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Li J, Hatten-Beck M, Lee JKY, Hoofnagle AN. Insights into insulin analog cross-reactivity: a comparative study of Siemens Atellica and LC-MS/MS. Endocrine 2024:10.1007/s12020-024-03970-6. [PMID: 39030378 DOI: 10.1007/s12020-024-03970-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND To address the challenges posed by inconsistent detection of analog insulin in commercially available insulin immunoassays, resulting in potential discrepancies in clinical findings and misdiagnosis during the investigation of factitious hypoglycemia., we aimed to evaluate the ability of the Siemens Atellica automated immunoassay to detect insulin analogs compared with LC-MS/MS. METHODS Five insulin analogs were analyzed at 10 ng/mL spiked into serum samples, with recombinant human insulin as positive controls. Insulin and C-peptide assays were performed using Siemens Atellica and LC-MS/MS. Recovery rates were calculated. RESULTS Siemens Atellica immunoassay demonstrated robust cross-reactivity (92-121%) of insulin analogs. In contrast, glargine was detected by LC-MS/MS but other analogs were not observed (<10% recovery). CONCLUSION Our results indicate that the insulin assay conducted on the Siemens Atellica platform could be used to diagnose factitious hypoglycemia by detecting the specific insulin analogs involved. The findings from our studies indicate the suitability of this method for clinical laboratory use in cases where factitious hypoglycemia is under consideration as a potential diagnosis. Clinicians should take these results into account when interpreting insulin measurements, particularly in instances where insulin analog overdose is suspected.
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Affiliation(s)
- Jieli Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Maya Hatten-Beck
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jason K Y Lee
- Department of Clinical Laboratory, University Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, USA.
- Department of Medicine, University of Washington, Seattle, WA, USA.
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2
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Teoli J, Chikh K, Jouini-Bouhamri R, Charriere S, Fabien N, Raverot V. When discordant insulin and C-peptide levels lead to a medical diagnosis in a patient with transient hypoglycemia: Varying degrees of interference of insulin-antibody complexes on three insulin immunoassays. Heliyon 2024; 10:e34009. [PMID: 39071705 PMCID: PMC11280251 DOI: 10.1016/j.heliyon.2024.e34009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/30/2024] Open
Abstract
Background Determining the cause of hypoglycemia partly relies on blood insulin and C-peptide assays. Although the pancreatic secretion of these peptides is equimolar, discrepancies in their concentrations may occur. Case presentation We report the case of a 73-year-old woman with type 2 diabetes mellitus (T2DM) and a history of gastric bypass. The T2DM was initially treated with insulin analogs, which were interrupted due to transient hypoglycemia episodes three years before hospitalization in our endocrinology department. During this hospitalization, the most common etiologies of hypoglycemia were excluded. Fasting insulin level was high (190 mIU/L, reference values (RV): 5-25) on Architect i2000 (an assay recognizing insulin analogs) despite normal blood C-peptide (4.5 μg/L, RV: 0.8-5.2) and slight hypoglycemia (4.5 mmol/L, RV: 4.6-6.1). Insulin level using the Elecsys assay (an assay with low sensitivity to insulin analogs) was very high (>1000 mIU/L, RV: 2.6-24.9). This pattern was observed on several samples, including some taken during a fasting test. Insulin level was only slightly increased using the Mercodia iso-insulin ELISA kit (an assay recognizing insulin analogs). These results excluded an exogenous insulin intake and were suggestive of an interference on insulin assays. To explore the latter possibility, free anti-insulin antibodies were measured and found strongly positive. The presence of interfering insulin-antibody complexes was further investigated using gel filtration chromatography, polyethylene glycol precipitation, and dilution test. Based on these findings, an insulin autoimmune syndrome (IAS) was suspected to cause the hypoglycemic episodes observed. Conclusion Although a discrepancy between blood insulin and C-peptide levels points to insulin analog intake, IAS should also be considered, particularly in a patient with transient hypoglycemia. IAS is characterized by the presence of insulin-antibody complexes, which can induce varying degrees of interference on insulin immunoassays and may lead to discordant insulin and C-peptide levels according to the insulin immunoassay used.
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Affiliation(s)
- Jordan Teoli
- Laboratoire de Biologie Médicale Multisites, Service de Biochimie et Biologie Moléculaire, UM Biologie Endocrinienne, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Bron, France
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Institut Cellule Souche et Cerveau (SBRI), Unité INSERM 1208, Centre de Recherche INSERM, Bron, France
| | - Karim Chikh
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Laboratoire de biologie Médicale Multisites, Service de Biochimie et Biologie Moléculaire, UM Biologie Endocrinienne, Centre de Biologie et Pathologie Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Laboratoire CarMen, UMR INSERM U1060/INRAE U1397, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - Ryme Jouini-Bouhamri
- Fédération d'Endocrinologie, Maladies Métaboliques, Diabète, et Nutrition, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Sybil Charriere
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Laboratoire CarMen, UMR INSERM U1060/INRAE U1397, Université Claude Bernard Lyon 1, Pierre Bénite, France
- Fédération d'Endocrinologie, Maladies Métaboliques, Diabète, et Nutrition, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Nicole Fabien
- Service d'immunologie, Centre de Biologie et Pathologie Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Véronique Raverot
- Laboratoire de Biologie Médicale Multisites, Service de Biochimie et Biologie Moléculaire, UM Biologie Endocrinienne, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Bron, France
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Violin A, Enard E, Blin J, Paillusson D, Collin A, Guénet D, Raverot V, Bach-Ngohou K, Masson D. Insulin: Know what your immunoassay detects. Evaluation of two new immunoassays. Clin Chim Acta 2023; 548:117516. [PMID: 37598742 DOI: 10.1016/j.cca.2023.117516] [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: 06/02/2023] [Revised: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Insulin is essential for glycemic regulation but diseases can cause a default or an excess of insulin secretion leading to dysregulated glycemia. Hence, measurement of insulinemia is useful to investigate hypoglycemia, determine the pathogenesis of diabetes and evaluate β-cell function. Thus, diabetic patients need supplementation with recombinant human insulin and/or insulin analogues. Analogues have primary sequences different from native human insulin and may not be detected by some immunoassays. The objective of our study was to evaluate new insulin immunoassays by determining their ability to detect different types of human insulin or analogues. METHODS This study compared the reactivity of two new insulin immunoassays with five well-established immunoassays on ten commercial insulins. We also measured insulin in blood samples from diabetic or pancreas transplant patients with known treatment. RESULTS Contrary to recombinant human insulin, there were differences in the specificity to insulin analogues. We distinguished three immunoassay categories: those recognizing all types of insulin such as the non-specific BI-INS-IRMA®, Architect® and Access® immunoassays; those recognizing human insulin only (Cobas®); and those recognizing human insulin and analogues in variable proportions (Liaison XL®, iFlash® and Maglumi®). CONCLUSION An accurate biological interpretation of insulinemia relies on knowledge of the specificity of the immunoassay used.
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Affiliation(s)
- Alizee Violin
- Nantes Université, CHU Nantes, Department of Biology, Laboratory of Biochemistry, F-44000 Nantes, France.
| | - Emmanuel Enard
- Nantes Université, CHU Nantes, Department of Biology, Laboratory of Biochemistry, F-44000 Nantes, France
| | - Justine Blin
- Nantes Université, CHU Nantes, Department of Biology, Laboratory of Biochemistry, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM U1235, The Enteric Nervous System in Gut and Brain Disorders, IMAD, F-44000 Nantes, France
| | - Dimitri Paillusson
- Nantes Université, CHU Nantes, Department of Biology, Laboratory of Biochemistry, F-44000 Nantes, France
| | - Antoine Collin
- Nantes Université, CHU Nantes, Department of Biology, Laboratory of Biochemistry, F-44000 Nantes, France
| | - David Guénet
- Normandie Univ, UNICAEN, CHU of Caen Normandie, Laboratory of Biochemistry, 14000 Caen, France
| | - Véronique Raverot
- Service de Biochimie et Biologie Moléculaire, Laboratoire de Biologie Médicale Multi-Sites (LBMMS), Hospices Civils de Lyon, Lyon, France
| | - Kalyane Bach-Ngohou
- Nantes Université, CHU Nantes, Department of Biology, Laboratory of Biochemistry, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM U1235, The Enteric Nervous System in Gut and Brain Disorders, IMAD, F-44000 Nantes, France
| | - Damien Masson
- Nantes Université, CHU Nantes, Department of Biology, Laboratory of Biochemistry, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM U1235, The Enteric Nervous System in Gut and Brain Disorders, IMAD, F-44000 Nantes, France
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Seegmiller JC, Schmit DJ, Arends VL, Steffes MW, Kahn SE, Younes N. Assessment of circulating insulin using liquid chromatography-mass spectrometry during insulin glargine treatment in type 2 diabetes: Implications for estimating insulin sensitivity and β-cell function. Diabetes Obes Metab 2023; 25:1995-2004. [PMID: 36999229 PMCID: PMC10239335 DOI: 10.1111/dom.15072] [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: 01/24/2023] [Revised: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023]
Abstract
AIM To determine the potential impact of the cross-reactivity of insulin glargine U-100 and its metabolites on insulin sensitivity and β-cell measures in people with type 2 diabetes. MATERIALS AND METHODS Using liquid chromatography-mass spectrometry (LC-MS), we measured concentrations of endogenous insulin, glargine and its two metabolites (M1 and M2) in fasting and oral glucose tolerance test-stimulated plasma from 19 participants and fasting specimens from another 97 participants 12 months after randomization to receive the insulin glargine. The last dose of glargine was administered before 10:00 PM the night before testing. Insulin was also measured on these specimens using an immunoassay. We used fasting specimens to calculate insulin sensitivity (Homeostatic Model Assessment 2 [HOMA2]-S%; QUICKI index; PREDIM index) and β-cell function (HOMA2-B%). Using specimens following glucose ingestion, we calculated insulin sensitivity (Matsuda ISI[comp] index) and β-cell response (insulinogenic index [IGI], and total incremental insulin response [iAUC] insulin/glucose). RESULTS In plasma, glargine was metabolized to form the M1 and M2 metabolites that were quantifiable by LC-MS; however, the analogue and its metabolites cross-reacted by less than 100% in the insulin immunoassay. This incomplete cross-reactivity resulted in a systematic bias of fasting-based measures. By contrast, because M1 and M2 did not change following glucose ingestion, a bias was not observed for IGI and iAUC insulin/glucose. CONCLUSIONS Despite glargine metabolites being detected in the insulin immunoassay, dynamic insulin responses can be used to assess β-cell responsiveness. However, given the cross-reactivity of the glargine metabolites in the insulin immunoassay, fasting-based measures of insulin sensitivity and β-cell function are biased.
