Is serum transthyretin a reliable marker of nutritional status in patients with end-stage renal disease?

Plasma α1-antitrypsin: a neglected predictor of angiographic severity in patients with stable angina pectoris

Background:

As an acute phase protein, α1-antitrypsin (AAT) has been extensively studied in acute coronary syndrome, but it is unclear whether a relationship exists between AAT and stable angina pectoris (SAP). The purpose of the present study was to investigate the association between AAT plasma levels and SAP.

Methods:

Overall, 103 SAP patients diagnosed by coronary angiography and clinical manifestations and 118 control subjects matched for age and gender were enrolled in this case-control study. Plasma levels of AAT, high-sensitivity C-reactive protein (hsCRP), lipid profiles and other clinical parameters were assayed for all participants. The severity of coronary lesions was evaluated based on the Gensini score (GS) assessed by coronary angiography.

Results:

Positively correlated with the GS (r = 0.564, P < 0.001), the plasma AAT level in the SAP group was significantly higher than that in the control group (142.08 ± 19.61 mg/dl vs. 125.50 ± 19.67 mg/dl, P < 0.001). The plasma AAT level was an independent predictor for both SAP (odds ratio [OR] = 1.037, 95% confidence interval [CI]: 1.020–1.054, P < 0.001) and a high GS (OR = 1.087, 95% CI: 1.051–1.124, P < 0.001) in a multivariate logistic regression model. In the receiver operating characteristic curve analysis, plasma AAT level was found to have a larger area under the curve (AUC) for predicting a high GS (AUC = 0.858, 95% CI: 0.788–0.929, P < 0.001) than that of hsCRP (AUC = 0.665, 95% CI: 0.557–0.773, P = 0.006; Z = 2.9363, P < 0.001), with an optimal cut-off value of 137.85 mg/dl (sensitivity: 94.3%, specificity: 68.2%).

Conclusions:

Plasma AAT levels correlate with both the presence and severity of coronary stenosis in patients with SAP, suggesting that it could be a potential predictive marker of severe stenosis in SAP patients.

Immunochemotherapy-associated protein patterns in tumour tissue and serum of patients with metastatic renal cell carcinoma

CONTEXT

Systemic treatment of metastatic renal cell carcinoma (mRCC) with targeted therapies became widely accepted; however, there are few patients who greatly benefit from immunochemotherapy (ICT). It is crucial to recognize these patients for individual treatment.

OBJECTIVES

Definition of protein patterns in tissue and serum from mRCC-patients to predict benefit from ICT.

MATERIALS AND METHODS

Twenty-five tissue samples and 59 sera were analysed by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS). Protein peaks of interest were identified by 2D-PAGE and peptide mass fingerprinting. Validation was carried out by Western Blot and ELISA.

RESULTS

Protein patterns associated with therapy response were determined. Caveolin-1 (CAV-1) and plasminogen activator inhibitor 1 (PAI-1) were identified in tissue; serum amyloid A (SAA) and transthyretin (TTR) were found in serum.

CONCLUSION

Individual prediction of therapy benefit and selecting patients for ICT based on molecular biological profiles appear to be feasible in the future.

Identification and quantitative analysis of human transthyretin variants in human serum by Fourier transform ion-cyclotron resonance mass spectrometry

Transthyretin (TTR) is a homotetrameric protein involved in thyroid hormone transport in blood and in retinol binding in the central nervous system. More than 80 point mutations in this protein are known to be associated with the formation of amyloid deposits and systemic amyloidotic pathologies. Age at onset varies according to the mutation but considerable variations also occur for subjects carrying the same mutation. Moreover, wild-type TTR forms amyloid deposits in systemic senile amyloidosis, a geriatric disorder. An accurate diagnostic and the choice of therapeutic options depend on the identification of the specific mutation. Previous characterization of TTR variants by mass spectrometry required the use of antibodies for sample enrichment. We developed a novel assay based on ultra high-resolution mass spectrometry to identify human TTR variants. The method, requiring a very low sample amount, is based on SDS-PAGE fractionation of human serum, followed by peptide mass fingerprinting by MALDI-FTICR-MS (matrix assisted laser desorption ionization coupled to Fourier transform ion cyclotron resonance mass spectrometry). Moreover, it is possible to perform a relative quantification of wild type and mutant TTR forms by mass spectrometry. The method was tested and validated with the V30M mutant, involved in familial amyloidotic neuropathy of Portuguese type.

Assessment of prealbumin in hemodialysis and renal-transplant patients

OBJECTIVE

This study assessed prealbumin in hemodialysis (HD) and renal-transplant (RT) patients, and compared it with other biochemical and anthropometric markers, clinical conditions, and treatment variables.

DESIGN

We used a research design.

PATIENTS

Serum prealbumin was measured in 84 HD patients with a mean age of 60.47 +/- 17.81 years and a mean body mass index (BMI) of 24.38 +/- 4.87 kg/m(2), and in 154 RT patients with a mean age of 44.08 +/- 13.59 years and a mean BMI of 24.97 +/- 3.87 kg/m(2). Renal-transplant patients were divided into three groups, based on year of renal transplantation (first year, first to second year, and third to tenth year). Serum albumin, creatinine, cholesterol, glucose, triglycerides, white blood cells, BMI, midarm circumference, and triceps and biceps skinfolds were measured.

RESULTS

Prealbumin levels were significantly higher in HD patients compared with RT patients. Both groups had prealbumin levels <30 mg/dL, but almost all RT patients in our study had prealbumin levels <20 mg/dL. Gender, age, and presence of anemia, hypertension, and diabetes did not significantly affect prealbumin levels in the two groups. Prealbumin levels were significantly positively correlated with duration of dialysis in the HD group and with albumin in the RT group.

CONCLUSIONS

Hemodialysis patients have higher levels of prealbumin compared with RT patients. Prealbumin levels are below normal range in both groups of patients. Prealbumin reflects nutritional status in RT patients, but is also affected by other factors.

Efficacy of Corrected Rapid Turnover Protein Increment Index (CRII) for Early Detection of Improvement of Nutrition Status in Patients with Malnutrition

Serum prealbumin level is useful for assessment of changes in nutritional status but it is markedly affected by the inflammation. In this study, we examined the efficacy of the corrected rapid turnover protein increment index (CRII) for prealbumin, which is calculated as [prealbumin level/C-reactive protein (CRP) level on the assessment day]/[prealbumin level/CRP level on the day of starting nutritional care], for prediction of improvement of nutritional status in patients with malnutrition. The subjects were 50 hospitalized patients with low albuminemia, who were receiving nutritional care. Serum concentrations of albumin, prealbumin and CRP were measured every week for 5 weeks. We defined patients whose serum albumin level was elevated by more than 0.2 g/dl after 5 weeks as those showing improved nutritional status. There was a significant difference in the prealbumin level between improved and unimproved patients at 5 weeks after the start of nutritional support. On the other hand, the prealbumin CRII value showed a significant difference between the groups at 1 and 2 weeks after the start of nutritional support. In conclusion, assessment of prealbumin CRII is useful for early prediction of improved nutritional status in patients with malnutrition.