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Azimi V, Slade M, Fiala M, Fortier JM, Stockerl-Goldstein K, Frater JL, Brestoff JR, Jackups R, Zaydman MA. A Single Reference Interval for Interpreting Serum Free Light Chains across Patients with Varying Renal Function. Clin Chem 2023:7153471. [PMID: 37147848 DOI: 10.1093/clinchem/hvad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Serum free light chain (sFLC) assays are interpreted using a sFLC-ratio-based reference interval (manufacturer's interval) that was defined using a cohort of healthy patients. However, renal impairment elevates the sFLC-ratio, leading to a high false positive rate when using the manufacturer's interval. Prior studies have developed renal-specific reference intervals; however, this approach has not been widely adopted due to practical limitations. Thus, there remains a critical need for a renally robust sFLC interpretation method. METHODS Retrospective data mining was used to define patient cohorts that reflect the spectrum of renal function seen in clinical practice. Two new reference intervals, one based on the sFLC-ratio and one based on a novel principal component analysis (PCA)-based metric, were developed for the FREELITE assay (Binding Site) on the Roche Cobas c501 instrument (Roche). RESULTS Compared to the manufacturer's reference interval, both new methods exhibited significantly lower false positive rates and greater robustness to renal function while maintaining equivalent sensitivity for monoclonal gammopathy (MG) diagnosis. While not significantly different, the point estimate for sensitivity was highest for the PCA-based approach. CONCLUSION Renally robust sFLC interpretation using a single reference interval is possible given a reference cohort that reflects the variation in renal function observed in practice. Further studies are needed to achieve sufficient power and determine if the novel PCA-based metric offers superior sensitivity for MG diagnosis. These new methods offer the practical advantages of not requiring an estimated glomerular filtration rate result or multiple reference intervals, thereby lowering practical barriers to implementation.
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Affiliation(s)
- Vahid Azimi
- Department of Pathology and Immunology, Washington University in St. Louis, School of Medicine, St. Louis, MO, United States
| | - Michael Slade
- Department of Medicine, Division of Oncology, Washington University in St. Louis, School of Medicine, St. Louis, MO, United States
| | - Mark Fiala
- Department of Medicine, Division of Oncology, Washington University in St. Louis, School of Medicine, St. Louis, MO, United States
| | - Julie M Fortier
- Department of Medicine, Division of Oncology, Washington University in St. Louis, School of Medicine, St. Louis, MO, United States
| | - Keith Stockerl-Goldstein
- Department of Medicine, Division of Oncology, Washington University in St. Louis, School of Medicine, St. Louis, MO, United States
| | - John L Frater
- Department of Pathology and Immunology, Washington University in St. Louis, School of Medicine, St. Louis, MO, United States
| | - Jonathan R Brestoff
- Department of Pathology and Immunology, Washington University in St. Louis, School of Medicine, St. Louis, MO, United States
| | - Ronald Jackups
- Department of Pathology and Immunology, Washington University in St. Louis, School of Medicine, St. Louis, MO, United States
| | - Mark A Zaydman
- Department of Pathology and Immunology, Washington University in St. Louis, School of Medicine, St. Louis, MO, United States
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Kaya ZZ, Serdar M, Aksungar F, Kilercik M, Serteser M, Baykal AT. Rapid detection of serum free light chains by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. EUROPEAN JOURNAL OF MASS SPECTROMETRY (CHICHESTER, ENGLAND) 2023; 29:132-140. [PMID: 36734073 DOI: 10.1177/14690667231153616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Introduction: Serum free light chain (FLC) measurements are increasingly prominent for patients with plasma cell disorders (PCDs) in screening, prognostic stratification, and monitoring therapy responses. Objectives: We aimed to develop a sensitive, reliable, and accurate method for diagnosing PCDs that can notably decrease the time and cost of current methods. Methods: Here, we present a novel approach for FLC measurement using immunoenrichment on micro-affinity chromatography in combination with matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) detection. In this study, serum free kappa (κ) and free lambda (λ) light chain (LC) levels in the serum of 105 patients were compared between the nephelometric serum FLC quantification and MALDI-TOF MS detection. Results: Cohen's kappa coefficient between the MALDI-TOF MS-based method and the FLC assay revealed an almost perfect agreement in the case of normal (negative) results (κ = 0.92; 95% confidence interval (CI): 0.837 to 0.968) and a good agreement in the case of increased (positive) results (κ = 0.76; 95% CI: 0.608 to 0.870). In Spearman's correlation analysis, the best correlation was found between serum free κ/λ ratios (r = 0.628, 0.496 to 0.732; p <0.0001). Our method showed sensitivity (92.5%) and specificity (76.3%) for discrimination between the κ/λ FLC ratio compared to the serum FLC assay. Conclusion: The proposed method can significantly contribute to diagnosing and monitoring PCDs as it can significantly be time-saving, cost-effective in FLC measurement.
