Identification of a Hemolysis Threshold That Increases Plasma and Serum Zinc Concentration

Ischemia modified albumin as a marker of hypoxia in preterm infants in the first week after birth

BACKGROUND

Tissue hypoxia remains a leading cause of morbidity and mortality in preterm infants. Current biomarkers often detect irreversible hypoxic cellular injury (i.e. lactate) and are non-specific. A new biomarker is needed which detects tissue hypoxia before irreversible damage occurs.

AIMS

To investigate the relation between serum ischemia modified albumin (IMA), a marker of hypoxia; and analytic variables, patient related variables and conditions associated with hypoxia, in preterm infants.

STUDY DESIGN

Retrospective cohort study.

SUBJECTS

Infants with a gestational age < 30 weeks and/or birth weight < 1000 g.

OUTCOME MEASURES

We collected two remnant blood samples in the first week after birth and measured IMA. IMA/albumin ratio (IMAR) was used to adjust for albumin. We assessed correlations between IMA(R) and analytic variables (albumin, lipemia- and haemolysis index); mean-2 h SpO2; mean-2 h variability of regional splanchnic oxygen saturation (rsSO2), measured using near-infrared spectroscopy; and patent ductus arteriosus (PDA).

RESULTS

Sixty-five infants were included. Albumin, the lipemia- and haemolysis index correlated negatively with IMA (r:-0.620, P<0.001; r:-0.458, P<0.001; and r:-0.337, P=0.002). IMAR correlated negatively with SpO2 (rho:-0.614, P<0.001). Lower rsSO2 variability correlated with higher IMAR values (rho:-0.785, n=14, P=0.001 and rho:-0.773, n=11, P=0.005). Infants with a hemodynamic significant PDA (hsPDA) had higher IMAR values than infants without PDA (0.13 [0.11-0.28], n=16 vs. 0.11 [0.08-0.20], n=29, P=0.005 and 0.11 [0.09-0.18], n=13 vs. 0.09 [0.06-0.17], n=37, P=0.026).

CONCLUSIONS

When adjusted for albumin, the lipemia- and haemolysis index, IMAR has potential value as a marker for systemic hypoxia in preterm infants, considering the associations with SpO2, variability of rsSO2, and hsPDA.

Dried blood spot analysis for elements of nutritional concern as demonstrated in studies of Galápagos land iguanas (Conolophus species)

BACKGROUND

Dried blood spot (DBS) technology is valuable in providing simple means of storing blood samples from wildlife with small blood volumes. Methods designed for heavy metal analysis on DBS become more useful if extended to elements of nutritional significance.

PURPOSE

(1) Development of procedures for measuring Mn, Fe, Co, Cu, Zn, Se and Mo in DBS; (2) use the designed methods in health assessments of Galápagos land iguanas (Conolophus species).

PROCEDURES

Elements were measured by inductively coupled plasma/mass spectrometry (ICP-MS) following acid digestion of whole blood or DBS from the same animal for direct comparison. Study animals comprised free-ranging iguanas from separate islands in the Galápagos archipelago.

MAIN FINDINGS

DBS spikes (Mn, Fe, Co, Cu, Zn, Se and Mo) demonstrated accuracy to ∼100 ppb; reporting limits were set there except for Fe and Zn which were set at 1000 ppb. Plasma samples - generally preferable for nutritional element diagnostics - were submitted from Galápagos land iguanas along with DBS as part of a large-scale health assessment. In plasma versus DBS concentration comparisons, Fe, Cu, Se and Mn correlated well with R^2 values of 0.799, 0.818, 0.896 and 0.899, respectively, and slopes ranging 0.88 - 1.3. Co and Zn showed greater scatter. Mo had insufficient points above its reporting limit and offered advantages for toxicity assessments. Bland-Altman diagrams showed flat scatter between 2x standard deviation boundaries with no undue trends except for Mn which had few points above its reporting limit. Bias, defined as the average difference [DBS - plasma] divided by the average value, was relatively low throughout, with values of - 19.3 % (Fe), - 48.7 % (Co), - 19.6 % (Cu), - 6.9 % (Zn), - 21.4 % (Se) and + 40.7 % (Mn). Normal distribution assessment of iguana Cu, Zn, Se and Fe plasma values showed unanticipated divergences between two species.

CONCLUSIONS

The DBS approach for nutritional element analysis offers a suitable methodology for determining crucial elements Mn, Fe, Co, Cu, Zn, Se, and Mo in veterinary samples. Analyses of samples from Conolophus species revealed interesting divergences particularly for Cu, Zn, Se and Fe, elements generally associated with defense against oxidative stress.

