title: Multiple macroenzymes in a patient with AIDS: diagnosis using ultrafiltration.
abstract: OBJECTIVE
  Multiple immunoglobulin-bound enzymes (macroenzymes) are reported for the first time in an individual with AIDS. Possible causes and suitable methods of detection are addressed.
  
  
  METHODS
  An asymptomatic man with a history of AIDS with hypergammaglobulinemia and elevated creatine kinase, amylase, and liver enzyme concentrations was evaluated before enrollment in a clinical trial. Macroenzymes were considered a possible source of these elevated concentrations.
  
  
  RESULTS
  Polyethylene glycol (PEG) precipitation and ultrafiltration (UF) were used to evaluate the presence of seven macroenzymes. PEG results suggested the presence of six of seven macroenzymes tested, while UF revealed three. UF results supported the clinical presentation.
  
  
  CONCLUSIONS
  A previous report shows that in cases of excess immunoglobulin, PEG coprecipitates monomeric enzymes along with serum globulins, causing false-positive reporting of macroenzymes. This may explain the discrepancy between PEG and UF results in the presence of hypergammaglobulinemia, making UF a better method of detection in these circumstances.
authors.affiliation: From the ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT;
authors.forename: Sara P
authors.initials: SP
authors.lastname: Wyness
authors.affiliation: SUNY, Stony Brook School of Medicine, Stony Brook, NY;
authors.forename: Michael A
authors.initials: MA
authors.lastname: Yee
authors.affiliation: From the ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT;
authors.forename: Sonia L
authors.initials: SL
authors.lastname: La'ulu
authors.affiliation: Department of Medicine, Jersey City Medical Center, Jersey City, NJ; and.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Tosiello
authors.affiliation: From the ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Department of Pathology, University of Utah, Salt Lake City. joely.a.straseski@aruplab.com.
authors.forename: Joely A
authors.initials: JA
authors.lastname: Straseski
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000175:diagnosis / Q000201:enzymology* / Q000276:immunology; D006678:HIV / Q000201:enzymology* / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D006942:Hypergammaglobulinemia / Q000150:complications / Q000175:diagnosis; D007136:Immunoglobulins / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D014462:Ultrafiltration / Q000379:methods
chemical_list: D007136:Immunoglobulins; D011092:Polyethylene Glycols
keywords: HIV; Hypergammaglobulinemia; Immunoglobulin; Macroenzyme; Precipitation; Ultrafiltration