牛心肌钙蛋白T的纯化

以小牛心肌为原料,用匀浆提取、热处理、硫酸铵沉淀、ＤＥＡＥ—纤维素柱层析纯化了牛心肌钙蛋白Ｔ（ｃＴｎＴ）。纯化的蛋白在ＳＤＳ—聚丙烯酰胺凝胶电泳上为一条带,分子量为３７,０００道尔顿。用ＴｒｏｐｏｎｉｎＴ快速半定量试纸条测定该蛋白,呈现强阳性反应。这说明我们纯化的蛋白为牛心肌钙蛋白Ｔ。     

HER2基因组DNA标准物质互通性研究

采用实验室建立的数字PCR方法 (ddPCR)和荧光定量PCR (qPCR)方法研究HER2基因组DNA标准物质的互通性,评价HER2基因组DNA标准物质与临床样本的互通性,为临床实验室检测提供具有互通性的可溯源标准物质.将研制的5个水平标准物质随机穿插于29例临床样本间,使用ddPCR方法与qPCR方法同时进行检测.参考美国临床实验室标准化协会(CLSI)指南文件EP30和中华人民共和国卫生行业标准基质效应与互通性评估指南WS/T356-2011的推荐,采用Deming回归法评价标准物质的互通性.结果显示,5种标准物质与临床样本之间具有良好的互通性,可以用于临床实验室对HER2基因拷贝数变异检测方法的方法验证和质量控制.     

International External Quality Assessment Study for Molecular Detection of Lassa Virus

Lassa virus (LASV) is a causative agent of hemorrhagic fever in West Africa. In recent years, it has been imported several times to Europe and North America. The method of choice for early detection of LASV in blood is RT-PCR. Therefore, the European Network for Diagnostics of ‘Imported’ Viral Diseases (ENIVD) performed an external quality assessment (EQA) study for molecular detection of LASV. A proficiency panel of 13 samples containing various concentrations of inactivated LASV strains Josiah, Lib-1580/121, CSF, or AV was prepared. Samples containing the LASV-related lymphocytic choriomeningitis virus (LCMV) and negative sera were included as specificity controls. Twenty-four laboratories from 17 countries (13 European, one African, one Asian, two American countries) participated in the study. Thirteen laboratories (54%) reported correct results, 4 (17%) laboratories reported 1 to 2 false-negative results, and 7 (29%) laboratories reported 3 to 5 false-negative results. This EQA study indicates that most participating laboratories have a good or acceptable performance in molecular detection of LASV. However, several laboratories need to review and improve their diagnostic procedures.     

Results of the National External Quality Assessment for Toxoplasmosis Serological Testing in China

Background

Toxoplasmosis is typically diagnosed by serologic testing. External quality assessment (EQA) of clinical laboratories could ensure the accuracy and reliability of serological tests. We assessed the quality of toxoplasma serological assays in Chinese clinical laboratories by an EQA performed between 2004 and 2013 by the National Center for Clinical Laboratories.

Methodology and Findings

EQA panels were prepared and shipped at room temperature to participating laboratories that employed toxoplasma IgG and IgM serological detection. By 2013, 5,384 EQA test reports for toxoplasma-specific IgM and 2,666 reports for toxoplasma-specific IgG were collected. Enzyme-linked immunosorbent (ELISA) and chemical immunofluorescent assays were the most commonly used detection methods. The overall coincidence rates of negative samples were better than those of positive samples. The overall EQA score for toxoplasma-specific IgM detection ranged between 84.3% and 99.6%. The ratio of laboratories that achieved correct IgG detection ranged from 61.1% to 99.3%. However, the inter- and intra-assay variabilities were found to be considerable. The most common problem was failure to detect low titers of antibody.

Conclusion

The EQA scheme showed an improvement in toxoplasma serological testing in China. However, further optimization of assay sensitivity to detect challenging samples remains a future challenge.     

