Bio-Rad Laboratories Research Articles

A-115 Iron assay improvement: The need for thiourea addition in Ferene/Ferrozine reagent cartridge

Abstract Background Iron assay is often ordered along with ferritin, transferrin, and iron binding capacity in patients suspected of having iron deficiency anemia or iron overload. A ferene/Ferrozine chromogen-based iron assay is more common in College of American Pathology accredited laboratories across U.S. Recently, a product recall/field safety notice was issued by a major manufacturer for several lots of ferene based iron reagent due to unacceptable positive bias in patient iron results. However, the reason(s) underlying this positive bias was not provided. In this report, we investigated the possible causes for the recall of specific lots of iron assay reagents. Methods The performance of 2 lots of recalled iron test kits was compared against 2 good lots (Sentinel Diagnostics) on the Alinity c analyzer utilizing approved calibrator lots, quality control (QC) materials (Bio-Rad Laboratories), and excess/leftover de-identified patient samples. Spectral scan (in the visible wavelength) of good and recalled lots of reagents, R1 and R2 was performed on the Tecan microplate reader. Trace elements in R1 and R2 reagents were estimated with Quantitative Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Spiking experiments in calibrator, discarded patient samples, and reagents were undertaken to further elucidate the cause and prevention of positive bias seen with recalled reagent lots. Graphs and statistical analysis were generated using Graphpad prism 10.1. Results Iron levels in QC materials and de-identified patient samples (n=42) tested with 2 recalled lot of reagents on Alinity c analyzer showed a positive bias of 15-36% compared to unimpacted lots of reagents. Calibrator and blank absorbance of recalled lots was much higher than the unimpacted lots. Percentage change in the basal absorbance of recalled vs unimpacted R2 reagent measured from 500 to 600 nm in 25 nm increments and corrected to 700 nm ranged from 150 to 250%. No such changes were noted with both R1 reagents. Interestingly, ICP-MS heavy metal panel analysis revealed that R2 reagent of the recalled lots had unanticipated presence of Cu (∼22 υg/dL) and lead (7.5 υg/L), which was not present in R1 reagents. Increased concentrations of Cu spiking (100, 200, and 400 υγ/dL) in R2 reagent from recalled lots discernibly increased the Cal Factor values as well as patient iron results relative to unspiked reagent. Further, the presence of Cu over time deteriorated the accuracy of R2 reagent reflecting on very high rise in Cal Factor and patient iron values. Interestingly, TU addition to R2 reagent from unimpacted lot prevented the Cu-induced spurious rise in Cal Factor and iron measurements in the patient samples. Further, TU exhibited sustained preventive effect on Cu-induced iron measurement changes over time. Conclusions Based on our investigation, we conclude that copper contamination of R2 reagent is the possible cause for the positive bias in the recalled iron assay reagent lots. We recommend the addition of TU to Ferene containing R2 reagent pack as a simple and effective step to prevent Cu-induced false elevation in iron values.

B-055 Comparison of two different methods for quantitation of anti-dsDNA antibody

Abstract Background Anti-dsDNA antibody is a specific marker of rheumatic disorder, primarily systemic lupus erythematosus (SLE). Early detection of these diseases is most important in treatment and prognosis. We evaluated two different quantitation systems of anti-dsDNA antibody: the BioPlex 2200 multiplex simultaneous detect system and the single detection method, which is the Phadia 250 system. Methods 53 serum samples were analyzed by two different methods, which are BioPlex 2200, Bio-Rad Laboratories, Hercules, CA, and Padia 250, Thermo Fisher Scientific, Uppsala, Sweden, respectively. The method of the BioPlex 2200 system is multiplexed bead assay, and that of Phadia 250 is Fluorescence Enzyme Immunoassay (FEIA). Results The quantitation results of BioPlexx 2200 were 1 to 126 IU/mL, and those from Phadia 250 were 0.08 to 109.53 IU/mL, respectively. These two groups of the anti-dsDNA antibody values showed excellent correlations (r=0.9036). Conclusions The quantitation of anti-dsDNA antibody were performed mainly by a single analyzing method, Phadia 250, in Korea. Bioplex 2200 system is multiplex bead assay; it can analyze eight different Extractable Nuclear Antigen Antibodies (anti-ENA) simultaneously: Anti Ribosomal P Ab, Anti SSa/Ro Ab, Anti SSb/La Ab, Anti Centromere Ab, Anti Sm Ab, Anti RNP Ab, Anti SCL-70 Ab, Anti Jo-1 Ab as well. Nevertheless, these anti-ENA results showed semiquantitative results.

A-272 Evaluation of a Real-Time Multiplex Polymerase Chain Reaction Assay for Simultaneous Detection of Respiratory Pathogens in Nasopharyngeal Specimens

