Anti-goat antibodies as a rare cause of high gonadotropin levels during menopausal transition

Abstract

Objective: To understand the origin of extremely high gonadotropin levels in a perimenopausal woman.

Methods: A 52-year-old woman with a 2?months of amenorrhea followed spontaneous menstrual cycles recovery was referred to our outpatient clinic with elevated follicle-stimulating hormone (FSH, 483 mUI/ml), luteinizing hormone (LH, 475 mUI/ml) and prolactin (PRL, 173?ng/ml). She was known to take levosulpiride. The gonadotropin levels did not fit with the clinical features.

Results: A gonadotroph tumor was ruled out. Further analysis confirmed constantly high FSH, LH and PRL levels. The measurements were repeated using different analytical platforms with different results. After serial dilutions, nonlinearity was present suggesting an immunoassay interference. After post-polyethylene glycol recovery, hormone levels appeared in the normal range. Anti-goat antibodies were recognized in the serum of the patient.

Conclusions: This case report shows a case of falsely abnormal high gonadotropin and PRL levels in a woman during menopause transition. In the clinical practice the evaluation of gonadotropin profile is not recommended at this age, but the abnormal levels stimulated further evaluation. An interference in the assay due to anti-goat antibodies resulted in abnormally high level of FSH and LH. A strict collaboration between clinicians and the laboratory is needed, when laboratory findings do not correspond to clinical findings.     

Laser investigation of bilirubin-photobilirubin photoconversion

The reversibility of the configurational photoisomerization process of bilirubin (BR) with laser lines in the blue-green spectral region is investigated. Photoisomerization efficiency of BR is found to depend strongly on wavelength, and to decrease when the excitation wavelength is increased from blue to green. Reversion of BR photoisomers (identical to photobilirubin, PBR) back to native BR is demonstrated for several laser lines by irradiating PBR/BR mixtures with wavelengths greater than the excitation wavelengths. Green lines turn out to be very efficient for PBR----BR reversion. The PBR concentrations at photoequilibrium, obtained from the spectrophotometric data, are in close agreement with the corresponding values measured with the high performance liquid chromatography technique in the case of 10 nm bandwidth filtered light reported in the literature. The 457 nm blue laser line produces 32% PBR concentration at photoequilibrium; only 14, 7, and 3% PBR concentrations are produced by the blue-green lines at 488, 501, 514 nm, respectively. The effect on the photostationary PBR/BR mixture of successive irradiations with different wavelengths, and the influence of the wavelength sequence are reported. In the case of blue lines our results support the assumption of the first-order kinetics for the BR in equilibrium PBR photoreaction. Departures are observed with green-lines (501, 514 nm). The present results, together with the i) good clinical efficiency reported for fluorescent green lamps; and ii) slow elimination of configurational photoisomers in infants, tend to confirm the lumirubin-pathway as the main mechanism for phototherapy, and call for clinical investigation of narrow-spectrum lamps with peak emission wavelength in the (biologically safer) 480 divided by 530 nm range.     

Phototherapy for neonatal jaundice: clinical equivalence of fluorescent green and "special" blue lamps

The relative efficacy of fluorescent green (Sylvania F20T12/G) and "special" blue (Westinghouse F20T12/BB) lamps in the phototherapy of jaundiced neonates was investigated. Two groups of low birth weight infants with a mean gestational age of 35 weeks and mean birth weight of 1930 gm, who developed hyperbilirubinemia within the first 5 days of life, were given green or blue lamp phototherapy under the same irradiation conditions. No statistically significant difference in plasma bilirubin concentrations was found between the two groups after 24 or 48 hours of treatment. Because recent measurements indicate that green lamps are much less efficient than special blue lamps for the production of Z, E isomers of bilirubin in vitro and in vivo, the clinical equivalence of these two types of lamps seems to support the hypothesis that production of structural photoisomers of bilirubin is the main mechanism of phototherapy in humans. Therefore, fluorescent green lamps provide an alternative to special blue lamps for treatment of neonatal hyperbilirubinemia.     