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Affiliation(s)
- Zelal Zuhal Kaya
- Department of Biochemistry and Molecular Biology, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Muhittin Serdar
- Department of Medical Biochemistry, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Fehime Aksungar
- Department of Medical Biochemistry, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Meltem Kilercik
- Department of Medical Biochemistry, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of Medical Biochemistry, Acibadem Labmed Clinical Laboratories, Istanbul, Turkey
| | - Mustafa Serteser
- Department of Medical Biochemistry, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of Medical Biochemistry, Acibadem Labmed Clinical Laboratories, Istanbul, Turkey
| | - Ahmet Tarik Baykal
- Department of Medical Biochemistry, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Elenjickal N, Kulkarni C, Algeri R, Kothari J, Almeida A, Sirsat R. Plasma Cell Dyscrasia: A Case Series of a Masquerader. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:492-497. [PMID: 37843149 DOI: 10.4103/1319-2442.385971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Plasma cell dyscrasia is a result of an abnormal clonal proliferation of plasma cells. These cells arise from B cells in the bone marrow and produce immunoglobulins. Multiple myeloma is a type of plasma cell dyscrasia that commonly presents with symptoms secondary to hypercalcemia, hyperviscosity, renal failure, and bone pain. Here, we report three patients with unusual presentations of plasma cell dyscrasias.
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Affiliation(s)
- Nikhil Elenjickal
- Department of Nephrology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Chaitanya Kulkarni
- Department of Nephrology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Rashmi Algeri
- Department of Nephrology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Jatin Kothari
- Department of Nephrology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Alan Almeida
- Department of Nephrology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Rashika Sirsat
- Department of Nephrology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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4
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Kaya ZZ, Tuzuner MB, Sahin B, Akgun E, Aksungar F, Koca S, Serdar M, Sahin S, Cinar N, Karsidag S, Hanagasi HA, Kilercik M, Serteser M, K Baykal AT. Kappa/Lambda light-chain typing in Alzheimer's Disease. Curr Alzheimer Res 2022; 19:84-93. [PMID: 35100957 DOI: 10.2174/1567205019666220131101334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alzheimer's disease is a progressive neurodegenerative disorder characterized by memory loss and cognitive impairment. The diagnosis of Alzheimer's disease according to symptomatic events is still a puzzling task. Developing a biomarker-based, low-cost, and high-throughput test, readily applicable in clinical laboratories, dramatically impacts the rapid and reliable detection of the disease. OBJECTIVE This study aimed to develop an accurate, sensitive, and reliable screening tool for diagnosing Alzheimer's disease, which can significantly reduce the cost and time of existing methods. METHODS We have employed a MALDI-TOF-MS-based methodology combined with a microaffinity chromatogra Results: We observed a statistically significant difference in the kappa light chain over lambda light chain (κLC/LC) ratios between patients with AD and controls (% 95 CI: -0.547 to -0.269, p<0.001). Our method demonstrated higher sensitivity (100.00%) and specificity (71.43%) for discrimination between AD and controls. CONCLUSION We have developed a high-throughput screening test with a novel sample enrichment method for determining κLC/LC ratios associated with AD diagnosis. Following further validation, we believe our test has a potential for clinical laboratories.