Abstract Background Respiratory infections present a significant challenge due to the diverse range of pathogens involved and the possibility of concurrent infections, emphasizing the importance of rapid and accurate detection for effective treatment. Advancements in molecular methods have provided cost-effective and reliable solutions for the identification of respiratory pathogens. In this study, we aimed to assess performance characteristics of the Seegene Allplex™ 2019-nCoV Assay and Seegene Novaplex™ Respiratory Panel Assays for simultaneous amplification and detection of 22 respiratory pathogens using real-time multiplex polymerase chain reaction (PCR). Methods Nucleic acid extraction was performed using the MagMAX™ Viral/Pathogen Nucleic Acid Isolation Kit (Thermo Fisher Scientific, MA) on the CyBio® FeliX liquid handler (Analytik Jena, Germany). PCR amplification and detection were performed using the Seegene Novaplex™ Respiratory Panels 1A, 2, 3, PneumoBacter Assay, and Allplex™ 2019-nCoV Assay (Seegene Inc, South Korea) on the CFX96™ System (Bio-Rad Laboratories, CA). The assays utilize Seegene MuDT™ technology that allows for the detection of multiple targets in a single channel without the need for melt curve analysis. For method validation, precision studies were performed within-run and over 4 days. The limit of detection was verified by using plasmids from Seegene containing the target sequence for each pathogen at known concentrations. Method comparison studies were carried out by extracting and analyzing a range of 41 to 79 split samples for each pathogen against the BioFire® Respiratory 2.1 Panel (bioMérieux, France), cobas® Influenza A/B & RSV Assay on the cobas® liat system (Roche Diagnostics, IN), and Lyra® SARS-CoV-2 Assay (Quidel, CA) on the CFX96™ system. Additional accuracy studies were performed by spiking negative patient samples with standards from ZeptoMetrix® (Antylia Scientific, IL) containing known concentrations of the targeted respiratory pathogens. Results Precision studies demonstrated consistent and reproducible results for all pathogens. The limit of detection was verified at 1000 copies/reaction for human parainfluenza virus 4 and human metapneumovirus, and at 100 copies/reaction for all other pathogens. Results of the spike-and-recovery studies were consistent with expected results for all targets. Patient correlation studies showed 100% agreement with expected pathogen identification for 19 pathogens, and greater than 97.9% agreement for influenza B virus, respiratory syncytial virus, human parainfluenza virus 4, and human coronavirus 229E. Conclusions The Seegene Allplex™ 2019-nCoV Assay and Novaplex™ Respiratory Panel Assays offer a rapid and reliable method for detecting respiratory pathogens in nasopharyngeal specimens. The capability of the assays to detect multiple targets in a single well enhances efficiency, cost-effectiveness, and turnaround time.

Seasonal increase in syphilis screening reactivity rates in whole blood donors, United States, 2011-2023.

In December 2021, the U.S. Food and Drug Administration published a letter to clinical laboratory staff and healthcare providers detailing a risk of false Rapid Plasma Reagin (RPR) when using the Bio-Rad Laboratories BioPlex 2200 Syphilis Total & RPR kit in people who had received COVID-19 vaccination; Treponema pallidum particle agglutination assays did not appear to be impacted by this issue. We evaluated reactivity rates of syphilis screening with negative confirmatory testing at our institution by year and seasonality. We performed a retrospective study of routine syphilis testing of whole blood (WB) collections at an academic hospital-based donor center in the eastern United States. All WB donations from 2011 to 2023 which demonstrated reactive syphilis screening (Beckman Coulter PK TP Microhemagglutination) with negative confirmatory testing (CAPTIA Syphilis (T. pallidum)-G) were evaluated. Reactivity rates by year and season of donation were compared using unpaired t-tests. A total of 109 WB donations from 86 unique donors who donated from 2011 to 2023 screened reactive for syphilis with negative confirmatory testing. The unconfirmed syphilis reactivity rate increased from 2018 to 2023 (mean: 0.360%) compared to 2011-2017 (mean: 0.071%, p < .05). An autumnal peak in unconfirmed reactives was observed. The unconfirmed syphilis reactivity rate among WB donors at our institution increased markedly since 2017 compared to the 7 years prior and doubled from 2020 to 2021. No testing assay changes explain these results. The autumnal peak in unconfirmed reactives suggests a possible environmental trigger such as viral infection or vaccination.

The Impact of the Reduction in Environmental Pollution during COVID-19 Lockdown on Healthy Individuals.

The lockdown imposed to combat the COVID-19 pandemic produced a historic fall in air pollution in cities like Barcelona. This exceptional situation offered a unique context in which to examine the effects of air pollutants on human health. The present study aims to determine and compare the oxidative stress biomarkers Th1/Th2 and inflammatory-related cytokines in healthy individuals first during lockdown and then six months after the easing of the restrictions on mobility. A prospective study of a representative sample of 58 healthy, non-smoking adults was carried out. During lockdown and six months post-easing of restrictions, blood samples were drawn to measure the percentage of eosinophils, levels of Th1/Th2 and inflammatory-related cytokines assessed by a multiplex assay (BioRad Laboratories S.A., Marnes-la-Coquette, France), and levels of 8-isoprostane, glutathione peroxidase activity, and myeloperoxidase (Cayman Chemical Co., Ann Arbor, MI, USA), to assess their value as biomarkers of oxidative stress. Six months after easing mobility restrictions, increases in the levels of 8-isoprostane (p < 0.0001), IL-1β (p = 0.0013), IL-1ra (p = 0.0110), IL-4 (p < 0.0001), IL-13 (p < 0.0001), G-CSF (p = 0.0007), and CCL3 (p < 0.0001) were recorded, along with reductions in glutathione peroxidase (p < 0.0001), IFN-γ (p = 0.0145), TNFα (p < 0.0001), IP-10 (p < 0.0001), IL-2 (p < 0.0001), IL-7 (p < 0.0001), basic FGF (p < 0.0001), CCL4 (p < 0.0001), and CCL5 (p < 0.0001). No significant differences were observed in the rest of the biomarkers analyzed. The reduction in environmental pollution during the COVID-19 lockdown significantly lowered the levels of oxidative stress, systemic inflammation, and Th2-related cytokines in healthy people.

