Annayya R. Aroor

Serum immunoglobulins in brain tumours.

SummaryImmunoglobulin level in the sera of 62 patients with intracranial space occupying lesions was assayed using the radial immunodiffusion method. Serum IgM levels showed a highly significant increase in all types of brain tumour when compared to controls. Serum IgG levels were also increased in benign as well as malignant cases. Serum IgA levels were high only in benign cases. Hence, increased serum Ig levels may be of prognostic value in these cases.

Serum Apolipoproteins A and B, Lecithin: Cholesterol Acyl Transferase Activities and Urinary Cholesterol Levels in Nephrotic Syndrome Patients before and during Steroid Treatment

Serum apolipoproteins A (Apo-A) and B (Apo-B) and lecithin: cholesterol acyl transferase (LCAT) activities and 24-hour urinary cholesterol levels were estimated in 25 nephrotic children before and during steroid treatment with 4 weeks of daily prednisolone followed by another 4 weeks of alternate-day prednisolone. The patients with untreated nephrotic syndrome (NS) showed significant decrease in serum Apo-A and LCAT activities associated with significant increase in serum Apo-B and urinary cholesterol levels compared to healthy controls (n = 25). Serum Apo-A levels correlated directly and Apo-B levels inversely with the serum albumin concentrations. After a transient elevation, the serum Apo-A level returned to control range by 8 weeks of treatment accompanied by a gradual increase in serum LCAT activity and decrease in urinary cholesterol excretion. Though, the serum Apo-B level was decreased with treatment, it was still significantly high compared to the controls.

Diagnostic significance of estimation of serum apolipoprotein A along with α-fetoprotein in alcoholic cirrhosis and hepatocellular carcinoma patients

The serum apolipoprotein A (Apo A) and alpha-fetoprotein (AFP) were evaluated in histologically verified 30 cases of alcoholic cirrhosis and 18 cases of hepatocellular carcinoma (HCC). The latter were also divided into subgroups depending on the presence or absence of associated cirrhosis. Serum Apo A levels were found to be significantly decreased in cirrhotics (p less than 0.001) compared to controls and non-cirrhotic HCC patients. In 22 cases of alcoholic cirrhosis (AFP less than 10 ng/ml) and 12 cases of HCC (AFP greater than 600 ng/ml), the AFP levels itself were diagnostic, but in the remaining cases, AFP levels (100-600 ng/ml) were not able to differentiate between cirrhosis and malignancy. In this later group of patients with low pathological range of AFP, serum Apo A levels found to be significantly decreased in alcoholic cirrhotic patients (p less than 0.001) compared to HCC patients. Thus, estimation of Apo A levels may be helpful to interpret the AFP values at lower pathological range due to suspected liver pathology.

Urinary Excretion of 6-Hydroxymethylpterin in Brain Tumours

The urinary 6-hydroxymethylpterin(Pt-6-CH2OH) excretion was determined in 87 patients with brain tumours and in 50 control patients. The Pt-6-CH2OH levels were significantly elevated in all patients with tumours. No difference was observed when malignant tumours were compared with benign neoplasms. Following therapy, the Pt-6-CH2OH levels were partially reduced when compared with control patients and their pre-operative values.

Serum apoproteins A and B and the lecithin: cholesterol acyl transferase activities in liver cirrhosis and hepatic coma patients

Serum apoproteins A and B and LCAT activities were estimated in 80 patients, 46 with posthepatic cirrhosis and 34 with alcoholic cirrhosis. The cirrhosis patients were also divided into compensated, decompensated, and hepatic coma subgroups. Apo-A and LCAT activities were significantly decreased in both cirrhotic groups without any significant difference between posthepatitic and alcoholic cirrhotic groups, while Apo-B was decreased in hepatic coma patients only. The decompensated cirrhosis patients showed lower Apo-A levels than the compensated cirrhosis patients and hepatic coma patients showed still lower levels compared to decompensated subgroup, while no significant decrease was observed in LCAT activities between compensated and decompensated cirrhosis patients. Apo-A level was correlated more significantly with serum albumin level than the LCAT activity. The study confirms that Apo-A level is highly related to the degree of liver injury and also suggests that this decrease may be mainly due to impaired liver synthesis and that the serum levels of Apo-A and Apo-B can be utilized in the differential diagnosis of chronic liver diseases.

