ß2-Microglobulina un biomarcador de actividad en pacientes con lupus eritematoso sistémico / ß2-Microglobulin a biomarker of disease activity in systemic lupus erythematosus patients

El lupus eritematoso sistémico (LES) es una enfermedad autoinmune, caracterizada por daño crónico a órganos o sistemas, caracterizada por la activación anormal de linfocitos T y/o B debido a una presentación y reconocimiento antigénico anormal que favorece la producción de citoquinas pro inflamatorias y auto-anticuerpos fijadores de complemento que promueven la formación y depósito de complejos inmunes con el consecuente daño celular. También se caracteriza por periodos cíclicos de brote y remisión de la enfermedad. La búsqueda de biomarcadores clínicamente útiles para conocer de manera anticipada un brote de la enfermedad aún está en curso, entre los biomarcadores se sugiere que la ß2-microglobulina (ß2M) puede ser útil para evaluar la actividad del LES. El objetivo del estudio fue correlacionar la concentración de ß2M sérica con los marcadores comúnmente evaluados para establecer la actividad del LES. MATERIAL Y MÉTODO La población de estudio consistió en 119 pacientes con LES activo y no activo (57 pacientes control, 42 pacientes con LES activo y 20 pacientes con LES inactivo) los cuales firmaron su consentimiento para participar en el estudio. El grupo control correspondía a pacientes sin antecedentes clínicos y familiares de enfermedad autoinmune. El grupo de pacientes con LES cumplía al menos 4 criterios de clasificación de LES del Colegio Americano de Reumatología. La concentración de ß2M se midió por ELISA. La actividad del LES fue evaluada mediante parámetros clínicos, niveles séricos de anti-ds-DNA, fracción del complemento C3 y C4. Los niveles de ß2M fueron asociados con marcadores serológicos de anti-nucleosoma, anti-C1q y creatinina. RESULTADOS El estudio reveló diferencia significativa en los niveles séricos de ß2M (p<0.001) entre los tres grupos de estudio, en los pacientes con LES activo se observó una mediana 5,4 ug/mL, P25 3,17 ug/mL P75 6,72 ug/mL; el grupo control presentó una mediana menor al grupo LES activo de 1,8 ug/mL P25 1,6 ug/mL P75 1,9 ug/mL y al grupo de LES inactivo con mediana de 3,25 ug/mL P25 2,63 ug/mL P75 3,55 ug/mL. Además, se observó correlación de resultados entre la concentración de ß2M y niveles de anti-ds-DNA (p<0,01; r=0,595) y niveles séricos del complemento C3 (p<0,01; r=−0,519) y C4 (p=0,019; r=−0,345). CONCLUSIONES La medición de la ß2M sérica puede ser un biomarcador útil para evaluar la actividad de la enfermedad del LES siempre y cuando sea empleado con otros test de laboratorio que se utilizan de manera rutinaria para evaluar la actividad de LES.

Systemic lupus erythematosus (SLE) is an autoimmune disease, characterized by chronic damage to organs or systems, due to abnormal activation of T and/or B-lymphocytes, caused by abnormal antigenic presentation and recognition that gives the production of pro- inflammatory cytokines and complement-fixing autoantibodies that promote formation of immune complexes and cellular damage. It is also characterized by cyclic periods of activation and remission. The search for clinically useful biomarkers for early knowledge of disease outbreak is going; biomarkers suggest that ß2-microglobulin (ß2M) is useful for evaluating the activity of the SLE. The objective of this study was to analyze the relationship between serum ß2M concentrations with markers of SLE activity. MATERIAL AND METHODS One hundred nineteen patients were included (control 57, active SLE 42 and inactive SLE 20) who signed their consent to participate in the study. The control group corresponded to patients without clinical and family history of autoimmune disease. The patients group with SLE met at least four criteria of the American Society of Rheumatology for lupus diagnostic. ß2M concentration was measured using an ELISA test. SLE activity was evaluated by clinical parameters, serum levels of anti-ds-DNA, complement levels C3 and C4. ß2M levels were associated with anti-nucleosome, anti-C1q and creatinine. RESULTS The study revealed a significant difference between the three study groups (p<0,01), in active SLE group a median 5,4 ug/mL, P25 3,17 ug/mL P75 6,72 ug/mL was observed. The control group presented a lower median to the active SLE group of 1,8 ug/mL P25 1,6 ug/mL P75 1,9 ug/mL and to the inactive SLE group with a median 3,25 ug/mL P25 2,63 ug/mL P75 3,55 ug/mL. In addition, correlation of results was observed between ß2M concentration and anti-ds-DNA levels (p<0,01, r=0,595) and complement serum level C3 (p<0,01, r=-0,519) and C4 (p=0,019; r=-0,345). CONCLUSION ß2M serum measurement can be a useful biomarker to assess the SLE activity as long as it is used with other laboratory tests that are routinely used to evaluate the activity of SLE.

