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Wang J, Zhang H, Wan W, Yang H, Zhao J. Advances in nanotechnological approaches for the detection of early markers associated with severe cardiac ailments. Nanomedicine (Lond) 2024; 19:1487-1506. [PMID: 39121377 PMCID: PMC11318751 DOI: 10.1080/17435889.2024.2364581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/31/2024] [Indexed: 08/11/2024] Open
Abstract
Mortality from cardiovascular disease (CVD) accounts for over 30% of all deaths globally, necessitating reliable diagnostic tools. Prompt identification and precise diagnosis are critical for effective personalized treatment. Nanotechnology offers promising applications in diagnostics, biosensing and drug delivery for prevalent cardiovascular diseases. Its integration into cardiovascular care enhances diagnostic accuracy, enabling early intervention and tailored treatment plans. By leveraging nanoscale innovations, healthcare professionals can address the complexities of CVD progression and customize interventions based on individual patient needs. Ongoing advancements in nanotechnology continue to shape the landscape of cardiovascular medicine, offering potential for improved patient outcomes and reduced mortality rates from these pervasive diseases.
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Affiliation(s)
- Jie Wang
- Department of Cardiac Care Unit, Yantaishan Hospital, Yantai, Shandong, 264003, China
| | - Haifeng Zhang
- Department of Cardiology, Yantai Yeda Hospital, Yantai, Shangdong, 264006, China
| | - Weiping Wan
- Department of Ultrasound, Yantaishan Hospital, Yantai, Shandong, 264003, China
| | - Haijiao Yang
- Department of Cardiac Care Unit, Yantaishan Hospital, Yantai, Shandong, 264003, China
| | - Jing Zhao
- Department of Critical Care Medicine, Yantaishan Hospital, Yantai, Shandong, 264003, China
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2
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Gigase FAJ, Suleri A, Isaevska E, Rommel AS, Boekhorst MGBM, Dmitrichenko O, El Marroun H, Steegers EAP, Hillegers MHJ, Muetzel RL, Lieb W, Cecil CAM, Pop V, Breen M, Bergink V, de Witte LD. Inflammatory markers in pregnancy - surprisingly stable. Mapping trajectories and drivers in four large cohorts. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.19.599718. [PMID: 38948713 PMCID: PMC11213028 DOI: 10.1101/2024.06.19.599718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Adaptations of the immune system throughout gestation have been proposed as important mechanisms regulating successful pregnancy. Dysregulation of the maternal immune system has been associated with adverse maternal and fetal outcomes. To translate findings from mechanistic preclinical studies to human pregnancies, studies of serum immune markers are the mainstay. The design and interpretation of human biomarker studies require additional insights in the trajectories and drivers of peripheral immune markers. The current study mapped maternal inflammatory markers (C-reactive protein (CRP), interleukin (IL)-1β, IL-6, IL-17A, IL-23, interferon- γ ) during pregnancy and investigated the impact of demographic, environmental and genetic drivers on maternal inflammatory marker levels in four multi-ethnic and socio-economically diverse population-based cohorts with more than 12,000 pregnant participants. Additionally, pregnancy inflammatory markers were compared to pre-pregnancy levels. Cytokines showed a high correlation with each other, but not with CRP. Inflammatory marker levels showed high variability between individuals, yet high concordance within an individual over time during and pre-pregnancy. Pre-pregnancy body mass index (BMI) explained more than 9.6% of the variance in CRP, but less than 1% of the variance in cytokines. The polygenic score of CRP was the best predictor of variance in CRP (>14.1%). Gestational age and previously identified inflammation drivers, including tobacco use and parity, explained less than 1% of variance in both cytokines and CRP. Our findings corroborate differential underlying regulatory mechanisms of CRP and cytokines and are suggestive of an individual inflammatory marker baseline which is, in part, genetically driven. While prior research has mainly focused on immune marker changes throughout pregnancy, our study suggests that this field could benefit from a focus on intra-individual factors, including metabolic and genetic components.
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3
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Guastapaglia L, Chiamolera MI, Viana Lima Junior J, Ferrer CMDF, Godoy Viana L, Veiga Chang C, Andrade Siqueira R, Monteiro Barros Maciel R, Henriques Vieira JG, Biscolla RPM. False diagnosis of recurrent thyroid carcinoma: the importance of testing for heterophile antibodies. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e230115. [PMID: 38456952 PMCID: PMC11081039 DOI: 10.20945/2359-4292-2023-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/18/2023] [Indexed: 03/09/2024]
Abstract
Thyroglobulin (Tg) levels are important to predict recurrence in differentiated thyroid cancer patients.However, false-positive results can hence the request of unnecessary tests and treatments. We reported two cases of interference in thyroglobulin measurement and the workup to investigate them. Both patients achieved an excellent response to therapy after total thyroidectomy and one patient had also received radioiodine treatment. During the follow-up, Tg levels increased and there was no evidence of recurrent disease in the imaging studies. The Tg levels by the Access platform were positive but the results by Elecsys platform and LC-MS/MS were undetectable, leading to the hypothesis of heterophile antibodies (HAbs) interference. The possibility of HAbs interference must be considered when the Tg levels do not fit in the clinical picture. The measurement of Tg by another immunoassay or by LC-MS/MS may be useful in these situations.
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Affiliation(s)
- Leila Guastapaglia
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Maria Izabel Chiamolera
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Grupo Fleury, São Paulo, SP, Brasil
| | | | | | | | - Claudia Veiga Chang
- Divisão de Endocrinologia,Faculdade do Instituto Superior de Medicina (ISMD),São Paulo, SP, Brasil
| | - Raquel Andrade Siqueira
- Divisão de Endocrinologia, Hospital Geral de Goiânia (Hospital Alberto Rassi), Goiânia, GO, Brasil
| | - Rui Monteiro Barros Maciel
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Grupo Fleury, São Paulo, SP, Brasil
| | - José Gilberto Henriques Vieira
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
- Grupo Fleury, São Paulo, SP, Brasil
| | - Rosa Paula Mello Biscolla
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil,
- Grupo Fleury, São Paulo, SP, Brasil
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4
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Asha W, Obi E, Tendulkar R. Heterophilic Antibodies Resulting in False Positive Elevation of PSA After Radical Prostatectomy. Adv Radiat Oncol 2023; 8:101288. [PMID: 38047224 PMCID: PMC10692288 DOI: 10.1016/j.adro.2023.101288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/05/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Wafa Asha
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Elizabeth Obi
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Rahul Tendulkar
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
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5
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Elzieny M, Fisher JA, Sims MD, Lauter CB, Carey-Ballough RA, Sun Q. Falsely decreased vancomycin caused by rheumatoid factor: A case report. Clin Chim Acta 2023; 548:117460. [PMID: 37390942 DOI: 10.1016/j.cca.2023.117460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Vancomycin is associated with potential nephrotoxicity and trough concentrations need to be monitored in certain patients. Falsely decreased vancomycin measurement may result in overtreatment and need to be identified promptly by clinicians and pharmacists to avoid toxicities. METHODS AND RESULTS We report a case of rheumatoid factor-mediated falsely low vancomycin measurement with Abbott particle-enhanced turbidimetric inhibition immunoassay (PETINIA) method. Reanalyzing the sample using an alternative method, removing the interferences using heterophile blocking reagent as well as rheumatoid factor clean-up solution all helped to solve the false results. Results from alternative method and interference studies showed vancomycin concentrations reached toxic concentrations in the patient and administration of the drug was immediately terminated. The patient experienced a transient increase in serum creatinine. CONCLUSIONS Even though most modern immunoassays use blocking agents to neutralize interfering antibodies such as rheumatoid factor, it is important for health care professionals to understand that occasional interference still occurs due to the heterogeneous nature of rheumatoid factor.
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Affiliation(s)
- Mai Elzieny
- Department of Pathology and Laboratory Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Jordan A Fisher
- Section of Infectious Diseases, Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Matthew D Sims
- Section of Infectious Diseases, Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA; Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA
| | - Carl B Lauter
- Section of Infectious Diseases, Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA; Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA; Section of Allergy - Immunology, Department of Internal Medicine, Corewell Health William, Beaumont University Hospital, Royal Oak, MI, USA
| | - Robin A Carey-Ballough
- Department of Pathology and Laboratory Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Qian Sun
- Department of Pathology and Laboratory Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA; Department of Pathology and Laboratory Medicine, Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA.
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Bedin F, Benoit V, Ferrazzi E, Aufradet E, Boulet L, Rubens A, Dalbon P, Imbaud P. Procalcitonin detection in human plasma specimens using a fast version of proximity extension assay. PLoS One 2023; 18:e0281157. [PMID: 36795693 PMCID: PMC9934411 DOI: 10.1371/journal.pone.0281157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/13/2023] [Indexed: 02/17/2023] Open
Abstract
An exciting trend in clinical diagnostics is the development of easy-to-use, minimally invasive assays for screening and prevention of disease at the point of care. Proximity Extension Assay (PEA), an homogeneous, dual-recognition immunoassay, has proven to be sensitive, specific and convenient for detection or quantitation of one or multiple analytes in human plasma. In this paper, the PEA principle was applied to the detection of procalcitonin (PCT), a widely used biomarker for the identification of bacterial infection. A simple, short PEA protocol, with an assay time suitable for point-of-care diagnostics, is presented here as a proof of concept. Pairs of oligonucleotides and monoclonal antibodies were selected to generate tools specifically adapted to the development of an efficient PEA for PCT detection. The assay time was reduced by more than 13-fold compared to published versions of PEA, without significantly affecting assay performance. It was also demonstrated that T4 DNA polymerase could advantageously be replaced by other polymerases having strong 3'>5' exonuclease activity. The sensitivity of this improved assay was determined to be about 0.1 ng/mL of PCT in plasma specimen. The potential use of such an assay in an integrated system for the low-plex detection of biomarkers in human specimen at the point of care was discussed.
