Acta Pathol Microbiol Scand and Clin Lab Med use in PPT for external audience verified via Rightsphere 25Jul

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Acta Pathol Microbiol Scand and Clin Lab Med use in PPT for external audience verified via Rightsphere 25Jul2011 4

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Kringle domains K4 and K5 of apo(a) are homologous to those of plasminogen. Therefore, Lp(a) may compete with plasminogen for availability of plasminogen activator (converting plasminogen to plasmin), thus inhibiting fibrinolysis. The effect of this inhibition on the thrombus dissolution and/or plaque stability is not clear. Clin Lab Med copyright for PPT for external use verified via Rightsphere 25Jul2011 8

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Methods of measuring Lp(a) Lp(a) immunoassays may not provide an accurate measure of Lp(a) concentration if the antibodies in the assay bind to epitopes that may be present in apo(a) in multiple copies or if a single epitope within apo(a) is altered by conformational changes because of large variation in apo(a) size Methods of measuring Lp(a) Immunochemical: dissociation-enhanced ligand fluorescence immunoassay (DELFIA), electroimmunodiffusion (EID), enzyme-linked immunosorbent assay (ELISA), immunonephelometric assay (INA), immunoturbidimetric assay (ITA), radioimmunoassay (RIA), fluorescent immunoassay (FIA) Non-Immunologically based: ultracentrifugation followed by Lp(a)-cholesterol assay, ultracentrifugation (sinking pre-b-lipoprotein), lectin-affinity chromatography, electrophoretic separation followed by in situ enzymatic assay 10

Lp(a) measuring unites: the molar units reflect the measure of the number of circulating Lp(a) particles and because the particles are variable in size, this is the most scientifically correct way to express the level of Lp(a) in human plasma Lp(a) unit conversion: because the molecular weight of Lp(a) can vary from 180 to approx. 800 kDa, there is no single conversion factor that can be used, but the factor will vary depending on the size of the molecule in a specific sample. The conversion factor from mg/dL to nmol/L varies from 2.85 for a small to 1.85 for a large Lp(a) size; a mean conversion factor of 2.4 is recommended (Brown WV et al. J Clin Lipidol. 2010;4:240-247, Marcovina et al. J Lipid Res. 1996;37:2569)

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Positive association of Lp(a) with CVD is modest compared to other established risk factors, based on analyses of unselected primary prevention populations. Further evaluation is needed to clarify the specificity of Lp(a) as a biomarker of CVD risk. 15

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