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Affiliation(s)
- Zelal Zuhal Kaya
- Department of Medical Biochemistry, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Betul Sahin
- cibadem Labmed Clinical Laboratories, Istanbul, Turkey
| | - Emel Akgun
- Department of Medical Biochemistry, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- cibadem Labmed Clinical Laboratories, Istanbul, Turkey
| | - Fehime Aksungar
- Department of Medical Biochemistry, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- cibadem Labmed Clinical Laboratories, Istanbul, Turkey
| | - Sebile Koca
- Department of Medical Biochemistry, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Muhittin Serdar
- Department of Medical Biochemistry, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Sevki Sahin
- Maltepe University, School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Nilgun Cinar
- Maltepe University, School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Sibel Karsidag
- Maltepe University, School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Hasmet Ayhan Hanagasi
- istanbul University, Istanbul Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Meltem Kilercik
- Department of Medical Biochemistry, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- cibadem Labmed Clinical Laboratories, Istanbul, Turkey; 3 Maltepe University, School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Mustafa Serteser
- Department of Medical Biochemistry, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- cibadem Labmed Clinical Laboratories, Istanbul, Turkey
| | - Ahmet Tari K Baykal
- Department of Medical Biochemistry, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- cibadem Labmed Clinical Laboratories, Istanbul, Turkey
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Irshad L, Faustini S, Evans L, Drayson MT, Campbell JP, Heaney JLJ. Salivary free light chains as a new biomarker to measure psychological stress: the impact of a university exam period on salivary immunoglobulins, cortisol, DHEA and symptoms of infection. Psychoneuroendocrinology 2020; 122:104912. [PMID: 33086142 DOI: 10.1016/j.psyneuen.2020.104912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/10/2020] [Accepted: 10/07/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Measurement of immunoglobulin free light chains (FLCs) in saliva can serve as a non-invasive biomarker in health and behavioural research. FLCs have been explored in relation to physiological stress but FLC responses to psychological stress and their relationship with infections remain unknown. This study aimed to investigate the impact of exam period stress on salivary FLCs alongside other established biomarkers of stress and whether FLCs relate to symptoms of infection. METHODS 58 healthy adults studying at university completed saliva samples and questionnaires in a period without exams (baseline), and again prior to the start of an exam period. Saliva samples were assessed for FLCs, IgA, cortisol and dehydroepiandrosterone (DHEA). Measures of life events stress, perceived stress, anxiety and depression were completed. Students also reported incidence and severity of symptoms of infection and rated general well-being at baseline, prior to, during and after the exam period. Exercise, sleep and alcohol consumption were also assessed at both timepoints. RESULTS FLCs secretion rates were significantly lower at the exam period compared to baseline (p < .01), with reductions of 26% and 25% for κ FLC and λ FLC, respectively. In agreement, salivary IgA secretion rate was lower at exams (non-significant trend, p = .07). Cortisol concentration significantly increased at exams (p < .05) while DHEA did not change, leading to an increase in the cortisol:DHEA ratio (p = .06). Depression (p < .05) and anxiety increased from baseline to exams and life stress reported in the build up to the exam period was higher compared with baseline (p < .001). Well-being significantly decreased from baseline to exams (p < .01). The proportion of participants reporting infection symptoms (70%) was unchanged between baseline and prior to exams. No significant relationships were found between FLCs or other saliva parameters and infection symptoms, well-being or stress/psychological measures. Changes in saliva parameters between timepoints were independent of health behaviours. CONCLUSIONS Salivary FLCs are responsive to life events stress and corroborate with IgA. This preliminary study highlights the potential utility of FLCs as a new salivary biomarker in stress research.
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Affiliation(s)
- Lylah Irshad
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Sian Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Lili Evans
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
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Epstein MM, Saphirak C, Zhou Y, LeBlanc C, Rosmarin AG, Ash A, Singh S, Fisher K, Birmann BM, Gurwitz JH. Identifying monoclonal gammopathy of undetermined significance in electronic health data. Pharmacoepidemiol Drug Saf 2020; 29:69-76. [PMID: 31736189 PMCID: PMC7365702 DOI: 10.1002/pds.4912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Monoclonal gammopathy of undetermined significance (MGUS) is a prevalent yet largely asymptomatic precursor to multiple myeloma. Patients with MGUS must undergo regular surveillance and testing, with few known predictors of progression. We developed an algorithm to identify MGUS patients in electronic health data to facilitate large-scale, population-based studies of this premalignant condition. METHODS We developed a four-step algorithm using electronic health record and health claims data from men and women aged 50 years or older receiving care from a large, multispecialty medical group between 2007 and 2015. The case definition required patients to have at least two MGUS ICD-9 diagnosis codes within 12 months, at least one serum and/or urine protein electrophoresis and one immunofixation test, and at least one in-office hematology/oncology visit. Medical charts for selected cases were abstracted then adjudicated independently by two physicians. We assessed algorithm validity by positive predictive value (PPV). RESULTS We identified 833 people with at least two MGUS diagnosis codes; 429 (52%) met all four algorithm criteria. We randomly selected 252 charts for review, including 206 from patients meeting all four algorithm criteria. The PPV for the 206 algorithm-identified charts was 76% (95% CI, 70%-82%). Among the 49 cases deemed to be false positives (24%), 33 were judged to have multiple myeloma or another lymphoproliferative condition, such as lymphoma. CONCLUSIONS We developed a simple algorithm that identified MGUS cases in electronic health data with reasonable accuracy. Inclusion of additional steps to eliminate cases with malignant disease may improve algorithm performance.
