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Liu Y, Tao Y, Yeung PSW, Lu M, Liu J, Yu F, Shi RZ, Luo RY. An up-conversion fluorescence lateral-flow immunoassay for rapid detection of Daratumumab in serum protein electrophoresis clinical samples. Clin Chim Acta 2024; 559:119677. [PMID: 38636694 DOI: 10.1016/j.cca.2024.119677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/26/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Daratumumab (DARA) is a commonly used monoclonal antibody (mAb) drug for the treatment of multiple myeloma (MM). Its appearance as a visible abnormal band in the γ-region of a serum protein electrophoresis (SPEP) gel may interfere with the SPEP result interpretation. With the advantages of portability and rapid testing capabilities, up-conversion fluorescence lateral-flow immunoassay (LFA) can be an ideal solution to detect DARA interference. METHODS An up-conversion fluorescence LFA strip was designed and constructed to perform semi-quantitative DARA testing in clinical samples. The LFA strip test was evaluated for limit of detection (LOD), dynamic range, and analytical interference. RESULTS To demonstrate the clinical utility of the LFA strip, 43 SPEP-positive patient serum samples were tested for the presence of DARA, and the results exactly matched the DARA usage history in patient medical records. CONCLUSIONS The performance of the up-conversion fluorescence LFA strip meets the purpose of clarifying DARA interference in SPEP results. It may be used as an independent and objective confirmation of the presence of DARA in clinical samples. The LFA strip offers a cost-effective rapid on-site test to check for DARA interference alongside standard SPEP equipment, which significantly improves the interpretation of ambiguous SPEP results involving DARA, and does not intervene the current SPEP workflow in clinical laboratory practice.
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Affiliation(s)
- Yajing Liu
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Yanru Tao
- Polariton Life Technologies, Suzhou, Jiangsu, China
| | - Priscilla S-W Yeung
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA; Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | - Mengyan Lu
- Polariton Life Technologies, Suzhou, Jiangsu, China
| | - Jing Liu
- Polariton Life Technologies, Suzhou, Jiangsu, China
| | - Fang Yu
- Polariton Life Technologies, Suzhou, Jiangsu, China
| | - Run-Zhang Shi
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA; Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | - Ruben Yiqi Luo
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA; Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA.
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Luo RY, Pfaffroth C, Yang S, Hoang K, Yeung PSW, Zehnder JL, Shi RZ. Study of β 1-transferrin and β 2-transferrin using microprobe-capture in-emitter elution and high-resolution mass spectrometry. Sci Rep 2023; 13:14974. [PMID: 37696850 PMCID: PMC10495423 DOI: 10.1038/s41598-023-42064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
Cerebrospinal fluid (CSF) leak can be diagnosed in clinical laboratories by detecting a diagnostic marker β2-transferrin (β2-Tf) in secretion samples. β2-Tf and the typical transferrin (Tf) proteoform in serum, β1-transferrin (β1-Tf), are Tf glycoforms. An innovative affinity capture technique for sample preparation, called microprobe-capture in-emitter elution (MPIE), was incorporated with high-resolution mass spectrometry (HR-MS) to study the Tf glycoforms and the primary structures of β1-Tf and β2-Tf. To implement MPIE, an analyte is first captured on the surface of a microprobe, and subsequently eluted from the microprobe inside an electrospray emitter. The capture process is monitored in real-time via next-generation biolayer interferometry (BLI). When electrospray is established from the emitter to a mass spectrometer, the analyte is immediately ionized via electrospray ionization (ESI) for HR-MS analysis. Serum, CSF, and secretion samples were analyzed using MPIE-ESI-MS. Based on the MPIE-ESI-MS results, the primary structures of β1-Tf and β2-Tf were elucidated. As Tf glycoforms, β1-Tf and β2-Tf share the amino acid sequence but contain varying N-glycans: (1) β1-Tf, the major serum-type Tf, has two G2S2 N-glycans on Asn413 and Asn611; and (2) β2-Tf, the major brain-type Tf, has an M5 N-glycan on Asn413 and a G0FB N-glycan on Asn611. The resolving power of the innovative MPIE-ESI-MS method was demonstrated in the study of β2-Tf as well as β1-Tf. Knowing the N-glycan structures on β2-Tf allows for the design of more novel test methods for β2-Tf in the future.
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Affiliation(s)
- Ruben Yiqi Luo
- Department of Pathology, Stanford University, Stanford, CA, USA.
- Clinical Laboratories, Stanford Health Care, 3375 Hillview Ave, Palo Alto, CA, 94304, USA.