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Affiliation(s)
- Frederic Bedin
- Innovation Department, BioMérieux SA, Marcy L’Etoile, France
- * E-mail:
| | - Vincent Benoit
- Innovation Department, BioMérieux SA, Marcy L’Etoile, France
| | | | | | - Laurent Boulet
- Innovation Department, BioMérieux SA, Marcy L’Etoile, France
| | - Agnes Rubens
- Innovation Department, BioMérieux SA, Marcy L’Etoile, France
| | - Pascal Dalbon
- Innovation Department, BioMérieux SA, Marcy L’Etoile, France
| | - Pierre Imbaud
- Innovation Department, BioMérieux SA, Marcy L’Etoile, France
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Racek J, Potočová I, Rajdl D, Trefil L, Šolcová M. False positive result of human chorionic gonadotropin caused by human anti-mouse antibodies. Biochem Med (Zagreb) 2023; 33:010802. [PMID: 36817853 PMCID: PMC9927729 DOI: 10.11613/bm.2023.010802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/29/2022] [Indexed: 02/05/2023] Open
Abstract
Immunochemical reactions are fast, can be automated, and generally do not require pretreatment of biological material. Based on these advantages, they are widely used. On the other hand, they are susceptible to analytical interference that can lead to inaccurate results. These factors include the presence of anti-mouse antibodies, causing false positive (or sometimes false negative) results. Although the anti-mouse antibodies over many decades have been repeatedly identified to be the causative source but due to the rarity of such encounters they remain insufficiently considered. Here we show a case, a 45 year-old female who was mis-diagnosed with pregnancy due to falsely elevated human chorionic gonadotropin (hCG) due to anti-mouse antibodies. This led to the patient undergoing two ultrasound examinations and laparoscopy before the hCG was repeated on alternative assays which showed negative results, preventing the patient from methotrexate treatment. Here we describe the details of the case, outline the assay principal, supporting the finding from literature and outlining a process on how to identify such interferences in timely manner.
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Affiliation(s)
- Jaroslav Racek
- Department of Clinical Biochemistry and Hematology, University Hospital and Faculty of Medicine, Charles University, Pilsen, Czech Republic,Corresponding author:
| | - Ivana Potočová
- Department of Gynecology and Obstetrics, Klatovska Hospital, Klatovy, Czech Republic
| | - Daniel Rajdl
- Department of Clinical Biochemistry and Hematology, University Hospital and Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Ladislav Trefil
- Department of Clinical Biochemistry and Hematology, University Hospital and Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Marie Šolcová
- Department of Clinical Biochemistry and Hematology, University Hospital and Faculty of Medicine, Charles University, Pilsen, Czech Republic
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8
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Hattori N, Aisaka K, Yamada A, Matsuda T, Shimatsu A. Prevalence and Pathogenesis of Macro-Thyrotropin in Neonates: Analysis of Umbilical Cord Blood from 939 Neonates and Their Mothers. Thyroid 2023; 33:45-52. [PMID: 36345221 DOI: 10.1089/thy.2022.0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Macro-thyrotropin (macro-TSH) is a large molecular weight TSH that causes elevated serum TSH concentrations due to its slow clearance. It is primarily a complex of TSH and anti-TSH autoantibodies. The aims of this study were to examine the prevalence and nature of macro-TSH in neonates and to determine how to cope with macro-TSH in neonates suspected to have congenital hypothyroidism through neonatal mass screening. Methods: The presence of macro-TSH was examined using polyethylene glycol (PEG), gel filtration chromatography (GFC), and 125I-TSH binding studies in 939 umbilical cord blood samples from neonates and their mothers. Results: Among 138 serum samples with a PEG precipitation ratio of TSH >68.9% (mean + standard deviation), human anti-mouse antibodies were found in nine samples. The presence of macro-TSH was examined in the remaining 129 serum samples using a 125I-TSH binding study and GFC. The 125I-TSH binding study revealed that four babies (0.43%) had significantly high ratios of 125I-TSH binding to their sera. Two of the babies were siblings, and their mother and the other two mothers also showed significantly high binding ratios. The 125I-TSH binding was displaced by a large amount (1 μg) of unlabeled human TSH in a similar way between babies and their mothers in all cases, suggesting the presence of anti-TSH autoantibodies in their sera. Further characterization of the autoantibodies in one baby and its mother showed a low affinity and high specificity to human TSH, and the nature was very similar between them. These findings may indicate that the anti-TSH autoantibodies that developed in the mother were transferred to the baby through the placenta and formed macro-TSH by binding to neonatal TSH. GFC revealed macro-TSH in only one baby and its mother, probably because of the dissociation of TSH from autoantibodies during the analytical procedure. Conclusions: Macro-TSH was found in 0.43% of neonates, and their mothers all had macro-TSH as well. We recommend that if a baby's serum TSH concentration is high enough to consider levothyroxine treatment suspecting congenital hypothyroidism but the free thyroxine level is normal, their mother's macro-TSH should be checked.
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Affiliation(s)
- Naoki Hattori
- Department of Pharmaceutical Sciences, Ritsumeikan University, Shiga, Japan
| | - Kohzo Aisaka
- Department of Obstetrics and Gynecology, Hamada Hospital, Tokyo, Japan
| | - Ayato Yamada
- Department of Pharmaceutical Sciences, Ritsumeikan University, Shiga, Japan
| | - Takeshi Matsuda
- Department of Pharmaceutical Sciences, Ritsumeikan University, Shiga, Japan
| | - Akira Shimatsu
- Advanced Medical Care Center, Omi Medical Center, Shiga, Japan
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9
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Merashli M, Ames PRJ. Retrospective diagnosis of Behcet’s disease prompted by a false-positive D-dimer. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00145-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractA 42-year-old lady underwent extensive investigations looking for thrombosis, cancer or vasculitis following repeated D-dimer testing with values greater than 60,000 μg/ml; the negativity of the imaging ruled out cancer or thrombosis, but a review of her clinical history suggested she had features of Behcet’s disease several years earlier, leading also the hypothesis that the elevated D-dimer could have been a false positive, as subsequently demonstrated. Careful history taking is mandatory for the early interpretation of symptoms linked to Behcet’s disease, and a high degree of suspicion for a false positivity must be applied to asymptomatic people with unusually high levels of D-dimer.
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10
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Larsson A, Campbell A, Eriksson M. Chicken antibodies are highly suitable for particle enhanced turbidimetric assays. Front Immunol 2022; 13:1016781. [PMID: 36304451 PMCID: PMC9595070 DOI: 10.3389/fimmu.2022.1016781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Antibody-based assays are commonly used in clinical laboratories for analyzing plasma, serum and other samples for particular protein markers. Although such assays have been traditionally based on antibodies raised in mammals (e.g., mice, rabbits, goats), there are several advantages of using avian antibodies (IgY) raised in chickens, including production volumes, costs, and ethical/animal welfare considerations. A further disadvantage of using mammalian IgG in such assays is the potential for agglutination when exposed to rheumatoid factor (RF) in serum. However, when used in the free form the immune complexes formed with avian antibodies have been reported to have less ability than those formed with mammalian antibodies to cause the light scatter which are used for instrument measurement. In addition, when the amount of antigen exceeds the maximum precipitating point in relation to the amount of antibody, there is a rapid decline in the absorbance values of the immune complexes (antigen excess) when IgY is used. However, when avian antibodies are conjugated to a substrate and used in particle enhanced turbidimetric assays (PETIA), these problems are avoided. Here we investigated three clinical assays using chicken antibodies, one using free (unbound) IgY and two with IgY-based PETIA. The IgY PETIA demonstrated a strong scatter response, even at high antigen concentrations in contrast to the steep decline seen with free IgY antibodies. IgY PETIA reagents can provide test results with low coefficient of variation (<1% for duplicate samples). We also investigated the effect of RF on agglutination of mammalian antibodies (IgG from mouse, rabbit, sheep, and human) and chicken antibodies. Whereas agglutination was observed with all the mammalian antibodies in the presence of RF, this was not observed at all with chicken IgY. Our results support the growing body of evidence that chicken egg yolks can thus be a valuable source of antibodies for use in PETIA in clinical laboratories.
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Affiliation(s)
- Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
- *Correspondence: Anders Larsson,
| | | | - Mats Eriksson
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
- NOVA Medical School, New University of Lisbon, Lisboa, Portugal
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Chupradit S, Jasim SA, Bokov D, Mahmoud MZ, Roomi AB, Hachem K, Rudiansyah M, Suksatan W, Bidares R. Recent advances in biosensor devices for HER-2 cancer biomarker detection. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2022; 14:1301-1310. [PMID: 35318477 DOI: 10.1039/d2ay00111j] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The human epidermal growth factor receptor 2 (HER-2) protein is a member of the epidermal growth factor receptor (EGFR or ErbB) family and is a transmembrane tyrosine kinase receptor. HER-2 is highly regulated in ovarian, lung, gastric, oral, and breast cancers. The low specificity, complexity, expensiveness and the lack of sensitivity are essential restrictions in traditional diagnosis methods such as FISH, immunohistochemistry and PCR and these disadvantages led to the need for more studies on alternative methods. Biosensor technology has greatly affected the quality of human life owing to its features including, sensitivity, specificity, and rapid diagnosis and monitoring of different patient diseases. In this review article, we examine various biosensors, considering that they have been categorized based on the transducers used including piezoelectric biosensors, optical sensors such as fluorescence and surface plasmon resonance, and electrochemical types for the diagnosis of HER-2 and the effectiveness of some drugs against that. Attention to developing some types of biosensor devices such as colorimetric biosensors for HER-2 detection can be an important point in future studies.
