COVID – 19 UPDATE APRIL 2020
ALL TESTS UNTIL 30 JUNE 2020 WILL BE DISCOUNTED BY 10%
IMPORTANT – WE ARE HERE TO HELP
We hope you are well and managing the current life-style changes brought about by COVID-19 Pandemic. It certainly has brought about many changes in our day-to-day lives and for many people CHANGE = STRESS. The current working and daily conditions will undoubtedly have an effect on the mental health of Australians.
AAL will continue to provide essential laboratory services through the COVID-19 pandemic with upgraded laboratory protocols to ensure even more staff safety. AAL always maintains a clean office and laboratory space and has only needed to increase frequency of disinfections.
There is important clinical material from a series of AAL research papers, yet to be published, we perceive it prudent to release, due to the risks associated of recommending high dose nutrients when not needed.
We have seen a number of cases where patients have suffered B6 toxicity (including collapse – and determined to be B6 toxicity) due to dosages based on “normalised” pyrrole results from other labs.
Through accreditation activities we have characterised the DMAB “active” that most (if not, all other) laboratories are testing and found it to be UROBILINOGEN (and NOT “Kryptopyrrole”). “Kryptopyrrole” is NOT found in human urine. In our lab, kryptopyrrole is a handy compound in that it provides AAL with one of the reference materials we use in combination with a spike-recovery standard to calibrate the assay. We also use it as a precursor in synthetic chemical research (we have found unequivocally that kryptopyrrole is NOT the active measured). AAL’s work with a local universities’ world leading NMR facility is investigating a synthetic pathway for proposed chemical structures and we have succeeded in elucidating part of the chemical mechanism of that pathway. We have also elucidated some of the fundamental mechanistic properties of related compounds in biological systems.
OUR TEST IS DISTINCTLY MORE SCIENTIFIC
The AAL test is now very distinctly different to all competitors, as we now distinguish between the urobilinogen content and a pyrrole fraction. Interference studies revealed that urobilinogen interferes greatly with the pyrrole reading and adjustment of collection times is NOT enough to account/correct for this (ie the second morning void can still detect more urobilinogen than pyrrole – giving confounding results for labs not familiar with this).
We now use a known compound as our external reference for the test (and we have performed extensive spike-recovery experiments validating this). Since making the subsequent necessary reporting changes, we have also noticed much more clinical clarity with the interpretation of results.
We have studied the degradation of both the urobilinogen and the pyrrole fraction in situ and are confident pyrroles are the RESULT of oxidative stress, (as is taught by Bill Walsh) NOT the CAUSE of “pyroluria” as it has become commonly confused.
In brief, the urobilinogen is quite stable, while the pyrrole fraction degrades rapidly, hence the need for careful collection, storage and transport to protect from light, heat and x-rays as per the AAL’s “SOP3001 Urinary Pyrrole collection protocol”.
We now also screen ALL samples using an automated Siemens 10SG system (and we participate in RCPA run proficiency testing for this system). This also enables us to continue to provide a fixed stable referenced assay, ties our assay in with current conventional haematology and provides an extra level of assurance to aid diagnosis with the additional detection of Bilirubin, Blood, Leukocytes, Nitrites, Protein, Ketones and Glucose.
Providing samples are adequately collected, the absence of Urobilinogen can also indicate biliary obstruction – for which we have a distinct profile.
OUR REFERENCE RANGES HAVE BEEN SET THROUGH STATISTICAL ANALYSIS OF RESULTS OF POPULATION AND SCHIZOPHRENIA STUDIES, DISCUSSION WITH CLINICIANS, NATA AND THE RCPA – CONTRARY TO SOME EXPRESSED OPINIONS.
AAL IS THE ONLY LABORATORY TO HAVE DONE THIS. AAL ARE ALSO TGA REGISTERED.
To demonstrate clinical utility in a couple of extreme cases:
A 15yo male presented to clinic with severe acne. The pyrrole result was >2000ug/dL, Urobilinogen was 55umol/L and protein was detected in the specimen (According to NPAAC guidelines, we’re required to alert practitioners with results of >400ug/dL). My recommendation was for urgent renal/LFT’s (Liver Function Tests). With those results, the patient was admitted to a local hospital (and had 4 weeks in ICU with 18 months home based care). The diagnosis was severe neoplastic anaemia.
A 13 yo male presented to clinic with lethargy and inability to digest fatty foods (and general gut dysbiosis). The AAL pyrrole test found no detectable urobilinogen, some detectable pyrrole (approximately 5ug/dL – a normal reading) and some detectable blood. We suggested biliary obstruction and a subsequent ultra sound revealed a normal gall bladder, but enlarged spleen (which was determined to be caused by infection). The enlarged spleen was preventing the flow of bilirubin.
Please note that these are extreme cases, and we have many, many more that, VERY IMPORTANTLY, distinctly show that results improve with adequate treatment over time (through testing before and after treatment).
AAL is working closely with the Bio Balance Health Board (BBH is now run by a board of doctors and medical professionals). As we have made the only recent major discoveries in this area, BBH asked Brett Lambert (Principal of AAL) to create the written material for the pyrrole component of their Annual doctor training (and to present to the advanced doctors at this event). Originally scheduled for April it is now scheduled for November 2020 due to COVID-19. We strongly recommend MEDICAL DOCTORS wanting to learn the latest in this area (and how to correctly interpret the urinary pyrrole lab report) attend the Bio Balance Health-WALSH Research Institute training later this year.
Please regularly visit our website to keep abreast of the latest information that we are currently able to release prior to research publication www.apanlbs.com and contact us if you have any queries.
Please exercise care, due diligence and stay well through these currently uncertain times. We’d love to hear from you.
Brett Lambert MAppSc, BAppSc (Chem)
Principal Scientist & Director