| | - Christopher Pfaffroth
- Clinical Laboratories, Stanford Health Care, 3375 Hillview Ave, Palo Alto, CA, 94304, USA
| | - Samuel Yang
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Kevin Hoang
- Clinical Laboratories, Stanford Health Care, 3375 Hillview Ave, Palo Alto, CA, 94304, USA
| | - Priscilla S-W Yeung
- Department of Pathology, Stanford University, Stanford, CA, USA
- Clinical Laboratories, Stanford Health Care, 3375 Hillview Ave, Palo Alto, CA, 94304, USA
| | - James L Zehnder
- Department of Pathology, Stanford University, Stanford, CA, USA
- Clinical Laboratories, Stanford Health Care, 3375 Hillview Ave, Palo Alto, CA, 94304, USA
| | - Run-Zhang Shi
- Department of Pathology, Stanford University, Stanford, CA, USA
- Clinical Laboratories, Stanford Health Care, 3375 Hillview Ave, Palo Alto, CA, 94304, USA
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Chang-Graham AL, Sahoo MK, Huang C, Solis D, Sibai M, August G, Calayag L, Kenji OM, Shi RZ, Mostafa HH, Lei GS, Relich RF, Pinsky BA. Comparison of nucleocapsid antigen with strand-specific reverse-transcription PCR for monitoring SARS-CoV-2 infection. J Clin Virol 2023; 164:105468. [PMID: 37119583 PMCID: PMC10124094 DOI: 10.1016/j.jcv.2023.105468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Tests that sensitively detect the presence of actively replicating SARS-CoV-2 may improve patient care by allowing the safe and timely discontinuation of isolation. Correlates of active replication include nucleocapsid antigen and virus minus-strand RNA. METHODS Qualitative agreement of the DiaSorin LIAISON SARS-CoV-2 nucleocapsid antigen chemiluminescent immunoassay (CLIA) with minus-strand RNA was determined using 402 upper respiratory specimens from 323 patients previously tested using a laboratory-developed SARS-CoV-2 strand-specific RT-qPCR. Nucleocapsid antigen levels, minus-strand and plus-strand cycle threshold values, as well as virus culture, were used to evaluate discordant specimens. Receiver operating characteristic curves were also used to identify virus RNA thresholds for active replication, including values harmonized to the World Health Organization International Standard. RESULTS Overall agreement was 92.0% [95% confidence interval (CI): 89.0 - 94.5], positive percent agreement was 90.6% (95% CI: 84.4 - 95.0), and negative percent agreement was 92.8% (95% CI: 89.0 - 95.6). The kappa coefficient was 0.83 (95% CI: 0.77 - 0.88). Discordant specimens contained low levels of nucleocapsid antigen and minus-strand RNA. 84.8% (28/33) were negative by culture. Sensitivity-optimized plus-strand RNA thresholds for active replication were 31.6 cycles or 3.64 log10 IU/mL; resulting in 100.0% sensitivity (95% CI: 97.6 to 100.0) and 55.9 specificity (95% CI: 49.7 to 62.0). CONCLUSIONS Detection of nucleocapsid antigen by CLIA performs equivalently to minus-strand detection via strand-specific RT-qPCR, though these methods may overestimate replication-competent virus compared to culture. Careful implementation of biomarkers for actively replicating SARS-CoV-2 has the potential to inform infection control decision-making and patient management.
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Affiliation(s)
| | - Malaya K Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; Clinical Virology Laboratory, Stanford Health Care, Stanford, CA, USA
| | - ChunHong Huang
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel Solis
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mamdouh Sibai
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gianna August
- Clinical Virology Laboratory, Stanford Health Care, Stanford, CA, USA
| | - Lira Calayag
- Special Chemistry and Immunology Laboratory, Stanford Health Care, CA, USA
| | - Obadia M Kenji
- Clinical Virology Laboratory, Stanford Health Care, Stanford, CA, USA
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; Special Chemistry and Immunology Laboratory, Stanford Health Care, CA, USA
| | - Heba H Mostafa
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Guang-Sheng Lei
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ryan F Relich
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; Clinical Virology Laboratory, Stanford Health Care, Stanford, CA, USA; Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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4
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Yeung PSW, Miller P, Lai-Nyugen TB, Cheng P, Ibrahim A, Shi RZ, Bowen RA, Luo RY. Mass spectrometry quantitation of immunosuppressive drugs in clinical specimens using online solid-phase extraction and accurate-mass full scan-single ion monitoring. J Mass Spectrom Adv Clin Lab 2023; 28:99-104. [PMID: 36937810 PMCID: PMC10014293 DOI: 10.1016/j.jmsacl.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction Therapeutic drug monitoring (TDM) of immunosuppressants is essential for optimal care of transplant patients. Immunoassays and liquid chromatography-mass spectrometry (LC-MS) are the most commonly used methods for TDM. However, immunoassays can suffer from interference from heterophile antibodies and structurally similar drugs and metabolites. Additionally, nominal-mass LC-MS assays can be difficult to optimize and are limited in the number of detectable compounds. Objectives The aim of this study was to implement a mass spectrometry-based test for immunosuppressant TDM using online solid-phase extraction (SPE) and accurate-mass full scan-single ion monitoring (FS-SIM) data acquisition mode. Methods LC-MS analysis was performed on a TLX-2 multi-channel HPLC with a Q-Exactive Plus mass spectrometer. TurboFlow online SPE was used for sample clean up. The accurate-mass MS was set to positive electrospray ionization mode with FS-SIM for quantitation of tacrolimus, sirolimus, everolimus, and cyclosporine A. MS2 fragmentation pattern was used for compound confirmation. Results The method was validated in terms of precision, analytical bias, limit of quantitation, linearity, carryover, sample stability, and interference. Quantitation of tacrolimus, sirolimus, everolimus, and cyclosporine A correlated well with results from an independent reference laboratory (r = 0.926-0.984). Conclusions Accurate-mass FS-SIM can be successfully utilized for immunosuppressant TDM with good correlation with results generated by standard methods. TurboFlow online SPE allows for a simple "protein crash and shoot" sample preparation protocol. Compared to traditional MRM, analyte quantitation by FS-SIM facilitates a streamlined assay optimization process.
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Key Words
- Accurate-mass
- CAP, College of American Pathologists
- CLSI, Clinical & Laboratory Standards Institute
- CV, coefficient of variation
- ESI, electrospray ionization
- FS-SIM, full scan-single ion monitoring
- Full scan single-ion monitoring
- HCD, high-energy C-trap dissociation
- IRB, Institutional Review Board
- Immunosuppressive drugs
- LC-MS, liquid chromatography-mass spectrometry
- LDT, laboratory developed test
- MRM, multiple reaction monitoring
- Mass spectrometry
- Online solid-phase extraction
- SD, standard deviation
- SPE, solid-phase extraction
- TDM, therapeutic drug monitoring
- Therapeutic drug monitoring
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Affiliation(s)
- Priscilla S.-W. Yeung
- Department of Pathology, Stanford University, Stanford, CA, USA
- Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | - Paige Miller
- Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | | | - Phil Cheng
- Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | - Amira Ibrahim
- Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | - Run-Zhang Shi
- Department of Pathology, Stanford University, Stanford, CA, USA
- Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | - Raffick A.R. Bowen
- Department of Pathology, Stanford University, Stanford, CA, USA
- Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | - Ruben Yiqi Luo
- Department of Pathology, Stanford University, Stanford, CA, USA
- Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
- Corresponding author at: 3375 Hillview Ave, Palo Alto, CA 94304, USA.
