estimated from clinically ordered lipid panels to improve ASCVD risk assessment.
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Affiliation(s)
| | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch National Heart, Lung, and Blood Institute, National Institutes of Health Bethesda MD
| | - Maureen Sampson
- Clinical Center, Department of Laboratory Medicine National Institutes of Health Bethesda MD
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN
| | | | - Paul A Decker
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN
| | - Jill M Killian
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN
| | - Paul Y Takahashi
- Division of Community Internal Medicine, Department of Medicine National Heart, Lung, and Blood Institute, National Institutes of Health Bethesda MD
| | - Véronique L Roger
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN
- Epidemiology and Community Health Branch National Heart, Lung, and Blood Institute, National Institutes of Health Bethesda MD
| | | | - Reyna Lam
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN
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Kasozi RN, Meeusen JW, Lieske JC. Estimating glomerular filtration rate with new equations: can one size ever fit all? Crit Rev Clin Lab Sci 2023; 60:549-559. [PMID: 37259709 PMCID: PMC10592396 DOI: 10.1080/10408363.2023.2214812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/25/2023] [Accepted: 05/13/2023] [Indexed: 06/02/2023]
Abstract
Glomerular filtration rate (GFR) is thought to be the best overall indicator of kidney health. On an individual patient basis, a working knowledge of GFR is important to understand the future risk for chronic kidney disease (CKD) progression, enhanced risk for cardiovascular disease and death, and for optimal medical management including the dosing of certain drugs. Although GFR can be directly measured using exogenous compounds that are eliminated by the kidney, these methods are not scalable for repeated and routine use in clinical care. Thus, in most circumstances GFR is estimated, termed estimated GFR (eGFR), using serum biomarkers that are eliminated by the kidney. Of these, serum creatinine, and to a lesser extent cystatin C, are most widely employed. However, the resulting number is simply a population average for an individual of that age and sex with a given serum creatinine and/or cystatin C, while the range of potential GFR values is actually quite large. Thus, it is important to consider characteristics of a given patient that might make this estimate better or worse in a particular case. In some circumstances, cystatin C or creatinine might be the better choice. Ultimately it is difficult, if not impossible, to have an eGFR equation that performs equally well in all populations. Thus, in certain cases it might be appropriate to directly measure GFR for high consequence medical decision-making, such as approval for kidney donation or prior to certain chemotherapeutic regimens. In all cases, the eGFR thresholds of CKD stage should not be viewed as absolute numbers. Thus, clinical care should not be determined solely by CKD stage as determined by eGFR alone, but rather by the combination of an individual patient's likely kidney function together with their current clinical situation.
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Affiliation(s)
- Ramla N. Kasozi
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL
| | - Jeffrey W. Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - John C. Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
- Department of Internal Medicine, Division of Nephrology and Hypertension Mayo Clinic, Rochester, MN
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Beunders R, Donato LJ, van Groenendael R, Arlt B, Carvalho-Wodarz C, Schulte J, Coolen ACC, Lieske JC, Meeusen JW, Jaffe AS, Pickkers P. Assessing GFR With Proenkephalin. Kidney Int Rep 2023; 8:2345-2355. [PMID: 38025210 PMCID: PMC10658254 DOI: 10.1016/j.ekir.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/27/2023] [Accepted: 08/07/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction In clinical practice, kidney (dys)function is monitored through creatinine-based estimations of glomerular filtration rate (eGFR: Modification of Diet in Renal Disease [MDRD], Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]). Creatinine is recognized as a late and insensitive biomarker of glomerular filtration rate (GFR). The novel biomarker proenkephalin (PENK) may overcome these limitations, but no PENK-based equation for eGFR is currently available. Therefore, we developed and validated a PENK-based equation to assess GFR. Methods In this international multicenter study in 1354 stable and critically ill patients, GFR was measured (mGFR) through iohexol or iothalamate clearance. A generalized linear model with sigmoidal nonlinear transfer function was used for equation development in the block-randomized development set. Covariates were selected in a data-driven fashion. The novel equation was assessed for bias, precision (mean ± SD), and accuracy (eGFR percentage within ±30% of mGFR, P30) in the validation set and compared with MDRD and CKD-EPI. Results Median mGFR was 61 [44-81] ml/min per 1.73 m2. In order of importance, PENK, creatinine, and age were included, and sex or race did not improve performance. The PENK-based equation mean ± SD bias of the mGFR was 0.5 ± 15 ml/min per 1.73 m2, significantly less compared with MDRD (8 ± 17, P < 0.001) and 2009 CKD-EPI (5 ± 17, P < 0.001), not reaching statistical significance compared with 2021 CKD-EPI (1.3 ± 16, P = 0.06). The P30 accuracy of the PENK-based equation was 83%, significantly higher compared with MDRD (68%, P < 0.001) and 2009 CKD-EPI (76%, P < 0.001), similar to 2021 CKD-EPI (80%, P = 0.13). Conclusion Overall, the PENK-based equation to assess eGFR performed better than most creatinine-based equations without using sex or race.
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Affiliation(s)
- Remi Beunders
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leslie J. Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Roger van Groenendael
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Anton CC. Coolen
- Department of Biophysics, Donders Institute, Radboud University, Nijmegen, The Netherlands
- Saddle Point Science Europe BV, Nijmegen, The Netherlands
| | - John C. Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey W. Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Allan S. Jaffe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiology, Mayo Clinic, Rochester, USA
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Medical Center, Nijmegen, The Netherlands
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Schwäble Santamaria A, Grassi M, Meeusen JW, Lieske JC, Scott R, Robertson A, Schiffer E. Performance of Nuclear Magnetic Resonance-Based Estimated Glomerular Filtration Rate in a Real-World Setting. Bioengineering (Basel) 2023; 10:717. [PMID: 37370648 DOI: 10.3390/bioengineering10060717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
An accurate estimate of glomerular filtration rate (eGFR) is essential for proper clinical management, especially in patients with kidney dysfunction. This prospective observational study evaluated the real-world performance of the nuclear magnetic resonance (NMR)-based GFRNMR equation, which combines creatinine, cystatin C, valine, and myo-inositol with age and sex. We compared GFRNMR performance to that of the 2021 CKD-EPI creatinine and creatinine-cystatin C equations (CKD-EPI2021Cr and CKD-EPI2021CrCys), using 115 fresh routine samples of patients scheduled for urinary iothalamate clearance measurement (mGFR). Median bias to mGFR of the three eGFR equations was comparably low, ranging from 0.4 to 2.0 mL/min/1.73 m2. GFRNMR outperformed the 2021 CKD-EPI equations in terms of precision (interquartile range to mGFR of 10.5 vs. 17.9 mL/min/1.73 m2 for GFRNMR vs. CKD-EPI2021CrCys; p = 0.01) and accuracy (P15, P20, and P30 of 66.1% vs. 48.7% [p = 0.007], 80.0% vs. 60.0% [p < 0.001] and 95.7% vs. 86.1% [p = 0.006], respectively, for GFRNMR vs. CKD-EPI2021CrCys). Clinical parameters such as etiology, comorbidities, or medications did not significantly alter the performance of the three eGFR equations. Altogether, this study confirmed the utility of GFRNMR for accurate GFR estimation, and its potential value in routine clinical practice for improved medical care.
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Affiliation(s)
| | - Marcello Grassi
- Department of Research and Development, Numares AG, 93053 Regensburg, Germany
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - John C Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Renee Scott
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Andrew Robertson
- Department of Research and Development, Numares AG, 93053 Regensburg, Germany
| | - Eric Schiffer
- Department of Research and Development, Numares AG, 93053 Regensburg, Germany
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Stämmler F, Derain-Dubourg L, Lemoine S, Meeusen JW, Dasari S, Lieske JC, Robertson A, Schiffer E. Impact of race-independent equations on estimating glomerular filtration rate for the assessment of kidney dysfunction in liver disease. BMC Nephrol 2023; 24:83. [PMID: 37003973 PMCID: PMC10064726 DOI: 10.1186/s12882-023-03136-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Altered hemodynamics in liver disease often results in overestimation of glomerular filtration rate (GFR) by creatinine-based GFR estimating (eGFR) equations. Recently, we have validated a novel eGFR equation based on serum myo-inositol, valine, and creatinine quantified by nuclear magnetic resonance spectroscopy in combination with cystatin C, age and sex (GFRNMR). We hypothesized that GFRNMR could improve chronic kidney disease (CKD) classification in the setting of liver disease. RESULTS We conducted a retrospective multicenter study in 205 patients with chronic liver disease (CLD), comparing the performance of GFRNMR to that of validated CKD-EPI eGFR equations, including eGFRcr (based on creatinine) and eGFRcr-cys (based on both creatinine and cystatin C), using measured GFR as reference standard. GFRNMR outperformed all other equations with a low overall median bias (-1 vs. -6 to 4 ml/min/1.73 m2 for the other equations; p < 0.05) and the lowest difference in bias between reduced and preserved liver function (-3 vs. -16 to -8 ml/min/1.73 m2 for other equations). Concordant classification by CKD stage was highest for GFRNMR (59% vs. 48% to 53%) and less biased in estimating CKD severity compared to the other equations. GFRNMR P30 accuracy (83%) was higher than that of eGFRcr (75%; p = 0.019) and comparable to that of eGFRcr-cys (86%; p = 0.578). CONCLUSIONS Addition of myo-inositol and valine to creatinine and cystatin C in GFRNMR further improved GFR estimation in CLD patients and accurately stratified liver disease patients into CKD stages.