Carpal Tunnel Syndrome and Peripheral Polyneuropathy in Patients with End Stage Kidney Disease

This study was designed to identify the causes of the development of carpal tunnel syndrome (CTS) associated with end stage kidney disease (ESKD). A total of 112 patients with ESKD, 64 on hemodialysis (HD) and 48 on peritoneal dialysis (PD), were enrolled. The duration of ESKD and dialysis, the site of the arteriovenous (A-V) fistula for HD, laboratory data such as blood urea nitrogen, creatinine, and beta-2-microglobulin were determined. Clinical evaluation of CTS and electrophysiological studies for the diagnosis of CTS and peripheral neuropathy were performed. The electrophysiological studies showed that the frequency of CTS was not different in the HD and PD groups (P = 0.823) and the frequency of CTS was not different in the limb with the A-V fistula compared to the contralateral limb (P = 0.816). The frequency of HD and PD were not related to beta-2-microglobulin levels, an indicator of amyloidosis. The frequency of CTS did not increase as the severity of the peripheral neuropathy and the duration of ESKD and dialysis increased (P = 0.307). The results of this study do not support that microglobulin induced amyloidosis or placement of an A-V fistula are associated with an increase in CTS.

Myelomatous Pleural Effusion: A Case Series in a Single Institution and Literature Review / 대한진단검사의학회지

BACKGROUND: Myelomatous pleural effusion (MPE) is rare in myeloma patients. We present a consecutive series of patients with MPE in a single institution. METHODS: We retrospectively reviewed the medical records of 19 patients diagnosed with MPE between 1989 and 2008 at the Asan Medical Center. Diagnoses were confirmed by cytologic identification of malignant plasma cells in the pleural fluid. RESULTS: Our patients showed dominance of IgA (36.8%) and IgD (31.6%) subtypes. Of 734 myeloma patients, the incidence of MPE was remarkably high for the IgD myeloma subtype (16.7%), compared to the other subtypes (1.4% for IgG and 4.6% for IgA). At the time of diagnosis of MPE, elevated serum beta2-microglobulin, anemia, elevated serum lactate dehydrogenase, and elevated creatinine levels were found in 100%, 89.5%, 83.3%, and 57.9% of the patients, respectively. Approximately one-third (31.3%) of the patients had adenosine deaminase (ADA) activities in their pleural fluid exceeding the upper limit of the reported cutoff values for tuberculous pleural effusion (55.8 U/L). Chromosome 13 abnormality was seen in 77.8% of the tested patients. The median survival period from the development of MPE was 2.8 months. CONCLUSIONS: Patients with MPE have aggressive clinical and laboratory characteristics. The preponderance of IgD myeloma in MPE patients is a noteworthy finding because IgD myeloma is a rare subtype. Elevated ADA activity in the pleural fluid is also noteworthy, and may be helpful for detecting MPE. Physicians treating myeloma patients should monitor the development of MPE and consider the possibility of a worse clinical course.