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Affiliation(s)
- Jesse C. Seegmiller
- Department of Laboratory Medicine, Advanced Research and Diagnostic Laboratory, University of Minnesota, Minneapolis, MN, USA
| | - David J. Schmit
- Department of Laboratory Medicine, Advanced Research and Diagnostic Laboratory, University of Minnesota, Minneapolis, MN, USA
| | - Valerie L. Arends
- Department of Laboratory Medicine, Advanced Research and Diagnostic Laboratory, University of Minnesota, Minneapolis, MN, USA
| | - Michael W. Steffes
- Department of Laboratory Medicine, Advanced Research and Diagnostic Laboratory, University of Minnesota, Minneapolis, MN, USA
| | - Steven E. Kahn
- Division of Metabolism, Endocrinology and Nutrition, VA Puget Sound Health Care System and University of Washington, Seattle, WA, USA
| | - Naji Younes
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, USA
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Momeni Z, Boulé NG, Prado CM, Hinz HA, Yardley JE. The Effect of Starting Blood Glucose Levels on Serum Electrolyte Concentrations during and after Exercise in Type 1 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2109. [PMID: 36767477 PMCID: PMC9915529 DOI: 10.3390/ijerph20032109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Fear of hypoglycemia is a major exercise barrier for people with type 1 diabetes (PWT1D). Consequently, although guidelines recommend starting exercise with blood glucose (BG) concentration at 7-10 mmol/L, PWT1D often start higher, potentially affecting hydration and serum electrolyte concentrations. To test this, we examined serum and urine electrolyte concentrations during aerobic exercise (cycling 45 min at 60%VO2peak) in 12 PWT1D (10F/2M, mean ± SEM: age 29 ± 2.3 years, VO2peak 37.9 ± 2.2 mL·kg-1·min-1) with starting BG levels: 8-10 (MOD), and 12-14 (HI) mmol/L. Age, sex, and fitness-matched controls without diabetes (CON) completed one exercise session with BG in the normal physiological range. Serum glucose was significantly higher during exercise and recovery in HI versus MOD (p = 0.0002 and p < 0.0001, respectively) and in MOD versus CON (p < 0.0001). During exercise and recovery, MOD and HI were not significantly different in serum insulin (p = 0.59 and p = 0.63), sodium (p = 0.058 and p = 0.08), potassium (p = 0.17 and p = 0.16), calcium (p = 0.75 and 0.19), and magnesium p = 0.24 and p = 0.09). Our findings suggest that exercise of moderate intensity and duration with higher BG levels may not pose an immediate risk to hydration or serum electrolyte concentrations for PWT1D.
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Affiliation(s)
- Zeinab Momeni
- Augustana Faculty, University of Alberta, 4901-46th Avenue, Camrose, AB T4V 2R3, Canada
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, 112 Street, Edmonton, AB T6G 2T9, Canada
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Normand G. Boulé
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, 112 Street, Edmonton, AB T6G 2T9, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 3-100 University Hall, Van Vliet Complex, Edmonton, AB T6G 2H9, Canada
| | - Carla M. Prado
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Human Nutrition Research Unit, Alberta Diabetes Institute, 112 Street, Edmonton, AB T6G 2T9, Canada
- Faculty of Agricultural, Life and Environmental Science, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Heather A. Hinz
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, 112 Street, Edmonton, AB T6G 2T9, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 3-100 University Hall, Van Vliet Complex, Edmonton, AB T6G 2H9, Canada
| | - Jane E. Yardley
- Augustana Faculty, University of Alberta, 4901-46th Avenue, Camrose, AB T4V 2R3, Canada
- Physical Activity and Diabetes Laboratory, Alberta Diabetes Institute, 112 Street, Edmonton, AB T6G 2T9, Canada
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 3-100 University Hall, Van Vliet Complex, Edmonton, AB T6G 2H9, Canada
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Muacevic A, Adler JR, Awadalla AM, Ababneh F, AlMuneef MA. Factitious Hypoglycemia in an Infant With Undetectable Exogenous Insulin by a Commercial Insulin Immunoassay: A Diagnostic Pitfall. Cureus 2023; 15:e33224. [PMID: 36733550 PMCID: PMC9888595 DOI: 10.7759/cureus.33224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 01/02/2023] Open
Abstract
Factitious hypoglycemia in infancy is a rare, life-threatening manifestation of Munchausen syndrome by proxy (MSBP). The hallmark of such presentation is the detection of low c-peptide combined with high insulin at the time of hypoglycemia. We report the case of a male infant who presented with recurrent severe unexplained hypoglycemic episodes since the age of six months. Two of his siblings had similar unexplained hypoglycemia episodes at a young age. He was extensively investigated, and all were normal, for endocrine and metabolic etiologies. He underwent fundoplication and insertion of a gastrostomy tube with multiple lengthy hospital admissions. His mother had diabetes and was on insulin treatment; she also had mental health issues with family-related social stressors. His hypoglycemic attacks resolved once separated briefly from his mother on the ward, raising our suspicion of MSBP. The exogenous administration of insulin was only confirmed following a scheduled change of our local Insulin assay in our laboratory when his insulin was detectable with low C-peptide on one of his typical attacks. Apparently, our previous insulin immunoassay lacked sensitivity for his mother's long-acting insulin. We are reporting this case to raise awareness about this potential diagnostic pitfall.
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7
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Quantification of Insulin Analogs by Liquid Chromatography-High-Resolution Mass Spectrometry. Methods Mol Biol 2022; 2546:217-226. [PMID: 36127592 DOI: 10.1007/978-1-0716-2565-1_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Administration of exogenous insulin or insulin analogs is a common cause of hypoglycemia. The etiology of hypoglycemic episodes can be investigated by the measurement of insulin. However, frequently used synthetic insulin analogs show variable reactivity with immunoassays designed for the quantification of human insulin and may produce misleading results. To overcome this challenge, mass spectrometric methods can be applied to differentiate and accurately quantify insulin and its analogs. Here we describe a liquid chromatography-tandem high-resolution accurate mass (LC-HRAM) for the highly specific and independent quantification of insulin and its synthetic analogs including aspart, detemir, glargine, glulisine, and lispro. This method utilizes antibody affinity extraction followed by analysis on a high-resolution accurate mass spectrometer.
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8
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Lian K, Feng H, Liu S, Wang K, Liu Q, Deng L, Wang G, Chen Y, Liu G. Insulin quantification towards early diagnosis of prediabetes/diabetes. Biosens Bioelectron 2022; 203:114029. [DOI: 10.1016/j.bios.2022.114029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 12/19/2022]
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Suwaydi MA, Gridneva Z, Perrella SL, Wlodek ME, Lai CT, Geddes DT. Human Milk Metabolic Hormones: Analytical Methods and Current Understanding. Int J Mol Sci 2021; 22:ijms22168708. [PMID: 34445437 PMCID: PMC8395916 DOI: 10.3390/ijms22168708] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023] Open
Abstract
Human milk (HM) contains a wide array of peptide hormones including leptin and adiponectin, which are involved in the regulation of infant growth and development. These essential hormones might play an important role in the regulation of metabolic reprogramming of the new-born infant. However, HM hormone studies are sparse and heterogeneous in regard to the study design, sample collection, preparation and analysis methods. This review discussed the limitations of HM hormone analysis highlighting the gaps in pre-analytical and analytical stages. The methods used to quantify HM metabolic hormones (leptin, adiponectin, ghrelin, insulin, obestatin, resistin and apelin) can be classified as immunoassay, immunosensor and chromatography. Immunoassay methods (ELISA and RIA) have been predominantly used in the measurement of these HM hormones. The relative validity parameters of HM hormones analysis are often overlooked in publications, despite the complexity and differences of HM matrix when compared to that of plasma and urine. Therefore, appropriate reports of validation parameters of methodology and instrumentation are crucial for accurate measurements and therefore better understanding of the HM metabolic hormones and their influences on infant outcomes.