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Affiliation(s)
- Supat Chupradit
- Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | | | - Dmitry Bokov
- Institute of Pharmacy, Sechenov First Moscow State Medical University, 8 Trubetskaya St., Bldg. 2, Moscow, 119991, Russian Federation
- Laboratory of Food Chemistry, Federal Research Center of Nutrition, Biotechnology and Food Safety, 2/14 Ustyinsky pr., Moscow, 109240, Russian Federation
| | - Mustafa Z Mahmoud
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Ali B Roomi
- PhD Biochemistry, Ministry of Education, Directorate of Education Thi-Qar, Thi-Qar, 64001, Iraq
- Biochemistry and Biological Engineering Research Group, Scientific Research Center, Al-Ayen University, Thi-Qar, 64001, Iraq
| | - Kadda Hachem
- Laboratory of Biotoxicology, Pharmacognosy and Biological Valorization of Plants (LBPVBP), Faculty of Sciences, University of Saida - Dr Moulay Tahar, 20000 Saida, Algeria
| | - Mohammad Rudiansyah
- Division of Nephrology & Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
| | - Wanich Suksatan
- Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, 10210, Thailand
| | - Ramtin Bidares
- Department of Anatomy, Histology Forensic Medicine, Sapienza University of Rome, Rome, Italy
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12
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Wauthier L, Plebani M, Favresse J. Interferences in immunoassays: review and practical algorithm. Clin Chem Lab Med 2022; 60:808-820. [PMID: 35304841 DOI: 10.1515/cclm-2021-1288] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/01/2022] [Indexed: 12/14/2022]
Abstract
Immunoassays are currently the methods of choice for the measurement of a large panel of complex and heterogenous molecules owing to full automation, short turnaround time, high specificity and sensitivity. Despite remarkable performances, immunoassays are prone to several types of interferences that may lead to harmful consequences for the patient (e.g., prescription of an inadequate treatment, delayed diagnosis, unnecessary invasive investigations). A systematic search is only performed for some interferences because of its impracticality in clinical laboratories as it would notably impact budget, turnaround time, and human resources. Therefore, a case-by-case approach is generally preferred when facing an aberrant result. Hereby, we review the current knowledge on immunoassay interferences and present an algorithm for interference workup in clinical laboratories, from suspecting their presence to using the appropriate tests to identify them. We propose an approach to rationalize the attitude of laboratory specialists when faced with a potential interference and emphasize the importance of their collaboration with clinicians and manufacturers to ensure future improvements.
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Affiliation(s)
- Loris Wauthier
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Julien Favresse
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
- Department of Pharmacy, Namur Research Institute for LIfes Sciences, University of Namur, Namur, Belgium
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13
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Yamada A, Hattori N, Matsuda T, Nishiyama N, Shimatsu A. Clearance of macro-TSH from the circulation is slower than TSH. Clin Chem Lab Med 2022; 60:e132-e135. [PMID: 35285221 DOI: 10.1515/cclm-2022-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/04/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Ayato Yamada
- Department of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu-city, Shiga, Japan
| | - Naoki Hattori
- Department of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu-city, Shiga, Japan
| | - Takeshi Matsuda
- Department of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu-city, Shiga, Japan
| | - Norito Nishiyama
- Department of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu-city, Shiga, Japan
| | - Akira Shimatsu
- Advanced Medical Care Center, Omi Medical Center, Kusatsu-city, Shiga, Japan
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14
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Chaulin AM. False-Positive Causes in Serum Cardiac Troponin Levels. J Clin Med Res 2022; 14:80-87. [PMID: 35317362 PMCID: PMC8912997 DOI: 10.14740/jocmr4664] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/14/2022] [Indexed: 11/15/2022] Open
Abstract
Cardiac troponins (cTns) are the most valuable and specific markers of cardiovascular diseases, including acute myocardial infarction. These biomarkers can also be used to assess the degree of myocardial damage in non-cardiac diseases that can negatively affect the cells of cardiac muscle tissue. However, in everyday clinical practice, doctors often encounter with false-positive cases of increased cTns. False-positive cases of increased cTns can contribute to incorrect diagnosis and subsequent inadequate treatment, which causes significant harm to the patient. This review discusses some common causes of a false-positive increase in the level of cTns in the blood serum. Such causes are fibrin clots, heterophilic antibodies, alkaline phosphatase, rheumatoid factor, and cross-reactions of diagnostic (anti-cTn) antibodies with skeletal troponins. Detailed attention is focused on the mechanisms of false-positive increase, and ways to identify and combat these false-positive causes of increased cTns. This has an important practical significance in modern clinical practice.
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Affiliation(s)
- Aleksey Michailovich Chaulin
- Department of Cardiology and Cardiovascular Surgery, Faculty of Medicine, Samara State Medical University, Samara, Russia
- Department of Clinical Chemistry, Samara Regional Clinical Cardiological Dispensary, Samara, Russia
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15
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Ghazal K, Brabant S, Prie D, Piketty ML. Hormone Immunoassay Interference: A 2021 Update. Ann Lab Med 2022; 42:3-23. [PMID: 34374345 PMCID: PMC8368230 DOI: 10.3343/alm.2022.42.1.3] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/08/2021] [Accepted: 07/21/2021] [Indexed: 12/17/2022] Open
Abstract
Immunoassays are powerful qualitative and quantitative analytical techniques. Since the first description of an immunoassay method in 1959, advances have been made in assay designs and analytical characteristics, opening the door for their widespread implementation in clinical laboratories. Clinical endocrinology is closely linked to laboratory medicine because hormone quantification is important for the diagnosis, treatment, and prognosis of endocrine disorders. Several interferences in immunoassays have been identified through the years; although some are no longer encountered in daily practice, cross-reaction, heterophile antibodies, biotin, and anti-analyte antibodies still cause problems. Newer interferences are also emerging with the development of new therapies. The interfering substance may be exogenous (e.g., a drug or substance absorbed by the patient) or endogenous (e.g., antibodies produced by the patient), and the bias caused by interference can be positive or negative. The consequences of interference can be deleterious when clinicians consider erroneous results to establish a diagnosis, leading to unnecessary explorations or inappropriate treatments. Clinical laboratories and manufacturers continue to investigate methods for the detection, elimination, and prevention of interferences. However, no system is completely devoid of such incidents. In this review, we focus on the analytical interferences encountered in daily practice and possible solutions for their detection or elimination.
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Affiliation(s)
- Khaldoun Ghazal
- Assistance Publique Hopitaux de Paris, Department of Functional Explorations, Necker Enfants Malades Hospital, Paris-Centre University, Paris Cedex, France
| | - Severine Brabant
- Assistance Publique Hopitaux de Paris, Department of Functional Explorations, Necker Enfants Malades Hospital, Paris-Centre University, Paris Cedex, France
| | - Dominique Prie
- Assistance Publique Hopitaux de Paris, Department of Functional Explorations, Necker Enfants Malades Hospital, Paris-Centre University, Paris Cedex, France
| | - Marie-Liesse Piketty
- Assistance Publique Hopitaux de Paris, Department of Functional Explorations, Necker Enfants Malades Hospital, Paris-Centre University, Paris Cedex, France
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16
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Chaulin AM. Some Common Causes of False Positive Increases in Serum Levels of Cardiac Troponins. Curr Cardiol Rev 2022; 18:e130422203527. [PMID: 35422225 PMCID: PMC9893154 DOI: 10.2174/1573403x18666220413124038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 11/22/2022] Open
Abstract
Cardiac troponin molecules (cTnI and cTnT) are the most valuable and in-demand biomarkers for detecting various types of myocardial damage (reversible and irreversible, ischemic, inflammatory, toxic, etc.) in current clinical practice. These biomarkers are widely used for early diagnosis of acute myocardial infarction (AMI) and risk stratification of patients suffering from a number of cardiac (such as myocarditis, heart failure, cardiomyopathy, etc.) and extra-cardiac diseases (such as sepsis, renal failure, pulmonary embolism, neurological pathologies, etc.) that negatively affect the cells of cardiac muscle tissue. However, in daily routine clinical activities, internists and cardiologists often encounter cases of false increases in the concentrations of cardiospecific troponins. A false increase in the concentration of troponins contributes to an incorrect diagnosis and incorrect therapy, which can harm the patient. A false increase in the concentration of troponins contributes to an incorrect diagnosis and incorrect therapy, which can harm the patient, therefore, internists and cardiologists should be well aware of the main reasons and mechanisms for false-positive results cTnI and cTnT. This review article mainly focuses on the causes of falsepositive increases in serum levels of cTnI and cTnT, which provide helpful clues for the accurate diagnosis of AMI and evidence for the differential diagnosis.
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Affiliation(s)
- Aleksey Michailovich Chaulin
- Department of Cardiology and Cardiovascular Surgery, Medical Faculty, Samara State Medical University, Samara, Russia
- Department of Clinical Chemistry, Samara Regional Clinical Cardiological Dispensary, Samara, Russia
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17
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Eskafi AH, Bagheri KP, Behdani M, Yamabhai M, Shahbazzadeh D, Kazemi-Lomedasht F. Development and characterization of human single chain antibody against Iranian Macrovipera lebetina snake venom. Toxicon 2021; 197:106-113. [DOI: 10.1016/j.toxicon.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 12/18/2022]
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18
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Gönel A, Tascanov MB, Bayraktar N, Koyuncu I, Agan V, Enes M, Guzelcicek A. In Vitro Demonstration of Drug-Reagent Interactions Among Commonly Used Parenteral Drugs in Cardiology. Cardiovasc Hematol Agents Med Chem 2021; 19:43-49. [PMID: 32101135 DOI: 10.2174/1871525718666200226115235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Drug-drug interactions are undesirable, as they reduce drug bioavailability. Drug-reagent interactions in biochemical tests may directly affect the accuracy of test results. OBJECTIVE The aim of the present study was to investigate the impact of drug-reagent interactions of drugs used in cardiology on different cardiac markers (troponin I, Nt-proBNP, CK-MB mass, CK, AST, and LDH) and the D-dimer test. METHODS Eleven drugs (enoxaparin, tirofiban hydrochloride monohydrate, diltiazem, glyceryl trinitrate, metoprolol, epinephrine, heparin sodium, atropine sodium, furosemide, norepinephrine tartrate, and amiodarone HCl) were tested in an interference study. The interference protocol was applied to the control material of troponin I, CK-MB mass, Nt-proBNP, CK, AST, LDH tests with 11 different drugs and performed with analyzers. Cardiac Markers Plus Control (Bio-Rad, Irvine, CA, USA; Lot: 23662) materials were used to assess the impact of drug-reagent interactions on the accuracy of tests of cardiac markers based on immunoassay methods. The bias rate, defined as the extent of deviation from the target value (bias %), in the interference study was calculated in each test. RESULTS For all 11 drugs, positive interference in the range of 43.58% to 130.06% occurred in the CK-MB mass test, whereas positive interference in the range of 11.98% to 107.44% occurred in the troponin I test. All the drugs, except enoxaparin sodium, led to negative interference in the range of - 84.21 to -29.6% in the Nt-proBNP test. In the D-dimer test, amiodarone HCl and diltiazem caused interference (122.87% and 28.08%, respectively). The percentage of interference caused by the other drugs ranged from -1.27% to 11.44%. Minimal deviations in the target values (between -3.31% and 3.86%) were observed in the CK, AST, and LDH tests measured using spectrophotometric methods. CONCLUSION Parenteral drugs used in cardiology can significantly interfere with troponin I, CK-MB mass, Nt-proBNP, and D-dimer tests in the analytical phase because of drug-reagent interactions. Minimal deviations in the CK, AST, and LDH tests were observed using spectrophotometric methods. Thus, changes in test results may be due to drug interference rather than the treatment itself. Clinicians should consider the possibility of drug interference in cases of doubtful cardiac test results that do not comply with the diagnosis.
