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Clinical Chemistry 44: 991-1001, 1998;
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(Clinical Chemistry. 1998;44:991-1001.)
© 1998 American Association for Clinical Chemistry, Inc.


Endocrinology and Metabolism

Accurate measurement of cholecystokinin in plasma

Jens F. Rehfelda

Dept. of Clinical Biochemistry, Rigshospitalet, DK-2100 Copenhagen, Denmark.
a Author for correspondence. Fax 45 3545 4640; e-mail rehfeld{at}rh.dk.


   Abstract
Top
Abstract
Introduction
definition of CCK peptides
Materials and Methods
Results
Discussion
References
 
Shortage of reliable plasma assays has hampered studies of cholecystokinin (CCK). The assay problems are low plasma concentrations, extensive molecular heterogeneity, and close homology of CCK to gastrin, which circulates in higher concentrations. To develop an accurate CCK RIA, antibodies were raised in rabbits, guinea pigs, and mice in titers from 200 to 4 000 000. The specificity of the antisera was tested with homologous peptides, and tissue and plasma extracts. Rabbit 92128 produced antibodies in high titer (>=500 000) with sufficient avidity (K eff° >= 1012 mol-1) and the desired specificity. The antiserum binds the bioactive forms of CCK with equimolar potency and displays no reactivity with gastrin. CCK concentrations in plasma from healthy humans rose from 1.13 ± 0.10 pmol/L (mean ± SE, n = 26) to 4.92 ± 0.34 pmol/L after a mixed meal. Chromatography of human plasma revealed traces of CCK-58, a predominance of CCK-33 and CCK-22, and moderate amounts of CCK-8. The results show that it is possible to produce specific CCK-antisera using a sulfated CCK-12 analog.


   Introduction
Top
Abstract
Introduction
definition of CCK peptides
Materials and Methods
Results
Discussion
References
 
The gut hormone cholecystokinin (CCK) regulates pancreatic growth, enzyme secretion, and contraction of the gallbladder. Moreover, CCK influences intestinal motility and satiety. CCK is also a widespread transmitter in the nervous system. Finally, CCK is involved in pancreatic carcinogenesis (for reviews, see references (1)(2)(3)). The role of circulating CCK, however, is in many instances still obscure because quantitation of the hormone in plasma is difficult (for review, see reference (4)). Thus, earlier reports on plasma CCK may be inaccurate because the assays used did not possess the necessary sensitivity and specificity.

A sensitive and specific bioassay has been described (5)(6), but it is labor-intensive and has seen limited use for plasma measurements. Several laboratories have tried to develop RIAs. The first difficulty in this endeavor was a shortage of peptides for immunizations. Mutt and Jorpes reported in 1971 the structure of porcine CCK-33 (7), but synthesis of sulfated CCK-33 became possible only recently, and only limited amounts of natural CCK were available. A batch of sulfated CCK-8 was synthesized (8), but antibodies against it also reacted with gastrin. The next difficulty was the isotopic labeling, because methionyl residues are oxidized easily, and CCK-8 contain two such residues. The problem was solved by nonoxidative labeling (9). The third difficulty is the low concentrations of CCK in plasma, which requires antibodies of high affinity and tracers of high specific activity. The largest obstacle, however, is specificity. Hence, the antibodies should bind the "active site" of CCK without binding the homologous gastrin. Alignment of the active site sequences of CCK and gastrin (Fig. 1 ) illustrates the problem, which seems unsurmountable because antibody binding sites are assumed to harbor epitopes of no more than four to six amino acid residues (10). The specificity problem is accentuated by the higher gastrin concentrations in plasma.



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Figure 1. (Top) Primary structure of the O-sulfated heptapeptide amide sequence, which constitutes the specific "active site" of CCK; (Bottom) corresponding gastrin sequence.

