Falsely elevated serum estradiol due to heterophile antibody interference: a case report

SUMMARY Falsely elevated estradiol is rare, may result from heterophile antibody interference, and can result in unnecessary investigation and intervention. We present the case of a 56-year-old female with falsely elevated estradiol levels inconsistent with her overall clinical picture, which ultimately led to an unnecessary surgical procedure. With the use of alternative analytical platforms and a heterophile antibody blocking agent, we determined the false elevation was due to heterophile antibody interference. Clinicians must suspect and investigate for laboratory error when the clinical picture contradicts laboratory results.

Heterophilic antibodies in sera from individuals without loxoscelism cross-react with phospholipase D from the venom of Loxosceles and Sicarius spiders

Background Loxoscelism is a severe human envenomation caused by Loxosceles spider venom. To the best of our knowledge, no study has evaluated the presence of antibodies against Loxosceles venom in loxoscelism patients without treatment with antivenom immunotherapy. We perform a comparative analysis for the presence of antibodies capable of recognizing Loxosceles venom in a group of patients diagnosed with loxoscelism and in a group of people without loxoscelism. Methods The detection of L. laeta venom, Sicarius venom and recombinant phospholipases D from Loxosceles (PLDs) in sera from people with loxoscelism (Group 1) and from healthy people with no history of loxoscelism (Group 2) was evaluated using immuno-dot blot, indirect ELISA, and Western blot. Results We found naturally heterophilic antibodies (IgG-type) in people without contact with Loxosceles spiders or any clinical history of loxoscelism. Either serum pools or single sera from Group 1 and Group 2 analyzed by dot blot tested positive for L. laeta venom. Indirect ELISA for venom recognition showed titles of 1:320 for Group 1 sera and 1:160 for Group 2 sera. Total IgG quantification showed no difference in sera from both groups. Pooled sera and purified IgG from sera of both groups revealed venom proteins between 25 and 32 kDa and the recombinant phospholipase D isoform 1 (rLlPLD1), specifically. Moreover, heterophile antibodies cross-react with PLDs from other Loxosceles species and the venom of Sicarius spider. Conclusions People without contact with the spider venom produced heterophilic antibodies capable of generating a cross-reaction against the venom of L. laeta and Sicarius spiders. Their presence and possible interference should be considered in the development of immunoassays for Loxosceles venom detection.

Heterophilic antibodies in sera from individuals without loxoscelism cross-react with phospholipase D from the venom of Loxosceles and Sicarius spiders

Loxoscelism is a severe human envenomation caused by Loxosceles spider venom. To the best of our knowledge, no study has evaluated the presence of antibodies against Loxosceles venom in loxoscelism patients without treatment with antivenom immunotherapy. We perform a comparative analysis for the presence of antibodies capable of recognizing Loxosceles venom in a group of patients diagnosed with loxoscelism and in a group of people without loxoscelism. Methods The detection of L. laeta venom, Sicarius venom and recombinant phospholipases D from Loxosceles (PLDs) in sera from people with loxoscelism (Group 1) and from healthy people with no history of loxoscelism (Group 2) was evaluated using immuno-dot blot, indirect ELISA, and Western blot. Results We found naturally heterophilic antibodies (IgG-type) in people without contact with Loxosceles spiders or any clinical history of loxoscelism. Either serum pools or single sera from Group 1 and Group 2 analyzed by dot blot tested positive for L. laeta venom. Indirect ELISA for venom recognition showed titles of 1:320 for Group 1 sera and 1:160 for Group 2 sera. Total IgG quantification showed no difference in sera from both groups. Pooled sera and purified IgG from sera of both groups revealed venom proteins between 25 and 32 kDa and the recombinant phospholipase D isoform 1 (rLlPLD1), specifically. Moreover, heterophile antibodies cross-react with PLDs from other Loxosceles species and the venom of Sicarius spider. Conclusions People without contact with the spider venom produced heterophilic antibodies capable of generating a cross-reaction against the venom of L. laeta and Sicarius spiders. Their presence and possible interference should be considered in the development of immunoassays for Loxosceles venom detection.(AU)

Repeated spurious elevation of serum prostate-specific antigen values solved by chemiluminescence analysis: A possible interference by heterophilic antibodies

Heterophilic antibodies are human immunoglobulins directed against various animal antigens. They can produce false-positive results in the analysis of different tumor markers, including prostate-specific antigen. This interference can lead to misdiagnosis, unnecessary tests, and overtreatment in some cases. We present herein the case of a 52-year-old man with repeated spurious elevation of prostate-specific antigen, reaching levels of 108.7 ng/mL, that were suspected to be caused by heterophilic antibodies. The interference was solved by changing the analysis technique. Real values of prostate-specific antigen were less than 1 ng/mL.

