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Characterization of circulating antibodies with affinity to an epitope used in antibody-conjugated magnetic immunoassays from a case of falsely elevated cyclosporine A.

Authors
 Sunyoung Ahn  ;  Jooyoung Cho  ;  Soon Il Kim  ;  Jisook Yim  ;  Sang-Guk Lee  ;  Jeong-Ho Kim 
Citation
 CLINICA CHIMICA ACTA, Vol.458 : 35-39, 2016 
Journal Title
CLINICA CHIMICA ACTA
ISSN
 0009-8981 
Issue Date
2016
MeSH
Adult ; Antibodies, Monoclonal/blood* ; Antibodies, Monoclonal/immunology* ; Cyclosporine/blood* ; Epitopes/immunology* ; Humans ; Immunoassay* ; Magnetic Phenomena* ; Male
Keywords
Antibody-conjugated magnetic immunoassay ; Assay interference ; Cyclosporine ; Therapeutic drug monitoring
Abstract
BACKGROUND: We report a case demonstrating falsely elevated cyclosporine A (CsA) levels by using the antibody-conjugated magnetic immunoassay (ACMIA). To determine the cause of the false positive result, we examined the presence of an interferent in the patient's sample.
METHODS: A 26-year-old male patient displayed a high CsA concentration eight weeks after discontinuation of CsA treatment when measured by ACMIA. The possibility of assay interference was examined using serial dilution tests, heterophilic blocking tubes, erythrocyte washing, polyethylene glycol (PEG) protein precipitation, and a Protein A sepharose bead immunoabsorption assay.
RESULTS: The serial dilution test showed nonlinearity, suggesting the presence of an interferent. CsA concentrations in the patient's plasma pre- and post-heterophilic blocking tube treatment were similar. Erythrocyte washing and PEG protein precipitation tests indicated the existence of a protein interferent in the plasma. Moreover, the Protein A bead immunoabsorption assay identified the interferent as antibodies against a unique epitope on the monoclonal antibody-β-galactosidase (mAb-β-gal) enzyme conjugate used in CsA ACMIA.
CONCLUSIONS: We identified a circulating antibody against the unique epitope of the CsA ACMIA mAb-β-gal conjugate that induces falsely high CsA concentrations. These findings suggest that clinically aberrant CsA levels require immediate re-measurement by reference methods such as mass spectrometry.
Full Text
http://www.sciencedirect.com/science/article/pii/S0009898116301462
DOI
10.1016/j.cca.2016.04.021
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Soon Il(김순일) ORCID logo https://orcid.org/0000-0002-0783-7538
Kim, Jeong Ho(김정호) ORCID logo https://orcid.org/0000-0003-2479-0548
Lee, Sang-Guk(이상국) ORCID logo https://orcid.org/0000-0003-3862-3660
Yim, Jisook(임지숙)
Cho, Jooyoung(조주영)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146841
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