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Affiliation(s)
- Majed A. Suwaydi
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (M.A.S.); (S.L.P.); (M.E.W.); (C.T.L.); (D.T.G.)
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan 54142, Saudi Arabia
| | - Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (M.A.S.); (S.L.P.); (M.E.W.); (C.T.L.); (D.T.G.)
- Correspondence: ; Tel.: +61-8-6488-4467
| | - Sharon L. Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (M.A.S.); (S.L.P.); (M.E.W.); (C.T.L.); (D.T.G.)
| | - Mary E. Wlodek
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (M.A.S.); (S.L.P.); (M.E.W.); (C.T.L.); (D.T.G.)
- Population Health, Murdoch Children’s Research Institute (MCRI), Parkville, VIC 3052, Australia
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (M.A.S.); (S.L.P.); (M.E.W.); (C.T.L.); (D.T.G.)
| | - Donna T. Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (M.A.S.); (S.L.P.); (M.E.W.); (C.T.L.); (D.T.G.)
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Yukina M, Nuralieva N, Troshina E, Malysheva N, Zuraeva Z, Bratchikova A. Clinical Case of Surreptitious Hypoglycemia Due to Deliberate Insulin Analog Administration. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211009234. [PMID: 33958903 PMCID: PMC8064658 DOI: 10.1177/11795476211009234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
Hypoglycemic syndrome is a life-threatening condition that can lead to hypoglycemic coma and death. Surreptitious hypoglycemic syndrome is the deliberate use of insulin preparations or oral hypoglycemic drugs aimed to reduce blood glucose level. If human insulin is injected, high level of immunoreactive insulin (IRI) and low level of C-peptide at the moment of hypoglycemia are always detected. However, the fact of deliberate administration of insulin analogs is difficult to prove. In these cases if insulin kit test with low cross-reactivity with insulin analogs is used, the low levels of IRI and C-peptide will be suspected. Some experts suggest the presence of cross reactivity with analogs of insulin in a number of commercial kits, which makes it possible to detect cases of surreptitious hypoglycemia. We present a clinical case of a patient with surreptitious hypoglycemia due to the administration of insulin analogs and discuss the problems of its laboratory diagnosis.
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11
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Abstract
The qualitative and quantitative determination of insulin and its related substances (e. g., C-peptide) is of great importance in many different areas of analytical chemistry. In particular, due to the steadily increasing prevalence of metabolic disorders such as diabetes mellitus, an adequate control of the circulating amount of insulin is desirable. In addition, also in forensics and doping control analysis, the determination of insulin in blood, urine or other biological matrices plays a major role. However, in order to establish general reference values for insulin and C-peptide for diabetology, the comparability of measured concentrations is indispensable. This has not yet been fully implemented, although enormous progress has been made in recent years, and the search for a "gold standard" method is still ongoing. In addition to established ligand-binding assays, an increasing number of mass-spectrometric methods have been developed and employed as the to-date available systems (for example, high-resolution/high accuracy mass spectrometers) provide the sensitivity required to determine analyte concentrations in the sub-ng/mL (sub-100pmol/L) level. Meanwhile, also high-throughput measurements have been realized to meet the requirement of testing a high number of samples in a short period of time. Further developments aim at enabling the online measurement of insulin in the blood with the help of an insulin sensor and, in the following, in addition to a brief review, today's state of the art testing developments are summarized.
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Affiliation(s)
- Andreas Thomas
- Institute of Biochemistry/Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany.
| | - Mario Thevis
- Institute of Biochemistry/Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany; European Monitoring Center for Emerging Doping Agents (EuMoCEDA), Cologne/Bonn, Germany
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12
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Barmanray R, Chiang CY, Yeoh K, Yates CJ. A Case of Surreptitious Glargine Overdose Confirmed by Insulin Pharmacokinetic Time Curves. J Anal Toxicol 2019; 43:e4-e6. [PMID: 31329878 DOI: 10.1093/jat/bkz025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/04/2019] [Accepted: 03/30/2019] [Indexed: 11/15/2022] Open
Abstract
CASE A 49-year-old man presented with recurrent altered conscious state suggestive of encephalitis. This was followed by an episode of severe hypoglycemia requiring protracted intravenous glucose administration. Comparing the pharmacokinetic time curves of serum insulin levels on two insulin immunoassays with different insulin analog cross-reactivity allowed the likely diagnosis of surreptitious glargine overdose to be made rapidly. DISCUSSION The differing insulin analog cross-reactivity of serum insulin immunoassays, in this case the Abbott ARCHITECT and Roche Elecsys, allows the presence of insulin analog to be detected. Through comparison of time curves the characteristic signature of the specific causative insulin analog can be identified. This information confirms surreptitious insulin overdose in a timely manner, therefore avoiding the expensive and time-consuming investigations required to exclude alternate causes of severe hypoglycemia.
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Affiliation(s)
- Rahul Barmanray
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Cherie Ying Chiang
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Pathology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Kim Yeoh
- Department of Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Christopher James Yates
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
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Kaneko K, Satake C, Izumi T, Tanaka M, Yamamoto J, Asai Y, Sawada S, Imai J, Yamada T, Katagiri H. Enhancement of postprandial endogenous insulin secretion rather than exogenous insulin injection ameliorated insulin antibody-induced unstable diabetes: a case report. BMC Endocr Disord 2019; 19:5. [PMID: 30621663 PMCID: PMC6325663 DOI: 10.1186/s12902-018-0326-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/13/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Insulin injection, especially with insulin analogs, occasionally induces the production of insulin antibodies with high binding capacity and low affinity, similar to the insulin autoantibodies characteristic of insulin autoimmune syndrome (IAS). Production of these "IAS-like" insulin antibodies causes marked glycemic fluctuations with postprandial hyperglycemia and fasting hypoglycemia. CASE PRESENTATION A 66-year-old man with a 27-year history of diabetes was admitted because of marked glycemic fluctuations. Human insulin treatment had been initiated at age 56, followed by multiple daily injections of insulin analogs 5 years later. After the initial year of insulin analog treatment, the patient began to experience frequent morning hypoglycemic attacks and day-time hyperglycemia. Marked hyperinsulinemia (4500 μU/mL) and high titers of insulin antibodies (80.4%) with high binding capacity and low affinity indicated that IAS-like insulin antibodies were causing severe glucose fluctuations. Altering insulin formulations (insulin aspart → regular human insulin→ insulin lispro) proved to be ineffective. After several therapeutic trials, cessation of exogenous insulin and addition of mitiglinide to liraglutide with voglibose finally attenuated glycemic fluctuations with increased postprandial insulin secretion. Continuous glucose monitoring revealed improvement of morning hypoglycemia and postprandial hyperglycemia with smaller mean amplitude of glycemic excursion. Therefore, compared to exogenously injected insulin, endogenously secreted insulin directly and rapidly acts on hepatocytes and suppresses postprandial glucose output. CONCLUSIONS Proper enhancement of postprandial endogenous insulin aimed at suppressing postprandial glucose output without stimulating excessive glucose uptake in the periphery is potentially useful for treating diabetes with insulin antibody-induced glycemic instability.
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Affiliation(s)
- Keizo Kaneko
- Department of Diabetes and Metabolism, Tohoku University Hospital, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Chihiro Satake
- Department of Diabetes and Metabolism, Tohoku University Hospital, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Tomohito Izumi
- Department of Diabetes and Metabolism, Tohoku University Hospital, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Mamiko Tanaka
- Department of Diabetes and Metabolism, Tohoku University Hospital, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Junpei Yamamoto
- Department of Diabetes and Metabolism, Tohoku University Hospital, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Yoichiro Asai
- Department of Diabetes and Metabolism, Tohoku University Hospital, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Shojiro Sawada
- Department of Diabetes and Metabolism, Tohoku University Hospital, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Junta Imai
- Department of Diabetes and Metabolism, Tohoku University Hospital, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Tetsuya Yamada
- Department of Diabetes and Metabolism, Tohoku University Hospital, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Hideki Katagiri
- Department of Diabetes and Metabolism, Tohoku University Hospital, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi 980-8575 Japan
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Sato Y, Mizuno Y, Suganuma K, Shiroto K, Ikeda T, Yamashita K, Kimura T, Yamauchi K, Aizawa T. Pharmacokinetics of insulin disappearance after massive overdosing. Endocr J 2018; 65:1147-1153. [PMID: 30185719 DOI: 10.1507/endocrj.ej18-0118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Long-term glucose supplementation is required to prevent hypoglycemia after massive insulin overdosing. We fitted the blood insulin concentration-time profile to the model: I = A·exp(-a·t) + B·exp(-b·t), where I (μU/mL) is the serum/plasma insulin concentration, A (μU/mL) and B (μU/mL) are the peak insulin concentrations of each component, a (time-1) and b (time-1) are the time constants of each component, and t (h) is the time elapsed from the peak of blood insulin level. Additional components were considered as needed. Patient 1 had auto-injected 600 U NovoRapid® 30Mix, and Patient 2 had auto-injected 300 U Novolet®R (regular) and 1,800 U NovoLet®N (NPH). We used the disappearance of therapeutic doses of the respective insulin in healthy individuals as controls, and we obtained parameters by Excel solver. In Patient 1, the parameter values were A = 1490.04 and a = 0.15 for insulin aspart and B = 60.66 and b = 0.04 for protaminated aspart. In Patient 2, the values were A = 784.45 and a = 0.38 for regular insulin and B = 395.84 and b = 0.03 for NPH. Compared with controls, the half-lives (t1/2) for insulin aspart and protaminated aspart were 4 and 2 times longer, respectively, in Patient 1. In Patient 2, the t1/2 for regular and NPH insulin were 2 and 7 times longer than those in the controls, respectively. In conclusion, the t1/2 for insulin was elongated 2 to 7 times after massive overdosing, explaining why glucose supplementation is needed for long periods in these cases.
