Clinical Chemistry
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Clinical Chemistry 55: 499-504, 2009. First published January 8, 2009; 10.1373/clinchem.2008.117143
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
clinchem.2008.117143v1
55/3/499    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Palladini, G.
Right arrow Articles by Merlini, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Palladini, G.
Right arrow Articles by Merlini, G.
(Clinical Chemistry. 2009;55:499-504.)
© 2009 American Association for Clinical Chemistry, Inc.

Proteomics and Protein Markers

Identification of Amyloidogenic Light Chains Requires the Combination of Serum-Free Light Chain Assay with Immunofixation of Serum and Urine

Giovanni Palladini1, Paola Russo1,2, Tiziana Bosoni3, Laura Verga1,4, Gabriele Sarais1, Francesca Lavatelli1,2, Mario Nuvolone1,2, Laura Obici1, Simona Casarini1, Simona Donadei1, Riccardo Albertini3, Gabriella Righetti5, Maddalena Marini5, Maria Stella Graziani5, Gian Vico Melzi D'Eril6, Remigio Moratti3 and Giampaolo Merlini1,a

1 Center for Amyloidosis, Biotechnology Research Laboratories, Department of Biochemistry; 2 Department of Internal Medicine; 3 Clinical Chemistry Laboratory; and 4 Department of Pathology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo and University of Pavia, Pavia, Italy; 5 Clinical Chemistry Laboratory, Ospedale Civile Maggiore, Verona, Italy; 6 Department of Medicine and Surgery, University of Milan, Milan, Italy.

aAddress correspondence to this author at: Amyloid Center, Biotechnology Research Laboratories—Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi, 19-27100 Pavia, Italy. Fax +39-0382-502990; e-mail gmerlini{at}unipv.it.

Background: The diagnosis of systemic immunoglobulin light-chain (AL) amyloidosis requires demonstration of amyloid deposits in a tissue biopsy and amyloidogenic monoclonal light chains. The optimal strategy to identify the amyloidogenic clone has not been established. We prospectively assessed the diagnostic sensitivity of the serum free light chain (FLC) {kappa}/{lambda} ratio, a commercial serum and urine agarose gel electrophoresis immunofixation (IFE), and the high-resolution agarose gel electrophoresis immunofixation (HR-IFE) developed at our referral center in patients with AL amyloidosis, in whom the amyloidogenic light chain was unequivocally identified in the amyloid deposits.

Methods: The amyloidogenic light chain was identified in 121 consecutive patients with AL amyloidosis by immunoelectron microscopy analysis of abdominal fat aspirates and/or organ biopsies. We characterized the monoclonal light chain by using IFE and HR-IFE in serum and urine and the FLC {kappa}/{lambda} ratio in serum. We then compared the diagnostic sensitivities of the 3 assays.

Results: The HR-IFE of serum and urine identified the amyloidogenic light chain in all 115 patients with a monoclonal gammopathy. Six patients with a biclonal gammopathy were omitted from the statistical analysis. The diagnostic sensitivity of commercial serum and urine IFE was greater than that of the FLC {kappa}/{lambda} ratio (96% vs 76%). The combination of serum IFE and the FLC assay detected the amyloidogenic light chain in 96% of patients. The combination of IFE of both serum and urine with the FLC {kappa}/{lambda} ratio had a 100% sensitivity.

Conclusions: The identification of amyloidogenic light chains cannot rely on a single test and requires the combination of a commercially available FLC assay with immunofixation of both serum and urine.




The following articles in journals at HighWire Press have cited this article:


Home page
 Clin. Chem.Home page
J. A. Katzmann, R. A. Kyle, J. Benson, D. R. Larson, M. R. Snyder, J. A. Lust, S. V. Rajkumar, and A. Dispenzieri
Screening Panels for Detection of Monoclonal Gammopathies
Clin. Chem., August 1, 2009; 55(8): 1517 - 1522.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2009 by the American Association for Clinical Chemistry.