In pursuit of incorporation of markers of oxidative stress in traditional biochemical panels in clinical Chemistry: A risk assessment step in diagnosis and biotherapy

Chemical pathology (clinical chemistry/biochemistry) is the branch of laboratory medicine concerned with the detection of alterations in the chemical constituents and biochemical mechanisms, which ensure health, culminating in disease. The disease itself is a pattern of response to some insult or injury resulting in a disturbed function or structure. It is often difficult to ascertain precisely the point of transition from health to a disease state. Pathological changes, including metabolic and molecular perturbations, with the potential to progress to clinical disease, are also present in healthy populations, noteworthy are the reactive oxygen species such as hydroxyl radicals with the propensity to cause oxidative DNA damage. Biochemical profiles or panels such as liver function tests, renal function tests, bone profile, lipid profile, acid-base, and critical care have served as biomarkers employed in indicating the presence of or measuring the progress of the disease, as well as the effect of treatment. Oxidative stress, an imbalance between bio-available antioxidants and reactive species, is now widely recognized as accompanying most pathological states. Hence, the exclusion of antioxidant components in biochemical profiles appears a grave oversight. Basic components of the antioxidant system, glutathione (GSH), zinc, uric acid, ascorbic acid, and α-tocopherol, may be selected for incorporation. GSH is particularly important; as a scavenger for damaging oxidative intermediates in cells, it promises to be a good predictor of disease progression and prognosis. Including the antioxidant component into traditional profiles may aid physicians in more confidently ruling out disease, enabling further investigations, and/or reassuring patients. It is proposed that redefining the traditional profiles in chemical pathology by incorporating the indexes of the antioxidant system promises considerable improvement in the risk assessment process, in disease detection and recognition of the threshold of clinical concern in disease management and biotherapy.