The role of serum protein electrophoresis in the detection of multiple myeloma: an experience of a corporate hospital

Mitigating Aflatoxin B1-Induced Growth Impairment and Hepatic Stress in Nile Tilapia (Oreochromis niloticus): Comparative Efficacy of Saccharomyces cerevisiae and Silicate-Based Detoxifiers

The objective of this study was to detect the effects of acute aflatoxin B1 (AFB1) exposure in Nile tilapia (Oreochromis niloticus) and the effectiveness of Saccharomyces cerevisiae and silicate in reducing these effects. Two hundred and forty Nile tilapia fingerlings (16 ± 0.5 g) were randomly assigned to four experimental groups, each with 60 fish and three replicates. Control basal diet (Diet 1) and three test diets were formulated, where Diet 2 was supplemented with 200 ppb AFB1. Diets 3 and 4 were intoxicated with AFB1 (200 ppb) and supplemented with 0.5% S. cerevisiae or 0.5%, respectively. After 60 days, Diet 1 had considerably greater growth characteristics than the other groups (p < 0.05). Diet 2 revealed a reduced (p < 0.05) survival rate after 1 month of exposure. In addition, Diet 1 showed higher (p < 0.05) total protein and albumin levels than Diets 3 and 4. AFB1 residues were detected in the liver in fish-fed Diet 2, Diet 4, and Diet 3. Alanine aminotransferase, aspartate aminotransferase, creatinine, and urea levels increased (p < 0.05) in fish-fed Diet 2. The glutathione peroxidase, lysozyme, and catalase activity were decreased (p < 0.05) in the fish-fed Diet 2. The malondialdehyde level was significantly higher in fish given Diet 2 (p < 0.05) than in fish-fed Diets 3 and 4. Histopathological investigation of fish-fed Diet 2 revealed impaired liver and spleen; however, both treatments (Diets 3 and 4) successfully lowered inflammation and preserved liver and spleen integrities. In conclusion, AFB1 impaired growth performance and posed a severe health risk to Nile tilapia. Furthermore, S. cerevisiae alleviated the contamination of AFB1 effects more efficiently than silicate employed for toxin adsorption.

Monoclonal Light Chains with alpha 2 mobility on Serum Protein Electrophoresis

Multiple myeloma (MM) is a neoplasm characterized by malignant proliferation of plasma cells that produce excessive quantities of a single type of immunoglobulin (Ig) called as monoclonal immunoglobulin or M-protein or paraprotein. M-protein produced can be either an intact antibody with both heavy and light-chain components or only light chains or rarely only heavy chains. Presence of M-protein in serum protein electrophoresis (PEP) is useful in the diagnosis, prognosis, and treatment of MM and other plasma cell dyscrasias. These M-proteins are identified commonly in beta and gamma regions and very rarely in alpha 2 region, appearing as a narrow band in agarose electrophoresis or as a sharp symmetric spike (M-spike) or peak in capillary zone electrophoresis. Here, we present an unusual case of monoclonal light chains producing two M- spikes in the alpha 2 globulin region in capillary zone electrophoresis.

Biochemical Analysis of Aqueous Humor in an Elderly Patient with Multiple Myeloma Presenting First as Bilateral Chronic Uveitis

PURPOSE

To study the biochemical analysis of aqueous humor in a patient with multiple myeloma presenting first as chronic uveitis.

METHODS

Observational case report.

RESULTS

A 63-year-old healthy woman presented with blurred vision in both eyes for 9 months. Slit-lamp examination showed bilateral conjunctival congestion, corneal oedema, and anterior uveitis. Fundus exam revealed normal optic disc with fine retinal folds in the macula. Serum protein electrophoretogram showed a monoclonal M protein band in the gamma globulin region. The bone marrow biopsy revealed hypercellular marrow with trilineage haematopoiesis and the bone marrow aspirate showed clonal plasma cells >10%, confirming the diagnosis of multiple myeloma. Aqueous fluid showed a differential band in electrophoretic profile of aqueous humor protein that on mass spectrometry analysis was strongly suggestive of immunoglobulin band.

CONCLUSION

The biochemical analysis of aqueous humor is another diagnostic test to monitor M protein in patients with multiple myeloma.