Pre-analytical variables influence zinc measurement in blood samples

Zinc deficiency continues to be a major concern for global public health. The zinc status of a target population is typically estimated by measuring circulating zinc levels, but the sampling procedures are not standardized and thus may result in analytical discrepancies. To examine this, we designed a study that controlled most of the technical parameters in order to focus on five pre-analytical variables reported to influence the measurement of zinc in blood samples, including (1) blood draw site (capillary or venous), (2) blood sample matrix (plasma or serum), (3) blood collection tube manufacturer (Becton, Dickinson and Company or Sarstedt AG & Co), (4) blood processing time (0, 4, or 24 hours), and (5) blood holding temperatures (4°C, 20°C, or 37°C). A diverse cohort of 60 healthy adults were recruited to provide sequential capillary and venous blood samples, which were carefully processed under a single chain of custody and measured for zinc content using inductively coupled plasma optical emission spectrometry. When comparing blood draw sites, the mean zinc content of capillary samples was 0.054 mg/L (8%; p<0.0001) higher than venous blood from the same donors. When comparing blood sample matrices, the mean zinc content of serum samples was 0.029 mg/L (5%; p<0.0001) higher than plasma samples from the same donors. When comparing blood collection tube manufacturer, the mean zinc content from venous blood samples did not differ between venders, but the mean zinc content from BD capillary plasma was 0.036 mg/L (6%; p<0.0001) higher than Sarstedt capillary plasma from the same donors. When comparing processing times, the mean zinc content of plasma and serum samples was 5-12% higher (p<0.0001) in samples processed 4-24 hour after collection. When comparing holding temperatures, the mean zinc content of plasma and serum samples was 0.5-7% higher (p = 0.0007 or p = 0.0061, respectively) in samples temporarily held at 20°C or 37°C after collection. Thus even with the same donors and blood draws, significant differences in zinc content were observed with different draw sites, tube types, and processing procedures, demonstrating that key pre-analytic variables can have an impact on zinc measurement, and subsequent classification of zinc status. Minimizing these pre-analytical variables is important for generating best practice guidelines for assessment of zinc status.

Zinc for infection prevention in children with sickle cell anemia: a randomized double-blind placebo-controlled trial

Data from small clinical trials in the United States and India suggest zinc supplementation reduces infection in adolescents and adults with sickle cell anemia (SCA), but no studies of zinc supplementation for infection prevention have been conducted in children with SCA living in Africa. We conducted a randomized double-blind placebo-controlled trial to assess zinc supplementation for prevention of severe or invasive infections in Ugandan children 1.00-4.99 years with SCA. Of 252 enrolled participants, 124 were assigned zinc (10 mg) and 126 assigned placebo once daily for 12 months. The primary outcome was incidence of protocol-defined severe or invasive infections. Infection incidence did not differ between treatment arms (282 vs. 270 severe or invasive infections per 100 person-years, respectively, incidence rate ratio of 1.04 [95% confidence interval (CI), 0.81, 1.32, p=0.78]), adjusting for hydroxyurea treatment. There was also no difference between treatment arms in incidence of serious adverse events or SCA-related events. Children receiving zinc had increased serum levels after 12-months, but at study exit, 41% remained zinc deficient (<65 μg/dL). In post-hoc analysis, occurrence of stroke or death was lower in the zinc treatment arm (adjusted hazard ratio (95% CI), 0.22 (0.05, 1.00); p=0.05). Daily 10 mg zinc supplementation for 12 months did not prevent severe or invasive infections in Ugandan children with SCA, but many supplemented children remained zinc deficient. Optimal zinc dosing and the role of zinc in preventing stroke or death in SCA warrant further investigation. This trial was registered at clinicaltrials.gov as #NCT03528434.

Studying ferroptosis and iron metabolism pre- and post-radiotherapy treatment in breast cancer patients

BACKGROUND

Radiotherapy (RT) is an important part of the treatment of many tumors. Radiotherapy causes oxidative damage in all cellular compartments, including lipid membrane, on a random basis. Toxic lipid peroxidation accumulation has only lately been linked to a regulated type of cell death known as ferroptosis. Iron is required for ferroptosis sensitization in cells.

AIM OF THE WORK

This work aimed to study ferroptosis and iron metabolism before and after RT in BC patients.

SUBJECTS AND METHODS

Eighty participants were included divided into two main groups: group I: 40 BC patients treated with RT. Group II: 40 healthy volunteers' age and sex matched as control group. Venous blood samples were collected from BC patients (prior to and after RT) and healthy controls. Glutathione (GSH), malondialdehyde (MDA), serum iron levels and % of transferrin saturation were measured by colorimetric technique. Ferritin, ferroportin, and prostaglandin-endoperoxide synthase 2 (PTGS2) levels were assessed by ELISA.

RESULTS

Serum ferroportin, reduced glutathione, and ferritin showed significant decrease after radiotherapy in comparison to before radiotherapy. However, there was significant increase in serum PTGS2, MDA, % of transferrin saturation and iron levels after radiotherapy in comparison to before radiotherapy.

