Role Of Ischemia-modified Albumin Research Articles

Association of Maternal Serum Ischemia Modified Albumin (IMA) with Placental Histopathological Changes and Fetomaternal Outcome: A Prospective Case Control Study in Normotensive and Pre-eclamptic Women.

Ischemia and oxidative stress leads to generation of hydroxyl free radicals and modification of 'N-terminus' of human serum albumin. This modified albumin molecule, known as Ischemia Modified Albumin (IMA), is elevated in early stages of ischemia. It has recently been approved by US Food and Drug Administration (US FDA) for its clinical use, as early marker of myocardial ischemia in cardiology. IMA is a novel marker of ischemia and is elevated in other clinical conditions associated with ischemia like pulmonary embolism, uncontrolled type II diabetes mellitus, acute decompensated heart failure, preeclampsia, recurrent pregnancy losses and IUGR. Role of IMA in birth asphyxia in perinatology is of current interest and needs further research. A prospective case control study was conducted in a tertiary center in North India for one year. Total 80 pregnant women between 34 and 40weeks were recruited and allocated in two groups. Case group comprised of 40 pre-eclamptic pregnant women and control group comprised of 40 normotensive pregnant women. Comparison and association of maternal serum IMA levels with fetomaternal outcome and number and types of placental histopathological changes was done in two groups. In preeclampsia group mean serum IMA (115.23 ± 49.51) was significantly higher as compared to the normotensive group (79.21 ± 14.35). The optimum cut off value of IMA to detect a case was 94.5IU/ml (sensitivity 65%, specificity 87.5%, PPV 83.9%, NPV 71.4% and diagnostic accuracy of 76.3). Pre-eclamptic women, had significantly higher incidence of PTVD, lower fetal birth weight and placental histopathological changes as compared to normotensive group. 83.8% of the women with raised IMA levels were pre-eclamptic. Raised IMA levels were significantly associated with higher incidence of PTVD, birth weight ≤ 2kg and hypoxic histopathological lesions of chorangiosis, intervillous fibrin and hyalinization. Determination of maternal serum IMA levels early in pregnancy can predict preeclampsia and avoid future severe preeclampsia related complications. It might be useful to optimize both maternal and fetal/neonatal outcomes.

Effects of exercise on serum ischemia-modified albumin, brain natriuretic peptide and copeptin levels in boxers and kick boxers.

Introductionboxing and kick boxing are combat sports that can cause severe head, neck, face and hand injuries during fighting. Then, traumatic brain injury (TBI) incidence is high in these sports. Ischemia-modified albumin (IMA), brain natriuretic peptide (BNP) and copeptin have diagnostic and prognostic value for cardiac and non-cardiac ischemic events. The purpose of this study is to evaluate exercise-induced variations of serum IMA, BNP and copeptin.Methodstwenty male boxers, twenty-three male kick boxers and twenty-three age-matched male were enrolled in the study. Health assessment data were analysed. Boxers and kick boxers underwent an exercise program including training plus fighting matches. Serum samples were collected in the pre- and post-exercise periods. Serum IMA, BNP and copeptin concentrations were measured in these specimens using ELISA reagents.Resultscomparative analysis of analytes before and after exercise showed that exercise significantly increased serum IMA, BNP and copeptin levels both in boxers and kick boxers.Conclusionin conclusion, IMA, BNP and copeptin levels may be candidate biomarkers for exercise-related traumatic brain injuries. The identification of new biomarkers in patients with acute and chronic neurological disorders is of considerable interest to clinicians. Then, further studies should be conducted to evaluate the possible role of IMA, BNP and copeptin in TBI pathophysiology.

Effect of methylenetetrahydrofolate reductase gene polymorphisms and oxidative stress in silent brain infarction.

Ischemic infarctions occur under the influence of genetic and environmental factors. In our study, the role of ischemia-modified albumin and thiol balance, which are new markers in determining oxidative damage together with MTHFR gene polymorphisms and homocysteine levels, in the development of SBI was investigated. White matter lesions in the magnetic resonance imaging (MRI) results of the patients were evaluated according to the Fazekas scale and divided into groups (Grade 0, 1, 2, and 3). Homocysteine, folate, B12, IMA, total thiol, and native thiol were measured by biochemical methods. The polymorphisms in MTHFR genes were investigated by the RT-PCR method. According to our results, a significant difference was found between the groups in age, homocysteine, folate, IMA, total thiol, and native thiol parameters (p < 0.05). When we compared the groups in terms of genotypes of the C677T gene, we found a significant difference in TT genotype between grades 0/3 and 1/3 (p < 0.05). We determined that homocysteine and IMA levels increased and folate levels decreased in CC/TT and CT/TT genotypes in the C677T gene (p < 0.05). Considering our results, the observation of homocysteine and IMA changes at the genotype level of the MTHFR C677T gene and between the groups, and the deterioration of thiol balance between the groups suggested that these markers can be used in the diagnosis of silent brain infarction.