临床检验前阶段室间质量评价方案的设计

在检验医学领域中,有很多研究已描述检验全过程不同阶段出现的最频繁的差错,且这些差错的很大部分都出现在检验前阶段。检验中阶段的误差登记然后反馈给参加者的方案已经由室间质评（External Quality Assessment,EQA）组织在大多数国家进行了数十年。但是迄今为止,只有很少的组织专注于检验前阶段,而且大多数的EQA组织并不提供检验前EQA方案（External Quality Assessment Schemes,EQAS）。执行和标准化检验前EQAS是比较困难的,认可机构也并没有对实验室参加这类方案提出要求。然而,一些正在进行的检验前阶段EQA计划是存在的,使用的方法可以分为三种类型：收集实验室检验前程序的信息、发放真实样品来收集可能影响测量程序的干扰因素、或者登记真实的实验室差错并将这些内容关联到质量指标。这三个类型有不同的侧重点和不同的实施挑战,这三者的结合可能是检出和监视出现在检验前阶段的广泛差错所必须的。     

External Quality Assessment of Molecular Detection of Ebola Virus in China

In 2014, Ebola hemorrhagic fever broke out in West Africa. As contact between China and West Africa is frequent, the possibility that Ebola virus would enter China was high. Thus, an external assessment of the quality of Ebola virus detection was organized by the National Center for Clinical Laboratories in China. Virus-like particles encapsulating known sequences of epidemic strains of Ebola virus from 2014 were prepared as positive quality controls. The sample panel, which was composed of seven positive and three negative samples, was dispatched to 19 laboratories participating in this assessment of Ebola virus detection. Accurate detection was reported at 14 of the 19 participating laboratories, with a sensitivity of 91.43% and a specificity of 100%. Four participants (21.05%) reported false-negative results and were classified as “acceptable.” One participant (5.26%) did not detect any positive samples and was thus classified as “improvable.” Based on the results returned, the ability to detect weakly positive Ebola specimens should be improved. Furthermore, commercial assays and the standard primers offered by the Chinese Centers for Disease Control and Prevention were found to be most accurate and dependable for Ebola detection. A two-target detection approach is recommended for Ebola screening; this approach could reduce the probability of false-negative results. Additionally, standardization of operations and punctual adjustment of instruments are necessary for the control and prevention of Ebola virus.     

Removal of the Cardiac Troponin I N-terminal Extension Improves Cardiac Function in Aged Mice

The cardiac troponin I (cTnI) isoform contains a unique N-terminal extension that functions to modulate activation of cardiac myofilaments. During cardiac remodeling restricted proteolysis of cTnI removes this cardiac specific N-terminal modulatory extension to alter myofilament regulation. We have demonstrated expression of the N-terminal-deleted cTnI (cTnI-ND) in the heart decreased the development of the cardiomyopathy like phenotype in a β-adrenergic-deficient transgenic mouse model. To investigate the potential beneficial effects of cTnI-ND on the development of naturally occurring cardiac dysfunction, we measured the hemodynamic and biochemical effects of cTnI-ND transgenic expression in the aged heart. Echocardiographic measurements demonstrate cTnI-ND transgenic mice exhibit increased systolic and diastolic functions at 16 months of age compared with age-matched controls. This improvement likely results from decreased Ca²⁺ sensitivity and increased cross-bridge kinetics as observed in skinned papillary bundles from young transgenic mice prior to the effects of aging. Hearts of cTnI-ND transgenic mice further exhibited decreased β myosin heavy chain expression compared to age matched non-transgenic mice as well as altered cTnI phosphorylation. Finally, we demonstrated cTnI-ND expressed in the heart is not phosphorylated indicating the cTnI N-terminal is necessary for the higher level phosphorylation of cTnI. Taken together, our data suggest the regulated proteolysis of cTnI during cardiac stress to remove the unique cardiac N-terminal extension functions to improve cardiac contractility at the myofilament level and improve overall cardiac function.     