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Luo RY, Wong C, Xia JQ, Glader BE, Shi RZ, Zehnder JL. Neutral-Coating Capillary Electrophoresis Coupled with High-Resolution Mass Spectrometry for Top-Down Identification of Hemoglobin Variants. Clin Chem 2023; 69:56-67. [PMID: 36308334 DOI: 10.1093/clinchem/hvac171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Identification of hemoglobin (Hb) variants is of significant value in the clinical diagnosis of hemoglobinopathy. However, conventional methods for identification of Hb variants in clinical laboratories can be inadequate due to the lack of structural characterization. We describe the use of neutral-coating capillary electrophoresis coupled with high-resolution mass spectrometry (CE-HR-MS) to achieve high-performance top-down identification of Hb variants. METHODS An Orbitrap Q-Exactive Plus mass spectrometer was coupled with an ECE-001 capillary electrophoresis (CE) unit through an EMASS-II ion source. A PS1 neutral-coating capillary was used for CE. Samples of red blood cells were lysed in water and diluted in 10 mM ammonium formate buffer for analysis. Deconvolution of raw mass spectrometry data was carried out to merge multiple charge states and isotopic peaks of an analyte to obtain its monoisotopic mass. RESULTS The neutral-coating CE could baseline separate individual Hb subunits dissociated from intact Hb forms, and the HR-MS could achieve both intact-protein analysis and top-down analysis of analytes. A number of patient samples that contain Hb subunit variants were analyzed, and the variants were successfully identified using the CE-HR-MS method. CONCLUSIONS The CE-HR-MS method has been demonstrated as a useful tool for top-down identification of Hb variants. With the ability to characterize the primary structures of Hb subunits, the CE-HR-MS method has significant advantages to complement or partially replace the conventional methods for the identification of Hb variants.
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Affiliation(s)
- Ruben Yiqi Luo
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA.,Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | - Carolyn Wong
- Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | | | - Bertil E Glader
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA.,Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| | - Run-Zhang Shi
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA.,Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | - James L Zehnder
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA.,Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
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Xia JJ, Wang SL, Hu YF, Shen WW, Lin HJ, Shi RZ, Ma ZH, Li ZH, Li SZ, Ding YY, Chen XX, He N. [Neurocognitive impairment and characteristics of neurocognitive performance among people with HIV on antiretroviral treatment]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:1651-1657. [PMID: 36456499 DOI: 10.3760/cma.j.cn112338-20220524-00456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Objective: Using two measuring tools to examine the prevalence and correlates of neurocognitive impairment (NCI) as well as characteristics of neurocognitive performance among people with HIV (PWH) on antiretroviral treatment (ART). Methods: A total of 2 250 treated PWH from the Comparative HIV and Aging Research in Taizhou (CHART) were recruited in Taizhou, Zhejiang province. The Chinese version of the Mini-mental State Examination (MMSE) and the International HIV Dementia Scale (IHDS) were used to evaluate their neurocognitive performance. Cluster analysis was conducted on the seven cognitive domains in the scale. Results: Among 2 250 treated PWH, 48.0% (1 080/2 250) were aged 45 to 89, 79.2% (1 782/2 250) were male, and 37.8% (852/2 250) had primary school education or below. The prevalence of neurocognitive impairment judged by MMSE and IHDS among HIV-infected people was 14.3% (321/2 250) and 31.8% (716/2 250), respectively. Aged 60 to 89 (aOR=2.63, 95%CI:1.52-4.56), depressive symptoms (aOR=5.58, 95%CI:4.20-7.40) and treatment with EFV (aOR=2.86, 95%CI:1.89-4.34) were main risk factors of NCI diagnosed by MMSE. Male (aOR=0.71, 95%CI:0.51-1.00), overweight (aOR=0.63, 95%CI:0.44-0.89), and high education level (aOR=0.11, 95%CI:0.05-0.25) were protective factors of NCI diagnosed by MMSE. Aged 60 to 89 (aOR=3.10, 95%CI:2.09-4.59), depressive symptoms (aOR=1.78, 95%CI:1.44-2.20) and treatment with EFV (aOR=1.79, 95%CI:1.41-2.29) were risk factors of NCI diagnosed by IHDS. Male (aOR=0.75, 95%CI:0.58-0.97), underweight (aOR=0.67, 95%CI:0.47-0.96), baseline CD4+ T lymphocyte (CD4) counts ≥350 cells/μl (aOR=0.69, 95%CI:0.53-0.91) and high education level (aOR=0.23, 95%CI:0.14-0.39) were protective factors of NCI diagnosed by IHDS. The neurocognitive performance of HIV-infected people can be divided into four main types. Among four types, age, gender, education level, alcohol drinking, depressive symptoms, waist-to-hip ratio, hypertension, diabetes, baseline CD4 counts and treatment with EFV were different statistically (all P<0.05). Conclusions: There are four main types of neurocognitive performance in treated PWH. The prevalence of NCI is high among this population, underscoring the need for tailored prevention and intervention.
