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Vroemen WHM, Denessen EJS, van Doorn WPTM, Pelzer KEJM, Hackeng TM, Litjens EJR, Henskens YMC, van der Sande FM, Wodzig WKWH, Kooman JP, Bekers O, de Boer D, Mingels AMA. Differences in Cardiac Troponin T Composition in Myocardial Infarction and End-Stage Renal Disease Patients: A Blood Tube Effect? J Appl Lab Med 2024:jfae052. [PMID: 38816928 DOI: 10.1093/jalm/jfae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Cardiac troponin T (cTnT) is key in diagnosing myocardial infarction (MI) but is also elevated in end-stage renal disease (ESRD) patients. Specific larger cTnT proteoforms were identified for the acute phase of MI, while in serum of ESRD patients solely small cTnT fragments were found. However, others allocated this to a pre-analytic effect due to abundant thrombin generation in serum. Therefore, we investigated the effect of various anticoagulation methods on cTnT composition and concentration and compared the cTnT composition of MI and ESRD patients. METHODS The agreement of cTnT concentrations between simultaneously collected serum, lithium-heparin (LH) plasma, and ethylenediaminetetraacetic acid (EDTA) plasma was studied using the high-sensitivity (hs-)cTnT immunoassay. cTnT proteoform composition was investigated in a standardized time-dependent manner through spike experiments and in simultaneously collected blood matrixes of MI and ESRD patients. RESULTS Excellent hs-cTnT concentration agreements were observed across all blood matrixes (slopes > 0.98; 95% CI, 0.96-1.04). Time-dependent degradation (40 kDa intact:29 kDa fragment:15 to 18 kDa fragments) was found in LH plasma and EDTA plasma, and serum in ratios (%) of 90:10:0, 0:5:95, and 0:0:100, respectively (48 h after blood collection). Moreover, gel filtration chromatography (GFC) profiles illustrated mainly larger cTnT proteoforms in MI patients, while in ESRD patients mainly 15 to 18 kDa fragments were found for all matrices. CONCLUSIONS The extent of cTnT degradation in vitro is dependent on the (anti)coagulation method, without impacting hs-cTnT concentrations. Furthermore, mainly larger cTnT proteoforms were present in MI patients, while in ESRD patients mainly small 15 to 18 kDa cTnT fragments were found. These insights are essential when developing a novel hs-cTnT assay targeting larger cTnT proteoforms.
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Affiliation(s)
- Wim H M Vroemen
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ellen J S Denessen
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - William P T M van Doorn
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kelly E J M Pelzer
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Tilman M Hackeng
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Elisabeth J R Litjens
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Yvonne M C Henskens
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Frank M van der Sande
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Will K W H Wodzig
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Otto Bekers
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Douwe de Boer
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Alma M A Mingels
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
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Riabkova NS, Bogomolova AP, Kogan AE, Katrukha IA, Vylegzhanina AV, Pevzner DV, Alieva AK, Bereznikova AV, Katrukha AG. Interaction of heparin with human cardiac troponin complex and its influence on the immunodetection of troponins in human blood samples. Clin Chem Lab Med 2024; 0:cclm-2024-0066. [PMID: 38738903 DOI: 10.1515/cclm-2024-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Heparin is a highly charged polysaccharide used as an anticoagulant to prevent blood coagulation in patients with presumed myocardial infarction and to prepare heparin plasma samples for laboratory tests. There are conflicting data regarding the effects of heparin on the measurement of cardiac isoforms of troponin I (cTnI) and troponin T (cTnT), which are used for the immunodiagnosis of acute myocardial infarction. In this study, we investigated the influence of heparin on the immunodetection of human cardiac troponins. METHODS Gel filtration (GF) techniques and sandwich fluoroimmunoassay were performed. The regions of сTnI and cTnT that are affected by heparin were investigated with a panel of anti-cTnI and anti-cTnT monoclonal antibodies, specific to different epitopes. RESULTS Heparin was shown to bind to the human cardiac full-size ternary troponin complex (ITC-complex) and free cTnT, which increased their apparent molecular weights in GF studies. Heparin did not bind to the low molecular weight ITC-complex and to binary cTnI-troponin С complex. We did not detect any sites on cTnI in the ITC-complex that were specifically affected by heparin. In contrast, cTnT regions limited to approximately 69-99, 119-138 and 145-164 amino acid residues (aar) in the ITC-complex and a region that lies approximately between 236 and 255 aar of free cTnT were prone to heparin influence. CONCLUSIONS Heparin binds to the ITC-complex via cTnT, interacting with several sites on the N-terminal and/or central parts of the cTnT molecule, which might influence the immunodetection of analytes in human blood.