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Affiliation(s)
- Mara Meyer Epstein
- The Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Cassandra Saphirak
- The Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA
| | - Yanhua Zhou
- The Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Arlene Ash
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sonal Singh
- The Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kimberly Fisher
- The Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jerry H Gurwitz
- The Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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What the Intensivists Need to Know About Critically Ill Myeloma Patients. ONCOLOGIC CRITICAL CARE 2020. [PMCID: PMC7121630 DOI: 10.1007/978-3-319-74588-6_98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multiple myeloma (MM) is a hematological malignancy characterized by an increase in aberrant plasma cells in the bone marrow leading to rising monoclonal protein in serum and urine. With the introduction of novel therapies with manageable side effects, this incurable disease has evolved into a chronic disease with an acceptable quality of life for the majority of patients. Accordingly, management of acute complications is fundamental in reducing the morbidity and mortality in MM. MM emergencies include symptoms and signs related directly to the disease and/or to the treatment; many organs may be involved including, but not limited to, renal, cardiovascular, neurologic, hematologic, and infectious complications. This review will focus on the numerous approaches that are aimed at managing these complications.
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Rapson A, Collman E, Faustini S, Yonel Z, Chapple IL, Drayson MT, Richter A, Campbell JP, Heaney JLJ. Free light chains as an emerging biomarker in saliva: Biological variability and comparisons with salivary IgA and steroid hormones. Brain Behav Immun 2020; 83:78-86. [PMID: 31557507 DOI: 10.1016/j.bbi.2019.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/10/2019] [Accepted: 09/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Salivary free light chains (FLCs) are an emerging biomarker in health and behavioural research. However, little is known regarding biological variability of salivary FLCs and how they relate to other established salivary biomarkers. This study aimed to investigate the diurnal and day-to-day variation of salivary FLCs and their relationship with salivary IgA and steroid hormones. METHODS A total of 46 healthy adults participated in studies exploring the biological variability of FLCs. Diurnal variation was investigated by collecting saliva samples immediately upon waking, 0.5 h, 3 h, 6 h, 9 h and 14 h post-waking. Saliva samples were assessed for FLCs, IgA, cortisol and dehydroepiandrosterone (DHEA). Between-day variation in FLCs and IgA was assessed by collecting saliva samples immediately upon waking for seven consecutive days. Participants underwent a dental examination to exclude oral health as a potential confounding variable. Within and between-person day-to day variation was explored in relation to a range of different factors: awakening time, sleep, exercise, well-being and alcohol consumption. RESULTS Salivary secretion rates of FLCs decreased following waking and up to 3 h post-waking and then plateaued. This same pattern was observed for IgA. DHEA was stable upon waking and higher levels were seen in the morning with significantly lower levels thereafter. Cortisol levels significantly increased 0.5 h post-waking then continued to decline across the day. FLCs were significantly correlated with IgA but not cortisol or DHEA. Both FLCs and IgA parameters showed day-to-day variability, with coefficients of variation ≥ 40%. Earlier waking time was significantly correlated with higher FLC and IgA secretion rates. Inter-person differences in saliva parameter variability were observed but the degree of variation in FLCs and IgA was related within person. Inter-person day-to-day variation appeared to be uninfluenced by lifestyle or behavioural factors. CONCLUSIONS Saliva FLCs secretion exhibits diurnal fluctuation that mirrors IgA fluctuation. Findings strongly indicate salivary FLC secretion is orchestrated by local plasma cells. FLCs and IgA both showed notable variability day-to-day, which was similar within person and influenced by awakening time. FLCs offer a promising adjunct to IgA in the measurement of oral immune activation.