CONCLUSION

Radiotherapy induced ferroptosis in breast cancer patients as a new cell death mechanism and PTGS2 is a biomarker of ferroptosis. Iron modulation is a useful approach for the treatment of BC especially if combined with targeted therapy and immune-based therapy. Further studies are warranted to be translated into clinical compounds.

Cellular Zinc Deficiency Impairs Heme Biosynthesis in Developing Erythroid Progenitors

Anemia is the most prevalent nutrition-related disorder worldwide. Zinc is an essential trace element for various biological processes in the body, and zinc deficiency has been associated with anemia in humans. However, the molecular mechanisms by which zinc availability alters red blood cell development remain uncertain. The present study identifies the essentiality of zinc during erythroid development, particularly for normal heme biosynthesis. G1E-ER4 mouse cells were used as an in vitro model of terminal erythroid differentiation, which featured elevated cellular zinc content by development. Restriction of zinc import compromised the rate of heme and α-globin production and, thus, the hemoglobinization of the erythroid progenitors. Heme is synthesized by the incorporation of iron into protoporphyrin. The lower heme production under zinc restriction was not due to changes in iron but was attributable to less porphyrin synthesis. The requirement of adequate zinc for erythroid heme metabolism was confirmed in another erythropoietic cell model, MEL-DS19. Additionally, we found that a conventional marker of iron deficiency anemia, the ZnPP-to-heme ratio, responded to zinc restriction differently from iron deficiency. Collectively, our findings define zinc as an essential nutrient integral to erythroid heme biosynthesis and, thus, a potential therapeutic target for treating anemia and other erythrocyte-related disorders.

Extracellular and Intracellular Concentrations of Molybdenum and Zinc in Soccer Players: Sex Differences

Molybdenum (Mo) and zinc (Zn) play important roles in the process of adaptation to physical training. The aims of the present study were: (i) to analyze the differences in extracellular (plasma and urine) and intracellular (erythrocytes and platelets) Mo and Zn concentrations between sexes and (ii) to relate extracellular Zn concentrations with biomarkers of muscle damage and muscle mass. The present study involved 138 semi-professional soccer players divided according to sex: male (n = 68) and female (n = 70). Mo and Zn concentrations were determined by inductively coupled plasma mass spectrometry. Erythrocytes, platelets, creatine kinase (CK), and lactate dehydrogenase (LDH) values were also determined by automatic cell counter and spectrophotometric techniques. There were no sex differences in Mo and Zn intake. Male soccer players obtained higher values of erythrocytes, CK, and LDH (p < 0.05), and showed higher plasma and urinary concentrations of Mo and Zn (p < 0.05). Female soccer players showed relatively higher Zn concentrations in erythrocytes (p < 0.05). Finally, positive correlations were observed between extracellular Zn concentrations with CK, LDH and muscle mass. Extracellular concentrations of Mo and Zn were higher in male soccer players. However, the relative concentrations of Zn in relation to the number of erythrocytes were higher in female soccer players.

The Significance of Zinc in Patients with Chronic Liver Disease

Zinc is an essential trace element for the maintenance of life because it acts as a center of activity or cofactor for hundreds of enzymes. Zinc deficiency causes a variety of symptoms, including anemia, dermatitis, stomatitis, alopecia, bedsores, decreased appetite, impaired growth, gonadal dysfunction, susceptibility to infection, and taste disorders, etc. In March 2017, zinc acetate hydrate, which had been approved for Wilson disease in Japan, received an additional indication for hypozincemia. Hypozincemia is frequently observed in patients with chronic liver disease (CLD), especially cirrhosis, and it has recently been shown that hypozincemia is closely related to the development of liver fibrosis and increased risk of liver carcinogenesis, in addition to the appearance of various subjective symptoms. Moreover, hypozincemia in CLD may be associated with sarcopenia (i.e., decrease in muscle strength and muscle mass) and frailty (i.e., vulnerability), which receive much attention these days. It is assumed that treatment with zinc acetate hydrate will become widespread in patients with CLD. Zinc acetate hydrate may also have potential for improving sarcopenia in patients with CLD. This review primarily outlines the significance of zinc in patients with CLD.

Impact of Time Delay in the Analysis of Serum Ionized Calcium, Sodium, and Potassium

Introduction Delay in the analysis of serum electrolytes along with clot contact time can lead to difference in results significant enough to affect clinical decisions. This study was undertaken to evaluate the effect of time lag between centrifugation and analysis on levels of serum sodium, potassium, and ionized calcium in a tertiary level health care set up.

Materials and Methods In this cross-sectional study, 70 serum samples were analyzed for ionized calcium, sodium, and potassium under different conditions with respect to time lag and clot contact time. The analysis of ionized calcium was done on Eschweiler Combiline 2, a direct ion-selective electrode (ISE) analyzer. Serum sodium and potassium were analyzed on fully automated chemistry analyzer, which is an indirect ISE analyzer. The statistical analysis was done in IBM SPSS software version 21.