HIV rapid tests immunological internal control can be misleading

Objective: To assess whether internal controls (IC) of HIV rapid tests (HRT) and a rapid confirmatory assay (Geenius) were designed to solely prevent procedural missteps or wether they can also alert for insufficient sample quantity.Material and methods: Thirteen tests were evaluated using distilled water, phosphate buffered saline, and HIV-1 positive serum samples : Autotest VIH® (Autotest) (AAZ-LMB), INSTITM HIV-1/HIV-2 Antibody Test (INSTI) (Biolytical), MULTISURE® HIV Rapid Test (MULTISURE) (MP Diagnostics Asia Pacific Pte. CE Ltd), Biosynex® HIVTOP (Biosynex), Exacto HIVTOP® (Biosynex), Exacto® TEST HIV PRO (Biosynex), GenieTM Fast HIV 1/2 (Bio-Rad laboratories), GeeniusTM HIV 1/2 Confirmatory Assay (Geenius) (Bio-Rad laboratories), VIKIA® HIV 1/2 (bioMérieux), FIRST RESPONSE® Test VIH 1-2.O CARTE (Premier Medical Corporation), Hexagon HIV (Human), DetermineTM HIV EARLY DETECT (Determine) (Abbott), and ONE STEP Anti-HIV 1&2 (InTec PRODUCTS, Xiamen, Fujian P. R. China).Results: Among the 13 tests, 4 were invalid when tested without human serum sample: Autotest, Geenius, INSTI and MULTISURE. The Autotest and INSTI accurately labelled diluted samples, with a Test line positive at least one dilution below the IC. Geenius test line and IC were positive up to the same dilution with automated reading. However, MULTISURE IC was positive up to 1000-fold dilution higher than its test line, making it unsuitable to alert for low sample quantity.

Comparison of quantitative and qualitative anti-dsDNA assays.

In evaluation of systemic lupus erythematosus (SLE), anti-double-stranded DNA antibodies (anti-dsDNA) play a significant role in diagnosis, monitoring SLE activity, and assessing prognosis. However, evaluations of the performance and limitations for recently developed methods for anti-dsDNA assessment are sparse. Specimens used for antinuclear antibody testing (n = 129) were evaluated for anti-dsDNA assay comparability across 4 medical centers in the United States. The methods compared were Werfen Quanta Lite dsDNA, Zeus Scientific dsDNA Enzyme Immunoassay, Bio-Rad multiplex immunoassay (MIA) dsDNA, ImmunoConcepts Crithidia, and Bio-Rad Laboratories Crithidia. For quantitative anti-dsDNA measurements, Spearman's correlation coefficient was highest between Zeus and Werfen (ρ = 0.86; CI, 0.81-0.90; P < .0001). Comparison of MIA to Werfen or Zeus yielded similar results to each other (ρ = 0.58; CI, 0.44-0.68; P < .0001; and ρ = 0.59; CI, 0.46-0.69; P < .0001, respectively), but lower than the correlation between Zeus and Werfen. Positive concordance between assays ranged from 31.4% to 97.1%, and negative concordance between assays ranged from 58.5% to 100%. The detection of anti-dsDNA in those with SLE diagnosis ranged from 50.9% to 77.4% for quantitative assays and 15.1% to 24.5% for Crithidia assays. Current quantitative anti-dsDNA assays are not interchangeable for patient follow-up. Crithidia-based assays demonstrate high negative concordance and lack positive concordance among the methods.

Increased plasminogen activator inhibitor-1 (PAI-1) and its associations with metabolic risk in healthy young adults with early life stress

ObjectivesWe aimed to characterize the interplay between early life stress (ELS), metabolic syndrome (MetS), and plasminogen activator inhibitor-1 (PAI-1), a major inhibitor of the fibrinolytic system implicated in cardiometabolic diseases. We also examined the understudied intersection of ELS, physical activity and PAI-1. MethodsHealthy young adults ages 18–40 (N=200; 68% female) were recruited from the community. Participants with ELS (N=118) experienced childhood maltreatment, and the majority (n=92) also experienced childhood parental loss. Control participants (N=82) had no history of childhood maltreatment or parental loss. Participants had no current cardiometabolic or thrombotic conditions. Fasting plasma samples were assessed for markers of metabolic risk and total PAI-1 using the Bio-Plex Pro Human Diabetes Panel (Bio-Rad Laboratories). A composite metabolic risk z-score (MetS risk) was computed from the mean standardized z-scores of waist-to-height ratio, systolic and diastolic blood pressure, triglycerides, total cholesterol, LDL and HLD cholesterol, fasting plasma glucose, and hemoglobin A1c. ResultsWe found that a history of ELS was linked to both higher PAI-1 levels and a higher MetS risk score. ELS was associated with a higher MetS Z-score in adulthood via increased circulating PAI-1 levels (Average Causal Mediation Effect [ACME]= 0.07, p = 0.036). ELS was also linked to increased PAI-1 levels via greater MetS z-scores (ACME = 0.02, p < 0.001). There was a significant interaction effect of ELS and exercise on PAI-1 levels (p = 0.03), such that engaging in higher levels of daily exercise was linked to lower PAI-1 levels in individuals with ELS. ConclusionHealthy young adults with ELS have elevated PAI-1 levels and metabolic risk scores. Among individuals with ELS, exercise is linked to lower PAI-1 levels, suggesting a potential direction for early intervention.

