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Evans CR, Leckie G, Subramanian S, Bell A, Merlo J. A tutorial for conducting intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). SSM Popul Health 2024; 26:101664. [PMID: 38690117 PMCID: PMC11059336 DOI: 10.1016/j.ssmph.2024.101664] [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: 12/21/2023] [Revised: 02/22/2024] [Accepted: 03/20/2024] [Indexed: 05/02/2024] Open
Abstract
Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (I-MAIHDA) is an innovative approach for investigating inequalities, including intersectional inequalities in health, disease, psychosocial, socioeconomic, and other outcomes. I-MAIHDA and related MAIHDA approaches have conceptual and methodological advantages over conventional single-level regression analysis. By enabling the study of inequalities produced by numerous interlocking systems of marginalization and oppression, and by addressing many of the limitations of studying interactions in conventional analyses, intersectional MAIHDA provides a valuable analytical tool in social epidemiology, health psychology, precision medicine and public health, environmental justice, and beyond. The approach allows for estimation of average differences between intersectional strata (stratum inequalities), in-depth exploration of interaction effects, as well as decomposition of the total individual variation (heterogeneity) in individual outcomes within and between strata. Specific advice for conducting and interpreting MAIHDA models has been scattered across a burgeoning literature. We consolidate this knowledge into an accessible conceptual and applied tutorial for studying both continuous and binary individual outcomes. We emphasize I-MAIHDA in our illustration, however this tutorial is also informative for understanding related approaches, such as multicategorical MAIHDA, which has been proposed for use in clinical research and beyond. The tutorial will support readers who wish to perform their own analyses and those interested in expanding their understanding of the approach. To demonstrate the methodology, we provide step-by-step analytical advice and present an illustrative health application using simulated data. We provide the data and syntax to replicate all our analyses.
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Affiliation(s)
- Clare R. Evans
- Department of Sociology, University of Oregon, Eugene, OR, USA
| | - George Leckie
- Centre for Multilevel Modelling and School of Education, University of Bristol, UK
| | - S.V. Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - Andrew Bell
- Sheffield Methods Institute, University of Sheffield, Sheffield, UK
| | - Juan Merlo
- Research Unit of Social Epidemiology, Faculty of Medicine, University of Lund, Sweden
- Center for Primary Health Care Research, Region Skåne, Malmö, Sweden
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2
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Yan Y, Hemmler D, Schmitt-Kopplin P. Discovery of Glycation Products: Unraveling the Unknown Glycation Space Using a Mass Spectral Library from In Vitro Model Systems. Anal Chem 2024; 96:3569-3577. [PMID: 38346319 PMCID: PMC10902809 DOI: 10.1021/acs.analchem.3c05540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
The nonenzymatic reaction between amino acids (AAs) and reducing sugars, also known as the Maillard reaction, is the primary source of free glycation products (GPs) in vivo and in vitro. The limited number of MS/MS records for GPs in public libraries hinders the annotation and investigation of nonenzymatic glycation. To address this issue, we present a mass spectral library containing the experimental MS/MS spectra of diverse GPs from model systems. Based on the conceptional reaction processes and structural characteristics of products, we classified GPs into common GPs (CGPs) and modified AAs (MAAs). A workflow for annotating GPs was established based on the structural and fragmentation patterns of each GP type. The final spectral library contains 157 CGPs, 499 MAAs, and 2426 GP spectra with synthetic model system information, retention time, precursor m/z, MS/MS, and annotations. As a proof-of-concept, we demonstrated the use of the library for screening GPs in unidentified spectra of human plasma and urine. The AAs with the C6H10O5 modification, fructosylation from Amadori rearrangement, were the most found GPs. With the help of the model system, we confirmed the existence of C6H10O5-modified Valine in human plasma by matching both retention time, MS1, and MS/MS without reference standards. In summary, our GP library can serve as an online resource to quickly screen possible GPs in an untargeted metabolomics workflow, furthermore with the model system as a practical synthesis method to confirm their identity.
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Affiliation(s)
- Yingfei Yan
- Research Unit Analytical BioGeoChemistry, Helmholtz Zentrum München, Neuherberg 85764, Germany
| | - Daniel Hemmler
- Research Unit Analytical BioGeoChemistry, Helmholtz Zentrum München, Neuherberg 85764, Germany
- Chair of Analytical Food Chemistry, Technical University of Munich, Freising 85354, Germany
| | - Philippe Schmitt-Kopplin
- Research Unit Analytical BioGeoChemistry, Helmholtz Zentrum München, Neuherberg 85764, Germany
- Chair of Analytical Food Chemistry, Technical University of Munich, Freising 85354, Germany
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3
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Gillery P. Biological management of diabetes mellitus, the laboratory medicine specialist and the patient. Clin Chem Lab Med 2024; 62:1-2. [PMID: 37682246 DOI: 10.1515/cclm-2023-0959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Philippe Gillery
- Laboratory of Biochemistry-Pharmacology-Toxicology, Biology and Pathology Department, University Hospital of Reims, Rue du Général Koenig, F-51092 Reims Cedex, France
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4
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Zhou X, Liu Z, Ma Y, Zhang C, Wu Y. A mathematical algorithm to harmonize measurements for thyroid-stimulating hormone between instruments. Clin Chim Acta 2023; 548:117513. [PMID: 37562523 DOI: 10.1016/j.cca.2023.117513] [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: 05/15/2023] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Thyroid-stimulating hormone (TSH) is measured differently between diagnostic units using different devices, which makes cross-comparisons challenging. Here, we have developed a mathematical algorithm to harmonize TSH measurements between 2 instruments, the Abbott ISR2000 and the Siemens ADVIA Centaur XP. METHODS Applying the principle of the maximum allowable error between the standard curve and real signal values, the minimum number of comparison samples required for TSH hormone detection was calculated for both instruments. Next, a mathematical algorithm describing the relationship between TSH standard curves from both instruments was established. The algorithm was then tested on sample measurements from both instruments, with signals transformed to Siemens ADVIA Centuar XP-type data. Finally, test results were assessed where the relative error was RESULTS Before conversion, the mean percentage error between the TSH results of samples measured on both instruments was 23.20% (>1/2 TEa). After algorithmic transformation, the average percentage error was reduced to 7.93% (<1/2 TEa). CONCLUSIONS Our algorithm enables TSH measurements across different instruments to be comparable, and provides a method to harmonize TSH data between laboratories that utilize different instrumentation.
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Affiliation(s)
- Xin Zhou
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China; Jintang First People's Hospital, Chengdu 610400, China
| | - Zaishuan Liu
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yining Ma
- College of Mathematics of Sichuan University, Chengdu 610065, China
| | - Chongwei Zhang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yongkang Wu
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China; Jintang First People's Hospital, Chengdu 610400, China.
