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We developed an improved enzymatic assay of D-sorbitol in human erythrocytes by employing highly specific D-sorbitol dehydrogenase from Pseudomonas sp. (EC 1.1.1.14) and replacing perchloric acid (HClO4) and potassium carbonate (K2CO3), generally used for deproteinization, with sodium hydroxide (NaOH) and zinc sulphate (ZnSO4). In this assay, erythrocytes were separated from plasma by centrifugation and washed once with physiological saline. Subsequently, the erythrocytes were lysed with distilled water and proteins precipitated with NaOH and ZnSO4. After centrifugation, the resulting colourless supernatant was mixed with a glycine buffer (pH 9.0) containing NAD+ and D-sorbitol dehydrogenase. After incubation for 30 min at 37 degrees C, the NADH produced was measured fluorimetrically. The fluorescence intensities were corrected for sample blanks, and the values of D-sorbitol were normalized for haemoglobin content. The method had an analytical range of 1-180 micromol/L. The intra- and inter-assay precisions were < 3.3% and < 5.8%, respectively. The detection limit was 0.65 micromol/L. In terms of the linearity, precision and sensitivity, the improved method using NaOH and ZnSO4 was superior to the conventional method using HClO4 and K2CO3.

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BACKGROUND: Apolipoproteins, which are contained in lipoprotein particles, play important roles in the transport of lipids. METHODS: Serum levels of apolipoproteins (apo) A-I, A-II, B, C-II, C-III, and E were determined by immunoturbidimetry in a healthy Japanese study population (1018 men and 1167 women, age 20-69 years) to establish reference intervals. RESULTS: Among the 2185 subjects examined, the mean serum value for apoA-I was 1.42 +/- 0.20 g/l, for apoA-II was 0.30 +/- 0.05 g/l, for apoB was 0.87 +/- 0.18 g/l, for apoC-II was 29 +/- 13 mg/l, for apoC-III was 75 +/- 20 mg/l, and for apoE was 36 +/- 9 mg/l. A sex difference was detected in the mean serum concentrations of all six apolipoproteins. Alcohol consumption and cigarette use had a slight effect on serum apolipoprotein concentrations. Age effects were observed among women in apoB, apoC-II, and apoC-III concentrations. Moreover, individuals with elevated serum lipoprotein (a) [Lp(a), >300 mg/l] also displayed increased serum apoB and apoC-II levels and an increased apoB/apoA-I ratio. CONCLUSION: The reference intervals for apolipoproteins in Japanese adults that we established, using commercially available reagents for automated analyzers, will be helpful for assessing risk of coronary heart disease and pathological conditions of patients with hyperlipidemia. We recommend use of these reference intervals for the clinical interpretation of serum apolipoprotein concentrations.

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We describe two patients with abnormal immunoglobulins: Case 1 was a non-diabetic patient with IgA-kappa type M-protein whose serum fructosamine(FRA) value was markedly elevated; and Case 2 was a patient with pseudo-leukocytosis induced by the interaction of etylenediaminetetraacetic acid(EDTA) and IgG-kappa type M-protein. The M-protein in Case 1 was found to be conjugated to serum albumin by immunoelectrophoresis. By gel filtration, the FRA peak of the patient's serum was shown in the high molecule weight fraction. The glycation of IgA-kappa type M-protein was clearly demonstrated by FRA staining after fractionation by serum protein electrophoresis. Although serum FRA values of other non-diabetic patients with IgA type M-protein were elevated, patients with IgG type M-protein and IgM type M-protein had low or normal serum FRA values. In Case 2, the white blood cell count of the patient's blood anti-coagulated with EDTA was 52,300/microliter as determined using an automated counter, but was within normal limits when counted manually by light microscopy using a hemacytometer. The white precipitates were formed by the interaction of the patient's serum with EDTA. Immunofixation electrophoresis revealed that the precipitates were IgG2-kappa type M-protein.