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Affiliation(s)
- Alec Rapson
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Emily Collman
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Sian Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Zehra Yonel
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, University of Birmingham, UK
| | - Iain L Chapple
- Periodontal Research Group, School of Dentistry, Institute of Clinical Sciences, University of Birmingham, UK
| | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Alex Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
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Heaney JLJ, Killer SC, Svendsen IS, Gleeson M, Campbell JP. Intensified training increases salivary free light chains in trained cyclists: Indication that training volume increases oral inflammation. Physiol Behav 2018; 188:181-187. [PMID: 29427565 DOI: 10.1016/j.physbeh.2018.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/06/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
Periods of short-term intensified training (IT) are often used by athletes during training cycles over the season and undergoing phases of increased physical stress may impact upon the immune system. This study investigated the effects of a period of IT on free light chains (FLCs) in saliva - an emerging immune biomarker of oral inflammation - and matched serum samples in well-trained athletes. It also examined if IT influences basal FLC levels and FLC flux during acute exercise. Highly trained male cyclists (n = 10) underwent a 9-day period of IT; before and after IT participants performed a 1 h time trial (TT) on a cycle ergometer, with blood and saliva samples collected pre- and post-exercise. FLCs were assessed in serum and saliva, and IgG, IgA, IgM and creatinine were also measured in serum. Weekly training volume increased by 143% (95% CI 114-172%), p < 0.001, during IT compared with pre-trial baseline training. Following IT, the cyclists demonstrated higher salivary FLC levels. Both salivary lambda FLC concentrations (p < 0.05, η2 = 0.384) and secretion rates, and kappa FLC concentrations and secretion rates increased after IT. Salivary FLCs concentration and secretion rates decreased in response to the TT following IT (p < 0.05, η2 = 0.387-0.428), but not in response to the TT prior to IT. No significant effects of IT on serum FLCs were observed. There were no significant changes in serum FLCs in response to the TT, before or after the IT period, nor did IT impact upon other serological responses to the TT. In conclusion, IT increased basal salivary FLC parameters and amplified decreases in salivary FLCs in response to acute exercise. Increases in salivary FLC concentration likely reflects alterations to oral inflammation during times of heavy training, and we show for the first time that FLCs may have utility as a marker of exercise stress and oral health status.
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Affiliation(s)
- Jennifer L J Heaney
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, UK.
| | - Sophie C Killer
- English Institute of Sport, Loughborough Performance Centre, UK
| | - Ida S Svendsen
- Olympiatoppen, Norwegian Olympic and Paralympic Committee, Norway
| | - Michael Gleeson
- School of School of Sport, Exercise & Health Sciences, Loughborough University, UK
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10
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The role of free kappa and lambda light chains in the pathogenesis and treatment of inflammatory diseases. Biomed Pharmacother 2017; 91:632-644. [DOI: 10.1016/j.biopha.2017.04.121] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 04/08/2017] [Accepted: 04/27/2017] [Indexed: 12/12/2022] Open
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Gagliardi A, Carbone C, Russo A, Cuccurullo R, Lucania A, Cioppa PD, Misso G, Caraglia M, Tommasino C, Mastrullo L. Combined use of free light chain and heavy/light chain ratios allow diagnosis and monitoring of patients with monoclonal gammopathies: Experience of a single institute, with three exemplar case reports. Oncol Lett 2016; 12:2363-2370. [PMID: 27698801 PMCID: PMC5038391 DOI: 10.3892/ol.2016.4965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/02/2016] [Indexed: 01/06/2023] Open
Abstract
Monoclonal gammopathies are characterized by serum monoclonal component (MC) plus an intact immunoglobulin and a free light chain (FLC), or a combination of both. The measurement of FLC with Freelite® is the standard practice recommended by International Myeloma Working Group guidelines. Recently, Hevylite® heavy/light chains (HLC) assays were introduced to specifically target junctional epitopes between the heavy and light chains of intact immunoglobulins, allowing the independent quantification of the involved (MC) and uninvolved (polyclonal immunoglobulin background) HLC isotype. Between January 2012 and March 2014, 90 patients were examined: 49 multiple myeloma (MM), 6 smoldering MM (SMM) and 35 monoclonal gammopathy of undetermined significance (MGUS). Of these 90 patients, 300 samples were collected at different times. The diagnostic and monitoring contribution of Hevylite A and G assays was assessed in all 90 patients examined. Additionally, 3 representative cases were selected. The Hevylite absolute values and ratio demonstrated high sensitivity and specificity with respect to serum protein electrophoresis and serum immunofixation. The combined use of Hevylite A and G with Freelite was particularly useful in dubious cases with more than one MC or with co-migrating components, as well as in the course of monitoring to assess the independent change of FLC and HLC, possibly reflecting the presence of clonal heterogeneity in the cohort. From this study, it can be concluded that FLC and HLC are independent, useful markers to monitor the MC and to assess with greater specificity and sensitivity the effect of therapy, thereby providing clinical support. Further studies are required to assess the prognostic potential of Hevylite in MGUS and SMM.