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Affiliation(s)
- Frank Stämmler
- Department of Research and Development, Numares AG,, Am BioPark 9, 93053, Regensburg, Germany
| | - Laurence Derain-Dubourg
- Department Néphrologie, Dialyse, Hypertension Et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Université Claude Bernard, Lyon 1, Lyon, France
| | - Sandrine Lemoine
- Department Néphrologie, Dialyse, Hypertension Et Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Université Claude Bernard, Lyon 1, Lyon, France
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Surendra Dasari
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - John C Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Andrew Robertson
- Department of Research and Development, Numares AG,, Am BioPark 9, 93053, Regensburg, Germany
| | - Eric Schiffer
- Department of Research and Development, Numares AG,, Am BioPark 9, 93053, Regensburg, Germany.
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Meeusen JW, Stämmler F, Dasari S, Schiffer E, Lieske JC. Serum myo-inositol and valine improve metabolomic-based estimated glomerular filtration rate among kidney transplant recipients. Front Med (Lausanne) 2022; 9:988989. [PMID: 36465899 PMCID: PMC9712186 DOI: 10.3389/fmed.2022.988989] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/31/2022] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Close monitoring of glomerular filtration rate (GFR) is essential for the management of patients post kidney transplantation. Measured GFR (mGFR), the gold standard, is not readily accessible in most centers. Furthermore, the performance of new estimated GFR (eGFR) equations based upon creatinine and/or cystatin C have not been validated in kidney transplant patients. Here we evaluate a recently published eGFR equation using cystatin C, creatinine, myo-inositol and valine as measured by nuclear magnetic resonance (eGFRNMR). METHODS Residual sera was obtained from a cohort of patients with clinically ordered iothalamate renal clearance mGFR (n = 602). Kidney transplant recipients accounted for 220 (37%) of participants. RESULTS Compared to mGFR, there was no significant bias for eGFRcr or eGFRNMR, while eGFRcr-cys significantly underestimated mGFR. P30 values were similar for all eGFR. P15 was significantly higher for eGFRNMR compared to eGFRcr, while the P15 for eGFRcr-cys only improved among patients without a kidney transplant. Agreement with mGFR CKD stages of <15, 30, 45, 60, and 90 ml/min/1.73 m2 was identical for eGFRcr and eGFRcr-cys (61.8%, both cases) while eGFRNMR was significantly higher (66.4%) among patients with a kidney transplant. CONCLUSION The 2021 CKD-EPI eGFRcr and eGFRcr-cys have similar bias, P15, and agreement while eGFRNMR more closely matched mGFR with the strongest improvement among kidney transplant recipients.
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Affiliation(s)
- Jeffrey W. Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Frank Stämmler
- Department of Research and Development, numares AG, Regensburg, Germany
| | - Surendra Dasari
- Department of Quantitative Health Sciences, Division of Computational Biology, Mayo Clinic, Rochester, MN, United States
| | - Eric Schiffer
- Department of Research and Development, numares AG, Regensburg, Germany
| | - John C. Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
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Ramos P, Meeusen JW. Ceramide Risk Scores Can Bring Lipidomics to Clinical Medicine. Clin Chem 2022; 68:1479-1480. [DOI: 10.1093/clinchem/hvac169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Paola Ramos
- Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester, MN , USA
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester, MN , USA
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Ramos PA, Meeusen JW. A more accessible lipid phenotype for predicting type 2 diabetes. Lancet Healthy Longev 2022; 3:e312-e313. [PMID: 36098305 DOI: 10.1016/s2666-7568(22)00099-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 01/14/2023] Open
Affiliation(s)
- Paola A Ramos
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
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Fuhrmann M, Schwaeble Santamaria A, Scott R, Meeusen JW, Fernandes M, Venz J, Rothe V, Stämmler F, Ehrich J, Schiffer E. Analytical Validation of GFRNMR: A Blood-Based Multiple Biomarker Assay for Accurate Estimation of Glomerular Filtration Rate. Diagnostics (Basel) 2022; 12:diagnostics12051120. [PMID: 35626276 PMCID: PMC9139323 DOI: 10.3390/diagnostics12051120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023] Open
Abstract
Accurate and precise monitoring of kidney function is critical for a timely and reliable diagnosis of chronic kidney disease (CKD). The determination of kidney function usually involves the estimation of the glomerular filtration rate (eGFR). We recently reported the clinical performance of a new eGFR equation (GFRNMR) based on the nuclear magnetic resonance (NMR) measurement of serum myo-inositol, valine, and creatinine, in addition to the immunoturbidometric quantification of serum cystatin C, age and sex. We now describe the analytical performance evaluation of GFRNMR according to the Clinical and Laboratory Standards Institute guidelines. Within-laboratory coefficients of variation (CV%) of the GFRNMR equation did not exceed 4.3%, with a maximum CV% for repeatability of 3.7%. Between-site reproducibility (three sites) demonstrated a maximum CV% of 5.9%. GFRNMR stability was demonstrated for sera stored for up to 8 days at 2–10°C and for NMR samples stored for up to 10 days in the NMR device at 6 ± 2°C. Substance interference was limited to 4/40 (10.0%) of the investigated substances, resulting in an underestimated GFRNMR (for glucose and metformin) or a loss of results (for naproxen and ribavirin) for concentrations twice as high as usual clinical doses. The analytical performances of GFRNMR, combined with its previously reported clinical performance, support the potential integration of this NMR method into clinical practice.
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Affiliation(s)
- Markus Fuhrmann
- Department of Research and Development, numares AG, 93053 Regensburg, Germany; (M.F.); (A.S.S.); (J.V.); (V.R.); (F.S.)
| | - Amauri Schwaeble Santamaria
- Department of Research and Development, numares AG, 93053 Regensburg, Germany; (M.F.); (A.S.S.); (J.V.); (V.R.); (F.S.)
| | - Renee Scott
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; (R.S.); (J.W.M.)
| | - Jeffrey W. Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; (R.S.); (J.W.M.)
| | | | - John Venz
- Department of Research and Development, numares AG, 93053 Regensburg, Germany; (M.F.); (A.S.S.); (J.V.); (V.R.); (F.S.)
| | - Victoria Rothe
- Department of Research and Development, numares AG, 93053 Regensburg, Germany; (M.F.); (A.S.S.); (J.V.); (V.R.); (F.S.)
| | - Frank Stämmler
- Department of Research and Development, numares AG, 93053 Regensburg, Germany; (M.F.); (A.S.S.); (J.V.); (V.R.); (F.S.)
| | - Jochen Ehrich
- Children’s Hospital, Hannover Medical School, 30625 Hannover, Germany;
| | - Eric Schiffer
- Department of Research and Development, numares AG, 93053 Regensburg, Germany; (M.F.); (A.S.S.); (J.V.); (V.R.); (F.S.)
- Correspondence: ; Tel.: +49-941-280-949-00
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Zheng W, Chilazi M, Park J, Sathiyakumar V, Donato LJ, Meeusen JW, Lazo M, Guallar E, Kulkarni KR, Jaffe AS, Santos RD, Toth PP, Jones SR, Martin SS. Assessing the Accuracy of Estimated Lipoprotein(a) Cholesterol and Lipoprotein(a)-Free Low-Density Lipoprotein Cholesterol. J Am Heart Assoc 2022; 11:e023136. [PMID: 35023348 PMCID: PMC9238537 DOI: 10.1161/jaha.121.023136] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Accurate measurement of the cholesterol within lipoprotein(a) (Lp[a]‐C) and its contribution to low‐density lipoprotein cholesterol (LDL‐C) has important implications for risk assessment, diagnosis, and treatment of atherosclerotic cardiovascular disease, as well as in familial hypercholesterolemia. A method for estimating Lp(a)‐C from particle number using fixed conversion factors has been proposed (Lp[a]‐C from particle number divided by 2.4 for Lp(a) mass, multiplied by 30% for Lp[a]‐C). The accuracy of this method, which theoretically can isolate “Lp(a)‐free LDL‐C,” has not been validated. Methods and Results In 177 875 patients from the VLDbL (Very Large Database of Lipids), we compared estimated Lp(a)‐C and Lp(a)‐free LDL‐C with measured values and quantified absolute and percent error. We compared findings with an analogous data set from the Mayo Clinic Laboratory. Error in estimated Lp(a)‐C and Lp(a)‐free LDL‐C increased with higher Lp(a)‐C values. Median error for estimated Lp(a)‐C <10 mg/dL was −1.9 mg/dL (interquartile range, −4.0 to 0.2); this error increased linearly, overestimating by +30.8 mg/dL (interquartile range, 26.1–36.5) for estimated Lp(a)‐C ≥50 mg/dL. This error relationship persisted after stratification by overall high‐density lipoprotein cholesterol and high‐density lipoprotein cholesterol subtypes. Similar findings were observed in the Mayo cohort. Absolute error for Lp(a)‐free LDL‐C was +2.4 (interquartile range, −0.6 to 5.3) for Lp(a)‐C<10 mg/dL and −31.8 (interquartile range, −37.8 to −26.5) mg/dL for Lp(a)‐C≥50 mg/dL. Conclusions Lp(a)‐C estimations using fixed conversion factors overestimated Lp(a)‐C and subsequently underestimated Lp(a)‐free LDL‐C, especially at clinically relevant Lp(a) values. Application of inaccurate Lp(a)‐C estimations to correct LDL‐C may lead to undertreatment of high‐risk patients.
