Development of monoclonal antibodies to pre-haptoglobin 2 and their use in an enzyme-linked immunosorbent assay (ELISA).

Haptoglobins (HPs) are alpha 2-globulin proteins that bind free hemoglobin in plasma to prevent oxidative damage. HPs are produced as preproteins that are proteolytically cleaved in the ER into alpha and beta chains prior to forming mature, functional tetramers. Two alleles exist in humans (HP1 and HP2), therefore three genotypes are present in the population, i.e., HP1-1, HP2-1, and HP2-2. A biochemical role for nascent haptoglobin 2 (pre-haptoglobin 2 or pre-HP2) as the only known modulator of intestinal permeability has been established. In addition, elevated levels of serum pre-HP2 have been detected in multiple conditions including celiac disease and type I diabetes, which are believed to result in part through dysregulation of the intestinal barrier. In this study, we report the development of a monoclonal antibody that is specific for pre-HP2 with a binding affinity in the nanomolar range. Additional antibodies with specificities for preHP but not mature haptoglobin were also characterized. A sandwich enzyme-linked immunosorbent assay (ELISA) was established and validated. The ELISA showed high specificity for pre-HP2 even in the presence of excess pre-HP1 or mature haptoglobins, and has excellent linearity and inter- and intra-assay reproducibility with a working range from 3.1ng/mL to 200ng/mL. Testing of sera from 76 healthy patients revealed a non-Gaussian distribution of pre-HP2 levels with a mean concentration of 221.2ng/mL (95% CI: 106.5-335.9ng/mL) and a median value of 23.9ng/mL. Compared to current approaches, this ELISA offers a validated, monoclonal-based method with high sensitivity and specificity for measuring pre-HP2 in human serum.

Autoantibody detection using multiplex technologies.

Measurement of multiple antibodies has been possible for years using labor-intensive methods such as counterimmunoelectrophoresis and radioimmunoprecipitation. Recently, simpler methods that are more practical for routine analysis, often described as multiplex technologies, have been introduced. One common technique, the line assay, uses nitrocellulose strips that are precoated at different locations with more than a dozen recombinant proteins or peptides. Detection of results may be performed visually or with scanning instrumentation. A second technique uses families of polystyrene beads that are dyed to establish a unique identity; each bead type is then coated with a specific affinity-purified or recombinant protein. Detection is performed by flow cytometry. There have been multiple descriptions of the use of these techniques for measuring antibodies associated with the antinuclear antibody screen. More recent reports describe applications to antibodies associated with hypothyroidism, ANCA, anti-phospholipid syndrome, and celiac disease. This review summarizes the work that has been performed to date and examines the potential benefits of multiplexing to both the laboratory and the physician.

Evaluation of the BioPlex 2200 ANA screen: analysis of 510 healthy subjects: incidence of natural/predictive autoantibodies.

The BioPlex 2200 ANA Screen is a fully automated system that determines levels for 13 different autoimmune antibodies of established clinical significance. The objective of this study was to determine the specificity of the BioPlex 2200 ANA Screen assay and to analyze the antibody profile samples collected from healthy subjects against comparative ELISA and IIF screening methods. A total of 510 specimens were randomly selected from a cohort of apparently healthy blood bank donors. Samples were distributed to five age brackets. All samples were tested using Bio-Rad's ANA Screen kit. Specificity was compared to IIF and ELISA results. Most of the samples were found negative in all ANA screening systems (84.5% by IIF, 92.5% by BioPlex 2200 ANA Screen kit, and 94.5% by ELISA). The frequency of positive results was highest (15.5%) using IIF, in comparison to almost similar results (5.5% vs. 7.5%) achieved by ANA ELISA and BioPlex 2200 ANA Screen kits. The positive rate of autoantibodies was significantly reduced when analyzed by different combinations of ANA screen assays (from 2.35% using IIF + BioPlex ANA Screen tests to 0.98% by using all three tests). Using the BioPlex 2200 ANA Screen system, we were able to identify samples with high levels of individual antibodies: anti-dsDNA at 20-63 IU/mL, antichromatin at 4-8 AI, anti-SmRNP at 2-6 AI, and anti-RNPA at 2-4.5 AI. Importantly, from 7 IIF and ELISA positive sera, 5 of these were also BioPlex 2200 positive, suggesting that the BioPlex is seeing the samples that are of the greatest interest, using the established techniques. The specificity of the BioPlex 2200 ANA Screen analysis of 13 different analytes (dsDNA, centromere B, chromatin, Jo1, ribosomal P, RNP 68, RNP A, Scl-70, Sm, SmPNP, SS-A52, SS-A60, SS-B) is comparable (P < 0.252) to the ELISA ANA screening test. Like the ELISA, the BioPlex 2200 has a lower (P < 0.001) positive rate than IIF for the autoantibody screening.