Role of ischemia-modified albumin in the evaluation of oxidative stress in intrahepatic cholestasis of pregnancy

Objective: The objective of this study is to investigate the ischemia-modified albumin (IMA) level, and the IMA/albumin ratio (IMAR) in healthy pregnant women, and pregnant women with intrahepatic cholestasis of pregnancy (ICP).Material and method: This cross-sectional study included 53 women with ICP and 52 healthy pregnant women. Their serum IMA and albumin levels were analyzed, and the women were followed up to delivery.Results: No significant intergroup differences were identified in maternal age, body mass index, and gestational age at the time that the blood samples were taken. The gestational age at delivery and the serum albumin level was significantly lower (p = .002 and p < .0001, respectively) in the ICP group than in the healthy pregnant women. Although no differences in IMA levels were shown between the groups, IMA/albumin levels were higher in the ICP group than in the healthy pregnant women (p = .004).Conclusion: Serum IMA levels did not differ between pregnant women with ICP and healthy pregnant women, while the IMAR was significantly higher in the ICP group versus the healthy pregnant women.

Role of Ischemia-Modified Albumin in Early Diagnosis of Acute Mesenteric Ischemia in Rats

Aim: The role of ischemia-modified albumin (IMA) was investigated in the early diagnosis of arterial and venous mesenteric ischemia. We aimed to determine novel procedures for the early diagnosis of Acute Mesenteric Ischemia (AMI), by evaluating serum IMA levels during the first 30 minutes, first, and third hours, in groups that have developed arterial and venous ischemia. Materials and Methods: In the experimental part of the study, three groups, each consisting of eight rats; 1st group: control; the 2nd group: ligation of superior mesenteric artery (SMA); and the 3rd group: ligation of superior mesenteric vein (SMV). Samples of venous blood were withdrawn in the first 30 minutes, first, and third hours in all three groups, and serum IMA levels were evaluated. Results: IMA levels in the first 30 minutes, first, and third hours were significantly higher in the 2nd group where SMA was ligated, and in the 3rd group where SMV was ligated, compared with the control group. Statistically significant results were obtained regarding the high IMA levels in the first half hour following ligation of SMA and SMV, which might be indicative of the period prior to ischemia. Conclusion: IMA may be considered as a new marker in the early diagnosis of AMI

Can Ischemia Modified Albumin Help In Differentiating Myocardial Perfusion Scintigraphy Results?

Myocardial perfusion scintigraphy (MPS) is a diagnostic tool commonly used to detect significant coronary lesion. However equivocal, false negative or positive results can be yielded. Controversial findings regarding the role of ischemia-modified albumin (IMA) in MPS evaluation persist. The aim of the present study was to examine the role of serum IMA in the assessment of MPS results. MPS using technetium (99mTc) sestamibi and transthoracic echocardiography was performed on 62 consecutive subjects prospectively enrolled. Exercise treadmill test (ETT) with modified Bruce protocol was used to induce coronary ischemia. During MPS performance, blood samples for serum IMA were obtained at 3 times: at pre-exercise, at the peak of ETT, and 6 hours after ETT. Patients were classified into 3 groups according to MPS results (normal, equivocal, and ischemia). Sixty-two patients (23 normal, 20 equivocal, 19 with ischemia) were included. Pre- and peak-exercise IMA values were similar among the groups (p=0.706 and 0.904). Post-exercise IMA values of the normal and equivocal groups were similar (p=0.733), while that of the ischemia group was significantly higher than the values of either the normal (p<0.001) or equivocal groups (p<0.001). ΔIMA (the difference between post-exercise and peak-exercise IMA) of the ischemia group was significantly higher than that of either the normal (p<0.001) or equivocal groups (p<0.001). Serum IMA was found to be significantly increased in cases of ischemia on MPS. Subjects with normal and equivocal MPS had a similar pattern during the test. IMA may be used in differentiation of equivocal results from false positive results.

