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Galior KD, Ladwig PM, Snyder MR, Algeciras-Schimnich A, Bornhorst JA, Block DR, Baumann NA, Willrich MAV. Lack of observed interference by therapeutic monoclonal antibodies in select commonly utilized immunoassays. Clin Biochem 2023; 121-122:110685. [PMID: 37972806 DOI: 10.1016/j.clinbiochem.2023.110685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Therapeutic monoclonal antibodies (tmabs) have been hypothesized to interfere with immunoassay measurements, although studies investigating this potential new class of interference are lacking. This study evaluated the effects of tmabs used in cancers ipilimumab (Bristol Myers Squibb), nivolumab (Bristol Myers Squibb), pembrolizumab (Merck) and autoimmune disorders adalimumab (AbbVie), infliximab (Janssen) and vedolizumab (Takeda) in common immunoassays used in the clinical laboratory. METHODS Residual sera from 10 randomly chosen patients were split into two tubes and spiked with same volume (approximately 5 % final volume) of either saline (control) or 6 tmabs (final concentration of 100 μg/mL each). Concentrations from sixteen analytes in 19 different assays were assessed: TSH (Roche and Beckman), free thyroxine (Roche and Siemens), cortisol (Beckman), Cancer Antigens (CA): CA19-9 (Beckman), CA15-3 (Roche), CA125 (Roche), and CA27.29 (Siemens), carcinoembryonic antigen (Beckman), alpha-fetoprotein (Beckman), thyroglobulin (Beckman) and thyroglobulin antibodies (Beckman), thyroid peroxidase antibody (Beckman), beta-human chorionic gonadotropin (Roche and Beckman), total prostate-specific antigen (Roche), parathyroid hormone (Roche) and antinuclear antibodies IgG (Werfen). The tmab spiked residual sera were compared with matched saline spiked sera and percent error was assessed against allowable total error defined from biological variation or CLIA limits. RESULTS None of the tested immunoassays were affected by the presence of the tmabs, in samples within or outside assay reference intervals. The median % error among all immunoassays ranged between -2.0% (for TSH) to 2.7% (for TPO Ab assay). CONCLUSION These findings demonstrate no detectable tmab interference for the assessed immunoassays using spiked preparations of the tmabs in residual human sera. The findings are limited to the tmabs and immunoassays studied here.
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Affiliation(s)
- Kornelia D Galior
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA.
| | - Paula M Ladwig
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Melissa R Snyder
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Joshua A Bornhorst
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Darci R Block
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Nikola A Baumann
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Egan AM, Galior KD, Maus AD, Fatica E, Simha V, Shah P, Singh RJ, Vella A. Pitfalls in Diagnosing Hypoglycemia Due to Exogenous Insulin: Validation and Utility of an Insulin Analog Assay. Mayo Clin Proc 2022; 97:1994-2004. [PMID: 36210202 PMCID: PMC9996747 DOI: 10.1016/j.mayocp.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/24/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To overcome the limitations of commercially available insulin immunoassays which have variable detection of analog insulin and can lead to clinically discordant results and misdiagnosis in the workup of factitious hypoglycemia. PATIENTS AND METHODS We performed analytical validation of a liquid chromatography high resolution accurate mass (LC-HRAM) immunoassay to detect insulin analogs. We completed clinical assessment using a large cohort of human serum samples from 78 unique individuals, and subsequently used the assay in the evaluation of eight individuals with high diagnostic suspicion for factitious hypoglycemia. RESULTS The performance characteristics show that the LC-HRAM immunoassay can be applied to detect five commonly used synthetic insulin analogs (lispro, glulisine, aspart, glargine metabolite, and detemir) in human serum. Our clinical cases show that this assay could be used in the diagnosis of factitious hypoglycemia by identifying the analog insulin(s) in question. CONCLUSION The LC-HRAM immunoassay reported here overcomes a gap in our diagnostic pathway for hypoglycemia. The results obtained from our studies suggest that this method is appropriate for use in clinical laboratories when factitious hypoglycemia is considered as a differential diagnosis.
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Affiliation(s)
- Aoife M Egan
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Kornelia D Galior
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI, USA
| | - Anthony D Maus
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Erica Fatica
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Vinaya Simha
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Pankaj Shah
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Ravinder J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Adrian Vella
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, MN, USA.