Immune enhancement activities of silk lutein extract from Bombyx mori cocoons

BACKGROUND: Declining immune function poses an important clinical challenge worldwide and supplementation with natural products that possessing immune enhancing properties is a promising approach for preventing or delaying immune function decline. Cocoons from yellow silkworms are a significant source of lutein, and this unexplored silk extract could be a viable alternative source for dietary lutein. This study assessed immunomodulatory activities of the silk lutein extract. Female BALB/c mice orally received lutein, either as silk or marigold extracts (10 or 20 mg/kg daily), or vehicle only (1% tween 80 in PBS pH 7.4) for 4 weeks. Natural killer (NK) cell activity, specific antibody production, lymphocyte subpopulations, mitogen-induced lymphocyte proliferation, and cytokine production were examined. RESULTS: Silk lutein extract increased NK cell activity, and the effect was dose-related whereas marigold lutein extract was ineffective. Silk lutein extract dose-dependently enhanced antibody production in pre-immunized mice but marigold lutein extract had no effect. Feeding with silk lutein extract increased the populations of CD3+ and CD4 + CD3 + cells. Silk lutein extract also stimulated concanavalin A- and lipopolysaccharide-induced proliferations of T and B lymphocytes, respectively. Moreover, silk lutein extract increased IL-2 and IFN-γ production while the effect of marigold lutein extract was undetectable. CONCLUSIONS: Together, silk lutein extract enhanced both innate and adaptive immune functions. This preparation may prove to be an effective supplement for strengthened immunity.

Production and evaluation of chicken antibodies against a synthetic peptide from glial growth factor / Producción y evaluación de anticuerpos de gallinas contra un péptido sintético del factor de crecimiento glial

Neuregulins (NRG) are proteins that belong to the family of epidermal growth factors. It is well established that these factors are essential for the development and maintenance of the nervous system. Due to the difficulty of purifying enough quantities of these factors and the lack of specificity from commercially available antibodies, the aim of this work was to produce antibodies against a synthetic peptide capable to detect and identify neuregulin GGFb isoforms. To accomplish this goal, polyclonal antibodies were raised in hens against a synthetic peptide designed from the GGFb1 extracellular sequence. The sequence analysis was made using different epitope-predicting programs. Our results showed that the peptide sequence selected was immunogenic because it was capable of inducing a specific type B immune response in the experimental animal model. These antibodies were also capable of recognizing a recombinant GGF protein and GGF isoforms present in different samples. Our results suggest that the development of immunoglobulin Y (IgY) using synthetic peptides represents, a valuable tool for neuroscience research.

Las Neuregulinas (NRG) son proteínas que pertenecen a la familia de los factores de crecimiento epidermal. Se ha demostrado que estos factores son esenciales para el desarrollo y mantenimiento de la funcionalidad del sistema nervioso. Debido a la dificultad para purificar estas proteínas y la falta de especificidad de los anticuerpos disponibles comercialmente, el objetivo de este trabajo fue producir anticuerpos contra un péptido sintético capaz de detectar e identificar una isoforma de la Neuregulina (GGFb). Para lograr este objetivo, se desarrollaron anticuerpos en gallinas (IgY) contra un péptido sintético diseñado a partir de la secuencia aminoacídica de la región extracelular de GGFb, utilizando programas de predicción de epítopes. Los resultados demuestran que el péptido seleccionado fue immunogénico debido a que estimuló una respuesta inmune específica tipo B en el modelo utilizado. Estos anticuerpos fueron también capaces de reconocer una proteína recombinante e isoformas de GGF presentes en diferentes muestras biológicas. Nuestros resultados demuestran el potencial valor de las inmunoglobulinas Y (IgY) contra péptidos sintéticos como una herramienta de aplicación para la investigación en neurociencia.