In spite of the somber prognosis, we have tried to raise useful antibodies. Insufficient specificity of the first led to design of haptens to yield antibodies that might bind both the C-terminal phenylalanyl amide and the CCK-specific tyrosyl sulfate in position 7 (as counted from the C-terminus). Using a directionally coupled CCK-12-analog, we have raised such an antiserum.


   definition of CCK peptides
Top
Abstract
Introduction
definition of CCK peptides
Materials and Methods
Results
Discussion
References
 
Human proCCK is a protein of 95 amino acid residues. Sequence 84–86 (Gly-Arg-Arg) constitutes the crucial amidation site, which requires processing by prohormone convertases, carboxypeptidase E, and the amidation enzyme complex to release bioactive carboxyamidated CCK peptides. The largest bioactive form is CCK-83, which corresponds to the amidated sequence 1–83 of proCCK. This sequence is cleaved variably at four monobasic sites to release CCK-58, CCK-33, CCK-22, and CCK-8, all of which have the same C-terminal heptapeptide amide sequence (-Tyr(SO 3-)-Met-Gly-Trp-Met-Asp-PheNH2, Fig. 1Up ), which is necessary for receptor binding. Binding to CCK-A receptors requires that the tyrosyl residue of the heptapeptide amide is O-sulfated (Fig. 1Up ), whereas CCK-B receptors do not discriminate between sulfated and nonsulfated CCK-peptides or between CCK and gastrin peptides (for review, see references 1–3).


   Materials and Methods
Top
Abstract
Introduction
definition of CCK peptides
Materials and Methods
Results
Discussion
References
 
antigens
Natural porcine O-sulfated CCK-33 was generously donated by Viktor Mutt, Karolinska Institutet, Sweden. Nonsulfated synthetic porcine CCK-29 and CCK-33 were generous gifts from Ulf Ragnarsson, University of Uppsala, Sweden. The C-terminal amide, CCK-4, nonsulfated porcine CCK-8, CCK-12, CCK-13, and an analog of human O-sulfated CCK-12 (Gly-Gly-Asp-Arg-Asp-Tyr (SO4)-Met-Gly-Trp-Met-Asp-Phe-NH2) were custom synthesized by ZENECA. The purity, structure, and amount of the synthetic peptides were controlled in our laboratory by reversed-phase HPLC, gas-phase microsequencing, and mass spectrometry.

The first batch of natural porcine CCK-33 (30 mg, 20% purity) was dissolved in 12 mL of 0.05 mol/L sodium phosphate, pH 7.5, and divided into four portions, which were stored at -20 °C. The next batches of natural porcine CCK-33 (30 mg, 20% purity and 8 mg, 75% purity), synthetic nonsulfated CCK-33 and CCK-29 (6 and 5 mg, 85% purity) were each dissolved in 1.0 mL of N,N-dimethylformamide and conjugated to 25 or 30 mg of bovine serum albumin (the Serum Institute) and dissolved in 2.5 mL of 0.05 mol/L sodium phosphate, pH 7.5, by the addition of 135 mg of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide HCl (Sigma Chemical) to give molar ratios between the CCK-peptide, albumin, and ethyl-carbodiimide of 1:0.1:40. The reagents were mixed for 20 h at 20 °C, and each conjugate was then divided into six portions and stored at -20 °C until immunization.

Sulfated and nonsulfated synthetic CCK-4, CCK-8, CCK-12, and CCK-13 (2.0, 4.0, and 6.0 mg of each) were dissolved in 10 mL of 0.05 mol/L sodium phosphate, pH 7.5, and conjugated to 15 mg of bovine serum albumin by dropwise addition of 100 µL of 500 g/L glutaraldehyde. The solution was mixed for 4 h at 20 °C, applied to a calibrated Sephadex G-10 column (10 x 60 mm), and eluted at 20 °C with 0.05 mol/L sodium phosphate, pH 7.5, in fractions of 1.0 mL. The void volume fractions containing the conjugate were pooled, divided into six portions, and stored at -20 °C until immunization.

tracers
Two types of tracers were used: Sera from rabbits immunized with CCK-33 and CCK-29 were examined with CCK-33 labeled by nonoxidative conjugation of [I]hydroxyphenylpropionic-succinimide ester to either the {alpha}- or {epsilon}- NH2 groups of the N-terminal lysyl residue as detailed elsewhere (9)(11)(12). Sera from rabbits immunized with CCK-13, CCK-12, CCK-8, CCK-4, and the corresponding analogs were examined with Bolton-Hunter-labeled CCK-8 (Amersham). The tracers displayed specific radioactivities of 1500–1700 kCi/mol. Thus, the 1000-cpm tracer used for the RIA incubations corresponds to ~0.5 fmol of peptide.