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Yekelchyk M, Madan E, Wilhelm J, Short KR, Palma AM, Liao L, Camacho D, Nkadori E, Winters MT, Rice ES, Rolim I, Cruz‐Duarte R, Pelham CJ, Nagane M, Gupta K, Chaudhary S, Braun T, Pillappa R, Parker MS, Menter T, Matter M, Haslbauer JD, Tolnay M, Galior KD, Matkwoskyj KA, McGregor SM, Muller LK, Rakha EA, Lopez‐Beltran A, Drapkin R, Ackermann M, Fisher PB, Grossman SR, Godwin AK, Kulasinghe A, Martinez I, Marsh CB, Tang B, Wicha MS, Won KJ, Tzankov A, Moreno E, Gogna R. Flower lose, a cell fitness marker, predicts COVID-19 prognosis. EMBO Mol Med 2021; 13:e13714. [PMID: 34661368 PMCID: PMC8573598 DOI: 10.15252/emmm.202013714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 01/08/2023] Open
Abstract
Risk stratification of COVID-19 patients is essential for pandemic management. Changes in the cell fitness marker, hFwe-Lose, can precede the host immune response to infection, potentially making such a biomarker an earlier triage tool. Here, we evaluate whether hFwe-Lose gene expression can outperform conventional methods in predicting outcomes (e.g., death and hospitalization) in COVID-19 patients. We performed a post-mortem examination of infected lung tissue in deceased COVID-19 patients to determine hFwe-Lose's biological role in acute lung injury. We then performed an observational study (n = 283) to evaluate whether hFwe-Lose expression (in nasopharyngeal samples) could accurately predict hospitalization or death in COVID-19 patients. In COVID-19 patients with acute lung injury, hFwe-Lose is highly expressed in the lower respiratory tract and is co-localized to areas of cell death. In patients presenting in the early phase of COVID-19 illness, hFwe-Lose expression accurately predicts subsequent hospitalization or death with positive predictive values of 87.8-100% and a negative predictive value of 64.1-93.2%. hFwe-Lose outperforms conventional inflammatory biomarkers and patient age and comorbidities, with an area under the receiver operating characteristic curve (AUROC) 0.93-0.97 in predicting hospitalization/death. Specifically, this is significantly higher than the prognostic value of combining biomarkers (serum ferritin, D-dimer, C-reactive protein, and neutrophil-lymphocyte ratio), patient age and comorbidities (AUROC of 0.67-0.92). The cell fitness marker, hFwe-Lose, accurately predicts outcomes in COVID-19 patients. This finding demonstrates how tissue fitness pathways dictate the response to infection and disease and their utility in managing the current COVID-19 pandemic.
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Affiliation(s)
- Michail Yekelchyk
- Department of Cardiac Development and RemodellingMax Planck Institute for Heart and Lung ResearchBad NauheimGermany
| | - Esha Madan
- Champalimaud Centre for the UnknownLisbonPortugal
| | - Jochen Wilhelm
- Universities Giessen & Marburg Lung CenterGerman Center for Lung Research (DZL)Justus‐Liebig‐UniversityGiessenGermany
- Institute for Lung Health (ILH)Universities Giessen & Marburg Lung CenterGerman Center for Lung Research (DZL)Justus‐Liebig‐University GiessenGiessenGermany
| | - Kirsty R Short
- School of Chemistry and Molecular BiosciencesThe University of QueenslandBrisbaneQldAustralia
| | | | - Linbu Liao
- Biotech Research and Innovation Centre (BRIC)University of CopenhagenCopenhagen NDenmark
| | | | - Everlyne Nkadori
- Department of Pathology and Laboratory MedicineUniversity of Wisconsin Carbone Cancer CenterUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWIUSA
| | - Michael T Winters
- Department of MicrobiologyImmunology & Cell Biology and WVU Cancer InstituteWest Virginia UniversityMorgantownWVUSA
| | - Emily S Rice
- Department of MicrobiologyImmunology & Cell Biology and WVU Cancer InstituteWest Virginia UniversityMorgantownWVUSA
| | - Inês Rolim
- Champalimaud Centre for the UnknownLisbonPortugal
| | - Raquel Cruz‐Duarte
- Instituto de Medicina Molecular João Lobo AntunesFaculdade de MedicinaUniversidade de LisboaLisboaPortugal
| | | | - Masaki Nagane
- Department of BiochemistrySchool of Veterinary MedicineAzabu UniversityKanagawaJapan
| | - Kartik Gupta
- Department of SurgerySchool of Medicine and Public HealthUniversity of WisconsinMadisonWIUSA
| | - Sahil Chaudhary
- Department of SurgerySchool of Medicine and Public HealthUniversity of WisconsinMadisonWIUSA
| | - Thomas Braun
- Department of Cardiac Development and RemodellingMax Planck Institute for Heart and Lung ResearchBad NauheimGermany
- Member of the German Center for Cardiovascular Research (DZHK)GreifswaldGermany
| | - Raghavendra Pillappa
- Department of PathologyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Mark S Parker
- Department of Diagnostic Radiology and Internal Medicine, Early Detection Lung Cancer Screening Program, Thoracic Imaging Division, Thoracic Imaging Fellowship ProgramVCU Health SystemsRichmondVAUSA
| | - Thomas Menter
- Pathology, Institute of Medical Genetics and PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Matthias Matter
- Pathology, Institute of Medical Genetics and PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Jasmin Dionne Haslbauer