Application of Cystatin C Reduction Ratio to High-Flux Hemodialysis as an Alternative Indicator of the Clearance of Middle Molecules

BACKGROUND/AIMS: Although high-flux (HF) dialyzers with enhanced membrane permeability are widely used in current hemodialysis (HD) practice, urea kinetic modeling is still being applied to indicate the adequacy of both low-flux (LF) and HF HD. In comparison with urea (molecular weight, 60 Da) and beta2-microglobulin (beta2MG, 12 kDa), cystatin C (CyC, 13 kDa) is a larger molecule that has attractive features as a marker for assessing solute clearance. We postulated that CyC might be an alternative for indicating the clearance of middle molecules (MMs), especially with HF HD. METHODS: Eighty-nine patients were divided into LF and HF groups. Using single pool urea kinetic modeling, the urea reduction ratio (URR) and equilibrated Kt/Vurea (eKt/Vurea) were calculated. The serum CyC concentrations were measured using particle-enhanced immunonephelometry. As indices of the middle molecular clearance, the reduction ratios of beta2MG and CyC were calculated. RESULTS: The beta2MG reduction ratio (beta2MGRR) and CyC reduction ratio (CyCRR) were higher in the HF group compared to the LF group. However, the URR and eKt/Vurea did not differ between the two groups. The CyCRR was significantly correlated with the eKt/Vurea and beta2MGRR (r = 0.47 and 0.69, respectively, both p < 0.0001). CONCLUSIONS: Compared to the LF dialyzer, the HF dialyzer removed CyC and beta2MG more efficiently. Unlike the beta2MGRR, the CyCRR was correlated with the eKt/Vurea and beta2MGRR. This study suggests a role for the CyCRR as an alternative indicator of the removal of MMs.

Incomplete immunological recovery following anti-tuberculosis.

Background & objectives: Mycobacterium tuberculosis infection has been shown to result in increased HIV replication and disease progression in HIV-infected individuals through increased immune activation. The objective of this study was to correlate plasma levels of immune activation markers with the presence of tuberculosis (TB) in HIV-infected and uninfected individuals, and to study the changes following anti-tuberculosis treatment. Methods: Plasma markers of immune activation - neopterin, beta-2-microglobulin (β2M) and soluble tumour necrosis factor alpha receptor type I (sTNFα-RI) were measured by ELISA in 42 HIV positive TB patients (HIV+TB+) undergoing a six-month course of TB chemotherapy. Thirty seven HIV+ persons without active TB, 38 TB patients without HIV infection, and 62 healthy volunteers served as controls. Results: Plasma levels of all three markers were elevated in HIV+ individuals, more so in those with active TB. When HIV+ individuals were further categorized based on CD4+ T cell counts, HIV+TB+ patients with CD4+ T cells counts < 200 cells/μl were found to have the highest levels at baseline with a steep fall in neopterin and sTNFα-RI during treatment, but in most instances the levels did not drop to normal. β2M levels remained persistently high despite completing TB treatment. Interpretation & conclusions: The fi ndings of the study suggest that both HIV and TB act synergistically to activate the host immune system. Although ATT was effective in clearing M. tuberculosis infection, a high proportion of HIV+ TB patients continued to have levels well above the normal range, indicating that underlying immune activation persists despite TB treatment. None of the markers were specific enough to be used to assess cure of TB.

Intervalos de referencia para la β 2 microglobulina sérica empleando dos enzimoinmunoensayos / Reference intervals of serum beta2 microglobulin using two different immunoassays

La obtención de un intervalo de referencia es importante para la correcta interpretación de los resultados, toma de decisiones y seguimiento clínico de los pacientes que integran la población del lugar. Los objetivos de este trabajo fueron obtener y validar los intervalos de referencia de la beta2 microglobulina sérica en la ciudad de Bahía Blanca. Se emplearon simultáneamente dos ensayos inmunoenzimáticos. Como población de referencia se tomaron individuos que concurrieron a donar sangre a la Unidad de Hematología y Hemoterapia del Hospital Municipal de Agudos "Dr. Leónidas Lucero" y estudiantes de Bioquímica de la Universidad Nacional del Sur, previo interrogatorio para descartar posibles alteraciones preanalíticas. A la muestra de referencia seleccionada se le extrajo sangre venosa. Los intervalos de referencia obtenidos fueron de 0,78 a 1,47 mg/L para el primer método y de 1,18 a 2,36 mg/L para el segundo. En el primer caso el rango obtenido no coincidió con el reportado por el fabricante. Los dos métodos no resultaron comparables ni en exactitud ni en precisión. De este estudio se desprende que cada sistema de medición debería informarse con su correspondiente intervalo de referencia.

