Progress on the Study and Application of Serum Adenosine Deaminase in the Diagnosis of Autoimmune Diseases / 现代检验医学杂志

Adenosine deaminase (ADA)plays an important role in the regulation of normal immune system.The altered activ-ity of serum ADA could associate with some autoimmune diseases(AID).Various studies abroad have found the elevated ac-tivity of serum ADA compared with healthy controls in many kinds of AID such as systemic lupus erythematosus (SLE), rheumatoid arthritis(RA),et al (P<0.05).Many studies foused on the correlation of altered activity of serum ADA with the disease severity,but there is still controversy.To explore the diagnostic value of serum ADA in AID,make a review a-bout the application research progress of ADA in several AID.

A study of Adenosine Deaminase and Gamma Glutamyl Transpeptidase in Acute Pancreatitis.

Background: Acute pancreatitis is an important cause of morbidity and mortality worldwide. Alcohol and gallstone disease remain the commonest causes of acute pancreatitis but metabolic abnormalities, obesity and genetic susceptibility are thought to be increasingly important etiological factors. Serum enzymes amylases and lipase are used as conventional biomarkers of acute pancreatitis. Objectives: To assay serum enzymes amylase, lipase, adenosine deaminase (ADA) and gamma glutamyl transpeptidase (GGT) in acute pancreatitis of alcoholic and non-alcoholic etiology. The present study also aimed to find the correlation among the enzymes. Materials and methods: The study subjects were categorized as non-alcoholic acute pancreatitis (n=30), alcoholic acute pancreatitis (n=30) and healthy controls (n=30). Levels of amylase, lipase, adenosine deaminase and gamma glutamyl transpeptidase were estimated in serum samples by standard spectrophotometric methods. Results: The levels of amylase, lipase, ADA and GGT were significantly higher in acute pancreatitis patients than controls. With respect to amylase and lipase, more pronounced increase was seen in nonalcoholic than the alcoholic acute pancreatitis patients. Increase in GGT was more in alcoholic acute pancreatitis while increase in ADA was comparable in acute pancreatitis of alcoholic and non- Yerrajwala KS, Saradhini V, Reddy BR, Gudimella S. A study of Adenosine Deaminase and Gamma Glutamyl Transpeptidase in Acute Pancreatitis. IAIM, 2016; 3(3): 162-167. Page 163 alcoholic etiologies. Serum amylase showed significant positive correlation with lipase, GGT and ADA in alcoholic acute pancreatitis and with lipase in non-alcoholic acute pancreatitis. Conclusion: Serum levels of enzymes amylase, lipase, ADA and GGT served sensitive markers of acute pancreatitis. Future studies employing larger sample size and differentiating various etiologies of acute pancreatitis, findings correlation among enzyme biomarkers are required.

Effect of Zinc Supplementation on Adenosine Deaminase Activity in Leprosy.

Serum Adenosine Deaminase (ADA) acts as marker of cellular immunity and its activity is found to be altered in various diseases in which there is a cell mediated immune response (CMI) including leprosy. The role of zinc is well established in the development and maintainence of immunocompetence and its supplementation activates the immune response in particular Tlymphocytes and monocytes in several ways. The aim of the study was planned to evaluate the effect of nutritional zinc supplementation on cell mediated immune response by investigating the pre and post intervention serum ADA levels after oral zinc sulphate supplementation in leprosy patients. A total of 49 cases, 30 Tuberculoid Leprosy (TT) and 19 Lepromatous Leprosy (LL) patients, within the age group of 25-60 years were enrolled in the study along with 30 age matched healthy controls. Serum ADA was estimated in all the subjects before and after (2 months and 4 months) oral zinc supplementation. Pre intervention serum ADA level was observed to be significantly increased in both the TT and LL (p<0.001) groups as compared to controls, revealing raised immunological activity in the patients. After oral zinc sulphate supplementation serum ADA re-evaluation was done in 38 cases. A highly significant (p < 0.001 ) rise in ADA level was registered in the post intervention period (4 months supplementation) in TT cases with a moderately significant (p< 0.05) increase in LL cases, indicating the ability of oral zinc therapy to affectively alter the cell mediated immune response in leprosy.

Evaluation of Adenosine Deaminase (ADA) Activity for Diagnosis of Tubercular Pleural Effusion.

To find out a sensitive and specific marker for early diagnosis of tubercular pleural effusion, this cross sectional study was carried out in the of National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka. One hundred and three pleural effusion cases were enrolled in the study. Out of the 103 cases, 62 were tubercular pleural effusion cases and 49 were nontubercular cases. Among the nontubercular cases, 30 cases were due to malignancy, 8 were due to pneumonia and rest 3 cases were due to nephrotic syndrome, congestive cardiac failure and rheumatoid arthritis. Considering 40 U/L as a cut off value for ADA level, the test result was positive in 58 out of 62 patients of tuberculosis indicating sensitivity of the test as 94%; however, among 41 non-tuberculous patients, 5 presented ADA activity level more than 40U/L, which lowers the specificity of the test to 88%. ADA levels were significantly higher in tuberculous than in nontuberculous cases (p value <0.001). It may be concluded that ADA levels are significantly high in patients with tuberculous pleural effusion compared to that in non-tubercular group. Sensitivity (94%) and specificity (88%) of the test in tuberculous pleural effusions are very high, when cut off value set at 40U/L. The result indicated that the analysis of ADA levels in pleural effusion constitute a very useful marker for the diagnosis of tubercular pleural effusion (TPE) which, in addition, can be made quickly in a noninvasive way.