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Affiliation(s)
- Ataman Gönel
- Department of Medicinal Biochemistry, Harran University, Sanliurfa, Turkey
| | | | - Nihayet Bayraktar
- Department of Medicinal Biochemistry, Harran University, Sanliurfa, Turkey
| | - Ismail Koyuncu
- Department of Medicinal Biochemistry, Harran University, Sanliurfa, Turkey
| | - Veysel Agan
- Department of Health Services, Harran University, Sanliurfa, Turkey
| | - Mehmet Enes
- Department of Medicinal Biochemistry, Harran University, Sanliurfa, Turkey
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19
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McKinski K, McNulty D, Zappacosta F, Birchler M, Szapacs M, Evans C. Orthogonal quantification of soluble inducible T-cell costimulator (ICOS) in healthy and diseased human serum. J Pharm Anal 2021; 12:317-323. [PMID: 35582393 PMCID: PMC9091914 DOI: 10.1016/j.jpha.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/02/2021] [Accepted: 06/24/2021] [Indexed: 12/04/2022] Open
Abstract
Inducible T-cell costimulator (ICOS), a homodimeric protein expressed on the surface of activated T-cells, is being investigated as a potential therapeutic target to treat various cancers. Recent studies have reported aberrant increases in the soluble form of ICOS (sICOS) in human serum in disease-state patients, primarily using commercial ELISA kits. However, results from our in-house immunoassay did not show these aberrant increases, leading us to speculate that commercial sICOS ELISAs may be prone to interference. We directly tested that hypothesis and found that one widely used commercial kit yields false-positives and is prone to human anti-mouse antibody interference. We then analyzed a panel of healthy, cancer, chronic hepatitis C virus, systemic lupus erythematosus, and diffuse cutaneous systemic sclerosis human serum using our in-house immunoassay and reported the measured sICOS concentrations in these populations. Since even well characterized immunoassay methods are prone to non-specific interference, we also developed a novel sICOS LC-MS/MS method to confirm the results. Using these orthogonal approaches, we show that sICOS is a low abundance soluble protein that cannot be measured above approximately 20 pg/mL in human serum. Soluble ICOS is a low-abundance protein that is not detectable above approximately 20 pg/mL in human serum. Commercial soluble ICOS kits may be prone to HAMA interference and thus false-positives. Off-the-shelf assay kits should be well characterized in order to minimize non-specific interferences.
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20
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Mouliou DS, Gourgoulianis KI. False-positive and false-negative COVID-19 cases: respiratory prevention and management strategies, vaccination, and further perspectives. Expert Rev Respir Med 2021; 15:993-1002. [PMID: 33896332 PMCID: PMC8074645 DOI: 10.1080/17476348.2021.1917389] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: A novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was reported via nucleic acid identification in December, 2019. Accuracy of SARS-CoV-2 diagnostic assays has emerged as a major barrier to COVID-19 diagnosis, particularly in cases requiring urgent or emergent treatment. Areas covered: In this review, we explore the major reasons for false-positive and false-negative SARS-CoV-2 test results. How clinical characteristics, specific respiratory comorbidities and SARS-CoV-2 vaccination impact on existing diagnostic assays are highlighted. Different COVID-19 management algorithms based on each test and limitations are thoroughly presented. Expert opinion: The diagnostic accuracy and the capacity of every available assay, which need to be interpreted in the light of the background incidence of SARS-CoV-2 infection in the communities in which they are used, are essential in order to minimize the number of falsely tested cases. Automated testing platforms may enhance diagnostic accuracy by minimizing the potential for human error in assays’ performance. Prior immunization against SARS-CoV-2 impairs the utility of serologic testing of suspected COVID-19 cases. Future avenues of research to evaluate lung tissue innate immune responses hold promise as a target for research to optimize SARS-CoV-2 and future infections’ testing accuracy.
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Affiliation(s)
- Dimitra S Mouliou
- Department of Respiratory Medicine, University of Thessaly, Larissa, Greece
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21
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Hayden H, Ibrahim N, Klopf J, Zagrapan B, Mauracher LM, Hell L, Hofbauer TM, Ondracek AS, Schoergenhofer C, Jilma B, Lang IM, Pabinger I, Eilenberg W, Neumayer C, Brostjan C. ELISA detection of MPO-DNA complexes in human plasma is error-prone and yields limited information on neutrophil extracellular traps formed in vivo. PLoS One 2021; 16:e0250265. [PMID: 33886636 PMCID: PMC8062102 DOI: 10.1371/journal.pone.0250265] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/03/2021] [Indexed: 12/16/2022] Open
Abstract
Over the past years, neutrophil extracellular traps (NETs) were shown to contribute to states of acute and chronic inflammatory disease. They are composed of expelled chromatin and decorated by neutrophil-derived proteins. Therefore, the analysis of DNA complexes with myeloperoxidase (MPO) by ELISA has become an attractive tool to measure NET formation in in vitro and in vivo samples. When we used a published MPO-DNA ELISA protocol and included an isotype control for the anti-MPO coating antibody, we observed high assay specificity for in vitro prepared NET samples, whereas the specificity for in vivo plasma samples was low. In addition, the assay failed to detect in vitro generated MPO-DNA complexes when spiked into plasma. Therefore, we set out to improve the specificity of the MPO-DNA ELISA for plasma samples. We found that the use of Fab fragments or immunoglobulins from different species or reversal of the antibody pair led to either a high background or a low dynamic range of detection that did not improve the specificity for plasma samples. Also, the use of higher plasma dilutions or pre-clearing of plasma immunoglobulins were ineffective. Finally, we found that a commercial reagent designed to block human anti-mouse antibodies and multivalent substances increased the detection window between the MPO antibody and isotype control for highly diluted plasma. We applied this modified ELISA protocol to analyze MPO-DNA complexes in human blood samples of acute and chronic inflammatory conditions. While markers of neutrophil activation and NET formation such as MPO, elastase and citrullinated histone H3 correlated significantly, we observed no correlation with the levels of MPO-DNA complexes. Therefore, we conclude that ELISA measurements of MPO-DNA complexes in human plasma are highly questionable regarding specificity of NET detection. In general, plasma analyses by ELISA should more frequently include isotype controls for antibodies to demonstrate target specificity.
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Affiliation(s)
- Hubert Hayden
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Nahla Ibrahim
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Johannes Klopf
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Branislav Zagrapan
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Lisa-Marie Mauracher
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Lena Hell
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Thomas M. Hofbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Anna S. Ondracek
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Christian Schoergenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Irene M. Lang
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Ingrid Pabinger
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Wolf Eilenberg
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Christine Brostjan
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
- * E-mail:
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22
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Li J, Lillehoj PB. Microfluidic Magneto Immunosensor for Rapid, High Sensitivity Measurements of SARS-CoV-2 Nucleocapsid Protein in Serum. ACS Sens 2021; 6:1270-1278. [PMID: 33629833 PMCID: PMC7931624 DOI: 10.1021/acssensors.0c02561] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/17/2021] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic has highlighted the importance and urgent need for rapid and accurate diagnostic tests for COVID-19 detection and screening. The objective of this work was to develop a simple immunosensor for rapid and high sensitivity measurements of SARS-CoV-2 nucleocapsid protein in serum. This assay is based on a unique sensing scheme utilizing dually-labeled magnetic nanobeads for immunomagnetic enrichment and signal amplification. This immunosensor is integrated onto a microfluidic chip, which offers the advantages of minimal sample and reagent consumption, simplified sample handling, and enhanced detection sensitivity. The functionality of this immunosensor was validated by using it to detect SARS-CoV-2 nucleocapsid protein, which could be detected at concentrations as low as 50 pg/mL in whole serum and 10 pg/mL in 5× diluted serum. We also adapted this assay onto a handheld smartphone-based diagnostic device that could detect SARS-CoV-2 nucleocapsid protein at concentrations as low as 230 pg/mL in whole serum and 100 pg/mL in 5× diluted serum. Lastly, we assessed the capability of this immunosensor to diagnose COVID-19 infection by testing clinical serum specimens, which revealed its ability to accurately distinguish PCR-positive COVID-19 patients from healthy, uninfected individuals based on SARS-CoV-2 nucleocapsid protein serum levels. To the best of our knowledge, this work is the first demonstration of rapid (<1 h) SARS-CoV-2 antigen quantification in whole serum samples. The ability to rapidly detect SARS-CoV-2 protein biomarkers with high sensitivity in very small (<50 μL) serum samples makes this platform a promising tool for point-of-care COVID-19 testing.
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Affiliation(s)
- Jiran Li
- Department of Mechanical Engineering, Rice University, Houston, TX 77005
| | - Peter B. Lillehoj
- Department of Mechanical Engineering, Rice University, Houston, TX 77005
- Department of Bioengineering, Rice University, Houston, TX 77030
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23
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Ye Q, Zhang T, Lu D. Potential false-positive reasons for SARS-CoV-2 antibody testing and its solution. J Med Virol 2021; 93:4242-4246. [PMID: 33710634 PMCID: PMC8250967 DOI: 10.1002/jmv.26937] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has brought a huge impact on global health and the economy. Early diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is essential for epidemic prevention and control. The detection of SARS-CoV-2 antibodies is an important criterion for diagnosing COVID-19. However, SARS-CoV-2 antibody testing also has certain false positives causing confusion in clinical diagnosis. This article summarizes the causes of false-positive detection of SARS-CoV-2 antibodies in clinical practice. The results indicate that the most common endogenous interferences include rheumatoid factor, heterophile antibodies, human anti-animal antibodies, lysozyme, complement, and cross-antigens. The exogenous interference is mainly incomplete coagulation of the specimen, contamination of the specimen, and insufficient optimization of the diagnostic kit's reaction system.
