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  • 1 Medical and Health Science Center, University of Debrecen Department of Clinical Biochemistry and Molecular Pathology and Clinical Analytical Chemistry PO Box 55 H-4012 Debrecen Hungary
  • 2 San Francisco State University Center for Biomedical Laboratory Science San Francisco CA USA
  • 3 Medical and Health Science Center, University of Debrecen 3rd Department of Internal Medicine Debrecen Hungary
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Background: Serum LD activity is increased in several diseases. The clinical significance of elevated LD may be evaluated by isoenzyme analysis. Here, we report on a long-term elevation of serum LD activity with a rare isoenzyme pattern caused by LD-IgG complexes. Patient, methods: A 75-year old female with atherosclerosis and implantations of two stents showed increased LD activity and an unusual isoenzyme pattern. LD activity, inhibition and immunoglobulins were measured with Roche tests; immunofixation was performed with a Helena test. LD isoenzymes were separated in agarose gel and quantified by the color formed by NADH, reduced phenazine methosulfate and nitro blue tetrazolium. Results: LD isoenzyme analyses revealed one band near the slowly migrating LD-4 position. The band contained LD complexed with immunoglobulins (IgG with κ light chains), The long-term increased serum LD enzyme activity in this patient may have been due to abnormally slow clearance of these large macro-LD complexes from circulation. Conclusions: An increased LD activity and a rare LD-IgG pattern were detected for five years in a patient who had not rare diseases but atherosclerosis and two stents. Evaluation of LD activity and its isoenzyme test results may be complicated and misleading for patients with the same LD-IgG complex in their serum.

  • Markert, C. L., Shakelee, J. B., Whitt, G. S.: Evolution of a gene structure, function and regulation. Science, 1975, 189 , 102–104.

    Whitt G. S. , 'Evolution of a gene structure, function and regulation ' (1975 ) 189 Science : 102 -104.

    • Search Google Scholar
  • Sudo, K., Maekawa, M.: A case of immunoglobulin G conjugated with lactate dehydrogenase, producing both loss of enzyme activity and an abnormal isoenzyme pattern. Clin. Chem., 1986, 32 , 1420–1422.

    Maekawa M. , 'A case of immunoglobulin G conjugated with lactate dehydrogenase, producing both loss of enzyme activity and an abnormal isoenzyme pattern ' (1986 ) 32 Clin. Chem. : 1420 -1422.

    • Search Google Scholar
  • Izumi, Y., Monta, S., Ueda, Y. et al.: Transient appearance of lactate dehydrogenase (LD)-linked immunoglobulin and thyroid dysfunction at the postpartum. Internal Med., 2004, 43 , 575–577.

    Ueda Y. , 'Transient appearance of lactate dehydrogenase (LD)-linked immunoglobulin and thyroid dysfunction at the postpartum ' (2004 ) 43 Internal Med. : 575 -577.

    • Search Google Scholar
  • Fujishima, T., Morita, S., Shijubo, N. et al.: Lactate dehydrogenase-immunglobulin G kappa complex in a patient with idiopathic interstitial pneumonia. Internal Med., 1996, 35 , 413–415.

    Shijubo N. , 'Lactate dehydrogenase-immunglobulin G kappa complex in a patient with idiopathic interstitial pneumonia ' (1996 ) 35 Internal Med. : 413 -415.

    • Search Google Scholar
  • Tozuka, M., Hidaka, H., Okumura, N. et al.: A case of immunoglobulin A-lambda conjugated with lactate dehydrogenase-5 isoenzyme, causing an extremely high enzyme activity in serum. Clin. Chem., 1996, 42 , 1288–1290.

    Okumura N. , 'A case of immunoglobulin A-lambda conjugated with lactate dehydrogenase-5 isoenzyme, causing an extremely high enzyme activity in serum ' (1996 ) 42 Clin. Chem. : 1288 -1290.

    • Search Google Scholar
  • Liu, Z. J., Zhang, Y.: Macro lactate dehydrogenase in a patient with myocarditis. Clin. Chem. Lab. Med., 2000, 38 , 307–308.