Results The results for intergroup comparison with different time lag and clot contact time between all the four groups for sodium, potassium, and ionized calcium were statistically significant, as obtained by application of Kruskal–Wallis test. There was consistent decrease in the concentration of sodium and ionized calcium, and an increase in serum potassium with increased delay in analysis and clot contact time.

Conclusion The accurate measurement of electrolytes is of paramount importance for the treatment and better prognosis of critically ill patients. This can be accomplished by better management of the preanalytical phase of analysis by maintaining a standard protocol in the laboratory and sample transportation.

Measuring haemolysis in cattle serum by direct UV-VIS and RGB digital image-based methods

A simple, rapid procedure is required for the routine detection and quantification of haemolysis, one of the main sources of unreliable results in serum analysis. In this study, we compared two different approaches for the rapid determination of haemolysis in cattle serum. The first consisted of estimating haemolysis via a simple direct ultraviolet–visible (UV–VIS) spectrophotometric measurement of serum samples. The second involved analysis of red, green, blue (RGB) colour data extracted from digital images of serum samples and relating the haemoglobin (Hb) content by means of both univariate (R, G, B and intensity separately) and multivariate calibrations (R, G, B and intensity jointly) using partial least squares regression and artificial neural networks. The direct UV–VIS analysis and RGB-multivariate analysis using neural network methods were both appropriate for evaluating haemolysis in serum cattle samples. The procedures displayed good accuracy (mean recoveries of 100.7 and 102.1%, respectively), adequate precision (with coefficients of variation from 0.21 to 2.68%), limit of detection (0.14 and 0.21 g L^–1, respectively), and linearity of up to 10 g L^–1.

Influence of physical training on intracellular and extracellular zinc concentrations

Background

Physical exercise affects zinc (Zn) homeostasis. This study aimed to analyze the influence of physical training on extracellular (serum, plasma, and urine) and intracellular (erythrocytes and platelets) concentrations of Zn.

Methods

Forty young men, divided into a training group (TG; n = 20; 18.15 ± 0.27 years; 68.59 ± 4.18 kg; 1.76 ± 0.04 m) and a control group (CG; n = 20; 19.25 ± 0.39 years; 73.45 ± 9.04 kg; 1.79 ± 0.06 m), participated in this study. The TG was formed by semiprofessional soccer players from a youth category with a regular training plan of 10 h/week. The CG was formed by healthy men who did not practice physical exercise and had not followed any specific training plan. Plasma, serum, urine, erythrocyte, and platelet samples of Zn were obtained and analyzed by inductively coupled plasma mass spectrometry.

Results

The TG showed elevated plasma Zn concentrations (p < 0.01) despite similar intakes. However, TG showed reduced absolute (p < 0.01) and relative (p < 0.05) Zn concentrations in erythrocytes.

Conclusions

Athletes who underwent regular physical training showed elevated plasma and reduced erythrocyte Zn concentrations despite similar intakes to the CG.

Studying ferroptosis and pyroptosis as new cell death mechanisms induced by ionizing radiation in Ehrlich solid tumor-bearing mice

OBJECTIVE

Our objective was to explore the effect of different fractionation schedule on ferroptosis and pyroptosis biomarkers as new cell death mechanisms induced by IR.

MATERIALS AND METHODS

This study included 40 tumor bearing mice divided into: Group I: Includes 8 untreated tumor-bearing mice. Group II: Includes 8 tumor bearing mice exposed to single dose 6 Gy of IR. Group III: Includes 8 tumor bearing mice exposed to 12 Gy in 2 fractions (2 × 6 Gy) of IR. Group IV: Includes 8 tumor bearing mice exposed to 12 Gy in 3 fractions (3 × 4 Gy) of IR. Group V: Includes 8 tumor bearing mice exposed to 8 Gy in 4 fractions (4 × 2 Gy) of IR. IL-1β, IL-18, and GSDMD-CT levels were assessed by ELISA. PTGS2 and ACSL4 expression were assessed by RT-PCR.

RESULTS

(2 × 6 Gy) group showed the highest ACSL4 expression followed by (3 × 4 Gy), then (4 × 2 Gy) and finally 6 Gy. (2 × 6 Gy) group resulted in the highest PTGS2 expression followed by (3 × 4 Gy), then 6 Gy, and finally (4 × 2 Gy). MDA significantly increased at (2 × 6 Gy), (3 × 4 Gy), and 6 Gy groups and insignificantly increased at (4 × 2 Gy) group. Iron significantly increased at (2 × 6 Gy), (3 × 4 Gy), and (4 × 2 Gy) groups and insignificantly at 6 Gy. Glutathione was significantly decreased at (2 × 6 Gy), (3 × 4 Gy), and (4 × 2 Gy) groups and insignificantly at 6 Gy. GSDMD-CT, IL-1β, and IL-18 levels significantly reduced in tumor tissues after exposure to IR at all doses.

