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Assessment of the Influence of the Patient's Inflammatory State on The Lassout et al. Clinical Proteomics 2014, 11:38 http://www.clinicalproteomicsjournal.com/content/11/1/38 CLINICAL PROTEOMICS RESEARCH Open Access Assessment of the influence of the patient’s inflammatory state on the accuracy of a haptoglobin selected reaction monitoring assay Olivier Lassout1, Denis Hochstrasser1,2 and Pierre Lescuyer1,2* Abstract Background: The use of targeted LC-MS/MS methods for protein quantitation in clinical laboratories implies a careful evaluation of potential sources of analytical interference. In this study, we investigated whether inflammation, which is associated with both the release of proteolytic enzymes and increased expression of acute phase protease inhibitors, is affecting the accuracy of a haptoglobin selected reaction monitoring (SRM) assay. Results: A SRM assay was developed and used to quantify haptoglobin in 57 human serum samples. The SRM assay had CVs (n = 6) of 12.9% at 698 mg/L and 11.8% at 1690 mg/L. Results of the SRM assay were compared to those of a commercial immunonephelometric test. Passing-Bablok regression gave a proportional bias of 0.92 (95% CI: 0.82 to 1.04) and a constant bias of 75.40 (95% CI: −71.09 to 251.04), indicating that SRM and immunonephelometric assays provided comparable results. We then investigated whether the accuracy of the SRM assay was influenced by the patient’s inflammatory state by assessing the relationship between the serum CRP concentration and the bias between the two methods. No correlation was found between the SRM/immunoassay bias and the CRP concentration (Pearson correlation coefficient r = 0.0898). Conclusions: These data indicate that neither the release of proteolytic enzymes nor the increased level of protease inhibitors occurring during inflammation processes have a significant impact on the haptoglobin SRM assay accuracy. Such studies provide important information about potential sources of analytical interferences in protein SRM assays. Keywords: Inflammation, Haptoglobin, Protease inhibitor, Quantitative proteomics, Selected reaction monitoring, Trypsin digestion Background LC-MS/MS for routine applications by a non-specialized Thanks to the development of instruments and proto- team easier. Third, the availability of commercial reagents, cols, the use in clinical laboratories of liquid chromatog- including HPLC columns, mobile phases, calibrators, and raphy coupled to tandem mass spectrometry (LC-MS/ internal standards, together with dedicated support from MS) is expanding. A combination of factors explains this vendors for clinical applications greatly simplifies the im- trend. First, very high analytical performances (sensitiv- plementation of a new MS assay. All these factors have ity, scan speed) can be achieved with relatively simple contributed to the democratization of the use of LC-MS/ and entry-level instruments, such as ion trap or triple- MS methods in clinical laboratories. Reports from external quadrupole mass spectrometers. Second, improvement quality schemes shows that LC-MS/MS is becoming a of the robustness of LC-MS/MS systems and the develop- major player in some important clinical areas, such as ment of user-friendly software interfaces make the use of therapeutic drug monitoring of immunosuppressants or measurement of 25-OH-vitamin D and steroid hormones. * Correspondence: [email protected] It is noteworthy that MS protein assays do not yet fol- 1Department of Genetic and Laboratory Medicine, Geneva University low this trend despite an indubitable and sustained Hospitals, Geneva, Switzerland 2Department of Human Protein Sciences, Faculty of Medicine, Geneva interest from the clinical chemistry community [1,2]. University, Geneva, Switzerland MS assays may indeed provide a number of advantages © 2014 Lassout et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Lassout et al. Clinical Proteomics 2014, 11:38 Page 2 of 7 http://www.clinicalproteomicsjournal.com/content/11/1/38 over immunoassays, which are classically used for pro- accuracy of SRM-based protein quantification, we devel- tein quantification in clinical laboratories, particularly in oped a SRM assay for the quantification of serum hapto- terms of multiplexing capabilities and analytical specifi- globin. Haptoglobin is a protein routinely measured in city. Hoofnagle and Werner have thus described differ- laboratory medicine, in particular for the detection of ent situations where immunoassay limitations could be hemolytic anemia [19]. This SRM assay was then com- overcame by the use