Reagent | C-Reactive Protein (CRP)
The Most Sensitive Acute Phase Reactant
Benefits of the Randox Assay
The Randox CRP assay has shown to have limited interference from conjugate and free bilirubin, haemoglobin, Intralipid® and triglycerides.
Wide measuring range
The Randox CRP assay has a measuring range of 2.88 – 220 mg/l for the comfortable detection of clinically important results.
The Randox CRP assay is available in a liquid ready-to-use format for convenience and ease-of-use.
Stable to expiry
The Randox CRP assay is stable to expiry when stored at +2oC to +8oC.
Dedicated calibrator and controls available
Dedicated CRP calibrator and controls available offering a complete testing package.
Applications available detailing instrument-specific settings for the convenient use of the Randox CRP assay on a variety of clinical chemistry analysers.
Instrument Specific Applications (ISA’s) are available for a wide range of biochemistry analysers. Contact us to enquire about your specific analyser.
C-reactive protein (CRP) is the dominant acute phase protein in mammals 1. Elevated levels of CRP are not disease specific but are synthesised, by hepatocytes, in response to pro-inflammatory cytokines during inflammatory and/or infectious processes 2, 3. The physiological function of CRP is the enhancement of cell-mediated immunity through the promotion of phagocytosis, accelerated chemotaxis and the activation of platelets 1.
Known as a biomarker of acute inflammation, many large-scale prospective studies demonstrate the association between CRP and chronic inflammation, including: cardiovascular disease (CVD), cerebrovascular accident (CVA) (ischaemic stroke), Alzheimer’s Disease, and age-related macular degeneration 2.
CRP is a major cardiovascular disease (CVD) risk factor. A CRP level of >10mg/l correlates with a >4% risk of developing a fatal CVD event in 10 years, including: myocardial infarction, peripheral arterial disease, stroke and sudden cardiac death. Inflammation is an integral part in the development and rapid progression of coronary heart disease (CHD) 4.
The coronary artery disease (CAD) process is characterised by increasing levels of inflammatory biomarkers. CRP is not only an excellent biomarker or mediator of atherosclerosis but is a strong independent marker in the prediction of adverse CV events, including: myocardial infarction, ischaemic stroke, and sudden cardiac death. CPR can be utilised as a clinical guide for the diagnosis, management and prognosis of CVD 5.
The development of a cerebrovascular accident (CVA) (stroke) is the result of longstanding vascular inflammation, thrombosis, plaque rupture and subsequent brain ischaemia or infarction. Elevated CRP levels is associated with the development of CVA 6.
High sensitivity CRP (hsCRP) plays an important role in the early diagnosis, prognosis, long and short death risk and prediction of etiological subtypes of stroke 7. Find out more about the Randox hsCRP assay.
Alzheimer’s disease (AD) is the most common form of dementia, accounting for 60-80% of dementia cases 7. CRP is believed to be involved in the pathophysiology of cerebral small vessel disease (CSVD) and neurodegeneration 8. CRP levels are associated with cognitive impairment 9. Inflammation should be considered as a target treatment, with the aim of delaying the progression of subclinical brain damage and cognitive decline 8. Midlife elevations in CRP are associated with an increased risk of developing AD. Patients with AD, CRP elevations continues to predict increased dementia severity suggestive of a possible pro-inflammatory endophenotype in AD 10.
In COVID-19 patients, CRP testing has proved to perform well in discriminating disease severity and predicting adverse outcomes 11. CRP levels positively correlates with lung lesions, reflecting disease severity, and should be considered a key indicator in disease monitoring (see fig. 1) 12.
CRP levels are associated with computed tomography (CT) scores and COVID-19 disease development, with CRP levels increasing in the initial stage of severe COVID-19, prior to the CT findings 13.
Elevated CRP levels have been identified in 86% of patients admitted to hospital. CRP measurements are useful in diagnosis, assessing prognosis and monitoring for clinical improvements or deterioration 14.
Fig. 1. Relation between CRP levels, clinical severity, and lung lesions 12
Specific Protein EQA
 Thanoon IAJ, Abdul-Jabber HAS, Taha DA. Oxidative Stress and C-Reactive Protein in Patients with Cerebrovascular Accident (Ischaemic Stroke) The role of Ginkgo biloba extract. Sultan Qaboos University Medical Journal 2012; 12(2): 197-205.
 Cozlea DL, Farcas DM, Nagy A, Keresztesi AA, Tifrea R, Cozlea L, Carasca E. The Impact of C Reactive Protein on Global Cardiovascular Risk on Patients with Coronary Artery Disease. Current Health Sciences Journal 2013; 39(4): 225-231.
