Professional Documents
Culture Documents
d a ced Lab
ab Interpretation
e p e a o with
Summary: Connecting Lab Data
to Treatment and Outcome
James Jeffrey Bradstreet MD, MD(H) FAAFP
Director, ICDRC
Adjunct Professor, Pediatrics
Southwest College
g of Naturopathic
p
Medicine
321-259-7111
www.icdrc.org
Biomarkers
We must define individual needs,
issues and pathologies.
Assists the selection of proper
treatment instead of trial and error and
g approaches.
pp
shotgun
Monitors efficacy of interventions
When are we done treating
g
Did we give enough or too much treatment
Evaluation of possible side-effects
OXIDATIVE STESS
Urine
8-OHG (prepub work Bradstreet et al)
Isoprostane (Ming, et al. Prostaglandins
Leukot Essent Fatty Acids. 2005
Nov;73(5):379-84.)
Blood
Bl d
Transferrin, Ceruloplasmin, (Chauhan, et al.
Lif S
Life
Sci.
i 2004 O
Oct 8
8;75(21):2539-49.)
(21) 2 39 49 )
Ammonia and Lactate (Filipek et al. J Autism
D Di
Dev
Disord.
d 2004 D
Dec;34(6):615-23.)
34(6) 615 23 )
Reduced Glutathione or GSSG - if available.
Calprotectin
Eosinophil Protein X
Blood and Leukocytes
y
METHYLATION AND
TRANSSULFATION
Urine
Methylmalonic acid B12 indicator (James
et al.
al Clin Chim Acta.
Acta 2009 Feb;400(1-2):77Feb;400(1 2):77
81. )
Fasting
g Cysteine,
y
, Methionine,, Taurine &
Sulfate
FOLATE CYCLE
TRANSMETHYLATION
THF
B6
SAM
MS
MSR
5,10-CH2-THF
DMG
B12
MTHFR
Methyl acceptor
Methyl transfease
Trimethylglycine
SAH
5-CH3-THF
SAHH
Methylated
M
th l t d Product
P d t
(DNA, RNA, Protein,
neurotransmittors)
Homocysteine
B6
Adenosine
CBS
Cystathionine
Cell membrane
B6
TRANSSULFURATION
Cysteine
Reactive Oxygen
Species:
Peroxides
Glutathione
Peroxide
GST M1
GSH
GSSG
NULL
HEAVY METALS
Blood:
Packed
P k dE
Erythrocyte
th
t Minerals
Mi
l and
dT
Toxic
i
Metals (Biol Trace Elem Res. 1990 JulDec;26-27:683-9 )
Dec;26-27:683-9.)
Lymphocyte Metallthionein pre/post induction
(Scand J Immunol.
Immunol 1982 Feb;15(2):217-20
Feb;15(2):217 20.))
Urinary:
Fractionated Porphyrins (ref later)
If porphyrins elevated or history strongly
suggestive get post
post-chelation
chelation challenge = 6
or 24 hour urine toxic metal assay
Measles Vaccine
MV Persistence
B t i - Dysbiosis
Bacteria
D bi i
Laboratory
Yeast Metabolism
http://biochemie.web.med.uni-muenchen.de/Yeast_Biol/03%20Yeast%20Metabolism.pdf
Lost Weight
g After MMR
Diagnostic Evaluation
Language Deficit
Ex 21
J , Hepner
p
g , J.,
J , & Krigsman
g
p
of
Walker,, S.J.,
K.,, Segal,
A.,, Department
Physiology & Pharmacology, Wake Forest University School of
Medicine, Winston-Salem, NC 27101 USA
Methods: Patients who had been diagnosed with autism and who were
f d to
t a pediatric
di t i gastroenterologist
t
t l i t for
f evaluation
l ti off chr
h onic
i GI
referred
symptoms were eligible to participateTerminal ileum (TI) biopsy
tissue was assayed by RT-PCR for the presence of measles virus RNA
and PCR-p
positive samples
p were sequenced.
q
Results: Medical and clinical data have been collected for >275 patients
who fit the study inclusion criteria. PCR analysis on TI biopsy tissue
from an initial 82 patients showed that 70 (85%) were positive for
the
th F gene
n amplicon
pli n.
Conclusions: Preliminary results from this large cohort of pediatric
autistic patients with chronic GI symptoms confirm earlier findings of
measles virus RNA in the terminal ileum and support an association
between measles virus and ileocolitis /LNH. (personal communcation
with the lead author indicates all strains are vaccine related except one
which is both WT and vaccine type.
IVIG Responder
Intern Med.
Med 2005 Nov;44(11):1204-5
Nov;44(11):1204 5
Yokoyama T, et al First Department of Internal Medicine, Tokyo Medical
University, Tokyo.
Medical Therapy
R
Remarkable
k bl R
Recovery
Additional Cases
Allergic Component to
Inflammation in Gut
Helminthic
Therapy
TSO
http://www.ovamed.org/english/home/home.html
Monthly Dosing will reduce the Androgen burden if Spironolactone fails, may
consider starting with Lupron and changing to Spritonolactone after levels are
under control for 3 months. Cost ~ $800/month for 7.5 and $1500 for 15 mg
Be Cautious:
Different labs
use different
control units
Porphyrin pathway
Response to DMPS IV
Response to CaEDTA
Heavy Metals:
Hg & Pb,
Hg,
Pb etc
Heavy Metals:
Hg, & Pb, etc
Heavy Metals:
Hg, & Pb, etc
Increased Neopterin
Increased Porphyrins
Increased 8OHG and Isoprostane
Study Design
Retrospective chart/database review of over
700 medical records.
All charts reviewed to exclude prior
chelation, antioxidant (apart from routine
vitamins) & immune therapy (N=197
(N 197 Cases)
Practices in US, Norway and France
Ages
g 1 through
g 8
Evaluated Biomarkers prior to Intervention
Controls were volunteers from US (>50%),
Switzerland and France (N = 43)
ClinicalBiomarkersBetween
Cases(N=86)andControls(N=43)
60
Mean (nmo
M
ol/gCr)
***
50
***
40
30
***
***
***
20
***
***
***
10
dG
G
x8
O
H
x8
O
ro
U
Pr
eC
op
ro
Cli i l biomarker
Clinical
bi
k
Control
Cases
Cases similar Cr
ClinicalBiomarkersBetweenCases
(N=86)andControls(N=43)
700
Mean
n (mol/mC
Cr)
600
***
*** ***
500
***
Control
Cases
Cases s
similar
a C
Cr
400
300
***
***
200
100
0
Iso
((ng/gCr)
gg )
Biopterin
Neopterin
Environmental Intoxication
((Metals,, Dysbiosis,
y
, Viruses,,
Chemicals)?
Structure Modification
Inflammation
Oxidant Stress
Functional Loss
Genetic
Association &
R
Regulation
l ti
Summary
Follow the history,
history physical & make a
medical diagnosis: eg encephalitis
Obtain objective biomarkers whenever
possible
Check
Ch k tto make
k sure your ttreatment
t
t is
i
effective at correcting underlying
pathophysiology
th h i l