Toxoplasma gondii: evaluation of immunofluorescence assay using heterologous secondary antibody in experimentally infected wild small rodents / Toxoplasma gondii: avaliação da reação de imunofluorescência indireta usando anticorpo secundário heterólogo em roedores silvestres experimentalmente infectados

Toxoplasmosis is a zoonotic infection caused by Toxoplasma gondii that affects a wide range of vertebrates. Rodents are intermediate hosts and serve as food for felids, the definitive hosts. However, because of the high variety of species in the order Rodentia, the serological diagnosis is difficult to perform, since the most used techniques require the use of specific antibody conjugated to fluorescein or enzymes. The aim of this study was to evaluate the use of a heterologous secondary antibody conjugate in Immunofluorescence Antibody Test (IFAT) for diagnosis of anti-T. gondii antibodies in two species of wild rodents: Euryoryzomys russatus (WAGNER, 1848) and Calomys callosus (RENGGER, 1830). The specie Mus musculus (Linnaeus, 1758) was used as control conjugate. The animals were experimentally infected with five cysts of T. gondii (strain ME 49) per animal. The Modified Agglutination Test (MAT), which does not require the use of conjugates, and the presence of T. gondii cysts in the rodents were used to confirm the infection. For each animal species, serum samples were collected weekly for five weeks and tested (50 samples per rodent specie, total of 150 samples). None of the samples from C. callosus and E. russatus were positive in the IFAT when anti-mouse heterologous conjugate was used. Brain cysts of T. gondii were microscopically observed in all animals, except in one of the E. russatus. Positive results were found in the MAT 14 days after T. gondii infection in all three species of rodents and IFAT of the control group (M. musculus) was also positive 14 days after infection using anti-mouse (homologous) conjugate. The use of heterologous secondary antibody conjugates should be used with caution and the MAT had a good agreement for serological diagnosis of T. gondii in the studied rodent species.

A toxoplasmose é uma zoonose causada pelo Toxoplasma gondii, que afeta uma grande variedade de vertebrados. Os roedores são hospedeiros intermediários e servem de alimento para felinos, os hospedeiros definitivos. No entanto, por causa da elevada variedade de espécies na ordem Rodentia, o diagnóstico serológico é difícil de ser realizado, uma vez que as técnicas mais empregadas requerem a utilização de um anticorpo específico conjugado com fluoresceína ou enzimas. O objetivo deste estudo foi avaliar o uso de um conjugado secundário heterólogo na Reação de Imunofluorescência Indireta (RIFI) para diagnóstico de anticorpos anti-T. gondii em duas espécies de roedores silvestres: Euryoryzomys russatus (WAGNER, 1848) e Calomys callosus (RENGGER, 1830). A espécie Mus musculus (Linnaeus, 1758) foi utilizada como controle do conjugado. As três espécies de roedores foram experimentalmente infectadas com cinco cistos de T. gondii (cepas ME 49) por animal. O Teste de Aglutinação Modificado (MAT), que não requer o uso de conjugados, bem como, a presença de cistos de T. gondii nos roedores foram usados para confirmar a infecção. Para cada espécie de animal, amostras de soro foram coletadas durante cinco semanas e testadas (50 amostras por espécie de roedor, total de 150 amostras). Nenhuma das amostras de C. callosus e E. russatus foram positivas na RIFI, quando foi usado o conjugado heterólogo anti-camundongo. Cistos cerebrais de T. gondii foram microscopicamente observados em todos os animais, exceto em um dos E. russatus. Resultados positivos foram encontrados pelo MAT após 14 dias de inoculação em todas as três espécies estudadas e pela RIFI no grupo controle (M. musculus), também no dia 14 após a infecção utilizando conjugado anti-camundongo. O uso de conjugados secundários heterólogos deve ser empregado com cautela e o MAT apresentou uma boa concordância para o diagnóstico sorológico de T. gondii nas espécies de roedores estudadas.