The creation of a reference interval is important for the accurate diagnosis and prognosis on the local population. The aims of this study were to determine and verify the reference interval of serum beta2 microglobulin in Bahia Blanca. Two different immunoenzymatic assays were used simultaneously. The reference population was taken among volunteer blood donors who donated at the Hematology and Hemotheraphy Unit of the Hospital Municipal de Agudos "Dr. Leónidas Lucero", and Biochemistry students from the Universidad Nacional del Sur. Preanalytical alterations were ruled out using a questionnaire, and afterwards, venous blood samples were obtained. The calculated reference intervals were 0.78 to 1.47 mg/L and 1.18 to 2.36 mg/L for each method respectively. In the first case, it disagreed with that reported by the manufacturer. None of the assays was comparable, neither in accuracy nor in precision. This study shows that each measurement system should be informed with its corresponding reference interval.

Elevation of Serum Ferritin is Associated with the Outcome of Patients with Newly Diagnosed Multiple Myeloma

BACKGROUND/AIMS: Serum ferritin is a marker of acute phase reactions and iron storage. In addition, hematologic malignancies are associated with elevated serum ferritin levels. Other studies have suggested that ferritin is a surrogate for advanced disease and has an impact on relapse, because elevated serum ferritin predicts overall survival (OS) and relapse-free survival following autologous stem cell transplantation for lymphomas. METHODS: We studied 89 consecutive patients with newly diagnosed multiple myeloma to determine the value of serum ferritin in comparison with known prognostic factors. RESULTS: The OS in the elevated serum ferritin group (> or =300 ng/mL) was shorter than that in the normal serum ferritin group (<300 ng/mL, p<0.001) after a median follow-up of 25 months. In univariate analysis, elevated ferritin was correlated with poor survival in the patients (relative risk [RR], 2.588; 95% confidence interval [CI], 1.536 to 4.358; p<0.001). Furthermore, multivariate analysis showed that elevated serum ferritin was an independent predictor of mortality in patients with multiple myeloma (RR, 2.594; 95% CI, 1.403 to 4.797; p=0.002). CONCLUSIONS: The serum ferritin can a prognostic parameter of survival as well as disease activity in patients with multiple myeloma.

The effectiveness of on-line hemodiafiltration on beta-2 microglobulin clearance in end stage renal disease.

OBJECTIVE: To compare beta2-microglobulin (beta2M) clearance between on-line hemodiafiltration (HDF) and high flux hemodialysis (HFHD). MATERIAL AND METHOD: The total, convection/diffusion, and membrane adsorption components of beta2M clearance in 10 hemodialysis patients treated with on-line HDF at the replacement fluid rates of 75 (HDF75) and 125 (HDF125) mL/min, were determined and compared with HFHD. RESULTS: The total beta2M clearance in the HDF 125 group was significantly higher than the HDF75 group (124.5 +/- 4.4 vs 101.3 +/- 4.1 mL/min; p < 0.05); both values were much greater than the HFHD group (p < 0.01). The convection/diffusion was the major portion of total beta2M clearance in all three groups. The values of convection/diffusion and membrane adsorption in both HDF groups were about 2 and 3 times, respectively, of the HFHD group (p < 0.01). Both components of beta2M clearance in the HDF125 group did not statistically differ from the HDF75 group, however; the value of convection/diffusion clearance in HDF125 was more than in the HDF75 group. Regarding Kt/Vurea and phosphate clearance, there were no significant differences among the study groups. CONCLUSION: On-line HDF could provide more beta2M clearance than HFHD by increasing both the convection/ diffusion, and membrane adsorption clearances. HDF125 provided more total beta2M clearance than HDF75 from the convection/diffusion mechanism while the adsorptive mechanisms were equal.