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Affiliation(s)
- J J Xia
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China Yiwu Research Institute, Fudan University, Yiwu 322000, China
| | - S L Wang
- Taizhou Prefectural Center for Disease Control and Prevention, Taizhou 318000, China
| | - Y F Hu
- Taizhou Prefectural Center for Disease Control and Prevention, Taizhou 318000, China
| | - W W Shen
- Taizhou Prefectural Center for Disease Control and Prevention, Taizhou 318000, China
| | - H J Lin
- Taizhou Prefectural Center for Disease Control and Prevention, Taizhou 318000, China
| | - R Z Shi
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China Yiwu Research Institute, Fudan University, Yiwu 322000, China
| | - Z H Ma
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China Yiwu Research Institute, Fudan University, Yiwu 322000, China
| | - Z H Li
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China Yiwu Research Institute, Fudan University, Yiwu 322000, China
| | - S Z Li
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China Yiwu Research Institute, Fudan University, Yiwu 322000, China
| | - Y Y Ding
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China Yiwu Research Institute, Fudan University, Yiwu 322000, China
| | - X X Chen
- Taizhou Prefectural Center for Disease Control and Prevention, Taizhou 318000, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China Yiwu Research Institute, Fudan University, Yiwu 322000, China
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Pepper MA, Wiredja DD, Patel PM, Stevens BA, Pinsky BA, Shi RZ. A Spurious Positive Result on the Abbott Architect 4 th generation HIV Ag/Ab Combo Assay in a Low-Risk Patient. Clin Chim Acta 2022; 531:386-388. [PMID: 35568208 DOI: 10.1016/j.cca.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Michael A Pepper
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Danica D Wiredja
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Payal M Patel
- Special Chemistry and Immunology laboratory, Stanford Health Care, Palo Alto, California
| | - Bryan A Stevens
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Stanford, California
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Murugesan K, Jagannathan P, Altamirano J, Maldonado YA, Bonilla HF, Jacobson KB, Parsonnet J, Andrews JR, Shi RZ, Boyd S, Pinsky BA, Singh U, Banaei N. Long-Term Accuracy of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Interferon-γ Release Assay and Its Application in Household Investigation. Clin Infect Dis 2022; 75:e314-e321. [PMID: 35079772 PMCID: PMC8807306 DOI: 10.1093/cid/ciac045] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND An immunodiagnostic assay that sensitively detects a cell-mediated immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is needed for epidemiological investigation and for clinical assessment of T- cell-mediated immune response to vaccines, particularly in the context of emerging variants that might escape antibody responses. METHODS The performance of a whole blood interferon-gamma (IFN-γ) release assay (IGRA) for the detection of SARS-CoV-2 antigen-specific T cells was evaluated in coronavirus disease 2019 (COVID-19) convalescents tested serially up to 10 months post-infection and in healthy blood donors. SARS-CoV-2 IGRA was applied in contacts of households with index cases. Freshly collected blood in the lithium heparin tube was left unstimulated, stimulated with a SARS-CoV-2 peptide pool, and stimulated with mitogen. RESULTS The overall sensitivity and specificity of IGRA were 84.5% (153/181; 95% confidence interval [CI]: 79.0-89.0) and 86.6% (123/142; 95% CI: 80.0-91.2), respectively. The sensitivity declined from 100% (16/16; 95% CI: 80.6-100) at 0.5-month post-infection to 79.5% (31/39; 95% CI: 64.4-89.2) at 10 months post-infection (P < .01). The IFN-γ response remained relatively robust at 10 months post-infection (3.8 vs 1.3 IU/mL, respectively). In 14 households, IGRA showed a positivity rate of 100% (12/12) and 65.2% (15/23), and IgG of 50.0% (6/12) and 43.5% (10/23) in index cases and contacts, respectively, exhibiting a difference of + 50% (95% CI: +25.4 to +74.6) and +21.7% (95% CI: +9.23 to +42.3), respectively. Either IGRA or IgG was positive in 100% (12/12) of index cases and 73.9% (17/23) of contacts. CONCLUSIONS The SARS-CoV-2 IGRA is a useful clinical diagnostic tool for assessing cell-mediated immune response to SARS-CoV-2.
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Affiliation(s)
- Kanagavel Murugesan
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Prasanna Jagannathan
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan Altamirano
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Yvonne A Maldonado
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Hector F Bonilla
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Karen B Jacobson
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Julie Parsonnet
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA,Clinical Virology Laboratory, Stanford Health Care, Stanford, CA, USA
| | - Upinder Singh
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA,Department of Microbiology and Immunology
| | - Niaz Banaei
- Corresponding Author: Niaz Banaei MD , 3375 Hillview Ave, Rm. 1602, Palo Alto, Ca 94304 USA, Phone 650-736-8052,
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Noel JE, Thatipamala P, Hung KS, Chen J, Shi RZ, Orloff LA. Pre-Operative Anti-Thyroid Antibodies in Differentiated Thyroid Cancer. Endocr Pract 2021; 27:1114-1118. [PMID: 34217894 DOI: 10.1016/j.eprac.2021.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the significance of anti-thyroglobulin and anti-thyroid peroxidase antibody levels in locoregional metastatic disease in patients with well-differentiated thyroid cancer. METHODS Included patients underwent initial treatment for well-differentiated thyroid cancer at our institution between 2014 and 2018. The following variables were collected: age, sex, pre-operative thyroid stimulating hormone (TSH), thyroglobulin (Tg), anti-thyroglobulin antibody (TgAb), anti-thyroid peroxidase antibody (TPOAb); extent of surgery; T-stage; N-stage; extrathyroidal extension (ETE), extranodal extension (ENE), lymphovascular invasion (LVI), and multifocal disease. The relationships between pre-operative TPOAb, TgAb, Tg, and TSH and disease status were analyzed. RESULTS 405 patients were included in the study. 66.4% were female. Mean age was 52 years. Elevated TgAb was associated with the presence of lymph node metastases (LNM) in both the central and lateral neck (p<0.01), with stronger correlation with N1b compared with N1a disease (p=0.03). Presence of ETE was inversely associated with TgAb titer (p=0.03). TPOAb was associated with lower T- stage, fewer LNM, and lower likelihood of ETE (p=0.04, p=0.04, p=0.02). In multivariable analysis, TgAb≥40 IU/mL was an independently predictive factor of higher N-stage (p<0.01 for N0 v. N1 and p=0.01 for N1a v. N1b), and for ENE (p<0.01). TPOAb≥60 IU/mL was associated with lower T-stage (p=0.04 for T< 3) and absence of ETE (p=0.01). CONCLUSIONS Elevated pre-operative TgAb was an independent predictor of nodal metastases and ENE, while elevated TPOAb was associated with a lower pathologic T and N stage. Pre-operative anti-thyroid antibody titers may be useful to inform disease extent and features.
