Specificity of two-site immunoassays

Pseudohyperthyroxinemia in a hypothyroid patient secondary to chronic phlegmon

Background: Elevated free thyroxine could be primary or secondary, endogenous or exogenous and often presents with symptoms of hyperthyroidism. Thyroxine levels are low in hypothyroidism, where the individual requires exogenous supplementation to maintain a euthyroid state. However, thyroxine levels may be elevated in a hypothyroid patient because of over-supplementation/over-suppression with exogenous agent(s) or secondary to other pathologies and rarely, laboratory error or assay interference may cause alteration in the levels of the thyroid hormones.

Case report: A 44-year-old man with well controlled hypothyroidism was referred for assessment of markedly elevated TSH and free thyroxine levels with low free T3. Clinically the patient was hypothyroid with symptoms of fatigue and weight gain of 30 pounds over the past 3-months and the TSH levels were consistent with marked hypothyroidism. However, free thyrxoine was markedly elevated, opposite of what to be expected. A systematic evaluation, presented here, was helpful in the diagnosis of pseudohyperthyroxinemia secondary to assay interferences in a timely fashion, avoiding unnecessary further investigations.

Conclusions: Interference in immunoassays is an important clinical problem that is underestimated and can have important clinical consequences. It is important to recognize the possibility of such interferences early in the diagnostic process and to implement protocols to identify these whenever possible, in a timely fashion, to prevent untoward consequences. Vigilance by both the clinician and the laboratory staff is important.

Multiplexed microbead immunoassays by flow cytometry for molecular profiling: Basic concepts and proteomics applications

Flow cytometry was originally established as an automated method for measuring optical or fluorescence characteristics of cells or particles in suspension. With the enormous increase in development of reliable electronics, lasers, micro-fluidics, as well as many advances in immunology and other fields, flow cytometers have become user-friendlier, less-expensive instruments with an increasing importance for both basic research and clinical applications. Conventional uses of flow cytometry include immunophenotyping of blood cells and the analysis of the cell cycle. Importantly, methods for labeling microbeads with unique combinations of fluorescent spectral signatures have made multiplex analysis of soluble analytes (i.e. the ability to detect multiple targets in a single test sample) feasible by flow cytometry. The result is a rapid, high-throughput, sensitive, and reproducible detection technology for a wide range of biomedical applications requiring detection of proteins (in cells and biofluids) and nucleic acids. Thus, novel methods of flow cytometry are becoming important for diagnostic purposes (e.g. identifying multiple clinical biomarkers for a wide range of diseases) as well as for developing novel therapies (e.g. elucidating drug mechanisms and potential toxicities). In addition, flow cytometry for multiplex analysis, coupled with automated sample handling devices, has the potential to significantly enhance proteomics research, particularly analysis of post-translational modifications of proteins, on a large scale. Inherently, flow cytometry methods are strongly rooted in the laws of the physics of optics, fluidics, and electromagnetism. This review article describes principles and early sources of flow cytometry, provides an introduction to the multiplex microbead technology, and discusses its applications and advantages in comparison to other methods. Anticipated future directions, particularly for translational research in medicine, are also discussed.

An indirect perfluorosulfonated ionomer-coated electrochemical immunosensor for the detection of the protein human chorionic gonadotrophin

The development of an amperometric immunosensor for the detection of human chorionic gonadotrophin (hCG) is described. In this immunosensor, Nafion was used to immobilize an anti-hCG monoclonal antibody onto a glassy carbon electrode. A systematic study on the effects of experimental parameters such as the quantity of ethanol present in the Nafion solution, the percentage composition of Nafion, the pH of the immobilization buffer, and the concentration of antibody used for entrapment experiments on the binding between the immobilized antibody and 125I-labeled hCG has been carried out. Two immobilization methods, coimmobilization and adsorption immobilization, have then been attempted. A binding of approximately 3% was obtained in the former method, while 5.5% binding was achieved in the latter. On the basis of these results, adsorption immobilization was employed to entrap antibody on the electrode surface. A sandwich assay was then developed for hCG in which the enzyme horseradish peroxidase was conjugated to a second anti-hCG monoclonal antibody. The activity of the enzyme was determined electrochemically by the reduction of benzoquinone to hydroquinone. Binding of hCG to immobilized antibody determines the quantity of enzyme-conjugated antibody at the electrode surface, permitting the quantification of hCG. By a standard additions calibration method of hCG performed in blank human serum samples, the immunosensor exhibits a limit of linearity at 200 mIU mL-1 and a detection limit of 11.2 mIU mL-1 (based on twice the standard deviation of the blank solution).

Computational models in immunological methods: an historical review

The utilization of computational models in immunology dates from the birth of the science. From the description of antibody-antigen binding to the structural models of receptors, models are utilized to bring fundamental understandings of the processes together with laboratory measurements to uncover implications of these data. In this review, an historical view of the role of computational models in the immunology laboratory is presented, and short mathematical descriptions are given of fundamental assays. In addition, the range of current uses of models is explored -- especially as seen through papers which have appeared in the Journal of Immunological Methods from volume 1 (1971/1972) to volume 208 (1997). Each paper which introduced a new mathematical, statistical, or computer simulation model, or introduced an enhancement to an instrument through a model in those volumes is cited and the type of computational model noted.