Aim A major limitation of the single antigen bead (SAB) assay is its susceptibility to interference by complement activation, which inhibits binding of anti-IgG-PE to HLA specific antibodies. This interference, known as prozone effect, can reduce MFI values leading to false negative reactions. Schnaidt et. al. (2011) described a method to eliminate prozone by treating sera with EDTA to chelate calcium, preventing complement activation. However, anecdotal evidence suggests that the method is not always effective. This may be due to differences in EDTA concentration used by different labs given the original description is ambiguous and lacks sufficient detail to follow the protocol. The goal of this study was to determine the minimum EDTA concentration required to eliminate prozone. Methods Six well characterized, prozone +ve sera (3 class I and 3 class II HLA) were selected. Prozone +ve specificities were defined as >5000 MFI increase in SAB assay reactivity upon titration. Sera were treated with several concentrations of dipotassium EDTA (1.2–6 mM) or PBS control and were tested in parallel using LABScreen SAB assay. MFI values of prozone +ve specificities were then compared. Results A total of 52 prozone +ve specificities (28 class I and 24 class II HLA) were identified in titration studies. Prozone was eliminated for all 52 specificities when sera were treated with either 6 mM or 3 mM EDTA (Fig. 1). In contrast, treatment with either 2 mM or 1.2 mM EDTA was ineffective (Fig. 1). Prozone −ve specificities were not affected by EDTA treatment at any concentrations used. Conclusion EDTA treatment of sera is effective at eliminating prozone if appropriate EDTA concentrations are used. Interestingly, our experiments demonstrate that the threshold at which EDTA is effective is very distinct (3 mM is effective while 2 mM is ineffective). Since EDTA forms a 1:1 chelate complex with calcium, the concentration threshold of EDTA required to eliminate prozone is consistent with physiologic serum calcium concentration (2.1–2.6 mM). Download : Download high-res image (369KB) Download : Download full-size image
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