Pleural Effusion in Children How often do we suspect Tubercular origin.

Introduction: Pleural effusion is a common problem in children; mostly due to common causes like pyogenic or tubercular infections. Different studies have showed that about 30%-60% of pleural effusion have resulted into formation of empyema. Method: This was an observational study done in children aged 3 months to 14 years with a diagnosis of pleural effusion admitted at Kanti Children’s Hospital, Maharajgunj from August 2009 to March 2010. The aim of the study was done to find out different modalities of treatment for the same and their outcome. A detailed clinical history and physical examination, was done in all children. Chest x-ray, laboratory reports and treatment were recorded and all patients followed up until death or discharge. Any change of management was also noted. Pleural effusion caused by nephritic syndrome or congestive cardiac failure were excluded from the study. Results: During the study period of eight months, 64 patients were admitted with the diagnosis of pleural effusion. Boys to girls ratio was 2:1. Right-sided pleural effusions were more common than left sided pleural effusions (53% vs. 37%). Most of patients improved with parental antibiotics along with chest tube drainage (62%). One in three patients (31%) received anti-tubercular drugs. Three patients (4.6%) were referred to surgeon for decortications and one patient (1.6%) died. Conclusion: Though chest tube drainage with parental antibiotics was the mainstay of treatment of pleural effusion, however one-third of patients also received anti- tubercular drugs.

A Case of Tuberculous Pericarditis Diagnosed by Increased ADA Activity in Pericardial Fluid

There is no diagnostic study for the presence of tuberculous pericarditis that is highly accurate as well as safe and easy to perform. As a result, the diagnosis is often delayed or missed, resulting in a clinical course characterized by increased mortality and late complications. Adenosine deaminase (ADA) in pleural or pericardial fluid is known for a useful marker of extrapulmonary tuberculosis. A 76-year old woman visited for dyspnea and generalized edema. Culture for sputum, pleural fluid, and pericardial fluid were negative for tubercle bacillus. But We diagnosed tuberculous pericarditis with pleuritis by increased titer of ADA activity in the pericardial fluid. After 2 weeks of initiation of antituberculous treatment, pericardial and pleural effusion gradually decreased while clinical symptoms improved markedly. Therefore, authors report a case of tuberculous pericarditis diagnosed by increased ADA activity in pericardial fluid with reviewing the previous literatures.

Diagnostic Value of Adenosine Deaminase(ADA) and its Isoenzyme in Pleural Effusion / 결핵

BACKGROUND: Etiologic diagnosis of pleural effusion is usually made by clinical characteristics, pleural fluid analysis and pleural biopsy. But, despite careful diagnostic study, the cause of pleural effusion cannot be found in about 20 percent of patients, especially in loculated pleural effusions. Tuberculous pleurisy is one of the most common cause of pleural effusion in Korea. But, pleural fluid culture for Mycobacterium tuberculosis are positive in only 20 to 30 percent of patients and typical pleural biopsy finding in less than 50 percent of patients with this disease. In recent studies, adenosine deaminse(ADA) and its isoenzymes were proposed to be a useful diagnostic tool for differential diagnosis of pleural effusion We investigated the pattern of ADA and its isoenzyme activities in various cause of pleural effusions to evaluate the diagnostic value of measuring ADA and its isoenzymes. METHOD: We measured total ADA and its isoenzyme activities in pleural fluid and serum from 54 patients with pleural effusion(25 tuberculous pleural effusion, 10 parapneumonic effusion, 14 malignant pleural effusion, 5 transudative pleural effusion), including 5 loculated tuberculous pleural effusions and 6 loculated parapneumonic effusions. Total ADA activity was measured by the spectrophotometric method and ADA2 isoenzyme activity was measured with same method using EHNA, potent inhibitor of ADA1 isoenzyme activity. RESULT: Total ADA activity of tuberculous pleural effusion was higher than malignant pleural effusion(p<0.01), but no significant difference was found between tuberculous pleural effusion and parapneumonic effusion (tuberculous pleural effusion:148.9+/-9.91U/L, parapneumonic effusion:129.0+/-119.41U/L, malignant pleural effusion 48.7+/-9.71U/L). Percentage of ADA2 activity to total ADA activity(ADA2%) of pleural effusion of tuberculous pleurisy was higher than parapneumonic effusion(p<0.05), but no significant difference was found between tuberculous pleural effusion and malignant pleural effusion(tuberculous pleural effusion: 57.2+/-10.7%, parapneumonic effusion: 35.9+/-17.8%, malignant pleural effusion: 60.7+/-4.1%). In loculated pleural effusion, ADA2% of tuberculous pleural effusion was higher than parapneumoriic effusion(tuberculous pleural effusion: 53.3+/-3.9%, parapneumonic effusion: 27.8+/-7.9%). CONCLUSION: Measurement of ADA isoenzyme activity is useful for differentiating tuberculous pleural effusion from parapneumonic effusion, especially in loculated pleural effusion.