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Kravchenko M, Forbes W, Graybill S. Association of Serum Thyroxine and Atrial Fibrillation in Patients on Levothyroxine. Mil Med 2024:usae324. [PMID: 38913449 DOI: 10.1093/milmed/usae324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION Excess thyroid hormone is a well-documented risk factor for the development of atrial fibrillation (AF). The purpose of the study is to assess incidence of AF in patients taking levothyroxine for hypothyroidism and correlate it with biochemical thyroid function. MATERIALS AND METHODS This was a retrospective cohort study of patients aged 18 years and older who were treated with levothyroxine. Exclusion criteria were pre-existing diagnosis of AF and use of amiodarone in the prior year. Patients were followed 2012 through 2019 and stratified into 4 groups based on mean thyroid-stimulating hormone (TSH) value or mean fT4 value in 2012. Primary outcome was incidence of AF. Rates of AF between groups were assessed via Poisson regression with control of underlying confounders. RESULTS Of 21,035 patients, 1091 (5.2%) developed AF during follow-up. Thyroid-stimulating hormone at baseline was not significantly associated with incident AF. Higher fT4 levels at baseline were associated with increased AF risk in age- and sex-adjusted analyses (hazard ratio 1.22; 95% CI, 1.03-1.44) for the highest quartile versus the lowest quartile of fT4. CONCLUSIONS In hypothyroid patients treated with levothyroxine, higher circulating fT4 levels are associated with increased risk of incident AF. There is no association of serum TSH with risk of AF. In patients at risk for AF, consideration should be given to avoiding fT4 levels in the highest quartile.
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Affiliation(s)
- Maria Kravchenko
- Department of Medicine, Division of Endocrinology, Brooke Army Medical Center and Wilford Hall Ambulatory Surgical Center, San Antonio, TX 78234, USA
- Maryland Metabolic Institute, Ascension Saint Agnes Hospital, Baltimore, MD 21229, USA
| | - Whitney Forbes
- Defense Health Agency, Lackland Air Force Base, San Antonio, TX 78234, USA
| | - Sky Graybill
- Department of Medicine, Division of Endocrinology, Brooke Army Medical Center and Wilford Hall Ambulatory Surgical Center, San Antonio, TX 78234, USA
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2
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Balieiro Neto G, Engracia Filho JR, Budino FEL, Freitas AWDP, Soares WVB. Effects of High-Biotin Sample Interference on Antibody Concentrations in Sandwich Immunoassays. Vaccines (Basel) 2023; 11:1627. [PMID: 38005959 PMCID: PMC10674817 DOI: 10.3390/vaccines11111627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 11/26/2023] Open
Abstract
The use of antimicrobial growth promoters (AGPs) is banned because of problems associated with drug residues in animal products and increased bacterial resistance. The immunization of chickens with specific antigens is a promising strategy for generating specific antibodies that can target a wide range of antibiotic-resistant bacteria and can be used as an alternative to antibiotics. Immunoglobulin Y (IgY) antibodies in a polyclonal antibody (pAb) format, when administered orally, modulate the ruminal microbiome and maintain animal health and performance; however, there are concerns pertaining to protein impurities and biotin concentrations in the samples. Signal amplification strategies involving the noncovalent interaction of biotin with streptavidin is extensively used in diagnosis and scientific research, particularly in enzyme-linked immunosorbent assays (ELISAs). However, the high concentrations of biotin in samples, especially in those derived from rich sources such as egg yolk, can pose challenges and potentially harm the accuracy of diagnostic tests and protein concentration measurements. This study aimed to evaluate the influence of biotin on the measurement of IgY in freeze-dried egg yolk samples obtained from immunized laying hens using immunoassays with biotin-avidin/streptavidin. The detection of IgY in yolk samples using ELISA with streptavidin-biotin binding could lead to misdiagnosis due to biotin interference; the level of interference varies with the specific assay conditions and the concentration of biotin in the yolk samples. An ELISA without streptavidin-biotin binding is advisable to avoid interactions between biotin and target proteins, prevent biotin interference with the results, and achieve more reliable and accurate results.
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Affiliation(s)
- Geraldo Balieiro Neto
- Animal Science Institute, Sao Paulo Agency for Agribusiness Technology–APTA, Department of Agriculture and Food Supply, Ribeirao Preto 14030-670, SP, Brazil; (F.E.L.B.); (A.W.d.P.F.); (W.V.B.S.)
| | - Jair Rodini Engracia Filho
- Graduate Program of Animal Science, School of Life Sciences, Pontificia Universidade Catolica do Parana, Curitiba 80215-901, PR, Brazil;
| | - Fabio Enrique Lemos Budino
- Animal Science Institute, Sao Paulo Agency for Agribusiness Technology–APTA, Department of Agriculture and Food Supply, Ribeirao Preto 14030-670, SP, Brazil; (F.E.L.B.); (A.W.d.P.F.); (W.V.B.S.)
| | - Acyr Wanderley de Paula Freitas
- Animal Science Institute, Sao Paulo Agency for Agribusiness Technology–APTA, Department of Agriculture and Food Supply, Ribeirao Preto 14030-670, SP, Brazil; (F.E.L.B.); (A.W.d.P.F.); (W.V.B.S.)
| | - Weber Vilas Boas Soares
- Animal Science Institute, Sao Paulo Agency for Agribusiness Technology–APTA, Department of Agriculture and Food Supply, Ribeirao Preto 14030-670, SP, Brazil; (F.E.L.B.); (A.W.d.P.F.); (W.V.B.S.)
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3
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Caglayan M, Gonel A, Tayman C, Cakir U, Koyuncu I, Temiz E, Sert Y. Investigation of the effect of vitamin K1 prophylaxis on newborn screenings tests in newborns. J Med Biochem 2023; 42:376-382. [PMID: 37814616 PMCID: PMC10560507 DOI: 10.5937/jomb0-40162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 11/22/2022] [Indexed: 10/11/2023] Open
Abstract
Background Routine screening for hereditary disorders in newborns includes screening for treatable metabolic and endocrine disorders, such as biotidinase deficiency, galactosemia, maple syrup urine disease, hypothyroidism, and cystic fibrosis. Incorrect test results may be encountered due to the use of vitamin K1. To investigate the interference effect of vitamin K1 on neonatal screening tests and to raise awareness of erroneous measurements. Methods Heel blood samples were taken from 25 newborns born in a neonatal intensive care unit. Dry blood C0, C2, C3, C4, C4DC, C5:1, C5OH, C5DC, C6, C6DC, C8, C8:1, C8DC, C10, C10:1, C10DC, C12, C14, C14:1, C14:2, C16, C16:1, C18, C18:1, C18:2, C18:OH, methylglutaryl, valine, leucine/isoleucine, methionine, phenylalanine, argininosuccinic acid, aspartate, alanine, arginine, citrulline, glycine, ornithine, and glutamate tests were studied using the tandem mass spectrometry (MS) method. The results of the heel blood samples obtained before and after the application of vitamin K1 (Phyto menadione) were compared. Results In two studies conducted with in vitro and in vivo tests, C0, C2, C3, C4, C4DC, C5, C5OH, C6, C8, C10, C10:1, C14, C16, C16:1, C18, C18:1, methylglutaryl, phenylalanine, argininosuccinic acid, tyrosine, aspartate, arginine, citrulline, glycine, and glutamine were all significantly elevated (p < 0.05). Conclusions Heel blood samples may yield false results due to vitamin K1 administration. In the case of doubtful results, a new sample should be taken and the measurement should be repeated.
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Affiliation(s)
- Murat Caglayan
- Health Science University, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Medical Biochemistry, Ankara, Turkey
| | - Ataman Gonel
- Hasan Kalyoncu University, Faculty of Health Science, Medical Park Gaziantep Hastanesi, Department of Nutrition and Dietetics, Gaziantep, Turkey
| | - Cuneyt Tayman
- University of Health Sciences, Ankara City Hospital, Department of Neonatology, Cankaya, Ankara, Turkey
| | - Ufuk Cakir
- University of Health Sciences, Ankara City Hospital, Department of Neonatology, Cankaya, Ankara, Turkey
| | - Ismail Koyuncu
- Harran University, Medicine Faculty, Department of Medical Biochemistry, Sanliurfa, Turkey
| | - Ebru Temiz
- Harran University, Health Services Vocational School, Program of Medical Promotion and Marketing, Sanliurfa, Turkey
| | - Yasemin Sert
- Ankara City Hospital, Department of Gynecology Obstetrics, Ankara, Turkey
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4
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Giovanella L, D'Aurizio F, Algeciras-Schimnich A, Görges R, Petranovic Ovcaricek P, Tuttle RM, Visser WE, Verburg FA. Thyroglobulin and thyroglobulin antibody: an updated clinical and laboratory expert consensus. Eur J Endocrinol 2023; 189:R11-R27. [PMID: 37625447 DOI: 10.1093/ejendo/lvad109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/12/2023] [Accepted: 05/31/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Thyroglobulin measurement is the cornerstone of modern management of differentiated thyroid cancer, with clinical decisions on treatment and follow-up based on the results of such measurements. However, numerous factors need to be considered regarding measurement with and interpretation of thyroglobulin assay results. DESIGN The present document provides an integrated update to the 2013 and 2014 separate clinical position papers of our group on these issues. METHODS Issues concerning analytical and clinical aspects of highly-sensitive thyroglobulin measurement will be reviewed and discussed based on an extensive analysis of the available literature. RESULTS Thyroglobulin measurement remains a highly complex process with many pitfalls and major sources of interference, especially anti-thyroglobulin antibodies, need to be assessed, considered and, when necessary, dealt with appropriately. CONCLUSIONS Our expert consensus group formulated 53 practical, graded recommendations for guidance on highly-sensitive thyroglobulin and TgAb in laboratory and clinical practice, especially valuable where current guidelines do not offer sufficient guidance.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Federica D'Aurizio
- Institute of Clinical Pathology, Department of Laboratory Medicine, University Hospital of Udine, Udine, Italy
| | | | - Rainer Görges
- Department of Nuclear Medicine, University Hospital of Essen, Essen, Germany
| | - Petra Petranovic Ovcaricek
- Department of Oncology and Nuclear Medicine, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - W Edward Visser
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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5
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Cheng J, Mu D, Wang D, Qiu L, Cheng X. Preanalytical considerations in parathyroid hormone measurement. Clin Chim Acta 2023; 539:259-265. [PMID: 36566956 DOI: 10.1016/j.cca.2022.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Automated immunoassays used to evaluate parathyroid function are vulnerable to different types of interference, which can affect clinical practices. This review provides a detailed overview of the six main types of interference known to affect the measurement of parathyroid hormone (PTH): heterophilic antibodies, biotin, PTH fragments, oxidized PTH (oxPTH), phosphorylated PTH, and some preanalytical factors. Because the prevalence of some of these conditions has been reported to approach 11.7%, and the frequency of testing for parathyroid function is important, the scale of the problem might be tremendous. Potential interference in parathyroid function testing should always be suspected whenever clinical or biochemical discrepancies arise. Their identification typically relies on additional laboratory tests, including method comparison, serial dilution, blocking reagent studies, affinity adsorption, and polyethylene glycol precipitation. Moreover, some of these issues can be mitigated with the development of mass spectrometry. This review also evaluated the clinical impact of parathyroid interference on immunoassays, including misdiagnosis, inappropriate parathyroidectomy; and delay in receiving appropriate therapy. Hence, strong communication should be maintained between the clinician and laboratory to avoid such scenarios.
