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Cannarella R, Curto R, Condorelli RA, Lundy SD, La Vignera S, Calogero AE. Molecular insights into Sertoli cell function: how do metabolic disorders in childhood and adolescence affect spermatogonial fate? Nat Commun 2024; 15:5582. [PMID: 38961093 PMCID: PMC11222552 DOI: 10.1038/s41467-024-49765-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 06/12/2024] [Indexed: 07/05/2024] Open
Abstract
Male infertility is a major public health concern globally with unknown etiology in approximately half of cases. The decline in total sperm count over the past four decades and the parallel increase in childhood obesity may suggest an association between these two conditions. Here, we review the molecular mechanisms through which obesity during childhood and adolescence may impair future testicular function. Several mechanisms occurring in obesity can interfere with the delicate metabolic processes taking place at the testicular level during childhood and adolescence, providing the molecular substrate to hypothesize a causal relationship between childhood obesity and the risk of low sperm counts in adulthood.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Roberto Curto
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Scott D Lundy
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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2
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Grigoryan S, Clines GA. Hormonal Control of Bone Architecture Throughout the Lifespan: Implications for Fracture Prediction and Prevention. Endocr Pract 2024; 30:687-694. [PMID: 38631489 DOI: 10.1016/j.eprac.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/31/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Skeletal modeling in childhood and adolescence and continuous remodeling throughout the lifespan are designed to adapt to a changing environment and resist external forces and fractures. The flux of sex steroids in men and women, beginning from fetal development and evolving through infancy, childhood, puberty, young adulthood, peri/menopause transition, and postmenopause, is critical for bone size, peak bone mass, and fracture resistance. OBJECTIVE This review will highlight how changes in sex steroids throughout the lifespan affect bone cells and the consequence of these changes on bone architecture and strength. METHODS Literature review and discussion. RESULTS The contributions of estrogen and testosterone on skeletal development have been difficult to study due to the reciprocal and intertwining contributions of one on the other. Although orchiectomy in men renders circulating testosterone absent, circulating estrogen also declines due to testosterone being the substrate for estradiol. The discovery of men with absent estradiol or resistance to estrogen and the study of mouse models led to the understanding that estrogen has a larger direct role in skeletal development and maintenance in men and women. The mechanistic reason for larger bone size in men is incompletely understood but related to indirect effects of testosterone on the skeleton, such as higher muscle mass leading to larger mechanical loading. Declines in sex steroids during menopause in women and androgen deprivation therapies in men have profound and negative effects on the skeleton. Therapies to prevent such bone loss are available, but how such therapies can be tailored based on bone size and architecture remains an area of investigation. CONCLUSION In this review, the elegant interplay and contribution of sex steroids on bone architecture in men and women throughout the lifespan is described.
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Affiliation(s)
- Seda Grigoryan
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Gregory A Clines
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Endocrinology Section, Veterans Affairs Medical Center, Ann Arbor, Michigan.
