From the Guidelines
Low alpha-1, alpha-2, and beta-2 globulins on Serum Protein Electrophoresis (SPEP) indicate a potential immunodeficiency or liver dysfunction, and patients should be referred to a specialist for further evaluation and management. The findings suggest potential protein deficiency, liver dysfunction, or specific genetic disorders, which can have significant implications for morbidity, mortality, and quality of life 1. Initial steps should include comprehensive blood tests, including complete blood count, liver function tests, nutritional assessment, and possibly genetic testing.
Key Considerations
- The clinical presentation is primarily suggestive of an antibody defect or any evaluation of cellular function is thus far normal, and the clinical presentation is at least consistent with a possible antibody deficiency and not suggestive of a cellular component (eg, lack of opportunistic infections) 1.
- The initial laboratory examination of humoral immunity consists of measuring levels of various immunoglobulin isotypes (IgG, IgA, IgM, and possibly IgG subclasses) in serum, as well as a measure of function or specific antibody production, which should include both protein and polysaccharide antigens.
- Specific management depends on the underlying cause, and treatment targets the underlying cause rather than the protein deficiency directly.
Management Options
- For protein deficiency, increasing dietary protein intake to 1.2-1.5 g/kg/day and treating any malabsorption issues is recommended.
- For liver dysfunction, addressing the underlying liver disease is crucial.
- For genetic disorders like alpha-1 antitrypsin deficiency, specific treatments such as augmentation therapy may be needed.
- Regular monitoring with repeat SPEP every 3-6 months is advisable to track response to treatment.
Important Functions of Globulins
- These proteins serve important functions including transport, immune response, and inflammation regulation, so their deficiency can have systemic effects.
- Deficiencies in these proteins can lead to increased susceptibility to infections, autoimmune disorders, and other complications, highlighting the need for prompt evaluation and management 1.
From the Research
Implications of Low Alpha-1, Alpha-2, and Beta-2 Globulins on SPEP
- Low concentrations of alpha-1, alpha-2, and beta-2 globulins can be associated with various conditions, including nephrotic syndrome 2 and may be a characteristic of certain breeds, such as Greyhounds 3.
- In Greyhounds, low serum protein concentrations are the result of low concentrations of alpha and beta globulins, which should be considered when evaluating both healthy and sick Greyhounds 3.
- The distribution of alkaline phosphatase activity in serum protein fractions, including alpha-1, alpha-2, and beta globulins, can vary in different conditions, such as bone disorders and hepatobiliary disorders 4.
- High-resolution electrophoresis (HRE) can be used to separate single proteins and characterize serum protein patterns, including the identification of proteins in the alpha-1, alpha-2, and beta-2 regions 5.
- Reference intervals for serum protein concentrations, including alpha-1, alpha-2, and beta-2 globulins, have been established for various species, such as horses 6, and can be used to interpret SPEP results.
Protein Fractions and SPEP
- SPEP can provide valuable information about changes in the concentrations of albumin and alpha-, beta-, and gamma-globulins, helping to characterize dysproteinemias in various species 6.
- The electrophoretic profile of serum proteins can differ between species and conditions, and the independent regulation of each protein fraction can result in varying serum protein profiles, even when all protein fractions are lost in the urine 2.
Clinical Interpretation
- The interpretation of SPEP results should take into account the species, breed, and condition of the individual, as well as the reference intervals established for that species 3, 6.
- Low alpha-1, alpha-2, and beta-2 globulin concentrations can be associated with various conditions, and further testing, such as HRE and electrophoretic immunofixation, may be necessary to characterize the serum protein pattern and diagnose underlying conditions 5, 2.