Featured Reagent – Adiponectin
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
Latex Enhanced Immunoturbidimetric Method
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 compared to commercially available methods.
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.
The Randox adiponectin assay is stable to expiry date when stored at +2 to +8°C and has an onboard stability of 28 days when stored at +10oC.
Applications are available
Applications are available detailing instrument-specific settings for the convenient use of the Randox adiponectin assay on a variety of clinical chemistry analysers. Contact us to enquire about your specific analyser.
APDN 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 5.
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 6 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 7.
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 8
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 9
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 10, 11, 12.
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 13
Decreasing ADPN levels begins at an early stage before the onset of hypertension, diabetes, MetS or dyslipidaemia. Moreover, in those with metabolic abnormalities / physiological abnormalities, adiponectin 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 14
Subjects with high AVF or low ADPN had a 3-fold increased risk of IR. 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 ADPN levels, especially in HMW oligomer, is an independent risk factor for CVD 15. 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 16
The risk of carotid intima media thickness (CIMT) inversely correlates with ADPN levels in both genders. Adiponectin 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 17
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 15
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 adiponectin as a novel risk marker in the diagnosis and prognosis of cancer 17. 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 (BC). Furthermore, APDN has the potential to serve as a biomarker of BC risk and aid in the identification of those at a high risk of developing BC.
Fig. 3. The association between obesity, low adiponectin levels and cancer progression 18
2. International Brazilian Journal of Urology (2019): Role of adiponectin in prostate cancer 20
Oxidative stress has been identified as a key event in the initiation, development and progression of PC. ADPN increased cellular anti-oxidative defence mechanisms and inhibited oxidative stress through increasing the NADPH oxidase NOX2 and NOX4 expressions in human 22Rv1 and DU – 145 PC cell lines. The review support ADPN as a protective and safe factor to prevent the progression of PC.
Obesity: The Risk Factor
Obesity, a major global health epidemic that burdens on healthcare systems, has increased at an alarming rate with 39% of adults (18+) classed as overweight and 13% classed as obese in 2016. Moreover, in the same year, 340 million children aged between 5 and 16 were identified as overweight or obese and 41 million children under 5 years of age were also classed as overweight or obese. Worldwide, obesity prevalence rates have almost tripled between 1975 and 2016 21, 22.
The main reason obesity is a massive health problem is because of the secondary diseases that develop due to obesity. Obesity has contributed to 23% of ischaemic heart disease cases, 7 – 41% of specific cancer cases and 44% of diabetes cases. Obesity is now no longer confined to developed countries. As the industrialisation of developing countries continues to emerge, high calorie diets and subsequently obesity increases 23.
Obesity reduces the number of disease free years. It was uncovered that those who were mildly obese lost 3 – 4 more disease – free years and those who were severely obese lost 7-8 more disease free years than non-obese individuals. Consequently, at least 2.8 million deaths per year are attributed to obesity 24, 25.
Obesity is a major risk factor for T2DM, IR, CVD and various types of malignancies. These secondary health-related problems cost the economy “$2 trillion annually and roughly 2.8% of the global gross domestic product (GDP)”. Moreover, childhood obesity costs the economy $14.1 billion annually 26, 27, 23. Whilst there are numerous parties involved to aid in the prevention of obesity, urgent actions are required to prevent obesity and the subsequent secondary health – related problems.
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 Sifferlin, Alexandra.Why BMI isn’t the Best Measure for Weight (or Health). Time. [Online] August 26, 2013. [Cited: May 21, 2019.] http://healthland.time.com/2013/08/26/why-bmi-isnt-the-best-measure-for-weight-or-health/.
 Nath, Trevir. The Economic Cost Of An Obese Society. Investopedia. [Online] June 25, 2019. [Cited: July 18, 2019.] https://www. investopedia.com/articles/personal – finance/041715/economic – cost – obese – society.asp.
The aim of Biomedical Science Day is to raise the public’s awareness of the importance of biomedical science and the vital role it plays in the world. Randox are dedicated to improving healthcare worldwide through placing a major focus on research and development. The Randox scientists work in pioneering research into a range of common illnesses such as cancer, cardiovascular disease and Alzheimer’s disease.
A recent blog from Doris-Ann Williams, the Chief Executive at BIVDA, explains how “increased funding is not enough to sustain the NHS” and how “we need to make better use of in vitro diagnostics to ensure a successful future”.