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BACKGROUND: As part of the NIH/National Heart, Lung and Blood Institute Contract for the Standardization of Lipoprotein(a) [Lp(a)] Measurements, a study was performed in collaboration with the IFCC Working Group for the Standardization of Lp(a) Assays. The aims of the study, performed with the participation of 16 manufacturers and 6 research laboratories, were to evaluate the IFCC proposed reference material (PRM) for its ability to transfer an accuracy-based value to the immunoassay calibrators and to assess concordance in results among different methods. METHODS: Two different purified Lp(a) preparations with protein mass concentrations determined by amino acid analysis were used to calibrate the reference method. A Lp(a) value of 107 nmol/L was assigned to PRM. After uniformity of calibration was demonstrated in the 22 evaluated systems, Lp(a) was measured on 30 fresh-frozen sera covering a wide range of Lp(a) values and apolipoprotein(a) [apo(a)] sizes. RESULTS: The among-laboratory CVs for these samples (6-31%) were, in general, higher than those obtained for PRM (2.8%) and the quality-control samples (14%, 12%, and 9%, respectively), reflecting the broad range of apo(a) sizes in the 30 samples and the sensitivity of most methods to apo(a) size heterogeneity. Thus, although all of the assays were uniformly calibrated through the use of PRM, no uniformity in results was achieved for the isoform-sensitive methods. CONCLUSIONS: Linear regression analyses indicated that to various degrees, apo(a) size heterogeneity affects the outcome of the immunochemical methods used to measure Lp(a). We have also shown that the inaccuracy of Lp(a) values determined by methods sensitive to apo(a) size significantly affects the assessment of individual risk status for coronary artery disease.

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BACKGROUND: Recently, the biological effects of oxidized lipoprotein(a) [Lp(a)] have been reported to be more potent than Lp(a), the arteriosclerosis-relevant lipoprotein. Thus, investigations with oxidized Lp(a) are expected to provide viewpoints different from the conventional ones based on Lp(a). METHODS AND RESULTS: An anti-Lp(a) monoclonal antibody (161E2) was produced against synthetic peptide antigen (Arg-Asn-Pro-Asp-Val-Ala-Pro). This epitope was characterized as having various properties because its external exposure was induced as a result of oxidative modification. Using 161E2 antibody, we developed a new enzyme-linked immunosorbent assay to measure Lp(a) modified by oxidative stress. The present data demonstrated that oxidized Lp(a) that contains the epitope of 161E2 antibody was present in the serum of humans. Therefore, we used this new enzyme-linked immunosorbent assay to evaluate the role of oxidized Lp(a) in patients with hypertension, which induces oxidative stress. Interestingly, hypertensive patients with complications showed a significantly higher level of oxidized Lp(a) in serum than did normotensive subjects (P:<0.01), whereas there was no significant difference in native Lp(a) between normotensive and hypertensive subjects. Importantly, positive immunostaining with 161E2 monoclonal antibody was found in the human arteriosclerotic tissue. CONCLUSIONS: We developed a new antibody against an epitope in Lp(a) as a result of oxidation treatment but not in native Lp(a). The present data demonstrated in vivo the presence of oxidized Lp(a) in the atherosclerotic tissue and its elevation in hypertensive patients. The presence of oxidized Lp(a) may be important in understanding the role of Lp(a) in cardiovascular disease.

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We tried to establish the reference values of plasma lipoprotein (a) [Lp(a)] concentration in phenotype groups of apoliprotein(a) [apo A] classified by a new criterion. Lp(a) concentration was determined by latex agglutination immunoassay, and apo A was analysed by electrophoresis in sodium dodecyl sulphate-polyacrylamide gel and a Western blotting technique. According to the relative mobility to the apo B-100 band, apo A was classified into 11 isoforms, i.e. F, B, and S1-S9, and the phenotype was defined by their apparent combination. The frequency ratio of single-band versus double-band was approximately 2:1. In 382 cases of single-band, the most frequent phenotype was S5 (24.3%), followed by S4 (17.3%), S6 (15.4%) and S3 (14.4%). In 181 cases of double-band, S5/S6 phenotype was observed most frequently (12.2%). followed by S4/S5 (10.5%) and S3/S6 (7.2%). The reference value was determined between antilogs of the mean +/- 1.96 standard deviation by logarithmic transformation of all observed values for individual phenotype cases. These results suggest that the reference values shown to be variable with apo A phenotypes should be useful for evaluating Lp(a) values in diagnosis of atherosclerosis.