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Affiliation(s)
- Jin Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Danni Mu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Danchen Wang
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinqi Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China.
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Mannstadt M, Cianferotti L, Gafni RI, Giusti F, Kemp EH, Koch CA, Roszko KL, Yao L, Guyatt GH, Thakker RV, Xia W, Brandi ML. Hypoparathyroidism: Genetics and Diagnosis. J Bone Miner Res 2022; 37:2615-2629. [PMID: 36375809 DOI: 10.1002/jbmr.4667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/22/2022] [Accepted: 07/31/2022] [Indexed: 01/05/2023]
Abstract
This narrative report summarizes diagnostic criteria for hypoparathyroidism and describes the clinical presentation and underlying genetic causes of the nonsurgical forms. We conducted a comprehensive literature search from January 2000 to January 2021 and included landmark articles before 2000, presenting a comprehensive update of these topics and suggesting a research agenda to improve diagnosis and, eventually, the prognosis of the disease. Hypoparathyroidism, which is characterized by insufficient secretion of parathyroid hormone (PTH) leading to hypocalcemia, is diagnosed on biochemical grounds. Low albumin-adjusted calcium or ionized calcium with concurrent inappropriately low serum PTH concentration are the hallmarks of the disease. In this review, we discuss the characteristics and pitfalls in measuring calcium and PTH. We also undertook a systematic review addressing the utility of measuring calcium and PTH within 24 hours after total thyroidectomy to predict long-term hypoparathyroidism. A summary of the findings is presented here; results of the detailed systematic review are published separately in this issue of JBMR. Several genetic disorders can present with hypoparathyroidism, either as an isolated disease or as part of a syndrome. A positive family history and, in the case of complex diseases, characteristic comorbidities raise the clinical suspicion of a genetic disorder. In addition to these disorders' phenotypic characteristics, which include autoimmune diseases, we discuss approaches for the genetic diagnosis. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Luisella Cianferotti
- Bone Metabolic Diseases Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Rachel I Gafni
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Christian A Koch
- Department of Medicine/Endocrinology, Fox Chase Cancer Center, Philadelphia, PA, USA.,Department of Medicine/Endocrinology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kelly L Roszko
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Liam Yao
- Department of Health Research Methods, Evidence, and Impact, and Department of Medicine, McMaster University, Hamilton, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, and Department of Medicine, McMaster University, Hamilton, Canada
| | - Rajesh V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK.,Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Weibo Xia
- Department of Endocrinology, Peking Union Medical Collage Hospital, Beijing, China
| | - Maria-Luisa Brandi
- Fondazione Italiana sulla Ricerca sulle Malattie dell'Osso (F.I.R.M.O. Foundation), Florence, Italy
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Braunstein GD. Spurious Serum Hormone Immunoassay Results: Causes, Recognition, Management. TOUCHREVIEWS IN ENDOCRINOLOGY 2022; 18:141-147. [PMID: 36694886 PMCID: PMC9835809 DOI: 10.17925/ee.2022.18.2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/15/2022] [Indexed: 12/12/2022]
Abstract
For over 50 years, immunoassays have been extensively used to quantitate hormones in blood, other fluids and tissues. Each assay has its own sensitivity, specificity and other analytical components. Despite the differences between commercial products, these assays provide important clinical information about hormone levels in patients. However, inaccurate results can occur because of technical issues, as well as patient-specific factors that can interfere with immunoassay hormone measurements. The latter include excessive normal blood or serum components, the presence of cross-reacting substances, extremely high levels of hormones leading to the high-dose hook effect, and interference from a variety of endogenous factors such as human antibodies that interact with the assay components or high levels of biotin in the serum from exogenous ingestion. This article briefly reviews the sources and recognition of endogenous interference, and describes methods to determine the correct serum hormone concentration.
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Affiliation(s)
- Glenn D Braunstein
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Bilezikian JP, Khan AA, Silverberg SJ, Fuleihan GEH, Marcocci C, Minisola S, Perrier N, Sitges-Serra A, Thakker RV, Guyatt G, Mannstadt M, Potts JT, Clarke BL, Brandi ML, Balaya Z, Hofbauer L, Insogna K, Lacroix A, Liberman UA, Palermo A, Rizzoli R, Wermers R, Hannan FM, Pepe J, Cipriani C, Eastell R, Liu J, Mithal A, Moreira CA, Peacock M, Silva B, Walker M, Chakhtoura M, Schini M, Zein OE, Almquist M, Farias LCB, Duh Q, Lang BH, LiVolsi V, Swayk M, Vriens MR, Vu T, Yeh MW, Yeh R, Shariq O, Poch LL, Bandeira F, Cetani F, Chandran M, Cusano NE, Ebeling PR, Gosnell J, Lewiecki EM, Singer FR, Frost M, Formenti AM, Karonova T, Gittoes N, Rejnmark L. Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop. J Bone Miner Res 2022; 37:2293-2314. [PMID: 36245251 DOI: 10.1002/jbmr.4677] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022]
Abstract
The last international guidelines on the evaluation and management of primary hyperparathyroidism (PHPT) were published in 2014. Research since that time has led to new insights into epidemiology, pathophysiology, diagnosis, measurements, genetics, outcomes, presentations, new imaging modalities, target and other organ systems, pregnancy, evaluation, and management. Advances in all these areas are demonstrated by the reference list in which the majority of listings were published after the last set of guidelines. It was thus, timely to convene an international group of over 50 experts to review these advances in our knowledge. Four Task Forces considered: 1. Epidemiology, Pathophysiology, and Genetics; 2. Classical and Nonclassical Features; 3. Surgical Aspects; and 4. Management. For Task Force 4 on the Management of PHPT, Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology addressed surgical management of asymptomatic PHPT and non-surgical medical management of PHPT. The findings of this systematic review that applied GRADE methods to randomized trials are published as part of this series. Task Force 4 also reviewed a much larger body of new knowledge from observations studies that did not specifically fit the criteria of GRADE methodology. The full reports of these 4 Task Forces immediately follow this summary statement. Distilling the essence of all deliberations of all Task Force reports and Methodological reviews, we offer, in this summary statement, evidence-based recommendations and guidelines for the evaluation and management of PHPT. Different from the conclusions of the last workshop, these deliberations have led to revisions of renal guidelines and more evidence for the other recommendations. The accompanying papers present an in-depth discussion of topics summarized in this report. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- John P Bilezikian
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Aliya A Khan
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Shonni J Silverberg
- Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO CC for Metabolic Bone Disorders, Division of Endocrinology, American University of Beirut, Beirut, Lebanon
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy
| | - Salvatore Minisola
- Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, 'Sapienza', Rome University, Rome, Italy
| | - Nancy Perrier
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Rajesh V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Oxford, UK
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael Mannstadt
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John T Potts
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bart L Clarke
- Mayo Clinic Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Maria Luisa Brandi
- Fondazione Italiana sulla Ricerca sulle Malattie dell'Osso (F.I.R.M.O. Foundation), Florence, Italy
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Favresse J, Schiettecatte J, Wolff F, Cotton F, Elsen M, Eucher C, Rosseels C, Anckaert E. Two-site evaluation of the Roche Elecsys Vitamin D total III assay. Clin Chem Lab Med 2022; 60:1598-1606. [PMID: 35849629 DOI: 10.1515/cclm-2022-0177] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/03/2022] [Indexed: 08/16/2024]
Abstract
OBJECTIVES The high request for vitamin D testing in the last decades has led manufacturers to develop assays on automated immunoassay platforms. The objective of this study was to evaluate the performance of the new Elecsys Vitamin D total III assay for the measurement of total 25(OH)D. METHODS A total of 844 serum samples collected in two clinical laboratories were used to evaluate the new Roche Elecsys Vitamin D total III assay. Comparisons with Roche Elecsys Vitamin D total II and liquid chromatography tandem mass spectrometry (LC-MS/MS) were carried out. Additionally, assay imprecision, linearity, matrix effects, biotin interference, cross-reactivity with 24,25(OH)2D3 and 3-epi-25(OH)D3, and outlier rate were evaluated for the Elecsys Vitamin D total III assay. RESULTS Only the comparison between LC-MS/MS and Roche Elecsys Vitamin D total III achieved the optimal specification for bias (i.e., <3.4%). Imprecision, linearity and matrix effects showed acceptable results. The biotin interference threshold was increased up to 1,200 ng/mL and the outlier rate was low (0.26%). The cross-reactivity with 24,25(OH)2D3 and 3-epi-25(OH)D3 was weak or modest in available patient samples. However, using SRM972a with a high level of 3-epi-25(OH)D3 (enriched) revealed an important cross-reactivity with both Roche Elecsys Vitamin D total II and III assays (+74.7% and +73.7%). CONCLUSIONS In conclusion, the Roche Elecsys Vitamin D total III assay presents several advantages compared to the previous assay generation: higher biotin interference threshold, broader measuring range, and better comparability with LC-MS/MS. However, the cross-reactivity toward 3-epi-25(OH)D3 is still problematic in high titer samples.
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Affiliation(s)
- Julien Favresse
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
- Department of Pharmacy, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium
| | - Johan Schiettecatte
- Department of Clinical Chemistry and Radioimmunology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Fleur Wolff
- Department of Clinical Chemistry, LHUB-ULB, Université Libre de Bruxelles, Brussels, Belgium
| | - Frederic Cotton
- Department of Clinical Chemistry, LHUB-ULB, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Elsen
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Christine Eucher
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Catherine Rosseels
- Department of Laboratory Medicine, Clinique St-Luc Bouge, Namur, Belgium
| | - Ellen Anckaert
- Department of Clinical Chemistry and Radioimmunology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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10
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Development and Evaluation of an Anti-Biotin Interference Method in Biotin-Streptavidin Immunoassays. Diagnostics (Basel) 2022; 12:diagnostics12071729. [PMID: 35885633 PMCID: PMC9324022 DOI: 10.3390/diagnostics12071729] [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: 05/11/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
The strong non-covalent interaction between biotin and streptavidin places streptavidin-based assays, used by many laboratories, at an increased risk of interference by biotin. At present, a few manufacturers have developed fully automated anti-biotin interference methods, although compared with many detection platforms, these remain insufficient. Additionally, there is a need for more methods that can achieve fully automated anti-biotin interference. We sought to develop and evaluate a new biotin interference-resisting method based on a biotin-streptavidin chemiluminescence immunoassay. Streptavidin-coated magnetic microparticles (M) of different concentrations were prepared and tested for their biotin-resistance capabilities in an automated setting (Cobas e 601). The precision, accuracy, and detection capability were also assessed. Higher concentrations of M were found to have a stronger ability to resist biotin interference. A 2.16 mg/mL concentration of M was able to resist 500 ng/mL of biotin in samples while simultaneously having a relatively weak shielding effect on the optical signals. Moreover, the total precision and accuracy of this method, designated as M3, met acceptable standards. M3 has an improved ability to resist biotin interference, can achieve full automation, and its detection performance can meet the general laboratory quality requirements.