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Affiliation(s)
- Qing Ye
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Ting Zhang
- Laboratory Medicine Department, College of Medical Technology, Zhejiang Chinese Medical University, Hangzhou, China
| | - Dezhao Lu
- Laboratory Medicine Department, College of Medical Technology, Zhejiang Chinese Medical University, Hangzhou, China
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24
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Liu BM, Martins TB, Peterson LK, Hill HR. Clinical significance of measuring serum cytokine levels as inflammatory biomarkers in adult and pediatric COVID-19 cases: A review. Cytokine 2021; 142:155478. [PMID: 33667962 PMCID: PMC7901304 DOI: 10.1016/j.cyto.2021.155478] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/29/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a rapidly evolving infectious/inflammatory disorder which has turned into a global pandemic. With severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as its etiologic agent, severe COVID-19 cases usually develop uncontrolled inflammatory responses and cytokine storm-like syndromes. Measuring serum levels of pro-inflammatory cytokines (e.g., IL-6 and others) as inflammatory biomarkers may have several potential applications in the management of COVID-19, including risk assessment, monitoring of disease progression, determination of prognosis, selection of therapy and prediction of response to treatment. This is especially true for pediatric patients with COVID-19 associated Kawasaki-like disease and similar syndromes. In this report, we review the current knowledge of COVID-19 associated cytokines, their roles in host immune and inflammatory responses, the clinical significance and utility of cytokine immunoassays in adult and pediatric COVID-19 patients, as well as the challenges and pitfalls in implementation and interpretation of cytokine immunoassays. Given that cytokines are implicated in different immunological disorders and diseases, it is challenging to interpret the multiplex cytokine data for COVID-19 patients. Also, it should be taken into consideration that biological and technical variables may affect the commutability of cytokine immunoassays and enhance complexity of cytokine immunoassay interpretation. It is recommended that the same method, platform and laboratory should be used when monitoring differences in cytokine levels between groups of individuals or for the same individual over time. It may be important to correlate cytokine profiling data with the SARS-CoV-2 nucleic acid amplification testing and imaging observations to make an accurate interpretation of the inflammatory status and disease progression in COVID-19 patients.
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Affiliation(s)
- Benjamin M Liu
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Thomas B Martins
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Lisa K Peterson
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Harry R Hill
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA; ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA; Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
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25
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Lakusic N, Sopek Merkas I, Lucinger D, Mahovic D. Heterophile antibodies, false-positive troponin, and acute coronary syndrome: a case report indicating a pitfall in clinical practice. Eur Heart J Case Rep 2021; 5:ytab018. [PMID: 33569533 PMCID: PMC7859590 DOI: 10.1093/ehjcr/ytab018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/07/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Heterophile antibodies are one of the most common causes of false-positive troponin. CASE SUMMARY We report a case of a 53-year-old woman with false-positive troponin elevation and a clinical presentation understood and treated as non-ST-elevation acute coronary syndrome. Because of chronic basal elevation of troponin (at a 'plateau' level) and chest pain, the patient underwent several invasive coronary angiograms until false-positive increase of troponin due to heterophile antibodies was suspected. Borderline stenosis of a left circumflex coronary artery found on first coronary angiogram was a coincidental finding and heterophile antibodies in the patient's serum were confirmed. DISCUSSION This interesting case report aims to remind the clinicians about the possibility of false-positive troponin level due to laboratory analytical interference caused by heterophile antibodies. In this case, it is important to suspect false-positive troponin elevation, even when coronary artery disease is found. This rare and less mentioned and/or recognized cause of troponin elevation may lead to unnecessary invasive diagnostics and aggressive treatment of patients.
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Affiliation(s)
- Nenad Lakusic
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Croatia
| | - Ivana Sopek Merkas
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Croatia
| | - Daren Lucinger
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Croatia
| | - Darija Mahovic
- Department of Neurology, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Croatia
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26
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Oyatogun O, Sandhu M, Barata-Kirby S, Tuller E, Schust DJ. A rational diagnostic approach to the "phantom hCG" and other clinical scenarios in which a patient is thought to be pregnant but is not. Ther Adv Reprod Health 2021; 15:26334941211016412. [PMID: 34179786 PMCID: PMC8207263 DOI: 10.1177/26334941211016412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
The scenario in which a patient tests positive for human chorionic gonadotropin (hCG) in the absence of pregnancy can pose a diagnostic dilemma for clinicians. The term "phantom hCG" refers to persistently positive hCG levels on diagnostic testing in a nonpregnant patient and such results often lead to a false diagnosis of malignancy and subsequent inappropriate treatment with chemotherapy or hysterectomy. There remains a need for a consistent and rational diagnostic approach to the "phantom hCG." This article aims to review the different etiologies of positive serum hCG testing in nonpregnant subjects and concludes with a practical, stepwise diagnostic approach to assist clinicians encountering this clinical dilemma.
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Affiliation(s)
- Oluwafunmilayo Oyatogun
- Institute for Women’s Health Research and Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, 500 North Keene St Suite 203, Columbia, MO 65201, USA
| | - Mandeep Sandhu
- Institute for Women’s Health Research and Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, Columbia, MO, USA
| | - Stephanie Barata-Kirby
- Institute for Women’s Health Research and Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, Columbia, MO, USA
| | - Erin Tuller
- Institute for Women’s Health Research and Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, Columbia, MO, USA
| | - Danny J. Schust
- Institute for Women’s Health Research and Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, Columbia, MO, USA
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27
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Punchoo R, Bhoora S. Variation in the Measurement of Anti-Müllerian Hormone - What Are the Laboratory Issues? Front Endocrinol (Lausanne) 2021; 12:719029. [PMID: 34539570 PMCID: PMC8446602 DOI: 10.3389/fendo.2021.719029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
Anti-Müllerian Hormone (AMH) is a 140 kDa homodimeric glycoprotein consisting of two identical subunits linked by disulphide bonds and is synthesised by the testes and ovaries. Its clinical applications are prediction of ovarian response and gonadotropin dose selection upon in vitro fertilization. In males, AMH is used to investigate sexual developmental disorders and gonadal function. AMH is commonly assayed by enzyme-linked immunosorbent assay or automated immunoassay formats that show variation between methods. This review applies fundamental chemical pathology concepts to explain the observed analytical variation of AMH measurement. We examine the lack of standardisation between AMH assays, the impact of antibody design on variable measurements, consider the analytical detection of AMH isoforms, review analytical interference in AMH measurement, and briefly assess systematic bias between AMH assays. The improved attempt at standardising AMH measurement by the recent approval of a WHO Reference Reagent offers promise for harmonising immunoassay results and establishing consensus medical cut-off points for AMH in disease. Standardisation, however, will need to redress the issue of poor commutability of standard reference material and further assign a standard reference procedure to quantify AMH standard reference material. The improvement of the analytical phase of AMH testing will support harmonised method development and patient care.
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Affiliation(s)
- Rivak Punchoo
- Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
- Department of Chemical Pathology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- *Correspondence: Rivak Punchoo,
| | - Sachin Bhoora
- Department of Chemical Pathology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Baker P, Platton S, Gibson C, Gray E, Jennings I, Murphy P, Laffan M. Guidelines on the laboratory aspects of assays used in haemostasis and thrombosis. Br J Haematol 2020; 191:347-362. [PMID: 32537743 DOI: 10.1111/bjh.16776] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Peter Baker
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sean Platton
- Haemophilia Centre, Barts Health NHS Trust, London, UK
| | - Claire Gibson
- Specialist Haemostasis, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elaine Gray
- Haemostasis Section, Biotherapeutics Group, National Institute for Biological Standards and Controls, Hertfordshire, UK
| | | | - Paul Murphy
- Department of Haematology, the Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mike Laffan
- Centre for Haematology, Imperial College and Hammersmith Hospital, London, UK
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Fruzzetti F, Palla G, Sbrana A, Simoncini T, Sessa MR. Anti-goat antibodies as a rare cause of high gonadotropin levels during menopausal transition. Gynecol Endocrinol 2020; 36:938-940. [PMID: 33021135 DOI: 10.1080/09513590.2020.1780580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective: To understand the origin of extremely high gonadotropin levels in a perimenopausal woman.Methods: A 52-year-old woman with a 2 months of amenorrhea followed spontaneous menstrual cycles recovery was referred to our outpatient clinic with elevated follicle-stimulating hormone (FSH, 483 mUI/ml), luteinizing hormone (LH, 475 mUI/ml) and prolactin (PRL, 173 ng/ml). She was known to take levosulpiride. The gonadotropin levels did not fit with the clinical features.Results: A gonadotroph tumor was ruled out. Further analysis confirmed constantly high FSH, LH and PRL levels. The measurements were repeated using different analytical platforms with different results. After serial dilutions, nonlinearity was present suggesting an immunoassay interference. After post-polyethylene glycol recovery, hormone levels appeared in the normal range. Anti-goat antibodies were recognized in the serum of the patient.Conclusions: This case report shows a case of falsely abnormal high gonadotropin and PRL levels in a woman during menopause transition. In the clinical practice the evaluation of gonadotropin profile is not recommended at this age, but the abnormal levels stimulated further evaluation. An interference in the assay due to anti-goat antibodies resulted in abnormally high level of FSH and LH. A strict collaboration between clinicians and the laboratory is needed, when laboratory findings do not correspond to clinical findings.