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We encountered a patient who showed ethylenediaminetetraacetic acid (EDTA)-induced pseudoleukocytosis without pseudothrombocytopenia. The patient had IgG-kappa type monoclonal (M) gammopathy. The total protein concentration was 77 g/l, and the gamma-globulin fraction containing M-protein was 23.2%. The white blood cell count of the patient's blood anti-coagulated with EDTA was 52300/microl as determined using an automated counter, but was within normal limits when counted manually by light microscopy using a hemacytometer. Large amounts of a transparent substance were observed on blood smears, and white precipitates were formed by an interaction of the patient's serum with EDTA. Immunofixation electrophoresis showed these precipitates to be of the IgG(2)-kappa type M-protein. Western blotting analysis showed that the IgG molecules had a molecular mass of 155 kDa and were composed of two gamma-chains of approximately 53 kDa and two kappa-chains of 27 kDa. Pseudoleukocytosis was also observed when the patient's blood was anti-coagulated with O, O'-bis(2-amino-ethyl)-ethyleneglycol-N,N,N',N'-tetraacetic acid (EGTA) or sodium citrate, but not with lithium heparin. The present case seems to be the first report of pseudoleukocytosis induced by the interaction of EDTA and IgG(2)-kappa type M-protein.

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Using whole blood sample, we examined the correlation between concentration of granulocyte elastase (GEL) in granulocyte obtained by immunoassay and white blood cell counts. The correlation between concentration of GEL and granulocyte cell counts was also examined. The correlation coefficient between concentration of GEL and white blood cell counts was R = 0.87, and that between concentration of GEL and granulocyte cell counts was R = 0.91. The correlation coefficients of outpatients and patients with diseases accompanied by inflammation except for tumors were better than those of inpatients. The GEL concentration in granulocyte using whole blood sample well responded to the white blood cell counts against the tolerance for a short time, such as after operations. Especially on screening tests of diseases accompanied by inflammation and primary care, analysis of GEL in whole blood is not only useful for observation of inflammation and its progress but also suggests possibility of converting GEL to white blood cell counts or granulocyte. Furthermore, because it can be measured by easy-operative latex agglutination turbidimetric method, an easy measurement system can be built. Extended usage of the system as a rapid diagnostic tool on emergency tests in general clinics and hospitals are expected.

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At first, the ideal way of the scientific convention should be reexamined. It is approved the future direction which should do the joint with the related societies. It has been decided that it is held at a partly congruence with Japan Society of Clinical Chemistry in the next fiscal year. The Corporation Promotion Committee(chairman of prof. I. Sakurabayashi) negotiates with the Ministry of Education about the incorporation. The Society Improved Committee(chairman of prof. K. Watanabe) is discussing about a retirement system and improved select system of the councilor. And, though the more than 400 persons of clinical laboratory physicians has been registered as a certified clinical laboratory physicians, it copes in the selection committee of each university does not always taking laboratory medical doctor as a professor of the department of clinical laboratory. And, it becomes the name of the Japan Society of Clinical Pathology does not suit at present state. The Appellation Revision Subcommittee(chairman of K. Nakahara) is discussing in the ideal name of the Society. The opinion of the most part of way will concern national medical insurance. The clinical laboratory tests related groups(Japan Society of Clinical Pathology, Japanese Association of Clinical Laboratory Physicians, Japan Society of Medical technologists, Japan Registered Clinical Laboratories Association, Japan Association of Clinical Reagents Industries, Japan Council of Clinical Reagents wholesales) formed the Council on Clinical Laboratory Tests-Related Organization at present, and the demanding paper was submitted to related associations, such as Ministry of Health and Welfare, Japan Medical Association and so on.

