Level of Pyrethroid-resistance Associated with Cytochrome P450 Expression in German Cockroach Blattella germanica (Blattodea: Ectobiidae) in the Field Collected Strains

Background: Cytochrome P450-dependent monooxygenases are a very important metabolic system involve in insecti­cide resistance. This study was conducted to find the association between the expression level of cytochrome P450 (CYP450) and permethrin-resistance level among four strains of the German cockroach Blattella germanica (L) (Blat­todea: Ectobiidae). Methods: Three field strains of German cockroach with different frequency of exposure to pesticides, and a laboratory susceptible strain were used in the present study. Insecticide susceptibility bioassays were carried out to detect re­sistance to permethrin. The concentration of CYP450 in each strain was determined using ion-exchange HPLC chroma­tography. Biochemical assays was performed to analyse CYP450 activities. Results: The resistance ratios (RR) to permethrin among three field strains were 3.29, 4.10 and 6.17-fold comping with the susceptible stain. The CYP450 activity of three field strains was 1.6, 2.4 and 2.7 times higher than in the sus­ceptible stain. The amount of CYP450 per mg of protein was significantly different between the susceptible and the three re­sistant strains. The resistant cockroaches showed a relatively high expression of CYP450 enzymes. A strong corre­la­tion was found between permethrin resistance level and total concentration of CYP450 enzymes. Conclusion: The results of current study show that more frequent usage of a pyrethroid insecticide cause the metabolic insecticide resistance to rise in German cockroach. Therefore, there is a ratio correlation between resistance level and monooxygenases activities in insect. Thus, the control program must be managed according to history of pesticide us­age.

Lot variation and inter-device differences contribute to poor analytical performance of the DCA Vantage™ HbA1c POCT instrument in a true clinical setting

Objectives The glycated haemoglobin fraction A1c (HbA1c) is widely used in the management of diabetes mellitus, and the Siemens DCA Vantage™ point-of-care testing (POCT) instrument offers rapid HbA1c results even far from a clinical laboratory. However, the analytical performance has been questioned, and not much is known about effects of changing reagent lot, instrument and operator. We therefore compared the analytical performance of the DCA Vantage™ with established routine methods (Tosoh G8/G11 ion exchange HPLC) in a true clinical setting at two Danish hospitals. Methods We extracted all routine clinical HbA1c results incidentally drawn from the same patient within 48 h (n=960 pairs) and evaluated the effect of reagent lot, operator and instrument. We also performed a prospective method comparison in our diabetes out-patient clinic (n=97). Results The critical difference (CD) between two POCT results varied between 5.14 and 6.61 mmol/mol (0.47–0.55%), and the analytical imprecision of the DCA Vantage™ (CVA) was >3%. Significant effect of reagent lot and inter-instrument differences were found, whereas no effect of operator was seen. Conclusions The DCA Vantage™ HbA1c analysis does not fulfil the prevailing analytical performance specifications, but rigorous validation of new reagent lots and continuous recalibration of instruments may potentially improve the precision substantially. Our findings, therefore, clearly emphasise the necessity of a close collaboration between clinicians and laboratory professionals in the POCT field. Finally, POCT HbA1c results should always be interpreted together with other measures of glycaemic control to avoid inappropriate change of patient treatments due to measurement uncertainty.

Evaluation of an Ion-Exchange HPLC Device for HbA1c Measurement

Background The ADAMS™ HA-8180V is the 8th generation of a fully automated ion-exchange HPLC system from ARKRAY, and the first to be released onto the US market. We evaluated the HA-8180V, for routine hemoglobin A1c measurement in comparison with the Roche Cobas c501, the Tosoh G8 analyzer for normal hemoglobin, and with the Trinity analyzer for hemoglobin variants. Methods The analytical performance (linearity, precision, carryover, and sample stability) was assessed based on the Clinical and Laboratory Standards Institute (CLSI) and manufacturer guidelines. A comparison of the HA-8180V against two major analytical methods was performed for 100 whole blood samples. HA-8180V variant mode was also compared against the Trinity ultra2 A1c analyzer for 50 samples containing hemoglobin variants (HbC 14, HbS 14, HbD 12, and HbE 10). Results The within-run and total CVs were <0.01 and 0.75% at low HbA1c concentration and 0.46 and 0.63% at high HbA1c concentration, respectively. Linearity was shown in the concentration range 3.4–18.1% HbA1c, carryover was 0.00%, and stability values were excellent. Method comparison demonstrated a high concordance between methods. Conclusion The eighth generation ADAMS HA-8180V A1c analyzer demonstrated high analytical performance adequate for routine clinical use.