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Affiliation(s)
- F Fruzzetti
- Obstetrics and Gynaecology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Palla
- Obstetrics and Gynaecology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Sbrana
- Centro Ricerche Cliniche, Pisa, Italy
| | - T Simoncini
- Obstetrics and Gynaecology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M R Sessa
- Laboratory of Chemistry and Endocrinology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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30
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Song L, Park S, Cassidy T, Shamsa K, Getzug T, Dietz D. Elevated Troponin Results in a Patient on Immunotherapy for Crohn's Disease. J Appl Lab Med 2020; 6:554-559. [PMID: 32995876 DOI: 10.1093/jalm/jfaa088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/06/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Lu Song
- Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Sandy Park
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Thomas Cassidy
- Clinical Laboratory, Ronald Reagan Hospital, UCLA Health, Los Angeles, CA
| | - Kamran Shamsa
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Terri Getzug
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Donald Dietz
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
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31
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Significance of Blood and Cerebrospinal Fluid Biomarkers for Alzheimer's Disease: Sensitivity, Specificity and Potential for Clinical Use. J Pers Med 2020; 10:jpm10030116. [PMID: 32911755 PMCID: PMC7565390 DOI: 10.3390/jpm10030116] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 12/16/2022] Open
Abstract
Alzheimer's disease (AD) is the most common type of dementia, affecting more than 5 million Americans, with steadily increasing mortality and incredible socio-economic burden. Not only have therapeutic efforts so far failed to reach significant efficacy, but the real pathogenesis of the disease is still obscure. The current theories are based on pathological findings of amyloid plaques and tau neurofibrillary tangles that accumulate in the brain parenchyma of affected patients. These findings have defined, together with the extensive neurodegeneration, the diagnostic criteria of the disease. The ability to detect changes in the levels of amyloid and tau in cerebrospinal fluid (CSF) first, and more recently in blood, has allowed us to use these biomarkers for the specific in-vivo diagnosis of AD in humans. Furthermore, other pathological elements of AD, such as the loss of neurons, inflammation and metabolic derangement, have translated to the definition of other CSF and blood biomarkers, which are not specific of the disease but, when combined with amyloid and tau, correlate with the progression from mild cognitive impairment to AD dementia, or identify patients who will develop AD pathology. In this review, we discuss the role of current and hypothetical biomarkers of Alzheimer's disease, their specificity, and the caveats of current high-sensitivity platforms for their peripheral detection.
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32
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Sato H, Ito S, Nakazono K, Kurosawa Y, Nozawa Y, Nakatsue T, Wada Y, Kuroda T, Suzuki Y, Nakano M, Narita I. False-positive semiquantitative immunochromatography assays for procalcitonin in three patients with rheumatoid arthritis-A case series. Clin Case Rep 2020; 8:1704-1707. [PMID: 32983481 PMCID: PMC7495766 DOI: 10.1002/ccr3.2968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/24/2020] [Accepted: 04/21/2020] [Indexed: 11/06/2022] Open
Abstract
We report three rheumatoid arthritis (RA) patients with false-positive procalcitonin (PCT) based on semiquantitative immunochromatography assays without infection, but who had negative PCT assay results based on quantitative methods. Immunochromatography was useful for screening; however, other heterophilic antibodies rather than rheumatoid factor were possible to affect, especially in RA flare.
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Affiliation(s)
- Hiroe Sato
- Niigata University Health Administration CenterNiigata CityJapan
| | - Satoshi Ito
- Department of RheumatologyNiigata Rheumatic CenterShibata CityJapan
| | - Kiyoshi Nakazono
- Department of RheumatologyNiigata Rheumatic CenterShibata CityJapan
| | - Yoichi Kurosawa
- Division of Clinical Nephrology and RheumatologyNiigata University Graduate School of Medical and Dental SciencesNiigata CityJapan
| | - Yukiko Nozawa
- Division of Clinical Nephrology and RheumatologyNiigata University Graduate School of Medical and Dental SciencesNiigata CityJapan
| | - Takeshi Nakatsue
- Division of Clinical Nephrology and RheumatologyNiigata University Graduate School of Medical and Dental SciencesNiigata CityJapan
| | - Yoko Wada
- Division of Clinical Nephrology and RheumatologyNiigata University Graduate School of Medical and Dental SciencesNiigata CityJapan
| | - Takeshi Kuroda
- Niigata University Health Administration CenterNiigata CityJapan
| | - Yoshiki Suzuki
- Niigata University Health Administration CenterNiigata CityJapan
| | - Masaaki Nakano
- Department of Medical Technology, School of Health Sciences, Faculty of MedicineNiigata UniversityNiigata CityJapan
| | - Ichiei Narita
- Division of Clinical Nephrology and RheumatologyNiigata University Graduate School of Medical and Dental SciencesNiigata CityJapan
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Shahim P, Gill JM, Blennow K, Zetterberg H. Fluid Biomarkers for Chronic Traumatic Encephalopathy. Semin Neurol 2020; 40:411-419. [PMID: 32740901 DOI: 10.1055/s-0040-1715095] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neuropathological condition that has been described in individuals who have been exposed to repetitive head impacts, including concussions and subconcussive trauma. Currently, there is no fluid or imaging biomarker for diagnosing CTE during life. Based on retrospective clinical data, symptoms of CTE include changes in behavior, cognition, and mood, and may develop after a latency phase following the injuries. However, these symptoms are often nonspecific, making differential diagnosis based solely on clinical symptoms unreliable. Thus, objective biomarkers for CTE pathophysiology would be helpful in understanding the course of the disease as well as in the development of preventive and therapeutic measures. Herein, we review the literature regarding fluid biomarkers for repetitive concussive and subconcussive head trauma, postconcussive syndrome, as well as potential candidate biomarkers for CTE. We also discuss technical challenges with regard to the current fluid biomarkers and potential pathways to advance the most promising biomarker candidates into clinical routine.
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Affiliation(s)
- Pashtun Shahim
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | | | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London, United Kingdom.,UK Dementia Research Institute at UCL, London, United Kingdom
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Macagno A, Athanasiou A, Wittig A, Huber R, Weber S, Keller T, Rhiel M, Golding B, Schiess R. Analytical performance of thrombospondin-1 and cathepsin D immunoassays part of a novel CE-IVD marked test as an aid in the diagnosis of prostate cancer. PLoS One 2020; 15:e0233442. [PMID: 32421745 PMCID: PMC7233579 DOI: 10.1371/journal.pone.0233442] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/05/2020] [Indexed: 11/20/2022] Open
Abstract
The Prostate Specific Antigen (PSA) test suffers from low specificity for the diagnosis of Prostate Cancer (PCa). We originally discovered two cancer-related proteins thrombospondin-1 (THBS1) and cathepsin D (CTSD) using a mass-spectrometry-based proteomics approach. The two serum proteins were shown to improve the diagnosis of high-grade PCa. Thus, we developed quantitative ELISAs for the determination of their concentration in human serum. Here we report their analytical performance in terms of limit of detection, specificity, precision, linearity and interferences, which were determined based on CLSI guidelines. Further, we investigated the influence of pre-analytical factors on concentration measurements. For this, blood from 4-6 donors was collected in different tubes and stored at room temperature for different times prior to centrifugation at different centrifugal forces and temperatures. Stability of THBS1 and CTSD under different storage temperatures was also evaluated. Our results show that the assays are specific, linear and sensitive enough to allow measurement of clinical samples. Precision in terms of repeatability and total within-laboratory coefficient of variation (CV) are 5.5% and 8.1% for THBS1 and 4.3% and 7.2% for CTSD, respectively. Relative laboratory-to-laboratory differences were -6.3% for THBS1 and -3% for CTSD. Both THBS1 and CTSD were stable in serum samples, with 80-120% recoveries of concentrations across donors, sample preparation and storage. In conclusion, the ELISAs as part of the novel commercial in vitro diagnostic test Proclarix are suitable for the use in clinical practice. THBS1 and CTSD can be accurately measured for their intended use independent of the lot and laboratory when conditions consistent with routine practice for PSA sampling and storage are used.
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35
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Spuriously Elevated Cardiac Troponin in the Setting of Atypical Chest Pain Presentation. JACC Case Rep 2020; 2:790-795. [PMID: 34317349 PMCID: PMC8301700 DOI: 10.1016/j.jaccas.2020.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/24/2020] [Accepted: 03/19/2020] [Indexed: 11/23/2022]
Abstract
A 47-year-old woman presented with atypical chest pain and a troponin level of 30.15 ng/dl. A detailed diagnostic work-up did not detect an acute myocardial infarction but revealed the presence of heterophile antibodies. Laboratory values need to be interpreted in the context of the clinical picture when test results do not correspond to clinical findings. (Level of Difficulty: Beginner.)
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36
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Jara-Aguirre JC, Baumann NA, Block DR, Algeciras-Schimnich A. Human chorionic gonadotropin suspected heterophile interference investigations in immunoassays: a recommended approach. Clin Chem Lab Med 2020; 57:1192-1196. [PMID: 30753153 DOI: 10.1515/cclm-2018-1142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/18/2019] [Indexed: 11/15/2022]
Abstract
Background Heterophile antibody (HAb) interferences in immunoassays can cause falsely elevated hCG concentrations leading to incorrect diagnosis and treatments options. When results are not consistent with the clinical findings, hCG HAb interference investigation may be requested by the physician. A retrospective evaluation of the frequency of HAb interference was performed among cases of physician-requested investigations and the effectiveness of commercially available blocking reagents to detect HAb interference in two immunoassay systems was evaluated. Methods One hundred and thirteen physician requests for hCG HAb investigation from 2008 to 2017 were reviewed. The primary method used to measure hCG was the Beckman Coulter Access Total βhCG (2008-2010) and the Roche Elecsys HCG+β (2014-2017). HAb investigation included measurement by two immunoassays before and after treatment of samples with heterophile blocking reagents and serial dilution studies. Results Five cases of HAb and HAb-like interference were identified. The interference frequency was 6.7% for the Beckman assay and 2.9% for the Roche assay. The presence of HAb was detected using heterophile blocking reagents and an alternative method in three cases. The other two cases were detected due to discrepant results with an alternative method and non-linear serial dilutions (HAb-like). Conclusions HAb interference was observed in the Beckman and the Roche assays. The heterophile blocking reagents failed to detect 40% of interference cases. Blocking reagents should not solely be used for these investigations. Multiple strategies including the use of serial dilutions and using an alternative platform are critical when troubleshooting interferences in hCG immunoassays.