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Affiliation(s)
- Weili Zheng
- Department of Cardiology Heart Vascular and Thoracic InstituteCleveland Clinic Cleveland OH.,Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Michael Chilazi
- Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Jihwan Park
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Vasanth Sathiyakumar
- Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Leslie J Donato
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN
| | - Mariana Lazo
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Welch Center for Prevention, Epidemiology, and Clinical Research Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Eliseo Guallar
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Welch Center for Prevention, Epidemiology, and Clinical Research Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | | | - Allan S Jaffe
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN.,Department of Cardiology Mayo Clinic Rochester MN
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor)University of Sao Paulo Medical School Hospital Sao Paulo SP Brazil.,Hospital Israelita Albert Einstein Sao Paulo Brazil
| | - Peter P Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD.,CGH Medical Center Sterling IL
| | - Steven R Jones
- Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Welch Center for Prevention, Epidemiology, and Clinical Research Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
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13
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Stämmler F, Grassi M, Meeusen JW, Lieske JC, Dasari S, Dubourg L, Lemoine S, Ehrich J, Schiffer E. Estimating Glomerular Filtration Rate from Serum Myo-Inositol, Valine, Creatinine and Cystatin C. Diagnostics (Basel) 2021; 11:2291. [PMID: 34943527 PMCID: PMC8700166 DOI: 10.3390/diagnostics11122291] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022] Open
Abstract
Assessment of renal function relies on the estimation of the glomerular filtration rate (eGFR). Existing eGFR equations, usually based on serum levels of creatinine and/or cystatin C, are not uniformly accurate across patient populations. In the present study, we expanded a recent proof-of-concept approach to optimize an eGFR equation targeting the adult population with and without chronic kidney disease (CKD), based on a nuclear magnetic resonance spectroscopy (NMR) derived 'metabolite constellation' (GFRNMR). A total of 1855 serum samples were partitioned into development, internal validation and external validation datasets. The new GFRNMR equation used serum myo-inositol, valine, creatinine and cystatin C plus age and sex. GFRNMR had a lower bias to tracer measured GFR (mGFR) than existing eGFR equations, with a median bias (95% confidence interval [CI]) of 0.0 (-1.0; 1.0) mL/min/1.73 m2 for GFRNMR vs. -6.0 (-7.0; -5.0) mL/min/1.73 m2 for the Chronic Kidney Disease Epidemiology Collaboration equation that combines creatinine and cystatin C (CKD-EPI2012) (p < 0.0001). Accuracy (95% CI) within 15% of mGFR (1-P15) was 38.8% (34.3; 42.5) for GFRNMR vs. 47.3% (43.2; 51.5) for CKD-EPI2012 (p < 0.010). Thus, GFRNMR holds promise as an alternative way to assess eGFR with superior accuracy in adult patients with and without CKD.
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Affiliation(s)
- Frank Stämmler
- Department of Research and Development, numares AG, 93053 Regensburg, Germany; (F.S.); (M.G.)
| | - Marcello Grassi
- Department of Research and Development, numares AG, 93053 Regensburg, Germany; (F.S.); (M.G.)
| | - Jeffrey W. Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; (J.W.M.); (J.C.L.)
| | - John C. Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; (J.W.M.); (J.C.L.)
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Surendra Dasari
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA;
| | - Laurence Dubourg
- Service d’Explorations Fonctionnelles Rénales et Métaboliques, Hôpital Edouard Herriot, 69437 Lyon, France; (L.D.); (S.L.)
| | - Sandrine Lemoine
- Service d’Explorations Fonctionnelles Rénales et Métaboliques, Hôpital Edouard Herriot, 69437 Lyon, France; (L.D.); (S.L.)
| | - Jochen Ehrich
- Children’s Hospital, Hannover Medical School, 30625 Hannover, Germany;
| | - Eric Schiffer
- Department of Research and Development, numares AG, 93053 Regensburg, Germany; (F.S.); (M.G.)
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14
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Meeusen JW. Is Small Dense LDL a Highly Atherogenic Lipid or a Biomarker of Pro-Atherogenic Phenotype? Clin Chem 2021; 67:927-928. [PMID: 34100930 DOI: 10.1093/clinchem/hvab075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester MN, Rochester, MN 55905, USA
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15
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Meeusen JW, Amer H, Lieske JC. Has Noninvasive Kidney Transplant Surveillance Finally Arrived? Clin Chem 2021; 67:1047-1049. [PMID: 34352081 DOI: 10.1093/clinchem/hvab015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - Hatem Amer
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester MN, USA.,The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester MN, USA
| | - John C Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA.,Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester MN, USA
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16
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Vasile VC, Meeusen JW, Medina Inojosa JR, Donato LJ, Scott CG, Hyun MS, Vinciguerra M, Rodeheffer RR, Lopez-Jimenez F, Jaffe AS. Ceramide Scores Predict Cardiovascular Risk in the Community. Arterioscler Thromb Vasc Biol 2021; 41:1558-1569. [PMID: 33596665 DOI: 10.1161/atvbaha.120.315530] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Vlad C Vasile
- Department of Laboratory Medicine and Pathology (V.C.V., J.W.M., L.J.D., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN.,Department of Cardiovascular Diseases (V.C.V., J.R.M.J., R.R.R., F.L.-J., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology (V.C.V., J.W.M., L.J.D., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
| | - Jose R Medina Inojosa
- Department of Cardiovascular Diseases (V.C.V., J.R.M.J., R.R.R., F.L.-J., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
| | - Leslie J Donato
- Department of Laboratory Medicine and Pathology (V.C.V., J.W.M., L.J.D., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
| | - Christopher G Scott
- Department of Biomedical Statistics and Informatics (C.G.S., M.S.H.), Mayo Clinic College of Medicine, Rochester, MN
| | - Meredith S Hyun
- Department of Biomedical Statistics and Informatics (C.G.S., M.S.H.), Mayo Clinic College of Medicine, Rochester, MN
| | - Manlio Vinciguerra
- International Clinical Research Center (ICRC [Human Bridge for Strengthening Integration of ICRC into European Research Area]), St. Anne's University Hospital, Brno, Czech Republic (M.V.)
| | - Richard R Rodeheffer
- Department of Cardiovascular Diseases (V.C.V., J.R.M.J., R.R.R., F.L.-J., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
| | - Francisco Lopez-Jimenez
- Department of Cardiovascular Diseases (V.C.V., J.R.M.J., R.R.R., F.L.-J., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
| | - Allan S Jaffe
- Department of Laboratory Medicine and Pathology (V.C.V., J.W.M., L.J.D., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN.,Department of Cardiovascular Diseases (V.C.V., J.R.M.J., R.R.R., F.L.-J., A.S.J.), Mayo Clinic College of Medicine, Rochester, MN
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17
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Fatica E, Meeusen JW, Donato LJ. Impact of Lipoprotein(a)-Cholesterol on Accurate Classification of Familial Hypercholesterolemia. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa137.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Lipoprotein(a) [Lp(a)] is a pro-atherogenic and pro-thrombotic LDL-like particle recognized as an independent risk factor for cardiovascular disease (CVD) that is resistant to typical lipid-lowering treatments. The cholesterol within Lp(a) (Lp(a)-C) contributes to the reported LDL-cholesterol (LDL-C) concentration by nearly all available methods including beta-quantification, direct homogenous assays, and all estimating equations. Accurate LDL-C measurements are critical for identification of genetic hyperlipidemia conditions such as familial hypercholesterolemia (FH). FH risk estimators such as the Dutch Lipid Clinic Network (DLCN) criteria utilize LDL-C concentration cut-offs and other clinical inputs to assess the likelihood of FH. Therefore, failure to adjust for Lp(a)-C can impact accurate FH classification, appropriate follow-up testing and treatments, and interpretation of cholesterol-lowering treatment efficacy. Lp(a)-C can be estimated from Lp(a) mass as measured by immunoassay using an average cholesterol content per particle. However, Lp(a)-C size and composition varies significantly within individuals resulting in inaccurate Lp(a)-C estimates. In this study, we use direct Lp(a)-C measurements to assess the potential misclassification of FH risk due to the contribution of Lp(a)-C to LDL-C in patient samples submitted for advanced lipoprotein profiling. A total of 28,200 samples submitted for lipoprotein profiling were included. The profiling included lipid testing in a CDC-certified laboratory on Roche cobas 501 (cholesterol and triglycerides by enzymatic method, high-density lipoprotein cholesterol by MgCl2/dextran sulfate precipitation). LDL-C was measured by beta-quantification, and Lp(a)-C by quantitative lipoprotein electrophoresis (SPIFE Vis Cholesterol, Helena Laboratories). The DLCN LDL-C cut-offs (155, 190, 250, and 330mg/dL) were applied to LDL-C results before and after accounting for Lp(a)-C contribution. Lp(a)-C was detected in 3,728 (13.2%) samples. The median (range) concentrations of Lp(a)-C and LDL-C were 11mg/dL (5-108mg/dL) and 121mg/dL (27-678mg/dL), respectively. Overall, subtracting Lp(a)-C would reclassify 6.5% of all samples into a lower LDL-C category within the DLCN algorithm. Within the LDL-C scoring categories, 7.0% (n=222) of subjects with LDL-C 155-189mg/dL, 5.6% (n=66) of subjects with LDL-C 190-249mg/dL, 5.2% (n=10) of subjects with LDL-C 250-329mg/dL, and 3.4% (n=4) of subjects with LDL-C >330mg/dL would be down-classified after adjusting for Lp(a)-C. Limiting to subjects with measurable Lp(a)-C, reclassification to a lower diagnostic threshold occurred in 47.4% of subjects with LDL-C 155-189mg/dL, 37.5% with LDL-C 190-249mg/dL, 41.6% with LDL-C 250-329mg/dL, and 33.3% with LDL-C >330mg/dL after adjustment. Current guidelines recommend screening for elevated Lp(a) in patients with family history of CVD. Our data show that a high percentage of samples evaluated for advanced lipid testing contain measurable Lp(a)-C that could cause mis-classification in FH prediction algorithms. If labeled high probability of FH, these mis-classifications could trigger inappropriate work-up for suspected FH. As clinical follow-up and therapeutic strategies differ between FH and elevated Lp(a), proper distinction between LDL-C and Lp(a)-C is needed to guide appropriate patient management.