immunizations
Randomly bred white Danish rabbits (n = 78) were used for immunizations in nine series of 6–16 rabbits each. In addition, one series of 29 guinea pigs and one of 8 mice were immunized (Table 1 ). On the basis of our experience with the production of antibodies towards other peptides (13)(14)(15)(16)(17)(18)(19)(20)(21), we chose a specific immunization procedure for all of the animals: The first portion of the antigen was suspended in 8.5 g/L saline to a volume of 5 mL and emulsified with an equal volume of Freund's complete adjuvant (the Serum Institute). Two subcutaneous injections of the mixture were given over the hips in amounts corresponding to 100 µg of CCK-33 (~40 µg of CCK-12 or 25 µg of CCK-8) per animal. Five or more booster injections using Freund's incomplete adjuvant were administered simultaneously at 8-week intervals, using one-half of the initial dose of antigen per immunization. The rabbits were bled from an ear vein 10 days after immunization. Guinea pigs and mice were bled by cardiac puncture 10 days after immunization. Sera from the bleedings were separated and stored at -20 °C.


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Table 1. Antigens and antibody characteristics in the production of CCK antisera.

antiserum evaluation
Four characteristics of sera from the immunized animals were examined: (a) Titer was defined as the serum dilution that binds 33% of the 0.5-fmol tracer at equilibrium. (b) Affinity (expressed by the "effective" equilibrium constant (K eff°) was determined as the slope of the curve at zero peptide concentration in a Scatchard plot (22)(23). (c) Specificity was determined in percentage as the molar ratio of the concentrations of the CCK standard and the related peptide that produced a 50% inhibition of the binding of the tracer. (d) Homogeneity of the antibodies with respect to binding kinetics as expressed by the Sips index (24). An index of 1.0 indicates homogeneity of both the tracer and the antiserum in the binding, otherwise seen only for monoclonal antibodies (25). The ability of the peptides to displace tracers from the antisera was tested in peptide concentrations of 0, 3, 10, 30, 100, 1000, 10 000, and 100 000 pmol/L.

ria procedure
The RIA was carried out as an equilibrium system at pH 8.4 in disposable plastic tubes, using 0.02 mol/L barbital buffer, pH 8.4, containing 1 g/L bovine serum albumin (Ortho). Incubation mixtures of 2.4 mL contained 2.0 mL of antiserum dilution, 250 µL of tracer solution (giving 1000 cpm, corresponding to 0.5 fmol of freshly prepared I-labeled CCK-peptide), and 150 µL of standard solution or sample. The assays were set up at room temperature and incubated at 4 °C for 48 h to reach equilibrium. Antibody-bound (B) and free (F) tracers were separated by the addition of 0.5 mL of a suspension of 20 mg of activated charcoal (Merck) and blood plasma (equivolume mixture of buffer and outdated human plasma from the Blood Bank of Rigshospitalet, Denmark) in 0.02 mol/L sodium phosphate, pH 7.4, to each tube. The tubes were centrifuged for 10 min at 2000 rpm, and the supernatant (B) and sedimented charcoal (F) were counted in automatic {gamma}-scintillation counters for 5 min. The binding percentage was calculated as B - [(B F) x D]/(B F) - [(B F) x D] x 100, where the "damage" (D) is defined as B x 100/(B F) in the absence of antiserum. The damage was usually 2–3%, and the antisera were used at dilutions giving a binding percentage of ~33%. All samples were assayed in duplicate.

assay reliability
The assays were evaluated with respect to detection limit, specificity, between- and within-assay reproducibility, and accuracy.

tissue extracts
Biopsies of human jejunal mucosa were obtained from the Department of Surgical Gastroenterology and porcine jejunal mucosa from anesthetized pigs at the Department of Experimental Pathology, Rigshospitalet. The tissue samples were immediately frozen in liquid nitrogen. The frozen tissue was cut in pieces of a few milligrams, boiled in water (10 mL/g tissue) for 20 min, homogenized, and centrifuged at 10 000g for 30 min at 4 °C. The supernatant was decanted (neutral extract), and the pellet was redissolved in ice-cold acetic acid (10 mL/g), left at room temperature for 20 min, and centrifuged as described above (acid extract).

