A prospective analysis of the frequency, course, and possible prognostic significance of the joint manifestations of childhood leukemia.

During a 2-year prospective study of 28 leukemic children (24, acute lymphocytic leukemia [ALL]; 4, non-ALL) unselected for musculoskeletal symptoms, objective joint findings were present in 14 cases (p = 0.001 vs normal controls). These findings varied in severity, were most frequently present in the knee (12 of 14 children), and were found most frequently only at disease onset (7 of 14). The group with joint abnormalities had a higher frequency of functionally significant joint complaints prior to diagnosis of leukemia (p = less than 0.01) and radiographic abnormalities of periarticular bone of the knees and ankles (p = less than 0.10). Four of the 5 children with ALL who died had joint findings, a trend whose significance is uncertain because of unequal followup periods.

Measurement of serum proinsulin-like material: cross-reactivity of porcine and human proinsulin in the insulin radioimmunoassay.

The variation in cross-reactivity of human and porcine insulins and proinsulins was determined with a number of insulin antisera. The relative immunoreactivity of insulin and proinsulin with these antisera ranged from a ratio of 1.08 to 5.7 on a molar basis. The displacement curves of human insulin and proinsulin were not parallel, and the relationship of porcine and human proinsulin varied with different antisera. Sera with varying concentrations of PLM (proinsulin and its intermediate components) and serum PLM and insulin fractions (separated by gel filtration) were measured in two assays using the antisera which reacted most differently with human insulin and proinsulin standards. With the use of these two antisera, measurement of serum PLM against a human insulin standard gave different results, which were only partially corrected by reading the values from a human proinsulin standard. The magnitude of the serum IRI differences with these antisera was related to the proinsulin/insulin ratio in each sample. These results indicate the necessity for each laboratory to critically evaluate the reaction of their insulin antiserum with human proinsulin. In addition, measurement of serum PLM in terms of a insulin standard will give different results depending upon the particular antiserum used.

Circulating proinsulin in patients with maturity onset diabetes.

The contribution of proinsulin to the total serum immunoreactive insulin (IRI) was measured in 59 patients with maturity onset diabetes (23 being treated with diet alone and 36 with oral sulfonylurea agents) and compared to that in 44 control subjects. The percentage of proinsulin was increased in 11 patients and correlated with plasma glucose, but not with IRI. There was no difference between the drug-treated group and diet-treated group, or between patients taking different sulfonylurea agents. Sequential studies in one patient showed normalization of the proportion of proinsulin following lowering of the plasma glucose level. It is probably that the increased circulating proportion of proinsulin in hyperglycemic diabetic patients is secondary to beta cell exhaustion with release of less mature granules.

Measurement of human high density lipoprotein apolipoprotein A-1 in serum by radioimmunoassay.

A sensitive and specific double antibody radioimmunoassay for the major apolipoprotein (apo A-I) of human serum high density lipoprotein (HDL) was developed. Initial studies indicated that direct measurements of apo A-I concentration in whole untreated sera or isolated high density lipoprotein fractions yielded variable results, which were lower than those obtained in the corresponding samples which had been subjected to delipidation. Subsequently, it was observed that heating diluted sera or HDL for 3 hr at 52 degrees C prior to assay resulted in maximal increases in apo A-I immunoreactivity to levels comparable to those found in the delipidated specimens. This simple procedure permitted multiple sera to be assayed efficiently with full recovery of apo A-I.

Degradation of insulin in serum by insulin-specific protease.

The effect of insulin specific protease (ISP) in degrading plasma insulin over a wide concentration range was studied. In sera containing more than 50 muU per milliliter, more than 85 per cent of the insulin was destroyed. However, a smaller percentage of the hormone was degraded in sera containing less than 20 muU per milliliter and the results were highly variable. The residual insulin-like immunoreactivity in plasma after exposure to ISP thus represents both undegraded insulin as well as proinsulin. These findings explain the higher plasma proinsulin values obtained by the enzyme method when compared to gel filtration.

Serum proinsulin in children and adolescents with chemical diabetes.

Proinsulin levels (PLC) in serum were determined after gel filtration on specimens obtained during oral glucose tolerance testing (OGTT) in seven patients with repeated abnormality in OGTT and in a group of seven control subjects matched for age. Fasting and thirty-, sixty-, and 120-minute postglucose venous samples were analyzed for glucose (PG) and immunocreactive insulin (IRI) as well as PLC, PG and IRI mean concentrations were greater at all testing times in the patient population, but the mean IRI/PG was significantly higher in the patients only at fasting. PLC mean levels were higher in the patients but not to a level of significance. Percentage of total IRI atributable to PLC at each time point was identical between the two groups. The apparcent diminished effectiveness of circulating insulin in chemical diabetes cannot be attributed to an abnormal proportion of proinsulin.

Proinsulin, insulin, and C-peptide concentrations in human portal and peripheral blood.

Concentrations of insulin, proinsulin, and C-peptide were measured in portal and peripheral venous blood in six nondiabetic, nonobese subjects. Portal vein samples were obtained by umbilical vein catheterization. Three subjects were studied with intravenous infusion of 25 g glucose, and three with 30 g arginine. Insulin and proinsulin were determined in the insulin immunoassay after separation by gel filtration, and C-peptide was measured by direct immunoassay. With both glucose and arginine stimulation, portal vein levels of all three peptides peaked at 90-120 s after the onset of the stimulus. Relative increases in insulin concentration were greater than those of proinsulin or C-peptide. In peripheral venous blood, maximal levels of the three peptides were observed later (2-5 min), and the increase in insulin relative toproinsulin and C-peptide was not as great. At the time of peak secretion, portal vein insulin and C-peptide approached equimolar concentrations, and proinsulin, as measured against an insulin standard, comprised approximately 2.5% of the total immunoreactive insulin. After stimulation by glucose or arginine, portal insulin, proinsulin and C-peptide levels were not correlated with the concentrations measured in simultaneously drawn peripheral samples. At all sampling times, however, significant correlation was found between insulin and C-peptide in both peripheral and portal blood. The results indicate that under the conditions studied, insulin and C-peptide are secreted in equimolar concentrations in man, and that proinsulin is secreted in the same proportion to insulin as found in the pancreas. Consideration of the relative secretory and metabolic rates of the three beta cell peptides explains their peripheral concentrations. The data further support the use of plasma C-peptide as an indicator of beta cell secretory function.