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Affiliation(s)
- Jose C Jara-Aguirre
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, USA
| | - Nikola A Baumann
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, USA
| | - Darci R Block
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, USA
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Sriwijitalai W, Wiwanitkit V. Mildly Elevated TSH, High Free T3, and Normal Free T4: Antiidiotype Antibody Effect. Indian J Endocrinol Metab 2020; 24:226-227. [PMID: 32699800 PMCID: PMC7333766 DOI: 10.4103/ijem.ijem_647_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/24/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Viroj Wiwanitkit
- Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India
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Kirac CO, Abusoglu S, Paydas Hataysal E, Kebapcilar A, Ipekci SH, Ünlü A, Kebapcilar L. A rare cause of subclinical hypothyroidism: macro-thyroid-stimulating hormone. Diagnosis (Berl) 2020; 7:75-77. [PMID: 31271551 DOI: 10.1515/dx-2019-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/08/2019] [Indexed: 11/15/2022]
Abstract
Background Subclinical hypothyroidism is a situation in which the thyroid-stimulating hormone (TSH) value exceeds the upper limit of normal, but the free triiodothyronine (T3) and thyroxine (T4) values are within the normal range. The etiology is similar to overt hypothyroidism. Case presentation An 18-year-old female patient was referred to our endocrinology clinic due to elevated TSH levels detected during a routine examination. She was clinically euthyroid and had a normal thyroid ultrasound pattern. The TSH concentration was measured twice independently, giving values of 5.65 μIU/mL and 5.47 μIU/mL. The polyethylene glycol (PEG) method for TSH measurement was used to determine the concentration of macro-TSH (m-TSH), a macromolecule formed between TSH and immunoglobulin (Ig). Using the same blood samples for which the TSH levels were found to be high, the PEG method found TSH levels to be within a normal range, with values of 1.50 μIU/mL (5.65-1.50 μIU/mL measured; a decrease of 75%) and 1.26 μIU/mL (5.47-1.26 μIU/mL measured; a decrease of 77%), respectively. The TSH values determined by the PEG precipitation test were markedly low, with PEG-precipitable TSH ratios greater than 75%. Conclusions The cause of 55% of subclinical hypothyroidism is chronic autoimmune thyroiditis. However, it is necessary to exclude other TSH-elevated conditions for diagnosis. One of these conditions is m-TSH, which should be kept in mind even though it is rarely seen. m-TSH should be considered especially in patients who have a TSH value above 10 μIU/mL without hypothyroidism symptoms or who require a higher levothyroxine replacement dose than expected to make them euthyroid.
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Affiliation(s)
- Cem Onur Kirac
- Selcuk University, Faculty of Medicine, Internal Medicine Department, Division of Endocrinology and Metabolism, Selcuklu, Konya, Turkey
| | - Sedat Abusoglu
- Selcuk University, Biochemistry Department, Faculty of Medicine, Selcuklu, Konya, Turkey
| | - Esra Paydas Hataysal
- Selcuk University, Biochemistry Department, Faculty of Medicine, Selcuklu, Konya, Turkey
| | - Aysegul Kebapcilar
- Selcuk University, Gynecology and Obstetrics Department, Faculty of Medicine, Selcuklu, Konya, Turkey
| | - Suleyman Hilmi Ipekci
- Selcuk University, Internal Medicine Department, Faculty of Medicine, Selcuklu, Konya, Turkey
| | - Ali Ünlü
- Selcuk University, Biochemistry Department, Faculty of Medicine, Selcuklu, Konya, Turkey
| | - Levent Kebapcilar
- Selcuk University, Internal Medicine Department, Faculty of Medicine, Selcuklu, Konya, Turkey
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Wang L, Rasul A, Liu Z, Pan Y, Wang W, Li J, Li X. The Loss of Masculine With Declined Serum DHT Is Associated With High Risk of Hepatocellular Carcinoma in Chinese Men. Front Endocrinol (Lausanne) 2020; 11:362. [PMID: 32695068 PMCID: PMC7339940 DOI: 10.3389/fendo.2020.00362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Hepatocellular carcinoma (HCC) is a male-predominant cancer. However, the relationship between 5α-dihydrotestosterone (DHT), the active form of testosterone, and HCC risk has not been established yet. Methods: We performed a serum epidemiological study in the Chinese population. From 2010 to 2012, 106 male HCC patients and 318 age-matched controls were detected for their serum DHT and estradiol (E2). The odds ratios (ORs) and 95% confidence interval (CI) were estimated by logistic regression analysis with adjustment for potential risk factors. Bivariate Pearson correlations between hormone concentrations and liver function index were investigated. Results: Serum DHT levels were lower (to 1/3 of control), and E2 levels were higher (to 1.5-fold of control) in HCC patients. Compared with the low DHT level, men with a medium level had an adjusted multiple OR of 0.15 (95% CI 0.05-0.43, p trend < 0.01), and men with a high level had an OR of 0.05 (95% CI 0.01-0.21, p trend < 0.01). Notably, DHT concentration, but not E2, is correlated with liver injury. Conclusion: The data suggest that serum DHT is closely associated with HCC risk, providing a reference in order to accurately predict liver cancer and study the pathogenesis of this disease.
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Affiliation(s)
- Lichun Wang
- The Key Laboratory of Molecular Epigenetic, Institute of Genetics and Cytology, Northeast Normal University, Changchun, China
| | - Azhar Rasul
- The Key Laboratory of Molecular Epigenetic, Institute of Genetics and Cytology, Northeast Normal University, Changchun, China
- Department of Zoology, Faculty of Life Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Zili Liu
- The Key Laboratory of Molecular Epigenetic, Institute of Genetics and Cytology, Northeast Normal University, Changchun, China
| | - Ying Pan
- The Key Laboratory of Molecular Epigenetic, Institute of Genetics and Cytology, Northeast Normal University, Changchun, China
| | - Weihua Wang
- Department of Urology Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jiang Li
- Department of Prosthodontics, Dental Hospital of Jilin University, Changchun, China
- Department of Prosthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Jiang Li
| | - Xiaomeng Li
- The Key Laboratory of Molecular Epigenetic, Institute of Genetics and Cytology, Northeast Normal University, Changchun, China
- Xiaomeng Li
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Mahajan V, Rana A, Chauhan P, Mehta K, Sharma S, Sharma A, Sharma R. The association of thyroid dysfunction with chronic plaque psoriasis: A hospital-based retrospective descriptive observational study. Indian Dermatol Online J 2020; 11:771-776. [PMID: 33235844 PMCID: PMC7678532 DOI: 10.4103/idoj.idoj_432_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/11/2019] [Accepted: 11/26/2019] [Indexed: 01/10/2023] Open
Abstract
Background: Associations among thyroid dysfunction, thyroid autoimmunity, and clinical features including age, gender, disease duration, and severity of psoriasis is less studied. Objectives: To study frequency of thyroid dysfunction and thyroid autoimmunity and examine association among thyroid dysfunction, thyroid autoimmunity, and clinical features including gender, age, duration, and severity of psoriasis. Material and Methods: The medical records of 290 (m:f 2.15:1) patients aged 13–75 years with plaque psoriasis were analyzed for thyroid dysfunction and thyroid autoimmunity. Thyroid dysfunction was defined as 10% variation in any thyroid hormone levels. Thyroid autoimmunity was diagnosed from presence of antithyroid peroxide (anti-TPO) antibodies. Results: The majority, 57.9% patients, was aged ≥41 years (Type-2 psoriasis) and duration of disease was <5 years in 58.6% patients. Mild and moderate to severe psoriasis was present in 58.3% and 41.7% patients, respectively. Deranged thyroid functions were present in 29 (10%) patients. Hypothyroidism and hyperthyroidism occurred in 5.4% and 2.7% patients, respectively. Anti-TPO antibodies were observed in 13.5% patients; 11had hypothyroidism. There was no statistically significant difference in gender, age, duration, and severity of psoriasis when compared with patients having normal thyroid function tests. Conclusion: The study suggests possible thyroid dysregulation and thyroid autoimmunity in psoriasis but results need careful interpretation and clinical application. Their significance as standalone risk factor for the chronicity, severity, and relapses in psoriasis or whether thyroid hormone replacement or antithyroid drugs become a useful therapeutic option remains tenuous at best for need of more robust evidence. Retrospective, observational, cross-sectional study design, small number of patients, and lack of controls remain major limitations.
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Anti-streptavidin antibodies as a cause of false-positive results of streptavidin-based autoantibody assays. Clin Chem Lab Med 2019; 58:e5-e7. [DOI: 10.1515/cclm-2019-0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/17/2019] [Indexed: 11/15/2022]
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42
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Bergman D, Larsson A, Hansson-Hamlin H, Åhlén E, Holst BS. Characterization of canine anti-mouse antibodies highlights that multiple strategies are needed to combat immunoassay interference. Sci Rep 2019; 9:14521. [PMID: 31601945 PMCID: PMC6787031 DOI: 10.1038/s41598-019-51228-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/26/2019] [Indexed: 11/09/2022] Open
Abstract
Immunoassays are widely used for detection and quantification of analytes in biological samples, but are vulnerable to analytical errors caused by interfering sample substances. Of particular interest are endogenous anti-animal antibodies that may bind to the immunoassay antibodies and cause erroneous test results. This phenomenon is a hazard to patient safety in both human and veterinary medicine. Here, we demonstrate that anti-mouse antibodies in dogs bind selectively to different regions of the murine IgG molecule, cross-react with IgG from different species, and consist of all major antibody classes present in canine serum (IgA, IgG and IgM). The antibody characteristics varied among individuals and their prevalence differed between two dog breeds. The selective binding to different IgG regions suggests that the antibodies might not originate from immunization through exposure to mice or other species. These findings show that canine anti-mouse antibodies are highly heterogeneous in nature and therefore require a combination of strategies to be counteracted.
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Affiliation(s)
- Daniel Bergman
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, 750 07, Sweden.