CONCLUSION

High dose per fraction regimens induce the expression of ferroptosis markers more than low dose per fraction regimen and single dose of IR. IR at all doses induces pyroptotic cell death.

Preanalytical errors on zinc concentrations caused by single-use gloves

Preanalytical errors causing specimen contamination with zinc (Zn) are disastrous for routine medical diagnostics or scientific studies. The aim of the study presented here is to simulate contamination possibilities when using single-use gloves. The ability to release Zn into the specimen was tested using nitril (A), vinyl (B) and latex (C) gloves with 15 (14) replications. In our first approach, a 1 × 1 cm piece of the glove's fingertip was incubated for 10 min with serum. Our second approach imitated a very short contact of serum to the glove's material by letting serum run over the glove from a pipette for 3 cm distance into a tube. The effect of gloves' contact to liver tissue was examined using glove C only: a block of liver tissue was touched once at one side producing an experimental fingerprint. Zn was analyzed in serum and liver wet weight (ww) using ICP-MS; the basal serum/liver Zn concentration was set as zero for calculation. The calculated addition of Zn is given as median (p25 - p75). The first approach led to distinct contamination with Zn (in μg/L) being evident from all three types of gloves, but depended markedly from the type of material: A: 176.5 (129.7-204); B: 975.1 (663.6-1164.3); C: 2112 (1685-2516). Imitating a very short contact of serum to the glove's surface resulted in an additional Zn concentration of 105.7 (70.4-168.8), 56.2 (-13.5-121.4) and 955.7 (746-1159) μg/L using gloves A, B and C, respectively. A single fingerprint on liver tissue using glove C resulted an addition of 3995 (861-6435) μg Zn/kg liver ww. The data underline that the dimension of preanalytical contamination of blood and tissue samples for Zn analysis via single-use gloves is relevant for routine diagnostics and scientific studies. Critical steps and possibilities to minimize these effects should be considered seriously for specimen handling in routine laboratory diagnostics as well as in scientific studies to avoid preanalytical errors and, finally, misinterpretation of the data.

Influence of Haemolysis on the Mineral Profile of Cattle Serum

Simple Summary

The results of blood tests routinely used in clinical chemistry can be altered by haemolysis, the disruption of red blood cells. Haemolysis of serum samples is recognized to be the leading cause of preanalytical errors in clinical laboratories. The influence of haemolysis must be specifically studied for each analyte and species of clinical interest, as it is often not known how serum samples are affected. Little is known about the potential alterations in the concentrations of mineral elements in haemolyzed serum in general and the phenomenon has not been specifically studied in bovine serum samples. We investigate how haemolysis affects the mineral content of bovine samples.

Abstract

Haemolysis of serum samples is the leading cause of preanalytical errors in clinical laboratories. Little is known about the potential alterations in the concentrations of mineral elements in haemolyzed serum and the phenomenon has not been specifically studied in bovine serum samples. We investigate how haemolysis affects the mineral content of bovine samples. We used ICP-MS to measure the concentrations of 12 mineral elements (Ca, Co, Cr, Cu, Fe, Mg, Mn, Mo, Ni, P, Se and Zn) in bovine whole blood, serum and gradually haemolyzed samples and observed significant differences between the different types of samples, particularly in the Fe and Zn concentrations. However, in practice, the high interindividual variability makes it difficult to establish whether a given value corresponds to normal or haemolyzed samples. In response to this problem, we propose to consider that a result is significantly biased when the haemolysis threshold (the degree of haemolysis above which the concentration of an element in serum is significantly altered) of a given element is surpassed. The haemolysis threshold values for the different elements considered were found as follows: 0.015 g Hb L⁻¹ for Fe, 2 g for Zn, 4 g for Cr and 8 g for Ca, Se and Mo.

HDAC6 inhibitors sensitize non-mesenchymal triple-negative breast cancer cells to cysteine deprivation

Triple-negative breast cancer (TNBC) is a highly malignant type of breast cancer and lacks effective therapy. Targeting cysteine-dependence is an emerging strategy to treat the mesenchymal TNBC. However, many TNBC cells are non-mesenchymal and unresponsive to cysteine deprivation. To overcome such resistance, three selective HDAC6 inhibitors (Tubacin, CAY10603, and Tubastatin A), identified by epigenetic compound library screening, can synergize with cysteine deprivation to induce cell death in the non-mesenchymal TNBC. Despite the efficacy of HDAC6 inhibitor, knockout of HDAC6 did not mimic the synthetic lethality induced by its inhibitors, indicating that HDAC6 is not the actual target of HDAC6 inhibitor in this context. Instead, transcriptomic profiling showed that tubacin triggers an extensive gene transcriptional program in combination with erastin, a cysteine transport blocker. Notably, the zinc-related gene response along with an increase of labile zinc was induced in cells by the combination treatment. The disturbance of zinc homeostasis was driven by PKCγ activation, which revealed that the PKCγ signaling pathway is required for HDAC6 inhibitor-mediated synthetic lethality. Overall, our study identifies a novel function of HDAC6 inhibitors that function as potent sensitizers of cysteine deprivation and are capable of abolishing cysteine-independence in non-mesenchymal TNBC.