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Affiliation(s)
- Julia E Noel
- Department of Otolaryngology Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305.
| | - Priyanka Thatipamala
- Department of Otolaryngology Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305
| | - Kay S Hung
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305
| | - Julie Chen
- Division of Endocrinology, Gerontology, and Metabolism, Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 93405
| | - Lisa A Orloff
- Department of Otolaryngology Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305
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10
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Lawrence L, Stevens BA, Sahoo MK, Huang C, Yamamoto F, Röltgen K, Wirz O, Zehnder J, Shi RZ, Boyd SD, Schoolnik G, Pinsky BA, Hogan CA. Plasma as an alternative COVID-19 diagnostic specimen in a hospitalized patient negative for SARS-CoV-2 by nasopharyngeal swab. Diagn Microbiol Infect Dis 2021; 100:115365. [PMID: 33865070 PMCID: PMC7930728 DOI: 10.1016/j.diagmicrobio.2021.115365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 12/05/2022]
Abstract
We present the case of an inpatient with pneumonia and repeatedly negative nasopharyngeal SARS-CoV-2 testing. In such challenging cases, alternative diagnostic options include lower respiratory tract and plasma SARS-CoV-2 RNA testing, of which the latter may be particularly useful where bronchoscopy is deferred due to clinical factors or transmission risk.
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Affiliation(s)
- Lauren Lawrence
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Bryan A Stevens
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; Clinical Virology Laboratory, Stanford Health Care, Stanford, CA, USA
| | - Malaya K Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - ChunHong Huang
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Fumiko Yamamoto
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Katharina Röltgen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Oliver Wirz
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - James Zehnder
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Scott D Boyd
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary Schoolnik
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; Clinical Virology Laboratory, Stanford Health Care, Stanford, CA, USA; Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Catherine A Hogan
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA; Clinical Virology Laboratory, Stanford Health Care, Stanford, CA, USA.
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11
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van Winden LJ, Kok M, Acda M, Dezentje V, Linn S, Shi RZ, van Rossum HH. Simultaneous analysis of E1 and E2 by LC-MS/MS in healthy volunteers: estimation of reference intervals and comparison with a conventional E2 immunoassay. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1178:122563. [PMID: 34224962 DOI: 10.1016/j.jchromb.2021.122563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
Monitoring estrogen levels, especially estradiol (E2), is amongst others important for determining menopausal status and guidance of breast cancer treatment. We validated a serum E2 and estrone (E1) liquid chromatography tandem-mass spectrometry assay (LC-MS/MS) suitable for quantitation in human subjects. In addition, we compared our method with an E2 immunoassay (IA) and established preliminary reference values. Validation parameters were within the predetermined acceptance criteria. Assay linearity ranges were 4-1500 pmol/L for E1 and 4-2500 pmol/L for E2. Imprecision ranged from 7.4 to 9.6%. The lower limit of quantitation for E2 (8.0 pmol/L) was 11.4 times lower than the IA. The method comparison revealed differences in E2 quantitation up to 155% between both methods. The method allowed quantitation of E1 in all healthy volunteers, while E2 could not be detected in 95% versus 40% of the post-menopausal women using IA and LC-MS/MS, respectively. Male, pre-, peri- and postmenopausal female reference values were estimated. An LC-MS/MS based method combining E1 and E2 analysis was validated with superior E2 analytical sensitivity when compared to the IA.
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Affiliation(s)
- Lennart J van Winden
- Department of Laboratory Medicine, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Maik Kok
- Department of Laboratory Medicine, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Manon Acda
- Department of Laboratory Medicine, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Vincent Dezentje
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sabine Linn
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Huub H van Rossum
- Department of Laboratory Medicine, Netherlands Cancer Institute, Amsterdam, the Netherlands
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12
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Hogan CA, Gombar S, Wang H, Röltgen K, Shi RZ, Holubar M, Chang SI, Lee GM, Boyd SD, Zehnder J, Pinsky BA. Large-Scale Testing of Asymptomatic Healthcare Personnel for Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis 2020; 27. [PMID: 33256889 PMCID: PMC7774535 DOI: 10.3201/eid2701.203892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Large-scale, 1-time testing of >12,000 asymptomatic healthcare personnel in California, USA, during April–June 2020 showed that prevalence of severe acute respiratory syndrome coronavirus 2 was low (<1%). Testing might identify asymptomatic and presymptomatic persons, including some with high viral burden, enabling prompt implementation of measures to limit nosocomial spread.
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13
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Manalac J, Yee J, Calayag K, Nguyen L, Patel PM, Zhou D, Shi RZ. Evaluation of Abbott anti-SARS-CoV-2 CMIA IgG and Euroimmun ELISA IgG/IgA assays in a clinical lab. Clin Chim Acta 2020; 510:687-690. [PMID: 32910980 PMCID: PMC7476889 DOI: 10.1016/j.cca.2020.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND We report our findings of test performance especially specificity of a fully automated Abbott Architect anti-SARS-CoV-2 CMIA IgG and Euroimmun anti-SARS-CoV-2 ELISA IgA/IgG in human plasma. METHODS We used positive cohort of 97 samples from Covid-19 patients or healthcare workers, collected at late time points from symptom onsets. We also included another cohort of 215 samples as negative controls, 78 of which had positive serology test results of other infectious diseases or autoimmunity. Assay specificity was assessed by using a total of 847 anonymized samples which were collected before the Covid-19 pandemic from local patient populations seeking clinical care for rheumatoid diseases, thyroid cancer, and therapeutic drug monitoring. RESULTS Abbott IgG, Euroimmun IgG/IgA had high precision, demonstrated by both intra- and inter-day CVs of <2%. There was no Abbott or Euroimmun IgG assay cross reactivity in the 78 samples with positive serology of non-SARS-CoV-2 infectious diseases and positive autoimmune antibodies. The Abbott IgG has specificity of 99.6%, while Euroimmun IgG and IgA were as high as 91.5% and 71.5%, respectively. CONCLUSIONS Our evaluation confirmed high specificity of the Abbott IgG assay, while it was lower for Euroimmun IgG. Euroimmun IgA has suboptimal specificity which may limit its clinical use. Assay sensitivity was high for both Abbott and Euroimmun IgG assays.
