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Clinical utility of laboratory developed mass spectrometry assays for steroid hormone testing 实验室开发的质谱分析用于类固醇激素检测的临床应用
IF 2.2 4区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-04-01 DOI: 10.1016/j.jmsacl.2023.01.006
Deborah French
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引用次数: 2
Analysis of monoclonal immunoglobulins from bone marrow plasma cells using immunopurification and LC-MS 应用免疫纯化和LC-MS分析骨髓浆细胞中单克隆免疫球蛋白
IF 2.2 4区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-04-01 DOI: 10.1016/j.jmsacl.2023.04.001
David R. Barnidge , Angela Dispenzieri , Dragan Jevremovic , David L. Murray

Introduction

Clonal plasma cells secrete immunoglobulins, each with the exact same amino acid sequence, that are referred to as monoclonal immunoglobulins. The monoclonal heavy chain and light chain secreted from clonal plasma cells have the same molecular mass prior to the addition of post-translational modifications (PTMs) since their amino acid sequences are the same.

Objective

To examine the molecular masses of monoclonal light chains and heavy chains isolated directly from the cytoplasm of bone marrow (BM) plasma cells and compare them to the serum derived monoclonal heavy and light chains.

Methods

Using immunopurification and LC-MS we compared the molecular masses of immunoglobulins immunopurified from a patient’s serum to those immunopurified from the cytoplasm of their BM plasma cells.

Results

Our findings demonstrate that the light chain molecular masses were identical whether they were obtained from serum or plasma cell cytoplasm. However, the heavy chain molecular masses did not match in bone marrow and serum due to differences in glycosylation, a common post-translational modification (PTM) found on the heavy chain.

Conclusion

The data presented here show that by using LC-MS to analyze monoclonal immunoglobulins (also referred to as miRAMM) additional phenotype information is obtained at the cellular level which is complementary to other more common techniques such as flow cytometry and histopathology.

克隆浆细胞分泌免疫球蛋白,每个免疫球蛋白的氨基酸序列完全相同,称为单克隆免疫球蛋白。克隆浆细胞分泌的单克隆重链和轻链在添加翻译后修饰(PTM)之前具有相同的分子量,因为它们的氨基酸序列相同。目的检测直接从骨髓浆细胞细胞质中分离的单克隆轻链和重链的分子量,并将其与血清来源的单克隆重链和轻链进行比较。方法采用免疫纯化和LC-MS方法,比较了从患者血清中免疫纯化的免疫球蛋白和从BM浆细胞细胞质中免疫纯化免疫球蛋白的分子量。结果我们的研究结果表明,无论是从血清还是浆细胞浆中获得的轻链分子质量都是相同的。然而,由于糖基化的差异,重链分子量在骨髓和血清中不匹配,糖基化是在重链上发现的一种常见的翻译后修饰(PTM)。结论本文提供的数据表明,通过使用LC-MS分析单克隆免疫球蛋白(也称为miRAMM),可以在细胞水平上获得额外的表型信息,这与流式细胞术和组织病理学等其他更常见的技术是互补的。
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引用次数: 0
Pediatric laboratory developed tests filling the gaps for children in crisis 儿科实验室开发的检测方法填补了处于危机中的儿童的空白
IF 2.2 4区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-04-01 DOI: 10.1016/j.jmsacl.2023.02.012
Dustin R. Bunch
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引用次数: 0
A persistently febrile patient post-bone marrow transplant 骨髓移植后持续发热患者
IF 2.2 4区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-04-01 DOI: 10.1016/j.jmsacl.2023.01.005
Ashley R. Rackow, Claire E. Knezevic
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引用次数: 1
Pre-analytical conditions influencing analysis of folate in dried plasma microsamples 影响干燥血浆微量样品中叶酸分析的分析前条件
IF 2.2 4区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-04-01 DOI: 10.1016/j.jmsacl.2023.01.003
Christopher M. Shuford, Evan W. McConnell, Stacy Dee, Russell P. Grant

Introduction

Determination of folate insufficiency is of considerable interest given its importance in fetal development and red blood cell formation; however, access to blood tests may be limited due to the requirement for phlebotomy as well as controlled temperature shipping of blood specimens to laboratories for testing due to the inherent instability of folate and its vitamers.

Methods

An LC-MS/MS test was developed and validated for the measurement of 5-methyltetrahydrofolate (5MTHF) in dried plasma specimens collected from fingerstick blood using a laminar flow blood separation device, as well as liquid venous plasma for comparison. Two pre-analytical factors investigated influencing the measurement of 5MTHF in dried plasma were hemolysis of the fingerstick blood during collection and storage/shipment of the dried plasma.