of MS. This includes the lack of pared to a commercial immunonephelometric test used inter-assays standardization due to the use of different as reference quantification method. Finally, we determined antibodies recognizing different epitopes and the analyt- whether the serum C reactive protein (CRP) concentra- ical interferences related to the presence of autoanti- tion, a marker of the inflammatory state [20], had an im- bodies or anti-reagent antibodies in patients’ serum [3]. pact on the haptoglobin SRM assay inaccuracy, which was Moreover, numerous selected reaction monitoring defined as the bias between the LC-MS/MS and the (SRM) protein assays have been developed for the quan- immunonephelometric methods. tification of proteins of clinical interest in serum or urine. Some of these studies included a complete ana- Results and discussion lytical validation and a comparison with a reference Calibration of the haptoglobin SRM assay method to fulfill criteria used in laboratory medicine for Calibration of the SRM assay was performed using the method qualification. The list includes albumin [4,5], commercial haptoglobin standard solution provided for alpha-1-antitrypsin [6], apolipoproteins A1 and B [7], the nephelometric immunoassay. A four points calibra- parathyroid hormone [8,9], thyroglobulin [10,11], and tion was built ranging from 115 mg/L to 1150 mg/L. troponin I [12]. However, at the present time, the appli- Precision of the calibration process was evaluated by cation of these methods in a clinical setting, if any, is re- comparing data from three independent calibrations stricted to one or a few laboratories. One reason is (different trypsin digestion) performed on the same day. probably the complexity of the workflow used for sample Calibration curves are presented in Figure 1A. CVs of preparation, involving trypsin digestion and, often, an peak area ratios obtained for the different calibration immunoaffinity step for target peptide enrichment points ranged from 6.5 to 7.8%. Two additional calibra- [8-12]. The ability to run such assays on a routine basis tions were performed on two different days (Figure 1B). remains then restricted to a few specialized laboratories When including intra-day and inter-days five calibration with dedicated instruments and team. In addition, these data, the overall CVs of peak area ratios obtained for the SRM protein assays have their own specific problems in different calibration points ranged from 6.4 to 17%. The term of analytical interferences. Trypsin digestion, in highest CV was obtained for the lowest concentration of particular, was shown to be a major factor of analytical the calibration curve. These data demonstrated the re- imprecision [13]. Peptidase activities present in bio- producibility of the calibration process both intra- and logical samples may also be a source of analytical errors inter-days. by degrading peptides generated from the target protein or heavy isotope-labeled peptides used as internal refer- Haptoglobin quantification with the SRM assay ence standards [14,15]. Therefore, the biological and Haptoglobin concentration was measured by SRM in technical factors that can impact the performances of serum samples from 57 patients in two independent SRM protein assays must be carefully assessed before series. Two control sera were analyzed in triplicate in considering applying such methods in routine clinical each series. CVs obtained (n = 6) were 12.9% at 698 mg/ practice. L for the N Protein Control SL Low (target value: According to what has been shown regarding the crit- 650 mg/L) and 11.8% at 1690 mg/L for the N Protein ical influence of trypsin digestion and peptide stability Control SL high (target value: 1740 mg/L). All results on SRM protein assay performances, inflammation, from patient samples were within the measuring range, which is present in a wide range of disease states, repre- except two sera with a haptoglobin concentration above sent a particular concern in terms of analytical interfer- 4600 mg/L and five samples with a concentration below ences. Inflammation is indeed associated first with the 115 mg/L. Results are listed in Additional file 1. release of various proteolytic enzymes [16] that may affect protein and peptide stability in serum samples. Comparison with the immunonephelometric assay Second, inflammation is associated with an increased ex- Results from the SRM assay were compared with data of pression of acute phase proteins with antitrypsin activities, the commercial nephelometric immunoassay obtained such as alpha-1-antitrypsin
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