 Avan A, Tavakoly Sany SB, Ghayour-Mobarhan M, Rahimi HR, Tajfard M, et al. Serum C‐reactive protein in the prediction of cardiovascular diseases: Overview of the latest clinical studies and public health practice. Journal of Cellular Physiology 2018; 223(11): 1-18.
 Yu H, Huang Y, Chen XY, Nie WB, Wang YJ, Jiao Y, et al. High-sensitivity C-reactive protein in stroke patients – The importance in consideration of influence of multiple factors in the predictability for disease severity and death. Journal of Clinical Neuroscience 2017; 36(2017): 12-19.
 Hilal S, Ikram MA, Verbeek MM, Franco OH, Stoops E, Vanderstichele H, et al. C-Reactive Protein, Plasma Amyloid-β Levels, and Their Interaction With Magnetic Resonance Imaging Markers. Stroke 2018; 49(11): 2692-2698.
 Watanabe Y, Kitamura K, Nakamura K, Sanpei K, Wakasugi M, Yokoseki A, et al. Elevated C-Reactive Protein Is Associated with Cognitive Decline in Outpatients of a General Hospital: The Project in Sado for Total Health (PROST). Dementia and Genetic Cognitive Disorders 2016; 6(): 10-19.
 O’Bryant SE, Waring SC, Hobson V, Hall JR, Moore CB, Bottiglieri T, et al. Decreased C-Reactive Protein Levels in Alzheimer Disease. Journal of Geriatric Psychiatry and Neurology 2011; 23(1): 49-53.
 Tan C, Huang Y, Shi F, Tan K, Ma Q, Chen Y, et al. C‐reactive protein correlates with computed tomographic findings and predicts severe COVID‐19 early. Journal of Medical Virology 2020; 92(7): 856-862.
 The Royal College of Pathologists. Guidance on the use and interpretation of clinical biochemistry tests in patients with COVID-19 infection. https://www.rcpath.org/uploads/assets/3f1048e5-22ea-4bda-953af20671771524/G217-RCPath-guidance-on-use-and-interpretation-of-clinical-biochemistry-tests-in-patients-with-COVID-19-infection.pdf (accessed 14 June 2020).
Reagent | Adiponectin
A Unique Marker of Metabolic Risk Assessment
Adiponectin is an innovative blood test which accurately diagnoses early warning signs of type 2 diabetes mellitus (T2DM) as well as the risk of cardiac conditions, metabolic and insulin concerns, and cancer.
Benefits of Randox Adiponectin
The automated latex enhanced immunoturbidimetric method produces results in as little as ten minutes, facilitating faster patient diagnosis and treatment plan implementation compared to traditional ELISA based testing.
A correlation coefficient of r=0.989 was displayed when the new Randox methodology was compared against the old Randox methodology.
Extensive Measuring Range
The healthy range for adiponectin is 2 – 22μg/ml. The Randox adiponectin assay can comfortably detect levels outside of the healthy range, measuring between 0.32 – 23.8μg/ml.
Liquid Ready-To-Use Assay
The Randox adiponectin assay is available in a liquid ready-to-use format for convenience and ease-of-use.
Dedicated 6-point Calibrator & Control
Dedicated adiponectin 6-point calibrator and control available offering a complete testing package.
Applications are Available
Applications for variety of clinical chemistry analysers are available, detailing instrument-specific settings for the Randox adiponectin assay.
Adiponectin (ADPN) (adipocyte complement-related protein of 30kDa (Acrp30)) is an adipokine (protein hormone) produced and secreted by the adipose tissue, an endocrine organ 1. ADPN acts as a messenger in the communication of adipose tissue and metabolic organs. In doing so, ADPN suppresses the production of glucose in the liver through inhibiting the genes involved in glucose production and enhances fatty acid oxidation in skeletal muscle 2. Consequently, ADPN is a strong protector against several pathological events in various cells through inhibiting inflammation, suppressing cell death and enhancing cell survival 2.
ADPN has been identified as having pleiotropic functions widely associated with anti-atherogenic, anti-diabetic, cardioprotective and anti-inflammatory effects. ADPN levels inversely correlate with insulin levels, BMI, triglyceride levels, insulin resistance (IR), glucose, and most importantly, visceral fat accumulation 3. Moreover, physiological functions of adiponectin have also been observed in inflammation and cardiovascular disease (CVD), especially in atherosclerosis 2.
Fig. 1. Proposed salutary effects of adiponectin 1
ADPN has an inverse correlation with abdominal visceral fat (AVF). Low levels of ADPN increases the risk of metabolic abnormalities. Furthermore, excess adipose tissue, especially visceral adipose tissue (VAT) is an important risk factor for IR, correlating with an increased risk of CVD 4.