Association of polymorphic variants of cytokines genes, endothelial growth factor and matrix metalloproteinases with the development of uterine fibroids among russian women

One of the factors in the development of uterine fibroids is a genetic predisposition to its occurrence in some women, but the real molecular genetic mechanisms of this phenomenon remain unknown. Aim of the study was the distribution analysis of gene polymorphism of cytokines TNFα, IL-1β, IL-4, IL-6, IL-10, factors of angiogenesis (vascular endothelial growth factor, VEGF) and remodeling of extracellular matrix (metalloproteinases MMP2, MMP3, MMP9), which are associated with their levels. Material and methods. Genotyping was performed by real-time PCR using commercial test systems SYBR GreenI (Litech, Russia) and TaqMan (Syntol, Russia) in accordance with the instructions of the developer. Cytokine content in blood serum was determined by flow cytometry using microspheres coated with monoclonal antibodies to cytokines (Bio-Plex ProTM Human Cytokine 27-plex Assay), according to the instructions for Bio-Plex 200 (Bio-Rad Laboratories, USA).To evaluate the results obtained, in addition to the generally accepted methods of statistical processing for case – control studies, computational methods of bioinformatics were used for comparative analysis of the diagnostic value of various combined genetic traits. Results. It was shown that the maximum odds ratio value of uterine fibroids development are combined genetic traits that include representatives of all four regulatory factors: cytokines with pro-inflammatory activity, cytokines with anti-inflammatory activity, vascular endothelial growth factors and metalloproteinases (p = 0.002). Conclusions. The presented data reveal the real mechanisms of manifestation of the genetic predisposition of individual women to the uterine fibroids development, associated with the presence of polymorphism of certain genes in their genome, which provide features of the structure of cytokine networks with the predominance of certain activities in the regulation of tissue processes in the uterus. In addition to purely scientific interest, these results indicate the real possibility of their clinical application in the form of prognostic criteria with a certain level of prognostic significance.

Abstract 5363: New targeted therapy on SOCS1-related immune-response in triple-negative breast cancer

Abstract Background: Triple-negative breast cancer (TNBC) is heterogenous, which includes basal-like, immunomodulatory, mesenchymal, mesenchymal stem cell and luminal androgen receptor subtypes. In addition to chemotherapy, PARP inhibitors and immune checkpoint inhibitors are effective for TNBC with BRCA-mutated and PD-L1-positive cases. However, overall survival of TNBC remains unfavorable. To explore new targeted therapy in TNBC, we reported previously that SOCS1 (suppressor of cytokine signaling 1), IL-13 and several genes were predicted as interactive targets of miRNA in TNBC from the microarray expression analysis (Agilent Technologies, Inc.) of small RNA extracted from 11 breast cancer specimens (AACR2020, #1709). Thus, we investigated SOCS1-related immune-response under co-culture of TNBC and monocyte cell lines with or without paclitaxel exposure. Materials and Methods: MDA-MB-231, MDA-MB-468, RAW264.7 cell lines were used with co-culture system (Falcon® Cell Culture Inserts, Corning, NY, USA). SOCS1-expression vector and siSOCS1 were transfected into TNBC cell lines with polyethylenimine (PEI Max; Polysciences, Inc., Warrington, PA). RAW264.7 was activated with lipopolysaccaride (5ug/ml) and IFNγ (10ng/ml) for 2 days before co-culture. Relative cell viability of TNBC cell lines with vehicle control (DMSO) or paclitaxel exposure was measured with WST-8 (Cell Counting Kit-8; Dojindo, Japan) using TC20 Automated cell counter (Bio-Rad Laboratories, Inc., Japan) after 2 days’ co-culture of TNBC and RAW264.7 cells under several conditions of SOCS1 overexpression and/or RAW264.7 activation. Results: First, paclitaxel inhibited cell growth of MDA-MB-231 and MDA-MB-468 in a dose-dependent manner (at 1nM~100nM). Second, at paclitaxel exposure of 10 nM and 50 nM, relative cell viability of MDA-MB-468 decreased with co-culture of activated RAW264.7. The tendency was enhanced with SOCS1 overexpression in breast cancer cell lines. Similar results were observed in MDA-MB-231 cells. Discussions: SOCS1 is well known as a negative regulator of JAK-STAT pathway. SOCS1 is also related to suppression of T cell activation and modulation of M1 macrophage. At AACR2020, we reported that SOCS1 gene amplification in cancer tissues after neoadjuvant chemotherapy was relatively lower in 6 cases with pathologically partial or complete response than in 11 cases with no pathological response. In vitro, paclitaxel-toxicity in TNBC cells was augmented by activated monocyte (M1 macrophage) and more sensitized with SOCS1 overexpression in TNBC cells. These results suggest that proinflammatory cytokines from M1 macrophage influence cell viability of TNBC. Conclusion: SOCS1 is a promising molecular target to modulate immune-response in TNBC. Citation Format: Shigeru Imoto, Tomohiro Chiba, Hirohito Seki, Yoshiharu Ishizaka, Ai Tsuchiya, Tomoko Kitaoka. New targeted therapy on SOCS1-related immune-response in triple-negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5363.