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5
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Sartore G, Ragazzi E, Caprino R, Lapolla A. Long-term HbA1c variability and macro-/micro-vascular complications in type 2 diabetes mellitus: a meta-analysis update. Acta Diabetol 2023; 60:721-738. [PMID: 36715767 PMCID: PMC10148792 DOI: 10.1007/s00592-023-02037-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023]
Abstract
AIMS The aim of the present study was to evaluate, by means of a meta-analysis approach, whether new available data, appeared on qualified literature, can support the effectiveness of an association of HbA1c variability with the risk of macro- and/or micro-vascular complications in type 2 diabetes mellitus (T2DM). METHODS The meta-analysis was conducted according to PRISMA Statement guidelines and considered published studies on T2DM, presenting HbA1c variability as standard deviation (SD) or its derived coefficient of variation (CV). Literature search was performed on PubMed in the time range 2015-July 2022, with no restrictions of language. RESULTS Twenty-three selected studies fulfilled the aims of the present investigation. Overall, the analysis of the risk as hazard ratios (HR) indicated a significant association between the HbA1c variability, expressed either as SD or CV, and the complications, except for neuropathy. Macro-vascular complications were all significantly associated with HbA1c variability, with HR 1.40 (95%CI 1.31-1.50, p < 0.0001) for stroke, 1.30 (95%CI 1.25-1.36, p < 0.0001) for transient ischaemic attack/coronary heart disease/myocardial infarction, and 1.32 (95%CI 1.13-1.56, p = 0.0007) for peripheral arterial disease. Micro-vascular complications yielded HR 1.29 (95%CI 1.22-1.36, p < 0.0001) for nephropathy, 1.03 (95%CI 0.99-1.08, p = 0.14) for neuropathy, and 1.15 (95%CI 1.08-1.24, p < 0.0001) for retinopathy. For all-cause mortality, HR was 1.33 (95%CI 1.27-1.39, p < 0.0001), and for cardiovascular mortality 1.25 (95%CI 1.17-1.34, p < 0.0001). CONCLUSIONS Our meta-analysis on HbA1c variability performed on the most recent published data since 2015 indicates positive association between HbA1c variability and macro-/micro-vascular complications, as well as mortality events, in T2DM, suggesting that this long-term glycaemic parameter merits further attention as a predictive, independent risk factor for T2DM population.
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Affiliation(s)
- Giovanni Sartore
- Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Eugenio Ragazzi
- Department of Pharmaceutical and Pharmacological Sciences - DSF, University of Padua, Padua, Italy.
| | - Rosaria Caprino
- Department of Medicine - DIMED, University of Padua, Padua, Italy
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6
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Gillery P. HbA 1c and biomarkers of diabetes mellitus in Clinical Chemistry and Laboratory Medicine: ten years after. Clin Chem Lab Med 2022; 61:861-872. [PMID: 36239682 DOI: 10.1515/cclm-2022-0894] [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: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 11/15/2022]
Abstract
Since its discovery in the late 1960s, HbA1c has proven to be a major biomarker of diabetes mellitus survey and diagnosis. Other biomarkers have also been described using classical laboratory methods or more innovative, non-invasive ones. All biomarkers of diabetes, including the historical glucose assay, have well-controlled strengths and limitations, determining their indications in clinical use. They all request high quality preanalytical and analytical methodologies, necessitating a strict evaluation of their performances by external quality control assessment trials. Specific requirements are needed for point-of-care testing technologies. This general overview, which describes how old and new tools of diabetes mellitus biological survey have evolved over the last decade, has been built through the prism of papers published in Clinical Chemistry and Laboratory Medicine during this period.
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Affiliation(s)
- Philippe Gillery
- Laboratory of Biochemistry-Pharmacology-Toxicology, Biology and Pathology Department, University Hospital of Reims, Reims, France.,Laboratory of Medical Biochemistry and Molecular Biology, UMR CNRS/ URCA n°7369, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
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7
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Toft JH, Dalen I, Skadberg Ø, Gøransson L, Økland I, Bleskestad IH. Glycated albumin and continuous glucose monitoring metrics across pregnancy in women with pre-gestational diabetes. Endocrinol Diabetes Metab 2022; 5:e376. [PMID: 36121204 PMCID: PMC9659665 DOI: 10.1002/edm2.376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Glycated albumin (GA), a biomarker reflecting short-term glycaemia, may be useful to assess glycaemic control in pregnancy. We examined the association between GA and continuous glucose monitoring (CGM) metrics across gestation. METHODS In this prospective cohort study including 40 women with pre-gestational diabetes, blood samples for analysis of GA and glycated haemoglobin A1c (HbA1c) were collected at pregnancy week 12, 20, 24, 28, 32 and 36. In the CGM-group (n = 19), CGM data were collected from first trimester until pregnancy week 36. Receiver operating characteristic (ROC) curves were used to assess the accuracy of GA and HbA1c to detect poor glycaemic control, using CGM metrics as the reference standard. This study was conducted at Stavanger University Hospital, Norway, in 2016-2018. RESULTS Glycaemic control improved across gestation with more time spent in target range, coinciding with decreased glycaemic variability and lower mean GA level. There was statistically significant correlation between GA and most CGM metrics. The area under the ROC curves (AUC) for detecting time in range <70% and time above range >25% for the pregnancy glucose target 63-140 mg/dl (3.5-7.8 mmol/L) were 0.78 and 0.82 for GA, whereas AUCs of 0.60 and 0.72 were found for HbA1c, respectively. CONCLUSIONS Higher GA levels were associated with less time spent in target range, more time spent in the above range area and increased glycaemic variability. GA was more accurate than HbA1c to detect time above range >25% and time in range <70%.
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Affiliation(s)
- Johanne Holm Toft
- Department of Obstetrics and GynecologyStavanger University HospitalStavangerNorway,Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Ingvild Dalen
- Section of Biostatistics, Department of ResearchStavanger University HospitalStavangerNorway
| | - Øyvind Skadberg
- Department of Medical BiochemistryStavanger University HospitalStavangerNorway
| | - Lasse Gunnar Gøransson
- Department of Internal MedicineStavanger University HospitalStavangerNorway,Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Inger Økland
- Department of Obstetrics and GynecologyStavanger University HospitalStavangerNorway,Department of Caring and EthicsUniversity of StavangerStavangerNorway
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Forgrave LM, Wang M, Yang D, DeMarco ML. Proteoforms and their expanding role in laboratory medicine. Pract Lab Med 2022; 28:e00260. [PMID: 34950758 PMCID: PMC8672040 DOI: 10.1016/j.plabm.2021.e00260] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/31/2021] [Accepted: 11/22/2021] [Indexed: 12/17/2022] Open
Abstract
The term “proteoforms” describes the range of different structures of a protein product of a single gene, including variations in amino acid sequence and post-translational modifications. This diversity in protein structure contributes to the biological complexity observed in living organisms. As the concentration of a particular proteoform may increase or decrease in abnormal physiological states, proteoforms have long been used in medicine as biomarkers of health and disease. Notably, the analytical approaches used to analyze proteoforms have evolved considerably over the years. While ligand binding methods continue to play a large role in proteoform measurement in the clinical laboratory, unanticipated or unknown post-translational modifications and sequence variants can upend even extensively tested and vetted assays that have successfully made it through the medical regulatory process. As an alternate approach, mass spectrometry—with its high molecular selectivity—has become an essential tool in detection, characterization, and quantification of proteoforms in biological fluids and tissues. This review explores the analytical techniques used for proteoform detection and quantification, with an emphasis on mass spectrometry and its various applications in clinical research and patient care including, revealing new biomarker targets, helping improve the design of contemporary ligand binding in vitro diagnostics, and as mass spectrometric laboratory developed tests used in routine patient care.