The most commonly utilised methods for the assessment of AVF are waist circumference and BMI. Waist circumference does not measure total AVF reliably as the visceral fat / subcutaneous fat ratios vary by gender and ethnicity 5 and BMI cannot distinguish between muscle and fat and so classes those with high muscle and low fat mass as being overweight. Moreover, BMI also cannot distinguish between visceral fat and fat that sits beneath the skin 6.
Adiponectin levels are inversely correlated with AVF, proving to be a reliable indicator of at-risk patients.
The traditional biomarkers utilised in the assessment of T2DM risk include: oral glucose tolerance test (OGTT), fasting plasma glucose (FPG) and HbA1c. However, each of these tests are inadequate and a superior biomarker for T2DM risk assessment is vital.
1. JAMA (2009): Adiponectin levels and risk of type 2 diabetes: A systematic review and meta-analysis 7
Higher ADPN levels are associated with a lower risk of T2DM across diverse populations and is currently the strongest and most consistent biomarker of T2DM risk assessment.
2. BMJ Open Diabetes Research & Care (2016): Adiponectin levels predict prediabetes risk: The pathobiology in a biracial cohort (POP-ABC) study 8
Baseline ADPN levels were inversely related to the risk of pre-diabetes among the healthy African Americans and European Americans with a parental history of T2DM enrolled on the POP-ABC study. Despite gender and ethnic difference, this predictive relationship was evident.
The most commonly observed component of metabolic syndrome (MetS) is abdominal obesity. MetS encompasses several conditions including: hypercholesterolemia, triglyceridemia, glycaemia, hypertension, abdominal obesity and dyslipidaemia. The prevalence of MetS is 31% and is associated with a 1.5-fold increased risk of all-cause mortality, a 2-fold increased risk of coronary heart disease (CHD) and cerebrovascular accident (CVA), and a 5-fold increased risk of T2DM 9, 10, 11.
Adiponectin has been identified as a glucose regulator and lipid homeostasis through its insulin sensitising properties which are associated with MetS.
1. Nutrition and Diabetes (2011): Serum adiponectin level is not only decreased in metabolic syndrome but also in borderline metabolic abnormalities 12
Decreasing ADPN levels begins at an early stage before the onset of hypertension, diabetes, metabolic syndrome or dyslipidaemia. Moreover, in those with metabolic abnormalities / physiological abnormalities, ADPN is an important biomarker for the risk assessment of atherosclerosis, both independently and as a reflection of the accumulation of AVF.
2. Cardiovascular Diabetology (2015): Role of adiponectin and free fatty acids on the association between abdominal visceral fat and insulin resistance 13
Subjects with high abdominal visceral fat (AVF) or low ADPN had a 3-fold increased risk of insulin resistance. The combination of low ADPN with high AVF doubled this probability.
It has been recognised that mRNA expression of the ADPN gene and the section of high molecular weight (HMW) oligomeric ADPN are impaired in adipose tissue of obese patients. Epidemiological studies undertaken in different ethnic groups established that low ADPNn levels, especially in HMW oligomer, is an independent risk factor for CVD 14. Fig. 2 illustrates the pleiotropic role of adiponectin in the cardiovascular system.
1. PLOS ONE (2013): Adiponectin provides additional information to conventional cardiovascular risk factors for assessing the risk of atherosclerosis in both genders 15
The risk of carotid intima media thickness (CIMT) inversely correlates with ADPN levels in both genders. ADPN testing is a significant marker of atherosclerosis and can provide additional information in the assessment of atherosclerotic risk in both genders, independent of conventional cardiovascular risk factors.
2. European Journal of Preventive Cardiology (2015): Adiponectin, type 2 diabetes and cardiovascular risk 16
Increasing ADPN levels in plasma is associated with a decreased risk of T2DM and subsequently, a reduced risk of CVD.
Fig. 2. The pleiotropic role of adiponectin in the cardiovascular system 14
Excess body fat is not only associated with T2DM and CVD, but also with various types of malignancies. Many cancer cell lines express ADPN receptors, and adiponectin in vitro limits cell proliferation and induces apoptosis. Evidence exists supporting ADPN as a novel risk marker in the diagnosis and prognosis of cancer 14. Fig. 3 illustrates the association between obesity, low levels of adiponectin and cancer progression.
1. Medicine (2018): Serum adiponectin in breast cancer: A meta-analysis 19
The meta-analysis indicates an intriguing association between low levels of ADPN and an increased risk of breast cancer. Moreover, ADPN has the potential to serve as a biomarker of breast cancer risk and aid in the identification of those at a high-risk of developing breast cancer.
Fig. 3. The association between obesity, low adiponectin levels and cancer progression 15
2. International Brazilian Journal of Urology (2019): Role of adiponectin in prostate cancer 20
Numerous studies analysed in the review support ADPN as a protective and safe factor to prevent the progression of prostate cancer.