Trueness assessment of HbA1c routine assays: are processed EQA materials up to the job?

Background With the worldwide increase of diabetes mellitus prevalence, ensuring that HbA1c assays are accurate is essential. External quality assessment (EQA) programs enable laboratories to verify that analytical methods perform according to the manufacturers’ specifications. However, assessing trueness requires commutable materials, a property that is rarely characterized for EQA materials. Methods The difference in bias approach was used to assess commutability of 26 processed quality control materials for 17 of the most frequently used HbA1c assays. Involved assays included immuno-assays, enzymatic assays, affinity, ion-exchange HPLC boronate affinity HPLC and capillary electrophoresis. The measurements were performed at manufacturers or expert laboratories. Assay trueness was additionally assessed against the IFCC reference measurement procedure using fresh clinical specimens that were distributed to 450 medical laboratories. Results Commutability of processed EQA materials was highly heterogeneous and globally insufficient to rigorously assess the trueness of HbA1c assays. Using fresh clinical specimens, mean bias was −0.13 mmol/mol for low HbA1c (34 mmol/mol), between +1.0 and +1.3 mmol/mol for intermediate HbA1c (49 and 58 mmol/mol) and +1.2 mmol/mol for elevated HbA1c (90 mmol/mol). Conclusions This study demonstrates that due to insufficient commutability, most processed EQA materials are unsuitable to assess trueness of HbA1c assays and agreement between the different assays. These materials can only provide information on comparability of individual laboratory results with its peers and on assay precision. Using fresh whole blood samples, this study additionally shows that most HbA1c assays are fairly accurate and meet the total allowable error quality target of 5 mmol/mol.

DIFFERENCE IN GLICATED HEMOGLOBIN LEVEL BETWEEN BORONATE AFFINITY METHOD AND ION EXCHANGE-HIGH PERFORMANCE LIQUID CHROMATOGRAPHY METHOD IN TYPE 2 DIABETES MELLITUS

Background: Glycated Hb (HbA1c) test is needed to control glycemic in high prevalence type 2 diabetes mellitus (DM) patients. Hemoglobin fraction separated and chemical reaction are two main concepts in HbA1c test. Ion exchange-high performance liquid chromatography (HPLC) and boronate affinity use first concept. Ion exchange-HPLC is reference method in most of clinical laboratorium. Point of care testing (POCT) with boronate affinity method that has been standardized by international institution is available. The aim of this study was to compare boronate affinity POCT method and ion exchange-HPLC method.Method: This cross sectional study was conducted to 22 type 2 DM patients those fullfill inclusion and exclusion criteria in January 2017 to February 2018. Level of HbA1c was assayed with boronate affinity POCT and ion exchange-HPLC method. T-test was used to analyse data and no significance difference if p>0.005Results: Subjects of this study are women (59.1%) more than men (40.9%) with age mean 59.23 years old (8.1). Uncontroled type 2 DM (77.3%) more than controled type 2 DM (22.7%).Mean of HbA1 level was 8.0% (1.7) in boronate affinity POCT and 8.3% (1.8) in ion exchange-HPLC. T-test showed no significance difference between those two HbA1C assay methods (p>0.005).Conclusion: There was no difference HbA1c level between boronate affinity POCT method and ion exchange-HPLC method.