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18
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Larkey NE, Donato LJ, Jaffe AS, Meeusen JW. Low-Density Lipoprotein Subfractionation: What Is the Role of the Lab When Reporting Discrepant Results? Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa137.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Plasma concentrations of low-density-lipoprotein cholesterol (LDL-C) are directly associated with risk for coronary artery disease (CAD). Multisociety guidelines define LDL-C>160mg/dL as a risk factor for CAD and LDL-C>190mg/dL as an indication for lipid lowering medication, regardless of other clinical factors. Subfractionation of LDL according to size (LDL-s) enables differentiation between two LDL phenotypes: large-buoyant LDL and small-dense LDL. The small-dense LDL phenotype reportedly conveys increased risk for CAD. Major societies do not recommend LDL subfractions be used for clinical decision making and most payers do not cover LDL subfraction testing. Despite these restrictions, LDL subfraction is routinely requested by clinicians. Nuclear magnetic resonance (NMR) spectroscopy measures LDL-C and LDL-s. Following inquiries regarding interpretation of conflicting LDL-C and LDL-s results, we investigated associations between LDL-C and LDL-s measured by NMR in order to determine how often they provide contradicting or additive information. Verification of NMR LDL-C accuracy was confirmed by ß-quantification in a subset of patient samples (n=250). The average bias was -4.5mg/dL and the correlation coefficient was 0.92. High-risk was defined as LDL-C>160mg/dL or LDL-s<20.5 nm (small-dense LDL); and low-risk was defined as LDL-C<70mg/dL or LDL-s>20.5nm (large-buoyant LDL). In 26,710 clinical NMR analyses, the median LDL-C was 94.0mg/dL (range:5-436mg/dL) with median LDL-s of 20.8 nm (range:19.4–23.0nm). LDL-s moderately correlated with LDL-C (Ï#129;=0.51;p<0.01). Small-dense-LDL was identified in only 18% (407/2,191) of patients with elevated LDL-C (>160mg/dL) and was more common (73.2% of 6,093) in patients with low LDL-C (<70mg/dL;p<0.001). Associations with CAD were investigated among patients without cholesterol-lowering medication treatment referred for angiography (n=356). CAD (defined as stenosis >50% in one or more coronary artery) was diagnosed in 14% (1/7) of subjects with low LDL-C (<70mg/dL) compared to 59% (47/80) of subjects with elevated LDL-C (p=0.01). When stratifying by LDL-s, CAD was diagnosed in 50% (57/115) of subjects with small-dense LDL compared to 43% (104/241) of subjects with large-buoyant LDL (p=0.2). Small-dense LDL was identified in only 33% (26/80) of cases with elevated LDL-C. Limiting to subjects with elevated LDL-C, CAD was diagnosed in 50% (13/26) of subjects with concordant (high-risk) small-dense LDL compared to 61% (33/54) of subjects with discordant (low-risk) large-buoyant LDL (LDL-s>20.5nm) (p=0.3). Our data confirm that LDL-s subfraction measured by NMR is reported discordantly in most cases when LDL-C is unequivocally high or low. Furthermore, CAD diagnosis was significantly associated with LDL-C, but not with LDL-s. Our data also show that in discrepant samples, elevated LDL-C correlates better with disease state compared to LDL-s. Therefore, LDL-s should not be used to justify treatment decisions in patients with elevated LDL-C. Laboratories should consider carefully whether or not to report LDL-s when it is known that misleading and discordant values will be reported in a majority of cases.
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Meeusen JW, Donato LJ, Kopecky SL, Vasile VC, Jaffe AS, Laaksonen R. Ceramides improve atherosclerotic cardiovascular disease risk assessment beyond standard risk factors. Clin Chim Acta 2020; 511:138-142. [PMID: 33058843 DOI: 10.1016/j.cca.2020.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 12/26/2022]
Abstract
Ceramides are bioactive lipids that act as secondary messengers for both intra- and inter-cellular signaling. Elevated plasma concentrations of ceramides are associated with multiple risk factors of atherosclerotic cardiovascular diseases and comorbidities including obesity, insulin resistance and diabetes mellitus. Furthermore, atherosclerotic plaques have been shown to be highly enriched with ceramides. Increases in ceramide content may accelerate atherosclerosis development by promoting LDL infiltration to the endothelium and aggregation within the intima of artery walls. Thus, ceramides appear to play a key role in the development of cardiometabolic disease due to their central location in major metabolic pathways that intersect lipid and glucose metabolism. Recently published data have shown that ceramides are not only of scientific interest but may also have diagnostic value. Their independent prognostic value for future cardiovascular outcomes over and above LDL cholesterol and other traditional risk factors have consistently been shown in numerous clinical studies. Thus, ceramide testing with a mass spectrometer offers a simple, reproducible and cost-effective blood test for risk stratification in atherosclerotic cardiovascular diseases.
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Affiliation(s)
- Jeffrey W Meeusen
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, United States.
| | - Leslie J Donato
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, United States
| | | | - Vlad C Vasile
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, United States; Department of Cardiology, Mayo Clinic, Rochester, MN, United States
| | - Allan S Jaffe
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, United States; Department of Cardiology, Mayo Clinic, Rochester, MN, United States
| | - Reijo Laaksonen
- Zora Biosciences Oy, Espoo, Finland; Finnish Cardiovascular Research Center, Tampere University, Tampere, Finland
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20
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Fatica EM, Meeusen JW, Vasile VC, Jaffe AS, Donato LJ. Measuring the contribution of Lp(a) cholesterol towards LDL-C interpretation. Clin Biochem 2020; 86:45-51. [PMID: 32997972 DOI: 10.1016/j.clinbiochem.2020.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] is a pro-atherogenic and pro-thrombotic LDL-like particle recognized as an independent risk factor for cardiovascular disease (CVD). The cholesterol within Lp(a) (Lp(a)-C) contributes to the reported LDL-cholesterol (LDL-C) concentration by nearly all available methods. Accurate LDL-C measurements are critical for identification of genetic dyslipidemias such as familial hypercholesterolemia (FH). FH diagnostic criteria, such as the Dutch Lipid Clinic Network (DLCN) criteria, utilize LDL-C concentration cut-offs to assess the likelihood of FH. Therefore, failure to adjust for Lp(a)-C can impact accurate FH diagnosis and classification, appropriate follow-up testing and treatments, and interpretation of cholesterol-lowering treatment efficacy. OBJECTIVE In this study, we use direct Lp(a)-C measurements to assess the potential misclassification of FH from contributions of Lp(a)-C to reported LDL-C in patient samples submitted for advanced lipoprotein profiling. METHODS A total of 31,215 samples submitted for lipoprotein profiling were included. LDL-C was measured by beta quantification or calculated by one of three equations. Lp(a)-C was measured by quantitative lipoprotein electrophoresis. DLCN LDL-C cut-offs were applied to LDL-C results before and after accounting for Lp(a)-C contribution. RESULTS Lp(a)-C was detected in 8665 (28%) samples. A total of 940 subjects were reclassified to a lower DLCN LDL-C categories; this represents 3% of the total patient series or 11% of subjects with measurable Lp(a)-C. CONCLUSION Lp(a)-C is present in a significant portion of samples submitted for advanced lipid testing and could cause patient misclassification when using FH diagnostic criteria. These misclassifications could trigger inappropriate follow-up, treatment, and cascade testing for suspected FH.
