Erythrocyte transketolase test

The erythrocyte transketolase (ETK) activation assay (also known as the saturation test) measures the functional capacity of the enzyme transketolase in red blood cells i.e. erythrocytes). Transketolase is a thiamine-dependent enzyme in the non-oxidative branch of the pentose phosphate pathway (PPP), a process of glucose turnover that produces nicotinamide adenine dinucleotide phosphates (NADPH) as reducing equivalents and pentose sugars as essential components of nucleotides. In the absence of adequate thiamine, the PPP output is compromised. 

Nutritional status assessment for thiamine is generally carried out by assaying the total thiamine in whole blood or erythrocytes, or by measuring the activity of erythrocyte transketolase before and after incubation with exogenous thiamine pyrophosphate. The latter serves as the sensitive index of thiamine nutritional status (Brin 1980). In addition to the enzymatic test, a measure of urinary thiamine in relation to dietary intake has been the basis for balance studies to assess the adequacy of intake. When thiamine excretion is low, a larger portion of the test dose is retained, indicating a tissue s need for thiamine. A high excretion indicates tissue saturation. In the deficient state, excretion drops to zero. Plasma pyruvate and lactate concentrations have also been used to assess thiamine status. 

There are laboratory tests that might serve as markers of early stages of thiamine deficits. These include erythrocyte transketolase activity, blood TDP or serum y-glutamyl transferase, which in combination with questionnaire anamnesis, may facilitate early diagnosis to impose easy and efficient treatment with thiamine. 

Beriberi is caused by a deficiency of thiamin (also called thiamine, aneurin(e), and vitamin Bj). Classic overt thiamin deficiency causes cardiovascular, cerebral, and peripheral neurological impairment and lactic acidosis. The disease emerged in epidemic proportions at the end of the nineteenth century in Asian and Southeast Asian countries. Its appearance coincided with the introduction of the roller mills that enabled white rice to be produced at a price that poor people could afford. Unfortunately, milled rice is particularly poor in thiamin thus, for people for whom food was almost entirely rice, there was a high risk of deficiency and mortality from beriberi. Outbreaks of acute cardiac beriberi still occur, but usually among people who live under restricted conditions. The major concern today is subclinical deficiencies in patients with trauma or among the elderly. There is also a particular form of clinical beriberi that occurs in patients who abuse alcohol, known as the Wer-nicke-Korsakoff syndrome. Subclinical deficiency may be revealed by reduced blood and urinary thiamin levels, elevated blood pyruvate/lactate concentrations and a-ketoglutarate activity, and decreased erythrocyte transketolase (ETKL) activity. Currently, the in vitro stimulation of ETKL activity by thiamin diphosphate (TDP) is the most useful functional test of thiamin status where an acute deficiency state may have occurred. The stimulation is measured as the TDP effect. 

The transketolase activation test is in reality two tests one a measurement of basal activity and the other the degree to which the basal activity can be increased by exogenous thiamine pyrophosphate, and each may be influenced by different factors. There is evidence that chronic deficiency states of thiamine may down regulate synthesis of the apoen-zyme. In comparison studies against erythrocyte TPP concentrations, better correlations were obtained with basal activity rather than the activation coefficient. ... 

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