The National Health Service (NHS) is a publicly funded, primarily taxation, national healthcare system in the United Kingdom. It was first set-up on July 5th, 1948 by Aneurin Bevan as he believed that everyone, regardless of wealth, should have access to good healthcare. Whilst the NHS is an extremely important aspect of healthcare in the UK, in vitro diagnostics are the heart and soul of the healthcare system as healthcare professionals not only rely on blood tests to diagnose and treat patients, but also to rule out the different contributing causes to a disease state. In vitro diagnostics also plays a key role in monitoring chronic disease states. In vitro diagnostics can also aid in reducing hospital stays, reduce misdiagnosis and support patients in looking after their own health and to deliver personalised treatment plans.
The Randox scientists have developed several niche assays to improve patient diagnosis, monitor treatment and eliminate misdiagnosis.
Adiponectin is a protein hormone secreted by adipocytes with anti-inflammatory and insulin-sensitising properties. It plays an important role in a number of metabolic processes including glucose regulation and fatty acid oxidation. Adiponectin levels are inversely correlated with abdominal visceral fat which have proven to be a strong predictor of several pathologies, including: metabolic syndrome, type 2 diabetes mellitus (T2DM), cancers and cardiovascular disease (CVD). For more information on the importance of testing Adiponectin levels, check out our Adiponectin Whitepaper.
Cystatin C is an early risk marker for renal impairment. The most commonly run test for renal impairment is Creatinine. Creatinine measurements have proven to be inadequate as certain factors must be taken into consideration, including age, gender, ethnicity etc. The National Institute for Health and Care Excellence (NICE) have updated their guidelines, which now recommends Cystatin C as a more superior test for renal impairment due to its higher specificity for significant disease outcomes than those based on Creatinine. For more information on the importance of testing Cystatin C levels, check out our Cystatin C Whitepaper.
Small-dense LDL Cholesterol (sdLDL-C)
LDL Cholesterol (LDL-C) consists of two parts: the large and buoyant LDL Cholesterol and the small and dense LDL Cholesterol. Whilst all LDL-C transports triglycerides and cholesterol to bodily tissues, their atherogensis varies according to their size. As sdLDL-C is small and dense, they can more readily permeate the arterial wall and are more susceptible to oxidation. Research indicates that individuals with a predominance of sdLDL-C have a 3-fold increased risk of myocardial infarction. It has been noted that sdLDL-C carries less Cholesterol than large LDL, therefore a patient with predominately sdLDL-C particle may require nearly 70% more sdLDL-C particles to carry the same amount of cholesterol as the patient with predominately LDL-C particles. For more information on the importance of testing sdLDL-C levels, check out our sdLDL-C Whitepaper.
These three niche in vitro diagnostics tests developed by Randox scientists can aid in reducing NHS costs due to their higher performance compared to the traditional tests. Randox are constantly striving to improve healthcare worldwide.
For more information on the extensive range of Randox third-party in vitro diagnostic reagents, visit: https://www.randox.com/diagnostic-reagents/ or contact email@example.com.
During the first week of our adiponectin educational month, we focused on different aspects of our free white paper “Early Risk Assessment of Type 2 Diabetes Mellitus Through the use of the Biomarker Adiponectin”, which details the features and benefits of Randox automated Adiponectin, clinical significance and a comparison to traditional methods for diabetes risk assessment.
Randox Adiponectin is an automated biochemistry reagent, used as a biomarker which can powerfully predict the development of pathologies such as Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD). With the global prevalence of diabetes continually rising in adults over 18 years of age, from 4.7% in 1980 to 8.5% in 2014, adiponectin should be an integral part of every laboratory’s testing panel. Offering an improved method for assessing risk, with a convenient format for routine clinical use, Randox Adiponectin will enable physicians to accurately evaluate more individuals.
Read on to find out more!
Monday 11th September
Traditional Methods for Diabetes Risk Assessment
Randox adiponectin offers a more improved, automated method for assessing Type 2 Diabetes Mellitus (T2DM) risk compared to traditional methods of diabetes risk assessment. Such methods include:
- Fasting Plasma Glucose (FPG) – This is the most commonly used biochemical method of assessing T2DM, however, the specificity of this test is poor. Although many individuals are identified as having impaired fasting glucose (IFG), their absolute risk of conversion to diabetes is only 5-10% per year.
- Oral Glucose Tolerance Test (OGTT) – This method is more accurate for risk assessment than other traditional methods, however, it is rarely used in practice as it is takes two hours to perform and is uncomfortable for patients.
Non-biochemical methods for assessing a patient’s risk of developing T2DM take into consideration gender, age, family history of T2DM, BMI, waist size and high blood pressure to give a risk score. Two of the most popular, traditional indicators include:
- Waist circumference – measures abdominal fat reliably, but its association with visceral fat varies by gender and ethnicity.