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Affiliation(s)
- Erica M Fatica
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Vlad C Vasile
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States; Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Allan S Jaffe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States; Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Leslie J Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
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21
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Ye Q, Svatikova A, Meeusen JW, Kludtke EL, Kopecky SL. Effect of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors on Plasma Ceramide Levels. Am J Cardiol 2020; 128:163-167. [PMID: 32650914 DOI: 10.1016/j.amjcard.2020.04.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 11/20/2022]
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are novel drugs that provide striking lowering of low-density lipoprotein cholesterol (LDL-C) when added to maximum tolerated therapy in patients with hypercholesterolemia. Ceramides, novel cardiac risk markers, have been associated with increased cardiovascular mortality, independent of traditional cardiovascular risk factors. The Ceramide Risk Score (CRS) predicts the likelihood of adverse cardiovascular events within 1 to 3 years in patients with coronary artery disease. The effect of PCSK9 inhibition on plasma ceramides is not well known. The study examines the effect of PCSK9 inhibitors on plasma ceramides and CRS in patients with clinical indication for this therapy. Retrospective chart review of consecutive patients with hypercholesterolemia on PCSK9 inhibitors was conducted (n = 24; Mayo Clinic 2015 to 2018). Plasma ceramides were measured before the initiation of PCSK9 inhibitors and 2 to 12 months after treatment. CRS was calculated before and after therapy based on individual plasma concentrations of 4 ceramides. Treatment with PCSK9 inhibitors was associated with significant reduction in mean CRS and individual ceramides levels (p <0.0001). CRS significantly improved with PCSK9 therapy. PCSK9 inhibitors significantly decreased LDL-C levels by 63% (p <0.0001). The absolute reduction in CRS did not correlate with the absolute reduction in LDL-C (r = 0.31; confidence interval -0.10 to 0.64), indicating that CRS may evaluate a different pathway for risk reduction beyond LDL-C lowering. In conclusion, treatment with PCSK9 inhibitors is associated with significant reduction in CRS and distinct ceramide levels.
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Affiliation(s)
- Qian Ye
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anna Svatikova
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Erica L Kludtke
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephen L Kopecky
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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22
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El-Khoury JM, Remaley AT, Nordestgaard BG, Kaufman HW, Mora S, Cao J, Meeusen JW. Perspectives on the Changing Landscape of Measuring Cardiovascular Risk Related to LDL. Clin Chem 2019; 65:1487-1492. [DOI: 10.1373/clinchem.2019.307306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/27/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Joe M El-Khoury
- Department of Laboratory Medicine, Yale University, New Haven, CT
| | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Børge G Nordestgaard
- Professor and Chief Physician, Department of Clinical Biochemistry, Herlev Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Denmark
| | - Harvey W Kaufman
- Senior Medical Director, Medical Informatics, Quest Diagnostics, Secaucus, NJ
| | - Samia Mora
- Director, Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jing Cao
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX
- Department of Pathology, Texas Children's Hospital, Houston, TX
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Meeusen JW, Donato LJ, Jaffe AS. Risk of Adverse Neurocognitive Outcomes With PCSK-9 Inhibitors. J Am Coll Cardiol 2019; 69:2774-2775. [PMID: 28571647 DOI: 10.1016/j.jacc.2017.03.583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 11/30/2022]
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Meeusen JW. The Heart Attack Cure: Vaccinating Against Cardiovascular Disease. Clin Chem 2018; 64:1412. [DOI: 10.1373/clinchem.2018.291179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 05/31/2018] [Indexed: 11/06/2022]
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Abstract
Objective—
Ceramides are sphingolipids involved with cellular signaling. Synthesis of ceramides occurs in all tissues. Ceramides accumulate within tissues and the blood plasma during metabolic dysfunction, dyslipidemia, and inflammation. Elevations of ceramides are predictive of cardiovascular mortality. We sought to verify the utility of plasma concentrations of 4 ceramides: N-palmitoyl-sphingosine [Cer(16:0)], N-stearoyl-sphingosine [Cer(18:0)], N-nervonoyl-sphingosine [Cer(24:1)], and N-lignoceroyl-sphingosine [Cer(24:0)] in predicting major adverse cardiovascular events in a diverse patient population referred for coronary angiography.
Approach and Results—
Plasma ceramides were measured in 495 participants before nonurgent coronary angiography. Coronary artery disease, defined as >50% stenosis in ≥1 coronary artery, was identified 265 (54%) cases. Ceramides were not significantly associated with coronary artery disease. Patients were followed for a combined primary end point of myocardial infarction, percutaneous intervention, coronary artery bypass, stroke, or death within 4 years. Ceramides were significantly predictive of outcomes after adjusting for age, sex, body mass index, hypertension, smoking, LDL (low-density lipoprotein) cholesterol, HDL (high-density lipoprotein) cholesterol, triglycerides, serum glucose, and family history of coronary artery disease. The fully adjusted per SD hazard ratios (95% confidence interval) were 1.50 (1.16–1.93) for Cer(16:0), 1.42 (1.11–1.83) for Cer(18:0), 1.43 (1.08–1.89) for Cer(24:1), and 1.58 (1.22–2.04) for the ceramide risk score.
Conclusions—
Elevated plasma concentrations of ceramides are independently associated with major adverse cardiovascular events in patients with and without coronary artery disease.
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Affiliation(s)
- Jeffrey W. Meeusen
- From the Department of Laboratory Medicine and Pathology (J.W.M., L.J.D., L.M.B., A.S.J.)
| | - Leslie J. Donato
- From the Department of Laboratory Medicine and Pathology (J.W.M., L.J.D., L.M.B., A.S.J.)
| | | | - Linnea M. Baudhuin
- From the Department of Laboratory Medicine and Pathology (J.W.M., L.J.D., L.M.B., A.S.J.)
| | - Peter B. Berger
- Department of Cardiology (P.B.B., A.S.J.), Mayo Clinic, Rochester, MN
| | - Allan S. Jaffe
- From the Department of Laboratory Medicine and Pathology (J.W.M., L.J.D., L.M.B., A.S.J.)
- Department of Cardiology (P.B.B., A.S.J.), Mayo Clinic, Rochester, MN
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Meeusen JW. Apolipoprotein B or Low-Density Lipoprotein Cholesterol: Is It Time for a Twenty-First-Century Lipid Marker? Clin Chem 2018; 64:984-985. [PMID: 32100838 DOI: 10.1373/clinchem.2018.286641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/28/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Donato LJ, Meeusen JW, Lieske JC, Bergmann D, Sparwaßer A, Jaffe AS. Analytical performance of an immunoassay to measure proenkephalin. Clin Biochem 2018; 58:72-77. [PMID: 29782819 DOI: 10.1016/j.clinbiochem.2018.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/13/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Endogenous opioids, enkephalins, are known to increase with acute kidney injury. Since the mature pentapeptides are unstable, we evaluated the performance of an assay that measures proenkephalin 119-159 (PENK), a stable peptide formed concomitantly with mature enkephalins. METHODS PENK assay performance was evaluated on two microtiterplate/chemiluminescence sandwich immunoassay formats that required 18 or 1 h incubation times. PENK concentration was measured in plasma from healthy individuals to establish a reference interval and in patients with varied levels of kidney function and comorbidities to assess the association with measured glomerular filtration rate (mGFR) using iothalamate clearance. RESULTS Assay performance characteristics in plasma were similar between the assay formats. Limit of quantitation was 26.0 pmol/L (CV = 20%) for the 1 h assay and 17.3 pmol/L (CV = 3%) for the 18 h assay. Measurable ranges were 26-1540 pmol/L (1 h assay) and 18-2300 pmol/L (18 h assay). PENK concentrations are stable in plasma stored ambient to 10 days, refrigerated to at least 15 days, and frozen to at least 90 days. Results were comparable in paired SST serum and EDTA plasma. Age and sex were not associated with PENK concentrations in healthy individuals (reference interval: 36-97.5 pmol/L). Plasma PENK concentration correlated with mGFR. In a multivariate model PENK concentration, age, sex and transplant status were significant predictors of mGFR, and 49% of predicted GFR values fell within 30% of the mGFR. CONCLUSIONS Both assay formats are accurate and precise for measuring clinically relevant PENK concentrations. The association of PENK concentration with mGFR is influenced by gender, age, and history of kidney transplantation. Future studies will determine if blood PENK can be used clinically to estimate GFR and/or detect AKI.
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Affiliation(s)
- Leslie J Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States.