Measurement of serum zinc concentration in ruminants: a comparison of results from standard serum and specific trace element collection tubes

Aims: To evaluate agreement between the concentration of Zn in serum from samples collected from cattle and sheep into standard collection tubes for serum and from samples collected into tubes developed for trace element measurement. Methods: Eighty-eight animals (78 cattle and 10 sheep) on eight farms had paired blood samples collected into standard serum and trace element vacutainers. The paired samples were submitted the same day to the laboratory to be tested for the concentration of Zn in serum using atomic absorption spectrophotometry. The agreement between the paired results was then assessed using limits of agreement analysis. On one farm an additional 10 pairs of samples was taken from the same animals; this second set of paired samples was refrigerated for 48 hours prior to laboratory submission to identify the impact of delaying submission on the apparent concentration of Zn in serum. Results: The limits of agreement analysis found no evidence of a systematic difference between Zn concentrations in serum collected into standard serum tubes and into trace element tubes as neither the intercept nor the slope on the mean-difference plot were significantly different from zero. The SD of the difference between results increased as the concentration of Zn increased, so at the lowest Zn concentration reported in this study (6.9 μmol/L) the limits of agreement were ±1.07 μmol/L, while at the highest (23.5 μmol/L) they were ±3.39 μmol/L. Refrigerating the sample (as whole blood) for 48 hours prior to submission increased the apparent concentration of Zn in serum in both standard serum tubes and trace element tubes by 1.3 μmol/L (95% CI = 0.75-1.85). Conclusions: There was no evidence that the concentration of Zn in serum from standard serum tubes were artificially elevated. In contrast, delaying sample submission by 48 hours did elevate Zn concentrations. Clinical relevance: While these data apply only to the batch of vacutainers used in this study, there is unlikely to be much between batch variation in the potential for contamination. Thus these results suggest that monitoring zinc status in ruminants, by measuring the concentration of Zn in serum from samples collected into standard serum tubes does not result in clinically relevant alterations in Zn concentration compared to using specific trace element tubes. However delaying submission to the laboratory may result in significantly elevated concentrations of Zn in serum so should be avoided.

Evaluation of treatment with zinc acetate hydrate in patients with liver cirrhosis complicated by zinc deficiency

AIM

In Japan, no zinc preparation had been approved for therapeutic purposes before March 2017. Zinc acetate hydrate was recently approved for the treatment of hypozincemia. We evaluated the efficacy and safety of treatment with zinc acetate hydrate.

METHODS

A total of 97 patients with cirrhosis complicated by hypozincemia were treated with zinc acetate hydrate, and their serum zinc normalization rates; factors contributing to normalization; changes in blood ammonia levels; branched-chain amino acids-to-tyrosine ratios; levels of albumin, hemoglobin, alkaline phosphatase, serum copper, and iron; incidence of adverse events; improvement in subjective symptoms; and serum zinc levels taken at 3 months post-treatment were determined.

RESULTS

The cumulative serum zinc normalization rates, when normalization was defined as achievement of a serum zinc level ≥80 μg/dL, after 2, 4, and 6 months of treatment were 64.9%, 80.3%, and 82.5%, respectively. Multivariate analysis identified an albumin level of ≥3.3 g/dL and branched-chain amino acids to tyrosine ratio of ≥3.46 as factors contributing to zinc normalization within 3 months of treatment. Treatment resulted in a significant decrease in blood ammonia and serum copper levels, and significant increases in branched-chain amino acids-to-tyrosine ratios and alkaline phosphatase levels. Seven (7.2%) patients prematurely discontinued treatment due to hypocupremia. By the end of treatment, subjective symptoms had resolved in 46.2% of patients. By 3 months post-treatment, serum zinc levels had reverted to levels close to those at baseline.

CONCLUSIONS

Treatment with zinc acetate hydrate resulted in normalization of serum zinc levels at a high rate. The main reasons for discontinuation of treatment included hypocupremia.

Adjusting plasma or serum zinc concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

BACKGROUND

The accurate estimation of zinc deficiency at the population level is important, as it guides the design, targeting, and evaluation of nutrition interventions. Plasma or serum zinc concentration (PZC) is recommended to estimate zinc nutritional status; however, concentrations may decrease in the presence of inflammation.

OBJECTIVES

We aimed to assess the relation between PZC and inflammation in preschool children (PSC; 6-59 mo) and nonpregnant women of reproductive age (WRA; 15-49 y), and to compare different inflammation adjustment approaches, if adjustment is warranted.

