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Michael N Fahie-Wilson

Publications and source records attributed to Michael N Fahie-Wilson.

6 recordsLinked to original sources
PubMed2006

Specificity and clinical utility of methods for the detection of macroprolactin.

BACKGROUND: Increased serum concentrations of macroprolactin are a relatively common cause of misdiagnosis and mismanagement of hyperprolactinemic patients. METHODS: We studied sera from a cohort of 42 patients whose biochemical hyperprolactinemia was explained entirely by macroprolactin. Using 5 pretreatments, polyethylene glycol (PEG), protein A (PA), protein G (PG), anti-human IgG (anti-hIgG), and ultrafiltration (UF), to deplete macroprolactin from sera before immunoassay, we compared residual prolactin concentrations with monomer concentrations obtained by gel-filtration chromatography (GFC). A monomeric prolactin standard was used to assess recovery and specificity of the pretreatment procedures. RESULTS: Residual prolactin concentrations in all pretreated sera differed significantly (P < 0.001) from monomeric concentrations obtained after GFC. PEG underestimated (mean, 75%), whereas PA, PG, anti-hIgG, and UF overestimated (means, 178%, 151%, 178%, and 112%, respectively) the amount of monomer present. Of the 5 methods examined, PEG correlated best with GFC (r = 0.80) followed by PG (r = 0.78), PA (r = 0.72), anti-hIgG (r = 0.70), and UF (r = 0.61). After UF or pretreatment with anti-hIgG or PEG, recovery of monomeric prolactin standard was low: 60%, 85%, and 77% respectively. In contrast, pretreatment with PA or PG gave almost quantitative recovery. CONCLUSIONS: None of the methods examined yielded results identical to the GFC method. PEG pretreatment yielded results that correlated best and is recommended as the first-choice alternative to GFC.

Chromatography, Gel↗
PubMed2006

Cardiac troponin T circulates in the free, intact form in patients with kidney failure.

BACKGROUND: The clinical significance of the increased concentrations of cardiac troponins observed in patients with end stage renal disease (ESRD) in the absence of an acute coronary syndrome (ACS) is controversial. One proposed explanation is that immunoreactive fragments of cardiac troponin T (cTnT) accumulate in ESRD. We used gel-filtration chromatography (GFC) to ascertain whether fragments of cTnT, which could cross-react in the commercial diagnostic immunoassay (Roche Diagnostics), were the cause of the increased cTnT in the serum of patients with ESRD. METHODS: We subjected sera from ESRD patients (n = 21) receiving dialysis and having increased cTnT concentrations to size-separation GFC. We detected cTnT in the chromatography fractions by use of the same antibodies used in the commercial assay for serum cTnT. RESULTS: In all patients, cTnT immunoreactivity eluted as a major, homogeneous peak in an identical position between the peaks of serum prolactin [relative molecular mass (Mr) 23,000] and albumin (Mr 67,000): the elution pattern of cTnT in samples obtained from ACS patients was identical to that of the ESRD patients. There was no evidence that low-molecular-mass (Mr < 23,000) cTnT fragments were the cause of the increased cTnT in the patients studied. CONCLUSIONS: The form of cTnT observed in the serum of patients with kidney failure and immunoreactive in the diagnostic assay is predominantly the free intact form, as in patients with ACS. Our data are consistent with the view that circulating cTnT in renal failure reflects cardiac pathology.

Chromatography, Gel↗
PubMed2002

Gross variability in the detection of prolactin in sera containing big big prolactin (macroprolactin) by commercial immunoassays.

A high molecular mass form of prolactin (PRL), macroprolactin, accumulates in the sera of some subjects. Although macroprolactin exhibits limited bioactivity in vivo, it retains immunoreactivity. We examined the frequency of macroprolactinemia in clinical practice and the ability of immunoassay systems to distinguish between macroprolactin and monomeric PRL. Of 300 hyperprolactinemic sera identified, 71 normalized following treatment of sera with polyethylene glycol, indicating that 24% of hyperprolactinemia could be accounted for by macroprolactin. Ten of these macroprolactinemic sera were circulated to 18 clinical laboratories. Two sets of PRL measurements of the 10 untreated sera were obtained from each of the nine most commonly used immunoassay systems. Across the nine assay systems, differences in the PRL estimates ranged from 2.3- to 7.8-fold. Elecsys users reported the highest PRL levels. Somewhat lower values were reported for DELFIA systems followed by Immuno-1, AxSYM, and Architect assays. The Immulite 2000 assay generated PRL levels equivalent to approximately 50% of those reported by the high-reading methods. The lowest PRL levels were reported by Access, ACS:180, and Centaur systems. To avoid confusion caused by the frequent presence of macroprolactin accounting for hyperprolactinemia, secondary screening for the presence of macroprolactin is recommended.

Adult↗