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
| | - John C Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
| | | | | | - Allan S Jaffe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States; Division of Cardiology, Mayo Clinic, Rochester, MN 55905, United States
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Affiliation(s)
- Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
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Abstract
PURPOSE OF REVIEW The objective of this review was to summarize evidence gathered for the prognostic value of routine and novel blood lipids and lipoproteins measured in patients with acute coronary syndromes (ACS). RECENT FINDINGS Data supports clear association with risk and actionable value for non-high-density lipoprotein (Non-HDL) cholesterol and plasma ceramides in a setting of ACS. The prognostic value and clinical actionability of apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)] in ACS have not been thoroughly tested, while the data for omega-3 fatty acids and oxidized low-density lipoprotein (Ox-LDL) are either untested or more varied. Measuring basic lipids, which should include Non-HDL cholesterol, at the time of presentation for ACS is guideline mandated. Plasma ceramides also provide useful information to guide both treatment decisions and follow-up. Additional studies targeting ACS patients are necessary for apoB, Lp(a), omega-3 fatty acids, and Ox-LDL.
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Affiliation(s)
- Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Leslie J Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Allan S Jaffe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.,Department of Cardiology, Mayo Clinic, Rochester, MN, USA
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Donato LJ, Lueke A, Kenyon SM, Meeusen JW, Camilleri M. Description of analytical method and clinical utility of measuring serum 7-alpha-hydroxy-4-cholesten-3-one (7aC4) by mass spectrometry. Clin Biochem 2017; 52:106-111. [PMID: 29051033 DOI: 10.1016/j.clinbiochem.2017.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/04/2017] [Accepted: 10/15/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Imbalance of bile acids (BA) homeostasis in the gastrointestinal tract can lead to chronic diarrhea or constipation when BA in the colon are in excess or low, respectively. Since both disturbances of bowel function can result from other etiologies, identifying BA imbalance is important to tailor treatment strategies. Serum concentrations of 7-alpha-hydroxy-4-cholesten-3-one (7aC4), a precursor in bile acid synthesis, reflect BA homeostasis. Here we describe a method to accurately measure serum 7aC4 and evaluate the clinical utility in patients with diarrhea or constipation phenotypes. METHODS Serum 7aC4 is measured after acetonitrile protein precipitation using C18 liquid chromatography, tandem mass spectrometry, and deuterium-labeled 7aC4 internal standard. Assay performance including linearity, precision, and accuracy was assessed using waste serum samples. The reference interval was established in healthy individuals without BA-altering conditions or medications. Clinical performance was assessed in patients with irritable bowel syndrome. RESULTS The method precisely and accurately measured 7aC4 in human serum from 1.4-338ng/mL with no ion suppression or interference from related 7-keto-cholesterol. Central 95th percentile reference interval was 2.5-63.2ng/mL. Lower serum 7aC4 was found in patients with constipation with sensitivity/specificity of 79%/55% compared to healthy controls. Higher 7aC4 was found in patients with bile acid diarrhea (BAD) compared to those without BAD with sensitivity/specificity of 82%/53%. CONCLUSIONS We have developed a sensitive and precise assay for measuring the concentration of 7aC4 in serum. The assay can be used to screen for diarrhea caused by bile acid malabsorption.
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Affiliation(s)
- Leslie J Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
| | - Alan Lueke
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Stacy M Kenyon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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Sepiashvili L, Dahl AR, Meeusen JW, Loftus CG, Donato LJ. A Man with Recurrent Ascites after Laparoscopic Cholecystectomy. Clin Chem 2017; 63:1199-1202. [PMID: 28659396 DOI: 10.1373/clinchem.2016.263756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/23/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | - Ashley R Dahl
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | - Conor G Loftus
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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Whelton SP, Meeusen JW, Donato LJ, Jaffe AS, Saenger A, Sokoll LJ, Blumenthal RS, Jones SR, Martin SS. Evaluating the atherogenic burden of individuals with a Friedewald-estimated low-density lipoprotein cholesterol <70 mg/dL compared with a novel low-density lipoprotein estimation method. J Clin Lipidol 2017; 11:1065-1072. [DOI: 10.1016/j.jacl.2017.05.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
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Katzman BM, Baumann NA, Odenbrett RL, Erb S, Miller MS, Waletich JL, Trivedi VA, Meeusen JW. Assessment of Cholesterol Measurement Variability: An Intra-Health System Comparison of Calculated, Direct, and ß-Quantification Methods for LDL-C. Am J Clin Pathol 2017. [DOI: 10.1093/ajcp/aqw191.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Meeusen JW. Spotlight on Laboratory Medicine: A Call for Reflections. J Appl Lab Med 2017; 1:462-463. [PMID: 33636813 DOI: 10.1373/jalm.2016.022087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 10/25/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Lueke AJ, Meeusen JW, Donato LJ, Gray AV, Butterfield J, Saenger AK. Analytical and clinical validation of an LC–MS/MS method for urine leukotriene E4: A marker of systemic mastocytosis. Clin Biochem 2016; 49:979-82. [DOI: 10.1016/j.clinbiochem.2016.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW The success of LDL cholesterol (LDL-C) as a predictor of atherosclerotic cardiovascular disease and a therapeutic target is indisputable. Apolipoprotein B (apoB) is a more contemporary and physiologically relevant measure of atherogenic lipoproteins. This report summarizes recent comparisons of apoB and LDL-C as biomarkers of cardiovascular risk. RECENT FINDINGS Multiple recent reports have found that LDL-C methods perform poorly at low concentrations (<70 mg/dl). Several meta-analyses from randomized controlled trials and large prospective observational studies have found that apoB and LDL-C provide equivalent information on risk of cardiovascular disease. More innovative analyses have asserted that apoB is a superior indicator of actual risk when apoB and LDL-C disagree. SUMMARY ApoB is more analytically robust and standardized biomarker than LDL-C. Large population studies have found that apoB is at worst clinically equivalent to LDL-C and likely superior when disagreement exists. Realistically, many obstacles prevent the wide spread adoption of apoB and for now providers and their patients must weigh the costs and benefits of apoB.
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Affiliation(s)
- Jeffrey W Meeusen
- aDepartment of Laboratory Medicine and PathologybDepartment of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
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Martin SS, Meeusen JW, Donato L, Jaffe A, Sokoll LJ, Jones S. APPLICATION OF A NOVEL METHOD FOR ESTIMATING LOW-DENSITY LIPOPROTEIN CHOLESTEROL AT LOW LEVELS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31927-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nowakowski AB, Meeusen JW, Menden H, Tomasiewicz H, Petering DH. Chemical–Biological Properties of Zinc Sensors TSQ and Zinquin: Formation of Sensor-Zn-Protein Adducts versus Zn(Sensor)2 Complexes. Inorg Chem 2015; 54:11637-47. [DOI: 10.1021/acs.inorgchem.5b01535] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Andrew B. Nowakowski
- Department of Chemistry
and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53201, United States
| | - Jeffrey W. Meeusen
- Department of Chemistry
and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53201, United States
| | - Heather Menden
- Department of Chemistry
and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53201, United States
| | | | - David H. Petering
- Department of Chemistry
and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53201, United States
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Donato LJ, Meeusen JW, Callanan H, Saenger AK, Jaffe AS. Advantages of the lipoprotein-associated phospholipase A2 activity assay. Clin Biochem 2015; 49:172-5. [PMID: 26365697 DOI: 10.1016/j.clinbiochem.2015.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Lipoprotein-associated phospholipase A2 (Lp-PLA2) is increased in circulation in patients at higher risk of coronary heart disease (CHD) events and stroke. Therefore, measurement of Lp-PLA2 can be used as an adjunct to traditional cardiovascular risk factors for identifying individuals at higher risk of cardiovascular events. Recently, a reagent for measuring Lp-PLA2 activity (diaDexus, San Francisco, CA) received FDA approval. Here we evaluate the assay performance of the Lp-PLA2 activity assay. METHODS Lp-PLA2 activity assay reagent performance was evaluated on an open user-defined channel on a Cobas 6000/c501 (Roche Diagnostics, Indianapolis, IN) using a 5-point calibration curve (0-400nmol/min/mL). Analytical performance was established for the following parameters: precision, linearity, accuracy, analytical sensitivity, analytical specificity, reference interval, reagent lot-to-lot comparison, specimen type, on-board reagent stability, and sample stability. RESULTS Assay limit of detection was determined to be 7.8nmol/min/mL with an average %CV of 2.8%. Precision studies revealed a coefficient of variation ≤1.6% between 79 and 307nmol/min/mL and accuracy was demonstrated between 4.8-368.7nmol/min/mL. Comparable results were generated in paired SST serum and EDTA plasma. No age association was found with Lp-PLA2 activity at the 95th percentile however a gender association was identified resulting in gender-specific 95th percentile limits in a healthy reference population. No bias was found when comparing results from several different lots of assay reagent. Lp-PLA2 activity results are extremely stable in both serum and EDTA plasma under refrigerate and frozen storage conditions up to 31days. CONCLUSIONS Lp-PLA2 activity assay displays accurate and precise performance characteristics on the Cobas c501 platform. The assay performance is significantly improved over the predecessor immunoassay allowing for adoption of Lp-PLA2 activity in clinical practice.
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Affiliation(s)
- Leslie J Donato
- Department of Laboratory Medicine and Pathology Mayo Clinic, Rochester, MN 55905, United States.