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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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12
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Moerman A, Delanghe JR. Sense and nonsense concerning biotin interference in laboratory tests. Acta Clin Belg 2022; 77:204-210. [PMID: 32567529 DOI: 10.1080/17843286.2020.1780770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Biotin supplementation (mainly OTC preparations) has gained popularity. There are concerns about biotin interference in immunoassays and potential misdiagnosis, especially since the discovery of high dose therapy in MS. This review summarizes the dangers of biotin usage and possible countermeasures. METHODS Immunoassays design determines whether positive or negative analytical errors may occur. Techniques using biotinylated reagent and biotin binding proteins may generate errors. In sandwich immunoassays, biotin causes lowered results. Competitive immunoassays are more vulnerable: biotin usage causes false increased results. The interference is platform dependent. Parameters vary in their susceptibility: a combination of false positives and negatives mimicking a coherent profile is dangerous, e.g. combining falsely lowered TSH with falsely elevated FT4/FT3 mimicking hyperthyreosis. Other susceptible parameters are thyroglobulin, DHEA-S, estradiol, testosterone, ferritin, progesterone, Vitamin D, Vitamin B12, PSA, PTH, LH, FSH, Troponins I and T, Pro-BNP. Digoxin and PSA may also be affected. Tumor markers and ß-hCG are robust. Inserts of serological markers of HIV, hepatitis B and C warn for biotin interference. RESULTS Manufacturers have made assays less vulnerable for biotin interference. In doubtful cases, it is helpful to determine testosterone in females and estrogen in males. Both are elevated if biotin interference is present. Biotin supplementation should be discontinued. However, this is impossible in MS patients needing biotin, as interrupting this medication is discouraged. CONCLUSIONS Solutions to overcome this interference are: informing patients prior to analysis (avoiding peak biotin values when sampling), choice of appropriate immunoassays, and use of biotin removing steps prior to analysis.
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Nelson HA, La'ulu SL, Lu J, Doyle K. Mitigation of Biotin Interference in Manual and Automated Immunoassays by Preconjugating Biotinylated Antibodies to the Streptavidin Surface as an Alternative to Biotin Depletion. J Appl Lab Med 2022; 7:762-775. [PMID: 35018420 DOI: 10.1093/jalm/jfab169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/28/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Streptavidin-to-biotin binding is one of the strongest noncovalent interactions in nature and incorporated into many immunoassays. Biotin-streptavidin coupling assays are susceptible to interference from free biotin in patient specimens, which may falsely decrease or increase results. To prevent biotin interference, we evaluated a method to preconjugate biotinylated antibodies to the assay's streptavidin solid surface before adding patient specimen and compared this technique to a biotin depletion protocol. METHODS Biotin interference in 3 manual ELISAs and 2 automated immunoassays was established. Mitigation of biotin interference by preincubation was evaluated in each assay by adding biotinylated antibody to the streptavidin-coated surface before adding biotin- or PBS-spiked serum. Lastly, the preincubation method was compared to a biotin-depletion protocol to compare the effectiveness of mitigating biotin interference. RESULTS In the presence of 400 µg/L biotin, analyte detection was reduced to 10% to 15% of total in the ELISA assays and to 15.2% in the automated sandwich (thyroglobulin) immunoassay. In the automated competitive (free thyroxine) immunoassay, biotin caused an increased detection of 551.6%. Preconjugation of the biotinylated capture antibody to the streptavidin surface in the ELISA assays resulted in 84% to 99% activity recovery, compared to 84% to 97% by a biotin depletion protocol. Similarly, automated sandwich and competitive immunoassays obtained 97.1% and 116.5% recovery by preconjugation, compared to 95.6% and 100.3% by the depletion method, respectively. CONCLUSION This study demonstrates how assay redesign to include preconjugation of biotinylated capture antibody to streptavidin is an effective alternative to biotin-depletion methods to mitigate biotin interference.
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Affiliation(s)
- Heather A Nelson
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Sonia L La'ulu
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Jun Lu
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Kelly Doyle
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
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14
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Dasgupta A. Immunoassay design and biotin interference. Adv Clin Chem 2022; 109:165-183. [DOI: 10.1016/bs.acc.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Ashraf Z, Farhat S, Rather MY. Use of Saliva as an Alternative Matrix to Serum/Plasma for Therapeutic Drug Monitoring Using Reverse-Phase HPLC. Clin Ther 2021; 43:2127-2135. [PMID: 34794834 DOI: 10.1016/j.clinthera.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE This study was conducted to examine and verify the use of saliva as an alternative matrix for monitoring phenytoin drug levels in patients with epilepsy. Drug concentrations are measured to evaluate whether a suitable drug level has been achieved to minimize the risk for toxicity, inadequate efficacy, or therapy resistance and compliance issues. METHODS Quantitative analysis was performed by using reverse-phase HPLC after sample pretreatment with acetonitrile. Seventy-eight patients who met the inclusion/exclusion criteria were examined in this study. Trough concentrations of both saliva and serum were taken at steady state. FINDINGS Of the 78 patients enrolled, only 11 (14.1%) had normal levels. Twenty-eight patients (35.9%) had subtherapeutic levels, and 39 (50%) had toxic levels. Simultaneously, salivary phenytoin levels were analyzed; only 13 patients (17.3%) had therapeutic levels, 25 patients (33.3%) had subtherapeutic levels, and 37 (49.3%) had toxic levels. Among the study population, most of the patients were aged 31 to 40 years (25.6%) followed by the age group 21 to 30 years (19.2%). The lowest percentage of patients were in the age groups 71 to 80 years and >80 years (1.3%) each. This study found a statistically significant relationship between free serum and salivary phenytoin levels (P < 0.001). A very weak and insignificant correlation was observed between serum/salivary phenytoin levels and sex/age of the study population. The results of the present study support the use of saliva as an alternative to serum/plasma for monitoring phenytoin therapy. IMPLICATIONS The free concentration of a drug represents the freely diffusible drug fraction, which is the therapeutically active form. Accordingly, the free drug concentration correlates to clinical efficacy and drug toxicity better than total concentration.
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Affiliation(s)
- Zuryat Ashraf
- Postgraduate Department of Pharmacology, Government Medical College Srinagar, Srinagar, India
| | - Samina Farhat
- Postgraduate Department of Pharmacology, Government Medical College Srinagar, Srinagar, India
| | - Mohd Younis Rather
- Multidisciplinary Research Unit, Government Medical College Srinagar, Srinagar, Jammu and Kashmir, India.
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16
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Öncül Ü, Eminoğlu FT, Köse E, Doğan Ö, Özsu E, Aycan Z. Serum biotin interference: A troublemaker in hormone immunoassays. Clin Biochem 2021; 99:97-102. [PMID: 34736903 DOI: 10.1016/j.clinbiochem.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/27/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Biotin therapy can affect the results of many immunoassay procedures. The present study investigates biotin's interference on 25-hydroxy vitamin D (25-OHD), parathyroidhormone (PTH) and thyroid-stimulating hormone (TSH) tests using four different assay systems and biotin neutralization. DESIGN AND METHODS Enrolled in the study were 50 children diagnosed with biotinidase deficiency (BTD) undergoing treatment with biotin (5-20 mg/day) who were subjected to a series of analyses involving 25-OHD (Roche Diagnostics assays, Beckman Coulter assays, HPLC, LC/MS-MS), TSH, PTH (Roche Diagnostics assays, Beckman Coulter assays) and biotin (LC/MS-MS), before and after biotin neutralization with Streptavidin-coated magnetic particles (SMP). RESULTS The median biotin concentration was found to be 175.2 [94.0-307.1] μg/L. There was no significant difference in the 25-OHD results before and after neutralization with the Beckman Coulter, HPLC and LC-MS/MS assays. In contrast, the median 25-OHD level was seen to decrease from 90.2 [35.9-105.3] ng/mL to 29.1 [22.6-37.6] ng/mL after neutralization with the Roche assay (p < 0.0001). While there was no statistically significant difference in the values recorded before and after neutralization in PTH analysis using Beckman assay, the median PTH levels increased from 7.8 [1.6-21.6] pg/mL to 28.2 [22.5-41.9] pg/mL after neutralization with the Roche assay (p < 0.0001). The cut-off values at which serum biotin interfered in the Roche assay PTH test, with 25-OHD levels determined as 51.4 μg/L and 62.9 μg/L, respectively. A significant increase was detected in the TSH levels analyzed with a Roche assay after neutralization (from 2.36 [1.85-3.00] mIU/L to 2.74 [1.93-3.70] mIU/L, p < 0.0001). CONCLUSIONS The PTH, 25-OHD and TSH results were found to be affected by high biotin concentrations in Roche assays, leading to a risk of misdiagnosis, although SMP neutralization can suppress any such interference efficiently.
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Affiliation(s)
- Ümmühan Öncül
- Department of Pediatric Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatma Tuba Eminoğlu
- Department of Pediatric Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Engin Köse
- Department of Pediatric Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özlem Doğan
- Department of Biochemistry, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elif Özsu
- Department of Pediatric Endocrinology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zehra Aycan
- Department of Pediatric Endocrinology, Ankara University Faculty of Medicine, Ankara, Turkey
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17
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Sobolevsky T, Ahrens B. Biotin as a masking agent in chorionic gonadotropin assays utilizing biotinylated antibodies. Drug Test Anal 2021; 13:1929-1935. [PMID: 34378342 DOI: 10.1002/dta.3141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 11/06/2022]
Abstract
Biotin interference in streptavidin/biotin-based immunoassays has been recently recognized as a confounding factor in clinical settings. Depending on the nature of the assay, the presence of excess biotin in patient samples can cause falsely high or low results. One of the platforms known to be affected, Roche Cobas, is widely used in anti-doping laboratories to test for intact chorionic gonadotropin (hCG) in urine. While biotin levels in blood have been well studied, less is known about urinary biotin due to its limited clinical significance. Having analyzed over 4000 urine samples, we have established a reference range for urinary biotin with a median concentration of approximately 12 ng/mL. However, a significant number of samples contain much higher amounts, with a maximum approaching 10 μg/mL, suggesting biotin supplementation. Consequently, the tolerance of hCG STAT assay towards biotin was investigated over a wide concentration range. The apparent hCG concentration was found to decrease almost linearly as biotin increased from 100 to 1000 ng/mL, with only 10% of the expected value reported by the assay as biotin reached 1000 ng/mL. Further increase of biotin resulted in a progressive, albeit more moderate, decline in measured hCG concentration. To avoid a false negative result in the context of anti-doping analysis, it is highly recommended to monitor biotin in urine and perform diafiltration before hCG measurement in samples with elevated biotin to remove the interference.