Dual detection high-speed capillary electrophoresis for simultaneous serum protein analysis and immunoassays

Serum protein electrophoresis (SPE) separates serum proteins into bands whose shape and amplitude can alert clinicians to a range of disorders. This is followed by more specific immunoassays to quantify important antigens and confirm a diagnosis. Here we develop a high-speed capillary electrophoresis (HSCE) platform capable of simultaneous SPE and immunoassay measurements. A single laser excitation source is focused into the detection zone of the capillary to measure both refractive index (SPE) and fluorescence signals (immunoassays). The refractive index signal measures characteristic SPE profiles for human serum separated in 100 mM boric acid (pH 10), 100 mM arginine (pH 11), and 20 mM CHES (pH 10). For the immunoassay, the fluorescence electropherograms reveal that CHES provides the optimal buffer for measuring the immunocomplex and separating it from the free antigen. Immunoassays in CHES yield a LOD of 23 nM and a LOQ of 70 nM for the detection of fluorescein. The high pH reduces protein adsorption but reduces antibody affinity. Preliminary studies carried out in 50 mM barbital at pH 8 show improved stability of the immunocomplex and better separation for immunoassay quantification. Further optimization will open new capabilities for measuring orthogonal diagnostic signals in seconds with HSCE.

Immunohistochemical typing of amyloid in fixed paraffin-embedded samples by an automatic procedure: Comparison with immunofluorescence data on fresh-frozen tissue

Amyloidosis comprises a spectrum of disorders characterized by the extracellular deposition of amorphous material, originating from an abnormal serum protein. The typing of amyloid into its many variants represents a pivotal step for a correct patient management. Several methods are currently used, including mass spectrometry, immunofluorescence, immunohistochemistry, and immunogold labeling. The aim of the present study was to investigate the accuracy and reliability of immunohistochemistry by means of a recently developed amyloid antibody panel applicable on fixed paraffin-embedded tissues in an automated platform. Patients with clinically and pathologically proven amyloidosis were divided into two cohorts: a pilot one, which included selected amyloidosis cases from 2009 to 2018, and a retrospective one (comprising all consecutive amyloidosis cases analyzed between November 2018 and May 2020). The above-referred panel of antibodies for amyloid classification was tested in all cases using an automated immunohistochemistry platform. When fresh-frozen material was available, immunofluorescence was also performed. Among 130 patients, a total of 143 samples from different organs was investigated. They corresponded to 51 patients from the pilot cohort and 79 ones from the retrospective cohort. In 82 cases (63%), fresh-frozen tissue was tested by immunofluorescence, serving to define amyloid subtype only in 30 of them (36.6%). On the contrary, the automated immunohistochemistry procedure using the above-referred new antibodies allowed to establish the amyloid type in all 130 cases (100%). These included: ALλ (n = 60, 46.2%), ATTR (n = 29, 22.3%), AA (n = 19, 14.6%), ALκ (n = 18, 13.8%), ALys (n = 2, 1.5%), and Aβ₂M amyloidosis (n = 2, 1.5%). The present immunohistochemistry antibody panel represents a sensitive, reliable, fast, and low-cost method for amyloid typing. Since immunohistochemistry is available in most pathology laboratories, it may become the new gold standard for amyloidosis classification, either used alone or combined with mass spectrometry in selected cases.

Significance of Serum Protein Electrophoresis in the Detection of Multiple Myeloma: A Diagnostic Interpretation of Patients with Varied Immunoglobulins

Background:

To determine the relationship between serum protein electrophoresis (SPE) and serum immunoglobulin profiles of patients with multiple myeloma (MM).

Methods:

This is a retrospective study conducted at the Eric Williams Medical Sciences Complex, focusing on patients over 18 years who received diagnostic blood tests for MM. Results for SPE and serum immunoglobulin profiles were obtained using lab logbooks. Descriptive and inferential statistics techniques were used to analyze the data.

Results:

The median age of MM patients in Trinidad and Tobago is of 69 years. The ratio of male and female patients with the MM is 50:50. Out of 131 patients, 24 (18.32%) had M bands present, 60 (45.80%) had an increase in gamma globulin, and 16 (12.21%) had a decrease in albumin. In cases of M band presence and raised gamma, there was noticeable increase in IgG concentration and a slight increase in IgM concentration. There was also an increase in IgA concentration in patients with the M-band but a decrease in concentration in those with raised gamma. Patients with an elevated gamma had a significant increase in IgG diameter and IgG concentration.