Ala Scanning of the Inhibitory Region of Cardiac Troponin I

In skeletal and cardiac muscles, troponin (Tn), which resides on the thin filament, senses a change in intracellular Ca²⁺ concentration. Tn is composed of TnC, TnI, and TnT. Ca²⁺ binding to the regulatory domain of TnC removes the inhibitory effect by TnI on the contraction. The inhibitory region of cardiac TnI spans from residue 138 to 149. Upon Ca²⁺ activation, the inhibitory region is believed to be released from actin, thus triggering actin-activation of myosin ATPase. In this study, we created a series of Ala-substitution mutants of cTnI to delineate the functional contribution of each amino acid in the inhibitory region to myofilament regulation. We found that most of the point mutations in the inhibitory region reduced the ATPase activity in the presence of Ca²⁺, which suggests the same region also acts as an activator of the ATPase. The thin filaments can also be activated by strong myosin head (S1)-actin interactions. The binding of N-ethylmaleimide-treated myosin subfragment 1 (NEM-S1) to actin filaments mimics such strong interactions. Interestingly, in the absence of Ca²⁺ NEM-S1-induced activation of S1 ATPase was significantly less with the thin filaments containing TnI(T144A) than that with the wild-type TnI. However, in the presence of Ca²⁺, there was little difference in the activation of ATPase activity between these preparations.Striated muscle thin filaments exist in equilibrium among multiple states. Ca²⁺ binding to the regulatory domain of troponin C (TnC)² along the thin filaments and strong cross-bridge interactions with thick filaments are thought to shift the equilibrium. Ca²⁺ binds to the regulatory domain of TnC, which regulates the interaction of troponin I (TnI) with actin-tropomyosin (Tm) and TnC (1–3). In the thin filaments, the inhibitory region of TnI (residues 104–115 of rabbit fast skeletal TnI (fsTnI) or 138–149 of mouse cardiac TnI (cTnI)) undergoes a structural transition depending on the Ca²⁺ state of TnC (4, 5). In the absence of Ca²⁺ at the regulatory site(s) of TnC, the inhibitory region interacts with actin to prevent activation of myosin ATPase activity. When Ca²⁺ binds to the regulatory site(s) of TnC, the switch region of TnI, which is located at the C terminus of the inhibitory region, interacts with the newly exposed hydrophobic patch of the N-terminal regulatory domain of TnC (6–8). This interaction causes the removal of the inhibitory region and the second actin-Tm binding region of TnI from the actin surface and allows actin to interact with myosin. In the presence of Ca²⁺ at the regulatory sites of TnC, the inhibitory region and the central helical region of TnC are mutually stabilized, according to the recent x-ray crystal structure of the core domain of the fsTn complex (9). The sequence variations in the N-terminal and the C-terminal regions of TnT, another component of the Tn complex, are known to alter the Ca²⁺ sensitivity of myofilament activity (10, 11). In addition, TnT is involved in the Ca²⁺-dependent interaction of the Tn complex with actin-Tm (12). However, the molecular mechanism whereby TnT participates in the Ca²⁺ regulation has not been established.There is evidence supporting the idea that each amino acid residue in the inhibitory region of TnI contributes differently and to a different degree to myofilament activities. One example is genetic mutations and phosphorylation of amino acid residues in the inhibitory region of cardiac TnI that cause the modification of myofilament activities. In hypertrophic or restrictive cardiomyopathy-linked mutations found in the inhibitory region, such as R142Q, L145Q, and R146G/Q/W mutations (mouse cTnI sequence number), induce Ca²⁺ sensitization of myofilament activities and an increase in ATPase/tension at low [Ca²⁺] (13, 14). Recently we reported that thin filaments reconstituted with R146G or R146W mutant cTnI bind Ca²⁺ tighter than those with cTnI(wt) (15). The Ca²⁺ sensitization may occur as a result of the destabilization of the off-state of the thin filaments due to the mutation introduced into the actin-Tm-interacting residue, i.e. Arg-146, of cTnI. On the other hand, Thr-144 is phosphorylated by protein kinase C (PKC) specifically, although the consequence of the PKC-dependent phosphorylation of Thr-144 has not yet been clearly defined. Pseudophosphorylation of Thr-144 was shown to cause Ca²⁺ desensitization in in vitro motility assays (16), whereas there is a report that indicates phosphorylation of Thr-144 sensitizes skinned cardiomyocytes to Ca²⁺ (17). Furthermore, Tachampa et al. reported that Thr-144 of cTnI is important for length-dependent activation of skinned cardiac muscle (18). Thus in each case presented above, a specific change in a single amino acid in the inhibitory region of TnI induced different and divergent effects on myofilament activities.Our aim of this study is to assess the functional contributions of the individual amino acid residues in the inhibitory region to the regulatory function. To assess the functional roles of the individual amino acid residues systematically, we used Ala scanning (19, 20). Ala substitution deletes all the interactions made by atoms beyond β-C yet does not alter the peptide backbone conformation, unless it is applied to Gly or Pro. Ala is one of the most abundant amino acids and is found in both buried and exposed positions. We found that almost the entire minimum inhibitory region of cTnI we investigated (Fig. 1) is important for both the inhibition and activation. Our data also indicate that the C-terminal part of the inhibitory region destabilizes the active state of the thin filaments. We also found that Thr-144 is involved in NEM-S1-dependent activation of ATPase activity in the absence of Ca²⁺.Open in a separate windowFIGURE 1.Inhibitory region of TnI. A, sequence comparison of the minimum inhibitory region from various vertebrates. The amino acid residues that are different from fsTnI are colored green in cardiac sequences. Note the amino acid sequence of the inhibitory region is highly conserved. Also the amino acid sequences of the minimum inhibitory region of the mutants we investigated in this study are shown. B, crystal structure of the inhibitory region and its surrounding region in chicken fsTn complex in the Ca²⁺-bound form (PDB: 1YTZ). TnC, pink; TnT, light blue; TnI, gray. The segment, corresponding to residues 143–149 of mouse cTnI, is colored red.     