Results

Although observed infrequently, hemolysis >10 % resulted in elevated 5MTHF measurements, but hemolysis >1 % resulted in elevated chloride measurements, which were necessary to normalize 5MTHF measurements for variation in volume of dried plasma specimens. Stability of 5MTHF was improved in dried plasma relative to liquid plasma at ambient temperatures, but not sufficiently to allow for uncontrolled temperature shipping despite controlling for humidity and light exposure. Shipping studies emulating ISTA procedure 7D were conducted with a reusable cold packaging solution. The packaging failed to stabilize 5MTHF in dried plasma specimens during a 2-day summer shipping evaluation, but did provide sufficient temperature control to stabilize 5MTHF during the overnight shipping evaluation.

Conclusion

Our studies provide boundary conditions with respect to hemolysis, storage, and shipping for successful analysis of 5MTHF from dried plasma specimens.

叶酸缺乏的测定在胎儿发育和红细胞形成中具有重要意义,因此引起了人们的极大兴趣;然而,由于叶酸及其维生素的固有不稳定性,需要静脉切开术以及将血液样本运送到实验室进行检测的温度控制,因此血液检测的机会可能会受到限制。方法采用液相色谱-质谱联用技术(LC-MS/MS)测定指尖血液干燥血浆样品中5-甲基四氢叶酸(5MTHF)的含量,并与液体静脉血浆进行比较。研究的影响干血浆中5MTHF测量的两个预分析因素是干血浆收集和储存/运输过程中手指棒血的溶血。结果尽管观察不多,但溶血>;10%导致5MTHF测量值升高,但溶血>;1%导致氯化物测量值升高,这对于使5MTHF测量值标准化以测量干燥血浆样品的体积变化是必要的。相对于环境温度下的液体等离子体,5MTHF在干燥等离子体中的稳定性得到了改善,但不足以允许不受控制的温度运输,尽管控制了湿度和光暴露。使用可重复使用的冷包装解决方案进行了模拟ISTA程序7D的装运研究。在为期两天的夏季装运评估中,包装未能稳定干燥血浆样品中的5MTHF,但在隔夜装运评估中提供了足够的温度控制以稳定5MTHF。结论我们的研究为成功分析干燥血浆样品中的5MTHF提供了溶血、储存和运输的边界条件。
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引用次数: 1
Evaluating the performance of the Roche FEN2 fentanyl immunoassay and its clinical implementation: The role of LDT-based mass spectrometry testing Roche FEN2芬太尼免疫测定的性能评估及其临床应用:基于LDT的质谱检测的作用
IF 2.2 4区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-04-01 DOI: 10.1016/j.jmsacl.2023.02.009
Marlen Menlyadiev , Raymond T. Suhandynata , Kyle Lund , Michael J. Kelner , Robert L. Fitzgerald

Introduction

While laboratory-developed tests (LDTs) using liquid chromatography tandem mass spectrometry (LC-MS/MS) are widely employed to support the development of FDA-cleared drug immunoassays, their significance in the clinical implementation and evaluation of such assays is often overlooked. This paper reports on the important role of LC-MS/MS LDTs in demonstrating improved performance of the Roche FEN2 fentanyl immunoassay compared with the Thermo DRI fentanyl immunoassay.

Methods

The FEN2 assay was implemented according to the manufacturer's instructions and its performance was compared to the existing DRI assay using LC-MS/MS as a reference. Clinical sensitivity and specificity were determined using 250 consecutive random patient specimens. Spiking experiments were conducted to determine cross-reactivity with 31 fentanyl analogs. Select DRI false-positive samples were analyzed by the FEN2 assay via time-of-flight mass spectrometry method (LC-QTOF).

Results

The FEN2 assay showed improved clinical sensitivity compared to the DRI (98% vs 61%) in 250 consecutive patient samples due to its ability to detect norfentanyl. It also showed better clinical specificity by correctly classifying select DRI false-positive results. Upon implementation in clinical practice, the FEN2 resulted in a higher screening positivity rate than the DRI (17.3% vs 13.3%) and a greater LC-MS/MS confirmation rate of immunoassay-positive samples (96.8% vs 88.8%, respectively).

Conclusion

The use of LC-MS/MS LDTs demonstrated that the FEN2 assay has greater clinical sensitivity and is less prone to false-positives than the DRI assay. These findings support the use of FEN2 in routine clinical practice and emphasize the role of mass spectrometry-based LDTs in clinical toxicology testing.