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Affiliation(s)
- Lauren M. Forgrave
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Meng Wang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - David Yang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Mari L. DeMarco
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, Providence Health Care, 1081 Burrard St, Vancouver, V6Z 1Y6, Canada
- Corresponding author. Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
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Heo CE, Kim M, Son MK, Hyun DG, Heo SW, Kim HI. Ion Mobility Mass Spectrometry Analysis of Oxygen Affinity-Associated Structural Changes in Hemoglobin. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2021; 32:2528-2535. [PMID: 34463503 DOI: 10.1021/jasms.1c00161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Hemoglobin (Hb) is a major oxygen-transporting protein with allosteric properties reflected in the structural changes that accompany binding of O2. Glycated hemoglobin (GHb), which is a minor component of human red cell hemolysate, is generated by a nonenzymatic reaction between glucose and hemoglobin. Due to the long lifetime of human erythrocytes (∼120 days), GHb is widely used as a reliable biomarker for monitoring long-term glucose control in diabetic patients. Although the structure of GHb differs from that of Hb, structural changes relating to the oxygen affinity of these proteins remain incompletely understood. In this study, the oxygen-binding kinetics of Hb and GHb are evaluated, and their structural dynamics are investigated using solution small-angle X-ray scattering (SAXS), electrospray ionization mass spectrometry equipped with ion mobility spectrometry (ESI-IM-MS), and molecular dynamic (MD) simulations to understand the impact of structural alteration on their oxygen-binding properties. Our results show that the oxygen-binding kinetics of GHb are diminished relative to those of Hb. ESI-IM-MS reveals structural differences between Hb and GHb, which indicate the preference of GHb for a more compact structure in the gas phase relative to Hb. MD simulations also reveal an enhancement of intramolecular interactions upon glycation of Hb. Therefore, the more rigid structure of GHb makes the conformational changes that facilitate oxygen capture more difficult creating a delay in the oxygen-binding process. Our multiple biophysical approaches provide a better understanding of the allosteric properties of hemoglobin that are reflected in the structural alterations accompanying oxygen binding.
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Affiliation(s)
- Chae Eun Heo
- Department of Chemistry, Korea University, Seoul 02841, Republic of Korea
- Center for Proteogenome Research, Korea University, Seoul 02841, Republic of Korea
| | - Minji Kim
- Department of Chemistry, Korea University, Seoul 02841, Republic of Korea
- Center for Proteogenome Research, Korea University, Seoul 02841, Republic of Korea
| | - Myung Kook Son
- Department of Chemistry, Korea University, Seoul 02841, Republic of Korea
- Center for Proteogenome Research, Korea University, Seoul 02841, Republic of Korea
| | - Da Gyeong Hyun
- Department of Chemistry, Korea University, Seoul 02841, Republic of Korea
- Center for Proteogenome Research, Korea University, Seoul 02841, Republic of Korea
| | - Sung Woo Heo
- Inorganic Metrology Group, Division of Chemical and Biological Metrology, Korea Research Institute of Standards and Science (KRISS), Daejeon 34113, Republic of Korea
| | - Hugh I Kim
- Department of Chemistry, Korea University, Seoul 02841, Republic of Korea
- Center for Proteogenome Research, Korea University, Seoul 02841, Republic of Korea
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10
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Gillery P. IFCC Scientific Division: A conductor of standardization in laboratory medicine. Clin Chim Acta 2021; 522:184-186. [PMID: 34364854 DOI: 10.1016/j.cca.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P Gillery
- International Federation of Clinical Chemistry and Laboratory Medicine, Scientific Division, Chair, Italy; University Hospital of Reims, Department of Biochemistry-Pharmacology-Toxicology, Reims, France; University of Reims Champagne-Ardenne, UMR CNRS/URCA N°7369 MEDyC, Faculty of medicine, Laboratory of Medical Biochemistry and Molecular Biology, Reims, France.
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11
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Qiu HY, Hou NN, Shi JF, Liu YP, Kan CX, Han F, Sun XD. Comprehensive overview of human serum albumin glycation in diabetes mellitus. World J Diabetes 2021; 12:1057-1069. [PMID: 34326954 PMCID: PMC8311477 DOI: 10.4239/wjd.v12.i7.1057] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/06/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
The presence of excess glucose in blood is regarded as a sweet hurt for patients with diabetes. Human serum albumin (HSA) is the most abundant protein in human plasma, which undergoes severe non-enzymatic glycation with glucose in patients with diabetes; this modifies the structure and function of HSA. Furthermore, the advanced glycation end products produced by glycated HSA can cause pathological damage to the human body through various signaling pathways, eventually leading to complications of diabetes. Many potential glycation sites on HSA have different degrees of sensitivity to glucose concentration. This review provides a comprehensive assessment of the in vivo glycation sites of HSA; it also discusses the effects of glycation on the structure and function of HSA. Moreover, it addresses the relationship between HSA glycation and diabetes complications. Finally, it focuses on the value of non-enzymatic glycation of HSA in diabetes-related clinical applications.
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Affiliation(s)
- Hong-Yan Qiu
- Department of Endocrinology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Ning-Ning Hou
- Department of Endocrinology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Jun-Feng Shi
- Department of Endocrinology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Yong-Ping Liu
- Department of Endocrinology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Cheng-Xia Kan
- Department of Endocrinology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Fang Han
- Department of Pathology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Xiao-Dong Sun
- Department of Endocrinology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
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Wright EE, Morgan K, Fu DK, Wilkins N, Guffey WJ. Time in Range: How to Measure It, How to Report It, and Its Practical Application in Clinical Decision-Making. Clin Diabetes 2020; 38:439-448. [PMID: 33384469 PMCID: PMC7755049 DOI: 10.2337/cd20-0042] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The A1C metric has been the gold standard for assessing glycemia for decades. This biologic assay, based on averaging, is fraught with limitations and may be giving way to more holistic approaches. This article reviews glycemic time in range as the new standard for assessing patients with continuous glucose monitoring data. Information from the International Consensus Group on Time in Range will be summarized.
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Affiliation(s)
| | - Kayla Morgan
- Division of Pharmacy Services, Atrium Health, Charlotte, NC
| | - Danny K. Fu
- Division of Pharmacy Services, Atrium Health, Charlotte, NC
| | - Nick Wilkins
- Division of Pharmacy Services, Atrium Health, Charlotte, NC
| | - William J. Guffey
- Charlotte Area Health Education Center, Charlotte, NC
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
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Kaiafa G, Veneti S, Polychronopoulos G, Pilalas D, Daios S, Kanellos I, Didangelos T, Pagoni S, Savopoulos C. Is HbA1c an ideal biomarker of well-controlled diabetes? Postgrad Med J 2020; 97:380-383. [PMID: 32913038 DOI: 10.1136/postgradmedj-2020-138756] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/15/2020] [Indexed: 12/16/2022]
Abstract
HbA1c is a biomarker with a central role in the diagnosis and follow-up of patients with diabetes, although not a perfect one. Common comorbidities encountered in patients with diabetes mellitus, such as renal insufficiency, high output states (iron deficiency anaemia, haemolytic anaemia, haemoglobinopathies and pregnancy) and intake of specific drugs could compromise the sensitivity and specificity of the biomarker. COVID-19 pandemic poses a pressing challenge for the diabetic population, since maintaining optimal blood glucose control is key to reduce morbidity and mortality rates. Alternative methods for diabetes management, such as fructosamine, glycosylated albumin and device-based continuous glucose monitoring, are discussed.