Over-expression of heme oxygenase-1 does not protect porcine endothelial cells from human xenoantibodies and complement-mediated lysis / 华中科技大学学报（医学）（英德文版）

Accommodated organs can survive in the presence of anti-organ antibodies and complement. Heme oxygenase-1 (HO-1) is essential to ensure accommodation in concordant xenotransplant models. However, whether induction of HO-1 over-expression could protect porcine endothelial cells (PECs) against human xenoantibodies and complement-mediated lysis and induce an in vitro accommodation is still unknown. The SV40-immortalized porcine aorta-derived endothelial cell line (iPEC) was pre-incubated with 20, 50, or 80 μmol/L of cobalt-protoporphyrins IX (CoPPIX) for 24 h, and the HO-1 expression in iPECs was analyzed by using Western blotting. CoPPIX-treated or untreated iPECs were incubated with normal human AB sera, and complement-dependent cytotoxicity (CDC) was measured by both flow cytometry and lactate dehydrogenase (LDH) release assay. In vitro treatment with CoPPIX significantly increased the expression of HO-1 in iPECs in a dose-dependent manner. Over-expression of HO-1 was successfully achieved by incubation of iPECs with either 50 or 80 μmol/L of CoPPIX. However, HO-1 over-expression did not show any protective effects on iPECs against normal human sera-mediated cell lysis. In conclusion, induction of HO-1 over-expression alone is not enough to protect PECs from human xenoantibodies and complement-mediated humoral injury. Additionally, use of other protective strategies is needed to achieve accommodation in pig-to-primate xenotransplantation.

Mechanism of Humoral and Cellular Immune Modulation Provided by Porcine Sertoli Cells

The understanding of main mechanisms that determine the ability of immune privilege related to Sertoli cells (SCs) will provide clues for promoting a local tolerogenic environment. In this study, we evaluated the property of humoral and cellular immune response modulation provided by porcine SCs. Porcine SCs were resistant to human antibody and complement-mediated formation of the membrane attack complex (38.41+/-2.77% vs. 55.02+/-5.44%, p=0.027) and cell lysis (42.95+/-1.75% vs. 87.99 +/-2.25%, p<0.001) compared to immortalized aortic endothelial cells, suggesting that porcine SCs are able to escape cellular lysis associated with complement activation by producing one or more immunoprotective factors that may be capable of inhibiting membrane attack complex formation. On the other hand, porcine SCs and their culture supernatant suppressed the up-regulation of CD40 expression (p<0.05) on DCs in the presence of LPS stimulation. These novel findings, as we know, suggest that immune modulatory effects of porcine SCs in the presence of other antigen can be obtained from the first step of antigen presentation. These might open optimistic perspectives for the use of porcine SCs in tolerance induction eliminating the need for chronic immunosuppressive drugs.

Thermostability of heterophile antibodies from human sera infected with Schistosoma mansoni and geo-helminths. an immuno-metric statistical analysis

Foram investigados anticorpos de soro humano que provocam lise de eritrócitos de carneiro em ensaios hemolíticos. O presente estudo mostra que a presença de anticorpos citolíticos termoestáveis contra hemácias de carneiro é dependente da infecção por Schistosoma mansoni e é mais freqüente em adultos do que em crianças. A característica termo estável da hemolisina em soros normais não é dependente da presença de Ascaris lumbricoides, Trichuris trichiura ou ancilostomídeos. Além disto, anticorpos heterófilos hemolíticos termo estáveis ativadores de complemento foram demonstrados em crianças com associação de altas cargas de ovos de S. mansoni. Os resultados foram obtidos usando-se os testes z- e o qui quadrado. O teste z- nos permite formular uma alternativa "one side", isto é, a tendência de um dos atributos. Por outro lado o teste do qui quadrado analisa a independência entre atributos usando-se uma tabela de contingência. Ao lado dos interessantes resultados obtidos no campo da esquistossomose mansoni, a abordagem estatística pode apontar novos caminhos para o tratamento de dados na ciência médica.

Journey from hepatocyte transplantation to hepatic stem cells: a novel treatment strategy for liver diseases.