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Affiliation(s)
- Justin Manalac
- Clinical Chemistry and Immunology Section of Clinical Laboratories, Stanford Health Care, United States
| | - Jennifer Yee
- Clinical Chemistry and Immunology Section of Clinical Laboratories, Stanford Health Care, United States
| | - Kyle Calayag
- Department of Pathology, Stanford University School of Medicine, United States
| | - Linda Nguyen
- Clinical Chemistry and Immunology Section of Clinical Laboratories, Stanford Health Care, United States
| | - Payal M Patel
- Clinical Chemistry and Immunology Section of Clinical Laboratories, Stanford Health Care, United States
| | - Daniel Zhou
- Clinical Chemistry and Immunology Section of Clinical Laboratories, Stanford Health Care, United States
| | - Run-Zhang Shi
- Clinical Chemistry and Immunology Section of Clinical Laboratories, Stanford Health Care, United States; Department of Pathology, Stanford University School of Medicine, United States.
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14
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Chao CS, Shi RZ, Kumar RB, Aye T. Salivary cortisol levels by tandem mass spectrometry during high dose ACTH stimulation test for adrenal insufficiency in children. Endocrine 2020; 67:190-197. [PMID: 31535345 DOI: 10.1007/s12020-019-02084-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Serum cortisol measurements after ACTH stimulation are currently used to evaluate for adrenal insufficiency in children. We aim to determine if salivary cortisol measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) can confirm or replace serum cortisol during high dose ACTH stimulation test to improve test compliance and interpretation. We also aim to gain preliminary understanding of normal ranges of salivary cortisol in normal children at am, bedtime, and midnight. METHODS Children aged 6-17 years meeting study criteria and tested for adrenal insufficiency were recruited to concomitantly collect saliva and serum samples during high dose ACTH stimulation test. Normal children aged 3-18 years were recruited to collect morning, bedtime, and midnight saliva samples. Salivary cortisol was measured using LC-MS/MS while serum cortisol was determined by an immunoassay. RESULTS Salivary cortisol in normal children were higher at am and lower at bedtime and midnight (p value <0.0002 and <0.007, respectively). The midnight and bedtime levels were not sufficiently different (p value 0.36). Salivary cortisol during ACTH stimulation test positively and closely correlated with serum cortisol with 100% specificity and sensitivity when 18 µg/dL for serum and 500 ng/dL for salivary cortisol were used as cutoff values respectively for adrenal sufficiency. CONCLUSIONS Measurement of salivary cortisol by LC-MS/MS is less invasive, more convenient and better time controlled in busy pediatric clinic, therefore is better suited for young children to be used during high dose ACTH stimulation test to evaluate for adrenal insufficiency and to assist interpretation of test results by serum cortisol.
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Affiliation(s)
- Christina S Chao
- Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA, USA
- Pediatric Endocrinology, Kaiser Permanente Roseville Medical Center, Roseville, CA, USA
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Rajiv B Kumar
- Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Tandy Aye
- Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Palo Alto, CA, USA
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15
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Weber J, Sahoo MK, Taylor N, Uy E, Shi RZ, Pinsky BA. Comparison of Transcription-Mediated Amplification and Real-Time PCR Assays for Hepatitis B Virus DNA Quantitation in Serum. J Appl Lab Med 2019; 4:383-390. [PMID: 31659075 DOI: 10.1373/jalm.2019.029058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/04/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND The quantification of hepatitis B (HBV) DNA in serum is critical to identify patients requiring antiviral therapy and to monitor the response to treatment. METHOD This study describes the evaluation of the Aptima HBV Quant Dx assay (Aptima HBV) performed on the automated Panther system. RESULTS Aptima HBV was linear from 1.70 to 7.70 log10 IU/mL with a commercial reference panel, as well as clinical specimens representing genotypes B and C, and total imprecision, as measured by the percentage coefficient of variation (%CV) at 2.0 log10 IU/mL was <10%. The specificity of Aptima HBV was 94.7% (126/133) and 96.6% (84/87) for serum specimens from individuals without HBV exposure and individuals with resolved HBV infection, respectively. The qualitative agreement and quantitative accuracy of Aptima HBV was compared to the COBAS AmpliPrep/COBAS TaqMan HBV Test v2.0 (CAP/CTM). Overall agreement was 90.8% (187/206) with a κ statistic of 0.708 (standard error, 0.063; 95% CI, 0.585-0.831). Passing-Bablok regression revealed a regression line of y = 0.953x + 0.075 (95% CI of the slope, 0.883-1.011; intercept, -0.100 to 0.299), and Bland-Altman analysis (Aptima - CAP/CTM) showed a slight negative bias (-0.054 log10 IU/mL, and 95% limits of agreement of -1.093 to 0.984). CONCLUSIONS The Aptima HBV test affords a suitable alternative to CAP/CTM for serum virus load testing and provides a key component of the diagnostic algorithm for the global eradication of viral hepatitis.