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The effect of aggregated low-density lipoprotein (agLDL) on cell viability and macrophage-specific gene expression using human peripheral blood monocytes in culture was investigated. AgLDL suppressed activation-induced cell death of phorbol ester-treated macrophages. The inhibition of apoptosis was accompanied by downregulation of apoptosis-promoting proteases, including interleukin-1beta-converting enzyme (ICE) and CPP32 and upregulation of anti-apoptotic cytokine (interleukin-1beta (IL-1beta)). In contrast, macrophage-colony stimulating factor (M-CSF) enhanced cell death of lipid-bearing macrophages, suggesting that the anti-atherogenic action of M-CSF is at least in part mediated through apoptotic elimination of macrophages. Then, we attempted to isolate the genes specifically induced by agLDL in macrophages using a subtraction-based cloning strategy. One of the genes isolated, termed LIG (LDL-inducible gene), encodes a human homolog of E2 ubiquitin-conjugating enzyme. Ubiquitination of multiple intracellular proteins was observed in agLDL-treated macrophages, which coincided with upregulation of LIG. These results suggest that LIG acts as a direct mediator of foam cell formation through polyubiquitination and subsequent degradation of cellular proteins with apoptosis-inducing properties. The regulation of apoptosis by macrophage-specific gene expression may contribute to foam cell formation and atherosclerosis.

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Recently, we have found that aggregated low density lipoprotein (agLDL) inhibits apoptosis of lipid-bearing macrophages, thereby facilitating foam cell formation and atherosclerosis. To clarify the mechanisms by which agLDL inhibits apoptosis of macrophages, we isolated the genes specifically induced by agLDL by using a subtraction-based cloning strategy. One of the cloned genes, termed low density lipoprotein (LDL)-inducible gene (LIG), encodes a human homologue of bovine ubiquitin-conjugating enzyme E2-25K. Although LIG mRNA was ubiquitously expressed among human tissues, including hematopoietic cells, the abundance of transcripts was markedly increased by agLDL treatment in activated monocytes. LIG mRNA expression was not enhanced by nonatherogenic lipoproteins such as native LDL and high density lipoprotein, suggesting a role in atherosclerosis. Polyubiquitination of intracellular proteins was observed in monocytes cultured with agLDL, which coincided with upregulation of LIG. Furthermore, ubiquitin-dependent degradation of p53, an inducer of apoptosis, was accompanied by LIG induction in agLDL-treated monocytes. The antiapoptotic effect of agLDL was abrogated by a specific proteasome inhibitor, which also increased the half-life of p53 in monocytes. These results suggest that LIG contributes to foam cell formation by the suppression of apoptosis of lipid-bearing macrophages through ubiquitination and subsequent degradation of p53.

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We developed sandwich ELISA methods in which anti-apo(a) kringle 4 type 5 through protease (K4 x 5-Pro) domain monoclonal antibody (clone: 203E2) is employed in each instance as the capture antibody and one of the three species of monoclonal antibody [Mab] (clones: 108B8, 202A9, 2B3) is used as the labeled antibody. Using serum containing apo(a) with 34 repeats of kringle 4 as the calibrator, a commercial kit using anti-Lp(a) polyclonal antibody (Pab) or anti-apo(a) Mab overestimated the Lp(a) concentration in samples containing apo(a) with more than 34 repeats of kringle 4 and underestimated the Lp(a) concentration in samples containing apo(a) with fewer than 34 repeats of kringle 4. Moreover, it was demonstrated that the ratios of commercial kit values to anti-apo(a) K4 x 5-Pro Mab-based method values increased as the size of apo(a) increased. The ratios of apo(a) K5 x Pro Mab-based method values to anti-apo(a) K4 x 5-Pro Mab-based method values, however, remained almost constant regardless of the size polymorphism. Thus, we suggest that apo(a) size heterogeneity can significantly affect Lp(a) measurement in the Lp(a) assay using anti-Lp(a) Pab. The novel Lp(a) assay method, using only anti-apo(a) K4 x 5-Pro Mab, is not subject to this phenomenon.

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