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Affiliation(s)
- Tim Sobolevsky
- UCLA Olympic Analytical Laboratory, Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, Los Angeles, California, USA
| | - Brian Ahrens
- UCLA Olympic Analytical Laboratory, Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, Los Angeles, California, USA
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Mohan S, Kolluri N, McCoy RG. 45-Year-Old Woman With Fever and Malaise. Mayo Clin Proc 2021; 96:2248-2253. [PMID: 34226032 PMCID: PMC8652236 DOI: 10.1016/j.mayocp.2020.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/21/2022]
Abstract
A 45-year-old woman presented to our clinic in July 2019 for evaluation of intermittent fever, rigors, diaphoresis, malaise, and urinary symptoms of frequency and urgency of 5 days’ duration. Her history was notable for Graves disease after total thyroidectomy 8 months previously after failed medical management, with no neck swelling or pain at present; an incidentally discovered and resected papillary thyroid microcarcinoma; and hypertension. A reconciled medication list included levothyroxine (125 μg/d), sertraline (100 mg/d), amphetamine-dextroamphetamine (20 mg/d), propranolol (40 mg twice daily), selenium (200 μg/d), and biotin (10 mg/d). She reported no relevant family history or sick contacts, but she may have had tick exposure. Physical examination revealed a temperature of 39.4 °C, heart rate of 64 beats/min, blood pressure of 98/56 mm Hg, weight of 85 kg, exophthalmos and lagophthalmos, and healed Kocher incision with no neck masses or tenderness. Abdominal examination revealed mild suprapubic tenderness. The differential diagnosis included infection (urinary tract infection [UTI], viral syndrome, tick-borne illness) and hyperthyroidism in the setting of ongoing levothyroxine therapy and her history of Graves disease. Subsequent laboratory studies revealed the following (reference ranges provided parenthetically): hemoglobin, 10.7 g/dL (11.6 to 15.0 g/dL); white blood cell count, 16.7 × 109/L (3.4 to 9.6 × 109/L); creatinine, 0.91 mg/dL (0.59 to 1.04 mg/dL); 2 sets of blood cultures with negative results; urine culture growing Escherichia coli, greater than 100,000 colony-forming units per milliliter; and negative results on a tick-borne pathogen panel including Lyme disease serology. Chest radiography revealed no abnormalities. Thyroid function testing (TFT) revealed the following: thyrotropin, 0.01 mIU/L (0.3 to 4.2 mIU/L); free thyroxine (fT4), 1.3 ng/dL (0.9 to 1.7 ng/dL); and free triiodothyronine (fT3) 2.4 pg/mL (2.8 to 4.4 pg/mL). Antimicrobial therapy was initiated for a UTI.
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Affiliation(s)
- Sneha Mohan
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Nikhil Kolluri
- Fellow in Cardiovascular Diseases, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Rozalina G McCoy
- Associate Professor of Medicine and Consultant in Community Internal Medicine and Health Care Policy and Research, Mayo Clinic, Rochester, MN.
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19
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Ylli D, Soldin SJ, Stolze B, Wei B, Nigussie G, Nguyen H, Mendu DR, Mete M, Wu D, Gomes-Lima CJ, Klubo-Gwiezdzinska J, Burman KD, Wartofsky L. Biotin Interference in Assays for Thyroid Hormones, Thyrotropin and Thyroglobulin. Thyroid 2021; 31:1160-1170. [PMID: 34042535 PMCID: PMC8420951 DOI: 10.1089/thy.2020.0866] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Biotin has been reported to interfere with several commonly used laboratory assays resulting in misleading values and possible erroneous diagnosis and treatment. This report describes a prospective study of possible biotin interference in thyroid-related laboratory assays, with a comparison of different commonly used assay platforms. Materials and Methods: Thirteen adult subjects (mean age 45 ± 13 years old) were administered biotin 10 mg/day for eight days. Blood specimens were collected at three time points on day 1 and on day 8 (baseline, two, and five hours after biotin ingestion). Thyrotropin (TSH), free triiodothyronine (fT3), free thyroxine (fT4), total triiodothyronine (TT3), total thyroxine (TT4), thyroxine binding globulin (TBG), and thyroglobulin (Tg) levels were analyzed with four different platforms: Abbott Architect, Roche Cobas 6000, Siemens IMMULITE 2000, and liquid chromatography with tandem mass spectrometry (LC-MS/MS). TSH, fT3, fT4, TT3, and TT4 were measured with Abbott Architect and Roche Cobas 6000. fT3, fT4, TT3, and TT4 were also measured by LC-MS/MS. Tg was measured by Siemens IMMULITE 2000. TBG was assessed with Siemens IMMULITE 2000. Results: Significant changes in TSH, fT4, and TT3 measurements were observed after biotin exposure when the Roche Cobas 6000 platform was used. Biotin intake resulted in a falsely lower Tg level when measurements were performed with Siemens IMMULITE 2000. At the time points examined, maximal biotin interference was observed two hours after biotin exposure both on day 1 and day 8. Conclusions: A daily dose of 10 mg was shown to interfere with specific assays for TSH, fT4, TT3, and Tg. Physicians must be aware of the potential risk of erroneous test results in subjects taking biotin supplements. Altered test results for TSH and Tg can be particularly problematic in patients requiring careful titration of levothyroxine therapy such as those with thyroid cancer.
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Affiliation(s)
- Dorina Ylli
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Steven J. Soldin
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Brian Stolze
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Bin Wei
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Girum Nigussie
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Hung Nguyen
- Department of Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland, USA
| | - Damodara Rao Mendu
- Department of Laboratory Medicine, Mount Sinai Hospital NY, New York, New York, USA
| | - Mihriye Mete
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Di Wu
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Cristiane J. Gomes-Lima
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Joanna Klubo-Gwiezdzinska
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Kenneth D. Burman
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Leonard Wartofsky
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Address correspondence to: Leonard Wartofsky, MD, Endocrinology Division, MedStar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
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20
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Li D, Ferguson A, Cervinski MA, Lynch KL, Kyle PB. AACC Guidance Document on Biotin Interference in Laboratory Tests. J Appl Lab Med 2021; 5:575-587. [PMID: 32445355 DOI: 10.1093/jalm/jfz010] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/28/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laboratory tests that use streptavidin-biotin binding mechanisms have the potential to be affected by high circulating biotin concentrations, which would produce positive and negative interference in biotinylated competitive and noncompetitive (sandwich) immunoassays, respectively. Consumption of high-dose biotin supplements for cosmetic or health-related reasons has drawn attention to biotin interference in clinical laboratory tests. Case reports and in vivo studies show that ingestion of supplemental biotin can cause clinically significant errors in select biotinylated immunoassays. CONTENT This AACC Academy document is intended to provide guidance to laboratorians and clinicians for preventing, identifying, and dealing with biotin interference. In vivo and in vitro spiking studies have demonstrated that biotin concentrations required to cause interference vary by test and by manufacturer. This document includes discussion of biotin's mechanisms for interference in immunoassays, pharmacokinetics, and results of in vitro and in vivo studies and cites examples of assays known to be affected by high biotin concentrations. This document also provides guidance recommendations intended to assist laboratories and clinicians in identifying and addressing biotin interference in laboratory testing. SUMMARY The recent increase in the use of high-dose biotin supplements requires laboratorians and clinicians to be mindful of the potential for biotin interference in biotinylated immunoassay-based laboratory tests. Laboratories, clinicians, regulators, and patients should work together to ensure accurate laboratory results. Laboratories have several options for identifying suspected biotin interference in specimens. Alternatively, the relatively fast elimination of biotin allows the potential for rapid follow-up specimen analysis if necessary.
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Affiliation(s)
- Danni Li
- Department of Lab Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN
| | - Angela Ferguson
- Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Mark A Cervinski
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Patrick B Kyle
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS
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21
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Favresse J, Bayart JL, Burlacu MC, Maiter D, Dogné JM, Douxfils J, Gruson D. Usefulness of a Non-Streptavidin Bead Technology to Overcome Biotin Interference: Proof of Principle with 25-OH Vitamin D, TSH, and FT4. J Appl Lab Med 2021; 6:1072-1077. [PMID: 33382887 DOI: 10.1093/jalm/jfaa203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Julien Favresse
- Department of Laboratory Medicine, Cliniques Universitaires St-Luc and Université catholique de Louvain, Brussels, Belgium.,Department of Laboratory Medicine, Clinique Saint-Luc, Namur, Belgium
| | - Jean-Louis Bayart
- Department of Laboratory Medicine, Cliniques Universitaires St-Luc and Université catholique de Louvain, Brussels, Belgium
| | - Maria-Cristina Burlacu
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université catholique de Louvain, Brussels, Belgium
| | - Dominique Maiter
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université catholique de Louvain, Brussels, Belgium
| | - Jean-Michel Dogné
- Department of Pharmacy, Namur Research Institute for Life Sciences, Namur Thrombosis and Hemostasis Center, University of Namur, Namur, Belgium
| | - Jonathan Douxfils
- Department of Pharmacy, Namur Research Institute for Life Sciences, Namur Thrombosis and Hemostasis Center, University of Namur, Namur, Belgium.,QUALIblood sa, Namur, Belgium
| | - Damien Gruson
- Department of Laboratory Medicine, Cliniques Universitaires St-Luc and Université catholique de Louvain, Brussels, Belgium.,Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université catholique de Louvain, Brussels, Belgium
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22
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Ettleson MD, Bianco AC, Zhu M, Laiteerapong N. Sociodemographic Disparities in the Treatment of Hypothyroidism: NHANES 2007-2012. J Endocr Soc 2021; 5:bvab041. [PMID: 34104843 PMCID: PMC8156978 DOI: 10.1210/jendso/bvab041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Both undertreatment and overtreatment of hypothyroidism with thyroid hormone are associated with adverse clinical outcomes. Disparities in the treatment of hypothyroidism may lead to a higher risk of adverse outcomes for certain sociodemographic groups. Our objectives were to identify sociodemographic disparities between those with treated and untreated hypothyroidism, and between those who were adequately and inadequately treated. METHODS This is a cross-sectional study of a representative sample of US adults aged 20 years and older with hypothyroidism (n = 698). The main measures were age, gender, race/ethnicity, education, income, and health care access differences among those with treated and untreated hypothyroidism. RESULTS Of those with hypothyroidism, women were more likely than men to be taking thyroid hormone (odds ratio [OR] 2.66 [95% confidence interval (CI) 1.42-4.99]), as were older participants (45-69 years old vs 20-44 years old: OR 7.25 [95% CI 4.15-12.67]; 70 years of age and older: OR 11.00 [95% CI 5.30-22.79]). Health care access was strongly associated with thyroid hormone use (OR 14.32, 95% CI 3.63-56.58). Hispanic race/ethnicity was associated with inadequate treatment compared with non-Hispanic whites (OR 2.42, 95% CI: 1.14-5.14). MAIN CONCLUSIONS Male gender, younger age, and lack of health care access were associated with untreated hypothyroidism, and Hispanic race was associated with inadequate treatment of hypothyroidism. Clinicians should be aware of these sociodemographic disparities in the hypothyroid population and consider strategies to improve treatment of hypothyroidism in men, younger adults, Hispanics, and those without routine health care access.