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Affiliation(s)
- Yuka Sato
- Diabetes Center, Aizawa Hospital, Matsumoto, 390-8510, Japan
| | - Yuta Mizuno
- Department of Critical Care and Emergency Medicine, Aizawa Hospital, Matsumoto, 390-8510, Japan
| | - Kazuki Suganuma
- Department of Critical Care and Emergency Medicine, Aizawa Hospital, Matsumoto, 390-8510, Japan
| | - Kosuke Shiroto
- Department of Critical Care and Emergency Medicine, Aizawa Hospital, Matsumoto, 390-8510, Japan
| | - Takeshi Ikeda
- Intensive Care Unit, Aizawa Hospital, Matsumoto, 390-8510, Japan
| | - Koh Yamashita
- Diabetes Center, Aizawa Hospital, Matsumoto, 390-8510, Japan
| | - Toshihide Kimura
- Department of Pharmacology, Oita University Faculty of Medicine, Oita, 879-5533, Japan
| | - Keishi Yamauchi
- Department of Diabetes, Endocrinology and Metabolism, International University of Health and Welfare Shioya Hospital, Yaita, 329-2145, Japan
| | - Toru Aizawa
- Diabetes Center, Aizawa Hospital, Matsumoto, 390-8510, Japan
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15
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Oh J, Kim JH, Park HD. Clinical Utility and Cross-Reactivity of Insulin and C-Peptide Assays by the Lumipulse G1200 System. Ann Lab Med 2018; 38:530-537. [PMID: 30027696 PMCID: PMC6056384 DOI: 10.3343/alm.2018.38.6.530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/21/2018] [Accepted: 07/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Measurement of insulin and C-peptide concentrations is important for deciding whether insulin treatment is required in diabetic patients. We aimed to investigate the analytical performance of insulin and C-peptide assays using the Lumipulse G1200 system (Fujirebio Inc., Tokyo, Japan). METHODS We examined the precision, linearity, and cross-reactivity of insulin and C-peptide using five insulin analogues and purified proinsulin. A method comparison was conducted between the Lumipulse G1200 and Roche E170 (Roche Diagnostics, Mannheim, Germany) systems in 200 diabetic patients on insulin treatment. Reference intervals for insulin and C-peptide concentrations were determined in 279 healthy individuals. RESULTS For insulin and C-peptide assays, within-laboratory precision (% CV) was 3.78-4.14 and 2.89-3.35%, respectively. The linearity of the insulin assay in the range of 0-2,778 pmol/L was R²=0.9997, and that of the C-peptide assay in the range of 0-10 nmol/L was R²=0.9996. The correlation coefficient (r) between the Roche E170 and Lumipulse G1200 results was 0.943 (P<0.001) for insulin and 0.996 (P<0.001) for C-peptide. The mean differences in insulin and C-peptide between Lumipulse G1200 and the Roche E170 were 19.4 pmol/L and 0.2 nmol/L, respectively. None of the insulin analogues or proinsulin showed significant cross-reactivity with the Lumipulse G1200. Reference intervals of insulin and C-peptide were 7.64-70.14 pmol/L and 0.17-0.85 nmol/L, respectively. CONCLUSIONS Insulin and C-peptide tests on the Lumipulse G1200 show adequate analytical performance and are expected to be acceptable for use in clinical areas.
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Affiliation(s)
- Jongwon Oh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Doo Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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16
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Anderson LJ, Tamayose JM, Garcia JM. Use of growth hormone, IGF-I, and insulin for anabolic purpose: Pharmacological basis, methods of detection, and adverse effects. Mol Cell Endocrinol 2018; 464:65-74. [PMID: 28606865 PMCID: PMC5723243 DOI: 10.1016/j.mce.2017.06.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/02/2017] [Accepted: 06/08/2017] [Indexed: 12/24/2022]
Abstract
Hormones with anabolic properties such as growth hormone (GH), insulin-like growth factor-1 (IGF-I), and insulin are commonly abused among professional and recreational athletes to enhance physical ability. Performance enhancing drugs (PEDs) such as these are also commonly used by recreational athletes to improve body aesthetics. The perception of increased muscle mass due to supraphysiologic hormone supplementation, or doping, is widespread among PED users despite a paucity of evidence-based data in humans. Even still, athletes will continue to abuse PEDs in hopes of replicating anecdotal results. It is important to educate the general public and potential treating physicians of the risks of PED use, including the dangers of polypharmacy and substance dependence. It will also be important for the research community to address the common challenges associated with studying PED use such as the ethical considerations of PED administration, the general reticence of the PED-using community to volunteer information, and the constant need to improve or create new detection methods as athletes continually attempt to circumvent current methods. This review highlights the anabolic mechanisms and suggestive data implicating GH, IGF-I, and insulin for use as PEDs, the specific detection methods with cutoff ranges that may be utilized to diagnose abuse of each substance, and their respective side effects.
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Affiliation(s)
- Lindsey J Anderson
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Jamie M Tamayose
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Jose M Garcia
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, United States; Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, WA, United States.
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17
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Chemmanam J, Isaacs M, Jones GR, Greenfield JR, Burt MG. Interpreting insulin immunoassays during investigation of apparent spontaneous hypoglycaemia and insulin overdose. Intern Med J 2017; 47:1448-1451. [PMID: 29224198 DOI: 10.1111/imj.13644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/02/2017] [Accepted: 05/24/2017] [Indexed: 10/18/2022]
Abstract
We report two cases of hypoglycaemia; one with apparently spontaneous hypoglycaemia and one with presumed insulin overdose. In both cases insulin concentration was normal when measured with the Roche immunoassay, but elevated when remeasured with the Advia Centaur immunoassay and a diagnosis of hypoglycaemia secondary to insulin analogue administration was made. These cases highlight that physicians need to understand the binding characteristics of the insulin immunoassay they use.
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Affiliation(s)
- Julie Chemmanam
- Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, South Austalia, Australia
| | - Michelle Isaacs
- Department of Endocrinology, St Vincent's Hospital, New South Wales, Australia
| | - Graham R Jones
- Department of Chemical Pathology, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of NSW, New South Wales, Australia
| | - Jerry R Greenfield
- Department of Endocrinology, St Vincent's Hospital, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of NSW, New South Wales, Australia.,Diabetes and Metabolism Research Program, Garvan Institute of Medical Research, New South Wales, Australia
| | - Morton G Burt
- Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, South Austalia, Australia.,School of Medicine, Flinders University, Adelaide, South Austalia, Australia
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18
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Unni SNC, Lakshman LR, Vaidyanathan K, Subhakumari KN, Menon NL. Alterations in the levels of plasma amino acids in polycystic ovary syndrome--A pilot study. Indian J Med Res 2016; 142:549-54. [PMID: 26658589 PMCID: PMC4743341 DOI: 10.4103/0971-5916.171281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background & objectives: Plasma amino acid levels are known to be altered in conditions like sepsis and burns which are situations of metabolic stress. Polycystic ovary syndrome (PCOS), a condition which affects a woman throughout her life, is said to be associated with metabolic stress. This study was undertaken to assess if there were significant alterations in the levels of plasma amino acids in women with PCOS. Methods: Sixty five women with PCOS along with the similar number of age matched normal controls were included in this study. Levels of 14 amino acids were determined using reverse phase high performance liquid chromatography. Results: The levels of methionine, cystine, isoleucine, phenylalanine, valine, tyrosine, proline, glycine, lysine and histidine were found to be significantly (P<0.001) lower in cases than in controls. Arginine and alanine levels were found to be significantly (P<0.001) higher in cases compared with controls. Interpretation & conclusions: Our findings showed significant derangement in the levels of plasma amino acids in women with PCOS which might be due to the oxidative and metabolic stress associated with it. Further studies need to be done to confirm the findings.
