The serum proteins in health and disease: Filter paper electrophoresis

Abstract The results of electrophoretic determinations of the serum proteins in a group of 100 normal subjects and in subjects with a wide variety of disease are summarized. The observations indicate that the total quantity of the serum proteins and the concentration of the various globulin components in the normal subject remain fairly constant within a relatively narrow range. Determinations showing significant deviation from the normal values have not, in general, been consistent with continued good health. At the same time it should be stressed that normal serum electrophoretic patterns may be observed in a proportion of most of the diseases which have been included in this study. Hyperglobulinemia with hypergammaglobulinemia may be observed in a variety of disease states including rheumatoid arthritis and other "collagen diseases," chronic liver disease, chronic ulcerative colitis, sarcoidosis, certain infective states, various types of thrombocytopenic and non-thrombocytopenic purpura, cryoglobulinemias and macroglobulinemias, lymphomas, multiple myeloma, primary amyloid disease and in some obscure illnesses in which a definite diagnosis can not be made even after autopsy examination. An increase in the gamma globulin over its whole breadth, such as commonly occurs in rheumatoid arthritis, systemic lupus erythematosus and related "collagen diseases," chronic liver disease and in a variety of other disease states, is not distinctive and appears to be of little diagnostic value other than that it may reflect a disturbance of the antibody-producing mechanism. The appearance of abnormal protein constituents, however, occurring in relatively narrow bands usually located somewhere in the region of the beta or gamma components, may be of distinct value in diagnosis. Such patterns were observed most commonly in multiple myeloma. Not infrequently a similar abnormal protein may be shown in the urine, and in the present instance was consistently demonstrated in multiple myeloma whenever there was an associated proteinuria. The demonstration of such abnormal bands by electrophoretic analysis is not, however, diagnostic of multiple myeloma since they were observed in a smaller proportion of other illnesses, including obscure diseases in which an accurate diagnosis could not be made either clinically or after postmortem examination. While it is a simple matter to determine whether or not cryoglobulins are present in such cases, the presence of macroglobulins can be verified only by ultra-centrifugal study. Examination of the serum proteins in patients with a clinical picture of the nephrotic syndrome may be helpful in differentiating nephrosis due to glomerulonephritis from systemic lupus erythematosus and other diseases associated with renal involvement, when other characteristic changes are lacking. Patients with the nephrotic syndrome resulting from glomerulonephritis showed a greatly increased alpha 2 fraction and reduced gamma globulin, in contrast to the relatively normal apha 2 fraction and normal gamma globulin observed in patients with the nephrotic syndrome due to systemic lupus erythematosus and other diseases with renal manifestations. In patients with agammaglobulinemia and hypogammaglobulinemia due to various causes, electrophoretic analysis of the serum proteins is a simple and reliable method of demonstrating this deficiency.