Comparison of Serum Beta 2-Microglobulin and 24 hour Urinary Creatinine Clearance as a Prognostic Factor in Multiple Myeloma

A new staging system for multiple myeloma (MM) has utilized serum concentrations of beta 2-microglobulin (S beta2 M) and albumin as important prognostic factors for survival. Since S beta2 M is an indicator of glomerular filtration rate, we compared the prognostic values of S beta2 M and 24-hr urinary creatinine clearance (Ccr) in patients with MM. We retrospectively reviewed the records of 170 MM patients from January 1996 to November 2003 whose 24-hr urinary Ccr was available at the time of diagnosis. We found that pretreatment S beta2 M was inversely related to Ccr (Spearman's correlation coefficient=-0.787). In univariate analysis, the hazard ratio (HR) of death was 1.043 (p<0.001) for S beta2 M and 0.985 (p<0.001) for Ccr. Multivariate analysis showed that S beta2 M (HR 1.030, p=0.010) and Ccr (HR 0.993, p=0.059) were significant prognostic factors in patients' survival. In conclusion, 24-hr urinary Ccr may be utilized for staging of patients with MM.

Immunological study of otitis media with effusion in children

Otistis media with effusion [OME] is one of the most common health problems seen in children [Kirglu et al., 2003].This study was undertaken to evaluate beta2-M levels in serum and effusion of the middle ear in patients with OME to determine whether there was any alterations which may shed a light on the pathogenesis of this disease. The present study was carried out on 30 patients [36 ears] with otitis media with effusion [OME] who were admitted to ENT Departments of Al-Azhar University Hospitals. The patients were given an interval of 3 weeks after diagnosis and before surgical interference to give them a chance for resolution with medical treatment. Those with persistent effusion were selected for the study. Diagnosis was done by a complete case history, clinical examination and audiological examination. Determination of beta2-M in the sera and MEE of patients with OME and the sera of normal controls showed that their mean values +/- SD were: 1.85 +/- 0.9, 3.57 +/- 2.41, 1.73 +/- 0.67 mg/l respectively. The mean concentration of beta2-M in serum of normal controls, serum and "MEE" of preschool age: 1.48 +/- 0.55, 1.5 +/- 0.58 and 3.18 +/- 2.1 mg/l respectively. The mean beta2-M value in serum and middle ear effusion in children with mucoid type were: 1.91 +/- 0.93 and 2.68 +/- 1.91 mg/l respectively. There was no correlation of the beta2-M levels with respect to the patients age, sex or MEE type. [2-M was detected in 100% of "MEE" samples and serum samples

Evaluation of beta2 microglobulin level as a marker to determine HIV/AIDS progression.

Levels of beta2 microglobulin (beta2M) were evaluated to monitor the progression of HIV disease, as an alternate economical marker to RNA viral load and CD4 cell count in resource poor situations. A cross sectional study of 32 HIV sero-negative controls (Group I), 43 asymptomatic HIV sero-positives (Group II-A), 44 HIV sero-positives with clinical and/or laboratory proven STDs (Group II-B) and 30 with AIDS indicator conditions (Group III) was carried out. beta2M levels were determined using an enzyme immuno assay. Mean +3 SD (3.04mg/l) of concentration of beta2M in sero-negative controls was chosen as threshold of abnormality. A significant rise (p<0.001) in mean beta2M levels (mg/l) from 1.87 +/- 0.39 (Group I) to 2.59 +/- 1.09 (Group IIA), 3.01 +/- 1.27 (Group IIB) to 5.16 +/- 2.48 (Group III) was observed. Higher values of beta2M in the symptomatic phase than those in the asymptomatic phase indicated that elevated levels of beta2M parallel progression of HIV disease and suggest its use as an alternate marker for determining HIV progression.

Beta2 microglobulin as a surrogate marker for HIV infection: good correlation with CD4 counts.