METHODS

Cross-sectional data from 13 nationally representative surveys (18,859 PSC, 22,695 WRA) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project were analyzed. Correlation and decile analyses were conducted, and the following 3 adjustment methods were compared if a consistent negative association between PZC and C-reactive protein (CRP) or α-1-acid glycoprotein (AGP) was observed: 1) exclude individuals with CRP > 5 mg/L or AGP > 1 g/L; 2) apply arithmetic correction factors; and 3) use the BRINDA regression correction (RC) approach.

RESULTS

In 6 of 12 PSC surveys, the estimated prevalence of zinc deficiency increased with increasing CRP deciles, and to a lesser extent, with increasing AGP deciles. In WRA, the association of PZC with CRP and AGP was weak and inconsistent. In the 6 PSC surveys in which adjustment methods were compared, application of RC reduced the estimated prevalence of zinc deficiency by a median of 11 (range: 4-18) percentage points, compared with the unadjusted prevalence.

CONCLUSIONS

Relations between PZC and inflammatory markers were inconsistent, suggesting that correlation and decile analyses should be conducted before applying any inflammation adjustments. In populations of PSC that exhibit a significant negative association between PZC and CRP or AGP, application of the RC approach is supported. At this time, there is insufficient evidence to warrant inflammation adjustment in WRA.

Comparison of Serum Trace Nutrient Concentrations in Epileptics Compared to Healthy Dogs

Idiopathic epilepsy (IE) is a common cause of seizures in dogs. There are several investigations regarding serum concentrations of trace nutrients, including copper, selenium, zinc, manganese, and iron in human epileptics and animal models. However, research of this nature in dogs with epilepsy is lacking. The purpose of this prospective study was to compare serum concentrations of several trace nutrients in healthy dogs to dogs with idiopathic epilepsy. Healthy client-owned dogs (n = 50) and dogs with IE (n = 92) were enrolled and blood samples were collected for trace nutrient analysis. Epileptics were subdivided into three groups: controlled: n = 27, uncontrolled: n = 42, and untreated: n = 23. Serum was evaluated for concentrations of copper, selenium, zinc, cobalt, manganese, molybdenum, and iron using inductively coupled plasma mass spectroscopy. Uncontrolled epileptics had significantly higher manganese concentrations compared to normal dogs (p = 0.007). Untreated epileptics had higher iron levels than the other three groups (p = 0.04). Significantly higher levels of copper (p < 0.0001) were found in controlled and uncontrolled epileptics compared to normal or untreated dogs. Significantly higher levels of molybdenum (p = 0.01) were found in controlled epileptics compared to normal or untreated epileptics. Uncontrolled and controlled epileptics had significantly higher levels of selenium (p = 0.0003) vs. normal dogs, and uncontrolled epileptics had higher levels of zinc (p = 0.0002) than normal and untreated dogs. The significant difference in serum concentrations of several trace nutrients (manganese, selenium, and zinc) may suggest a role for these nutrients in the pathophysiology and/or treatment of epilepsy. Additionally, these results suggest that anti-convulsant therapy may affect copper and molybdenum metabolism.

Determination of Essential and Toxic Elements in Cattle Blood: Serum vs Plasma

Simple Summary

Knowledge of type of blood sample (serum or plasma) for determination of essential and toxic elements is essential for assessing the health and nutritional status of the animals and the herd. We demonstrate that both plasma and serum samples are suitable and interchangeable for the determination of most of the essential and toxic elements in blood in cattle. Nevertheless, we must take into account that the concentrations of Cu and Se are lower in the serum than in plasma.

Abstract

This study was designed to evaluate the influence of type of blood sample (serum or plasma) on essential and toxic element analysis in cattle. Paired plasma and serum samples (n = 20) were acid digested, and the concentrations of As, B, Ba, Ca, Cd, Co, Cr, Cu, Fe, Hg, Li, Mg, Mn. Mo, Ni, P, Pb, Sb, Se, Sr and Zn were determined by inductively coupled plasma mass spectrometry (ICP-MS). The study findings indicate that plasma and serum samples appear suitable and interchangeable for the determination of most of the essential and toxic elements in blood in cattle. The only exceptions are Cu and Se, the concentrations of which were significantly lower (40.9 and 29.9% respectively) in serum than in plasma. Some of the Cu in blood samples from bovine ruminants is known to be sequestered during clotting. However, further research on Se in ruminants and other animal species is warranted. Finally, the significantly higher Mn (9.9%) concentrations in serum than in plasma may have been caused by haemolysis of some samples. Special attention should be paid to preventing haemolysis of samples during collection and processing, in order to prevent overestimation of elements present at high concentrations inside erythrocytes (i.e., Fe, Mn and Zn).