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Affiliation(s)
- Georgia Kaiafa
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stavroula Veneti
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - George Polychronopoulos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Dimitrios Pilalas
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stylianos Daios
- Internal Medicine Department, General Hospital of Serres, Greece
| | - Ilias Kanellos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Triantafyllos Didangelos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stamatina Pagoni
- 3rd Department of Internal Medicine, "G. Gennimatas" General Hospital of Athens, Greece.,Hellenic Society of Internal Medicine, Athens, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
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Reducing the probability of falsely elevated HbA1c results in diabetic patients by applying automated and educative HbA1c re-testing intervals. Clin Biochem 2020; 80:14-18. [PMID: 32229197 DOI: 10.1016/j.clinbiochem.2020.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Too frequent HbA1c measurements may lead to unnecessary treatment modifications of diabetic patients. The aim of this study was to estimate the percentage of falsely elevated HbA1c results in two hospitals, Landeskrankenhaus/Uniklinikum Salzburg (LKH) and Landesklinik St. Veit (STV), as well as to retrospectively investigate the effect of an automated and an educative 60-day re-testing interval (RTI). METHODS The amount of estimated falsely elevated results (eFER), based on odds calculated using the baseline and the follow-up values and the time between these measurements, the number of HbA1c re-testings within 60 days as well as the overall number of ordered and performed HbA1c analyses were calculated. In LKH, an automated algorithm cancelling inappropriate HbA1c testing was applied, and in STV, educational actions were taken. RESULTS Before RTI-implementation, eFER were 0.9% and 2.1% and within-60-days-re-testing were 15.0% and 7.4% of cases in LKH and STV, respectively. After RTI-implementation, these numbers decreased to 0.2% (p < .001) and 1.8% (p = .869) and within-60-days-re-testing decreased to 1.1% (p < .001) and 3.6% (p = .003) in LKH and STV, respectively. Median monthly HbA1c measurements decreased by 15.8% (p < .001) and 21.1% (p = .002) in LKH and STV, respectively. CONCLUSION Both the educational and the automated 60-day-RTI were proven to be efficient in reducing overall HbA1c measurements, re-testing within 60 days and eFER.
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Harmonization of immunoassays for biomarkers in diabetes mellitus. Biotechnol Adv 2020; 39:107359. [DOI: 10.1016/j.biotechadv.2019.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/07/2019] [Accepted: 02/21/2019] [Indexed: 12/13/2022]
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Muralidharan M, Bhat V, Mandal AK. Structural analysis of glycated human hemoglobin using native mass spectrometry. FEBS J 2019; 287:1247-1254. [PMID: 31599087 DOI: 10.1111/febs.15085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/15/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022]
Abstract
Glycated hemoglobin (GHb) is the indicator of the long-term glycemic index of an individual. GHb is formed by the irreversible modification of N-terminal α-amino group of β globin chain with glucose via Amadori rearrangement. Cation exchange chromatography exploits the difference in surface charges between GHb and native hemoglobin (HbA0 ) for their separation and quantification. However, glucose condensation is specific to primary amino groups. Therefore, structural characterization of GHb synthesized in vivo is essential as multiple glycation may interfere with GHb assessment. The stoichiometric composition of different glycated hemoglobin from a 19% GHb sample was deduced using native mass spectrometry. We observed a comparable population of α and β glycated tetramers for mono-glycated HbA0 . Surprisingly, doubly and triply glycated HbA0 also showed mono-glycated α and β globins. Thus, we propose that glycation of hemoglobin (HbA) occurs symmetrically across α and β globins with preference to unmodified globin first. Correlation between conventional and mass spectrometry-based quantification of GHb showed a reliable estimation of the glycemic index of individuals carrying HbA0 . Mutant HbAs have different retention time than HbA0 due to the differences in their surface charge. Thus, their glycated analog may elute at different retention time compared to GHb. Consequently, our method would be ideal for assessing the glycemic index of an individual carrying mutant HbA.
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Affiliation(s)
- Monita Muralidharan
- Clinical Proteomics Unit, Division of Molecular Medicine, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | | | - Amit Kumar Mandal
- Clinical Proteomics Unit, Division of Molecular Medicine, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
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Delatour V, Clouet-Foraison N, Jaisson S, Kaiser P, Gillery P. Trueness assessment of HbA1c routine assays: are processed EQA materials up to the job? ACTA ACUST UNITED AC 2019; 57:1623-1631. [DOI: 10.1515/cclm-2019-0219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/07/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
With the worldwide increase of diabetes mellitus prevalence, ensuring that HbA1c assays are accurate is essential. External quality assessment (EQA) programs enable laboratories to verify that analytical methods perform according to the manufacturers’ specifications. However, assessing trueness requires commutable materials, a property that is rarely characterized for EQA materials.
Methods
The difference in bias approach was used to assess commutability of 26 processed quality control materials for 17 of the most frequently used HbA1c assays. Involved assays included immuno-assays, enzymatic assays, affinity, ion-exchange HPLC boronate affinity HPLC and capillary electrophoresis. The measurements were performed at manufacturers or expert laboratories. Assay trueness was additionally assessed against the IFCC reference measurement procedure using fresh clinical specimens that were distributed to 450 medical laboratories.
Results
Commutability of processed EQA materials was highly heterogeneous and globally insufficient to rigorously assess the trueness of HbA1c assays. Using fresh clinical specimens, mean bias was −0.13 mmol/mol for low HbA1c (34 mmol/mol), between +1.0 and +1.3 mmol/mol for intermediate HbA1c (49 and 58 mmol/mol) and +1.2 mmol/mol for elevated HbA1c (90 mmol/mol).
Conclusions
This study demonstrates that due to insufficient commutability, most processed EQA materials are unsuitable to assess trueness of HbA1c assays and agreement between the different assays. These materials can only provide information on comparability of individual laboratory results with its peers and on assay precision. Using fresh whole blood samples, this study additionally shows that most HbA1c assays are fairly accurate and meet the total allowable error quality target of 5 mmol/mol.
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Affiliation(s)
- Vincent Delatour
- Laboratoire National de Métrologie et d’Essais (LNE) , Paris , France
| | - Noémie Clouet-Foraison
- Laboratoire National de Métrologie et d’Essais (LNE) , Paris , France
- University Hospital of Reims, Laboratory of Biochemistry , Reims , France
| | - Stéphane Jaisson
- University Hospital of Reims, Laboratory of Biochemistry , Reims , France
| | | | - Philippe Gillery
- University Hospital of Reims, Laboratory of Biochemistry , Reims , France
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Fayyaz B, Rehman HJ, Minn H. Interpretation of hemoglobin A1C in primary care setting. J Community Hosp Intern Med Perspect 2019; 9:18-21. [PMID: 30788069 PMCID: PMC6374926 DOI: 10.1080/20009666.2018.1559432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/11/2018] [Indexed: 11/03/2022] Open
Abstract
Diagnostic tests for diabetes have evolved with the emphasis shifting from blood glucose levels and/or oral glucose tolerance test to measurement of hemoglobin A1c (HbA1c) levels. With the advent of modern and standardized methods assaying the percentage of glycosylated hemoglobin, clinicians are relying more and more on HbA1c for the management of diabetic patients. A brief review of literature shows, although HbA1c is an important tool in the diagnosis and management of diabetes, it is still far from being perfect. Clinicians need to be more aware about these limitations and take extra steps to avoid medical errors.