plasma extracts
Blood samples were collected into chilled tubes containing 3.9 µmol of EDTA per mL of blood. Within 30 min, the samples were centrifuged at 3000g at 4 °C for 10 min. The plasma was stored at -20 °C until extraction, which was performed as follows. One volume of plasma (usually 1.0 mL) was mixed with two volumes of 960 mL/L ethanol on a whirlmixer for 10 s. The mixture was then centrifuged in 30 min at 1200g; the supernatant was decanted and evaporated at 37 °C in a speed-vac concentrator (SVC 200 H, Savant). The dried extracts were then reconstituted to the original volume with assay buffer and assayed. The basal and postprandial concentrations in plasma were measured in 15 healthy females and 11 healthy males (mean age, 36 years) after an overnight fast. The meal consisted of an omelet (two eggs mixed with 10 g of flour, 25 mL of cream, salt, and pepper) with two slices of bacon, 250 mL of orange juice, 250 mL of milk, 250 mL of yogurt, and two slices of toasted bread with butter and cheese, i.e., 1470 calories of which 45% was fat, 37% was carbohydrates, and 18% was protein. Blood samples were taken from each of the subjects from 60 min before to 125 min after ingestion of the meal.

plasma for chromatography
Four healthy persons (two of each sex, 23- to 40-years-old) ingested a meal as described above. Blood samples (200 mL) were drawn from an arm vein immediately before the meal as well as 30, 90, and 150 min postprandially. Because it has been suggested (26) that acidification is necessary to prevent in vitro degradation, one-half of each blood sample was drawn into EDTA tubes as described above (neutral sample), and the other half was drawn into EDTA tubes containing 1 mL 0.5 mol/L sodium acetate buffer (pH 3.6) per 5 mL of blood (acid sample (26)). Immediately after centrifugation, 50 mL of the neutral plasma samples was extracted directly on Sep-Pak cartridges, and 50 mL of the acidified plasma was poured slowly into 150 mL of 20 g/L trifluoroacetic acid (TFA) under constant stirring (26). This mixture was extracted on Sep-Pak C-18 cartridges (Waters Associates) prewashed with 10 mL of 960 mL/L ethanol followed by 10 mL of a 13 mmol/L solution of TFA. Ten milliliters of ice-cooled plasma were then loaded on each cartridge with a flow rate of 1 mL/min. After the cartridge was washed with 10 mL of 13 mmol TFA/L, the CCK-peptides were eluted by 2 mL of 800 mL/L ethanol containing 13 mmol TFA/L. Evaporation of the eluates was performed as described. All steps were performed consecutively without freezing the plasma or extracts.

chromatography
One milliliter of tissue extract or plasma concentrate was applied to a Sephadex G-50 superfine column (10 x 1000 mm) and eluted with either 125 mmol/L NH4HCO3, pH 8.2, or 20 mmol/L sodium veronal, pH 8.4, containing 0.6 mmol/L thiomersal and 1 g/L bovine serum albumin at 4 °C with a flow rate of 4 mL/h. Fractions of 1.0 mL were collected. The columns were calibrated with human CCK-33, CCK-22, and CCK-8, as well as with I-albumin and NaCl to indicate void (Vo) and total (Vt) volumes.

enzyme analysis
To measure the immunoreactivity of the larger endogenous forms of CCK using antiserum 92128, chromatographic fractions of the jejunal tissue extracts were also measured after tryptic cleavage. Each fraction was incubated with trypsin (100 mg/L Trypsin-TPCK ,Worthington) for 30 min at 20 °C. Tryptic cleavage was terminated by boiling the fraction for 10 min. Similarly, tissue extracts were also cleaved with trypsin before chromatography to ensure their CCK nature. Principles and details of the tryptic analysis have been described elsewhere (27).

gastrin measurements
Control measurements of gastrin in plasma were performed with a RIA using antiserum 2604, which binds all bioactive, carboxyamidated gastrins (gastrin-71, -34, -17, and -14) with equimolar potency irrespective of their degree of sulfation (14)(15). The assay does not measure CCK-peptides.

gastrin infusions
After an overnight fast, six healthy male volunteers (24- to 29-years-old) were intubated with a nasogastric tube (AN 10, Anderson Amplers). The position of the tube was controlled by fluoroscopy. The gastric contents were aspirated by intermittent pump suction. The infusions were preceded by an equilibrium period of at least 30 min, during which saline was infused. Subsequently, increasing doses of synthetic human nonsulfated gastrin-17 (0–60 pmol · kg · h; Sigma Chemical) were administered continuously into a cubital vein. Each dose (0, 10, 30, and 60 pmol · kg · h) was administered for 45 min. Venous blood samples were drawn from the opposite cubital vein every 15 min into EDTA tubes as described above. The tubes were immediately placed in crushed ice and centrifuged at 4 °C within 30 min. The plasma samples were stored at -20 °C until the measurement of gastrin and CCK.

ethics
The studies reported here were approved by the local committee for ethics in studies of human subjects.