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Ma C, Yu Z, Qiu L. Development of next-generation reference interval models to establish reference intervals based on medical data: current status, algorithms and future consideration. Crit Rev Clin Lab Sci 2024; 61:298-316. [PMID: 38146650 DOI: 10.1080/10408363.2023.2291379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/30/2023] [Indexed: 12/27/2023]
Abstract
Evidence derived from laboratory medicine plays a pivotal role in the diagnosis, treatment monitoring, and prognosis of various diseases. Reference intervals (RIs) are indispensable tools for assessing test results. The accuracy of clinical decision-making relies directly on the appropriateness of RIs. With the increase in real-world studies and advances in computational power, there has been increased interest in establishing RIs using big data. This approach has demonstrated cost-effectiveness and applicability across diverse scenarios, thereby enhancing the overall suitability of the RI to a certain extent. However, challenges persist when tests results are influenced by age and sex. Reliance on a single RI or a grouping of RIs based on age and sex can lead to erroneous interpretation of results with significant implications for clinical decision-making. To address this issue, the development of next generation of reference interval models has arisen at an historic moment. Such models establish a curve relationship to derive continuously changing reference intervals for test results across different age and sex categories. By automatically selecting appropriate RIs based on the age and sex of patients during result interpretation, this approach facilitates clinical decision-making and enhances disease diagnosis/treatment as well as health management practices. Development of next-generation reference interval models use direct or indirect sampling techniques to select reference individuals and then employed curve fitting methods such as splines, polynomial regression and others to establish continuous models. In light of these studies, several observations can be made: Firstly, to date, limited interest has been shown in developing next-generation reference interval models, with only a few models currently available. Secondly, there are a wide range of methods and algorithms for constructing such models, and their diversity may lead to confusion. Thirdly, the process of constructing next-generation reference interval models can be complex, particularly when employing indirect sampling techniques. At present, normative documents pertaining to the development of next-generation reference interval models are lacking. In summary, this review aims to provide an overview of the current state of development of next-generation reference interval models by defining them, highlighting inherent advantages, and addressing existing challenges. It also describes the process, advanced algorithms for model building, the tools required and the diagnosis and validation of models. Additionally, a discussion on the prospects of utilizing big data for developing next-generation reference interval models is presented. The ultimate objective is to equip clinical laboratories with the theoretical framework and practical tools necessary for developing and optimizing next-generation reference interval models to establish next-generation reference intervals while enhancing the use of medical data resources to facilitate precision medicine.
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Affiliation(s)
- Chaochao Ma
- Department of Laboratory Medicine, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Zheng Yu
- Department of Operations Research and Financial Engineering, Princeton University, Princeton University, Princeton, NJ, USA
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
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Lorton F, Lagares A, de la Cruz J, Méjan O, Pavlov V, Sapin V, Poca MA, Lehner M, Biberthaler P, Chauviré-Drouard A, Gras-Le-Guen C, Scherdel P. Performance of glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) biomarkers in predicting CT scan results and neurological outcomes in children with traumatic brain injury (BRAINI-2 paediatric study): protocol of a European prospective multicentre study. BMJ Open 2024; 14:e083531. [PMID: 38754888 PMCID: PMC11097883 DOI: 10.1136/bmjopen-2023-083531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/23/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION In light of the burden of traumatic brain injury (TBI) in children and the excessive number of unnecessary CT scans still being performed, new strategies are needed to limit their use while minimising the risk of delayed diagnosis of intracranial lesions (ICLs). Identifying children at higher risk of poor outcomes would enable them to be better monitored. The use of the blood-based brain biomarkers glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1) could help clinicians in this decision. The overall aim of this study is to provide new knowledge regarding GFAP and UCH-L1 in order to improve TBI management in the paediatric population. METHODS AND ANALYSIS We will conduct a European, prospective, multicentre study, the BRAINI-2 paediatric study, in 20 centres in France, Spain and Switzerland with an inclusion period of 30 months for a total of 2880 children and adolescents included. To assess the performance of GFAP and UCH-L1 used separately and in combination to predict ICLs on CT scans (primary objective), 630 children less than 18 years of age with mild TBI, defined by a Glasgow Coma Scale score of 13-15 and with a CT scan will be recruited. To evaluate the potential of GFAP and UCH-L1 in predicting the prognosis after TBI (secondary objective), a further 1720 children with mild TBI but no CT scan as well as 130 children with moderate or severe TBI will be recruited. Finally, to establish age-specific reference values for GFAP and UCH-L1 (secondary objective), we will include 400 children and adolescents with no history of TBI. ETHICS AND DISSEMINATION This study has received ethics approval in all participating countries. Results from our study will be disseminated in international peer-reviewed journals. All procedures were developed in order to assure data protection and confidentiality. TRIAL REGISTRATION NUMBER NCT05413499.