Conclusions:

This study showed a relationship between the presence of M bands and serum immunoglobulins. It has proven the significance of SPE and immunoglobulins, like IgG and IGM, in the detection of MM in the early and advanced stages. Therefore, it is recommended that SPE be used, along with other laboratory tests, in the diagnosis of MM.

Development of a clinical diagnostic tool to differentiate multiple myeloma from bone metastasis in patients with destructive bone lesions (MM-BM DDx)

BACKGROUND

Most patients with destructive bone lesions undergo a comprehensive diagnostic procedure to ensure that proper treatment decisions are pursued. For patients with multiple myeloma, this can lead to delays in diagnosis and treatment initiation. This study was conducted to develop a diagnostic rule that could serve as a tool for early identification of multiple myeloma and promote timely referral of patients to haematologists.

METHODS

The clinical prediction rule was developed using a retrospective case-series of patients with multiple myeloma (MM) and those with bone metastasis (BM) at Chiang Mai University Hospital from 2012 to 2015. Multivariable fractional polynomial logistic regression was used to derive a diagnostic model to differentiate between MM and BM patients (MM-BM DDx).

RESULTS

A total of 586 patients (136 MM patients and 450 BM patients) were included. Serum creatinine, serum globulin, and serum alkaline phosphatase were identified as significant indicators for the differentiation of MM and BM patients. The MM-BM DDx model showed excellent discriminative ability [AuROC of 0.90 (95%CI 0.86 to 0.93)] and good calibration.

CONCLUSIONS

This MM-BM DDx model could potentially allow for early myeloma diagnosis and improvement of overall prognosis. A prospective validation study is needed to confirm the accuracy of the MM-BM DDx model prior to its application in clinical practice.

The impact on early diagnosis and survival outcome of M-protein screening-driven diagnostic approach to multiple myeloma in China: a cohort study

Background: Most multiple myeloma (MM) patients in China were diagnosed only until severe complications occurred. The incidence of MM in China is 7.3 times lower than that of the United States, which could have been underestimated due to high rate of miss diagnosis and diagnostic delay in China. In Zhongshan Hospital Fudan University, serum protein electrophoresis (SPEP) is routinely incorporated into liver function test panel, and therefore providing us unique opportunities to carry out a hospital-population-based M-protein screening by SPEP and establish a screening-driven diagnostic approach.

Methods: A retrospective cohort study analyzing data of patients screened by SPEP and diagnosed with MM from 2014 to 2017 was performed. We compared the baseline features and outcome of patients diagnosed via screen-driven approach and symptom-driven approach. We also analyzed the efficacy of M-protein screening.

Results: A total of 690,000 people were screened and 335 eligible MM patients were identified, among which 151 of them were diagnosed via screening-driven approach. Compared to symptom-driven group, patients in screening-driven group had earlier ISS stage disease (P = 0.025), lower frequency of anemia (P = 0.000) and bone lesion (P = 0.012), and lesser number of end-stage symptoms (P = 0.000). M-protein screening approach demonstrated significantly (P = 0.029, HR: 0.415) better outcome (3-yr OS, 76.9%) than those in symptom-driven subgroup (3-yr OS, 46.6%) after being adjusted for age, gender, CRAB symptoms and ECOG score with a Cox proportional hazards model. Furthermore, the annual incidence of MM in Zhongshan Hospital screening population is 20.82/100,000, much higher than that in the whole China despite of selection bias.

Conclusion: We concluded that the actual MM incidence in China may have been underestimated and M-protein screening in hospital population by SPEP is an effective approach to improve early diagnosis rate and outcome.

Laboratory Features of Newly Diagnosed Multiple Myeloma Patients

Objectives: Multiple myeloma (MM) is a malignant disorder characterized by proliferation of a single clone of plasma cells derived from β-cells in the bone marrow. It is the second most common adult hematological malignancy, and it is the most common cancer with skeletal components as its primary site. The purpose of the retrospective study was to assess the hematological profile, different biochemical parameters, and the serum electrophoresis patterns of patients consistent with clinical symptoms of multiple myeloma.