A macro- and micronutrient-fortified complementary food supplement reduced acute infection, improved haemoglobin and showed a dose-response effect in improving linear growth: a 12-month cluster randomised trial

Inadequate protein quality may be a risk factor for poor growth. To examine the effect of a macronutrient-micronutrient supplement KOKO Plus (KP), provided to infants from 6 to 18 months of age, on linear growth, a single-blind cluster-randomised study was implemented in Ghana. A total of thirty-eight communities were randomly allocated to receive KP (fourteen communities, n 322), a micronutrient powder (MN, thirteen communities, n 329) and nutrition education (NE, eleven communities, n 319). A comparison group was followed cross-sectionally (n 303). Supplement delivery and morbidity were measured weekly and anthropometry monthly. NE education was provided monthly. Baseline, midline and endline measurements at 6, 12 and 18 months included venous blood draws, diet, anthropometry, morbidity, food security and socio-economics. Length-for-age Z-score (LAZ) was the primary outcome. Analyses were intent-to-treat using mixed-effects regressions adjusted for clustering, sex, age and baseline. No differences existed in mean LAZ scores at endline (-1·219 (sd 0·06) KP, -1·211 (sd 0·03) MN, -1·266 (sd 0·03) NE). Acute infection prevalence was lower in the KP than NE group (P = 0·043). Mean serum Hb was higher in KP infants free from acute infection (114·02 (sd 1·87) g/l) than MN (107·8 (sd 2·5) g/l; P = 0·047) and NE (108·8 (sd 0·99) g/l; P = 0·051). Compliance was 84·9 % (KP) and 87·2 % (MN) but delivery 60 %. Adjusting for delivery and compliance, LAZ score at endline was significantly higher in the KP v. MN group (+0·2 LAZ; P = 0·026). A macro- and micronutrient-fortified supplement KP reduced acute infection, improved Hb and demonstrated a dose-response effect on LAZ adjusting consumption for delivery.

Portable Device for Measuring Blood Test Hemolyzed Samples Based on Computer Vision and Neural Network

Hemolysis is a challenging problem and still represents a frequent source of errors in blood test laboratory practice. Due to the broad and heterogeneous bias induced in the measurement of several parameters by hemolysis, inaccurate results may be reported, and the patient may be required to repeat sample collection, delaying diagnosis. Existing automated laboratory devices including hemolysis detection are not suitable for lower volume and smaller sample collection sites. In many situations, hemolysis is still detected by visual inspection of the sample after centrifugation, during the blood test pre-analytical stage. Visual inspection is highly dependent on a qualified workforce, subjective to interpretation discrepancies, and thus difficult to standardize. The paper aims to describe the design and performance of a portable device for measuring hemolyzed samples based on computer vision and neural network. The results indicate that the device provides hemolysis indexes with sufficient accuracy to guide laboratory decision in the blood test pre-analytical stage.

How cellular Zn2+ signaling drives physiological functions

Zinc is an essential micronutrient affecting many aspects of human health. Cellular Zn²⁺ homeostasis is critical for cell function and survival. Zn²⁺, acting as a first or second messenger, triggers signaling pathways that mediate the physiological roles of Zn²⁺. Transient changes in Zn²⁺ concentrations within the cell or in the extracellular region occur following its release from Zn²⁺ binding metallothioneins, its transport across membranes by the ZnT or ZIP transporters, or release of vesicular Zn²⁺. These transients activate a distinct Zn²⁺ sensing receptor, ZnR/GPR39, or modulate numerous proteins and signaling pathways. Importantly, Zn²⁺ signaling regulates cellular physiological functions such as: proliferation, differentiation, ion transport and secretion. Indeed, novel therapeutic approaches aimed to maintain Zn²⁺ homeostasis and signaling are evolving. This review focuses on recent findings describing roles of Zn²⁺ and its transporters in regulating physiological or pathological processes.

Elevated zinc concentrations in a 5 months old infant: A case report

Pre-analytical errors account for the majority of laboratory-associated errors. In a 5 months old infant hospitalised with lung dysfunction due to prematurity, a routine measurement of zinc revealed an unexpected elevated concentration of 20.2 µmol/L (reference interval 10.0 - 19.0 µmol/L) compared to 11.6 µmol/L five days earlier. Zinc measurement was repeated two days later and had further increased to 42.4 µmol/L. Of note, there were no clinical signs of the increased zinc concentrations. Performance data for the zinc analysis (performed by inductively coupled plasma mass spectrometry) was found satisfactory. A thorough review of the patient´s medication and nutrition supplements revealed no relevant zinc content. The blood was obtained through capillary blood sampling, and anything at the skin puncture site containing zinc could therefore potentially contribute to the elevated zinc results. It was investigated if any ointment containing zinc had been applied at the puncture site, which revealed that the mother had applied vitamin E ointment containing zinc-oxide at the infant’s heel. A capillary sample obtained from the opposite heel, where no vitamin E ointment had been applied, revealed a zinc concentration of 14.3 µmol/L. In conclusion, pre-analytical contamination with ointments must be considered in case of unexpected measurements from capillary blood.