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Affiliation(s)
| | | | | | | | - N Leela Menon
- Department of Biochemistry, Amrita Institute of Medical Sciences & Research Centre, Kochi, India
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19
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Kahanovitz L, Seker E, Marks RS, Yarmush ML, Konry T, Russell SJ. Development of a Microsphere-Based System to Facilitate Real-Time Insulin Monitoring. J Diabetes Sci Technol 2016; 10:689-96. [PMID: 26721524 PMCID: PMC5038538 DOI: 10.1177/1932296815625081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The speed of insulin absorption after subcutaneous delivery is highly variable. Incorrect assumptions about insulin pharmacokinetics compromise effective glycemic regulation. Our ultimate goal is to develop a system to monitor insulin levels in vivo continuously, allowing pharmacokinetic parameters to be calculated in real time. We hypothesize that a bead-based detection system can be run on a flow-through microfluidic platform to measure insulin in subcutaneous fluid sampled via microdialysis. As a first step in development, we focused on microsphere-based measurement of insulin. METHODS Polystyrene microspheres coated with an anti-insulin monoclonal antibody were exposed to insulin-containing solutions, and after addition of a fluorescently labeled anti-insulin monoclonal antibody with a distinct epitope, bead-associated fluorescence was detected by fluorescence microscopy in 96-well plates or in a flow-through, microfluidic platform. RESULTS The bead detection system in plates had a linear range in buffer for regular human insulin (RHI), insulin lispro, and insulin aspart of 15-1115 µIU/ml, 14-976 µIU/ml, and 25-836 µIU/ml, respectively. Measurement on plasma samples demonstrated proportionality between basal and peak insulin levels similar to the laboratory reference method. Preliminary results in a polydimethylsiloxane-based, flow-through, microfluidic platform showed a strong signal at peak insulin levels. CONCLUSIONS We have developed a microsphere-based system to rapidly measure levels of insulin and insulin analogs. We have further demonstrated proof of concept that this bead detection system can be implemented in a lab-on-a-chip format, which will be further developed and combined with microdialysis for real-time monitoring of insulin in vivo.
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Affiliation(s)
- Lindy Kahanovitz
- Department of Biotechnology Engineering, Ben Gurion University of the Negev, Beer Sheva, Israel Diabetes Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Erkin Seker
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Shriners Burns Institute, Boston, MA, USA Department of Electrical and Computer Engineering, University of California, Davis, Davis, CA, USA
| | - Robert S Marks
- Department of Biotechnology Engineering, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Martin L Yarmush
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Shriners Burns Institute, Boston, MA, USA
| | - Tania Konry
- Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Shriners Burns Institute, Boston, MA, USA Department of Pharmaceutical Sciences, Northeastern University, Boston, MA, USA
| | - Steven J Russell
- Diabetes Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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20
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Strazhesko I, Tkacheva O, Boytsov S, Akasheva D, Dudinskaya E, Vygodin V, Skvortsov D, Nilsson P. Association of Insulin Resistance, Arterial Stiffness and Telomere Length in Adults Free of Cardiovascular Diseases. PLoS One 2015; 10:e0136676. [PMID: 26308091 PMCID: PMC4550423 DOI: 10.1371/journal.pone.0136676] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/06/2015] [Indexed: 01/11/2023] Open
Abstract
Background Chronic inflammation and oxidative stress might be considered the key mechanisms of aging. Insulin resistance (IR) is a phenomenon related to inflammatory and oxidative stress. We tested the hypothesis that IR may be associated with cellular senescence, as measured by leukocyte telomere length (LTL), and arterial stiffness (core feature of arterial aging), as measured by carotid-femoral pulse wave velocity (c-f PWV). Methods The study group included 303 subjects, mean age 51.8 ±13.3 years, free of known cardiovascular diseases and regular drug consumption. For each patient, blood pressure was measured, blood samples were available for biochemical parameters, and LTL was analyzed by real time q PCR. C-f PWV was measured with the help of SphygmoCor. SAS 9.1 was used for statistical analysis. Results Through multiple linear regression analysis, c-f PWV is independently and positively associated with age (p = 0.0001) and the homeostasis model assessment of insulin resistance (HOMA-IR; p = 0.0001) and independently negatively associated with LTL (p = 0.0378). HOMA-IR seems to have a stronger influence than SBP on arterial stiffness. In all subjects, age, HOMA-IR, LTL, and SBP predicted 32% of the variance in c-f PWV. LTL was inversely associated with HOMA-IR (p = 0.0001) and age (p = 0.0001). In all subjects, HOMA-IR, age, sex, and SBP predicted 16% of the variance in LTL. Conclusions These data suggest that IR is associated with cell senescence and arterial aging and could, therefore, become the main target in preventing accelerated arterial aging, besides blood pressure control. Research in telomere biology may reveal new ways of estimating cardiovascular aging and risk.
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Affiliation(s)
- Irina Strazhesko
- Department of aging and age-associated diseases prevention, National Research Center for Preventive Medicine, Moscow, Russian Federation
- * E-mail:
| | - Olga Tkacheva
- Department of aging and age-associated diseases prevention, National Research Center for Preventive Medicine, Moscow, Russian Federation
| | - Sergey Boytsov
- Department of Clinical Cardiology and Molecular Genetics, National Research Center for Preventive Medicine, Moscow, Russian Federation
| | - Dariga Akasheva
- Department of aging and age-associated diseases prevention, National Research Center for Preventive Medicine, Moscow, Russian Federation
| | - Ekaterina Dudinskaya
- Department of aging and age-associated diseases prevention, National Research Center for Preventive Medicine, Moscow, Russian Federation
| | - Vladimir Vygodin
- Department of Epidemiology of Chronic Non-Communicable Diseases Laboratory of Biostatistics, National Research Center for Preventive Medicine, Moscow, Russian Federation
| | - Dmitry Skvortsov
- Department of Chemistry, Lomonosov Moscow State University, Moscow, Russian Federation
| | - Peter Nilsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmo, Sweden
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21
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Parfitt C, Church D, Armston A, Couchman L, Evans C, Wark G, McDonald TJ. Commercial insulin immunoassays fail to detect commonly prescribed insulin analogues. Clin Biochem 2015; 48:1354-7. [PMID: 26171976 DOI: 10.1016/j.clinbiochem.2015.07.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/09/2015] [Accepted: 07/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Blood insulin and C-peptide are key investigations in the differential diagnosis of hypoglycaemia. Analogues of insulin have modified primary-sequences compared to native human insulin, as such may not cross react with insulin assays. This has important implications in detecting surreptitious or malicious insulin administration. The aim of this study is to assess the cross-reactivity of all insulins currently listed in the British National Formulary (BNF65, 2013) in clinical insulin assays currently used in UK clinical laboratories. DESIGN AND METHODS Sample sets were prepared for all 15 exogenous insulin classes listed in the BNF, at concentrations of 1000 pmol/L and 300 pmol/L, using pooled human serum. Samples were sent blinded to 5 participating analytical laboratories to cover analysis on the 10 major clinical insulin assays used in the UK. RESULTS The ability of insulin assays to detect exogenous insulin preparations was highly variable and ranged from 0% to >140% for a single exogenous insulin. Four assays were highly specific for the human insulin sequence and had no cross-reactivity with any synthetic analogue insulin. Two detected all insulin types (human sequence, animal and synthetic analogue), with the remaining having variable cross-reactivity. CONCLUSION The cross-reactivity of the 15 exogenous insulin preparations is highly variable in the assays used in clinical laboratories around the UK. It is important that laboratories and clinicians are aware of the limitations of their local assays to avoid missing the important diagnosis of hypoglycaemia secondary to excessive exogenous insulin. Where necessary, samples should be referred to specialist centres for insulin analysis and ideally by a validated and fully-quantitative mass spectrometry-based method.
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Affiliation(s)
- C Parfitt
- Blood Sciences, Royal Devon and Exeter Foundation Trust, UK
| | - D Church
- Department of Clinical Biochemistry, Addenbrooke's Hospital, UK; University of Cambridge Metabolic Research Laboratories, UK
| | - A Armston
- Department of Laboratory Medicine, University Hospital Southampton, UK
| | - L Couchman
- Viapath, Department of Clinical Biochemistry, King's College Hospital, London, UK
| | - C Evans
- Department of Medical Biochemistry & Immunology, University Hospital of Wales, UK
| | - G Wark
- Surrey Pathology Services, Royal Surrey County Hospital, UK
| | - T J McDonald
- Blood Sciences, Royal Devon and Exeter Foundation Trust, UK; NIHR Exeter Clinical Research Facility, University of Exeter, UK.
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22
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Nalbantoğlu Elmas Ö, Demir K, Soylu N, Çelik N, Özkan B. Importance of insulin immunoassays in the diagnosis of factitious hypoglycemia. J Clin Res Pediatr Endocrinol 2014; 6:258-61. [PMID: 25541899 PMCID: PMC4293663 DOI: 10.4274/jcrpe.1492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We report two cases emphasizing the importance of insulin assays for evaluation of hypoglycemia in diabetic patients. Case 1 was a 96/12-year-old female patient with type 1 diabetes mellitus and case 2 was a 1010/12-year-old male patient with DIDMOAD. Both patients were on a basal-bolus insulin regimen. Both were admitted because of persistent hypoglycemia. Analyses of serum samples obtained at the time of hypoglycemia initially showed low insulin and C-peptide levels. Recurrent episodes of unexplained hypoglycemia necessitated measurement of insulin levels by using different insulin assays, which revealed hyperinsulinemic hypoglycemia with low C-peptide levels, findings which confirmed a diagnosis of factitious hypoglycemia. Surreptitious administration of insulin should not be excluded in diabetic patients with hypoglycemia without taking into account the rate of cross-reactivity of insulin analogues with the insulin assay used.