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology Mayo Clinic, Rochester, MN 55905, United States
| | - Heidi Callanan
- Department of Laboratory Medicine and Pathology Mayo Clinic, Rochester, MN 55905, United States
| | - Amy K Saenger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, United States
| | - Allan S Jaffe
- Department of Laboratory Medicine and Pathology Mayo Clinic, Rochester, MN 55905, United States; Division of Cardiology, Mayo Clinic, Rochester, MN 55905, United States
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Karon BS, Meeusen JW, Bryant SC. Impact of Glucose Meter Error on Glycemic Variability and Time in Target Range During Glycemic Control After Cardiovascular Surgery. J Diabetes Sci Technol 2015; 10:336-42. [PMID: 26311721 PMCID: PMC4773953 DOI: 10.1177/1932296815602099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND We retrospectively studied the impact of glucose meter error on the efficacy of glycemic control after cardiovascular surgery. METHOD Adult patients undergoing intravenous insulin glycemic control therapy after cardiovascular surgery, with 12-24 consecutive glucose meter measurements used to make insulin dosing decisions, had glucose values analyzed to determine glycemic variability by both standard deviation (SD) and continuous overall net glycemic action (CONGA), and percentage glucose values in target glucose range (110-150 mg/dL). Information was recorded for 70 patients during each of 2 periods, with different glucose meters used to measure glucose and dose insulin during each period but no other changes to the glycemic control protocol. Accuracy and precision of each meter were also compared using whole blood specimens from ICU patients. RESULTS Glucose meter 1 (GM1) had median bias of 11 mg/dL compared to a laboratory reference method, while glucose meter 2 (GM2) had a median bias of 1 mg/dL. GM1 and GM2 differed little in precision (CV = 2.0% and 2.7%, respectively). Compared to the period when GM1 was used to make insulin dosing decisions, patients whose insulin dose was managed by GM2 demonstrated reduced glycemic variability as measured by both SD (13.7 vs 21.6 mg/dL, P < .0001) and CONGA (13.5 vs 19.4 mg/dL, P < .0001) and increased percentage glucose values in target range (74.5 vs 66.7%, P = .002). CONCLUSIONS Decreasing glucose meter error (bias) was associated with decreased glycemic variability and increased percentage of values in target glucose range for patients placed on intravenous insulin therapy following cardiovascular surgery.
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Affiliation(s)
- Brad S Karon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sandra C Bryant
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Meeusen JW, Snozek CL, Baumann NA, Jaffe AS, Saenger AK. Reliability of Calculated Low-Density Lipoprotein Cholesterol. Am J Cardiol 2015; 116:538-40. [PMID: 26059865 DOI: 10.1016/j.amjcard.2015.05.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 11/26/2022]
Abstract
Aggressive low-density lipoprotein cholesterol (LDL-C)-lowering strategies are recommended for prevention of cardiovascular events in high-risk populations. Guidelines recommend a 30% to 50% reduction in at-risk patients even when LDL-C concentrations are between 70 and 130 mg/dl (1.8 to 3.4 mmol/L). However, calculation of LDL-C by the Friedewald equation is the primary laboratory method for routine LDL-C measurement. We compared the accuracy and reproducibility of calculated LDL-C <130 mg/dl (3.4 mmol/L) to LDL-C measured by β quantification (considered the gold standard method) in 15,917 patients with fasting triglyceride concentrations <400 mg/dl (4.5 mmol/L). Both variation and bias of calculated LDL-C increased at lower values of measured LDL-C. The 95% confidence intervals for a calculated LDL-C of 70 mg/dl (1.8 mmol/L) and 30 mg/dl (0.8 mmol/L) were 60 to 86 mg/dl (1.6 to 2.2 mmol/L) and 24 to 60 mg/dl (0.6 to 1.6 mmol/L), respectively. Previous recommendations have emphasized the requirement for a fasting sample with triglycerides <400 mg/dl (4.5 mmol/L) to calculate LDL-C by the Friedewald equation. However, no recommendations have addressed the appropriate lower reportable limit for calculated LDL-C. In conclusion, calculated LDL-C <30 mg/dl (0.8 mmol/L) should not be reported because of significant deviation from the gold standard measured LDL-C results, and caution is advised when using calculated LDL-CF values <70 mg/dl (1.8 mmol/L) to make treatment decisions.
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Meeusen JW, Rule AD, Voskoboev N, Baumann NA, Lieske JC. Performance of cystatin C- and creatinine-based estimated glomerular filtration rate equations depends on patient characteristics. Clin Chem 2015; 61:1265-72. [PMID: 26240296 DOI: 10.1373/clinchem.2015.243030] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 06/29/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Kidney Disease Improving Global Outcomes (KDIGO) guideline recommends use of a cystatin C-based estimated glomerular filtration rate (eGFR) to confirm creatinine-based eGFR between 45 and 59 mL · min(-1) · (1.73 m(2))(-1). Prior studies have demonstrated that comorbidities such as solid-organ transplant strongly influence the relationship between measured GFR, creatinine, and cystatin C. Our objective was to evaluate the performance of cystatin C-based eGFR equations compared with creatinine-based eGFR and measured GFR across different clinical presentations. METHODS We compared the performance of the CKD-EPI 2009 creatinine-based estimated GFR equation (eGFRCr) and the newer CKD-EPI 2012 cystatin C-based equations (eGFRCys and eGFRCr-Cys) with measured GFR (iothalamate renal clearance) across defined patient populations. Patients (n = 1652) were categorized as transplant recipients (n = 568 kidney; n = 319 other organ), known chronic kidney disease (CKD) patients (n = 618), or potential kidney donors (n = 147). RESULTS eGFRCr-Cys showed the most consistent performance across different clinical populations. Among potential kidney donors without CKD [stage 2 or higher; eGFR >60 mL · min(-1) · (1.73 m(2))(-1)], eGFRCys and eGFRCr-Cys demonstrated significantly less bias than eGFRCr; however, all 3 equations substantially underestimated GFR when eGFR was <60 mL · min(-1) · (1.73 m(2))(-1). Among transplant recipients with CKD stage 3B or greater [eGFR <45 mL · min(-1) · (1.73 m(2))(-1)], eGFRCys was significantly more biased than eGFRCr. No clear differences in eGFR bias between equations were observed among known CKD patients regardless of eGFR range or in any patient group with a GFR between 45 and 59 mL · min(-1) · (1.73 m(2))(-1). CONCLUSIONS The performance of eGFR equations depends on patient characteristics that are readily apparent on presentation. Among the 3 CKD-EPI equations, eGFRCr-Cys performed most consistently across the studied patient populations.
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Affiliation(s)
| | - Andrew D Rule
- Department of Internal Medicine, Division of Nephrology and Hypertension, and Department of Health Sciences Research Division of Epidemiology, Mayo Clinic, Rochester, MN
| | | | | | - John C Lieske
- Department of Laboratory Medicine and Pathology, Department of Internal Medicine, Division of Nephrology and Hypertension, and
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Katrangi W, Katzman BM, Meeusen JW, Donato LJ. 56: Establishing Optimal Triglyceride Cutoff Values for Chylous Effusion Diagnosis. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/143.suppl1.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Waddah Katrangi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Brooke M. Katzman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jeffrey W. Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Leslie J. Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Abstract
Abstract
BACKGROUND
Aggressive LDL cholesterol (LDL-C)-lowering strategies are recommended for primary and secondary prevention of cardiovascular events. A newly derived equation for LDL-C estimation was recently published that addressed limitations in the commonly used Friedewald LDL-C calculation method. The novel method was reported to classify patients with superior concordance to measured LDL-C compared to the Friedewald method, particularly in patients with LDL-C <70 mg/dL.
METHODS
We evaluated the performance of the novel method within an independent cohort of 23 055 patients with LDL-C measured by the gold standard β-quantification reference method.
RESULTS
Overall Friedewald underestimated and the novel method overestimated measured LDL-C. Both estimations significantly deviated from the reference method when LDL-C was <70 mg/dL. Overall, the Friedewald and novel calculations correctly classified 77% and 78% of patients, respectively. The largest discrepancy in classification was observed in individuals with measured LDL-C <70 mg/dL. For this group the novel calculation would reclassify 8.7% of patients as >70 mg/dL compared to the Friedewald equation.
CONCLUSIONS
We compared both novel and Friedewald estimated LDL-C against the LDL-C reference method; in contrast, the prior study relied on validation of a subset of samples by β-quantification to allow the use of the vertical autoprofile method for LDL-C measurement. We conclude that the novel method has some benefits but it is unclear whether improvements over the Friedewald calculation are substantive enough to justify making the change in routine clinical practice and to improve patient outcomes.
