Development of a stable reference material for prostatic acid phosphatase.

We describe the development of a stable reference material for prostatic acid phosphatase, derived from human prostatic tissue and human seminal fluid. The enzyme was purified by an L-tartramic acid affinity-chromatography technique. Two-dimensional electrophoresis revealed essentially no contaminating proteins, and specific tests revealed no contaminating enzymes. The preparations, in a matrix containing 30 g of human serum albumin and 0.1 mol of sodium acetate per liter, pH 6.0, were studied with respect to stability of both catalytic activity and immunological identity. We conclude that the preparations from either source are satisfactorily stable, and that either is acceptable for use in preparing clinical reference materials. These materials will be used in developing a reference method.

Results of a nationwide survey of analyses for creatine kinase and creatine kinase isoenzymes.

More than 300 laboratories participated in an interlaboratory survey of creatine kinase (CK, EC 2.7.3.2) determinations in which they analyzed seven lyophilized samples for total CK and CK isoenzymes and furnished information about their methodology. The samples were not necessarily intended to mimic typical patients' specimens but rather to determine the analytical ability of the laboratories to distinguish isoenzyme fraction CK-MB from CK-BB and to detect small but abnormal amounts of CK-BB. For total CK measurement, most laboratories used an NADP+ reduction method monitored at 340 nm (89%), and reported results in units per liter (U/L) (99%) at either 30 degrees C (34%) or 37 degrees C (60%). Despite the variety of analytical conditions, most laboratories (89%) correctly reported results within their normal range for all samples. The 287 laboratories that reported isoenzyme distributions in the samples used either cellulose acetate (37%) or agarose (44%) electrophoresis, ion-exchange chromatography (9%), or immunoinhibition (7%). Results from laboratories that used nonspecific CK-MB immunoinhibition techniques were biased when a significant amount of CK-BB isoenzyme was present.

Development of a reference material for alkaline phosphatase.

In developing a Reference Material for alkaline phosphatase, we studied the stability, kinetic properties, and commutability of separate preparations of the purified enzyme from human liver, intestine, bone, and placenta. The Michaelis constants (Km) for the preparations from liver, bone, and intestine agreed well with the Km values we obtained for five human serum specimens, whereas that for the placental isoenzyme differed significantly. The first three isoenzymes exhibited nearly identical response-surface patterns, which closely paralleled those observed for 12 human serum specimens (commutability), but not that of the placental isoenzyme. Thus, we believe that a reference material could equally well consist of either the bone, intestinal, or liver isoenzyme. All four isoenzymes were satisfactorily stable in temperature-accelerated degradation studies. We chose the liver isoenzyme as an appropriate reference material because liver tissue is easier to obtain than bone or intestine and the isoenzyme is abundant in liver, is easy to extract, and is the one most commonly increased in human serum. This material is stable at -20 degrees C, is free of interfering and degradative enzymes and, being of human origin, is commutable with the enzyme in human serum.

Clinical studies of protein-bound calcium in various diseases.

A recently developed gel-filtration technique allows protein-bound calcium fractions to be separated and quantitated; the protein is separated under physiological conditions of pH, temperature, and concentrations of Na, Mg, and Ca to assure that the calcium-proteinate equilibrium is not disturbed. We used this gel-filtration technique to study the protein-bound calcium fractions in 18 patients with hyperparathyroidism, multiple myeloma, diabetes, osteoporosis, or liver cirrhosis. We calculated the amount of calcium bound per gram of protein for each of the three protein peaks and the intrinsic association constant (Ka) for calcium/albumin. Results with the multiple myeloma patients (three IgG, one IgA) indicated that IgG did not bind calcium appreciably, that IgA had about the same affinity as albumin for Ca, and that Ka was slightly low for one patient of the IgG type (79 L/mol) and normal for the other three myeloma patients (106, 90, and 91 L/mol). Results for patients with the other diseases were also essentially normal, except for the osteoporesis patients (two men, one woman), whose Ka values (69, 75, and 73 L/mol) were lower than normal.

A candidate reference method for uric acid in serum. I. Optimization and evaluation.

We describe our optimization and evaluation of a candidate Reference Method for uric acid in serum. Reaction parameters were optimized for a manual, enzymic method for uric acid in which highly purified microbial uricase is used to quantitate uric acid by a differential ultraviolet procedure. We evaluated the method in terms of freedom from interferences, analytical recovery, precision, and comparison with five other uric acid methods. We conclude that (a) the candidate uric acid Reference Method exhibits the least interference; (b) all six methods exhibit satisfactory analytical recoveries and precision; and (c) results by all six methods agree well. As a result of this evaluation study, the manual ultraviolet uricase method for uric acid, with Tris as buffer, was chosen as the candidate Reference Method for uric acid.

Characterization and intermethod relationships of materials containing purified human pancreatic and salivary amylase.

We describe the preparation and characterization of materials containing human pancreatic and salivary alpha-amylase (EC 3.2.1.1) and examine their relationship to endogenous amylase in human serum. Amylase was purified from human pancreas and saliva by solvent- and salt-fractionation and column chromatography to specific activities of 63 and 279 kU/g, respectively. Four liquid pools, differing only in activity, were prepared from each source of amylase, each in a matrix containing, per liter: 30 g of human albumin, 50 mmol of sodium chloride, 1 mmol of calcium chloride, and 50 mmol of Tris hydrochloride buffer, pH 7.4. Characterization of the pools showed that the amylase activity in the materials was stable for at least six months at 25 degrees C; among-vial variability of amylase activity was less than or equal to 0.5% (2 CV); and the pools were free from eight possible contaminating enzymes. Plots of salivary vs pancreatic amylase activity measure in our materials with eight commercially available methods showed least-squares slopes ranging from 0.51 to 1.0. The intermethod "commutability" of the materials (i.e., how closely they mimic endogenous serum amylase) was examined in relationship to approximately 100 human sera.

Effects of hemodialysis on protein-bound calcium.

This study evaluates whether hemodialysis alters the affinity of plasma proteins for calcium. We have used a new automated methodology for the determination of the dialyzable calcium fraction. Protein-bound calcium was estimated as the difference between the total and dialyzable calcium fractions. All measurements were made after adjustment of the sample pH to 7.40 +/- 0.02. The calcium fractions were determined in 12 patients before and after hemodialysis. In addition, we added calcium to the predialysis specimens to evaluate the effect of increased ionic calcium on protein binding and corrected the protein-bound calcium in these specimens for the increase in total protein observed in the postdialysis specimens. Hemodialysis significantly increased total, dialysable, and protein-bound calcium. The mean ratio of protein-bound calcium in the postdialysis specimens to the corrected protein-bound calcium in the predialysis specimens with calcium added was 0.97 +/- 0.02. We conclude that (1) the increase in protein-bound calcium to the predialysis specimens, and that (2) the binding affinity of serum proteins for calcium is not altered by hemodialysis.