Use of REMEDi HS in emergency toxicology for a rapid estimate of drug concentrations in urine, serum, and gastric samples.

The REMEDi HS is a broad spectrum drug identification system, designed for emergency toxicology screening and forensic applications. The total analysis time is about 20 min. The current library has 555 drugs and metabolites. The system has a software routine that uses an internal standard (IS) to perform quantitative analysis for target compounds when calibrators are available; further, response factors (RF) are supplied for a rapid estimate of drug concentrations when calibrators are unavailable. In the present study, The concentrations of six drugs (bromisovalum, ephedrine, hydroxyzine, diphenhydramine, ranitidine, and lidocaine) and a metabolite of lidocaine (glycinexylidide) were determined using both methods. The slopes of the regression lines between the rapid estimate method and the IS method were generally within 20% of unity, in agreement with the manufacturer's claim. Semiquantitative estimates based on RF also showed good agreement with results obtained using multipoint calibration. These estimates were sufficient for clinical differentiation of routine and toxic levels. Our study demonstrated that the REMEDi HS is particularly useful for a rapid estimate of drug concentrations in the samples from emergency cases when calibrators are not readily available. Our study also showed that this system can be used for the therapeutic monitoring of ranitidine, bromisovalum, lidocaine, and diphenhydrmine.

Use of direct-probe mass spectrometry as a toxicology confirmation method for demoxepam in urine following high-performance liquid chromatography.

The identification of the metabolite demoxepam in human urine establishes that chlordiazepoxide, a common benzodiazepine, has been administered. Like N-oxide metabolites of other drugs, demoxepam cannot be detected by gas chromatography-mass spectrometry (GC-MS), due to thermal decomposition, and the product, nordiazepam, is a metabolite common to many benzodiazepines. Demoxepam can be readily screened using a high-performance liquid chromatography (HPLC) system such as REMEDi HS; at 35 degrees C, no thermal decomposition will occur. Currently, there is no confirmation method available for the detection of demoxepam in urine samples. In this study, we demonstrated that following collection of the HPLC fraction, demoxepam can be confirmed using the technique of direct-probe MS. The mass spectra of demoxepam and nordiazepam differ and are easily distinguishable from each other. Ten urine samples that were analyzed by HPLC and determined to contain demoxepam were evaluated; demoxepam was confirmed in each case by direct-probe MS.

Forensic application of an automated drug-profiling system.

The rapid emergency drug identification (REMEDi) system is an automated drug-profiling system that employs high-performance liquid chromatography with a multicolumn design. It has previously proven successful in emergency toxicology situations and in the clinical analysis of urine and serum. Its capabilities include the broad spectrum identification of more than 500 basic, neutral, and slightly acidic drugs and metabolites. Forensic applications, including analysis of whole blood and tissue, were investigated, and comparisons with more traditional laboratory methods are reported. The whole blood and tissue samples require offline sample extraction prior to system analysis. Approximately 50 drugs were used as standards to test the preparation method, analytical system, and limit of detection. More than 50 cases from the medical examiner's office were analyzed with the combination extraction and automated drug-profiling system; these cases were compared with previously reported findings. Results showed that the REMEDi system is a useful complimentary tool for screening forensic cases; the current range of detectable drugs was expanded by using the system.

The development of a broad-spectrum toxicology screening program in Taiwan.