    Zhang Y. , 'Macro lactate dehydrogenase in a patient with myocarditis ' (2000 ) 38 Clin. Chem. Lab. Med. : 307 -308.

    • Search Google Scholar
  • Perry, C., Peretz, H., Ben-Tal, O. et al.: Highly elevated lactate dehydrogenase level in a healthy individual: A case of macro-LD. Am. J. Hematol., 1997, 55 , 39–40.

    Ben-Tal O. , 'Highly elevated lactate dehydrogenase level in a healthy individual: A case of macro-LD ' (1997 ) 55 Am. J. Hematol. : 39 -40.

    • Search Google Scholar
  • Mansoor, S., Roman, A., Weinstein, R.: Intravascular stents do not cause microangiopathic hemolysis or thrombotic mincroangiopathy. J. Clin. Apheresis, 1999, 14 , 130–134.

    Weinstein R. , 'Intravascular stents do not cause microangiopathic hemolysis or thrombotic mincroangiopathy ' (1999 ) 14 J. Clin. Apheresis : 130 -134.

    • Search Google Scholar
  • Henderson, A. R., Moss, D. W.: Enzymes. In: Burtis, C. A., Ashwood, E. R. (Eds): Tietz’s Fundamentals of Clinical Chemistry. 5th edition. Philadelphia: W. B. Saunders Co, 2001, pp. 362–366.

    Moss D. W. , '', in Tietz’s Fundamentals of Clinical Chemistry , (2001 ) -.

  • Maekawa, M., Sudo, K., Kobayashi, A. et al.: Fast-type electrophoretic variant of lactate dehydrogenase M(A) and comparison with other missense mutations in lactate dehydrogenase M(A) and H(B) genes. Clin. Chem., 1994, 40 , 665–668.

    Kobayashi A. , 'Fast-type electrophoretic variant of lactate dehydrogenase M(A) and comparison with other missense mutations in lactate dehydrogenase M(A) and H(B) genes ' (1994 ) 40 Clin. Chem. : 665 -668.

    • Search Google Scholar
  • Sudo, K., Maekawa, M., Houk, N. et al.: A novel in-frame deletion mutation in a case of lactate dehydrogenase (LD) H subunit deficiency showing an atypical LD isoenzyme pattern in serum and erythrocytes. Clin. Biochem., 1999, 32 , 137–141.

    Houk N. , 'A novel in-frame deletion mutation in a case of lactate dehydrogenase (LD) H subunit deficiency showing an atypical LD isoenzyme pattern in serum and erythrocytes ' (1999 ) 32 Clin. Biochem. : 137 -141.

    • Search Google Scholar
  • Takatani, T., Takaoka, N., Tatsumi, M. et al.: A novel missense mutation in human lactate dehydrogenase B-subunit gene. Mol. Gen. Metabol., 2001, 73 , 344–348.

    Tatsumi M. , 'A novel missense mutation in human lactate dehydrogenase B-subunit gene ' (2001 ) 73 Mol. Gen. Metabol. : 344 -348.

    • Search Google Scholar
  • Maekawa, M., Inomata, M., Sasaki, M. S. et al.: Electrophoretic variant of lactate dehydrogenase isoenzyme and selective promoter methylation of the LDA gene in human retinoblastoma cell line. Clin. Chem., 2002, 48 , 938–1943.

    Sasaki M. S. , 'Electrophoretic variant of lactate dehydrogenase isoenzyme and selective promoter methylation of the LDA gene in human retinoblastoma cell line ' (2002 ) 48 Clin. Chem. : 938 -1943.

    • Search Google Scholar
  • Sudo, K., Maekawa, M., Kanno, T.: Immunochemical properties of immunglobulin G conjugated with lactate dehydrogenase. Clin. Chem., 1985, 31 , 1178–1182.

    Kanno T. , 'Immunochemical properties of immunglobulin G conjugated with lactate dehydrogenase ' (1985 ) 31 Clin. Chem. : 1178 -1182.

    • Search Google Scholar