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Affiliation(s)
- Matthew D Ettleson
- Section of Endocrinology, Diabetes and Metabolism, Universtity of Chicago, Chicago, IL 60637, USA
| | - Antonio C Bianco
- Section of Endocrinology, Diabetes and Metabolism, Universtity of Chicago, Chicago, IL 60637, USA
| | - Mengqi Zhu
- Section of General Internal Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Neda Laiteerapong
- Section of General Internal Medicine, University of Chicago, Chicago, IL 60637, USA
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Salota R, Lapsley M, Nabi E, Packer S, Hyer S, Dockrell M. Time-resolved fluorescence immunoassay for urine retinol-binding protein is more sensitive than polyclonal and monoclonal assays. Ann Clin Biochem 2021; 58:505-519. [PMID: 34006121 DOI: 10.1177/00045632211020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Retinol-binding protein4 (RBP) assays using polyclonal antibodies (pRBP) have major problems of non-linearity of dilution and a very small useable dynamic range. Our objective was to develop a specific assay with a wider dynamic range to detect tubular proteinuria. METHODS mRBP (monoclonal capture and second antibody with colorimetric detection) and fluoroimmunoassays for RBP (fRBP) (polyclonal capture and monoclonal second antibody with fluorescence detection) were developed and compared with pRBP. Four hundred and eighty-eight patient samples were collected; 290 samples were analysed by mRBP and 198 samples with fRBP and compared with pRBP. RESULTS mRBP assay has the advantages of better linearity on dilution and wider analytical range over pRBP. It is limited by poor signal in the patients with albuminuria and glomerular proteinuria and inferior discrimination between patient groups. fRBP had an intra-assay and inter-assay CV of <6% and <8%, respectively, and analytical range was 2.3-599 µg/L. fRBP was linear on dilution within the analytical range. Correlation (r) was 0.8722 (95% CI 0.7621 to 0.9333, P< 0.0001); Mann-Whitney test revealed no significant difference (U = 18,877, n = 198, P = 0.5244) asserting that the medians of the two samples were identical. Bland-Altman test between pRBP and fRBP showed a mean negative bias of 16.43 (CI -994 to 1027) µg/mmol. CONCLUSIONS The combination assay with fluorescence detection (fRBP) proved more discriminatory than a purely monoclonal system especially in patients with significant proteinuria and has advantages of better linearity on dilution and wider analytical range than the existing pRBP assay and compared extremely well with pRBP.
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Affiliation(s)
- Rashim Salota
- Department of Clinical Biochemistry, Epsom and St Helier University Hospitals NHS Trust Surrey, UK
| | - Marta Lapsley
- Department of Clinical Biochemistry, Epsom and St Helier University Hospitals NHS Trust Surrey, UK
| | - Ekramun Nabi
- South West Thames Institute for Renal Research, Epsom and St. Helier University Hospitals NHS Trust, Surrey, UK
| | | | - Steve Hyer
- Diabetes and Endocrinology, Epsom and St Helier University Hospitals NHS Trust, Surrey, UK
| | - Mark Dockrell
- South West Thames Institute for Renal Research, Epsom and St. Helier University Hospitals NHS Trust, Surrey, UK
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Harley K, Bissonnette S, Inzitari R, Schulz K, Apple FS, Kavsak PA, Gunsolus IL. Independent and combined effects of biotin and hemolysis on high-sensitivity cardiac troponin assays. Clin Chem Lab Med 2021; 59:1431-1443. [PMID: 33761581 DOI: 10.1515/cclm-2021-0124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/16/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES This study compared the independent and combined effects of hemolysis and biotin on cardiac troponin measurements across nine high-sensitivity cardiac troponin (hs-cTn) assays. METHODS Parallel cTn measurements were made in pooled lithium heparin plasma spiked with hemolysate and/or biotin using nine hs-cTn assays: Abbott Alinity, Abbott ARCHITECT i2000, Beckman Access 2, Ortho VITROS XT 7600, Siemens Atellica, Siemens Centaur, Siemens Dimension EXL cTnI, and two Roche Cobas e 411 Elecsys Troponin T-hs cTnT assays (outside US versions, with and without increased biotin tolerance). Absolute and percent cTn recovery relative to two baseline concentrations were determined in spiked samples and compared to manufacturer's claims. RESULTS All assays except the Ortho VITROS XT 7600 showed hemolysis and biotin interference thresholds equivalent to or greater than manufacturer's claims. While imprecision confounded analysis of Ortho VITROS XT 7600 data, evidence of biotin interference was lacking. Increasing biotin concentration led to decreasing cTn recovery in three assays, specifically both Roche Cobas e 411 Elecsys Troponin T-hs assays and the Siemens Dimension EXL. While one of the Roche assays was the most susceptible to biotin among the nine studied, a new version showed reduced biotin interference by approximately 100-fold compared to its predecessor. Increasing hemolysis also generally led to decreasing cTn recovery for susceptible assays, specifically the Beckman Access 2, Ortho VITROS XT 7600, and both Roche Cobas e 411 Elecsys assays. Equivalent biotin and hemolysis interference thresholds were observed at the two cTn concentrations considered for all but two assays (Beckman Access 2 and Ortho VITROS XT 7600). When biotin and hemolysis were present in combination, biotin interference thresholds decreased with increasing hemolysis for two susceptible assays (Roche Cobas e 411 Elecsys and Siemens Dimension EXL). CONCLUSIONS Both Roche Cobas e 411 Elecsys as well as Ortho VITROS XT assays were susceptible to interference from in vitro hemolysis at levels routinely encountered in clinical laboratory samples (0-3 g/L free hemoglobin), leading to falsely low cTn recovery up to 3 ng/L or 13%. While most assays are not susceptible to biotin at levels expected with over-the-counter supplementation, severely reduced cTn recovery is possible at biotin levels of 10-2000 ng/mL (41-8,180 nmol/L) for some assays. Due to potential additive effects, analytical interferences should not be considered in isolation.
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Affiliation(s)
| | - Sarah Bissonnette
- Department of Pathology, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Rosanna Inzitari
- University College Dublin School of Medicine, Clinical Research Centre, Dublin, Ireland
| | - Karen Schulz
- Hennepin Healthcare Research Institute, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Fred S Apple
- Departments of Laboratory Medicine & Pathology, Hennepin Healthcare/Hennepin County Medical Center, Hennepin Healthcare Research Institute and University of Minnesota, Minneapolis, MN, USA
| | - Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Ian L Gunsolus
- Department of Pathology, Medical College of Wisconsin, 8701 W Watertown Plank Road, Milwaukee, WI, 53226, USA
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Oreskovic A, Lutz BR. Ultrasensitive hybridization capture: Reliable detection of <1 copy/mL short cell-free DNA from large-volume urine samples. PLoS One 2021; 16:e0247851. [PMID: 33635932 PMCID: PMC7909704 DOI: 10.1371/journal.pone.0247851] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/12/2021] [Indexed: 12/19/2022] Open
Abstract
Urine cell-free DNA (cfDNA) is a valuable non-invasive biomarker with broad potential clinical applications, but there is no consensus on its optimal pre-analytical methodology, including the DNA extraction step. Due to its short length (majority of fragments <100 bp) and low concentration (ng/mL), urine cfDNA is not efficiently recovered by conventional silica-based extraction methods. To maximize sensitivity of urine cfDNA assays, we developed an ultrasensitive hybridization method that uses sequence-specific oligonucleotide capture probes immobilized on magnetic beads to improve extraction of short cfDNA from large-volume urine samples. Our hybridization method recovers near 100% (95% CI: 82.6-117.6%) of target-specific DNA from 10 mL urine, independent of fragment length (25-150 bp), and has a limit of detection of ≤5 copies of double-stranded DNA (0.5 copies/mL). Pairing hybridization with an ultrashort qPCR design, we can efficiently capture and amplify fragments as short as 25 bp. Our method enables amplification of cfDNA from 10 mL urine in a single qPCR well, tolerates variation in sample composition, and effectively removes non-target DNA. Our hybridization protocol improves upon both existing silica-based urine cfDNA extraction methods and previous hybridization-based sample preparation protocols. Two key innovations contribute to the strong performance of our method: a two-probe system enabling recovery of both strands of double-stranded DNA and dual biotinylated capture probes, which ensure consistent, high recovery by facilitating optimal probe density on the bead surface, improving thermostability of the probe-bead linkage, and eliminating interference by endogenous biotin. We originally designed the hybridization method for tuberculosis diagnosis from urine cfDNA, but expect that it will be versatile across urine cfDNA targets, and may be useful for other cfDNA sample types and applications beyond cfDNA. To make our hybridization method accessible to new users, we present a detailed protocol and straightforward guidelines for designing new capture probes.
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Affiliation(s)
- Amy Oreskovic
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Barry R. Lutz
- Department of Bioengineering, University of Washington, Seattle, Washington, United States of America
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26
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Ben Jdidia I, Zribi K, Boubaker M, Brahem A, Sayadi M, Tlijani M, Saidani Z, Cherif A. Les médicaments qui interfèrent avec les bilans biologiques : revue de la littérature. Can J Hosp Pharm 2021; 74:378-385. [PMID: 34602626 PMCID: PMC8463014 DOI: 10.4212/c-jhp.v74i4.3200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Biological assessment is an integral part of the diagnostic process that guides therapeutic management decisions. However, these analyses remain subject to interference from endogenous or exogenous factors, which may alter the results. OBJECTIVE To provide an up-to-date and comprehensive overview of the most commonly documented types of interference attributable to medications, to ensure reliable interpretation of test results and better management of patients. DATA SOURCES This comprehensive systematic review of the literature was carried out in 2018. The bibliographic search was carried out in various online databases, specifically PubMed, ScienceDirect and Google Scholar. STUDY SELECTION Only publications in French or English concerning medicinal products for human use were retained. The investigators' examination of drug-related interference with laboratory tests was limited to blood assays (serum or plasma). DATA EXTRACTION An Excel spreadsheet was used to analyze the results. A total of 82 articles were selected. The interferences studied affected 47 biological parameters corresponding to various types of assessment: hormonal, hepatic, and renal. DATA SYNTHESIS The mechanisms reported in the literature identified were analytical (56.9%), physiological (17.82%), and pharmacological (20.11%). The remainder of the mechanisms (5.17%) were not defined. CONCLUSIONS Clinicians should be vigilant in validating and interpreting laboratory test results for patients receiving these types of drugs. Dialogue between clinicians and biological scientists is the best way to avoid unnecessary additional testing, which is often cumbersome and costly.