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Affiliation(s)
- Natalia S Riabkova
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Agnessa P Bogomolova
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Alexander E Kogan
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Ivan A Katrukha
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
| | | | - Dmitry V Pevzner
- National Medical Research Centre of Cardiology Named After Academician E.I. Chazov, Moscow, Russia
| | - Amina K Alieva
- National Medical Research Centre of Cardiology Named After Academician E.I. Chazov, Moscow, Russia
| | - Anastasia V Bereznikova
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Alexey G Katrukha
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
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Katrukha IA, Riabkova NS, Kogan AE, Vylegzhanina AV, Mukharyamova KS, Bogomolova AP, Zabolotskii AI, Koshkina EV, Bereznikova AV, Katrukha AG. Fragmentation of human cardiac troponin T after acute myocardial infarction. Clin Chim Acta 2023; 542:117281. [PMID: 36918061 DOI: 10.1016/j.cca.2023.117281] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/18/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Blood measurement of cardiac troponin T (cTnT) is one of the most widespread methods of acute myocardial infarction (MI) diagnosis. cTnT degradation may have a significant influence on the precision of cTnT immunodetection; however, there are no consistent data describing the level and sites of cTnT proteolysis in the blood of MI patients. In this study, we bordered major cTnT fragments and quantified their relative abundance in the blood at different times after MI. METHODS Serial heparin plasma samples were collected from 37 MI patients 2-37 h following the onset of MI. cTnT and its fragments were studied by western blotting and immunofluorescence analysis using monoclonal antibodies specific to various cTnT epitopes. RESULTS cTnT was present in the blood of MI patients as 23 proteolytic fragments with an apparent molecular mass of ∼ 8-37 kDa. Two major sites of cTnT degradation were identified: between amino acid residues (aar) 68 and 69 and between aar 189 and 223. Analysis of the abundance of cTnT fragments showed an increase in the fraction of free central fragments in the first few hours after MI, while the fraction of the C-terminal fragments of cTnT remained almost unchanged. CONCLUSION cTnT progressively degrades after MI and appears in the blood as a mixture of 23 proteolytic fragments. The cTnT region approximately bordered by aar 69-158 is a promising target for antibodies used for measurement of total cTnT.
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Affiliation(s)
- Ivan A Katrukha
- HyTest Ltd., Turku, Finland; Department of Biochemistry, School of Biology, Moscow State University, Moscow, Russia.
| | - Natalia S Riabkova
- HyTest Ltd., Turku, Finland; Department of Biochemistry, School of Biology, Moscow State University, Moscow, Russia
| | - Alexander E Kogan
- HyTest Ltd., Turku, Finland; Department of Biochemistry, School of Biology, Moscow State University, Moscow, Russia
| | | | | | - Agnessa P Bogomolova
- HyTest Ltd., Turku, Finland; Department of Biochemistry, School of Biology, Moscow State University, Moscow, Russia
| | - Artur I Zabolotskii
- Department of Biochemistry, School of Biology, Moscow State University, Moscow, Russia
| | | | - Anastasia V Bereznikova
- HyTest Ltd., Turku, Finland; Department of Biochemistry, School of Biology, Moscow State University, Moscow, Russia
| | - Alexey G Katrukha
- HyTest Ltd., Turku, Finland; Department of Biochemistry, School of Biology, Moscow State University, Moscow, Russia
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4
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Damen SAJ, Vroemen WHM, Brouwer MA, Mezger STP, Suryapranata H, van Royen N, Bekers O, Meex SJR, Wodzig WKWH, Verheugt FWA, de Boer D, Cramer GE, Mingels AMA. Multi-Site Coronary Vein Sampling Study on Cardiac Troponin T Degradation in Non-ST-Segment-Elevation Myocardial Infarction: Toward a More Specific Cardiac Troponin T Assay. J Am Heart Assoc 2019; 8:e012602. [PMID: 31269858 PMCID: PMC6662151 DOI: 10.1161/jaha.119.012602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/17/2019] [Indexed: 01/24/2023]
Abstract
Background Cardiac troponin T ( cTnT ) is seen in many other conditions besides myocardial infarction, and recent studies demonstrated distinct forms of cTnT . At present, the in vivo formation of these different cTnT forms is incompletely understood. We therefore performed a study on the composition of cTnT during the course of myocardial infarction, including coronary venous system sampling, close to its site of release. Methods and Results Baseline samples were obtained from multiple coronary venous system locations, and a peripheral artery and vein in 71 non- ST -segment-elevation myocardial infarction patients. Additionally, peripheral blood was drawn at 6- and 12-hours postcatheterization. cTnT concentrations were measured using the high-sensitivity- cTnT immunoassay. The cTnT composition was determined via gel filtration chromatography and Western blotting in an early and late presenting patient. High-sensitivity - cTnT concentrations were 28% higher in the coronary venous system than peripherally (n=71, P<0.001). Coronary venous system samples demonstrated cT n T-I-C complex, free intact cTnT , and 29 kD a and 15 to 18 kD a cTnT fragments, all in higher concentrations than in simultaneously obtained peripheral samples. While cT n T-I-C complex proportionally decreased, and disappeared over time, 15 to 18 kD a cTnT fragments increased. Moreover, cT n T-I-C complex was more prominent in the early than in the late presenting patient. Conclusions This explorative study in non- ST -segment-elevation myocardial infarction shows that cTnT is released from cardiomyocytes as a combination of cT n T-I-C complex, free intact cTnT , and multiple cTnT fragments indicating intracellular cTnT degradation. Over time, the cT n T-I-C complex disappeared because of in vivo degradation. These insights might serve as a stepping stone toward a high-sensitivity- cTnT immunoassay more specific for myocardial infarction.