Our institute serves as a centralized clinical laboratory for municipal and private hospitals in Taipei, a major international metropolis in the Asian region. Two key considerations leading to the development of our toxicology program are: a large number of foreign visitors and local residents returning from overseas trips may bring in chemicals which are less commonly seen in this region; and the lack of readily available assays for a large percentage of commonly used medicines, including prescription and over-the-counter drugs. Our toxicology screening program addresses the needs of both the Emergency Department Drug Screening and Drug of Abuse Screening. In Emergency Department Drug Screening, REMEDi HS is used as the general screening method. In Drug of Abuse Screening, the TDx is used for the initial screening of amphetamine-like substances and opiates, followed by REMEDi HS for the confirmation of positive samples. Emergency Department data collected at our institute over one year (September 1992 to August 1993) identified 57 different drugs in 713 samples. Opiates, narcotics and central stimulants accounted for 24% of the encountered drugs. Presently, there is no extensive reporting of misuse of benzodiazepines in this region. The detection of herbal ingredients like ephedrine and methylephedrine (from the Ma-Huang plant) in patient samples illustrates a large area often overlooked by western toxicology.

Standardization of a multi-wavelength UV detector for liquid chromatography-based toxicological analysis.

The performance of a multi-wavelength UV detector for automated drug identification following liquid chromatographic separation was evaluated. The ability of selected wavelength ratios to distinguish two closely related drugs was considered at different concentrations. Calibration of the detector based on wavelength ratios was then utilized to standardize two different detectors and to evaluate instrument-to-instrument variation of a series of detectors. Reproducibility of the second-derivative zero intercept for these drug spectra was also evaluated. Standardization of detector performance by reference to these two parameters permitted the transfer of UV spectral libraries stored on one instrument to another without compromising the reliability of qualitative data.

Ranitidine interference with the monoclonal EMIT d.a.u. amphetamine/methamphetamine immunoassay.

The interference of ranitidine with the monoclonal EMIT d.a.u. amphetamine/methamphetamine immunoassay (ME) was investigated. Urine specimens collected from 23 patients receiving 150-300 mg of ranitidine daily were found to contain 7-271 mg/L of the drug when analyzed by Remedi automated high pressure liquid chromatography. Only patient specimens and urine samples with ranitidine added at concentrations greater than 91 mg/L gave false positive ME results. Of the 63 patient urine samples analyzed by ME, 12 gave false positive results. All false positive results occurred in the first or second void after ingestion. No false positive results occurred with the polyclonal EMIT d.a.u. amphetamine or TDx amphetamine/methamphetamine II assays.

Identification of drugs in physiological fluids following on-line liquid chromatographic purification and analysis.

This paper describes the application of an automated algorithm for drug identification following the liquid chromatographic on-line separation and purification of drugs in physiological fluids. Two hundred fifty-seven (257) drugs and 45 drug metabolites were assembled for testing. Two internal standards were used which monitored different columns in the multi-step analytical separation. Retention reproducibility over a nine month period was 4 p. cent or less for most drugs. The algorithm for matching unknown peaks against the stored library utilized relative retention, lambda maxima, normalized spectral overlays, wavelength ratios and zero-intercepts from the second derivative in a combined forward-reverse search. Most of the drugs which could not be unambiguously identified were sedatives which eluted in the first minutes of the chromatogram. Diasteromers were partially resolved. Repetitive analysis of 200-400 micrograms/l of amphetamine, diphenhydramine, imipramine and morphine were evaluated to establish an absorption cutoff of 12 mAbs, above which at least 95% of peaks were correctly identified. This corresponded to a signal-to-noise ratio of 12 for the scanning UV detector which was evaluated.

Analysis of benzodiazepines and tricyclic antidepressants in serum using a common solid-phase clean-up and a common mobile phase.

A single, rapid and specific solid-phase clean-up procedure was developed for the analysis of benzodiazepines and tricyclic antidepressants using a carefully selected wash step and specific sequential elution. Benzodiazepines were eluted from the solid-phase column using as mixture of water-methanol-acetonitrile (2:3:3) followed by the elution of tricyclic antidepressants with methanol containing 0.6% diethylamine. A 30% solution of acetonitrile in phosphate buffer containing dimethyloctylamine was used as a common isocratic mobile phase for the analysis of benzodiazepines and tricyclic antidepressants on a reversed-phase column and detection was carried out at 242 nm. The sensitivity limit of the assay for benzodiazepines and tricyclic antidepressants was 25 ng/ml in serum with recoveries of 95-105% for benzodiazepines and 76-95% for tricyclic antidepressants. The results were linear for benzodiazepines over the range 50-2000 ng/ml and for tricyclic antidepressants over the range 25-500 ng/ml. Analysis for benzodiazepines and tricyclic antidepressants gave good precision, with a coefficient of variation of less than 5.0%. The method described here will be suitable for use in a clinical setting, where there is a concomitant use of benzodiazepines and tricyclic antidepressants.