   Results
Top
Abstract
Introduction
definition of CCK peptides
Materials and Methods
Results
Discussion
References
 
antibody production
The response to the immunizations varied between and within the series (Table 1Up ). The modest or low antibody titers in the early series (I-VII) may be due to inadequate methods for measuring hapten in the antigen-conjugate, a low degree of hapten purity, degraded peptides, and less efficient coupling procedures. Nevertheless, a few antisera in series I and III had titers and binding affinities of some usefulness (Table 1Up ). Two of these (4478 and 4698) were also specific for CCK and have proved useful for the characterization of CCK-peptides in tissue (9)(28)(29)(30). However, they were not useful for plasma measurements because there was too little antiserum (small volume of heartblood from guinea pigs) in titers that were too modest (<50 000) and because the animals died before the quality of their antibodies was known. In addition, only antiserum 4698 had the desired specificity, but it lacked sufficient affinity to measure plasma concentrations in fasting subjects.

High titers and affinities were obtained in series VIII and X (Table 1Up ), but none of the antisera had the specificity necessary for plasma measurement. Although several high-titer and high-affinity antisera were C-terminal directed (1559, 1560, 1564, 8007, and 8011), they all cross-reacted with gastrin peptides to a degree making them useless for plasma measurement. One high-titer antiserum in series VIII (1561) was monospecific for sequence 16–20 of porcine CCK-33. This antiserum has proved valuable for plasma measurement and affinity purification of porcine N-terminal desocta- and desnona-CCK-58, CCK-39 and CCK-33 fragments (31)(32). Unfortunately, the epitope was specific for a porcine CCK sequence. Hence, species variations of the sequence N-terminal for the bioactive C-terminal heptapeptide amide make antisera like 1561 useless for plasma measurements in man and other nonporcine species.

The last series (XI) was composed of 16 rabbits that all responded; some with high titers and affinities (Table 1Up ). Among the five antisera containing C-terminal-directed antibodies with binding affinities sufficient for measurement of basal CCK concentrations in plasma and with titers sufficient for long-term measurements (Table 2 ), only one antiserum (92128) displayed a specificity acceptable for the plasma measurement of CCK. In addition, it also binds the nonmammalian CCK homologs, cionin and caerulein, with full potency (Table 2 ).


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Table 2. Specificity1 of high-affinity (K°, >= 1012 mol-1) and high-titer (final dilution, >=0.5 x 106) CCK antisera in immunization series XI.

specificity characteristics of antiserum 92128
The epitope for antiserum 92128 was delineated on the basis of the reactivity with related peptides (Table 2Up ). The specificity was then corroborated by measurements of tissue and plasma extracts (Figs. 2 and 3). The results confirmed that antiserum 92128 binds O-sulfated CCK-8, CCK-22, CCK-33, and CCK-58 (as shown by tryptic cleavage) with equimolar potency (Table 2Up , Figs. 2 and 3 ).



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Figure 2. Gel chromatography of acid and neutral extracts of porcine jejunal mucosa.

The extracts were applied to Sephadex G-50 superfine columns (1 x 100 cm) and eluted with 0.02 mol/L sodium veronal, pH 8.4, containing 1 g/L bovine serum albumin. The chromatographic runs were monitored with the CCK-specific radioimmunoassay using antibody 92128 (Table 2Up ) before ({circ}) and after ({bullet}) incubation of each fraction with trypsin. The elution positions of known molecular forms of CCK are indicated by arrows. Similar chromatographic patterns were obtained with extracts of human jejunal mucosa (data not shown).



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Figure 3. Gel chromatography of acid ({circ}) and neutral ({bullet}) extracts of basal and postprandial plasma from two healthy young human subjects (left and right panels, respectively).

