Reason and Resolution of High Negative Control Beads in Solid-Phase Immunoassay.

OBJECTIVES: The Luminex technology is the most sensitive diagnostic method for HLA antibody detection and identification. However, the interpretation of immunoassays is commonly affected by the artifact, and non-specific background. Sera from some patients show high negative control bead (NC) value, which makes assessing and interpretation of HLA antibodies difficult. In this study, we evaluated the effect of Adsorb Out reagent, dithiothreitol (DTT), and Ethylenediaminetetraacetic acid (EDTA) on the NC median fluorescence intensity value by comparing treated versus untreated patient sera. In addition, we wanted to identify whether kidney disease and administered medication influenced high NC median fluorescence intensity values by comparing patient versus control results. MATERIALS AND METHODS: HLA antibody screening was performed on 3500 serum samples. Sera were analyzed using the standard protocol for Luminex antibody screening. Sera with high NC values were preincubated with Adsorb Out, DTT, and EDTA. Screening of these sera was then performed. RESULTS: We found that 4% of samples showed high NC values. Adsorb Out, DTT, and EDTA decreased the NC values at 723.5 (299.25-1443) versus 85 (34-218; P < .001), at 723.5 (299.25-1443) versus 184 (106-597; P < .001), and at 723.5 (299.25-1443) versus 455 (131-1177; P = .004). These succeeded in bringing back NC values to normal range in 69.2%, 43%, and 30% of treated sera, respectively. In addition, the differences of corticoids, immunosuppressive, and heparin drugs between patients and controls were statistically significant (P < .001, < .001, and = .043). However, presence of kidney disease was not significant between these groups. CONCLUSIONS: All pretreatments had an important effect in decreasing negative control values, with Adsorb Out having highest efficiency. Serum-specific components could contribute to high negative control bead median fluorescence intensity values. Further studies are needed to determine the adequate pretreatment of patient sera.

[Cytotoxicity of natural anti-HLA antibodies in Moroccan patients awaiting for kidney transplantation]. / Cytotoxicité des anticorps anti-HLA naturels chez des patients marocains candidats à la greffe rénale.

The presence of anti-HLA antibodies in the serum of a patient result from an immune response produced during an immunizing event as transfusion, pregnancy or graft. These antibodies can be cytotoxic by activating the complement pathway via C1q and may cause organ rejection during the transplant. Some male patients awaiting kidney transplantation are seropositive for anti-HLA antibodies when they have no immunizing antecedent event. These antibodies are qualified as natural antibodies. Our work is to assess the cytotoxicity of natural anti-HLA antibodies in patients followed at the immunology laboratory of the blood transfusion service and hemovigilance (STSH) as part of the kidney transplant. PATIENTS AND METHODS: We evaluated the cytotoxicity of HLA antibodies detected in male Moroccan patients without immunization history using C1qScreen One Lambda reagent for Luminex™. RESULTS: Non-immunized men were positive for HLA antibodies screening in 25.4%. These antibodies are not cytotoxic. CONCLUSION: Our study showed a positivity rate of natural HLA antibody low than the literature (25.4% against 63%). It appears that these natural antibodies are not cytotoxic and their involvement in renal transplant remains to be determined.

Radical-Scavenging Activity and Ferric Reducing Ability of Juniperus thurifera (L.), J. oxycedrus (L.), J. phoenicea (L.) and Tetraclinis articulata (L.).

Objective. The aim of this work is to study and compare the antioxidant properties and phenolic contents of aqueous leaf extracts of Juniperus thurifera, Juniperus oxycedrus, Juniperus Phoenicea, and Tetraclinis articulata from Morocco. Methods. Antioxidant activities of the extracts were evaluated by 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical-scavenging ability, Trolox equivalent antioxidant capacity (TEAC), and ferric reducing antioxidant power (FRAP) assays. Also the total phenolic and flavonoids contents of the extracts were determined spectrophotometrically. Results. All the extracts showed interesting antioxidant activities compared to the standard antioxidants (butylated hydroxytoluene (BHT), quercetin, and Trolox). The aqueous extract of Juniperus oxycedrus showed the highest antioxidant activity as measured by DPPH, TEAC, and FRAP assays with IC50 values of 17.91 ± 0.37 µg/mL, 19.80 ± 0.55 µg/mL, and 24.23 ± 0.07 µg/mL, respectively. The strong correlation observed between antioxidant capacities and their total phenolic contents indicated that phenolic compounds were a major contributor to antioxidant properties of these plants extracts. Conclusion. These results suggest that the aqueous extracts of Juniperus thurifera, Juniperus oxycedrus, Juniperus phoenicea, and Tetraclinis articulata can constitute a promising new source of natural compounds with antioxidants ability.

High background in Luminex® assay for HLA antibody screening: Interest of Adsorb Out™.

INTRODUCTION: The Luminex® technology has become an integral component of clinical decision-making and diagnosis of transplanted organ rejection. Despite the superior sensibility of this technology, it is not completely problem free. We have observed in these bead-based assays that sera of some patients give a high negative control bead (NC) value which makes assessing HLA antibodies difficult. Treatment of sera by the Adsorb Out™ reagent may reduce the high background. In this study, we want to evaluate the effect of the Adsorb Out™ on the NC's MFI value by comparing treated and untreated patients' sera. METHODS: HLA antibody screening was performed on 3011 sera. These sera came from patients awaiting and undergoing renal transplant from different Moroccan hospitals. The sera were analyzed using the standard protocol for Luminex® antibody screening. Sera with high NC's value has been pre-incubated by the Adsorb Out™, and analyzed on Luminex®. RESULTS: 3% of studied samples have high NC's value. The Adsorb Out™ decreases the NC's value and brings it back to a normal range in 62.2% treated sera. It has no effect in 12.3%. The Adsorb Out™ effect depends only of NC's value, independently to age, storage date, sex and immunization. CONCLUSION: The Adsorb Out™ reagent has an important effect in decreasing NC value of sera. However, it has no effect in some patient's sera. In these cases we could try another treatment, as EDTA, DTT. The non-specific binding may be caused by multiple patient-specific factors, it would be important to search correlation between them and NC's values.

Adjusting insulin doses: from knowledge to decision.

The aim of this study was to analyze the absence of adjustment of insulin doses in type 1 diabetic patients with poorly controlled diabetes. Twenty-eight patients (HbA(1)c higher than 8.5% during the last 6 months, performing at least three capillary blood glucose determinations per day), completed a questionnaire on the degree of confidence in their own knowledge, the nature of their health beliefs, their fear of hypoglycemia, their own appreciation on how they adjust their insulin doses (subjective score). An analysis of their diabetes logbook provided an objective score of the adjustment of doses actually performed. The results show that the subjective and objective scores of adjustment were not significantly correlated. Further there was a significant negative correlation between the score of uncertainty on knowledge and the subjective score of adjustment of the insulin doses, but not with the objective score. There was a significant correlation between the score of positive health beliefs and the subjective score of adjustment of the insulin doses, but not with the objective score. No correlation was found between the score of fear of hypoglycemia and the subjective score of adjustment of the insulin doses. Correlation with the objective score was higher, but not significant. Actually, the fear of hypoglycemia was the most frequently given reason for not adjusting the insulin doses, when the question was asked to the patients with an open answer. This study illustrates the difference between thinking and doing. It also shows that the degree of confidence in one's own knowledge, the health beliefs, and the fear of hypoglycemia differently influence the perception that the patients have of their behavior, and what they really do.