Serum free light chain analysis may miss monoclonal light chains that urine immunofixation electrophoreses would detect

Shaheen, Saad P.; Levinson, Stanley S.

doi:10.1016/j.cca.2009.04.024

Cited by 35 publications

(22 citation statements)

References 15 publications

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“…If suspected, immunofixation of serum and urine FLC assay should be obtained 12. The high frequency of kappa IgG FLC proteinaemia is a hallmark of AL amyloidosis 2.…”

Section: Discussionmentioning

confidence: 99%

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Dysphagia unveiling systemic immunoglobulin light-chain amyloidosis with multiple myeloma

González

Wahab²,

Kesari

2018

BMJ Case Reports

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Dysphagia is an uncommon presentation of systemic immunoglobulin light-chain (AL) amyloidosis with multiple myeloma (MM). Gastrointestinal (GI) involvement usually manifests with altered motility, malabsorption or bleeding. Furthermore, patients identified with GI amyloidosis, without previous diagnosis of a plasma cell disorder, are extremely rare. We report an elderly woman who presented with acute on chronic cardiac dysfunction, sick sinus syndrome and acute renal failure. While admitted, she developed intermittent dysphagia to both solids and liquids. Oesophagogastroduodenoscopy showed ulcerations of oesophagus and duodenum. Biopsies revealed focal amyloid deposition, stained with Congo red. Renal biopsy revealed amyloid deposition in renal arterioles. She underwent a bone marrow biopsy confirming MM, represented by more than 15% plasma cell population. She was started on treatment for heart failure, induction chemotherapy for MM and percutaneous gastrostomy tube for feeding. However, she continued to deteriorate, eventually opting for hospice, and ultimately died 2 days after discharge from hospital.

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“…If suspected, immunofixation of serum and urine FLC assay should be obtained 12. The high frequency of kappa IgG FLC proteinaemia is a hallmark of AL amyloidosis 2.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac, renal and liver biopsies are invasive and increase the risk of postprocedure haemorrhage 12. If amyloid deposits are identified, it is imperative to determine the extent of amyloidosis (localised or systemic) and the specific type of amyloid deposits, since it helps to avoid misdiagnosis and future treatment approach 2 12.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia unveiling systemic immunoglobulin light-chain amyloidosis with multiple myeloma

González

Wahab²,

Kesari

2018

BMJ Case Reports

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“…Dimers or polymers of immunoglobulin light chains (usually λ dimers) interfere the determination of serum or urine FLC analysis [29–30]. Shaheen SP et al reported serum FLC analysis might miss monoclonal light chains that urine IFE detected [31]. Moreover, the sensitivity of urine FLC detection was restricted by the kidney capacity for reabsorbing and catabolizing FLC [6].…”

Section: Discussionmentioning

confidence: 99%

Serum N-Glycans: A New Diagnostic Biomarker for Light Chain Multiple Myeloma

et al. 2015

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The aim of this study was to evaluate the diagnostic and differential diagnostic power of serum N-glycans for light chain multiple myeloma (LCMM). A total of 167 cases of subjects, including 42 LCMM, 42 IgG myeloma, 41 IgA myeloma, and 42 healthy controls were recruited in this study. DNA sequencer-assisted fluorophore-assisted capillary electrophoresis (DSA-FACE) was applied to determine the quantitive abundance of serum N-glycans. The core fucosylated, bisecting and sialylated modifications were analyzed in serum of LCMM patients (n=20) and healthy controls (n=20) randomly selected from the same cohort by lectin blot. Moreover, serum sialic acid (SA) level was measured by enzymatic method. We found two N-glycan structures (NG1A2F, Peak3; NA2FB, Peak7) showed the optimum diagnostic efficacy with area under the ROC curve (AUC) 0.939 and 0.940 between LCMM and healthy control. The sensitivity and specificity of Peak3 were 88.1% and 92.9%, while Peak7 were 92.9% and 97.6%, respectively. The abundance of Peak3 could differentiate LCMM from IgG myeloma with AUC 0.899, sensitivity 100% and specificity 76.2%, and Peak7 could be used to differentiate LCMM from IgA myeloma with AUC 0.922, sensitivity 92.9% and specificity 82.9%. Serum SA level was significantly higher in patients with LCMM than that in healthy controls. Moreover, the decreased core fucosylation, bisecting and increased sialylation characters of serum glycoproteins were observed in patients with LCMM. We concluded that serum N-glycan could provide a simple, reliable and non-invasive biomarker for LCMM diagnosis and abnormal glycosylation might imply a new potential therapeutic target in LCMM.

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“…A simple approach for improving urine protein detection was developed by combining silver staining with classic cellulose acetate membrane electrophoresis, prior to mass spectrometric analysis. Cellulose acetate membrane electrophoresis (CAME) is the classical method for identifying free light chain immunoglobulins (Bence-Jones proteins) in urine, based on relative mobility of the immunoglobulin fractions [73]. CAME allows discrimination of well-separated proteins on the cellulose acetate membrane, as well as the overlapping proteins.…”

Section: Advancements In Mass Spectrometry Based Urinary Proteomicsmentioning

confidence: 99%

Current state of the art for enhancing urine biomarker discovery

Harpole

Davis

Espina

2016

Expert Review of Proteomics

109

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Urine is a highly desirable biospecimen for biomarker analysis because it can be collected recurrently by non-invasive techniques, in relatively large volumes. Urine contains cellular elements, biochemicals, and proteins derived from glomerular filtration of plasma, renal tubule excretion, and urogenital tract secretions that reflect, at a given time point, an individual's metabolic and pathophysiologic state. High-resolution mass spectrometry, coupled with state of the art fractionation systems are revealing the plethora of diagnostic/prognostic proteomic information existing within urinary exosomes, glycoproteins, and proteins. Affinity capture pre-processing techniques such as combinatorial peptide ligand libraries and biomarker harvesting hydrogel nanoparticles are enabling measurement/identification of previously undetectable urinary proteins. Future challenges in the urinary proteomics field include a) defining either single or multiple, universally applicable data normalization methods for comparing results within and between individual patients/data sets, and b) defining expected urinary protein levels in healthy individuals.

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Serum free light chain analysis may miss monoclonal light chains that urine immunofixation electrophoreses would detect

Cited by 35 publications

References 15 publications

Dysphagia unveiling systemic immunoglobulin light-chain amyloidosis with multiple myeloma

Dysphagia unveiling systemic immunoglobulin light-chain amyloidosis with multiple myeloma

Serum N-Glycans: A New Diagnostic Biomarker for Light Chain Multiple Myeloma

Current state of the art for enhancing urine biomarker discovery

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