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Affiliation(s)
- Beenish Fayyaz
- Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA
| | - Hafiz J Rehman
- Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA
| | - Hmu Minn
- Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA
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Gillery P. The long way to standardization of practices: HbA1c as archetypal example. Clin Chem Lab Med 2018; 57:148-149. [PMID: 30465715 DOI: 10.1515/cclm-2018-1193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Philippe Gillery
- Service de Biochimie-Pharmacologie-Toxicologie, Pôle de Biologie Médicale et Pathologie, Hôpital Maison Blanche - CHU de Reims, 45 Rue Cognacq-Jay, 51095 Reims, France, Phone: +33 3 26 78 39 52, Fax: +33 3 26 78 38 82
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Jaisson S, Leroy N, Soulard M, Desmons A, Guillard E, Gillery P. Evaluation of the analytical performances of the Cobas c513 analyser for HbA 1c assay. Biochem Med (Zagreb) 2018; 28:030708. [PMID: 30429676 PMCID: PMC6214704 DOI: 10.11613/bm.2018.030708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/04/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Haemoglobin A1c (HbA1c) is considered to be the gold standard for the follow-up of glycaemic control in patients with diabetes mellitus and is also a diagnostic tool. Accordingly, reliable and efficient methods must be used for its quantification. Roche Diagnostics have recently adapted the Tina-quant® HbA1c Third Generation immunoassay on a fully dedicated analyser, the Cobas c513, which allows a high throughput of up to 400 samples per hour. The present article deals with the evaluation of the analytical performances of this system which has been recently introduced to the market. MATERIALS AND METHODS Precision, comparison with two ion-exchange high-performance liquid chromatography (HPLC) methods (Variant II and D-100 systems, BioRad Laboratories) using Passing Bablok and Bland-Altman analyses, accuracy and interference of the most frequent haemoglobin (Hb) variants on HbA1c measurement were evaluated. RESULTS Precision was high, with coefficients of variation lower than 1.1% (HbA1c values expressed in National Glycohemoglobin Standardization Program units, 1.7% for values expressed in International Federation of Clinical Chemistry and Laboratory Medicine [IFCC] units). The comparison study showed similar results with the two HPLC systems. The analysis of samples with IFCC-assigned values showed high methodological accuracy. Finally, no interference of bilirubin, triglycerides and common Hb variants (Hb AC, AD, AE, AS) was observed. CONCLUSIONS This evaluation showed that the analytical performance of the Cobas c513 analyser for HbA1c assay makes it suitable for a routine use in clinical chemistry laboratories.
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Affiliation(s)
- Stéphane Jaisson
- Biochemistry Department, University Hospital of Reims, Reims, France
| | - Nathalie Leroy
- Biochemistry Department, University Hospital of Reims, Reims, France
| | | | - Aurore Desmons
- Biochemistry Department, University Hospital of Reims, Reims, France
| | | | - Philippe Gillery
- Biochemistry Department, University Hospital of Reims, Reims, France
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Innovative approaches in diabetes diagnosis and monitoring: less invasive, less expensive… but less, equally or more efficient? Clin Chem Lab Med 2018; 56:1397-1399. [DOI: 10.1515/cclm-2018-0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Diallo AM, Novella JL, Lukas C, Souchon PF, Dramé M, François M, Decoudier B, Barraud S, Salmon AS, Ancelle D, Arndt C, Delemer B. Early predictors of diabetic retinopathy in type 1 diabetes: The Retinopathy Champagne Ardenne Diabète (ReCAD) study. J Diabetes Complications 2018; 32:753-758. [PMID: 29980433 DOI: 10.1016/j.jdiacomp.2018.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 04/30/2018] [Accepted: 05/15/2018] [Indexed: 10/16/2022]
Abstract
AIMS To determine the relationship between early markers of diabetes control and diabetic retinopathy (DR) in type 1 diabetes. METHODS A historic cohort study was conducted on 712 patients from the CARéDIAB database. HbA1c and usual metabolic parameters were measured one year after diagnosis of diabetes. First occurrences of severe hypoglycemia and ketoacidosis during follow-up were selected as time-dependent markers of diabetes control. Data were analyzed in a Cox model using SPSS software to predict DR with significance level at p-value <0.05. RESULTS In multivariate regression, any diabetic retinopathy was predicted by HbA1c (HR = 1.38; CI = 1.25-1.52; p < 0.0001), severe hypoglycemia (HR = 3; CI = 1.99-4.52; p < 0.0001), ketoacidosis (HR = 1.96; CI = 1.17-3.22; p = 0.009), and age at diagnosis (HR = 1.016; CI = 1.002-1.031; p = 0.02). Proliferative DR was predicted by HbA1c (HR = 1.67; CI = 1.51-1.79; p < 0.0001), severe hypoglycemia (HR = 3.67; CI = 2.74-5.25; p < 0.0001), and ketoacidosis (HR = 2.37; CI = 1.56-3.18; p < 0.0001). CONCLUSION This study shows that the failure to achieve diabetes control after the first year of diagnosis as well as early episodes of acute diabetes complications may contribute to the occurrence of diabetic retinopathy in type 1 diabetes patients.
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Affiliation(s)
- Alpha Mamadou Diallo
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France.
| | - Jean-Luc Novella
- Université de Reims Champagne-Ardenne, EA 3797 (Santé Publique, Vieillissement, Qualité de vie, et Réadaptation des Sujets Fragiles), 51, rue Cognacq-Jay, 51095 Reims Cedex, France
| | - Céline Lukas
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
| | | | - Moustapha Dramé
- Université de Reims Champagne-Ardenne, EA 3797 (Santé Publique, Vieillissement, Qualité de vie, et Réadaptation des Sujets Fragiles), 51, rue Cognacq-Jay, 51095 Reims Cedex, France
| | - Maud François
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
| | - Bénédicte Decoudier
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
| | - Sara Barraud
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
| | - Anne-Sophie Salmon
- Service de Pédiatrie, CHU de Reims, 48 rue Cognacq Jay, 51092 Reims Cedex, France
| | - Déborah Ancelle
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
| | - Carl Arndt
- Service d'Ophtalmologie, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
| | - Brigitte Delemer
- Service d'Endocrinologie, Diabète et Nutrition, CHU de Reims, Avenue du Général Koenig, 51092 Reims, France
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Limited benefit of haemoglobin glycation index as risk factor for cardiovascular disease in type 2 diabetes patients. DIABETES & METABOLISM 2018; 45:254-260. [PMID: 29784563 DOI: 10.1016/j.diabet.2018.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/05/2018] [Accepted: 04/18/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND The haemoglobin glycation index (HGI) has been proposed as a marker of interindividual differences in haemoglobin glycosylation. Previous studies have shown a relationship between high HGI and risk of cardiovascular disease (CVD) in patients with diabetes. However, no studies have investigated the role of previous CVD in this association. METHODS The study cohort comprised patients with type 2 diabetes mellitus (T2DM; n=1910) included in the Second Manifestations of Arterial Disease (SMART) study. The relationship between either HGI or HbA1c and a composite of cardiovascular events as the primary outcome, and mortality, cardiovascular mortality, myocardial infarction and stroke as secondary outcomes, was investigated using Cox proportional-hazards models. Similar analyses were performed after stratification according to previous CVD. RESULTS A 1-unit higher HGI was associated with a 29% greater risk of a composite of cardiovascular events (HR: 1.29, 95% CI: 1.06-1.57) in patients without previous CVD, whereas no such relationship was seen in patients with previous CVD (HR: 0.96, 95% CI: 0.86-1.08). The direction and magnitude of the hazard ratios (HRs) of HGI and HbA1c in relation to outcomes were similar. Additional adjustment for HbA1c in the association between HGI and outcomes lowered the HRs. CONCLUSION Similar to HbA1c, higher HGI is related to higher risk of cardiovascular events in patients with T2DM without CVD. As HbA1c has proved to be a comparable risk factor, and obtaining and interpreting the HGI is complicated, any additional benefit of applying the HGI in clinical settings is likely to be limited.
