Background-Cardiac troponin I and T (cTnI and cTnT) are specific biochemical serum markers for acute myocardial infarction (AMI). However, cTnI diagnostic assays are plagued by difficulties, resulting in Ն20-fold differences in measured values. These discrepancies may result from the release of the numerous cTnI modification products that are present in ischemic myocardium. The resolution of these discrepancies requires an investigation of the exact forms of cTnI present in the bloodstream of patients after myocardial injury. Methods and Results-A western blot-direct serum analysis protocol was developed that allowed us to detect intact cTnI and a spectrum of up to 11 modified products in the serum from patients with AMI. For the first time, we document both a cTnI degradation pattern and the existence of phosphorylated cTnI in serum. The number and extent of these modifications reflect patterns similar to the time profiles of the routine clinical serum markers of total creatine kinase, creatine kinase-MB, and cTnI (determined by ELISA). Data from in vitro experiments, which were undertaken to study the degradation of human recombinant cTnI and cTnT when spiked in serum, indicate that some modification products present in patient serum existed in the myocardium and that recombinant cTnI alteration dramatically reduces the detectability of cTnI by the Immuno1 assay over time (our assay was unaffected). Key Words: troponin Ⅲ myocardial infarction Ⅲ biological markers Ⅲ diagnosis Ⅲ blotting, western I t is widely accepted that the presence of cardiac troponin I or T (cTnI or cTnT) in blood serum indicates myocardial damage; thus, cTnI and cTnT are considered specific biochemical markers for acute myocardial infarction (AMI). [1][2][3] Despite the widespread use of cTnI and cTnT detection as a diagnostic tool in acute coronary syndromes, problems arise from variations in the sensitivity, selectivity, and specificity of various commercially available diagnostic cTnI immunoassay kits. 4 -7 These differences are due to (1) the lack of mass standardization, 8 -10 (2) the presence of post-translationally modified cTnI in the serum, and (3) variations in antibody cross-reactivities to the various detectable forms of cTnI. 10,11 Although cTnT is thought to be unaffected by such problems, this remains to be proven: thus far, only one manufacturer has marketed a diagnostic cTnT assay. The underlying reason for this controversy is the inability to determine reliably the exact forms and amounts of cTnI and cTnT present in blood. Conclusions-ThisOn the basis of previous findings, some have proposed that only a small amount of free intact cTnI is detectable in blood, with the predominant form being a complex between cTnI and cardiac tropinin C. 11-13 However, post-translational modifications, including selective degradation, covalent complex formation, and phosphorylation of cTnI, occur in the myocardium of ischemic-reperfused rat hearts 14 -16 and human postischemic myocardium. 17,18 In fact, these modification products, and ...

Background: B-Type natriuretic peptide (BNP) is released from the left ventricle of the heart into the circulation in response to ventricular stretching and volume overload. Increased BNP concentrations are associated with heart failure (HF).

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Prostate-specific antigen (PSA) in serum is primarily complexed with alpha 1-antichymotrypsin (alpha 1-ACT). However, 12-15% of prostate cancer (PCa) patients present with the predominant form being uncomplexed (free) PSA (Lilja et al., Clin Chem 1991;37:1618-24). We report that commercial immunoassays demonstrate variations in reactivity, especially to the uncomplexed form. We fractionated and analyzed commercial controls, PSA complexes prepared in vitro, and sera from patients with PCa or benign prostatic hyperplasia, using molecular sieve chromatography and Hybritech Tandem-R, Abbott IMx, and Ciba Corning ACS PSA assays. Peak integration of PCa samples demonstrated ACS:Tandem-R ratios of 1-1.3 for PSA/alpha 1-ACT complex. In contrast, ratios of uncomplexed peaks ranged from 2 to 4, suggesting a greater reactivity of the uncomplexed form in the ACS PSA assay. Discrepancies between assays, when PSA was measured in unfractionated sera, correlated directly with the percentage of the uncomplexed form. In controls, fractionation revealed the presence of uncomplexed PSA only, with ratios of ACS:Tandem-R and IMx:Tandem-R of 3:1 and 1.8:1, respectively. Immunoblots of PCa sera detected uncomplexed PSA (approximately 30 kDa) and PSA complexes of approximately 95 kDa (PSA/alpha 1-ACT) and > 200 kDa, indicative of alpha 2-macroglobulin. Maximal recognition of all forms of PSA may be important for early detection of disease progression.

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