Automated liquid chromatographic analysis of drugs in urine by on-line sample cleanup and isocratic multi-column separation.

A multi-column system has been developed for automated analysis of basic drugs in urine. Two polymeric pre-columns, containing PRP-1 and Aminex A-28, were used to isolate the drugs. A short reversed-phase column, coupled to a 150 x 4.6 mm I.D. silica column, produced the analytical separation. Sample preparation consisted of dilution and centrifugation. The entire procedure required less than 30 min. Careful optimization of mobile phase conditions led to retention of benzoylecgonine and barbiturates. For most drugs, levels of 0.3 mg/l were sufficient to produce peaks that could be matched against stored spectra with a computerized library search program.

Chromatographic techniques for therapeutic drug monitoring.

Although GLC is still used with some frequency, HPLC is currently the most widely practiced chromatographic technique for the measurement of therapeutic drugs. Efficiency and selectivity can be manipulated to meet the requirements of clinical samples, especially when drug metabolites are present and their concentrations are of importance. The ability to simultaneously quantitate several drugs has led to the development of many methods for antiepileptic, antiarrhythmic, and antidepressant drugs. Selective detectors offer more sensitive analysis in many separations and are increasingly popular. The development of automated methods for sample preparation suggests that more cost-effective strategies for the chromatographic analysis of new drugs will be possible in the near future.

Analysis of urinary catecholamines by high-performance liquid chromatography in the presence of labetalol metabolites.

Common sample preparation methods for catecholamines lead to contamination with metabolites of labetalol, an anti-hypertensive drug. When the extracts are analyzed by cation-exchange high-performance liquid chromatography, these metabolites are separated from the catecholamines, but their strong retention lengthens the analysis time. A procedure has been developed for complete removal of these drug metabolites from acidified urine by the use of XAD-4 resin. Loss of catecholamines is monitored by an internal standard. This pretreatment can be combined with extraction by weak cation-exchange resin and borate elution to simplify catecholamine analysis for patients receiving labetalol.

Measurement of urinary vanilmandelic acid and homovanillic acid by high-performance liquid chromatography with electrochemical detection following extraction by ion-exchange and ion-moderated partition.

An improved protocol has been developed to isolate homovanillic acid (HVA) and vanilmandelic acid (VMA) from urine with strong anion-exchange resin. The sample is diluted with acetate buffer and passed through a disposable column. HVA, uric acid, and many hydrophobic organic acids are removed with 1.0 M acetic acid--ethanol. Then VMA is eluted with 0.5 M phosphoric acid. Two isocratic mobile phases allow rapid high-performance liquid chromatographic measurement of VMA (5 min) and HVA (8 mins) on a 5-micron ODS column. Selective conditions were developed with dual-electrode coulometric detection to permit specific measurement of VMA, HVA, and internal standards, with less than 5% between-run variation.

Quantitation of urinary normetanephrine and metanephrine by reversed-phase extraction and mass-fragmentographic analysis.

Hydrolyzed urine with added ring-trideuterated normetanephrine and metanephrine is applied to wet C18-reversed-phase minicolumns. The "metanephrines" are eluted, dried, derivatized with pentafluoropropionic anhydride, and analyzed with the gas chromatograph-mass spectrometer. Ions for the nondeuterated and trideuterated compounds are monitored at ml z 458 and 461, respectively. For both normetanephrine and metanephrine, the standard curve is linear over the range 10-2000 micrograms/L and the procedure has adequate precision both within-run (CV less than 3%) and between-day (CV less than 7%). Alkaline pH in the extraction is important for optimal analytical recovery. We have examined the potential value of untimed urine specimens for screening purposes and compared 24-h urine concentrations of these analyses in normotensive and hypertensive persons.