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Affiliation(s)
- Fleur Lorton
- Nantes Université, CHU Nantes, INSERM, Department of Paediatric Emergency, CIC 1413, F-44000 Nantes, France
| | - Alfonso Lagares
- Department of Neurosurgery,Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria imas12, Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier de la Cruz
- Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria imas12, RICORS-SAMID, Madrid, Spain
| | - Odile Méjan
- Research and Development Immunoassay, bioMerieux SA, Marcy l'Etoile, France
| | | | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Maria Antonia Poca
- Department of Neurosurgery and Neurotraumatology and Neurosurgery Research Unit,Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Markus Lehner
- Department of Pediatric Surgery, Children's Hospital Lucerne, University of Lucerne, CH-6000 Lucerne, Switzerland
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Ismaningerstr 22, Technical University Munich, Munich, Germany
| | - Anne Chauviré-Drouard
- Nantes Université, CHU Nantes, INSERM, Department of Paediatric Emergency, CIC 1413, F-44000 Nantes, France
| | - Christèle Gras-Le-Guen
- Nantes Université, CHU Nantes, INSERM, Department of Paediatric Emergency, CIC 1413, F-44000 Nantes, France
| | - Pauline Scherdel
- Nantes Université, CHU Nantes, INSERM, Department of Paediatric Emergency, CIC 1413, F-44000 Nantes, France
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Stukas S, Cooper J, Higgins V, Holmes D, Adeli K, Wellington CL. Pediatric reference intervals for serum neurofilament light and glial fibrillary acidic protein using the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort. Clin Chem Lab Med 2024; 62:698-705. [PMID: 37882772 PMCID: PMC10895925 DOI: 10.1515/cclm-2023-0660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES Blood biomarkers have the potential to transform diagnosis and prognosis for multiple neurological indications. Establishing normative data is a critical benchmark in the analytical validation process. Normative data are important in children as little is known about how brain development may impact potential biomarkers. The objective of this study is to generate pediatric reference intervals (RIs) for serum neurofilament light (NfL), an axonal marker, and glial fibrillary acidic protein (GFAP), an astrocytic marker. METHODS Serum from healthy children and adolescents aged 1 to <19 years were obtained from the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort. Serum NfL (n=300) and GFAP (n=316) were quantified using Simoa technology, and discrete RI (2.5th and 97.5th percentiles) and continuous RI (5th and 95th percentiles) were generated. RESULTS While there was no association with sex, there was a statistically significant (p<0.0001) negative association between age and serum NfL (Rho -0.400) and GFAP (Rho -0.749). Two statistically significant age partitions were generated for NfL: age 1 to <10 years (lower, upper limit; 3.13, 20.6 pg/mL) and 10 to <19 years (1.82, 7.44 pg/mL). For GFAP, three statistically significant age partitions were generated: age 1 to <3.5 years (80.4, 601 pg/mL); 3.5 to <11 years (50.7, 224 pg/mL); and 11 to <19 years (26.2, 119 pg/mL). CONCLUSIONS Taken together with the literature on adults, NfL and GFAP display U-shaped curves with high levels in infants, decreasing levels during childhood, a plateau during adolescence and early adulthood and increasing levels in seniors. These normative data are expected to inform future pediatric studies on the importance of age on neurological blood biomarkers.
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Affiliation(s)
- Sophie Stukas
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Cooper
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Victoria Higgins
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Holmes
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, Providence Health, Vancouver, BC, Canada
| | - Khosrow Adeli
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cheryl L. Wellington
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Center, University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering (SBME), University of British Columbia, Vancouver, BC, Canada
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Wang F, Shao S, He W, Hu S. A case of mild partial androgen insensitivity syndrome in a juvenile boy. J Int Med Res 2024; 52:3000605241232520. [PMID: 38530023 DOI: 10.1177/03000605241232520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Androgen insensitivity syndrome (AIS) is a rare disorder with X-linked recessive inheritance in 46 XY patients. The clinical manifestations vary between patients, especially regarding external genitalia development. Herein, the case of AIS in a 13-year-old male, who was born with hypospadias and presented to the hospital with gynaecomastia that had developed from 8 years of age, is reported. No micropenis, cryptorchidism or bifid scrotum were found. Testis volume was 12 ml on both sides. His testosterone and luteinizing hormone levels were normal compared with sex- and age-adjusted reference range. His bone age was approximately 13 years according to Greulich-Pyle assessment. Sequence analysis of the androgen receptor (AR) gene revealed a mutation (c.2041A>G) in exon 4, a novel mutation site in the AR gene. Prediction analysis suggested this to be a disease-causing variant. A milder clinical presentation and normal hormone levels in cases of partial AIS might differ from the usually reported signs and symptoms. A diagnosis of AIS should not be ignored in teenage patients who present with gynaecomastia and hypospadias, but normal hormone levels.