Abstract 84: StarBright Dyes: Fluorophores with superior performance for multiplexing in flow cytometry and Western blotting

Abstract New StarBrightTM Dyes from Bio-Rad are bright fluorescent fluorophores ideal for many antibody-based applications, for example, western blotting and flow cytometry. Traditional fluorophores can be dim, have high cross laser excitation, or don’t work with all protocols, leading to poor data. StarBright Dyes have been designed to address these pain points. Western blotting secondary antibodies are available conjugated to StarBright Blue 700 and StarBright Blue 520 Dyes. Their brightness, the short exposure time required, and low background make them ideal for detection of a single target, or as shown here for multiplex detection of several proteins in combination with other common fluorophores. For flow cytometry, we have a full range of 32 StarBright Dyes excited by the most common laser lines: 355 nm, 405 nm, 488 nm, 561 nm, or 640 nm. They are available conjugated to highly cited clones against common immunophenotyping targets. Data shown here on the ZE5 Cell Analyser demonstrates how the features of StarBright Dyes can improve multiplexing immunophenotyping data. They have narrow excitation and emission spectral profiles, which reduce compensation and spread. This, combined with their exceptional brightness, enables high resolution of cell populations. They work in all buffers and fixatives, so including them in existing panels does not require a change in protocol. They can also be premixed in a master mix for over six months with no loss in performance. Premixes are ideal when using the same panel over an extended period, such as in clinical and longitudinal studies, to ensure reproducible results, also saving time and money. StarBright Dyes are ideal for multiplexing assays in both western blotting and flow cytometry. BIO-RAD and STARBRIGHT are trademarks of Bio-Rad Laboratories, Inc. in certain jurisdictions. All trademarks used herein are the property of their respective owner. Citation Format: Sharon Sanderson, Oliver Rosenwasser, Michael Blundell. StarBright Dyes: Fluorophores with superior performance for multiplexing in flow cytometry and Western blotting [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 84.

Quality control data management with unity real-time in molecular virology

IntroductionQuality control (QC) is one component of an overarching quality management system (QMS) that aims at assuring laboratory quality and patient safety. QC data must be acceptable prior to reporting patients’ results. Traditionally, QC statistics, records, and corrective actions were tracked at the Johns Hopkins Molecular Virology Laboratory using Microsoft Excel. Unity Real-Time (UnityRT), a QMS software (Bio-Rad Laboratories), which captures and analyzes QC data by instrument and control lot per assay, was implemented and its impact on the workflow was evaluated. The clinical utility of real-time QC monitoring using UnityRT is highlighted with a case of subtle QC trending of HIV-1 quantitative control results. MethodsA comprehensive workflow analysis was performed, with a focus on Epstein Barr Virus (EBV) and BKV quantitative viral load testing (Roche cobas 6800). The number of QC steps and time to complete each step were assessed before and after implementing UnityRT. ResultsOur assessment of monthly QC data review revealed a total of 10 steps over 57 min when using Microsoft Excel, versus 6 steps over 11 min when using UnityRT. HIV-1 QC monitoring revealed subtle trending of the low positive control above the mean from November to December 2022, correlating with a change in the reagent kit lot. This associated with a shift in patients’ results from positives below the lower limit of quantification to positives between 20 and 100 copies/mL. ConclusionsUnityRT consolidated QC analyses, monitoring, and tracking corrective actions. UnityRT was associated with significant time savings, which along with the interfaced feature of the QC capture and data analysis, have improved the workflow and reduced the risk of laboratory errors. The HIV-1 case revealed the value of the real-time monitoring of QC.

Utility of Perl's Prussian Blue Stain in Exfoliated Buccal Cells of Thalassemia and Sickle Cell Anemia Patients and Their Correlation With Serum Ferritin Levels.

Introduction Iron is essential for all living beings. Excess iron, on the other hand, is dangerous because it causes the creation of free radicals. As a result, iron absorption is carefully managed to maintain a balance between absorption and iron loss in the body. Due to the lack of particular excretory channels for iron in humans, iron excess in the tissues is common. It can be caused by a number of factors, including increased iron absorption, as seen in hemochromatosis, or frequent parenteral iron treatment, as seen in thalassemia and sickle cell anemia patients (a transfusional overload). Aim The study aims to demonstrate Perl's Prussian blue stain to identify iron overload at a preliminary stage and correlate with serum ferritin levels in patients withthalassemia and sickle cell anemia who frequently receive blood transfusions. Materials and methods The present study comprised 62 confirmed cases of thalassemia and sickle cell anemia patients undergoing repeated blood transfusions of a minimum of 15/more, along with 62 clinically healthy individuals between December 2016 and November 2018. The patients with thalassemia and sickle cell anemia were confirmed by hemoglobin electrophoresis (Bio-Rad D-10, Bio-Rad Laboratories, Inc, California, United States). The buccal smears were obtained from these patients along with the controls, and these slides were stained by Perl's Prussian blue stain and were examined under a light microscope. Results Sixty-two cases and 62 controls were considered in the current investigation. Forty-seven of the 62 people had thalassemia, and 15 had sickle cell anemia. Thirty-nine out of the 47 patients with thalassemia and six of the 15 individuals with sickle cell anemia had positive results for Perl's Prussian blue stain. All patients had elevated blood ferritin levels, with varying ranges associated with positive results for Perl's Prussian blue stain. Conclusion The objective of this study was to demonstrate the utility of oral exfoliative cytology in thalassemia and sickle cell anemia patients who often receive blood transfusions as a screening and diagnostic tool. The exfoliative cytology methods' acceptability and simplicity, along with their correlation with serum ferritin levels and Perl's Prussian blue reaction, make this noninvasive procedure an excellent screening and diagnostic tool for all patients who receive repeated blood transfusions.