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Affiliation(s)
- Jenna Weber
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - Malaya K Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - Nathaniel Taylor
- Clinical Virology Laboratory, Stanford Health Care, Stanford, CA
| | - Eirene Uy
- Clinical Virology Laboratory, Stanford Health Care, Stanford, CA
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA; .,Clinical Virology Laboratory, Stanford Health Care, Stanford, CA.,Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA
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16
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Luo A, El Gierari ETM, Nally LM, Sturmer LR, Dodd D, Shi RZ. Clinical utility of an ultrasensitive urinary free cortisol assay by tandem mass spectrometry. Steroids 2019; 146:65-69. [PMID: 30951757 DOI: 10.1016/j.steroids.2019.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND 24 h urinary free cortisol measurement is a clinically important first-line screening test for Cushing's syndrome (CS). Tandem mass spectrometry (LC-MS/MS) assays have superior sensitivity and specificity compared to immunoassays. Our goal was to improve and validate a LC-MS/MS method to measure urinary free cortisol in both adult and pediatric patients and to characterize its clinical diagnostic performance of CS by chart review. METHODS We improved a LC-MS/MS method previously reported for urinary free cortisol to be able to measure urinary and salivary cortisol in the same batch for increased efficiency. The sample preparation was by liquid-liquid extraction using dichloromethane followed by stepwise washing with acidic, basic and neutral solutions. The assay's analytical performance was characterized, and a retrospective patient chart review was conducted to evaluate the assay's clinical performance in diagnosing CS. RESULTS The LC-MS/MS assay demonstrated enhanced sensitivity and was linear within an analytical measurement range of 10-10,000 ng/dL. Assay accuracy was satisfactory as determined by spike and recovery studies and highly correlated with a reference LC-MS/MS method. The assay's clinical diagnostic sensitivity and specificity in detecting CS was 96% and 91%, respectively, when compared to a urinary cortisol excretion of at least 50 µg/24 h. CONCLUSIONS The improved LC-MS/MS method is both sensitive and specific with enhanced analytical performance and clinical diagnostic utility to screen for CS. The clinical diagnostic sensitivity and specificity were superior based on retrospective patient chart review.
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Affiliation(s)
- Amy Luo
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Laura M Nally
- Yale School of Medicine, New Heaven, CT, United States
| | - Lillian R Sturmer
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Dylan Dodd
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States.
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17
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Yang YC, Shi RZ, Tang RH, Ye RH, Wang JB, Duan X, Wang YK, Cheng HY, He N, Yao ST, Jiang Y, Duan S. [Estimating HIV incidence among female sex workers and injection drug users in Dehong Prefecture, 2009-2017]. Zhonghua Yu Fang Yi Xue Za Zhi 2019; 52:1243-1247. [PMID: 30522224 DOI: 10.3760/cma.j.issn.0253-9624.2018.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To obtain HIV incidence among injection drug users (IDU) and female sex workers (FSW) in Dehong Prefecture, Yunnan Province during 2009-2017. Methods: We recruited drug users and female sex workers from all sentinel surveillance sites across Dehong Prefecture during 2009-2017. A total of 10 480 IDU and 18 126 FSW in Dehong Prefecture were recruited by fingerprint technique. Data about drug uses, commercial sexual behavior, sociodemographic characteristics was collected by structured questionnaire. HIV-positive patients who were long-term infected or with CD4(+) T cell count was ≤200 were not included for further HIV incidence testing. Also, those who self-identified as on antiretroviral treatment (ART) or AIDS cases were also excluded. A total of 841 and 157 plasma specimens from IDU and FSW that met the inclusion criterion were finally included, respectively. Limiting antigen avidity enzyme immunoassay(LAg-Avidity EIA) were performed to calculate the HIV incidence among these two sub-populations. Results: A total of 3 444 IDU were HIV-positive, among which 884 (25.7%) were Burmese with age of (30.4±7.7), and 2 560 were Chinese with age of (36.6±7.3). Among 228 HIV-positive FSW, 109 (47.8%) were Burmese with age of (27.1±6.3), 119 (52.5%) were Chinese with age of (29.9±11.1). For IDU, the estimated HIV incidence among Burmese in 2009-2010, 2011-2012, 2013-2014, 2015-2017 was 4.20% (95%CI: -0.55%-8.95%), 7.75% (95%CI: 2.95%-12.55%), 11.79% (95%CI: 5.38%-18.20%), 10.30% (95%CI: 5.67%-14.94%), respectively, while Chinese were 3.11% (95%CI: 1.59%-4.64%), 0.03% (95%CI: -0.03%-0.08%), 1.55% (95%CI: 0.54%-2.57%), 0.58% (95%CI: -0.06%-1.04%), respectively. In 2009-2011, 2012-2014, 2015-2017, estimated HIV incidence among Burmese FSW was 0.22% (95%CI: -0.21%-0.64%), 1.24%(95%CI: 0.15%-2.32%), 0.55%(95%CI: 0.01%-1.08%). Whereas, estimated HIV incidence among Chinese FSW was 0.62% (95%CI: 0.25%-0.98%), 0.11% (95%CI: -0.04%-0.26%), 0.22% (95%CI: 0-0.44%). Conclusion: HIV incidences among Chinese IDU and FSW are on the downward trend, while Burmese IDU and FSW seem to be gaining momentum.