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Affiliation(s)
| | - Korcan Demir
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
,* Address for Correspondence: Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey GSM: +90 505 525 2743 E-mail:
| | - Nusret Soylu
- Children’s Hospital, Clinic of Child and Adolescent Psychiatry, Gaziantep, Turkey
| | - Nilüfer Çelik
- Dr. Behçet Uz Children’s Hospital, Division of Biochemistry, İzmir, Turkey
| | - Behzat Özkan
- Dr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
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23
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Dayaldasani A, Rodríguez Espinosa M, Ocón Sánchez P, Pérez Valero V. Cross-reactivity of insulin analogues with three insulin assays. Ann Clin Biochem 2014; 52:312-8. [DOI: 10.1177/0004563214551613] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 11/15/2022]
Abstract
Background Immunometric assays have recently shown higher specificity in the detection of human insulin than radioimmunoassays with almost no cross-reaction with proinsulin or C peptide. The introduction of the new insulin analogues on the market, however, has raised the need to define their cross-reactivity in these assays. Several studies have been published in this regard with different results. Methods The analogues studied were insulins lispro, aspart, glargine, detemir, and glulisine. Insulin concentrations were measured in Immulite® 2000 and Advia Centaur® XP (Siemens Healthcare Diagnostics), and Elecsys® Modular Analytics E170 (Roche). All samples were processed 15 times in the same analytical run following a random sequence. Those samples which showed statistically and clinically significant changes in insulin concentration were reprocessed using increasing concentrations of analogue, and this was done twice, using two different serum pools, one with a low concentration of insulin and one with a high concentration of insulin. Results In the Elecsys® E170 analyser, glargine showed statistical changes (comparison of mean concentrations with p < 0.05) and clinically significant changes in measured insulin (percentage difference 986.2% > reference change value: 59.8%), and the interference increased with increasing concentrations of analogue; the differences were not significant in the case of the other analogues. In the Advia Centaur® and Immulite® 2000 only the results for glulisine did not present significance (percentage difference 44.7% < reference change value 103.5%). Increasing concentrations of aspart, glargine, and lispro showed increased interference in Immulite® 2000. Conclusions In the Elecsys® E170 assay, relevant cross-reactivity was only detected with insulin glargine, whereas in the other analysers all analogues except glulisine showed significant interference.
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Affiliation(s)
- A Dayaldasani
- General Laboratory, Regional University Hospital, Málaga, Spain
| | | | - P Ocón Sánchez
- General Laboratory, Regional University Hospital, Málaga, Spain
| | - V Pérez Valero
- General Laboratory, Regional University Hospital, Málaga, Spain
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Peterman S, Niederkofler EE, Phillips DA, Krastins B, Kiernan UA, Tubbs KA, Nedelkov D, Prakash A, Vogelsang MS, Schoeder T, Couchman L, Taylor DR, Moniz CF, Vadali G, Byram G, Lopez MF. An automated, high-throughput method for targeted quantification of intact insulin and its therapeutic analogs in human serum or plasma coupling mass spectrometric immunoassay with high resolution and accurate mass detection (MSIA-HR/AM). Proteomics 2014; 14:1445-56. [DOI: 10.1002/pmic.201300300] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 01/08/2014] [Accepted: 03/24/2014] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Amol Prakash
- Thermo Fisher Scientific; BRIMS; Cambridge MA USA
| | | | | | - Lewis Couchman
- Department of Clinical Biochemistry; King's College Hospital NHS Foundation Trust; London UK
| | - David R. Taylor
- Department of Clinical Biochemistry; King's College Hospital NHS Foundation Trust; London UK
| | - Cajetan F. Moniz
- Department of Clinical Biochemistry; King's College Hospital NHS Foundation Trust; London UK
| | - Gouri Vadali
- Thermo Fisher Scientific; BRIMS; Cambridge MA USA
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Differential interferences of hemoglobin and hemolysis on insulin assay with the Abbott Architect®-Ci8200 immunoassay. Clin Biochem 2014; 47:445-7. [DOI: 10.1016/j.clinbiochem.2014.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/18/2013] [Accepted: 01/24/2014] [Indexed: 11/29/2022]
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Heurtault B, Reix N, Meyer N, Gasser F, Wendling MJ, Ratomponirina C, Jeandidier N, Sapin R, Agin A. Extensive study of human insulin immunoassays: promises and pitfalls for insulin analogue detection and quantification. ACTA ACUST UNITED AC 2013; 52:355-62. [DOI: 10.1515/cclm-2013-0427] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/04/2013] [Indexed: 11/15/2022]
Abstract
Abstract
Background: Over the last few decades, new synthetic insulin analogues have been developed. Their measurement is of prime importance in the investigation of hypoglycaemia, but their quantification is hampered by variable cross-reactivity with many insulin assays. For clinical analysis, it has now become essential to know the potential cross-reactivity of analogues of interest.
Methods: In this work, we performed an extensive study of insulin analogue cross-reactivity using numerous human insulin immunoassays. We investigated the cross-reactivity of five analogues (lispro, aspart, glulisine, glargine, detemir) and two glargine metabolites (M1 and M2) with 16 commercial human insulin immunoassays as a function of concentration.
Results: The cross-reactivity values for insulin analogues or glargine metabolites ranged from 0% to 264%. Four assays were more specific to human insulin, resulting in negligible cross-reactivity with the analogues. However, none of the 16 assays was completely free of cross-reactivity with analogues or metabolites. The results show that analogue cross-reactivity, which varies to a large degree, is far from negligible, and should not be overlooked in clinical investigations.
Conclusions: This study has established the cross-reactivity of five insulin analogues and two glargine metabolites using 16 immunoassays to facilitate the choice of the immunoassay(s) and to provide sensitive and specific analyses in clinical routine or investigation.
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Affiliation(s)
- Béatrice Heurtault
- Laboratoire d’Hormonologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Equipe de Biovectorologie, Laboratoire de Conception et Application de Molécules Bioactives, UMR 7199 CNRS/Université de Strasbourg, Faculté de Pharmacie, Illkirch Graffenstaden, France
| | - Nathalie Reix
- Laboratoire d’Hormonologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- ICube UMR7357 Université de Strasbourg/CNRS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Nicolas Meyer
- Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Françoise Gasser
- Laboratoire d’Hormonologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marie-Josée Wendling
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Charline Ratomponirina
- Laboratoire de Biochimie et de Biologie Moléculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nathalie Jeandidier
- Service d’endocrinologie et des maladies de la nutrition, Pôle NUDE, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Rémy Sapin
- Laboratoire d’Hormonologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Arnaud Agin
- Laboratoire d’Hormonologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- ICube UMR7357 Université de Strasbourg/CNRS, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
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Clinical application of the different cross-reactivities of anti-insulin antibodies to insulin lispro to evaluate endogenous insulin secretion. Clin Chim Acta 2013; 415:250-4. [DOI: 10.1016/j.cca.2012.10.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 10/11/2012] [Accepted: 10/29/2012] [Indexed: 01/09/2023]
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Development of a fast method for direct analysis of intact synthetic insulins in human plasma: the large peptide challenge. Bioanalysis 2013; 5:65-81. [DOI: 10.4155/bio.12.290] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Intact insulins are difficult to analyze by LC–MS/MS due to nonspecific binding and poor sensitivity, solubility and fragmentation. This work aims to provide a simpler, faster LC–MS method and focuses on solving the above issues. Results: A novel charged-surface chromatographic column produced peak widths for insulin that were significantly narrower than traditional C18 columns when using formic acid as mobile phase. Mass spectral fragments m/z >700 provided greater specificity, significantly reducing endogenous background. Detection limits in human plasma were 0.2 ng/ml for insulin glargine, glulisine and detemir, and 0.5 ng/ml for insulin aspart. Average accuracy for standard curve and QC samples was 93.4%. Conclusion: A simple SPE LC–MS analysis was developed for direct, simultaneous quantification of insulin glargine, detemir, aspart and glulisine.