Elevation of serum ceruloplasmin levels in brain tumours

Serum ceruloplasmin levels have been estimated in 80 patients with various intracranial space occupying lesions and in 30 controls. The ceruloplasmin levels were significantly increased in all brain tumours except in meningiomas. After therapy, the ceruloplasmin levels were still significantly increased when compared to controls and their respective preoperative values. However, the rise in levels of ceruloplasmin in malignant tumours compared to benign was statistically not significant. It is concluded that ceruloplasmin may have a role to play as an acute phase reactant protein in brain tumours.

Serum adenosine deaminase activity in brain tumours

SummaryAdenosine deaminase (ADA) activity in serum was estimated in 86 patients with intracranial tumours and 40 healthy volunteers. Although high ADA concentrations in biological fluids and tumour tissues were observed in several neoplastic conditions, there was no significant difference in the ADA in sera of brain tumour patients when compared to the control values. Therefore, cell-mediated immunity probably does not play a significant role in brain tumours.

Circulating Immune Complexes in Intracranial Neoplasms

SummaryThe levels of circulating immune complexes (CIC) were assayed in the sera of 109 patients with intracranial space occupying lesions. The CIC levels were significantly increased in all the brain tumours. After treatment, the CIC levels were still significantly increased when compared to the controls but showed no change when compared to their respective pre-operative values. Further, no change was observed in the CIC levels between the malignant and benign tumour case. Moreover, in brain tumours, 90% of the CIC precipitate consisted of IgG. However, the CIC levels fail to prognosticate the process of the disease in these patients.

Effect of cigarette smoking on serum lipid, lipoprotein and apolipoprotein levels in hypertensives receiving β-adrenoreceptor blocking drugs

Both cigarette smoking and propranolol administration significantly alter plasma lipid profile. We examined the relationship of cigarette smoking and propranolol administration with fasting serum total cholesterol, triglyceride, lipoprotein cholesterol subfractions (high density, low density, and very low density), Apo-A, Apo-B and ratios obtained from these variables in 42 hypertensive patients. Significantly lower values of HDL cholesterol, Apo-A and HDL-C/total cholesterol and Apo-A/Apo-B ratios were observed in smokers taking propranolol than non-smokers not taking propranolol. Smokers who were not on propranolol also had significantly lower values as compared to non-smokers. These findings suggest that smoking may be the more significant factor responsible for alteration in lipid profile.

Clinical utility of estimation of serum apolipoproteins A and B in patients with chronic liver disease

The liver obviously has a central role in human lipoprotein metaboKsm (1-8). Apolipoprotein-A (Apo-A, Apo A-I + Apo A-II), the major apoprotein of high density lipoproteins (HDL) (9, 10) and Apolipoprotein-B (Apo-B), the major apoprotein of low density lipoproteins (LDL) (11, 12) are partially synthesized by liver cells (13-15). Apart from being important structural components of HDL and LDL, the Apo A-I also functions as the activator for lecithin: cholesterol acyl transferase (LCAT) (16, 17), a plasma enzyme c, atalysing the conversion of nascent HDL to mature HDL (18, 19) whereas Apo A-II acts as an inhibitor for LCAT (17) and Apo-B plays an important role in regulating cholesterol synthesis and degradation (20-22). Due to several extensive epidemiological studies, interest has focused in recent years on the relationship between coronary artery disease (CAD) and plasma levels of lipoproteincholesterol subfractions, Apo-A and Apo-B (23, 24). However, ~he recognition of an association between alcohol intake and CAD (25-28) has prompted several authors to study the alcohol induced hepatic changes leading to alterations in serum lipids and lipoproteins (29-33) and many studies have also report e fl altered serum Apo-A or Apo A-I (Apo-A/A-I) and Apo-B levels in various liver diseases (34-42). However, on reevaluating the results observed for serum Apo-A/A-I and Apo-B levels in various liver diseases, it becomes apparent that the serum ApoA/A-I and Apo-B levels can also be utilized for solving various clinical and biochemical problems pertaining to liver pathology. This review article tries tff highlight this new in~eresting role of serum Apo-A/A-I and Apo-B levels in the field of diagnostic hepatology and to suggest some of the future research work that can be carried out in this field.