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Affiliation(s)
- Fen Wang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Branch of National Clinical Research Centre for Metabolic Diseases, Wuhan, Hubei, China
| | - Shiying Shao
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Branch of National Clinical Research Centre for Metabolic Diseases, Wuhan, Hubei, China
| | - Wentao He
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Branch of National Clinical Research Centre for Metabolic Diseases, Wuhan, Hubei, China
| | - Shuhong Hu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Branch of National Clinical Research Centre for Metabolic Diseases, Wuhan, Hubei, China
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Tybirk L, Hviid CVB, Knudsen CS, Parkner T. Serum GFAP - pediatric reference interval in a cohort of Danish children. Clin Chem Lab Med 2023; 61:2041-2045. [PMID: 37195150 DOI: 10.1515/cclm-2023-0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Glial fibrillary acidic protein (GFAP) in blood is an emerging biomarker of brain injury and neurological disease. Its clinical use in children is limited by the lack of a reference interval (RI). Thus, the aim of the present study was to establish an age-dependent continuous RI for serum GFAP in children. METHODS Excess serum from routine allergy testing of 391 children, 0.4-17.9 years of age, was measured by a single-molecule array (Simoa) assay. A continuous RI was modelled using non-parametric quantile regression and presented both graphically and tabulated as discrete one-year RIs based on point estimates from the model. RESULTS Serum GFAP showed a strong age-dependency with declining levels and variability from infants to adolescents. The estimated median level decreased 66 % from four months to five years of age and another 65 % from five years to 17.9 years of age. No gender difference was observed. CONCLUSIONS The study establishes an age-dependent RI for serum GFAP in children showing high levels and variability in the first years of life.
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Affiliation(s)
- Lea Tybirk
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Vinter Bødker Hviid
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Tina Parkner
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Schjørring ME, Parkner T, Knudsen CS, Tybirk L, Hviid CVB. Neurofilament light chain: serum reference intervals in Danish children aged 0-17 years. Scand J Clin Lab Invest 2023; 83:403-407. [PMID: 37632388 DOI: 10.1080/00365513.2023.2251003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/07/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023]
Abstract
Elevated levels of neurofilament light chain (NfL) in the blood is an unspecific biomarker for damage to neuronal axons. The measurement of NfL levels in the blood can provide useful information for monitoring and prognostication of various neurological disorders in children, but a reference interval (RI) is needed before the clinical implementation of the biomarker. We aimed to establish a RI for children aged 0-17 years. Serum samples from 292 healthy reference subjects aged 0.4-17.9 years were analysed by a single-molecule array (Simoa®) established for routine clinical use. Non-parametric quantile regression was used to model a continuous RI, and a traditional age-partitioned non-parametric RI was established according to Clinical and Laboratory Standard Institute (CLSI) guideline C28-A3. Furthermore, we investigated the effect of hemolysis on assay performance. The traditional age-partitioned non-parametric RI for the age group <3 years was 3.5-16.6 ng/L and 2.1-13.9 ng/L in the age group ≥3 years, respectively. The continuous RI showed an age-dependent decrease in median NfL levels in the first three years of life which was also evident in the age-partitioning of the traditional RI. We found no difference between sexes and no impact of hemolysis on the NfL test results. This study establishes a pediatric RI for serum NfL and lays the groundwork for its future use in clinical practice.