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Affiliation(s)
- Imene Ben Jdidia
- , Pharm. D., est une Pharmacienne spécialiste des hôpitaux et assistante hospitalo-universitaire en pharmacie hospitalière, Hôpital Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - Kaouther Zribi
- , Pharm. D., Ph. D., est une Pharmacienne spécialiste des hôpitaux et assistante hospitalo-universitaire en pharmacie hospitalière, Centre de maternité et de néonatologie de Monastir, Monastir, Tunisie
| | - Meriam Boubaker
- , Pharm. D., est une Pharmacienne et responsable de recherche et développement, Génome Humain et Maladies Multifactorielles (LR12ES07), Faculté de pharmacie, Université de Monastir, Monastir, Tunisie
| | - Amira Brahem
- , Pharm. D., est Pharmacienne et responsable de recherche et développement, Génome Humain et Maladies Multifactorielles (LR12ES07), Faculté de pharmacie, Université de Monastir, Monastir, Tunisie
| | - Mouna Sayadi
- , Pharm. D., est une Pharmacienne spécialiste des hôpitaux et assistante hospitalo-universitaire en pharmacie hospitalière, Centre de maternité et de néonatologie de Monastir, Monastir, Tunisie
| | - Marwa Tlijani
- , Pharm. D., est une Pharmacienne spécialiste des hôpitaux et assistante hospitalo-universitaire en pharmacie hospitalière, Centre de maternité et de néonatologie de Monastir, Monastir, Tunisie
| | - Zahra Saidani
- , MD, Médecin spécialiste en gynécologie et obstétrique, est professeur en médecine, Centre de maternité et de néonatologie de Monastir, Monastir, Tunisie
| | - Amani Cherif
- , Pharm. D., Ph. D., est une Pharmacienne spécialiste des hôpitaux et professeur agrégé en pharmacie hospitalière, Centre de maternité et de néonatologie de Monastir, Génome Humain et Maladies Multifactorielles (LR12ES07), Faculté de pharmacie, Université de Monastir, Monastir, Tunisie
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27
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Kodani M, Poe A, Drobeniuc J, Mixson-Hayden T. Determination of potential biotin interference on accuracy of results of serologic assays for various viral hepatitis markers. J Med Virol 2020; 92:3875-3879. [PMID: 32285946 DOI: 10.1002/jmv.25880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/12/2020] [Indexed: 01/08/2023]
Abstract
Biotin taken orally can interfere with some diagnostic immunoassays, including those for thyroid hormones, ferritin, and markers of infectious disease. Assays affected are ones that use streptavidin-biotin in their design. The goal of our study was to examine the effect of biotin concentrations of up to 1200 ng/mL on three serological assays performed on VITROS 3600 system, Immunoglobulin M (IgM) antibodies to hepatitis A virus (anti-HAV), total anti-HAV, and IgM antibodies to hepatitis B virus core antigen (anti-HBc), by spiking serum samples with variable amounts of biotin. No false-negative results were generated with either concentration of biotin for total anti-HAV (65/65). Likewise, biotin caused no false-positive IgM anti-HAV results (59/59) with either concentration of biotin; however, 6.7% false negativity was found for IgM anti-HAV when samples were spiked with 1200 ng/mL of biotin. Conversely, 100% false positivity (30/30) was produced by biotin interference in total anti-HAV negative specimens with both concentrations of biotin. False negativity rate was 87.5% in IgM anti-HBc positive samples when biotin levels were at 1200 ng/mL. These data show that individuals taking biotin-containing supplements may test false-positive in some serologic assays using streptavidin-biotin chemistries. Further studies are warranted to determine the extent of biotin interference resulting in false-positive and negative results and their impact, if any, on surveillance and diagnostic settings.
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Affiliation(s)
- Maja Kodani
- Division of Viral Hepatitis, National Center for Human Immunodeficiency Virus, Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention, Centers for Disease Control and Prevention
| | - Amanda Poe
- Division of Viral Hepatitis, National Center for Human Immunodeficiency Virus, Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention, Centers for Disease Control and Prevention
| | - Jan Drobeniuc
- Division of Viral Hepatitis, National Center for Human Immunodeficiency Virus, Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention, Centers for Disease Control and Prevention
| | - Tonya Mixson-Hayden
- Division of Viral Hepatitis, National Center for Human Immunodeficiency Virus, Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention, Centers for Disease Control and Prevention
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28
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Merrill AE, Malvik NM, Ford DC, Krasowski MD. Continuation of Over-the-Counter Biotin Supplements in the Inpatient Setting: An Unexpected Source of Laboratory Error. J Appl Lab Med 2020; 6:735-742. [PMID: 33928390 DOI: 10.1093/jalm/jfaa167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Over the past decade, use of high-dose biotin has increased significantly and can lead to erroneous results on some clinical immunoassays. In collaboration with pharmacists at our institution, we discovered that high biotin doses were being administered to inpatients as a continuation of patient-reported home biotin use. METHODS This retrospective study evaluated high-dose biotin administration in 226 inpatient encounters from 2009 to 2019 and its potential impact on concurrent immunoassay testing. RESULTS In 96% of cases, biotin was administered in the inpatient setting as a continuation of patient-reported home use. In total, 322 immunoassays capable of biotin interference were performed across 100 inpatient encounters with high-dose biotin administration. Troponin T and TSH were the most commonly performed immunoassays in this cohort. DISCUSSION Even though less than 5% of all high-dose biotin orders at our institution are placed for inpatients, hospitalized patients are still at risk for mismanagement due to erroneous immunoassay results. Immunoassay testing susceptible to biotin interference was performed in approximately 45% of inpatient encounters with biotin administration. Laboratories utilizing biotin-susceptible, sensitive cardiac troponin assays should be particularly cautious. Pharmacokinetic data for biotin clearance is especially lacking for certain populations likely to be hospitalized, such as those with renal failure. Given that medical conditions requiring high-dose biotin therapy are extremely rare, we recommend restricting biotin dosing during inpatient encounters for all other patients.
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Affiliation(s)
- Anna E Merrill
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Natalie M Malvik
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA.,Division of Transfusion Medicine, Department of Medicine, UMass Memorial Medical Center, Worcester, MA
| | - Diana C Ford
- Department of Pharmaceutical Care, University of Iowa Health Care, Iowa City, IA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
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29
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Voss SC, Orie NN, El-Saftawy W, Saghbazarian S, Al-Kaabi A, Georgakopoulos C, Athanasiadou I, Mohamed-Ali V, Al-Maadheed M. Horseradish-peroxidase-conjugated anti-erythropoietin antibodies for direct recombinant human erythropoietin detection: Proof of concept. Drug Test Anal 2020; 13:529-538. [PMID: 33119945 DOI: 10.1002/dta.2957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/11/2022]
Abstract
Antidoping testing for recombinant human erythropoietin (EPO) is routinely performed by gel electrophoresis followed by western blot analysis with primary and secondary antibodies. The two antibody steps add more than 24 h to the testing time of a purified sample. The aim of this study was to test the concept of using directly horseradish-peroxidase (HRP)-conjugated anti-EPO primary antibody, without the need for a secondary antibody, to reduce the analysis time and eliminate non-specific cross-reactivity with secondary antibodies. An in-house, periodate coupling (R&D systems, clone AE7A5) and three commercially available anti-human EPO-HRP conjugates from Genetex, Novus Biologicals and Santa Cruz were evaluated for specificity and sensitivity, using recombinant human EPO standards, negative human urine samples and urine samples from an EPO excretion study. The in-house anti-EPO-HRP conjugate was performed as well as the current two-step application of unconjugated primary and secondary antibodies used in routine analysis, with comparable specificity and sensitivity. The analysis time was markedly reduced for purified samples from 25 h with the routine method down to 7 h with the in-house HRP conjugate. Of the three commercially available conjugates tested, only the Santa Cruz anti-EPO-HRP conjugate showed comparable specificity but had lower sensitivity to both the in-house and the antibody combination currently applied routinely. The other two commercially available conjugates (Genetex and Novus Biologicals) did not show any visible bands with the EPO standards. The results clearly demonstrate the potential utility of a directly HRP-conjugated anti-EPO antibody to reduce analysis time for EPO in doping control.
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Affiliation(s)
| | - Nelson N Orie
- Anti-Doping Lab Qatar, Doha, Qatar.,Centre for Metabolism and Inflammation, Division of Medicine, University College London, London, UK
| | | | | | | | | | | | - Vidya Mohamed-Ali
- Anti-Doping Lab Qatar, Doha, Qatar.,Centre for Metabolism and Inflammation, Division of Medicine, University College London, London, UK
| | - Mohammed Al-Maadheed
- Anti-Doping Lab Qatar, Doha, Qatar.,Centre for Metabolism and Inflammation, Division of Medicine, University College London, London, UK
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30
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von Meyer A, Albert G, Kunzelmann S, Rank C, Zerback R, Imdahl R. Evaluating the performance of an updated high-sensitivity troponin T assay with increased tolerance to biotin. Clin Chem Lab Med 2020; 59:591-597. [PMID: 33112775 DOI: 10.1515/cclm-2020-0104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/27/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Biotin >20 ng/mL may interfere with the Elecsys® Troponin T-high sensitive assay (cTnT-hs; Roche Diagnostics International Ltd). We evaluated the performance of an updated assay, cTnT-hs*, which was designed to reduce biotin interference. METHODS cTnT-hs* assay performance was assessed using up to two applications (18 min/9 min) on three analyzers (cobas e 411/cobas e 601/cobas e 801). Biotin interference was determined by measuring recovery in an 11-sample series dilution with biotin ranging from 0-3600 ng/mL. Repeatability/reproducibility were evaluated in five serum sample pools (n=75 each). Method comparisons tested: cTnT-hs* vs. cTnT-hs (18 min/cobas e 601); cTnT-hs* assay 18 vs. 9 min (cobas e 601); cTnT-hs* (18 min) on cobas e 601 vs. cobas e 411 and cobas e 601 vs. cobas e 801. Concordance at the 99th percentile decision limit between cTnT-hs* and cTnT-hs (9 min/cobas e 601) was calculated using 300 lithium-heparin plasma samples and a 14 ng/L assay cutoff. RESULTS cTnT-hs* assay (18 min/cobas e 601) recovery was ≥96% for biotin ≤1250 ng/mL. Across all applications/analyzers, coefficients of variation for repeatability/reproducibility with the cTnT-hs* assay were <5% in most serum sample pools (mean cardiac troponin T: 8.528-9484 ng/L). High correlation (Pearson's r=1.000) was demonstrated for all method comparisons. Concordance at the 99th percentile decision limit was high between the cTnT-hs* and cTnT-hs assays. CONCLUSIONS The updated cTnT-hs* assay may provide greater tolerance to biotin interference, and shows good analytical and clinical agreement/concordance with the previous cTnT-hs assay.
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Affiliation(s)
- Alexander von Meyer
- Institute for Laboratory Medicine, Medical Microbiology and Technical Hygiene, München Klinik, Munich, Germany
| | - Gesa Albert
- Roche Diagnostics International Ltd., Rotkreuz, Switzerland
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Esteban Jiménez Ó, Letosa Gaudó J, Moreno Juste A, Urieta González L, González Rubio F. [Biotin interference in thyroid function tests]. Semergen 2020; 47:e1-e2. [PMID: 32798113 DOI: 10.1016/j.semerg.2020.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/14/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - A Moreno Juste
- Centro de Salud Casetas, Zaragoza, España; Grupo EpiChron de Investigación en Enfermedades Crónicas, IIS Aragón, Zaragoza, España
| | | | - F González Rubio
- Centro de Salud Delicias Sur, Zaragoza, España; Grupo EpiChron de Investigación en Enfermedades Crónicas, IIS Aragón, Zaragoza, España.
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32
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Clinical risk assessment of biotin interference with a high-sensitivity cardiac troponin T assay. Clin Chem Lab Med 2020; 58:1931-1940. [DOI: 10.1515/cclm-2019-0962] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 07/20/2020] [Indexed: 12/12/2022]
Abstract
Abstract
Objectives
Biotin >20.0 ng/mL (81.8 nmol/L) can reduce Elecsys® Troponin T Gen 5 (TnT Gen 5; Roche Diagnostics) assay recovery, potentially leading to false-negative results in patients with suspected acute myocardial infarction (AMI). We aimed to determine the prevalence of elevated biotin and AMI misclassification risk from biotin interference with the TnT Gen 5 assay.
Methods
Biotin was measured using an Elecsys assay in two cohorts: (i) 797 0-h and 646 3-h samples from 850 US emergency department patients with suspected acute coronary syndrome (ACS); (ii) 2023 random samples from a US laboratory network, in which biotin distributions were extrapolated for higher values using pharmacokinetic modeling. Biotin >20.0 ng/mL (81.8 nmol/L) prevalence and biotin 99th percentile values were calculated. AMI misclassification risk due to biotin interference with the TnT Gen 5 assay was modeled using different assay cutoffs and test timepoints.