- Pathology, Institute of Medical Genetics and PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Markus Tolnay
- Pathology, Institute of Medical Genetics and PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Kornelia D Galior
- Department of Pathology and Laboratory MedicineUniversity of Wisconsin Carbone Cancer CenterUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWIUSA
| | - Kristina A Matkwoskyj
- Department of Pathology and Laboratory MedicineUniversity of Wisconsin Carbone Cancer CenterUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWIUSA
| | - Stephanie M McGregor
- Department of Pathology and Laboratory MedicineUniversity of Wisconsin Carbone Cancer CenterUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWIUSA
| | - Laura K Muller
- Department of Pathology and Laboratory MedicineUniversity of Wisconsin Carbone Cancer CenterUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWIUSA
| | - Emad A Rakha
- Division of Cancer and Stem CellsDepartment of PathologySchool of MedicineNottingham University HospitalsUniversity of NottinghamNottinghamUK
| | - Antonio Lopez‐Beltran
- Champalimaud Centre for the UnknownLisbonPortugal
- Department of Morphological SciencesCordoba UniversityCordobaSpain
| | - Ronny Drapkin
- Penn Ovarian Cancer Research CenterDepartment of Obstetrics and GynecologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
- Graduate Program in Cell and Molecular BiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
- Basser Center for BRCAAbramson Cancer CenterUniversity of Pennsylvania School of MedicinePhiladelphiaPAUSA
| | - Maximilian Ackermann
- Institute of Pathology and Molecular PathologyHelios University Clinic WuppertalUniversity of Witten/HerdeckeWuppertalGermany
- Institute of Functional and Clinical AnatomyUniversity Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Paul B Fisher
- Department of Human and Molecular GeneticsSchool of MedicineVirginia Commonwealth UniversityRichmondVAUSA
- Massey Cancer CenterVirginia Commonwealth UniversityRichmondVAUSA
- Department of Human and Molecular GeneticsInstitute of Molecular MedicineSchool of MedicineVirginia Commonwealth UniversityRichmondVAUSA
| | - Steven R Grossman
- Department of Internal MedicineKeck School of MedicineNorris Comprehensive Cancer CenterLos AngelesCAUSA
- University of Southern CaliforniaLos AngelesCAUSA
| | - Andrew K Godwin
- Department of Pathology and Laboratory MedicineUniversity of Kansas Medical CenterKansas CityKSUSA
- University of Kansas Cancer CenterKansas CityKSUSA
| | - Arutha Kulasinghe
- The University of Queensland Diamantina InstituteThe University of QueenslandBrisbaneQldAustralia
| | - Ivan Martinez
- Department of MicrobiologyImmunology & Cell Biology and WVU Cancer InstituteWest Virginia UniversityMorgantownWVUSA
| | - Clay B Marsh
- Department of MicrobiologyImmunology & Cell Biology and WVU Cancer InstituteWest Virginia UniversityMorgantownWVUSA
| | - Benjamin Tang
- Department of Intensive Care MedicineNepean HospitalPenrithNSWAustralia
| | - Max S Wicha
- Rogel Cancer CenterUniversity of MichiganAnn ArborMIUSA
- Department of Internal MedicineMichigan MedicineUniversity of MichiganAnn ArborMIUSA
| | - Kyoung Jae Won
- Biotech Research and Innovation Centre (BRIC)University of CopenhagenCopenhagen NDenmark
- Faculty of Health and Medical SciencesNovo Nordisk Foundation Center for Stem Cell Biology, DanStemUniversity of CopenhagenCopenhagen NDenmark
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | | | - Rajan Gogna
- Champalimaud Centre for the UnknownLisbonPortugal
- Biotech Research and Innovation Centre (BRIC)University of CopenhagenCopenhagen NDenmark
- Faculty of Health and Medical SciencesNovo Nordisk Foundation Center for Stem Cell Biology, DanStemUniversity of CopenhagenCopenhagen NDenmark
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Galior KD, Baumann NA. Challenges with At-home and Mail-in Direct-to-Consumer Testing: Preanalytical Error, Reporting Results, and Result Interpretation. Clin Lab Med 2021; 40:25-36. [PMID: 32008637 DOI: 10.1016/j.cll.2019.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Companies that offer direct-to-consumer (DTC) testing on specimens such as saliva, blood, or urine, allow consumers to order laboratory tests without the involvement of a health care provider. This approach allows individuals to have direct access to their own laboratory results, interpret them, and make decisions regarding their health care. However, as with conventional clinical laboratory testing, there are factors that will impact the accuracy of DTC test results and limitations that consumers need to be aware of. This article focuses on challenges with DTC testing specifically related to preanalytical errors, result reporting, and result interpretation.
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Affiliation(s)
- Kornelia D Galior
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave Madison, WI 53792, USA
| | - Nikola A Baumann
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Hilton 3-70, Rochester, MN 55905, USA.
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