Acute liver failure (ALF) carries high morbidity and mortality (>80%) even in the best centres. Orthotopic liver transplantation (OLTx) is the only viable approach to the treatment of ALF. This has significantly improved the survival in these patients. The major limitations of OLTx are non availability of the donor liver, requirement of a major surgical procedure, high cost and longterm immunosuppression. Isolated hepatocyte transplantation is emerging as an appealing method for the treatment of ALF because of its technical simplicity and easy availability of cells. Transplantation of allogenic/xenogenic hepatocytes transplantation in experimentally induced ALF has shown an increased survival rate. Clinical studies in acute, chronic liver failure and metabolic disorders have also been undertaken in a few centres and have shown encouraging results. To maintain the continuous supply of cells, xenogenic source of hepatocytes (porcine, rabbit, canine) have offered a hope. A major concern regarding the use of xenogenic donors is the risk of transmission of zoonosis and immunogenicity. Recently, Porcine endogenous retrovirus (PERV) has been shown to infect human tissue in vitro. The problem of immunogenicity of xenogenic hepatocytes can be overcome to some extent by immunoisolation, encapsulation technique, which may also provide protection to the hepatocytes during cryopreservation. The knowledge of adult hepatic stem from tissue offered a new hope for the treatment of various chronic and metabolic diseases. Further, the transdifferentiation potentiality of haematopoietic stem cells to hepatic lineage has strengthened cell therapy.

Interference in T3 radio immunoassay due to heterophil antibodies

Autoantibodies and heterophile antibodies may be interfere with immunoassay methods and yield false results, leading to incorrect diagnosis and consequently inappropriate diagnostic and therapeutic interventions, which eventually may not be only costly, but also endanger the patient's health. Interference of autoantibodienature are usually analyte specific [i.e Anti-T3 interfere only in T3 assay] and those due to heterophile antibodies are usually method specific [such as IRMA or two-site methods]. This is a case report of a patient presenting with nonspecific symptoms suspected of hyperthyroidism the TFT, and T3 evaluations were more than twice were normal range exclusively by RIA method. After ruling out interferences due to binding proteins disorders and autoantibodies by in house methods, use of blocking and removal technique show that this false result in T3 assay was caused by a heterophile antibody from Ig G class. In our review of literature this is the first case report of interference in exclusively T3 assay by RIA method due to the heterophile antibody

A hyperthyroid patient with measurable thyroid-stimulating hormone concentration - a trap for the unwary

<p><b>INTRODUCTION</b>In a patient with hyperthyroidism, the detection of elevated thyroid hormone concentration with measurable thyroid-stimulating hormone (TSH) value poses considerable diagnostic difficulties.</p><p><b>CLINICAL PICTURE</b>This 38-year-old lady presented with clinical features of thyrotoxicosis. Her serum free thyroxine concentrations were unequivocally elevated [45 to 82 pmol/L (reference interval, 10 to 20 pmol/L)] but the serum TSH values were persistently within the reference interval [0.49 to 2.48 mIU/L (reference interval, 0.45 to 4.5 mIU/L)].</p><p><b>TREATMENT</b>Investigations excluded a TSH-secreting pituitary adenoma and a thyroid hormone resistance state and confirmed false elevation in serum TSH concentration due to assay interference from heterophile antibodies. The patient was treated with carbimazole for 18 months.</p><p><b>OUTCOME</b>The heterophile antibody-mediated assay interference disappeared 10 months following the initiation of treatment with carbimazole, but returned when the patient relapsed. It disappeared again 2 months after the initiation of treatment.</p><p><b>CONCLUSIONS</b>Clinicians should be aware of the potential for interference in immunoassays, and suspect it whenever the test results seem inappropriate to the patient's clinical state. Misinterpretation of test values, arising as a result of assay interference, may lead to misdiagnosis, unnecessary and at times expensive investigations, delay in initiation of treatment and worst of all, the initiation of inappropriate treatment.</p>

Heterophile antibody positive infectious mononucleosis.