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Bréhaux K. Un biomarqueur diagnostique peut-il être pronostique ? Med Sci (Paris) 2018; 34:167-170. [DOI: 10.1051/medsci/20183402015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Desmons A, Jaisson S, Leroy N, Gillery P, Guillard E. Labile glycated haemoglobin and carbamylated haemoglobin are still critical points for HbA 1c measurement. Biochem Med (Zagreb) 2017; 27:378-386. [PMID: 28694727 PMCID: PMC5493174 DOI: 10.11613/bm.2017.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/09/2017] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Haemoglobin A1c (HbA1c) is a key analyte for the monitoring of glycemic balance in diabetic patients and is used for diabetes diagnosis in many countries. The potential interference of carbamylated haemoglobin (cHb) and labile glycated haemoglobin (LA1c) on HbA1c assays must remain a matter of vigilance. Such a situation has occurred in our laboratory with a kit replacement on the Bio-Rad Variant™ II testing system, a cation-exchange high performance liquid chromatography (HPLC) system. With this method, LA1c and cHb coeluted in a same peak which may have different consequences on HbA1c values. MATERIALS AND METHODS The influence of increasing LA1c and cHb values on HbA1c results was studied with in vitro glycation and carbamylation of samples. Samples from patients with high and normal blood urea concentrations were assayed by HPLC and immunological assay. RESULTS We observed that the degree of interference greatly varied depending on the nature of the interfering Hb fractions found under the so-called "LA1c peak". Thus, we have decided to apply a decision tree using "LA1c" thresholds depending on: (i) the retention time, (ii) the shape of the peak, (iii) other analytes, like urea. If the peak recognized as "LA1c" is mainly formed by LA1c, we consider that there is no interference until 4%. If the peak is mainly formed by cHb, we consider an interference threshold equal to 2%. CONCLUSIONS This situation reminds that cHb and LA1c remain critical issues in chromatography-based HbA1c assays and that adapted criteria must be set up for result interpretation.
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Affiliation(s)
- Aurore Desmons
- Laboratory of Pediatric Biology and Research, University Hospital of Reims, Reims, France.,Laboratory of Medical Biochemistry and Medical Biology, Faculty of Medicine, University of Reims, Reims, France
| | - Stéphane Jaisson
- Laboratory of Pediatric Biology and Research, University Hospital of Reims, Reims, France.,Laboratory of Medical Biochemistry and Medical Biology, Faculty of Medicine, University of Reims, Reims, France
| | - Nathalie Leroy
- Laboratory of Pediatric Biology and Research, University Hospital of Reims, Reims, France
| | - Philippe Gillery
- Laboratory of Pediatric Biology and Research, University Hospital of Reims, Reims, France.,Laboratory of Medical Biochemistry and Medical Biology, Faculty of Medicine, University of Reims, Reims, France
| | - Emmanuelle Guillard
- Laboratory of Pediatric Biology and Research, University Hospital of Reims, Reims, France
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Zhang C, Glaros T, Manicke NE. Targeted Protein Detection Using an All-in-One Mass Spectrometry Cartridge. J Am Chem Soc 2017; 139:10996-10999. [DOI: 10.1021/jacs.7b05571] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Chengsen Zhang
- Department
of Chemistry and Chemical Biology, Indiana University—Purdue University Indianapolis, Indianapolis, Indiana 46202, United States
| | - Trevor Glaros
- BioSciences
Division, BioDefense Branch, US Army Edgewood Chemical Biological Center, Aberdeen Proving Ground, Maryland 21010, United States
| | - Nicholas E. Manicke
- Department
of Chemistry and Chemical Biology, Indiana University—Purdue University Indianapolis, Indianapolis, Indiana 46202, United States
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Abstract
Diabetes is a highly prevalent disease also implicated in the development of several other serious complications like cardiovascular or renal disease. HbA1c testing is a vital step for effective diabetes management, however, given the low compliance to testing frequency and, commonly, a subsequent delay in the corresponding treatment modification, HbA1c at the point of care (POC) offers an opportunity for improvement of diabetes care. In this review, based on data from 1999 to 2016, we summarize the evidence supporting a further implementation of HbA1c testing at POC, discuss its limitations and propose recommendations for further development.
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Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e.V., Neuherberg Munich, Germany
| | | | - Jianping Weng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital Sun Yat-Sen University, Guangzhou, China
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Gillery P, Young IS. Standardization: Recent achievements of the IFCC Scientific Division. Clin Chim Acta 2017; 467:1-3. [DOI: 10.1016/j.cca.2016.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Type 2 diabetes mellitus represents a major public health challenge, due to the continuously growing prevalence and the complexity of the diabetic complications. Hyperglycemia seems to be the main mechanism for the disease progression. During erythrocyte's long life span, erythrocyte membranes are affected by the chronic exposure to glucose, which triggers several biochemical modifications that lead to both structural and functional disruption, which are further involved in the physiopathology of diabetes and its complications. Non-enzymatic protein glycation of red blood cell membrane proteins occur in two phases: early glycation, characterized by Schiff bases and Amadouri compounds formation, and advanced glycation, characterized by advanced glycation end products (AGEs). These products could be valuable tools for early diagnosis or biomarkers for disease progression, depending on how advanced they are in the glycation process. Advanced glycated end products were linked with diabetic complications. Also, lipid peroxidation and decreased activity of the enzyme pumps occur in the erythrocyte membrane of the diabetic patients. The investigation of lipid rafts and erythrocyte membrane fatty acids are a valuable tool for long-term monitoring of metabolic status. Further investigation of the erythrocyte membrane could provide novel biomarkers for monitoring of diabetes and its complications.
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Khalafallah A, Phuah E, Al-Barazan AM, Nikakis I, Radford A, Clarkson W, Trevett C, Brain T, Gebski V, Corbould A. Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus. BMJ Open 2016; 6:e011059. [PMID: 27044587 PMCID: PMC4823451 DOI: 10.1136/bmjopen-2016-011059] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The oral glucose tolerance test (OGTT) is a cumbersome test that is time consuming, labour intensive and often poorly tolerated by pregnant women. To date, glycosylated haemoglobin (HbA1c) is the most accepted measure of chronic glycaemia outside of pregnancy. HbA1c is an uncomplicated test, less time consuming, does not require any specific patient preparation and is considered straightforward compared with the OGTT. Therefore, we prospectively tested the utility of the HbA1c when used as a screening tool in pregnancy for gestational diabetes mellitus (GDM). SETTINGS Primary health care. Single tertiary referral centre, Tasmania, Australia. PARTICIPANTS A direct comparison between HbA1c levels and the OGTT results in pregnant women, tested concurrently at the 24-28 gestational week, was undertaken. A full profile of 480 pregnant women during the period from September 2012 to July 2014 was completed. Median and mean age of participants was 29 years (range 18-47 years). INTERVENTIONS A simultaneous prospective assessment of HbA1c versus standard OGTT in a cohort of consecutive pregnant women presenting to our institute was performed. RESULTS The number of women who had GDM according to OGTT criteria was 57, representing 11.9% of the evaluated 480 pregnant women. Using a cut-off value for HbA1c at 5.1% (32 mmol/mol) for detecting GDM showed sensitivity of 61% and specificity of 68% with negative predictive value (NPV) of 93%, versus sensitivity of 27% and specificity of 95% with NPV of 91% when using HbA1c cut-off value of 5.4% (36 mmol/mol). CONCLUSIONS Our results suggest that pregnant women with an HbA1c of≥5.4% (36 mmol/mol) should proceed with an OGTT. This may result in a significant reduction in the burden of testing on both patients and testing facility staff and resources. Further investigations are required to integrate and optimise the HbA1c as a single, non-fasting, screening tool for GDM. TRIAL REGISTRATION NUMBER ACTRN12611000739910.
