Human Reproduction Update Advance Access originally published online on October 22, 2008
Human Reproduction Update 2009 15(1):69-95; doi:10.1093/humupd/dmn036
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Human choriogonadotrophin protein core and sugar branches heterogeneity: basic and clinical insights
1 Department of Gynaecology and Obstetrics, Faculty of Medical Sciences, Federal University of Mato Grosso, Rua Marechal Deodoro, 1055, Apto. 1302, 78005-101 Cuiabá, Mato Grosso, Brazil 2 Tropical Institute of Reproductive Medicine and Menopause, Cuiabá, Mato Grosso, Brazil 3 Reproductive Medicine at The Queen Elizabeth Hospital, Discipline of Obstetrics and Gynaecology, University of Adelaide, South Australia, Australia 4 Research Centre for Reproductive Medicine, Adelaide, South Australia, Australia
5 Correspondence address. Tel: +55-65-3322-7342; Fax: +55-65-3623-0079; E-mail: de.medeiros{at}terra.com.br
BACKGROUND: Human chorionic gonadotrophin (hCG) is measured in serum and urine for the early detection of ectopic pregnancy, patients with higher risk of miscarriage, embryos or fetuses with chromosome abnormalities, prediction of pre-eclampsia or fetal growth restriction and identification or follow-up of trophoblast neoplasia. This review examines basic knowledge on the heterogeneity of hCG protein core and sugar branches and its relevance to assays used in a clinical setting.
METHODS: The databases Scielo and Medline/Pubmed were consulted for identification of the most relevant published papers. Search terms were gonadotrophin, glycoprotein structure, hCG structure and molecular forms of hCG.
RESULTS: The synthesis of alpha (hCG
) and beta (hCGβ) peptide chains and their further glycosylation involve the complex action of different enzymes. After assembly, hCG reaches the cell surface and is secreted as a bioactive heterodimer. The complex cascade of enzymes acting in hCG secretion results in heterogeneous molecular forms. The hCG molecules are differently metabolized by the liver, ovary and kidney, but the majority of hCG forms are excreted in the urine. Intact hCG, hCG, hCGβ, hyperglycosylated (hCGh), nicked (hCGn) and core fragment of hCGβ (hCGβcf) forms have relevant clinical use. The immunogenicity of each hCG variant, their epitopes distribution and the available antibodies are important for the development of specific assays. Depending on the prevalent form or proportion in relation to the intact hCG, the choice of assay for measurement of a specific molecule in a particular clinical setting is paramount.
CONCLUSIONS: Measurement of hCG and/or its related molecules is useful in clinical practice, but greater awareness is needed worldwide regarding the use of new sensitive and specific assays tailored for different clinical applications.
Key words: human choriogonadotrophin / heterogeneity / structure / application
Received on May 7, 2007; revised April 18, 2008; accepted on July 14, 2008