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Simultaneous determination and validated quantification of human insulin and its synthetic analogues in human blood serum by immunoaffinity purification and liquid chromatography-mass spectrometry. Anal Bioanal Chem 2012; 404:1813-22. [DOI: 10.1007/s00216-012-6271-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/26/2012] [Accepted: 07/13/2012] [Indexed: 01/08/2023]
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Ando H, Kurita S, Shimizu A, Kato KI, Ishikura K, Taji K, Uno M, Takeshita Y, Misu H, Fujimura A, Kaneko S, Takamura T. Pharmacokinetics and pharmacodynamics of insulin aspart in patients with Type 2 diabetes: Assessment using a meal tolerance test under clinical conditions. Clin Exp Pharmacol Physiol 2012; 39:528-34. [DOI: 10.1111/j.1440-1681.2012.05708.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Seiichiro Kurita
- Department of Disease Control and Homeostasis; Kanazawa University Graduate School of Medical Science; Kanazawa; Japan
| | - Akiko Shimizu
- Department of Disease Control and Homeostasis; Kanazawa University Graduate School of Medical Science; Kanazawa; Japan
| | - Ken-ichiro Kato
- Department of Disease Control and Homeostasis; Kanazawa University Graduate School of Medical Science; Kanazawa; Japan
| | - Kazuhide Ishikura
- Department of Disease Control and Homeostasis; Kanazawa University Graduate School of Medical Science; Kanazawa; Japan
| | - Koumei Taji
- Department of Disease Control and Homeostasis; Kanazawa University Graduate School of Medical Science; Kanazawa; Japan
| | - Masafumi Uno
- Department of Disease Control and Homeostasis; Kanazawa University Graduate School of Medical Science; Kanazawa; Japan
| | - Yumie Takeshita
- Department of Disease Control and Homeostasis; Kanazawa University Graduate School of Medical Science; Kanazawa; Japan
| | - Hirofumi Misu
- Department of Disease Control and Homeostasis; Kanazawa University Graduate School of Medical Science; Kanazawa; Japan
| | - Akio Fujimura
- Division of Clinical Pharmacology; Department of Pharmacology; School of Medicine; Jichi Medical University; Shimotsuke; Japan
| | - Shuichi Kaneko
- Department of Disease Control and Homeostasis; Kanazawa University Graduate School of Medical Science; Kanazawa; Japan
| | - Toshinari Takamura
- Department of Disease Control and Homeostasis; Kanazawa University Graduate School of Medical Science; Kanazawa; Japan
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Perälä MM, Valsta LM, Kajantie E, Leiviskä J, Eriksson JG. Impact of early growth on postprandial responses in later life. PLoS One 2011; 6:e24070. [PMID: 21904606 PMCID: PMC3164134 DOI: 10.1371/journal.pone.0024070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 07/29/2011] [Indexed: 12/15/2022] Open
Abstract
Background Low birth weight and slow growth during infancy are associated with increased rates of chronic diseases in adulthood. Associations with risk factors such as fasting glucose and lipids concentrations are weaker than expected based on associations with disease. This could be explained by differences in postprandial responses, which, however, have been little studied. Our aim was to examine the impact of growth during infancy on postprandial responses to a fast-food meal (FF-meal) and a meal, which followed the macro-nutrient composition of the dietary guidelines (REC-meal). Methodology/Principal Findings We recruited 24 overweight 65–75 year-old subjects, 12 with slow growth during infancy (SGI-group) and 12 with normal early growth. All the subjects were born at term. The study meals were isocaloric and both meals were consumed once. Plasma glucose, insulin, triglycerides (TG) and free fatty acids (FFA) were measured in fasting state and over a 4-h period after both meals. Subjects who grew slowly during infancy were also smaller at birth. Fasting glucose, insulin or lipid concentrations did not differ significantly between the groups. The TG responses were higher for the SGI-group both during the FF-meal (P = 0.047) and the REC-meal (P = 0.058). The insulin responses were significantly higher for the SGI-group after the FF-meal (P = 0.036). Glucose and FFA responses did not differ significantly between the groups. Conclusions Small birth size and slow early growth predict postprandial TG and insulin responses. Elevated responses might be one explanation why subjects who were small at birth and experiencing slow growth in infancy are at an increased risk of developing cardiovascular diseases in later life.
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Affiliation(s)
- Mia-Maria Perälä
- Department of Chronic Disease Prevention, The National Institute for Health and Welfare, Helsinki, Finland.
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Insights in regulated bioanalysis of human insulin and insulin analogs by immunoanalytical methods. Bioanalysis 2011; 3:883-98. [PMID: 21510762 DOI: 10.4155/bio.11.50] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite the long and illustrious history of insulin and insulin analogs as important biotherapeutics, the regulated bioanalysis (in this article, regulated bioanalysis refers to the formalized process for generating bioanalytical data to support pharmacokinetic and toxicokinetic assessments intended for development of insulin and insulin analogs as biotherapeutics, as opposed to the analytical process used for measuring insulin as a biomarker) of these peptides remains a challenging endeavor for a number of reasons. Paramount is the fact that the therapeutic concentrations are often low in serum/plasma and not too dissimilar from the endogenous level, particularly in patients with insulin resistance, such as Type 2 diabetes mellitus. Accordingly, this perspective was written to provide helpful background information for the design and conduct of immunoassays to support regulated bioanalysis of insulin and insulin analogs. Specifically, it highlights the technical challenges for determination of insulin and insulin analogs by immunoanalytical methods that are intended to support evaluations of pharmacokinetics and toxicokinetics. In a broader sense, this perspective describes the general bioanalytical issues that are common to regulated bioanalysis of peptides and articulates some of the bioanalytical differences between conventional monoclonal antibodies and peptide therapeutics.
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Gruson D, Maisin D, Preumont V, Vandeleene B. Cross-reactivity of insulin analogs with the Diasorin Liaison Insulin assay. Clin Chem Lab Med 2011; 49:1081-2. [DOI: 10.1515/cclm.2011.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rosenthal MA, Katz HB. An innovative method for determining lipemia interference in blood specimens. Clin Chim Acta 2010; 412:665-7. [PMID: 21108941 DOI: 10.1016/j.cca.2010.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 11/11/2010] [Accepted: 11/15/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lipemia interference in blood samples is usually determined by adding exogenous substances that cause turbidity or by using ultracentrifugation to clarify the sample. However, there are a number of problems associated with these methods, which make it difficult to ascertain with certainty that lipemia is the cause of interference. We assessed a novel method for evaluating lipemia interference. METHODS Lipemic and non-lipemic serum samples, with similar HDL cholesterol concentrations, were mixed in various proportions (5 concentrations) and assayed for HDL and triglycerides. Thus, matched HDL samples with increasing triglycerides concentrations were tested. We then calculated the percent recovery for HDL for each mixture. RESULTS Six matched sets of samples had HDL recoveries ranging from 95.9% to 101.1% (n=6 sets, 5 concentrations per set, total of 30 concentrations), with HDL concentrations ranging from 0.78 to 2.16 mmol/l. Triglycerides concentrations in these samples ranged from 1.06 to 9.78 mmol/l for the 30 concentrations. CONCLUSIONS We determined that there was no triglycerides interference on the HDL method performed on the Hitachi S40 Clinical Analyzer up to a triglycerides concentration of 9.78 mmol/l. This matching method is simple to perform and proved useful in evaluating interference due to lipemia.
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Musshoff F, Hess C, Madea B. Disorders of glucose metabolism: post mortem analyses in forensic cases–part II. Int J Legal Med 2010; 125:171-80. [DOI: 10.1007/s00414-010-0510-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 08/24/2010] [Indexed: 11/24/2022]
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Glenn C, Armston A. Cross-reactivity of 12 recombinant insulin preparations in the Beckman Unicel DxI 800 insulin assay. Ann Clin Biochem 2010; 47:264-6. [DOI: 10.1258/acb.2010.010002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Insulin analogues used in the treatment of insulin-dependent diabetes may result in hypoglycaemia; however, these preparations show variable cross-reactivity in many insulin assays. In order to investigate a suspected insulin overdose, it is therefore essential to characterize the cross-reactivity of these preparations in insulin assays. Methods The cross-reactivity of 12 commercial insulin preparations was assessed on the Beckman DxI analyser, by comparison with the insulin calibration curve corresponding to the midpoint of the dose–response curve. This was achieved by manually plotting the relative light units generated by the analyser for each preparation. Results All 12 insulin preparations examined showed significant cross-reactivity with the Beckman DxI insulin assay, with 11 of the insulin preparations demonstrating cross-reactivity of 83% or greater. The lowest cross-reactivity was observed with detemir with a value of 47.6%. Conclusion When investigating hypoglycaemia it is important to be aware of the cross-reactivity of the recombinant insulin analogues in insulin assays. This study has established the cross-reactivity of 12 preparations in the Beckman DxI insulin assay.
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Affiliation(s)
- Christine Glenn
- Endocrine Laboratory, Laboratory Medicine, Mail point 087, Level D, South Academic Block, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Annie Armston
- Endocrine Laboratory, Laboratory Medicine, Mail point 087, Level D, South Academic Block, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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Pollex EK, Feig DS, Lubetsky A, Yip PM, Koren G. Insulin glargine safety in pregnancy: a transplacental transfer study. Diabetes Care 2010; 33:29-33. [PMID: 19808914 PMCID: PMC2797979 DOI: 10.2337/dc09-1045] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 09/14/2009] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Insulin glargine (Lantus) is an extended-action insulin analog with greater stability and duration of action than regular human insulin. The long duration of action and decreased incidence of hypoglycemia provide potential advantages for its use in pregnancy. However, the placental pharmacokinetics of insulin glargine have not been studied. Therefore, the objective of this study was to determine whether insulin glargine crosses the human placenta using the human perfused placental lobule technique. RESEARCH DESIGN AND METHODS Placentae were obtained with informed consent after elective cesarean section delivery of noncomplicated term pregnancies. Insulin glargine, at a therapeutic concentration of 150 pmol/l (20 microU/ml) was added to the maternal circulation. Additional experiments were carried out at insulin glargine concentrations 1,000-fold higher than therapeutic levels (150, 225, and 300 nmol/l). A subsequent perfusion for which the maternal circuit remained open and insulin glargine was continuously infused at 150 pmol/l was completed for further confirmation of findings. The appearance of insulin glargine in the fetal circulation was analyzed by a chemiluminescence immunoassay. RESULTS Results from perfusions carried out at therapeutic concentrations (150 pmol/l) of insulin glargine showed no detectable insulin glargine in the fetal circuit. After perfusion with very high insulin glargine concentrations of 150, 225, and 300 nmol/l, the rate of transfer remained low at 0.079 +/- 0.01, 0.14, and 0.064 pmol . min(-1) . g tissue(-1), respectively. CONCLUSIONS Insulin glargine, when used at therapeutic concentrations, is not likely to cross the placenta.