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Affiliation(s)
- Alhossain Khalafallah
- Department of Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
- Menzies Institute for Medical Research, University of Tasmania, Launceston, Tasmania, Australia
| | - Eileen Phuah
- Department of Obstetrics and Gynaecology, Launceston General Hospital and Royal Hobart Hospital, Launceston, Tasmania, Australia
| | | | - Irena Nikakis
- Department of Obstetrics and Gynaecology, Launceston General Hospital and Royal Hobart Hospital, Launceston, Tasmania, Australia
| | - Andrea Radford
- Pathology Department, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Wade Clarkson
- Pathology Department, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Clinton Trevett
- Pathology Department, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Terry Brain
- Pathology Department, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Val Gebski
- Australian National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
| | - Anne Corbould
- Department of Medicine, Launceston General Hospital, Launceston, Tasmania, Australia
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
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Zendjabil M. Biological diagnosis of diabetes mellitus. Curr Res Transl Med 2015; 64:S0369-8114(15)00100-5. [PMID: 26552327 DOI: 10.1016/j.patbio.2015.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
Diabetes mellitus is a common disease whose complications are severe. For decades, the diagnosis of diabetes and prediabetes was using only fasting glucose or glucose two hours during an oral glucose tolerance test. Recently, it is possible to use HbA1c. Each of these tests has advantages and limitations that must be well known by clinicians for better care for patients. So they could use one, two or three of this tests to reach to a proper diagnosis. The aim of this article is about the strong and weak points of these tests.
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Affiliation(s)
- M Zendjabil
- Laboratoire de biochimie, Établissement Hospitalier Universitaire d'Oran 1er Novembre 1954, BP No. 4166, Ibn Rochd, Oran, Algeria.
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Das R, Muralidharan M, Mitra G, Bhat V, Mathew B, Pal D, Ross C, Mandal AK. Mass spectrometry based characterization of Hb Beckman variant in a falsely elevated HbA1c sample. Anal Biochem 2015. [DOI: 10.1016/j.ab.2015.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gillery P, Jaisson S, Gorisse L, Pietrement C. [Role of protein carbamylation in chronic kidney disease complications]. Nephrol Ther 2015; 11:129-34. [PMID: 25794932 DOI: 10.1016/j.nephro.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 12/01/2022]
Abstract
Carbamylation corresponds to the non-enzymatic binding of isocyanic acid, mainly derived from urea decomposition, on amino groups of proteins, and participates in their molecular aging. This process is increased during chronic kidney disease (CKD) because of hyperuremia, and in other pathologies like atherosclerosis, where isocyanic may be formed from thiocyanate by myeloperoxidase in atheroma plates. Carbamylation triggers structural and functional modifications of proteins, thus impairing their biological roles and their interactions with cells. Much experimental evidence in vitro has shown the potential deleterious effects of carbamylated proteins on cell and tissue functions. Carbamylation-derived products (CDPs), and especially their major component homocitrulline, accumulate in organism in long half-life proteins, and may participate in the development of different complications of CKD, especially cardiovascular diseases, renal fibrosis, or nutritional and metabolic troubles. Recent clinical studies have confirmed the link between serum protein carbamylation and morbi-mortality in patients suffering from CKD or undergoing hemodialysis. Some CDPs could be used as biomarkers in these pathologies.
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Affiliation(s)
- Philippe Gillery
- Laboratoire de biologie et de recherche pédiatriques, hôpital Maison Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Laboratoire de biochimie médicale et biologie moléculaire, UMR CNRS/URCA n(o) 7369, faculté de médecine, université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095 Reims cedex, France.
| | - Stéphane Jaisson
- Laboratoire de biologie et de recherche pédiatriques, hôpital Maison Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Laboratoire de biochimie médicale et biologie moléculaire, UMR CNRS/URCA n(o) 7369, faculté de médecine, université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095 Reims cedex, France
| | - Laëtitia Gorisse
- Laboratoire de biochimie médicale et biologie moléculaire, UMR CNRS/URCA n(o) 7369, faculté de médecine, université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095 Reims cedex, France
| | - Christine Pietrement
- Laboratoire de biochimie médicale et biologie moléculaire, UMR CNRS/URCA n(o) 7369, faculté de médecine, université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, 51095 Reims cedex, France; Service de néphrologie-rhumatologie pédiatriques, American Memorial Hospital, CHU de Reims, 47, rue Cognacq-Jay, 51092 Reims cedex, France
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Abstract
In vivo modification of proteins by molecules with reactive carbonyl groups leads to intermediate and advanced glycation end products (AGE). Glucose is a significant glycation reagent due to its high physiological concentration and poorly controlled diabetics show increased albumin glycation. Increased levels of glycated and AGE-modified albumin have been linked to diabetic complications, neurodegeneration, and vascular disease. This review discusses glycated albumin formation, structural consequences of albumin glycation on drug binding, removal of circulating AGE by several scavenger receptors, as well as AGE-induced proinflammatory signaling through activation of the receptor for AGE. Analytical methods for quantitative detection of protein glycation and AGE formation are compared. Finally, the use of glycated albumin as a novel clinical marker to monitor glycemic control is discussed and compared to glycated hemoglobin (HbA1c) as long-term indicator of glycemic status.
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Using poly(3-aminophenylboronic acid) thin film with binding-induced ion flux blocking for amperometric detection of hemoglobin A1c. Biosens Bioelectron 2015; 63:317-324. [DOI: 10.1016/j.bios.2014.07.058] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 11/22/2022]
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[Assays of HbA1c and Amadori products in human biology]. ANNALES PHARMACEUTIQUES FRANÇAISES 2014; 72:330-6. [PMID: 25220229 DOI: 10.1016/j.pharma.2014.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/02/2014] [Accepted: 04/07/2014] [Indexed: 01/24/2023]
Abstract
Different Amadori products, formed during the early steps of the non-enzymatic glycation of proteins, may be assayed in current practice in human biology. The most important marker is HbA1c, resulting from the binding of glucose to the N-terminal extremity of HbA beta chains. HbA1c may be evaluated by various techniques (ion exchange or affinity high performance liquid chromatography, capillary electrophoresis, immunoassay, enzymatic technique) and is considered the best marker of diabetic patient survey. Due to its irreversible and cumulative formation, it provides a retrospective information on the glycemic balance over the four to eight weeks preceding blood collection. It benefits from an international standardization, based on a reference method using liquid chromatography coupled to capillary electrophoresis or mass spectrometry, maintained by an international network of reference laboratories. When HbA1c assay cannot be used (anemia, hemolysis, hemoglobinopathy) or when a shorter period of glycemic equilibrium must be evaluated (child and adolescent, pregnancy, therapeutic changes), other Amadori products may be assayed, like plasma fructosamine (all plasma glycated proteins) or glycated albumin. Nevertheless, these assays are less used in practice, because their semiological value has been less evidenced. Besides, fructosamine assay lacks specificity, and glycated albumin assay has been described recently. An expanding use of HbA1c assay is expected, especially for the diagnosis of diabetes mellitus and the evaluation of other risks, especially cardiovascular ones.