Photochromic and photoresponsive properties of optically active poly(methacrylate)s with pendant L‐leucine,L‐valine and L‐proline residues connected to 4‐aminoazobenzene moieties

The photochromic behaviour of optically active methacrylic polymers containing in the side chains a bulky chiral amino acid residue interposed between the backbone and the azobenzene chromophore through amido groups, such as poly[(S)‐4‐(2‐methacryloylamino‐4‐methylpentanoylamino)azobenzene] [poly(MLEA)], poly[(S)‐4‐(2‐methacryloylamino‐3‐methylbutanoylamino)azobenzene] [poly(MVA)] and poly[(S)‐4‐(N‐methacryloyl‐2‐pyrrolidinoylamino)azobenzene] [poly(MPA)] was investigated in comparison with the corresponding low molecular weight model compounds. The photoresponsive properties of the above polymers were also evaluated by circular dichroism measurements at various extent of photoisomerization and in solvents with different polarity. All the results are discussed in terms of structural requirements of the macromolecules.     

Tangier Disease

Tangier disease is one of the most severe forms of familial high-density lipoprotein (HDL) deficiency. Since its discovery it has been diagnosed in about 100 patients and is characterized by severe plasma deficiency or absence of HDL, apolipoprotein A-I (apoA-I, the major HDL apolipoprotein) and by accumulation of cholesteryl esters in many tissues throughout the body. The biochemical signs of this condition are plasma HDL concentrations less than 5mg/dL, low total plasma cholesterol (below 150mg/dL), and normal or high plasma triglycerides. Tangier disease is caused by mutations in the ‘ATP-Binding Cassette transporter Al’ (ABCA1) gene, which encodes the membrane transporter ABCA1. This transporter plays a key role in the first step of reverse cholesterol transport, through which the efflux of free cholesterol from peripheral cells is transferred to lipid-poor apoA-I. The Tangier disease clinical phenotype is inherited as an autosomal recessive trait, the biochemical phenotype is inherited as an autosomal co-dominant trait. Nearly all the children affected by Tangier disease were identified on the basis of large, yellow-orange tonsils, while half of the adult patients affected by Tangier disease came to medical attention because of symptoms of neuropathy. Diagnosis in the remaining subjects was related to the clinical features of hepatomegaly, splenomegaly, premature myocardial infarction (about 30% of Tangier disease cases) or stroke, thrombo-cytopenia, anemia, gastrointestinal disorders, corneal opacities, hypocholesterolemia, low HDL cholesterol, or following a familial screening of Tangier patients. To date there is no specific treatment for Tangier disease. Old and recently designed drugs, known to increase HDL levels, have been shown to be ineffective in Tangier patients. The possible and more realistic therapeutic strategy should be designed to obtain a selective increase of mature HDL concentration to restore cholesterol efflux. Recently designed drugs like the cholesteryl ester transfer protein (CETP) inhibitors dalcetrapib and anacetrapib and reconstituted forms of HDL could be considered until the development of gene therapy.     

LC characterisation of guaco medicinal extracts, Mikania laevigata and M. glomerata, and their effects on allergic pneumonitis

The leaves of guaco (Mikania glomerata and M. laevigata) are widely used for the treatment of asthma and bronchitis. An LC method for the quantification of coumarin and O-coumaric acid in medicinal extracts was developed and validated for linearity, limit of detection, accuracy, precision, as well as intra- and inter-day variations. Extracts and isolated markers were tested in the mice allergic pneumonitis model and the histopathological profile of the lung tissue was analysed. The values found for coumarin and O-coumaric acid in a fluid extract were 1.53 and 1.69 mg/mL, respectively, for M. glomerata, and 0.96 and 0.38 mg/mL for M. laevigata. The values found for the lyophilised aqueous extract were 0.22 and 0.11 mg/mL of coumarin and O-coumaric acid in M. glomerata and 0.05 and 0.02 mg/mL in M. laevigata, respectively . The analysed samples from the species M. glomerata presented more coumarin and O-coumaric acid than the analogous M. laevigata species. Both coumarin and O-coumaric acid are part of the phytocomplex which is responsible for the therapeutic activity of the guaco species. The lyophilisation process generated some alterations in the extract, in comparison with the fresh aqueous extract, and these extracts did not present anti-inflammatory activity. Comparing the histopathological images of the groups tested, a haemorrhagic profile of lung tissue of animals treated with lyophilised extract, O-coumaric acid and coumarin is observed, but not for the group treated with hydroalcoholic extract. It is probable that some protective effect of the whole extract (lost during the lyophilisation process) blocks the harmful effects of the isolated markers.