Results
ACS cohort: 1/797 (0.13%) 0-h and 1/646 (0.15%) 3-h samples had biotin >20.0 ng/mL (81.8 nmol/L); 99th percentile biotin was 2.62 ng/mL (10.7 nmol/L; 0-h) and 2.38 ng/mL (9.74 nmol/L; 3-h). Using conservative assumptions, the likelihood of false-negative AMI prediction due to biotin interference was 0.026% (0-h result; 19 ng/L TnT Gen 5 assay cutoff). US laboratory cohort: 15/2023 (0.74%) samples had biotin >20.0 ng/mL (81.8 nmol/L); 99th percentile biotin was 16.6 ng/mL (68.0 nmol/L). Misclassification risk due to biotin interference (19 ng/L TnT Gen 5 assay cutoff) was 0.025% (0-h), 0.0064% (1-h), 0.00048% (3-h), and <0.00001% (6-h).
Conclusions
Biotin interference has minimal impact on the TnT Gen 5 assay’s clinical utility, and the likelihood of false-negative AMI prediction is extremely low.
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Wang HY, Chen CH, Shi S, Chung CR, Wen YH, Wu MH, Lebowitz MS, Zhou J, Lu JJ. Improving Multi-Tumor Biomarker Health Check-up Tests with Machine Learning Algorithms. Cancers (Basel) 2020; 12:E1442. [PMID: 32492934 PMCID: PMC7352838 DOI: 10.3390/cancers12061442] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tumor markers are used to screen tens of millions of individuals worldwide at annual health check-ups, especially in East Asia. Machine learning (ML)-based algorithms that improve the diagnostic accuracy and clinical utility of these tests can have substantial impact leading to the early diagnosis of cancer. METHODS ML-based algorithms, including a cancer screening algorithm and a secondary organ of origin algorithm, were developed and validated using a large real world dataset (RWD) from asymptomatic individuals undergoing routine cancer screening at a Taiwanese medical center between May 2001 and April 2015. External validation was performed using data from the same period from a separate medical center. The data set included tumor marker values, age, and gender from 27,938 individuals, including 342 subsequently confirmed cancer cases. RESULTS Separate gender-specific cancer screening algorithms were developed. For men, a logistic regression-based algorithm outperformed single-marker and other ML-based algorithms, with a mean area under the receiver operating characteristic curve (AUROC) of 0.7654 in internal and 0.8736 in external cross validation. For women, a random forest-based algorithm attained a mean AUROC of 0.6665 in internal and 0.6938 in external cross validation. The median time to cancer diagnosis (TTD) in men was 451.5, 204.5, and 28 days for the mild, moderate, and high-risk groups, respectively; for women, the median TTD was 229, 132, and 125 days for the mild, moderate, and high-risk groups. A second algorithm was developed to predict the most likely affected organ systems for at-risk individuals. The algorithm yielded 0.8120 sensitivity and 0.6490 specificity for men, and 0.8170 sensitivity and 0.6750 specificity for women. CONCLUSIONS ML-derived algorithms, trained and validated by using a RWD, can significantly improve tumor marker-based screening for multiple types of early stage cancers, suggest the tissue of origin, and provide guidance for patient follow-up.
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Affiliation(s)
- Hsin-Yao Wang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (H.-Y.W.); (C.-H.C.); (Y.-H.W.)
- 20/20 GeneSystems, Inc., Rockville, MD 20850, USA; (S.S.); (M.S.L.)
- Program in Biomedical Engineering, Chang Gung University, Taoyuan City 33301, Taiwan
| | - Chun-Hsien Chen
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (H.-Y.W.); (C.-H.C.); (Y.-H.W.)
- Department of Information Management, Chang Gung University, Taoyuan City 33301, Taiwan
| | - Steve Shi
- 20/20 GeneSystems, Inc., Rockville, MD 20850, USA; (S.S.); (M.S.L.)
| | - Chia-Ru Chung
- Department of Computer Science and Information Engineering, National Central University, Taoyuan City 32001, Taiwan;
| | - Ying-Hao Wen
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (H.-Y.W.); (C.-H.C.); (Y.-H.W.)
| | - Min-Hsien Wu
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan City 33301, Taiwan;
| | | | - Jiming Zhou
- 20/20 GeneSystems, Inc., Rockville, MD 20850, USA; (S.S.); (M.S.L.)
| | - Jang-Jih Lu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (H.-Y.W.); (C.-H.C.); (Y.-H.W.)
- 20/20 GeneSystems, Inc., Rockville, MD 20850, USA; (S.S.); (M.S.L.)
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan City 33301, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33301, Taiwan
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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Biotin interference: evaluation of a new generation of electrochemiluminescent immunoassays for high-sensitive troponin T and thyroid-stimulating hormone testing. Clin Chem Lab Med 2020; 58:2037-2045. [DOI: 10.1515/cclm-2020-0214] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/20/2020] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Biotin is currently a matter of concern for laboratories using biotin-streptavidin-based immunoassays. Biotin interferences have been reported for high-sensitive troponin T (hsTnT) and thyroid-stimulating hormone (TSH) assays. We aimed to evaluate the new generation of hsTnT and TSH electrochemiluminescent immunoassays announced to be less sensitive to biotin.
Methods
Firstly, we assessed the analytical performances of new generation assays (imprecision, bias, total error, limit of quantification) and compared previous and new generation assays in the absence of biotin. Secondly, we challenged both generations of assays with samples spiked with seven different biotin levels. The efficiency of new generation assays was also compared to the streptavidin beads treatment.
Results
New generation assays presented suitable analytical performances. Previous and new generations of hsTnT and TSH assays were commutable in the absence of biotin. In the presence of biotin, we confirmed that previous generation assays were affected by biotin concentration as low as 40.5 ng/mL and that new generation assays were not affected up to the announced tolerance threshold of 1200 ng/mL. After the streptavidin beads treatment, we observed a higher imprecision for both parameters and a constant 10% negative bias for TSH compared to new generation assays.
Conclusions
New generation of electrochemiluminescent immunoassays appears as a reliable systematic solution to prevent biotin interference for hsTnT and TSH testing.
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Gyuricsko E. The "slightly" abnormal thyroid test: What is the pediatrician to do? Curr Probl Pediatr Adolesc Health Care 2020; 50:100770. [PMID: 32418870 DOI: 10.1016/j.cppeds.2020.100770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Thyroid disorders are common in pediatrics. Tests of thyroid function are widely available and frequently ordered in the pediatric healthcare setting. This is sometimes driven by common signs or symptoms of thyroid disease. All too often, it is driven by patients and their parents requesting thyroid tests for nonspecific symptoms, such as fatigue, obesity or family history of thyroid disease. The decision to order thyroid tests, as well as which test(s) of thyroid function to order, deserves careful thought rather than a reflexive "thyroid panel" for every patient. Thyroid stimulating hormone (TSH) is the single most appropriate test of thyroid function when screening a pediatric or adolescent for thyroid disorders. Adding more tests only increases the likelihood that a minor (and often insignificant) abnormality will be found. These incidental abnormalities can create anxiety for the parent and child, and usually results in additional testing, referral to a pediatric endocrinologist, and further expense. This review will aim to guide the pediatric primary care provider on the choice of appropriate screening test(s) for acquired thyroid dysfunction in children and adolescents, as well as the proper interpretation of the test(s). Emphasis will be placed on the "slightly" abnormal thyroid screening test. Specific thyroid tests to be reviewed include TSH, (free) T4, (free) T3, and thyroid antibodies. Finally, this review will aim to guide decisions on follow-up, additional testing, and reasons for referral to a pediatric endocrinologist. Congenital hypothyroidism, including abnormalities on state newborn screening, will not be discussed.
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Affiliation(s)
- Eric Gyuricsko
- Assistant Professor of Pediatrics, Eastern Virginia Medical School, Division of Pediatric Endocrinology, Children's Hospital of The King's Daughters, Children's Specialty Group, PLLC, Norfolk, VA, United States.
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Zhang Y, Wang R, Dong Y, Huang G, Ji B, Wang Q. Assessment of biotin interference in thyroid function tests. Medicine (Baltimore) 2020; 99:e19232. [PMID: 32118725 PMCID: PMC7478465 DOI: 10.1097/md.0000000000019232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 12/19/2022] Open
Abstract
The aim of the study was to systematically characterize the interference of biotin on thyroid function tests and biotin washout periods.Ten healthy adults were recruited with administration of 5 and 10 mg/d biotin for 7 days. Analyte concentrations of thyroid function tests were measured at baseline prior to starting biotin and from 2 hours to 2 days after withdrawal of 5 and 10 mg/d biotin. The outcomes were compared the baseline with the several points after taking biotin at Roche cobas e602, Beckman UniCel DxI 800, and Abbott Architect 2000 immunoassay platforms, respectively.Ingesting 5 or 10 mg/d of biotin for 7 days could produce positive or negative interference among the thyroid function tests at Roche cobas e602 and Beckman UniCel DxI 800 systems, but no interference on Abbott Architect 2000. Interference duration of 5 mg/d biotin for Roche cobas e602 and Beckman UniCel DxI 800 of thyroid function tests lasted for 8 hours, while 10 mg/d biotin interfered with Roche cobas e602 or Beckman UniCel DxI 800 for 1 day or 2 days.This study provides valuable guidance on biotin washout periods at doses common in over-the-counter supplements necessary to avoid false assay results.Trial registration: ChiCTR1800020472.
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Affiliation(s)
| | - Renjie Wang
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University
| | - Ying Dong
- Department of Radiotherapy, The Tumor Hospital of Jilin Province
| | - Guanning Huang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Bin Ji
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University
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Neubert H, Shuford CM, Olah TV, Garofolo F, Schultz GA, Jones BR, Amaravadi L, Laterza OF, Xu K, Ackermann BL. Protein Biomarker Quantification by Immunoaffinity Liquid Chromatography–Tandem Mass Spectrometry: Current State and Future Vision. Clin Chem 2020; 66:282-301. [DOI: 10.1093/clinchem/hvz022] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/12/2019] [Indexed: 12/19/2022]
Abstract
Abstract
Immunoaffinity–mass spectrometry (IA-MS) is an emerging analytical genre with several advantages for profiling and determination of protein biomarkers. Because IA-MS combines affinity capture, analogous to ligand binding assays (LBAs), with mass spectrometry (MS) detection, this platform is often described using the term hybrid methods. The purpose of this report is to provide an overview of the principles of IA-MS and to demonstrate, through application, the unique power and potential of this technology. By combining target immunoaffinity enrichment with the use of stable isotope-labeled internal standards and MS detection, IA-MS achieves high sensitivity while providing unparalleled specificity for the quantification of protein biomarkers in fluids and tissues. In recent years, significant uptake of IA-MS has occurred in the pharmaceutical industry, particularly in the early stages of clinical development, enabling biomarker measurement previously considered unattainable. By comparison, IA-MS adoption by CLIA laboratories has occurred more slowly. Current barriers to IA-MS use and opportunities for expanded adoption are discussed. The path forward involves identifying applications for which IA-MS is the best option compared with LBA or MS technologies alone. IA-MS will continue to benefit from advances in reagent generation, more sensitive and higher throughput MS technologies, and continued growth in use by the broader analytical community. Collectively, the pursuit of these opportunities will secure expanded long-term use of IA-MS for clinical applications.