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Affiliation(s)
- Erika K Pollex
- Division of Clinical Pharmacology and Toxicology, the Hospital for Sick Children, Toronto, Ontario, Canada.
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Linn T, Fischer B, Soydan N, Eckhard M, Ehl J, Kunz C, Bretzel RG. Nocturnal glucose metabolism after bedtime injection of insulin glargine or neutral protamine hagedorn insulin in patients with type 2 diabetes. J Clin Endocrinol Metab 2008; 93:3839-46. [PMID: 18611975 DOI: 10.1210/jc.2007-2871] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
AIMS/HYPOTHESIS Insulin glargine is a long-acting human insulin analog often administered at bedtime to patients with type 2 diabetes. It reduces fasting blood glucose levels more efficiently and with less nocturnal hypoglycemic events compared with human neutral protamine Hagedorn (NPH) insulin. Therefore, bedtime injections of insulin glargine and NPH insulin were compared overnight and in the morning. METHODS In 10 type 2 diabetic patients, euglycemic clamps were performed, including [6,6'](2)H(2) glucose, to study the rate of disappearance (Rd) and endogenous production (EGP) of glucose during the night. On separate days at bedtime (2200 h), patients received a sc injection of insulin glargine, NPH insulin, or saline in a randomized, double-blind fashion. RESULTS Similar doses of both insulins had different metabolic profiles. NPH insulin had a greater effect on both Rd and EGP in the night compared with insulin glargine. By contrast, in the morning, insulin glargine was more effective, increasing Rd by 5.8 micromol/kg(-1).min(-1) (95% confidence interval 4.7-6.9) and reducing EGP -5.7 (-5.0 to -6.4) compared with NPH insulin. Nearly 80% of the glucose lowering effect in the morning was due to insulin glargine's reduction of EGP. Its injection was associated with one-third lower morning glucagon levels compared with NPH insulin (P = 0.021). CONCLUSION/INTERPRETATION Nocturnal variations of EGP and Rd explain the reduced incidence of hypoglycemia and lower fasting glucose levels reported for insulin glargine compared with human NPH insulin.
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Affiliation(s)
- Thomas Linn
- Clinical Research Unit, 3rd Medical Clinic and Policlinic, Rodthohl 6, 35385 Giessen, Germany.
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Manley SE, Stratton IM, Clark PM, Luzio SD. Comparison of 11 human insulin assays: implications for clinical investigation and research. Clin Chem 2007; 53:922-32. [PMID: 17363420 DOI: 10.1373/clinchem.2006.077784] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The American Diabetes Association task force on standardization of insulin assays in 1996 showed wide variation in assay bias. Newer assays are specific for insulin, with several now available on automated immunoassay analyzers. METHODS In 2004, we compared 11 commercially available insulin assays by analyzing 150 serum samples (99 fasting/51 postprandial) from study participants with various degrees of glucose intolerance (exclusions being type 1 diabetes, insulin treatment, or presence of insulin antibodies). All assays were calibrated against International Reference Preparation 66/304. One assay was not specific for insulin and another was an RIA; 10 assays used enzyme/chemiluminescent labels. Bland-Altman difference plots were modified to use the mean insulin from all assays on the x-axis as a common comparator. RESULTS As in the 1996 study, insulin values from the different assays varied by a factor of 2, with the nonspecific assay ranking in the middle of the distribution. Spearman rank correlation coefficients, for ranking samples vs the mean, were 0.983-0.997. Both offsets and concentration-dependent differences were seen in the modified difference plots. Imprecision (mean CV) for automated assays (3%) was not significantly different from manual assays (5%). Similar values were obtained when one automated assay was run in laboratories in both the UK and the US. Results of 1 assay showed lower insulin concentrations in heparinized plasma than in serum. CONCLUSIONS Assay performance must be considered before comparing insulin results. The 2-fold variation in insulin results may be related to specificity, manufacturers' calibration procedures or conversion factors.
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Affiliation(s)
- Susan E Manley
- Department of Clinical Biochemistry, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, United Kingdom.
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Agin A, Jeandidier N, Gasser F, Grucker D, Sapin R. Glargine blood biotransformation: in vitro appraisal with human insulin immunoassay. DIABETES & METABOLISM 2007; 33:205-12. [PMID: 17360218 DOI: 10.1016/j.diabet.2006.12.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Accepted: 12/18/2006] [Indexed: 11/22/2022]
Abstract
AIM Glargine, a long-acting insulin analogue, is metabolized in the bloodstream and in subcutaneous tissue. Glargine metabolism and its implications for diabetes therapy remain poorly understood. The aim of our study was to assess in vitro the glargine blood biotransformation and its inter-individual variability. METHODS Formation of M1 glargine metabolite in vitro was studied with Elecsys Insulin immunoassay in pools of sera and sera from patients spiked with glargine. Elecsys Insulin assay is specific of human insulin, does not recognize glargine and its M2 metabolite but does recognize its M1 metabolite. RESULTS Glargine incubation with serum resulted in M1 metabolite formation which was detected and characterized as an enzymatic process: metabolite kinetics were dependant on temperature, substrate concentration and serum proportion. Carboxypeptidase inhibitors and chelating agents partially inhibited the activity of the enzyme(s). Glargine biotransformation was decreased when blood was collected on EDTA tubes. After 30 min incubation of glargine (100 mU/l) in 69 sera at 37 degrees C, percentage of glargine converted into M1 ranged from 46% to 98% (mean 72%; S.D. 11%). CONCLUSION Glargine blood biotransformation is an enzymatic process probably involving serum carboxypeptidase(s). Metabolite formation is rapid and non negligible. Inter-individual variability of glargine biotransformation is noteworthy and should be confronted to M1 metabolite bioactivity which has not been fully documented yet.
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Affiliation(s)
- A Agin
- Centre national de la recherche scientifique, UMR 7004, institut de physique biologique, faculté de médecine, université Louis-Pasteur, 67091 Strasbourg, France.
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Agin A, Jeandidier N, Gasser F, Grucker D, Sapin R. Use of insulin immunoassays in clinical studies involving rapid-acting insulin analogues: Bi-insulin IRMA preliminary assessment. Clin Chem Lab Med 2007; 44:1379-82. [PMID: 17087654 DOI: 10.1515/cclm.2006.257] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In clinical studies involving rapid-acting analogues (RAAs), insulin immunoreactivity is frequently measured, including endogenous, regular insulin (RI) and RAA immunoreactivities. Such a procedure implies equivalent cross-reactivities of all insulins present in serum. Commercially available human insulin immunoassays have been widely used, but their limitations (including hemolysis and anti-insulin antibodies) were not fully investigated. The aims of our study were to compare cross-reactivities of RI and RAAs in buffer and in serum and to investigate insulin immunoassay pitfalls. METHODS Cross-reactivities were assessed using Bi-insulin IRMA (Schering Cis-Bio International) in phosphate-buffered saline (PBS)-1% bovine serum albumin (BSA) and in pools of sera spiked with RI and RAAs (lispro and aspart). To investigate the influence of hemolysis, a pool of sera spiked with RAA was mixed with a concentrated hemolysate (final hemoglobin concentration 10 g/L) and incubated for 3 h at room temperature. To determine interference by anti-insulin antibodies, insulin was removed using charcoal from 18 sera with anti-insulin antibodies and from 17 sera without detectable anti-insulin antibodies. These insulin-free samples were then spiked with RI and RAAs and the immunoreactivity was determined. RESULTS Compared with buffer, cross-reactivity in serum for RI, lispro and aspart was lower (35%, 29% and 26% lower, respectively). Hemolysis degraded almost all RI and RAAs contained in the serum (>or=95%). Anti-insulin antibody interference was significant for RI and RAAs (p<or=0.004) and correlated with anti-insulin antibody level in the serum (p<or=0.001). CONCLUSIONS In serum, RI and RAA cross-reactivities are slightly lower than in buffer. For RAA assessment, hemolysed samples should be discarded and anti-insulin antibodies should be removed from samples before immunoreactivity measurements.
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Affiliation(s)
- Arnaud Agin
- Faculté de Médecine, Université Louis Pasteur, Centre National de la Recherche Scientifique, Unité Mixte de recherche 7004, Institut de Physique Biologique, Strasbourg, France.
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