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Affiliation(s)
- Mia Elbek Schjørring
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Tina Parkner
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | | | - Lea Tybirk
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Vinter Bødker Hviid
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Denmark
- Department of Clinical Medicine, Aalborg University, Denmark
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Doyle K, Bunch DR. Reference intervals: past, present, and future. Crit Rev Clin Lab Sci 2023; 60:466-482. [PMID: 37036018 DOI: 10.1080/10408363.2023.2196746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 04/11/2023]
Abstract
Clinical laboratory test results alone are of little value in diagnosing, treating, and monitoring health conditions; as such, a clinically actionable cutoff or reference interval is required to provide context for result interpretation. Healthcare practitioners base their diagnoses, follow-up treatments, and subsequent testing on these reference points. However, they may not be aware of inherent limitations related to the definition and derivation of reference intervals. Laboratorians are responsible for providing the reference intervals they report with results. Yet, the establishment and verification of reference intervals using conventional direct methods are complicated by resource constraints or unique patient demographics. To facilitate standardized reference interval best practices, multiple global scientific societies are actively drafting guidelines and seeking funding to promote these initiatives. Numerous national and international multicenter collaborations demonstrate the ability to leverage combined resources to conduct large reference interval studies by direct methods. However, not all demographics are equally accessible. Novel indirect methods are attractive solutions that utilize computational methods to define reference distributions and reference intervals from mixed data sets of pathologic and non-pathologic patient test results. In an effort to make reference intervals more accurate and personalized, individual-based reference intervals are shown to be more useful than population-based reference intervals in detecting clinically significant analyte changes in a patient that might otherwise go unrecognized when using wider, population-based reference intervals. Additionally, continuous reference intervals can provide more accurate ranges as compared to age-based partitions for individuals that are near the ends of the age partition. The advantages and disadvantages of different reference interval approaches as well as the advancement of non-conventional reference interval studies are discussed in this review.
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Affiliation(s)
- Kelly Doyle
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dustin R Bunch
- Nationwide Children's Hospital & College of Medicine, The Ohio State University, Columbus, OH, USA
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10
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Tybirk L, Hviid CVB, Knudsen CS, Parkner T. Serum GFAP - reference interval and preanalytical properties in Danish adults. Clin Chem Lab Med 2022; 60:1830-1838. [PMID: 36067832 DOI: 10.1515/cclm-2022-0646] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Glial fibrillary acidic protein (GFAP) is a promising biomarker that could potentially contribute to diagnosis and prognosis in neurological diseases. The biomarker is approaching clinical use but the reference interval for serum GFAP remains to be established, and knowledge about the effect of preanalytical factors is also limited. METHODS Serum samples from 371 apparently healthy reference subjects, 21-90 years of age, were measured by a single-molecule array (Simoa) assay. Continuous reference intervals were modelled using non-parametric quantile regression and compared with traditional age-partitioned non-parametric reference intervals established according to the Clinical and Laboratory Standards Institute (CLSI) guideline C28-A3. The following preanalytical conditions were also examined: stability in whole blood at room temperature (RT), stability in serum at RT and -20 °C, repeated freeze-thaw cycles, and haemolysis. RESULTS The continuous reference interval showed good overall agreement with the traditional age-partitioned reference intervals of 25-136 ng/L, 34-242 ng/L, and 5-438 ng/L for the age groups 20-39, 40-64, and 65-90 years, respectively. Both types of reference intervals showed increasing levels and variability of serum GFAP with age. In the preanalytical tests, the mean changes from baseline were 2.3% (95% CI: -2.4%, 6.9%) in whole blood after 9 h at RT, 3.1% (95% CI: -4.5%, 10.7%) in serum after 7 days at RT, 10.4% (95% CI: -6.0%, 26.8%) in serum after 133 days at -20 °C, and 10.4% (95% CI: 9.5%, 11.4%) after three freeze-thaw cycles. CONCLUSIONS The study establishes age-dependent reference ranges for serum GFAP in adults and demonstrates overall good stability of the biomarker.
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Affiliation(s)
- Lea Tybirk
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Vinter Bødker Hviid
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Tina Parkner
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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11
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Bunch DR, Holmes DT. Clinical pathology and the data science revolution. J Mass Spectrom Adv Clin Lab 2022; 24:41-42. [PMID: 35340694 PMCID: PMC8942826 DOI: 10.1016/j.jmsacl.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Dustin R. Bunch
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pathology, College of Medicine, The Ohio State University, Columbus, OH, USA
- Corresponding author at: Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA.
| | - Daniel T. Holmes
- St. Paul’s Hospital, Department of Pathology and Laboratory Medicine, 1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- University of British Columbia, Department of Pathology and Laboratory Medicine, 2211 Wesbrook Mall, Vancouver, BC V6T 1Z7, Canada
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