To determine if beta-2 microglobulin (beta2M) levels were elevated in our HIV infected patient population and if it could be used as a surrogate marker for disease progression. Thirty-eight HIV infected individuals and 26 age and sex-matched controls were studied. Measurement of CD4 cell count was carried out on a flowcytometer using anti-human CD4 monoclonal antibody and beta2M was measured by an enzyme immunoassay. Mean levels of HIV infected individuals were 1.29 +/- 0.52 mg/L and were significantly higher than 0.74 +/- 0.07 mg/L, the value of controls (p value <0.01). There was a negative correlation between CD4 counts and beta2M levels (r-value-0.79, p value <0.001). Beta2M levels in HIV infected individuals who have no opportunistic infection are elevated and these levels correlate with the CD4 counts. Beta2M can be used for the clinical follow-up of patients with HIV infection.

High Dose Therapy Followed by Autologous Peripheral Blood Stem Cell Transplantation as a First Line Treatment for Multiple Myeloma: a Korean Multicenter Study

We conducted a phase II multicenter trial to estimate the response and survival of patients with newly diagnosed multiple myeloma to high dose melphalan therapy followed by autologous peripheral blood stem cell transplantation. Eligible patients who had undergone induction with vincristine, adriamycin and dexamethasone (VAD) should have adequate cardiac, pulmonary and renal function (creatinine <2 mg/dL). Melphalan at 200 mg/m2 was used as a conditioning regimen. Eighty patients were enrolled from 13 centers. The median age of the patients was 53 yr (range; 20 to 68 yr). The initial stage was IA/IIA/IIB/IIIA/IIIB in 3/8/1/54/14 patients, respectively. Beta2-microglobulin, CRP and LDH were increased in 74, 42 and 34% of the patients examined. Cytogenetic data were available in 30 patients, and 6 patients showed numeric or structural abnormalities. Two therapy-related mortalities occurred from infection. Among the 78 evaluable patients, CR/PR/MR/NC/PD were achieved in 48/26/2/1/1patients, respectively. After a median follow-up of 30 months, the median overall and event-free survivals were 66 months (95% CI: 20-112) and 24 months (95% CI: 18-29), respectively. This study verifies the efficacy and feasibility of high dose melphalan therapy with autologous stem cell transplantation in newly diagnosed multiple myeloma.

Decline in beta-2 microglobulin levels after antitubercular therapy in tubercular patients with HIV infection.

BACKGROUND: Infection with Mycobacterium tuberculosis results in a state of immune activation, more so, when there is concomitant HIV infection. Beta-2 microglobulin (B2M) is a useful marker to study the state of immune activation among the HIV infected. Objective. To study the modulation of B2M levels among patients with HIV/TB coinfection, to correlate it with the CD4 count and also to study the change in these levels after four weeks of therapy. MATERIAL AND METHODS: Twelve patients with HIV infection and having concomitant TB diagnosed on the basis of positive acid fast bacilli were studied both at baseline and then at four weeks. Fourteen HIV infected individuals who had no overt opportunistic infection at the time of the study were also studied along with fourteen age and sex matched healthy volunteers. CD4 counts were performed using a flowcytometer. B2M was measured using a commercially available ELISA kit. RESULTS: B2M levels in HIV/TB coinfected patients were 1.62+/-0.45 mg/L (range 1-2.7 mg/L) and were significantly higher (p<0.0002) when compared with healthy controls, whose levels were 0.74+/-0.05 mg/L (range 0.48-81 mg/L). The levels in HIV infected individuals free of opportunistic infections were 1.2+/-0.16 mg/L (range 0.78-1.92 mg/L) and were significantly lower than the levels in HIV/TB coinfected (p<0.017), but significantly higher than the levels in healthy controls (p<0.01). Four weeks of antitubercular therapy resulted in a decline in B2M to 1.08+/-0.26 mg/L (range 0.8-1.74 mg/L) and was statistically significant (p<0.012). There was no correlation between the CD4 counts and the pre-treatment levels of B2M among these patients. CONCLUSION: Patients with HIV/TB coinfection had significantly higher levels of B2M than individuals with HIV infection without associated opportunistic infection and healthy controls. Four weeks of anti-tuberculous therapy resulted in a significant decline in these levels.