A-268 Evaluation of a Real-Time Multiplex PCR Assay for Simultaneous Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis in Urine Specimens

Abstract Background Infections with Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) are among the most prevalent and treatable sexually transmitted diseases in the US. Currently, most available testing methods require patient samples to be split between CT/NG and TV assays. Here, we evaluate performance characteristics of the Seegene Novaplex STI Essential Assay, a real-time multiplex polymerase chain reaction assay for concurrent amplification and detection of multiple pathogens including CT, NG, and TV. Methods To prepare urine samples for extraction, 1 mL of each sample was centrifuged at 13 000 rpm for 15 min. The supernatant was discarded and the pellet was rehydrated in 190 µL of saline. Nucleic acid extraction was performed on a CyBio® FeliX liquid handler (Analytik Jena, Germany) using MagMAX™ Viral/Pathogen Nucleic Acid Isolation Kit (Thermo Fisher Scientific, MA). PCR amplification and detection were performed using Seegene Novaplex STI assay (Seegene Inc, South Korea) on a CFX96™ System (Bio-Rad Laboratories, CA). The assay utilizes Seegene MuDT™ technology that allows detection of multiple targets in a single channel without melting curve analysis. For method validation, precision studies were performed within-run and over 5 days. Limits of detection were verified by spiking known negative urine samples with CT/NG standards from Exact Diagnostics (Bio-Rad Laboratories, CA) and TV standards from ZeptoMetrix® (Antylia Scientific, IL). Method comparison was carried out by extracting and analyzing split patient urine samples against cobas® CT/NG assay (Roche Diagnostics, IL) and Solana® Trichomonas assay (Quidel, CA) performed by a reference laboratory. Additional accuracy studies were performed by spiking 20 negative patient samples with variable concentrations of the three pathogens. Results Within-run and between-day precision studies demonstrated consistent and reproducible results for all pathogens. Limit of detection was established at 10 copies/mL for CT and NG and 10 cells/mL for TV. Results of the spike-and-recovery studies were consistent with expected results for all three targets across evaluated concentrations. Patient correlation studies demonstrated 100% agreement with results obtained by the reference laboratory for both NG (32 total samples, 11 positive) and TV (22 total samples, 4 positive), and 96% agreement for CT (29 total samples, 10 positive). Conclusion The Seegene Novaplex STI Essential Assay offers a rapid and reliable method for detecting CT, NG, and TV in urine samples. The capability of the assay to detect multiple targets in a single sample well improves efficiency and turnaround time.

A-276 Clinical Performance Evaluation of SMARTCHEK® SARS-CoV-2 Detection Kit and SMARTCHEK® SARS-CoV-2 Fast Detection Kit for Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Saliva

Abstract Background Saliva is a good alternative to the nasopharyngeal swab because it is non-invasive and does not require separate collection personnel. SMARTCHEK® SARS-CoV-2 Detection Kit (Genesystem, Daejeon, Korea) and SMARTCHEK® SARS-CoV-2 Fast Detection Kit (Genesystem) are rapid PCR kits for SARS-CoV-2 using a microfluidic chip-based PCR method. These two kits can provide results in 40 min and 20 min, respectively, enabling rapid point-of-care diagnostics. This study compared the diagnostic performance of SMARTCHEK® SARS-CoV-2 Detection Kit and SMARTCHEK® SARS-CoV-2 Fast Detection Kit using UF-340 Four-in-One Real-time PCR System (Genesystem) to the STANDARD M nCoV Real-Time Detection kit (SD Biosensor, Korea) using CFX96 Dx System (Bio-Rad Laboratories, Inc., USA) in saliva. Methods Saliva was collected in a sterile urine specimen cup after obtaining consent from subjects who were scheduled to perform a COVID-19 PCR within 24 h or had already performed it within 24 h at Ajou University hospital. RNA was extracted by SLA-E13200 (Taiwan Advanced Nanotech Inc., Taoyuan, Taiwan) and Saliva:DirectTM Extraction Buffer (Genesystem), respectively. The Saliva:DirectTM Extraction Buffer was able to extract RNA within 10 min without additional equipment. Real-time PCR was performed according to each manufacturer’s guidelines. The STANDARD M nCoV Real-Time Detection kit after RNA extraction by SLA-E13200 was tested as the control method. The positive, negative, and overall concordance rates were calculated for evaluation of correlation with the control method. This study was approved by Ajou University Hospital IRB. Results Among 66 samples, the control method identified 50 negative (76%) and 16 positive (24%) samples, two of which showed Ct values exceeding 30 (13% of positive samples). When RNA was extracted with SLA-E13200, the positive, negative, and overall concordance rates of SMARTCHEK® SARS-CoV-2 Detection Kit and SMARTCHEK® SARS-CoV-2 Fast Detection Kit were 100%, 100%, 100%, and 94%, 100%, 98%, respectively. A positive sample with a Ct value exceeding 30 showed discrepant results with SMARTCHEK® SARS-CoV-2 Fast Detection Kit. After RNA extraction with Saliva:DirectTM Extraction Buffer, positive condordance rates of STANDARD M nCoV Real-Time Detection Kit, SMARTCHEK®SARS-CoV-2 Detection Kit, and SMARTCHEK® SARS-CoV-2 Fast Detection Kit compared to the control method were 67%, 75%, and 81%, respectively. All negative concordance rates were 100%, and overall concordance rates were 94%, 94%, 95%, respectively. Four out of 16 positive samples by the control method showed inconclusive results with the STANDARD M nCoV Real-Time Detection Kit when RNA was extracted with Saliva:DirectTM Extraction Buffer. Conclusion SMARTCHEK® SARS-CoV-2 Detection Kit and SMARTCHEK® SARS-CoV-2 Fast Detection Kit can quickly and accurately diagnose COVID-19 in saliva after RNA extraction with SLA-E13200, and may be useful especially in small to medium-sized laboratories or areas lacking in space or equipment. Although the RNA extraction process with the Saliva:DirectTM Extraction Buffer is fast, simple, and doesn’t require supplementary equipment, some improvement is warranted before use in clinical settings due to relatively low positive concordance rates.