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Bayart JL, Favresse J, Stoefs A, Closset M, Roy T, Fillée C, Rodriguez-Villalobos H, Kabamba-Mukadi B, Gruson D. Biotin interferences: Have we neglected the impact on serological markers? Clin Chim Acta 2020; 503:107-112. [PMID: 31978405 DOI: 10.1016/j.cca.2020.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Biotin has been reported to be a leading cause of interference on several immunoassay platforms using the streptavidin-biotin immobilization system. While biotin interferences have now been well characterized for several assays, only few data are available on their impact on serological markers of infectious viral diseases. METHODS Overall, 10 healthy volunteers (HVs) received a single 100 mg dose of biotin to evaluate its effect on hepatitis B serological markers. Blood samples were taken several times before and after biotin intake. In addition, spiking experiments were applied to investigate biotin's impact on anti-HIV/p24 Ag and anti-HCV antibody levels. Several procedures designed to overcome this interference were evaluated. RESULTS Biotin intake resulted in a false-negative anti-HBs immunological status (<10 mIU/mL) in 40.0% of cases. According to our anti-HBc and anti-HBe results, biotin intake was associated with 90.0% and 80.0% of false positive results, respectively. At the theoretical biotin peak concentration following a 100 mg intake, 50.0% and 66.6% of anti-HIV and anti-HCV results were false negatives, respectively. All the procedures evaluated to overcome the interference were proven effective. CONCLUSION HBV, HCV, and HIV serological markers are likely to be highly sensitive to biotin. Our data confirm that the scope of biotin interference is broader than commonly described.
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Affiliation(s)
- Jean-Louis Bayart
- Département des Laboratoires Cliniques, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium.
| | - Julien Favresse
- Département des Laboratoires Cliniques, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium
| | - Anke Stoefs
- Département des Laboratoires Cliniques, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium
| | - Mélanie Closset
- Département des Laboratoires Cliniques, CHU - Mont-Godinne - Université Catholique de Louvain, Yvoir, Belgium
| | - Tatiana Roy
- Département des Laboratoires Cliniques, Cliniques Saint-Pierre, Ottignies, Belgium
| | - Catherine Fillée
- Département des Laboratoires Cliniques, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium
| | - Hector Rodriguez-Villalobos
- Département des Laboratoires Cliniques, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium
| | - Benoît Kabamba-Mukadi
- Département des Laboratoires Cliniques, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium; Pôle de Recherche en Microbiologie Médicale, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Damien Gruson
- Département des Laboratoires Cliniques, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium; Pôle de Recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc - Université Catholique de Louvain, Brussels, Belgium
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Luong JHT, Vashist SK. Chemistry of Biotin-Streptavidin and the Growing Concern of an Emerging Biotin Interference in Clinical Immunoassays. ACS OMEGA 2020; 5:10-18. [PMID: 31956746 PMCID: PMC6963918 DOI: 10.1021/acsomega.9b03013] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 12/04/2019] [Indexed: 05/27/2023]
Abstract
Overconsumption of biotin (5-100 mg daily) as a supplement by the general population poses a significant problem for clinical immunoassays (IAs) based on biotin-streptavidin (SA) interactions. This affinity pair has been exploited in immunoassays because of its avidity, sensitivity, specificity, and stability. The elevated biotin level in plasma varies from patient to patient, and its severe interference cannot easily be predicted and quantified. Thus, immunoassay manufacturers must investigate the biotin interference in the developed immunoassays to satisfy the threshold of 3510 ng/mL (14 367 nM), as stipulated by the FDA. There is no concrete solution to circumvent the biotin interference without extra costs and technical difficulties, albeit different strategies have been attempted. They include the IA format with biotinylated reagents prebound to streptavidin, the removal of biotin from the specimen, sample treatment, and biotin interference-free assays. The general public has been instructed to stop taking biotin supplements for 48 h or even weeks before the test, depending on the specific test, dose, and frequency of biotin uptake. As lab-based techniques cannot accommodate an enormous number of public samples, a rapid analytical procedure for biotin is urgently needed to quantify for its interference in immunoassays.
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Affiliation(s)
- John H. T. Luong
- School
of Chemistry and Analytical & Biological Chemistry Research Facility, University College Cork, Cork, Ireland
| | - Sandeep K. Vashist
- Pictor
Diagnostics, 311 Juelicherstr, 52070 Aachen, Germany
- Pictor
Limited, 24 Balfour Road, Parnell, Auckland 1052, New Zealand
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41
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Mimoto MS, Refetoff S. Clinical recognition and evaluation of patients with inherited serum thyroid hormone-binding protein mutations. J Endocrinol Invest 2020; 43:31-41. [PMID: 31352644 PMCID: PMC6954308 DOI: 10.1007/s40618-019-01084-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022]
Abstract
There are three important thyroid hormone-binding proteins in human serum, thyroxine-binding globulin, transthyretin, and albumin. Genetic variation in these proteins can lead to altered thyroid hormone binding and abnormalities in serum tests of thyroid hormone. Importantly, patients harboring these mutations are euthyroid; thus, the recognition of these conditions is crucial to prevent unnecessary repeated testing and treatment. This article provides an updated overview of serum thyroid hormone transport biology and reviews the underlying genetic alterations, clinical presentation, and appropriate evaluation of patients with suspected mutations in serum thyroid hormone-binding proteins.
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Affiliation(s)
- M S Mimoto
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 7381, San Diego, CA, USA
| | - S Refetoff
- Department of Medicine, The University of Chicago MC3090, 5841 South Maryland Avenue, Chicago, IL, 60637, USA.
- Department of Pediatrics, The University of Chicago MC3090, 5841 South Maryland Avenue, Chicago, IL, 60637, USA.
- Committee on Genetics, The University of Chicago MC3090, 5841 South Maryland Avenue, Chicago, IL, 60637, USA.
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42
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Best practices in mitigating the risk of biotin interference with laboratory testing. Clin Biochem 2019; 74:1-11. [DOI: 10.1016/j.clinbiochem.2019.08.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/28/2019] [Indexed: 12/23/2022]
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43
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Nanoporous gold electrode for ultrasensitive detection of neurotoxin fasciculin. Anal Chim Acta 2019; 1085:91-97. [PMID: 31522735 DOI: 10.1016/j.aca.2019.07.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/11/2019] [Accepted: 07/30/2019] [Indexed: 02/07/2023]
Abstract
Acetylcholinesterase (AChE), an efficient biocatalyst known to hydrolyze the neurotransmitter acetylcholine, could be inactivated in the presence of insecticides, nerve agents or other drug inhibitors to thus result in disrupted neurotransmission. Improvement in the peripheral cholinergic function, as well as overall cognition and neuronal functions of an exposed system could be achieved if the mechanisms of inhibitions are deactivated in a controlled fashion and with rapid response time. Herein, we proposed to develop a simple AChE biosensor capable to realize the rapid detection of neurotoxins. Our approach uses a nanoporous gold film (NPGF) and reduced graphene oxide-tin dioxide nanoparticle (RGO-SnO2) nanocomposite to define the highly active electrode interface where the electrochemical monitoring of the interaction between AChE and its target molecule, fasciculin, could take place. Our results demonstrate that the established biosensor had the ability to monitor fasciculin concentrations at the ultra-low limit of detection of 8 pM, an inhibition rate of 8% and within only 30min of electrochemical exposure. Our study provides a convenient technology for the rapid and ultrasensitive detection of neurotoxins and has the potential for large applicability to other drugs or toxins screening.
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Luong JH, Male KB, Glennon JD. Biotin interference in immunoassays based on biotin-strept(avidin) chemistry: An emerging threat. Biotechnol Adv 2019; 37:634-641. [DOI: 10.1016/j.biotechadv.2019.03.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 01/04/2023]
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Affiliation(s)
- Henry B Burch
- From the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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46
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Tascanov MB, Gönel A. How Do Contrast Agents Affect Cardiac Markers and Coagulation Tests? Experimental Study. Comb Chem High Throughput Screen 2019; 22:355-360. [DOI: 10.2174/1386207322666190603170438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/08/2019] [Accepted: 04/26/2019] [Indexed: 11/22/2022]
Abstract
Background:
The discovery that biotin interferes with results of troponin and Nt-proBNP led
some commercial firms to update their measurement methods. In particular, the clinical incompatibility of
cardiac test results may affect the risk of morbidity and mortality.
Objective:
The aim of this study is to investigate the interference effects of 7 different contrast agents on
cardiac markers (Troponin-I, Nt-proBNP, Mass CK-MB, CK, AST, LDH) and in coagulation tests (PT,
APTT).
Methods:
Seven different contrast media were added into control materials by using interference protocol.
The concentrations of PT, APTT, CK, AST, LDH, Mass CK-MB, Troponin-I, and Nt-proBNP were
measured by Sysmex CS-2100, Abbott c16000, Siemens Centaur XP and AFİAS-6 analyzer. The number
of deviations from target values was calculated.
Results:
The 7 different contrast media caused negative interference in troponin levels between 57.43%
and 62.87%. It was found that different contrast media produced false negativity in the Nt-proBNP test,
ranging from 6.11% to 96.01%. Enzymes and coagulation tests were less affected.
Conclusion:
Different contrast media may cause false negatives in cTnI and Nt-proBNP. The contrast
medium that causes the least interference should be preferred. The results of samples taken in the first hour
after contrast imaging should be interpreted with care.
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Affiliation(s)
| | - Ataman Gönel
- Department of Medical Biochemistry, Harran University, Sanliurfa, Turkey
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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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48
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Wolf B. High doses of biotin can interfere with immunoassays that use biotin-strept(avidin) technologies: Implications for individuals with biotin-responsive inherited metabolic disorders. Mol Genet Metab 2019; 127:321-324. [PMID: 31320189 DOI: 10.1016/j.ymgme.2019.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Barry Wolf
- Division of Genetics, Birth Defects and Metabolism, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, 225 E. Chicago, Chicago, IL 60611, United States of America.
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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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50
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Avery G. Biotin interference in immunoassay: a review for the laboratory scientist. Ann Clin Biochem 2019; 56:424-430. [DOI: 10.1177/0004563219842231] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The recent FDA Biotin (Vitamin B7): Safety Communication – May Interfere with Lab Tests and A statement from the ACB Scientific Committee regarding biotin/vitamin B7 interference in immunoassays have raised into the laboratory consciousness the need to understand and to manage the issues around biotin interference with some immunoassays and to provide education and advice to health-care providers. In patients who are prescribed biotin or take biotin supplements, biotin has the potential to cause falsely low or falsely high results in immunoassays using streptavidin–biotin binding as part of the assay methodology. Streptavidin–biotin binding is used by many manufacturers; some manufacturers use it for most of their immunoassays, some for a few of their immunoassays and some manufacturers do not use this assay format at all. The direction and magnitude of interference and the concentration of biotin which affects an assay are highly variable and assay specific. There have been many papers and case reports published recently of biotin interference in immunoassay, and biotin interference is probably one of the most difficult types of inference to detect and to obviate. This review will assess the currently available information on this topic and review the steps the laboratory can take to reduce the risk of incorrect patient results being reported.
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Affiliation(s)
- Gordon Avery
- Abbott Diagnostic Division, Abbott Laboratories, Maidenhead, UK
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