Suppression of beta 2 microglobulin by pentoxiphylline therapy in asymptomatic HIV infected individuals.

Pentoxiphylline, an inhibitor of tumor necrosis factor-alpha (TNF-alpha) has been used in the treatment of human immunodeficiency virus (HIV) infection. The inhibition of TNF-alpha results in decreased immune activation. Beta 2 microglobulin (beta 2 M) has been used as a surrogate marker to study the progression of HIV infection. The objective of this study was to see if use of pentoxiphylline resulted in any decline in beta 2 M levels. Twenty patients with HIV infection who were free of opportunistic infections at the time of inclusion in the study and 18 age and sex matched controls were studied. beta 2 M was measured using an enzyme immunoassay before and four weeks after the start of treatment with pentoxiphylline. Mean levels of beta 2 M before therapy were 1.51 +/- 0.77 mg/l (range 0.78-3.8 mg/l) and were significantly higher (P < 0.001) than the levels among controls [0.72 +/- 0.06 mg/l (range 0.46-0.88 mg/l)]. beta 2 M levels in patients declined to 0.85 +/- 0.22 mg/l (range 0.72-1.0 mg/l) after four weeks of therapy and this was statistically significant (P < 0.001). Use of pentoxiphylline for four weeks results in a significant decline in the levels of beta 2 M suggesting that the level of immune activation is reduced with the therapy.

Estimation of beta-2 microglobulin in serum and middle ear effusion in chidren with otitis media with effusion

Beta[2]-Microg1obulin [Beta[2]-M] is a low molecular weight protein. It is non-covalently associated with the heavy chain of human leucocytic antigen [HLA] antigens on cell membranes. This study was undertaken to evaluate beta[2]-M levels in serum and effusion of the middle ear in patients with OME to determine whether there was any alterations which may shed a light on the pathogenesis of this disease. The present study was carried out on 30 patients [36 ears] with otitis media with effusion [OME] who were admitted to ENT Departments of Al-Azhar University Hospitals. The patients were given an interval of 3 weeks after diagnosis and before surgical interference to give them a chance for resolution with medical treatment. Those with persistent effusion were selected for the study. Diagnosis was done by a complete case history, clinical examination and audiological examination. Determination of beta[2]-M in the sera and MEE of patients with OME and the sera of normal controls showed that their mean values +/- SD were: 1.85 +/- 0.9, 3.57 +/- 2.41, 1.73 +/- 0.67 mg/l respectively. The mean concentration of Beta [2] -M in serum of normal controls, serum and [MEE] of preschool children were: 1.89 +/- 0.71, 2.26 +/- 0.91 and 3.88 +/- 2.65 mg/1 respectively, while in the early school age: 1.48 +/- 0.55, 1.5 +/- 0.58 and 3.18 +/- 2.1 mg/1 respectively. The mean Beta[2]-M value in serum and middle ear effusion in children with mucoid type of OME were: 2 +/- 0.86 and 4.11 +/- 2.57 mg/1 respectively, while in those of serous type were: 1.91 +/- 0.93 and 2.68+1.91 mg/1 respectively. There was no correlation of the Beta[2] M levels with respect to the patients age, sex or MEE type. Beta[2]-M was detected in 100 percent of [MEE] samples and serum samples. It remains to be further investigated whether the Beta [2]-M immune complexes present in MEE may actually contribute to the pathogeneses of OME

Is beta2-microglobulin a marker of bone remodling in postmenopausal osteoporosis?