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, 751 85, Sweden
| | - Helene Hansson-Hamlin
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, 750 07, Sweden
| | - Emma Åhlén
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, 750 07, Sweden
| | - Bodil Ström Holst
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, 750 07, Sweden
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Maharjan AS, Wyness SP, Ray JA, Willcox TL, Seiter JD, Genzen JR. Detection and characterization of estradiol (E2) and unconjugated estriol (uE3) immunoassay interference due to anti-bovine alkaline phosphatase (ALP) antibodies. Pract Lab Med 2019; 17:e00131. [PMID: 31538105 PMCID: PMC6745434 DOI: 10.1016/j.plabm.2019.e00131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/17/2019] [Accepted: 08/26/2019] [Indexed: 11/15/2022] Open
Abstract
Objectives Competitive immunoenyzmatic assays for estradiol (E2) and unconjugated estriol (uE3) on UniCel DxI 800 Access immunoassay systems (Beckman Coulter) utilize bovine alkaline phosphatase (ALP) for amplification. In these assays, rare 'IND' error flags indicate that a relative light unit (RLU) raw result is past the high or low end of the calibration curve but cannot be differentiated from an instrument error or analytical interference. The present studies were conducted to establish a protocol to identify analytical interference and to characterize its mechanism when present. Design and methods Matrix and recovery studies were conducted to establish a protocol for interference identification. Spiking experiments with inactivated calf intestinal ALP were performed to determine whether interference could be blocked. Commercial anti-ALP antibodies (Abs) were spiked into human serum to model assay interference. Three E2 immunoassays which do not include ALP as a reagent component (cobas e602, Roche; Centaur XP, Siemens; ARCHITECT i2000SR, Abbott) were tested for comparative purposes. Results 1:2 dilution of specimen into Access Sample Diluent A (Beckman) differentiated IND error flags due to true low results (e.g. less than the analytical measurement range; AMR) from those due to assay interference. Interferences were reduced by pre-incubation with inactivated ALP and could be replicated by spiking with commercial anti-ALP Abs. Conclusions Patient anti-bovine ALP Abs can cause interference on DxI 800 E2 and uE3 assays. This model can be used to investigate interference risk with other ALP-dependent assays.
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Key Words
- ALP, alkaline phosphatase
- AMR, analytical measurement range
- Alkaline phosphatase
- Analytical systems
- CLIA, Clinical Laboratory Improvement Amendments
- E2, estradiol
- Endocrinology
- IND, indeterminate ‘no value’ error flag
- Immunoassay
- Interference
- MoM, multiple of the median
- PBS, phosphate buffered saline
- RLU, relative light unit
- ddH2O, demineralized distilled water
- uE3, unconjugated estriol
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Affiliation(s)
- Anu S. Maharjan
- Department of Pathology, University of Utah, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Sara P. Wyness
- ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Julie A. Ray
- ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Tanya L. Willcox
- ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
| | | | - Jonathan R. Genzen
- Department of Pathology, University of Utah, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
- ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
- ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT, 84108, USA
- Corresponding author. University of Utah, Department of Pathology, ARUP Laboratories, 500 Chipeta Way, Mail Code 115, Salt Lake City, UT, 84108, USA.
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Fitzgerald RL, Hollander JE, Peacock WF, Limkakeng AT, Breitenbeck N, Blechschmidt K, Laimighofer M, deFilippi C. Analytical performance evaluation of the Elecsys® Troponin T Gen 5 STAT assay. Clin Chim Acta 2019; 495:522-528. [DOI: 10.1016/j.cca.2019.05.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 05/24/2019] [Accepted: 05/28/2019] [Indexed: 11/28/2022]
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45
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Haddad RA, Giacherio D, Barkan AL. Interpretation of common endocrine laboratory tests: technical pitfalls, their mechanisms and practical considerations. Clin Diabetes Endocrinol 2019; 5:12. [PMID: 31367466 PMCID: PMC6657094 DOI: 10.1186/s40842-019-0086-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023] Open
Abstract
Pitfalls in hormonal assays are commonly seen in clinical practice and may lead to erroneous clinical impressions and treatments. In this article, we address common laboratory pitfalls encountered during evaluation of patients with real or presumed endocrine disorders including high dose hook effect and falsely normal prolactin in cases of macroprolactinomas, macroprolactinemia and falsely elevated prolactin, macrothyrotropinemia and falsely elevated TSH, heterophile antibodies leading to false elevation of hormonal concentration, biotin interference with different hormonal assays, cross-reactivity of steroid hormones immunoassays, and others. We describe the mechanisms of such laboratory pitfalls, review clinical scenarios in which they might occur, and discuss the ways to resolve such conundrums. The aim of this article is to present a learning material for the endocrine trainees and practitioners.
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Affiliation(s)
- Raad A. Haddad
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical Center, 24 Frank Lloyd Wright, G-1500, Ann Arbor, MI 48106 USA
| | - Donald Giacherio
- Department of Pathology, University of Michigan Medical Center, Ann Arbor, MI USA
| | - Ariel L. Barkan
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical Center, 24 Frank Lloyd Wright, G-1500, Ann Arbor, MI 48106 USA
- Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, MI USA
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46
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Bishop JD, Hsieh HV, Gasperino DJ, Weigl BH. Sensitivity enhancement in lateral flow assays: a systems perspective. LAB ON A CHIP 2019; 19:2486-2499. [PMID: 31251312 DOI: 10.1039/c9lc00104b] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Lateral flow assays (LFAs) are rapid, inexpensive, easy-to-manufacture and -use tests widely employed in medical and environmental applications, particularly in low resource settings. Historically, LFAs have been stigmatized as having limited sensitivity. However, as their global usage expands, extensive research has demonstrated that it is possible to substantially improve LFA sensitivity without sacrificing their advantages. In this critical review, we have compiled state-of-the-art approaches to LFA sensitivity enhancement. Moreover, we have organized and evaluated these approaches from a system-level perspective, as we have observed that the advantages and disadvantages of each approach have arisen from the integrated and tightly interconnected chemical, physical, and optical properties of LFAs.
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Affiliation(s)
| | - Helen V Hsieh
- Intellectual Ventures Laboratory, Bellevue, 98007 WA, USA.
| | | | - Bernhard H Weigl
- Intellectual Ventures Laboratory, Bellevue, 98007 WA, USA. and Department of Bioengineering, University of Washington, Seattle, Washington 98195, USA.
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47
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Bergman D, Larsson A, Hansson-Hamlin H, Ström Holst B. Investigation of interference from canine anti-mouse antibodies in hormone immunoassays. Vet Clin Pathol 2019; 48 Suppl 1:59-69. [PMID: 31318069 DOI: 10.1111/vcp.12764] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/25/2019] [Accepted: 03/10/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Canine anti-mouse antibodies are a potential source of immunoassay interference, but erroneous immunoassay results are not always easily identifiable. Anti-Müllerian hormone (AMH) is a marker for the presence of gonads in dogs, but elevated AMH concentrations in neutered dogs could also be caused by antibody interference. For other assays, a discrepant result obtained after antibody precipitation might indicate antibody interference. OBJECTIVES We aimed to evaluate if canine anti-mouse antibodies are a source of erroneous results in the AMH assay and if antibody precipitation with polyethylene glycol (PEG) is a useful tool for detecting antibody interference in a variety of immunoassays used in the veterinary clinical laboratory. METHODS Twenty-nine positive and 25 negative samples for anti-mouse antibodies were analyzed for AMH, canine total thyroxine (TT4 ), canine thyroid-stimulating hormone (TSH) and progesterone before and after treatment with PEG. Results that differed by more than four SDs from the intra-assay coefficients of variation were considered discrepant. Elevated AMH concentrations in neutered dogs with anti-mouse antibodies and no visible gonads present were considered evidence of interference. RESULTS Evidence of antibody interference was found in two samples analyzed for AMH. The presence of anti-mouse antibodies did not lead to a higher proportion of discrepant results after PEG treatment for any of the immunoassays. The overall incidence of discrepant results for healthy controls was very high (73%). CONCLUSIONS Canine anti-mouse antibodies are a source of erroneous AMH results. Antibody precipitation with PEG is not a useful tool for detecting interference caused by such antibodies.
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Affiliation(s)
- Daniel Bergman
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Helene Hansson-Hamlin
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Bodil Ström Holst
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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48
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Falconer RJ. Advances in liquid formulations of parenteral therapeutic proteins. Biotechnol Adv 2019; 37:107412. [PMID: 31254660 DOI: 10.1016/j.biotechadv.2019.06.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/25/2019] [Accepted: 06/24/2019] [Indexed: 01/01/2023]
Abstract
Liquid formulation of therapeutic proteins is a maturing technology. Demand for products that are easy to use in the clinic or that are amenable to self-administration make a ready to use liquid formulation desirable. Most modern liquid formulations have a simple composition; comprising a buffer, a tonicity modifier, a surfactant, sometimes a stabiliser, the therapeutic protein and water. Recent formulations of monoclonal antibodies often use histidine or acetate as the buffer, sucrose or trehalose as the tonicity modifier and polysorbate 20 or 80 as the surfactant with a pH of 5.7 +/- 0.4. The mechanisms for the behaviour of excipients is still debated by academics so formulation design is still a black art. Fortunately, a statistical approach like design of experiment is suitable for formulation development and has been successful when combined with accelerated stability experimentation. The development of prefilled syringes and pens has added low viscosity and shear resistance to the quality attributes for a successful formulation. To achieve patient compliance for self-administration, formulations that cause minimal pain and tissue damage is also desirable.
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Affiliation(s)
- Robert J Falconer
- Department of Chemical Engineering & Advanced Materials, University of Adelaide, South Australia 5005, Australia.
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49
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Zhang Z, Guan Y, Xu G, Guo C. A new washing-free immunosensor for tumor marker detection based on functionalized Fe3O4 submicron particles. Microchem J 2019. [DOI: 10.1016/j.microc.2019.03.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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50
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Kaur A, Eberlein M, Klesney-Tait J, Durkin MM, Wheat LJ, Gajurel K. Rabbit Antithymocyte Globulin Causes Blastomyces and Histoplasma Antigenemia. Open Forum Infect Dis 2019; 6:ofz165. [PMID: 31065562 PMCID: PMC6499897 DOI: 10.1093/ofid/ofz165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022] Open
Abstract
Rabbit antithymocyte globulin (rATG) is known to yield false-positive Histoplasma antigenemia. The fourth generation MiraVista Histoplasma antigen assay was modified to block this effect (MiraVista Diagnostics, Indianapolis, Indiana). We report a case of rATG-induced false-positive Blastomyces and Histoplasma antigenemia in a lung transplant recipient despite modifications of these antigen assays.
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Affiliation(s)
- Amrit Kaur
- Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Michael Eberlein
- Division of Pulmonology and Occupational Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Julia Klesney-Tait
- Division of Pulmonology and Occupational Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | | | | | - Kiran Gajurel
- Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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