False measurement of glycated hemoglobin in patients without hemoglobin A

Background: Hemoglobin (Hb) A1c, a biochemical marker widely used in monitoring diabetes mellitus, can be quantitatively measured by various examining systems. However, significant errors still exist. In the present study, we evaluated the HbA1c level in five patients with compound heterozygotes by five different examining systems and our goal is to identify the existence of erroneous HbA1c measurement. Methods: Blood samples collected from normal (no hemoglobin variants) and abnormal (compound heterozygotes) patients were analyzed by capillary electrophoresis technique and sequence analysis. The samples without HbA expression via above methods were further analyzed for HbA1c by ion exchange HPLC Variant II/ Variant II Turbo 2.0 (VII and VII-T 2.0), boronate affinity HPLC, capillary electrophoresis, and Tinaquant immunoassay. Results: HbA1c expression were unexpectedly detected in the compound heterozygous samples by using additional examining systems: The HPLC VII and VII-T 2.0 detected HbA1c expression in two of five samples and failed to detect the abnormal HbA2 expression; the CE system detected HbA1c expression in one of five samples with abnormal HbA2 expression; the Ultra2 and PPI system detected the HbA1c expression of all samples without abnormal HbA2. Conclusions: Five human samples without HbA expression were additionally detected with HbA1c expression with or without abnormal HbA2 expression by five analysis systems and the different examining assay potentially affected the test results. These results demonstrated that the limitations of current examining systems for monitoring patients with hemoglobin disorders highlighting the further improvement in the method of clinical HbA examination.

Hb Palencia: a novel δβδ-type two-way fusion variant with β-globin-like expression levels

AimsFusion proteins of unequal recombination events at the β-globin locus have pathological effect. The haemoglobin (Hb) variants of type Lepore are fusion proteins characterised by β-like globin chains with a δ-globin (HBD) N-terminus and a β-globin (HBB) C-terminus, whereas reciprocal products of underlying crossover events hold a HBB N-terminus and HBD C-terminus instead. Finally, Hb Parchman contains a β-like globin chain with a central HBB fragment and HBD-derived N-termini and C-termini, whereas reciprocal hybrid proteins are as yet unknown.MethodsThe propositus was an 80-year-old Caucasian man, whose HbA1c quantification by HPLC (Variant II turbo) for exclusion of type-2 diabetes revealed an abnormal peak. Haemoglobins were analysed by ion-exchange HPLC (Variant II) and capillary electrophoresis (Sebia Capillarys Flex) and DNA by automatic Sanger sequencing of δ-globin and β-globin genes.ResultsSequencing showed an HBB-HBD-HBB hybrid gene, with HBD-derived central codons 9–31, and HBB-derived UTRs and complementary coding regions. The corresponding new hybrid haemoglobin (Hb Palencia) is represented at ≈40%, similar to HbA.ConclusionHb Palencia contains the first globin variant with internal HBD sequences and HBB-derived N-terminal and C-terminal and regulatory sequences. Relative quantity of the new βδβ-type variant suggests transcriptional control by HBB elements and a half-life similar to normal HBB.

Heterozygote Hemoglobin G-Coushatta as the Cause of a Falsely Decreased Hemoglobin A1C in an Ion-Exchange HPLC Method

SummaryGlycated hemoglobin (HbA1c) is used for the assessment of glycemic control in patients with diabetes. The presence of genetic variants of hemoglobin can profoundly affect the accuracy of HbA1c measurement. Here, we report two cases of Hemoglobin G-Coushatta (HBB:c.68A>C) variant that interferes in the measurement of HbA1c by a cation-exchange HPLC (CE-HPLC) method. HbA1c was measured by a CE-HPLC method in a Tosoh HLC-723 G7 instrument. The HbA1c levels were 2.9% and 4%. These results alerted us to a possible presence of hemoglobinopathy. In the hemoglobin variant analysis, HbA2 levels were detected as 78.3% and 40.7% by HPLC using the short program for the Biorad Variant II. HbA1c levels were measured by an immunoturbidimetric assay in a Siemens Dimension instrument. HbA1c levels were reported as 5.5% and 5.3%. DNA mutation analysis was performed to detect the abnormal hemoglobin variant. Presence of Hemoglobin G-Coushatta variant was detected in the patients. The Hb G-Coushatta variants have an impact on the determination of glycated hemoglobin levels using CEHPLC resulting in a false low value. Therefore, it is necessary to use another measurement method.