B-062 A Self-Imposed Gray Area? Analysis of Anti-Tissue Transglutaminase and Anti-Endomysial Antibody Discordance in a Celiac Disease Screening Serology Testing Algorithm

Abstract Background Celiac disease (CD) is an autoimmune enteropathy affecting around 1% of the population. While occasionally asymptomatic, the disease can present in a variety of ways and can be triggered by dietary gluten at any age. CD serology, including anti-tissue transglutaminase (anti-tTG) IgA and/or IgG, anti-endomysial antibody IgA and/or IgG, and anti-deamidated gliadin peptide IgA and/or IgG, is a key tool for CD screening, diagnosis, and monitoring. Of these tests, the clinical utility of anti-EMA testing has been questioned due to its high cost and limited sensitivity: 5–10% of CD patients do not test positive for anti-EMA and a negative anti-EMA does not rule out CD. The objective of this study is to: 1) evaluate the concordance between anti-tTG and anti-EMA serology test results, and 2) assess the clinical validity of our current CD reflex testing algorithm in which every positive anti-tTG test result goes on for anti-EMA testing. Methods Using our laboratory’s information system, we conducted a retroactive study on patients who underwent CD serology testing at our institution. Query was performed for all patient data [pediatric (&amp;lt;18 years) and adult (&amp;gt;18 years)] collected between April 2020 and August 2022 for anti-tTG IgA performed on the BioPlex 2200 (BioRad Laboratories Inc., Hercules, CA) and anti-EMA IgA (Euroimmun, Germany) (N = 124 308). Vendor-supplied clinical sensitivity and specificity are as follows: anti-tTG IgA 94.3% sensitivity, 98.8% specificity; anti-EMA IgA 95.3% sensitivity and 98.0% specificity. Results From our data, we calculated a mean positive agreement between our anti-tTG IgA and anti-EMA test results of 53.2% (95% confidence interval (CI) 47.5–58.8%) for all anti-tTG IgA positive cases (N = 6691, 5.4% of total anti-tTG IgA test results). The agreement between anti-tTG IgA and anti-EMA test results is improved if multiples of the upper limit of normal (ULN) for anti-tTG IgA is applied. The mean positive agreement between anti-tTG IgA and anti-EMA test results when the anti-tTG result is &amp;gt;10x ULN is 98.4% (95% CI 97.7–99.2%). However, if an anti-tTG IgA cutoff of &amp;lt;10x ULN is employed a mean positive agreement of 32.3% (95% CI 25.8–38.7%) is observed. At an anti-tTG IgA cutoff of &amp;lt;3x ULN, the mean positive agreement is just 11.8% (95% CI 8.2–15.4%). These findings are consistent in both pediatric (N = 29 381) and adult (N = 94 961) populations and are problematic as 45.4% of our positive anti-tTG IgA test results are accompanied by a negative anti-EMA. Conclusion The agreement between anti-tTG IgA and anti-EMA is dependent on the value of anti-tTG IgA with greater agreement observed with increasing anti-tTG IgA values. As all specimens at our institution with positive anti-tTG IgA test results are automatically reflexed for anti-EMA testing, has led to physician confusion as the majority of patients are falling into a gray area with conflicting CD serology test results. Our algorithm is also out of line with most CD screening guidelines that suggest an initial positive anti-tTG test result is followed up with biopsy. Finally, discontinuing anti-EMA reflex testing could result in cost savings of approximately $120 000 CAD per year.

A specific early eluting peak in Bio-Rad Variant II cation-exchange high-performance liquid chromatography (CE-HPLC) for the screening of alpha-thalassaemia in a Chinese population

The early eluting peaks in the first minute of cation-exchange high-performance liquid chromatography (CE-HPLC) are often not analysed in haemoglobin pattern studies, except for haemoglobin (Hb) Bart's andHb H peaks. In this study, we described the presence of a specific α-thalassaemia early eluting peak (αEEP) atthe retention time of 0.24 min generated by Variant II CE-HPLC (β-Thalassaemia Short Program; Bio-Rad Laboratories). We have evaluated the utility of αEEP for the screening of α-thalassaemia trait in our local Chinese population in comparison to the Hb H inclusion body test. A total of 303 blood samples presenting with microcytosis were sent for haemoglobin pattern study and were analysed for the presence or absence of αEEP and Hb H inclusions. Twenty cases with a normal mean corpuscular volume were assessed as a control. Discordant results between the αEEP and the Hb H inclusion test were reviewed with the α-globin genotyping test performed. The concordance rate of the αEEP and the Hb H inclusion body test was 96.0% (κ=0.921, p<0.001). Eight of 303 cases (2.6%) were initially negative for the Hb H inclusion test but positive for the αEEP. All eight cases were found to have occasional Hb H inclusion bodies upon review. Four of 303 cases (1.3%) were negative for the αEEP but positive for the Hb H inclusion test. Of these four cases, two (50%) showed heterozygous Southeast Asian (SEA) type deletion, one (25%) showed Hb Quong Sze mutation, and one (25%) showed no mutation detected upon molecular testing. All the Hb E trait cases with no Hb H inclusions and the negative control group showed the absence of the αEEP. The sensitivity and specificity of αEEP for detecting SEA deletion were 93.8% and 100% respectively, which is superior to the Hb H inclusion test (sensitivity 81.3%, specificity 95.2%). The αEEP is found to be a more sensitive method than the Hb H inclusion body test in the screening of α-thalassaemia trait in our Chinese population, in which SEA type deletion is prevalent. Further study is needed to explore the utility of the αEEP in the screening of α-thalassaemia traits in other populations. The exact nature of the αEEP is yet to be defined.