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Miller WG, Tate JR, Barth JH, Jones GRD. Harmonization: the sample, the measurement, and the report. Ann Lab Med 2014; 34:187-97. [PMID: 24790905 PMCID: PMC3999316 DOI: 10.3343/alm.2014.34.3.187] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/01/2014] [Accepted: 03/07/2014] [Indexed: 01/06/2023] Open
Abstract
Harmonization of clinical laboratory results means that results are comparable irrespective of the measurement procedure used and where or when a measurement was made. Harmonization of test results includes consideration of pre-analytical, analytical, and post-analytical aspects. Progress has been made in each of these aspects, but there is currently poor coordination of the effort among different professional organizations in different countries. Pre-analytical considerations include terminology for the order, instructions for preparation of the patient, collection of the samples, and handling and transportation of the samples to the laboratory. Key analytical considerations include calibration traceability to a reference system, commutability of reference materials used in a traceability scheme, and specificity of the measurement of the biomolecule of interest. International organizations addressing harmonization include the International Federation for Clinical Chemistry and Laboratory Medicine, the World Health Organization, and the recently formed International Consortium for Harmonization of Clinical Laboratory Results (ICHCLR). The ICHCLR will provide a prioritization process for measurands and a service to coordinate global harmonization activities to avoid duplication of effort. Post-analytical considerations include nomenclature, units, significant figures, and reference intervals or decision values for results. Harmonization in all of these areas is necessary for optimal laboratory service. This review summarizes the status of harmonization in each of these areas and describes activities underway to achieve the goal of fully harmonized clinical laboratory testing.
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Affiliation(s)
- W. Greg Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jillian R. Tate
- Pathology Queensland, Department of Chemical Pathology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Julian H. Barth
- Blood Sciences, Old Medical School, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Graham R. D. Jones
- SydPath, Department of Chemical Pathology, St. Vincent's Hospital, Darlinghurst, NSW, and University of New South Wales, Kensington, Australia
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Wang SH, Wang TF, Wu CH, Chen SH. In-depth comparative characterization of hemoglobin glycation in normal and diabetic bloods by LC-MSMS. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2014; 25:758-766. [PMID: 24578002 DOI: 10.1007/s13361-014-0830-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/26/2013] [Accepted: 01/02/2014] [Indexed: 06/03/2023]
Abstract
The glycation level at β-Val-1 of the hemoglobin β chain in human blood (HbA1c%) is used to diagnose diabetes and other diseases. However, hemoglobin glycation occurs on multiple sites on different isoforms with different kinetics, but its differential profile has not been clearly demonstrated. In this study, hemoglobin was extracted from the blood of normal and diabetic individuals by protein precipitation. Triplicate solutions prepared from each sample were directly analyzed or digested with multiple enzymes and then analyzed by nano-LC/MS via bottom-up approach for side-by-side characterization. Intact hemoglobin analysis indicated a single glucose-dominant glycation, which showed good correlation with the HbA1c% values. Moreover, full sequence (100%) of α/β globin was mapped and seven glycation sites were unambiguously assigned. In addition to β-Val-1, two other major sites at α-Lys-61 and β-Lys-66, which contain the common sequence HGKK, and four minor sites (<1%) on α-Val-1, β-Lys-132, α-Lys-127, and α-Lys-40 were identified. All sites were shown to exhibit similar patterns of site distribution despite different glucose levels. Both the intact mass measurement and bottom-up data consistently indicated that the total glycation percentage of the β-globin was twice higher than the α-globin. Using molecular modeling, the 3D structure of the consensus sequence (HGKK) was shown to contain a phosphate triangle cavity, which helps to catalyze the glycation reaction. For the first time, hemoglobin glycation in normal and diabetic bloods was comparatively characterized in-depth with 100% sequence coverage. The results provide insight about the HbA1c parameter and help define the new and old markers.
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Affiliation(s)
- Shih-Hao Wang
- Department of Chemistry, National Cheng Kung University, Tainan, 701, Taiwan
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Desmons A, Guillard E, Jaisson S, Gillery P. Detection of unknown β-thalassemia cases from atypical HbA1c chromatograms. Clin Chem Lab Med 2013; 51:e301-3. [PMID: 23969468 DOI: 10.1515/cclm-2013-0364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/26/2013] [Indexed: 12/30/2022]
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Helander A, Kenan Modén N. Effect of transferrin glycation on the use of carbohydrate-deficient transferrin as an alcohol biomarker. Alcohol Alcohol 2013; 48:478-82. [PMID: 23690231 DOI: 10.1093/alcalc/agt045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Measurement of an alcohol-induced shift in the serum transferrin glycosylation pattern, termed carbohydrate-deficient transferrin (CDT), is used as a biomarker for sustained high alcohol consumption. The present work examined whether non-enzymatic reaction of transferrin with glucose (glycation) might interfere with the use of CDT as an alcohol biomarker. METHODS The blood specimens were leftover volumes from the routine sample pool. Plasma and serum were collected among samples submitted for hemoglobin A1c (HbA1c) and CDT testing. Quantification of individual transferrin glycoforms in percentage of total transferrin was performed by an HPLC candidate CDT reference method. RESULTS Incubating serum spiked with 20 or 200 mmol/l glucose caused time- and dose-dependent changes in the chromatographic profile of transferrin glycoforms, resulting in gradually wider peaks and reduced relative amounts of disialo- and trisialotransferrin. No similar chromatographic effects were seen in samples collected from diabetic patients with elevated HbA1c (>68 mmol/mol) values. These samples instead showed slightly higher mean %disialotransferrin levels (1.21%) compared with low HbA1c (<44 mmol/mol) samples (mean 1.06%; P = 0.023), pointing at a higher alcohol consumption level in the former group. Altogether ∼5% of the CDT values exceeded the cutoff. There was no significant difference in phosphatidylethanol (PEth) levels between the high and low HbA1c samples, but several (∼14%) showed elevated PEth concentrations. CONCLUSION Glycation of serum transferrin in vivo was indicated to differ from that in vitro, and suggested not to interfere with %CDT testing by the HPLC method. The results indicated that CDT and PEth are useful as objective, complementary alcohol biomarkers to identify risky drinking also in diabetic subjects.
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Affiliation(s)
- Anders Helander
- Alcohol Laboratory, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
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External quality assessment of HbA1c and its effect on comparison between Swedish pediatric diabetes clinics. Experiences from the Swedish pediatric diabetes quality register (Swediabkids) and Equalis. Clin Chem Lab Med 2013; 51:2045-52. [DOI: 10.1515/cclm-2013-0226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/29/2013] [Indexed: 11/15/2022]
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Aksungar FB, Serteser M, Coşkun A, Ünsal İ. A comparison between turbidimetric inhibition immunoassay and capillary electrophoresis in glycated hemoglobin (HbA1c) measurement. Clin Chem Lab Med 2013; 51:e191-3. [DOI: 10.1515/cclm-2013-0033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 02/25/2013] [Indexed: 11/15/2022]
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