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Affiliation(s)
- Sander A. J. Damen
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Wim H. M. Vroemen
- Central Diagnostic LaboratoryMaastricht University Medical CenterMaastrichtThe Netherlands
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - Marc A. Brouwer
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Stephanie T. P. Mezger
- Central Diagnostic LaboratoryMaastricht University Medical CenterMaastrichtThe Netherlands
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - Harry Suryapranata
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Niels van Royen
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Otto Bekers
- Central Diagnostic LaboratoryMaastricht University Medical CenterMaastrichtThe Netherlands
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - Steven J. R. Meex
- Central Diagnostic LaboratoryMaastricht University Medical CenterMaastrichtThe Netherlands
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - Will K. W. H. Wodzig
- Central Diagnostic LaboratoryMaastricht University Medical CenterMaastrichtThe Netherlands
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - Freek W. A. Verheugt
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Douwe de Boer
- Central Diagnostic LaboratoryMaastricht University Medical CenterMaastrichtThe Netherlands
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - G. Etienne Cramer
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Alma M. A. Mingels
- Central Diagnostic LaboratoryMaastricht University Medical CenterMaastrichtThe Netherlands
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
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5
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Vylegzhanina AV, Kogan AE, Katrukha IA, Koshkina EV, Bereznikova AV, Filatov VL, Bloshchitsyna MN, Bogomolova AP, Katrukha AG. Full-Size and Partially Truncated Cardiac Troponin Complexes in the Blood of Patients with Acute Myocardial Infarction. Clin Chem 2019; 65:882-892. [PMID: 30858159 DOI: 10.1373/clinchem.2018.301127] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/22/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The measurement of cardiac isoforms of troponin I (cTnI) and troponin T (cTnT) is widely used for the diagnosis of acute myocardial infarction (AMI). However, there are conflicting data regarding what forms of cTnI and cTnT are present in the blood of AMI patients. We investigated cTnI and cTnT as components of troponin complexes in the blood of AMI patients. METHODS Gel filtration techniques, sandwich fluoroimmunoassays, and Western blotting were used. RESULTS Plasma samples from patients with AMI contained the following troponin complexes: (a) a cTnI-cTnT-TnC complex (ITC) composed of full-size cTnT of 37 kDa or its 29-kDa fragment and full-size cTnI of 29 kDa or its 27-kDa fragments; (b) ITC with lower molecular weight (LMW-ITC) in which cTnT was truncated to the 14-kDa C-terminal fragments; and (c) a binary cTnI-cTnC complex composed of truncated cTnI of approximately 14 kDa. During the progression of the disease, the amount of ITC in AMI samples decreased, whereas the amounts of LMW-ITC and short 16- to 20-kDa cTnT central fragments increased. Almost all full-size cTnT and a 29-kDa cTnT fragment in AMI plasma samples were the components of ITC. No free full-size cTnT was found in AMI plasma samples. Only 16- to 27-kDa central fragments of cTnT were present in a free form in patient blood. CONCLUSIONS A ternary troponin complex exists in 2 forms in the blood of patients with AMI: full-size ITC and LMW-ITC. The binary cTnI-cTnC complex and free cTnT fragments are also present in patient blood.
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Affiliation(s)
| | - Alexander E Kogan
- HyTest Ltd., Turku, Finland.,Department of Bioorganic Chemistry, School of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - Ivan A Katrukha
- HyTest Ltd., Turku, Finland.,Department of Biochemistry, School of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
| | | | - Anastasia V Bereznikova
- HyTest Ltd., Turku, Finland.,Department of Bioorganic Chemistry, School of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - Vladimir L Filatov
- HyTest Ltd., Turku, Finland.,Department of Bioorganic Chemistry, School of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - Marina N Bloshchitsyna
- HyTest Ltd., Turku, Finland.,Department of Bioorganic Chemistry, School of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - Agnessa P Bogomolova
- Department of Biochemistry, School of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - Alexey G Katrukha
- HyTest Ltd., Turku, Finland.,Department of Biochemistry, School of Biology, M.V. Lomonosov Moscow State University, Moscow, Russia
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