Accuracy of serological tests in diagnosing mucosal leishmaniasis.

In this serum panel-based study, we evaluated the accuracy of serological tests originally developed for visceral leishmaniasis (VL), for diagnosis of mucosal leishmaniasis (ML). A total of five tests were evaluated, four of which are registered at the National Agency of Sanitary Surveillance (Agência Nacional de Vigilância Sanitária-ANVISA) (RIDASCREEN® Leishmania Ab from R-Biopharm AG., Leishmania ELISA IgG + IgM from Vircell S.L., IFI Leishmaniose Humana-BioManguinhos, and IT-LEISH® from Bio-Rad Laboratories, Inc.), and the other a direct agglutination test (DAT-LPC) prototype kit developed at Fiocruz. The panel was composed of 40 serum samples from patients with confirmed ML and 20 from patients with mucosal involvement and negative parasitological/molecular tests for leishmaniasis and confirmation of another etiology. All cases were treated from 2009 to 2016 in a referral center for leishmaniasis in Belo Horizonte, Minas Gerais, Brazil (Instituto René Rachou, Fiocruz). Diagnostic accuracy, based on the cut-off point for VL diagnosis, was 86.2% with RIDASCREEN® Leishmania Ab, 73.3% with Leishmania ELISA IgG + IgM, and 66.7% with IFI Leishmaniose Humana, while IT-LEISH® and DAT-LPC had the lowest accuracy (38.3%), despite high specificity (100% and 95%, respectively). New cut-off points defined with sera from ML patients improved accuracy from 86.2 to 89% (p = 0.64) and 73.3 to 88% (p = 0.04) for RIDASCREEN® Leishmania Ab and Leishmania ELISA IgG + IgM, respectively. Moreover, these tests presented greater sensitivity and immunoreactivity in patients with moderate/severe clinical ML forms. The data of this study suggest that ELISA assays can contribute to laboratory diagnosis, especially for patients with moderate or severe mucosal involvement.

Evaluation of Three Automated Nontreponemal Rapid Plasma Reagin (RPR) Tests for the Laboratory Diagnosis of Syphilis.

Automated nontreponemal rapid plasma reagin (RPR) tests were recently introduced in the United States for syphilis testing and limited performance data are available. In collaboration with the Association of Public Health Laboratories, three public health laboratories (PHL) were chosen through a competitive selection process to evaluate the performance of three FDA-cleared automated RPR test systems: BioPlex 2200 Syphilis Total & RPR assay (Bio-Rad Laboratories), AIX 1000 (Gold Standard Diagnostics), and ASI Evolution (Arlington Scientific). Panels prepared at the CDC included: a qualitative panel comprised of 734 syphilis reactive/nonreactive sera; a quantitative panel of 50 syphilis reactive sera (RPR titer 1:64 to 1:1,024); and a reproducibility panel of 15 nonreactive and reactive sera (RPR titer 1:1 to 1:64). Panels were shipped frozen to the PHL and tested on the automated RPR systems following manufacturers' instructions. Prior test results were blinded to all laboratories. When compared to manual RPR (Arlington Scientific) performed at the CDC as a reference test, the qualitative panel results demonstrated an overall concordance of 95.9% for AIX 1000, 94.6% for ASI Evolution, and 92.6% for Bioplex RPR; quantitative panel showed within range titer of 2-fold for 94% of specimens for AIX 1000, 68% for ASI Evolution, and 64% for BioPlex RPR, and the reproducibility testing panel demonstrated point estimates ranging from 69 to 95%. Automated RPR instruments could reduce turnaround time and minimize interpretation errors. However, additional evaluations with more specimens could assist laboratories with implementing automated RPR tests and understanding their limitations.

Aqueous Humor Cytokine Profile in Primary Congenital Glaucoma.

Cytokine profile in patients with primary open-angle glaucoma (POAG) differs from that in healthy controls. Due to the different pathophysiological mechanisms involved in the genesis of primary congenital glaucoma (PCG) and POAG, it is possible that the cytokine profile could also differ. The main objective of this study was to compare the concentrations of cytokines in the aqueous humor of patients with PCG with those of POAG patients and a control group. A cross-sectional study was conducted. Aqueous humor samples were taken from PCG and POAG patients eligible for glaucoma or cataract surgery and from patients undergoing cataract surgery. Twenty-seven cytokines were analyzed using the Human Cytokine 27-Plex Immunoassay Kit (Bio-Rad Laboratories, Hercules, CA, USA). A total of 107 subjects were included: patients with PCG (n = 19), patients with POAG (n = 54), and a control group (CG) of patients undergoing cataract surgery (n = 34). Most cytokines measured in aqueous humor in PCG presented decreased values compared with POAG and controls. A statistically significant difference was observed in IL-1ra, IL-2, IL-5, IL-7, IL-8, IL-10, IL-12, IL-15, IL-17A, Eotaxin, FGF basic, G-CSF, GM-CSF, IFN-γ, MIP-1α, PDGF-bb, MIP-1β, RANTES, TNF-α, and VEGF. PCG patients have a cytokine profile in aqueous humor different from POAG patients and patients without glaucoma, characterized by lower concentrations of multiple cytokines.