Materials and methods: A retrospective study of 99 patients diagnosed with multiple myeloma (MM) was carried out at the Hematology Department of Benghazi Medical Center (BMC) in Benghazi, Libya from January 2010 to March 2017. Information on the laboratory features was obtained at presentation (before treatment) and analyzed.

Results: Of the 99 study detected cases of multiple myeloma at diagnosis, 14% were younger than 45 years and 35% were 70 years or older. The mean age was 61 years, of which 42 (42.4%) were males and 57 (57.6%) were females. Anemia was seen in roughly half of the diagnosed cases, most of which was normocytic normochromic anemia. High erythrocyte sedimentation rate (ESR) was seen in 65.3% of cases and increased neutrophil-to-lymphocyte ratio (NLR) was seen in 29.7%. Other abnormal serum levels with regard to the cases are as follows: hyperproteinemia in 30%, low albumin/globulin (A/G) ratio in 54.2%, hypercalcemia in 11.3%, serum creatinine level of >2.0 mg/dL in 27.2% cases, and increased β2-microglobulin in 67%. Serum protein electrophoresis revealed a localized band in 70.8% of patients. Monoclonal bands were seen in 44 cases (95.7%) and a bi-clonal pattern in two cases (4.3%), 78% of M-band showed migration to γ-region of electrophoretogram and 18% to β-region.

Hypogammaglobulinemia was detected in 32.8% and hypergammaglobulinemia was detected in 49.2%. Of the hypergammaglobulinemia, 18.1% showed polyclonal gammaglobulinemia. Bence Jones protein was positive in 50% cases. IgG was the commonest type, followed by IgA then light chain. In 26.5% of cases, the only diagnosis was multiple myeloma. Light chain multiple myeloma patients had high α2 globulin concentration and normal A/G ratio. Apart from the diagnosis of multiple myeloma, a number of cases had varying diagnoses including the following: 4% non-secretory myeloma, 2% amyloidosis with nephrotic syndrome, 2% liver cirrhosis, and 18.2% renal failure. Most patients presented in stage III.

Conclusions: The presence of anemia, high ESR, and low A/G ratio in elderly patients should alert the clinician to investigate along the lines of multiple myeloma. In this study, unfortunately, the laboratory investigations were insufficient for diagnosing this disease in most patients. Most patients were diagnosed at stage III. Absence of paraprotein in the blood does not exclude multiple myeloma. It was further observed that most of the patients presented with significant renal damage, which attributed to hyperuricemia, hypercalcemia, or high NLR. Multiple causes of renal failure occur in myeloma and are often present at the time of diagnosis.

Role of Dietary Crocin in In Vivo Melanoma Tumor Remission

Background: Melanoma is a deadly form of malignancy. Early diagnosis might pave the way to cure but its aggressive nature leads to rapid dissemination and colonization of distant organs. Dietary herbs may play a significant role in prevention of cancer. In this study, we tested anti-tumor efficacy of the Crocus sativus derived active constituent crocin, it is well established to have anti-cancer properties in different cancer models by our group and other groups. Notably, crocin is reported to exert anti-proliferative effect on melanoma cells (B16F10) in vitro. However, roles of crocin on in vivo melanoma tumor remission have not yet been reported to our knowledge. Materials and Methods: Melanoma tumor model was established by transplanting B16F10 (5 X 105) cells into C57BL/6 mice, which were then observed for tumor development and once the tumor volume reached 6 mm, mice were divided into (Group I: tumor-bearing animals treated with normal saline and Group II: counterparts treated with crocin at 2 mg/kg body weight for 21 days). . Tumor remission and tumor growth related parameters such as tumor silent period (TSP), tumor volume doubling time (VDT), growth delay (GD), and mean survival time (MST) were determined. In addition, serum protein profiles were analyzed. Results: The 21 days crocin treatment significantly reduced the tumor burden in mice, extending the mean survival time significantly as compared to control. Crocin treatment also significantly increased the TGD and TSP and decreased VDT. Furthermore, while serum proteins such as albumin and globulin (alpha1, alpha2, beta, and gamma) were altered due to tumor burden, crocin treatment resulted in their levels near to normal at the end of the experimental period. Conclusion: Our study provided clear evidence that crocin may exhibit significant melanoma tumor remission properties by positively modulating tumor growth related parameters. In future, the molecular mechanisms of crocin action should be studied extensively in melanoma models before defining crocin-based melanoma drug formulations.