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Affiliation(s)
- Alfredo Gagliardi
- Complex Operative Unit of Hematology, San Gennaro Hospital, Naples 1 Local Health Center, I-80135 Naples, Italy
| | - Claudio Carbone
- Complex Operative Unit of Clinical Pathology, San Gennaro Hospital, Naples 1 Local Health Center, I-80135 Naples, Italy
| | - Angela Russo
- Complex Operative Unit of Clinical Pathology, San Gennaro Hospital, Naples 1 Local Health Center, I-80135 Naples, Italy
| | - Rosanna Cuccurullo
- Complex Operative Unit of Hematology, San Gennaro Hospital, Naples 1 Local Health Center, I-80135 Naples, Italy
| | - Anna Lucania
- Complex Operative Unit of Hematology, San Gennaro Hospital, Naples 1 Local Health Center, I-80135 Naples, Italy
| | - Paola Della Cioppa
- Complex Operative Unit of Hematology, San Gennaro Hospital, Naples 1 Local Health Center, I-80135 Naples, Italy
| | - Gabriella Misso
- Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, I-80138 Naples, Italy
| | - Michele Caraglia
- Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, I-80138 Naples, Italy
| | - Catello Tommasino
- Complex Operative Unit of Clinical Pathology, San Gennaro Hospital, Naples 1 Local Health Center, I-80135 Naples, Italy
| | - Lucia Mastrullo
- Complex Operative Unit of Hematology, San Gennaro Hospital, Naples 1 Local Health Center, I-80135 Naples, Italy
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Heaney JL, Phillips AC, Drayson MT, Campbell JP. Serum free light chains are reduced in endurance trained older adults: Evidence that exercise training may reduce basal inflammation in older adults. Exp Gerontol 2016; 77:69-75. [DOI: 10.1016/j.exger.2016.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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Zhang L, Morris JS, Zhang J, Orlowski RZ, Baladandayuthapani V. Bayesian joint selection of genes and pathways: applications in multiple myeloma genomics. Cancer Inform 2014; 13:113-23. [PMID: 25520554 PMCID: PMC4260770 DOI: 10.4137/cin.s13787] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 12/30/2022] Open
Abstract
It is well-established that the development of a disease, especially cancer, is a complex process that results from the joint effects of multiple genes involved in various molecular signaling pathways. In this article, we propose methods to discover genes and molecular pathways significantly associated with clinical outcomes in cancer samples. We exploit the natural hierarchal structure of genes related to a given pathway as a group of interacting genes to conduct selection of both pathways and genes. We posit the problem in a hierarchical structured variable selection (HSVS) framework to analyze the corresponding gene expression data. HSVS methods conduct simultaneous variable selection at the pathway (group level) and the gene (within-group) level. To adapt to the overlapping group structure present in the pathway–gene hierarchy of the data, we developed an overlap-HSVS method that introduces latent partial effect variables that partition the marginal effect of the covariates and corresponding weights for a proportional shrinkage of the partial effects. Combining gene expression data with prior pathway information from the KEGG databases, we identified several gene–pathway combinations that are significantly associated with clinical outcomes of multiple myeloma. Biological discoveries support this relationship for the pathways and the corresponding genes we identified.
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Affiliation(s)
- Lin Zhang
- Postdoctoral fellow, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Morris
- Professor, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jiexin Zhang
- Principal Statistical Analyst, Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert Z Orlowski
- Professor, Department of Lymphoma & Myeloma, and of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Yap CYF, Wong PW, Aw TC. Free Kappa and Lambda Light Chains in Plasma Cell Dyscrasias. PROCEEDINGS OF SINGAPORE HEALTHCARE 2011. [DOI: 10.1177/201010581102000111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Automated serum kappa (κ) and lambda (λ) free light chain (FLC) immunoassay may be used as a rapid screening tool for multiple myeloma and other light chain diseases as it is more sensitive and robust than serum protein electrophoresis (SPE) and urine immunofixation electrophoresis (IFE). Serum FLC enables earlier diagnosis and evaluation of tumour response to therapy. Serum FLC testing has been incorporated into an international guideline for all newly diagnosed plasma cell cancers for diagnosis, prognosis, monitoring and assessing treatment.
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Affiliation(s)
| | - Pey Wah Wong
- Department of Lab Medicine, Changi General Hospital, Singapore
| | - Tar Choon Aw
- Department of Lab Medicine, Changi General Hospital, Singapore
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