抗心肌肌钙蛋白T单抗杂交瘤细胞株的建立及鉴定

以牛心肌为原料,提取纯化得牛cTnT,并经特定处理,免疫BALB/C 小鼠,取其脾细胞与SP2/0 融合,获得两株抗cTnT 细胞3B2 和3D6 。Ig 亚类均是IgG1 。相加试验表明可识别不同表位,为建立测定cTnT方法奠定了基础。     

The N-Terminal Extension of Cardiac Troponin T Stabilizes the Blocked State of Cardiac Thin Filament

Cardiac troponin T (cTnT) is a key component of contractile regulatory proteins. cTnT is characterized by a ～32 amino acid N-terminal extension (NTE), the function of which remains unknown. To understand its function, we generated a transgenic (TG) mouse line that expressed a recombinant chimeric cTnT in which the NTE of mouse cTnT was removed by replacing its 1–73 residues with the corresponding 1–41 residues of mouse fast skeletal TnT. Detergent-skinned papillary muscle fibers from non-TG (NTG) and TG mouse hearts were used to measure tension, ATPase activity, Ca²⁺ sensitivity (pCa₅₀) of tension, rate of tension redevelopment, dynamic muscle fiber stiffness, and maximal fiber shortening velocity at sarcomere lengths (SLs) of 1.9 and 2.3 μm. Ca²⁺ sensitivity increased significantly in TG fibers at both short SL (pCa₅₀ of 5.96 vs. 5.62 in NTG fibers) and long SL (pCa₅₀ of 6.10 vs. 5.76 in NTG fibers). Maximal cross-bridge turnover and detachment kinetics were unaltered in TG fibers. Our data suggest that the NTE constrains cardiac thin filament activation such that the transition of the thin filament from the blocked to the closed state becomes less responsive to Ca²⁺. Our finding has implications regarding the effect of tissue- and disease-related changes in cTnT isoforms on cardiac muscle function.     