Beta[2]-microglobulin plays a role as a bone-derived growth factor regulating both osteoblast and osteoclast cell activity. Serum beta[2] -microglobulin has been proposed as a bone remodeling biological marker in high bone turnover conditions. Osteoclastic activity is, enhanced in postmenopausal osteoporosis, suggesting that beta[2] microglobulin concentration may also be increased in this disease. In this study, beta[2]- microglobulin concentration was found to be raised [P< 0.001] in 30 women with postmenopausal osteoporosis as compared with 30 normal women of similar age; tartrate - resistant acid phosphatase concentration also was raised [P< 0.001]. Linear regression analysis revealed a highly negative correlation result between total body bone mineral content and beta[2] - microglobulin [r = 0.577, P < 0.001], and positive correlation result between beta[2] - microglobulin and tartrate - resistant acid phosphatase concentration [r2 = 0.806, P< 0.00 I]. These findings, and the stimulatory effect of beta[2] microglobulin on osteoclastic and osteoblastic activity suggest that beta[2]- microglobulin may play an important role as a local regulator factor in the pathogenesis of postmenopausal osteoprosis

Correlation and prognostic value of serum beta-2 microglobulin, thymidine kinase and lactate dehydrogenase isoenzymes in acute lymphoblastic leukemia

The correlation between the serum levels of beta-2 microglobulin [beta-2 M], thymidine kinase [TK], lactate dehydrogenase [LDH] and its isoenzymes [LD1-5] as well as their relationship with liver function parameters were analyzed in adult patients with acute lymphoblastic leukemia. A significant increase in the mean values of serum beta-2 M, TK, total LDH, LD1, LD2, LD3, LD4, AST, ALP and GGT was found. Levels of LD5 and LD1/LD2 ratio showed a significant decrease. Correlation analyses showed an inverse correlation between beta-2 M and LD3 and a positive correlation between LDH, TK, LD2, LD3, LD4 and AST. It was concluded that using a combination of beta-2 M, TK, LDH and its isoenzymes could be used as useful markers for the activity of the proliferating tumor cells and that some alterations in the LDH isoenzymes pattern may help in refining the prognostic value of total LDH

Role of serum CIQ and beta 2-microglobulin in the pathogenesis of dialysis related amyloidosis

The aim of this work was to study the serum levels of B2m and Clq in hemodialysis [HD] patients and their relation to carpal tunnel syndrome [CTS] as a manifestation of dialysis related amyloidosis [DRA] and to investigate the role of B2m in the development of DRA. Clq and B2m were studied in the sera of 32 uremic patients on regular HD treatment. They were divided into two groups: Group I included 12 HD patients with clinical and electrophysiological manifestations of CTS and in whom amyloid deposition was identified during release surgery, group II comprised 20 HD patients with no evidence of clinical or electrophysiological CTS and group three included ten healthy control subjects. The results showed that serum levels of both B2m and Clq were significantly elevated in all HD patients in the two groups when compared with the controls. Serum Clq was significantly higher in HD patients of group I than in patients of group II, while serum B2m was elevated in both groups of I and II without a statistical difference. Serum B2m in patients of group I and II was 30.7 mg/L +/- 2.8 and 29.6 mg/L +/- 2.2, respectively. Immunohistochemical assay of biopsies taken during decompression surgery was positive for B2m in all patients of group I. The results suggested that Clq may contribute to DRA and serum Clq may be a reliable predictor for the diagnosis of DRA

Serum cystatin-C: a sensitive marker for early detection of reduction in glomerular fitration rate

The aim of the present study was to evaluate the diagnostic value of serum cystatin-C [Cys-C] as a serum marker of glomerular filtration rate [GFR] in patients with various renal diseases with a wide range of renal function as well as to compare between serum Cys-C, creatinine and beta 2-microglobulin [beta 2m] as indicators of GFR. The study included 63 patients [39 males and 24 females aged between 17 and 75 years]. Serum Cys-C was measured by automated particle- enhanced turbidimetry, serum creatinine by Synchron CX-7 autoanalyzer, serum beta 2m by enzymognost beta 2m assay and GFR by 99m Tc-labeled diethylenetriamine pentaacetic acid [99m TcDTPA] clearance. The results demonstrated that serum Cys-C significantly increased in patients with reduced GFR [less than 80ml/min], while serum creatinine and serum beta 2m were significantly increased at a later stage of renal insufficiency at GFR [less than 40ml/min]. The sensitivity and diagnostic accuracy of Cys-C were better than that of serum creatinine and beta 2m