Effect of Peripheral Arterial Disease on Serum Ischemia-Modified Albumin Levels in Type 2 Diabetic Patients

Background: The aim of this study is to evaluate the role of IMA and the effect of Type-2 diabetes in peripheral arterial ischemic patient. Methods: In our study, randomized patient groups to be undergone peripheral surgery, consisting of 16 diabetic and 12 non-diabetic patients diagnosed with peripheral arterial disease, have been examined. After standard anesthesia, the surgery was performed by the same surgical team, blood samples were taken before and after cross-clamp, and the levels of ischemia modified albumin (IMA), which is a new ischemic marker, were studied spectrophotometrically. Demographic data were compared with the type-2 diabetes association. Results: In this study, we found that there were no correlation with the ankle brachial index (ABI) and risk factors of diabetes between postoperative IMA levels (P: 0.47). Preoperative IMA serum blood levels were significantly higher in patients with peripheral arterial disease (P: 0.70), and positively associated with ABI (diabetic group P: 0.04, non-diabetic group P: 00). Also, no correlation was found with X clamp times, ABI, and IMA blood levels (P: 0.30). In diabetic group, ischemia marker increase was high and there was a positive correlation between HbA1c levels (P: 0.002). Conclusion: Our study suggested that, preoperative serum IMA levels were positively associated with ABI. In diabetic group, the increase in IMA levels was high and there was positive correlation between HbA1c levels. IMA was a benefit marker for monitoring and early diagnosis of the peripheral arterial disease.

Ischemia-modified albumin: We are ready for use in the emergency room?

We read the article by Shen et al.[1] about the assessment of ischemia-modified albumin (IMA) for emergency room diagnosis of acute coronary syndrome (ACS). We would like to point out some important aspect of the potential usefulness of serum IMA measurement in patients presenting to the emergency room with acute chest pain are suffering ACS. Most patients brought to the hospital with chest pain and suspected of ACS are eventually ruled out for acute myocardial infarction and active unstable coronary disease. The ideal role of an ischemia marker would thus be as a rule out test. The most logical place to use such a test is in the emergency department [2]. Not all investigators consider the diagnostic performance of IMA either alone or in combination with cardiac troponin, or other biomarkers of necrosis, to be adequate [3]. Recently, a large study prospectively on 248 patients presenting emergency department with symptoms suggestive of ACS did not support the use of IMA as a negative predictor for ACS. All patients had positive IMA results using the 85 U/ml cut-off value recommended by the manufacturer. Receiver operating characteristic curves failed to show improved cut-off points for diagnosis raised 12 h troponin levels or ACS, and the area under the curve was 0.52 and 0.53, respectively [4]. Likewise, Hjortshoj et al.[5] enrolled 107 subjects admitted with suspected ACS, where the sensitivity of admission IMA for a final diagnosis of ACS was 86%, a specificity of 49% and a negative predictive value of 88%. For efficient provision of care in the emergency department, a high negative predictive value may be most critical, for while false negatives are undesirable, true negatives are greater importance, because the correct exclusion of myocardial infarction preserves limited and expensive resources [3]. Although the main limitation of IMA at present is its low specificity, it may be a useful test to rule out ACS from low to moderate pre-test probability conditions with negative cardiac troponins and a negative electrocardiogram. As with any new marker, there are several issues and limitations that require caution: its cardiospecificity, its kinetics during the first hours after ACS, and the optimal cutpoint for clinical validation [6]. Further studies are required to investigate the role of IMA in cardiac ischemic diseases in the emergency department setting. An example is the large multicenter randomised controlled trial evaluating the utility of IMA for risk stratification in 1250 patients presenting with chest discomfort and possible ischemic heart disease, and to evaluate the diagnosis and prognostic implication for IMA for major adverse cardiac events (the IMAgine trial NCT00355992). This probably will provide a definitive answer. Therefore, a test like IMA may be enormously valuable to the emergency physician assessing chest pain patients but we require a better understanding on this marker before it is ready for use. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology (Shewan and Coats 2010;144:1–2).

Prognostic significance of ischemia-modified albumin in acute ischemic stroke patients: A preliminary study.

Ischemia-modified albumin (IMA) is a sensitive marker of ischemic event. However, limited studies are available regarding role of IMA in acute ischemic stroke (AIS). The aim of this study was to evaluate time course of IMA in AIS patient to validate its prognostic value. IMA level was estimated in serum samples collected from five AIS patients at admission, 24hrs, 48hrs, 72hrs, and 144hrs after admission and also from five control subjects. There was significant (p<0.05) increase in IMA level in AIS samples at admission, 24hrs, 48hrs and 144hrs respectively when compared with control. On comparing IMA levels in follow up AIS samples with that of admission value we found that it decreased in follow-up samples till 72hrs, and significant (p<0.05) decrease was observed at 24hrs and 72hrs. Findings shows that follow up estimation of IMA level in AIS may help in the prediction of the clinical status and outcome.