Clinical Implications of High-Sensitivity Cardiac Troponin Measurements in Hospitalized Medical Patients

Background

The increased use of high sensitivity cardiac troponins (hs-cTn), have made the diagnosis of non-ST elevation myocardial infarction (MI) challenging, especially in complex medical patients, in whom the clinical presentation of MI is nonspecific and multiple comorbidities as well as non-ischemic acute conditions may account for elevated hs-cTn levels. The aim of this study was to assess the frequency of both elevated hs-cTn levels and dynamic changes in hospitalized patients.

Methods and Findings

We conducted a retrospective study identifying all patients hospitalized in the Internal Medicine Division of Rabin Medical Center, Israel between January 2011 to December 2011, for whom at least one hs-cTn T (hs-cTnT) measurement was obtained. Collected data included patient demographics, acute and chronic diagnosis, hs-cTnT and creatinine levels and date of death. Hs-cTnT levels were obtained in 5,696 admissions and was above the 99th percentile (> = 13 ng/L) in 61.6% of the measurements. A relative change of 50% or higher was observed in 24% of the admissions. Among those with elevated hs-cTnT levels, acute coronary syndromes (ACS) accounted for only 6.1% of acute diagnoses. Maximal hs-cTnT levels above 100 ng/L but not dynamic changes discriminated between ACS and non-ACS conditions (positive and negative predictive values of 12% and 96% respectively). The frequency of elevated hs-cTnT levels was age-dependent and over 75% of patients aged >70 years-old had levels above the 99th percentile. Multivariate analysis identified hs-cTnT levels higher than the 99th percentile, as an independent, strong predictor for 30-day mortality (OR 4.58 [2.8, 7.49], p<0.0001).

Conclusions

Elevated hs-cTnT levels together with dynamic changes are frequent findings among hospitalized patients and in most cases, are not related to the ACS diagnosis. These findings highlight the diagnostic challenge of ACS in this complex population. Further studies are needed in order to optimize the use of hs-cTnT measurements in hospitalized patients.     

胰岛素及cAMP对培养人动脉平滑肌细胞HDL受体功能的影响

对胰岛素ｃＡＭＰ对培养人动脉平滑肌细胞（ＳＭＣ）ＨＤＬ受体功能的影响进行了研究,结果发现：胰岛素使ＳＭＣＨＤＬ受体的结合容量Ｂｍａｘ即受体数目显著下降,而对ＳＭＣＨＤＬ受体的Ｋｄ值亲和力无影响;ｃＡＭｐ则ＳＭＣＨＤＬ受体亲和力增加,而对受体数目无影响。     

Molecular Genetics External Quality Assessment Pilot Scheme for Irinotecan-Related UGT1A1 Genotyping in China

Irinotecan is widely used in the treatment of solid tumors, especially in colorectal cancer and lung cancer. Molecular testing for UGT1A1 genotyping is increasingly required in China for optimum irinotecan administration. In order to determine the performance of laboratories with regard to the whole testing process for UGT1A1 to ensure the consistency and accuracy of the test results, the National Center for Clinical Laboratories conducted an external quality assessment program for UGT1A1*28 genotyping in 2015. The panel, which comprised of four known mutational samples and six wild-type samples, was distributed to 45 laboratories that test for the presence of UGT1A1*28 polymorphisms. Participating laboratories were allowed to perform polymorphism analysis by using their routine methods. The accuracy of the genotyping and reporting of results was analyzed. Other information from the individual laboratories, including the number of samples tested each month, accreditation/certification status, and test methodology, was reviewed. Forty-four of the 45 participants reported the correct results for all samples. There was only one genotyping error, with a corresponding analytical sensitivity of 99.44% (179/180 challenges; 95% confidence interval: 96.94−99.99%) and an analytical specificity of 100% (270/270 challenges; 95% confidence interval: 98.64−100%). Both commercial kits and laboratory development tests were commonly used by the laboratories, and pyrosequencing was the main methodology used (n = 26, 57.8%). The style of the written reports showed large variation, and many reports showed a shortage of information. In summary, the first UGT1A1 genotyping external quality assessment result demonstrated that UGT1A1 genotype analysis of good quality was performed in the majority of pharmacogenetic testing centers that were investigated. However, greater education on the reporting of UGT1A1 genetic testing results is needed.     