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Affiliation(s)
- Y C Yang
- Department of STD/AIDS Prevention and Control, Dehong Prefecture Center for Disease Control and Prevention, Mangshi 678400, China
| | - R Z Shi
- School of Public Health, Fudan University, Shanghai 200032, China
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18
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Sturmer LR, Dodd D, Chao CS, Shi RZ. Clinical utility of an ultrasensitive late night salivary cortisol assay by tandem mass spectrometry. Steroids 2018; 129:35-40. [PMID: 29197558 DOI: 10.1016/j.steroids.2017.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Late night salivary cortisol measurement is a clinically important and convenient screening test for Cushing's syndrome. Tandem mass spectrometry (LC-MS/MS) assays have superior sensitivity and specificity compared to immunoassays. Our goal was to improve a LC-MS/MS method to measure salivary cortisol in both adult and pediatric patients and to characterize its analytical performance by method validation and clinical performance by chart review. METHODS We improved a LC-MS/MS method originally developed for urine cortisol to measure low level salivary cortisol. The sample preparation was by liquid-liquid extraction using dichloromethane followed by stepwise washing with acidic, basic and neutral solutions. The assay's analytical performance was characterized and retrospective patient chart review was conducted to evaluate the assay's clinical diagnostic performance. RESULTS The LC-MS/MS assay showed enhanced functional sensitivity of 10 ng/dL for salivary cortisol and was linear within an analytical measurement range of 10-10,000 ng/dL. Assay accuracy was within 84-120% as determined by recovery studies and correlation with a reference method. Data from healthy adult volunteers was compiled to establish the reference interval for late night salivary cortisol. Patient chart review determined subjects with diagnosis of Cushing's syndrome or disease, and assay's clinical diagnostic sensitivity of 100% and specificity of 92% when the cutoff value was 70 ng/dL. CONCLUSIONS The improved LC-MS/MS method is sensitive and specific with enhanced analytical performance and clinical diagnostic utility for screening Cushing's syndrome. The assay may have broad clinical application due to its high sensitivity and wide dynamic range.
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Affiliation(s)
- Lillian R Sturmer
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Dylan Dodd
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Christina S Chao
- Pediatric Endocrinology, Kaiser Permanente Roseville Medical Center, Roseville, CA, United States
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States.
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Shi RZ, El Gierari ETM, Faix JD, Manicke NE. Rapid Measurement of Cyclosporine and Sirolimus in Whole Blood by Paper Spray–Tandem Mass Spectrometry. Clin Chem 2016; 62:295-7. [DOI: 10.1373/clinchem.2015.245191] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Run-Zhang Shi
- Stanford University School of Medicine, Palo Alto, CA
| | | | - James D Faix
- Stanford University School of Medicine, Palo Alto, CA
| | - Nicholas E Manicke
- Department of Chemistry and Chemical Biology Indiana University–Purdue University Indianapolis, Indianapolis, IN
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Shi RZ, Seeley ES, Bowen R, Faix JD. Rapid blood separation is superior to fluoride for preventing in vitro reductions in measured blood glucose concentration. J Clin Pathol 2009; 62:752-3. [DOI: 10.1136/jcp.2008.062547] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gock SB, Shi RZ, Jin M, Jannetto PJ, Jentzen JM, Wong SH. Opioids Intoxication, Diversion And Pharmacogenomics for a Case Involving Methadone And Oxycodone. Ther Drug Monit 2005. [DOI: 10.1097/00007691-200504000-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
UNLABELLED BACKGROUND and aims. To compare the metabolic effects induced by the anticancer drugs, 6-mercaptopurine (6-MP), 6-thioguanine (6-TG) and 6-methylmercaptopurine riboside (MMPR), which may inhibit the de novo biosynthesis of purine nucleotides or be mis-incorporated into DNA or RNA. METHODS Leukaemia cells were grown in culture, exposed to a thiopurine and cell extracts were analyzed for NTPs, dNTPs, drug metabolites and P-Rib-PP. RESULTS In leukaemia cells, 6-MP was converted to MPR-MP, thio-XMP, thio-GMP, thio-GDP and thio-GTP. Metabolites of 6-TG included thio-XMP, thio-GMP, thio-GDP and thio-GTP, while MMPR-MP was the only major metabolite of MMPR, MMPR (25 microM, 4 h) induced a 16-fold increase in P-Rib-PP and 6-MP (25 microM, 4 h) induced a delayed 5.2-fold increase. MPR-MP, thio-GMP and MMPR-MP are inhibitors of amido phosphoribosyltransferase from leukaemia cells with Ki values of 114 +/- 7.10 microM, 6.20 +/- 2.10 microM and 3.09 +/- 0.30 microM, respectively. CONCLUSION The nucleoside-5'-monophosphate derivatives of the 3 thiopurines inhibit amido phosphoribosyltransferase in growing leukaemia cells but there is also an initial inhibition of the further conversion of IMP in the pathway. In growing cells, MMPR acts solely as an inhibitor of de novo purine biosynthesis while 6-TG and to a lesser extent, 6-MP, are converted to significant concentrations of di- and tri-phosphate derivatives which may have other mechanisms of cytotoxicity.
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Affiliation(s)
- R Z Shi
- Department of Biochemistry, University of Sydney, NSW, Australia
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Shi RZ, Ho YP, Yeung JH, Or PM, To KK, Lau MW, Arumanayagam M. Development of an enzyme-linked immunosorbent assay with monoclonal antibody for quantification of homovanillic acid [corrected] in human urine samples. Clin Chem 1998; 44:1674-9. [PMID: 9702954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A monoclonal antibody to homovanillic acid (HVA) was prepared by synthesis of a HVA-protein conjugate (HVA-ovalbumin) as an immunogen, immunization of mice, and the subsequent hybridization technique. Monoclonal antibodies were screened on the basis of sensitivity, specificity, and accuracy. An indirect ELISA was developed for quantification of HVA in human urine. The assay was characterized and shown to have high specificity, with cross-reactivities to vanillylmandelic acid and normetanephrine at 0.18% and <0.1%, respectively. The assay coefficients of variation were <10% within the working range of 0.5-40 mg/L. Initial results from testing urine samples of patients with neuroblastoma and other diseases were validated by HPLC, suggesting that this ELISA method is a reliable and convenient system for quantification of HVA in urine and can be used in the mass screening of neuroblastoma in infants.
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Affiliation(s)
- R Z Shi
- Department of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories
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