- Body Mass Index (BMI) – is another common method, however it has limitations in measuring athletes and varies depending on age, sex and race.
Given the limitations of OGTT and FPG, an improved method for assessing T2DM risk, with a convenient format for routine clinical use, would enable physicians to accurately evaluate more individuals. Randox adiponectin is an automated biochemistry test utilising a latex enhanced immunoturbidimetric method which removes the inconvenience and time consumption associated with traditional methods of testing, making it a superior method of testing T2DM.
Tuesday 12th September
Recent studies have advocated the testing of adiponectin in clinical settings. It has applications in assessing risk in several diabetes-related conditions including prediabetes, T2DM and GDM. These studies include:
BMJ (2016): Adiponectin levels predict prediabetes risk: the Pathobiology of Prediabetes in A Biracial Cohort
This study found that among health white and black adults with parental history of T2DM, adiponectin level is a powerful risk marker of incident prediabetes. Thus, the association of adiponectin with diabetes risk is evident at a much earlier stage in pathogenesis, during transition from normoglycemia to prediabetes.
Diabetes Care (2013): Low Pre-pregnancy Adiponectin Concentrations Are Associated With a Marked Increase in Risk for Development of Gestational Diabetes mellitus
This was a study carried out on 4098 women who had children within 6 years of initial blood sample and none of whom were pre-diabetic or diabetic. It was found that lower adiponectin concentration measured on average 6 years before pregnancy were associated with a 5-fold increased risk of developing GDM.
Implications for Clinicians
Adiponectin measurement is not yet a routinely run test in many laboratories worldwide and it is therefore not available for many clinicians to request. Yet the implications of this becoming widely available could be extremely valuable as it can help to assess:
- Type 2 Diabetes Mellitus and Incident prediabetes
- Cardiovascular events
- Gestational Diabetes
When risk is identified via adiponectin measurement, it is essential for individuals to carry out lifestyle modification to reduce visceral fat levels and lowering T2DM risk. This will also help to prevent the development of cardiovascular diseases and metabolic syndrome through the improvement of adiponectin production. This indicates that Randox automated adiponectin should be a routinely run test across the world.
13th September 2017
Methods of Measuring Adiponectin
Randox adiponectin automated method has many benefits for the laboratory, as the only method of adiponectin measurement available beforehand was through the ELISA assay. The benefits of switching from ELISA to an automated method include efficiencies and expansion.
The main drawback of using ELISAs for clinical testing within a laboratory is that it is time consuming and personnel consuming as it uses heavy resources with manual interaction. Switching from ELISA to an automated method for the detection of adiponectin increases time and personnel efficiency considerably which leads to cost effectiveness. This benefits laboratories through:
- Ensuring quality in testing practices and confidence in clinical results
- Lowering the risk of error and contamination avoiding compromising clinical results
Laboratories can expand their test offerings to patients and clinicians by transitioning analytes which were historically only available on ELISA methods. Adiponectin being available in an automated biochemistry format allows laboratories to expand their test menu with ease and enables the inclusion of adiponectin into routine testing panels. It also allows for detailed patient testing profiles through increased testing range and without the manual restrictions placed by running ELISA techniques.
Randox is presently the only diagnostic manufacturer who has a globally available automated biochemistry test for adiponectin measurement.
14th September 2017
Randox Automated Adiponectin Assay
The Randox adiponectin assay principle:
- The sample is reacted with a buffer and anti-adiponectin coated latex
- The formation of the antibody-antigen complex during the reaction results in an increase in turbidity – this is measured as the amount of light absorbed at 570nm.
- A sample with higher adiponectin levels will contain more adiponectin and so more antibody-antigen complexes will be formed and the increase in turbidimetry
- By constructing a standard curve from the absorbance of the standards, the adiponectin concentration of the sample can be determined.
Benefits of Randox adiponectin:
- A niche product meaning we are one of the only manufacturers to provide the adiponectin test in an automated biochemistry format
- Automated assay removing inconvenience and time consumption associated with traditional ELISA testing
- Applications available for a wide range of automated biochemistry analysers ensuring ease of programming and confidence in results
- Latex Enhanced Immunoturbidimetric method delivering high performance
- Extensive measuring range for measurement of clinically important results
- Complementary controls and calibrators available offering a complete testing package
The Randox automated immunoturbidimetric adiponectin test offers an improved method for assessing T2DM risk, with a convenient format for routine clinical use, to enable physicians to accurately evaluate at-risk individuals.
Please contact us at firstname.lastname@example.org for more information!
Download our white paper from the resource hub.