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Enzymes and Protein Markers |
1
Departments of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT 06102.
2
Department of Pathology and Laboratory Medicine,
Hennepin County Medical Center, Minneapolis, MN 55415.
3
Biosite Diagnostics Inc., San Diego, CA 92121.
4
Denver Health Medical Center, Denver, CO 80204.
5
The AACC cTnI Subcommittee on cTnI Standardization.
Subcommittee members: Dr. Bodor, Chairman; Dr. Apple and Robert
Christenson, University of Maryland, Baltimore; Francesco Dati, Dade
Behring Marburg GmBH, Marburg, Germany; Yehai Gawad, Cardiogenics Inc.,
Toronto, Ontario, Canada; Catherine LaRue, Sanofi Diagnostics Pasteur,
Marnes la Coquette, France; James Potter, University of Miami, Miami,
FL; Hemant Vaidya, Behring Dade, Newark, DE; Dr. Wu and Jean Rhame,
American Association for Clinical Chemistry, Washington, DC.
a Author for correspondence. Fax 860-545-5206; e-mail awu{at}harthosp.org.
We examined the release of cardiac troponin T (cTnT) and I (cTnI) into the blood of patients after acute myocardial infarction (AMI). Three postAMI serum samples were applied in separate analytical runs onto a calibrated gel filtration column (Sephacryl S-200), and the proteins were separated by molecular weight. Using commercial cTnT and cTnI assays measured on collected fractions, we found that troponin was released into blood as a ternary complex of cTnT-I-C, a binary complex of cTnI-C, and free cTnT, with no free cTnI within the limits of the analytical methodologies. The serum samples were also examined after incubation with EDTA and heparin. EDTA broke up troponin complexes into individual subunits, whereas heparin had no effect on the assays tested. We added free cTnC subunits to 24 AMI serum samples and found no marked increase in the total cTnI concentrations, using an immunoassay that gave higher values for the cTnI-C complex than free cTnI. To characterize the cross-reactivity of cTnT and cTnI assays, purified troponin standards in nine different forms were prepared, added to serum and plasma pools, and tested in nine quantitative commercial and pre-market assays for cTnI and one approved assay for cTnT. All nine cTnI assays recognized each of the troponin I forms (complexed and free). In five of these assays, the relative responses for cTnI were nearly equimolar. For the remainder, the response was substantially greater for complexed cTnI than for free cTnI. Moreover, there was a substantial difference in the absolute concentration of results between cTnI assays. The commercial cTnT assay recognized binary and ternary complexes of troponin on a near equimolar basis. We conclude that all assays are useful for detection of cardiac injury. However, there are differences in absolute cTnI results due to a lack of mass standardization and heterogeneity in the cross-reactivities of antibodies to various troponin I forms.
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