The concentrated extracts were applied to Sephadex G-50 superfine columns (1 x 100 cm) and eluted with 0.02 mol/L sodium veronal, pH 8.4, containing 1 g/L bovine serum albumin. The chromatographic runs were monitored with the CCK-specific radioimmunoassay using antibody 92128 (Ab. 92128) (Table 2Up ). The elution positions of known molecular forms of CCK are indicated by arrows. Note that CCK-58 like peptides were present in only modest amounts in both acid and neutral plasma extracts.

The single most crucial specificity problem for plasma CCK assays is interference from circulating gastrins. This point was examined in different ways: (a) Chromatography of plasma extracts revealed that antiserum 92128 bound no gastrin (data not shown); (b) no correlation existed between CCK and gastrin concentrations in human plasma samples covering a wide range of concentrations (Fig. 4 ); and (c) infusion of gastrin-17 into human subjects did not increase CCK concentrations in plasma. On the contrary, gastrin induced a decrease in plasma CCK (Fig. 5 ). Stripping of the antiserum showed that CCK circulates mainly as CCK-22 and CCK-8 in rabbit 92128 (data not shown).



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Figure 4. The relationship between CCK and gastrin concentrations in plasma from 49 healthy human subjects.

The samples were obtained from randomized population study. The CCK concentrations were measured with the radioimmunoassay using antibody 92128 (ordinate); the gastrin concentrations were measured with a RIA using antibody 2604 (abscissa).



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Figure 5. Effect of gastrin-17 infusion in three different doses on CCK secretion in six healthy young human subjects.

The plasma CCK concentrations (mean ± SE) were measured with the CCK-specific RIA using antibody 92128 (Fig. 2Up and Table 2Up ).

Plasma CCK concentrations in healthy young human subjects in the basal state were 1.13 ± 0.10 pmol/L (mean ± SE, n = 26), whereas the peak concentration at 60 min (or later) after onset of the meal was 4.92 ± 0.34 pmol/L (mean ± SE, n = 26; Fig. 6 ).



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Figure 6. Concentrations of CCK in plasma from healthy young human subjects (n = 26) 60 min before and 125 min after ingestion of a meal.

The meal was consumed in 10 min.

ria reliability
The CCK concentration two SD below the binding percentage at zero binding, (i.e., mean ± SD, 33.5 ± 0.4%, n = 10), was 0.1 pmol/L, which was defined as the detection limit of the assay. According to Ekins and Newman (23) this detection limit corresponds to 50 amol CCK in the assay tube.

The intra- and interassay variation at different concentrations within the working range of the assay ranged between 5% and 15% (Table 3 ).


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Table 3. Reproducibility of plasma CCK measurements (pmol/L) using Ab1 92128 (n = 10).

Accuracy evaluations by the addition of CCK-peptides to plasma, the dilution of plasma samples with high concentrations of endogenous CCK, and the mixing plasma samples with high and low concentrations of CCK showed a high degree of correlation with deviations <15% from the expected concentrations.


   Discussion
Top
Abstract
Introduction
definition of CCK peptides
Materials and Methods
Results
Discussion
References
 
This study has shown that it is possible to develop an assay for the accurate quantitation of CCK in plasma. The decisive step is the production of a high-affinity and high-titer antiserum with negligible or no binding of the closely related gastrins. Two features seemed critical for such production. First, the size and structure of the CCK-hapten is crucial. An octapeptide (like CCK-8) is too small for the production of high-titer and high-affinity antibodies with the desired specificity. All antibodies against CCK-8 have thus far bound gastrin, because the CCK-specific portion of CCK-8 is too small for the induction of specific antibodies (Fig. 1Up ). Therefore, the poor results with immunization against small CCK-peptides led to the design of a CCK-12 analog corresponding to O-sulfated CCK-10 extended at the N-terminus with a diglycine bridge for carrier coupling–the idea being that coupling at the N-terminus would inevitably produce antibodies directed towards the amidated C-terminus (common also for gastrin) but at the same time expose the CCK-specific sequence 3–5 of CCK-10 (Asp-Tyr (SO 3-)-Met-; see Fig. 1Up ). In other words, this hapten should offer a chance for the production of an antibody specific for the entire bioactive CCK-site–the sulfated heptapeptide amide sequence. For theoretical reasons (10), however, such a chance should be small because antibody combining sites usually have a size corresponding to the epitopes of five or six small amino acid residues. Therefore, the second precaution to be taken was to immunize a larger number of animals to increase the chance of obtaining an antiserum with the desired specificity. This explains why series XI was composed of 16 rabbits.