OBJECTIVE: The present study has been carried out to analyse the trend of heterophile antibody positive infectious mononucleosis cases. METHODS: A total of 1741 cases of clinically suspected infectious mononucleosis from various age groups were investigated during the period January, 1986 to December, 2000 and were analysed for infectious mononucleosis (IM) specific heterophile antibody by Paul-Bunnel-Davidsohn (PBD) test. Forty seven heterophile antibody negative samples were also tested simultaneously for the presence of the IgG antibody to viral capsid antigen (VCA) and Epstein Barr nuclear antigen (EBNA) to detect the exposure to Epstein Barr Virus (EBV) infection. RESULTS: The overall percentage of EBV specific heterophile (Paul-Bunnel) antibody positivity was found to be 11.1% (194/1741). The average Paul-Bunnel antibody positivity between 1986 to 1990 was 20.5% which declined drastically to 5.7% during 1991-2000. Males comprised of 55.2% of the serologically proven IM cases. Of the 47 heterophile antibody negative cases, 38 (80.9%) and 33 (70.2%) were found to be positive for anti-VCA IgG and anti-EBNA IgG antibodies respectively. Paul Bunnel antibody positivity was found to be higher in >14 year age group patients than those below 14 years. CONCLUSION: These findings suggest that the EBV infection still continues to be endemic in this part of the country, however, a declining trend in IM cases was observed during the last decade.

Ausencia de interferencias por anticuerpos heterófilos en la cuantificación de Troponina I Cardíaca, en pacientes con insuficiencia renal crónica terminal en tratamiento de hemodiálisis / Absence of interferences for heterophilic antibodies in the quantification de cardiac

El presente estudio pretende valorar el comportamiento de la adición del reactivo bloqueador de anticuerpos heterófilos (HBR) en la cuantificación de Troponina I cardíaca (TnIc) en pacientes con insuficiencia renal crónica terminal (IRCt) sometidos a tratamiento de hemodiálisis.Acada uno de los70 pacientes con IRCt en tratamiento de hemodiálisis en el Hospital Universitario Clínica San Rafael de Bogotá, se le tomó una muestra de suero y una de plasma heparinizado en la prediálisis, en las cuales se cuantificaron las concentraciones de TnIc con y sin adición de HBR, mediante el enzimoinmunoensayo Axsym. Se utilizó la prueba estadística de Wilcoxon. Los valores de TnIc en plasmas y sueros con y sin la adición de HBR no mostraron diferencias significativas (0.113 y 0.666 respectivamente), tanto en el total de los pacientes como en aquellos con enfermedad cardíaca crónica. El no haber encontrado diferencias en los valores de TnIc con y sin HBR nos lleva a pensar en la ausencia de anticuerpos heterófilos o en que el reactivo bloqueador HBR no tiene acción en esta población de pacientes.

Infectious mononucleosis presenting as acute hepatitis, with marked leukocytosis and renal involvement.

We report a 45-year-old lady with infectious mononucleosis due to Epstein-Barr virus. The unusual features of this case included a negative heterophil antibody test, marked leukocytosis, renal involvement and jaundice.

Avaliaçäo dos potenciais problemas pré-analíticos e metabológicos em dosagens hormonais / Evaluating potential pre-analytical and methodological problems in hormone dosage

Dosagens hormonais säo particularmente susceptíveis a potenciais interferências, que podem ser de várias origens. Estes fatores interferentes podem ser divididos em pré-analíticos, metodológicos e pós-analíticos. Nesta revisäo nós procuramos abordar os dois primeiros tipos de interferentes. Os pré-analíticos incluem variaçöes fisiológicas relativas a dieta, ritmos biológicos, estresse, doenças näo endócrinas, uso de medicaçöes hormonais, etc. Podem também englobar problemas de coleta de amostras, que incluem o tipo de material utilizado, as condiçöes de manuseio e envio das amostras, e as conseqüências na preservaçäo física dos analitos. Já os interferentes metodológicos podem ser de várias origens e incluem anticorpos heterófilos, anticorpos endógenos anti-hormônios e outros interferentes das mais variadas origens. Todos estes fatores devem ser analisados em conjunto quando da interpretaçäo de uma dosagem hormonal.

Heterophil negative infectious mononucleosis like syndrome due to hepatitis B virus.

A case of acute viral hepatitis B with features suggestive of infectious mononucleosis in a 20 year girl is described. A differential diagnosis of heterophil negative infectious mononucleosis like syndrome due to varied aetiology based on serology is emphasised.