人心肌肌钙蛋白Ⅰ单克隆抗体及多克隆抗体的制备

目的:以重组人心肌肌钙蛋白Ⅰ(cTnⅠ)为抗原制备鼠源单克隆抗体(McAb)及兔源多克隆抗体,并鉴定抗体的特性。方法:以纯化的重组人cTnⅠ为抗原免疫BALB/c小鼠,取鼠脾细胞同Sp2/0骨髓瘤细胞融合,利用选择培养基筛选融合的杂交瘤细胞,用有限稀释法分离获得能够稳定分泌抗cTnⅠ的McAb阳性克隆,并利用体内诱生法大规模制备McAb,用辛酸-硫酸铵沉淀法纯化抗体;兔多抗制备以cTnⅠ为抗原常规免疫后取其血清;用间接ELISA和Western印迹鉴定抗体的性质。结果:经ELISA鉴定,筛选出5株能分泌cTnⅠMcAb的杂交瘤细胞株,即C5B2、C5B3、C5B4、C5B1、B1A6,效价最高的B1A6株分泌的McAb为IgG3型,纯化后效价为1∶10000,亲和常数为1.08×10-9mol/L,Western印迹鉴定表明cTnⅠMcAb有良好的特异性;兔多抗纯化后的效价为1∶8000。结论:制备了具有良好特性的cTnⅠMcAb和多克隆抗体。     

人心肌肌钙蛋白T的纯化和单克隆抗体的制备

从人左室心肌中成功纯化心肌肌钙蛋白T(cTnT). 经匀浆, 70℃加热处理, 咪唑盐酸透析, DEAE-纤维素层析, 100g心肌获取cTnT 5mg, 纯度为97.6%. 同时采用脾内免疫法, 免疫Balb/C小鼠, 经细胞融合, 筛选, 克隆化得5株稳定分泌抗人cTnT单克隆抗体(McAb)的杂交瘤细胞(G₃, G₈, G₁₀, A₅, A₇), 4株为IgM, 1株为IgG, 染色体数目92～110条. 腹水效价为3.2×10^-6～1. 6×10^-7.     

Construction of a Preclinical Multimodality Phantom Using Tissue-mimicking Materials for Quality Assurance in Tumor Size Measurement

World Health Organization (WHO) and the Response Evaluation Criteria in Solid Tumors (RECIST) working groups advocated standardized criteria for radiologic assessment of solid tumors in response to anti-tumor drug therapy in the 1980s and 1990s, respectively. WHO criteria measure solid tumors in two-dimensions, whereas RECIST measurements use only one-dimension which is considered to be more reproducible ^{1, 2, 3,4,5}. These criteria have been widely used as the only imaging biomarker approved by the United States Food and Drug Administration (FDA) ⁶. In order to measure tumor response to anti-tumor drugs on images with accuracy, therefore, a robust quality assurance (QA) procedures and corresponding QA phantom are needed.To address this need, the authors constructed a preclinical multimodality (for ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI)) phantom using tissue-mimicking (TM) materials based on the limited number of target lesions required by RECIST by revising a Gammex US commercial phantom ⁷. The Appendix in Lee et al. demonstrates the procedures of phantom fabrication ⁷. In this article, all protocols are introduced in a step-by-step fashion beginning with procedures for preparing the silicone molds for casting tumor-simulating test objects in the phantom, followed by preparation of TM materials for multimodality imaging, and finally construction of the preclinical multimodality QA phantom. The primary purpose of this paper is to provide the protocols to allow anyone interested in independently constructing a phantom for their own projects. QA procedures for tumor size measurement, and RECIST, WHO and volume measurement results of test objects made at multiple institutions using this QA phantom are shown in detail in Lee et al. ⁸.