It may seem odd to describe the development of a RIA for a gut hormone in the 1990s. Such studies were generally reported in the 1970s and early 1980s (for a review, see reference 33). But the problems in developing a reliable CCK-RIA for plasma measurements have by far exceeded those of other gut hormones and of peptide hormones in general (4).

Since 1969, various reports have claimed to measure CCK in plasma (6)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63). Meaningful measurements, however, were not reported until the mid-1980s (6)(47)(52)(53)(57)(58)(59)(60)(61)(62); most of the antisera used in these assays suffer shortcomings. Some antisera bind gastrins to such a degree (51)(54)(59), that apparent hypercholecystokininemia has been assumed to occur during clinical hypergastrinemias and during infusion of gastrin. Thus, the phenomenon of gastrin-suppressed CCK secretion (Fig. 5Up ) has thus far escaped detection. Moreover, such antisera cannot be used in the search for CCK-producing tumors. Another shortcoming has been that too few bleedings, low titer, and/or suboptimal assay technology have limited the amounts of antiserum available for distribution so that only a few laboratories have successfully measured CCK in plasma in a reliable manner.

Another shortcoming has been the variable extent to which the molecular forms of CCK in plasma have been measured. This again has contributed to the confusion about the molecular nature of CCK in plasma (5)(6)(26)(31)(42)(43)(48)(61)(63)(64)(65)(66)(67)(68)(69)(70)(71). The molecular pattern reported thus far has varied considerably both in man (6)(42)(43)(48)(61)(63)(64)(65)(66)(67) and between mammalian species. Hence, the evidence in favor of predominance of either CCK-8 (42)(43) or CCK-58 (26)(64) is declining, and a pattern of mixed occurrences of CCK-33, CCK-22, and CCK-8 is emerging (Fig. 3Up ). Even in acidified human plasma, CCK-58 predominated neither in the basal state nor after a meal (Fig. 3Up ). In addition, the use of different analytical principles in the earlier studies, such as RIAs with different antisera, subtraction assays, combined RIA and enzyme assays, and bioassays have contributed to the confusion.

As mentioned in the introduction, a single bioassay has met the reliability demands for accurate plasma CCK measurements (5)(6). However, the complexity, labor-intensiveness, and costs for this bioassay measurements have precluded broader use. Therefore, the present RIA using antiserum 92128 should open avenues for new studies of the old hormone, CCK.


   Acknowledgments
 
We gratefully acknowledge the skillful technical assistance of Alice von der Lieth, Rikke Grønholt Pedersen, and Gitte Runge Hansen. We also gratefully acknowledge the kind help of Anders H. Johnsen in controlling the amount and structure of synthetic peptides. We appreciate the generous support with natural CCK peptides from Viktor Mutt (Stockholm, Sweden) and with synthetic CCK peptides from Ulf Ragnarsson (Uppsala, Sweden) and Miguel Ondetti (Princeton, NJ) in the early phases of the study. We also appreciate the kind permission of Kurt Borch (Linköping, Sweden) and Morten Wøjdemann (Copenhagen, Denmark) to use some of their plasma samples for CCK measurements. Finally, I thank Cathrine Ørskov and Lea Paloheimo for help with the application to the local ethical committee for studies in human subjects. The study was supported by grants from the Danish Medical Research Council, the Danish Cancer Union, the Danish Biotechnology Program for Peptide Research, the Gangsted Foundation, and the Vissing Foundation.


   References
Top
Abstract
Introduction
definition of CCK peptides
Materials and Methods
Results
Discussion
References
 

  1. Rehfeld JF. Cholecystokinin. Makhlouf GM eds. Handbook of physiology: the gastrointestinal system. Vol. II. Neural and endocrine biology 1989:337-358 American Physiological Society Bethesda, MD. .
  2. Liddle RA. Cholecystokinin. Walsh JH Dockray GJ eds. Gut peptides. Comprehensive endocrinology, revised series 1994:175-216 Raven Press New York. .
  3. Wank SA. Cholecystokinin receptors. Am J Physiol 1995;269:G628-G646. [Abstract/Free Full Text]
  4. Rehfeld JF. How to measure cholecystokinin in plasma?. Gastroenterology 1984;87:434-438. [Web of Science][Medline] [Order article via Infotrieve]
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