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Affiliation(s)
- Jeffrey W Meeusen
- Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Alan J Lueke
- Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Allan S Jaffe
- Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester MN
| | - Amy K Saenger
- Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Affiliation(s)
- Jeffrey W Meeusen
- Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology
| | - John C Lieske
- Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Meeusen JW, Haselkorn KE, Fryer JP, Kryzer TJ, Gibbons SJ, Xiao Y, Lennon VA. Gastrointestinal hypomotility with loss of enteric nicotinic acetylcholine receptors: active immunization model in mice. Neurogastroenterol Motil 2013; 25:84-8.e10. [PMID: 23072523 PMCID: PMC3535544 DOI: 10.1111/nmo.12030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Autoimmune gastrointestinal dysmotility (AGID) is a limited form of dysautonomia. The only proven effector to date is IgG specific for ganglionic nicotinic-acetylcholine receptors containing α3 subunits [α3*- nicotinic acetylcholine receptor (nAChR)]. Rabbits immunized with recombinant α3-polypeptide produce α3*-nAChR autoantibodies, and profound AGID ensues. Human and rabbit α3*-nAChR-specific-IgGs induce transient hypomotility when injected into mice. Here, we describe success and problems encountered inducing gastrointestinal hypomotility in mice by active immunization. METHODS We repeatedly injected young adult mice of seven different strains susceptible to autoimmunity (spontaneous diabetes or neural antigen immunization-induced myasthenia gravis or encephalomyelitis) with: (i) α3-polypeptide, intradermally or (ii) live α3*-nAChR-expressing xenogeneic cells, intraperitoneally. We measured serum α3*-nAChR-IgG twice monthly, and terminally assessed blue dye gastrointestinal transit, total small intestinal α3*-nAChR content (radiochemically) and myenteric plexus neuron numbers (immunohistochemically, ileal-jejunal whole-mount preparations). KEY RESULTS Standard cutaneous inoculation with α3-polypeptide was minimally immunogenic, regardless of dose. Intraperitoneally injected live cells were potently immunogenic. Self-reactive α3*-nAChR-IgG was induced only by rodent immunogen; small intestinal transit slowing and enteric α3*-nAChR loss required high serum levels. Ganglionic neurons were not lost. CONCLUSIONS & INFERENCES Autoimmune gastrointestinal dysmotility is inducible in mice by active immunization. Accompanying enteric α3*-nAChR reduction without neuronal death is consistent with an IgG-mediated rather than T cell-mediated pathogenesis, as is improvement of symptoms in patients receiving antibody-depleting therapies.
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Affiliation(s)
- Jeffrey W. Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - James P. Fryer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Thomas J. Kryzer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Simon J. Gibbons
- Department of Enteric Neuroscience Program, Mayo Clinic, Rochester, MN
| | - Yingxian Xiao
- Department of Pharmacology and Physiology, Georgetown University School of Medicine, Washington, DC
| | - Vanda A. Lennon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN,Department of Immunology, Mayo Clinic, Rochester, MN,Department of Neurology, Mayo Clinic, Rochester, MN
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Affiliation(s)
- Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Meeusen JW, Nowakowski A, Petering DH. Reaction of metal-binding ligands with the zinc proteome: zinc sensors and N,N,N',N'-tetrakis(2-pyridylmethyl)ethylenediamine. Inorg Chem 2012; 51:3625-32. [PMID: 22380934 PMCID: PMC3564517 DOI: 10.1021/ic2025236] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The commonly used Zn(2+) sensors 6-methoxy-8-p-toluenesulfonamidoquinoline (TSQ) and Zinquin have been shown to image zinc proteins as a result of the formation of sensor-zinc-protein ternary adducts not Zn(TSQ)(2) or Zn(Zinquin)(2) complexes. The powerful, cell-permeant chelating agent N,N,N',N'-tetrakis(2-pyridylmethyl)ethylenediamine (TPEN) is also used in conjunction with these and other Zn(2+) sensors to validate that the observed fluorescence enhancement seen with the sensors depends on intracellular interaction with Zn(2+). We demonstrated that the kinetics of the reaction of TPEN with cells pretreated with TSQ or Zinquin was not consistent with its reaction with Zn(TSQ)(2) or Zn(Zinquin)(2). Instead, TPEN and other chelating agents extract between 25 and 35% of the Zn(2+) bound to the proteome, including zinc(2+) from zinc metallothionein, and thereby quench some, but not all, of the sensor-zinc-protein fluorescence. Another mechanism in which TPEN exchanges with TSQ or Zinquin to form TPEN-zinc-protein adducts found support in the reactions of TPEN with Zinquin-zinc-alcohol dehydrogenase. TPEN also removed one of the two Zn(2+) ions per monomer from zinc-alcohol dehydrogenase and zinc-alkaline phosphatase, consistent with its ligand substitution reactivity with the zinc proteome.
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Affiliation(s)
- Jeffrey W. Meeusen
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53201
| | - Andrew Nowakowski
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53201
| | - David H. Petering
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53201
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Meeusen JW, Klein CJ, Pirko I, Haselkorn KE, Kryzer TJ, Pittock SJ, Lachance DH, Dyck PJ, Lennon VA. Potassium channel complex autoimmunity induced by inhaled brain tissue aerosol. Ann Neurol 2012; 71:417-26. [PMID: 22451206 PMCID: PMC3315155 DOI: 10.1002/ana.22674] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To test the hypothesis that autoimmunity induced by inhalation of aerosolized brain tissue caused outbreaks of sensory-predominant polyradiculoneuropathy among swine abattoir employees in the Midwestern United States. METHODS Mice were exposed intranasally, 5 days per week, to liquefied brain tissue. Serum from exposed mice, patients, and unaffected abattoir employees were analyzed for clinically pertinent neural autoantibodies. RESULTS Patients, coworkers, and mice exposed to liquefied brain tissue had an autoantibody profile dominated by neural cation channel immunoglobulin Gs (IgGs). The most compelling link between patients and exposed mice was magnetic resonance imaging (MRI) evidence of grossly swollen spinal nerve roots. Autoantibody responses in patients and mice were dose-dependent and declined after antigen exposure ceased. Autoantibodies detected most frequently, and at high levels, bound to detergent-solubilized macromolecular complexes containing neuronal voltage-gated potassium channels ligated with a high affinity Kv1 channel antagonist, 125I-α-dendrotoxin. Exposed mice exhibited a behavioral phenotype consistent with potassium channel dysfunction recognized in drosophila with mutant ("shaker") channels: reduced sensitivity to isoflurane-induced anesthesia. Pathological and electrophysiological findings in patients supported peripheral nerve hyperexcitability over destructive axonal loss. The pain-predominant symptoms were consistent with sensory nerve hyperexcitability. INTERPRETATION Our observations establish that inhaled neural antigens readily induce neurological autoimmunity and identify voltage-gated potassium channel complexes as a major immunogen.
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Affiliation(s)
- Jeffrey W. Meeusen
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Christopher J. Klein
- Department of Laboratory Neurology and College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Istvan Pirko
- Department of Laboratory Neurology and College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Keegan E. Haselkorn
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Thomas J. Kryzer
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Sean J. Pittock
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
- Department of Laboratory Neurology and College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Daniel H. Lachance
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
- Department of Laboratory Neurology and College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - P. James Dyck
- Department of Laboratory Neurology and College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Vanda A. Lennon
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
- Department of Laboratory Neurology and College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
- Department of Immunology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Meeusen JW, Tomasiewicz H, Nowakowski A, Petering DH. TSQ (6-methoxy-8-p-toluenesulfonamido-quinoline), a common fluorescent sensor for cellular zinc, images zinc proteins. Inorg Chem 2011; 50:7563-73. [PMID: 21774459 DOI: 10.1021/ic200478q] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zn(2+) is a necessary cofactor for thousands of mammalian proteins. Research has suggested that transient fluxes of cellular Zn(2+) are also involved in processes such as apoptosis. Observations of Zn(2+) trafficking have been collected using Zn(2+) responsive fluorescent dyes. A commonly used Zn(2+) fluorophore is 6-methoxy-8-p-toluenesulfonamido-quinoline (TSQ). The chemical species responsible for TSQ's observed fluorescence in resting or activated cells have not been characterized. Parallel fluorescence microscopy and spectrofluorometry of LLC-PK(1) cells incubated with TSQ demonstrated punctate staining that concentrated around the nucleus and was characterized by an emission maximum near 470 nm. Addition of cell permeable Zn-pyrithione resulted in greatly increased, diffuse fluorescence that shifted the emission peak to 490 nm, indicative of the formation of Zn(TSQ)(2). TPEN (N,N,N'N'-tetrakis(-)[2-pyridylmethyl]-ethylenediamine), a cell permeant Zn(2+) chelator, largely quenched TSQ fluorescence returning the residual fluorescence to the 470 nm emission maximum. Gel filtration chromatography of cell supernatant from LLC-PK(1) cells treated with TSQ revealed that TSQ fluorescence (470 nm emission) eluted with the proteome fractions. Similarly, addition of TSQ to proteome prior to chromatography resulted in 470 nm fluorescence emission that was not observed in smaller molecular weight fractions. It is hypothesized that Zn-TSQ fluorescence, blue-shifted from the 490 nm emission maximum of Zn(TSQ)(2), results from ternary complex, TSQ-Zn-protein formation. As an example, Zn-carbonic anhydrase formed a ternary adduct with TSQ characterized by a fluorescence emission maximum of 470 nm and a dissociation constant of 1.55 × 10(-7) M. Quantification of TSQ-Zn-proteome fluorescence indicated that approximately 8% of cellular Zn(2+) was imaged by TSQ. These results were generalized to other cell types and model Zn-proteins.
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Affiliation(s)
- Jeffrey W Meeusen
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53201, USA
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