引言虽然使用液相色谱-串联质谱法(LC-MS/MS)的实验室开发测试(LDT)被广泛用于支持FDA批准的药物免疫测定的开发,但它们在此类测定的临床实施和评估中的重要性往往被忽视。本文报道了LC-MS/MS LDTs在证明Roche FEN2芬太尼免疫测定与Thermo DRI芬太尼免疫测定相比性能提高方面的重要作用。方法按照制造商的说明书进行FEN2测定,并使用LC-MS/MS作为参考,将其性能与现有的DRI测定进行比较。使用250个连续的随机患者样本测定临床敏感性和特异性。进行加标实验以确定与31种芬太尼类似物的交叉反应性。通过飞行时间质谱法(LC-QTOF)用FEN2法分析选定的DRI假阳性样本。结果在250个连续的患者样本中,与DRI(98%对61%)相比,FEN2法由于能够检测去甲芬太尼,其临床灵敏度有所提高。通过正确分类DRI假阳性结果,它也显示出更好的临床特异性。在临床实践中实施后,FEN2的筛查阳性率高于DRI(17.3%vs 13.3%),免疫测定阳性样本的LC-MS/MS确认率更高(分别为96.8%vs 88.8%)。这些发现支持在常规临床实践中使用FEN2,并强调了基于质谱的LDT在临床毒理学测试中的作用。
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引用次数: 1
Comparison of two highly sensitive benzodiazepine immunoassay lab developed tests for urine drug testing in clinical specimens 比较两种高灵敏度苯二氮卓类药物免疫测定实验室研制的临床尿样药物检测方法
IF 2.2 4区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-04-01 DOI: 10.1016/j.jmsacl.2023.02.010
Kyle Lund , Marlen Menlyadiev , Kyunghoon Lee , Michael J. Kelner , Robert L. Fitzgerald , Raymond T. Suhandynata

Background

The VALID Act is a legislative effort that, if enacted, would alter the regulatory requirements of laboratory developed tests (LDTs) used for clinical testing in the United States. Benzodiazepines, which are primarily excreted into urine as glucuronidated metabolites such as lorazepam, cross-react poorly with FDA-cleared immunoassays, leading to false-negatives. This shortfall can be addressed with LDTs created by adding glucuronidase to the immunoassay reagents producing “high sensitivity” assays that detect glucuronidated metabolites.

Methods

Precision and stability of two high-sensitivity (HS) benzodiazepine immunoassays from Roche and Thermo Scientific were evaluated using manufacturer-supplied quality control (QC) material and glucuronidated QC material. The immunoassays were directly compared to an LC-MS/MS LDT benzodiazepine assay to determine clinical sensitivity/specificity using urine specimens (n = 82 for Thermo Scientific; n = 265 for Roche). The clinical impact of the HS LDT immunoassay was determined by analyzing clinical testing results 60 days before and after its implementation.

Results

The precision and clinical sensitivity/specificity of the HS-Thermo Scientific and HS-Roche benzodiazepine assays were acceptable. The reagent stability of the HS-Thermo Scientific immunoassay was poor, whereas the HS-Roche immunoassay was stable. After implementation of the HS-Roche benzodiazepine immunoassay as an LDT, there was a 30-fold increase (p-value: < 0.00001) in the percentage of lorazepam confirmations.

Conclusions

We demonstrate the development and validation of an immunoassay LDT with improved sensitivity for glucuronidated benzodiazepines. This LDT can detect glucuronidated benzodiazepines in clinical urine specimens and is stable for 60 days. Importantly, we were able to validate the immunoassay as an LDT by utilizing an LC-MS/MS LDT.

背景VALID法案是一项立法努力,如果颁布,将改变美国用于临床测试的实验室开发测试(LDT)的监管要求。苯二氮卓类药物主要以葡萄糖醛酸代谢产物(如劳拉西泮)的形式排泄到尿液中,与美国食品药品监督管理局批准的免疫测定法交叉反应不佳,导致假阴性。这种短缺可以通过在免疫测定试剂中添加葡萄糖醛酸酶来产生LDT来解决,该试剂产生检测葡萄糖醛酸代谢产物的“高灵敏度”测定。方法使用制造商提供的质量控制(QC)材料和葡萄糖醛酸化的QC材料,对罗氏和赛默科学的两种高灵敏度(HS)苯二氮卓免疫测定的准确性和稳定性进行评估。将免疫测定法与LC-MS/MS LDT苯二氮卓类测定法直接比较,以使用尿液样本确定临床敏感性/特异性(Thermo Scientific的n=82;罗氏的n=265)。HS LDT免疫测定的临床影响是通过分析实施前后60天的临床测试结果来确定的。结果HS Thermo Scientific和HS Roche苯二氮卓类药物测定的精密度和临床敏感性/特异性均可接受。HS Thermo Scientific免疫测定的试剂稳定性较差,而HS Roche免疫测定是稳定的。在实施HS Roche苯二氮卓免疫测定作为LDT之后,劳拉西泮的确认百分比增加了30倍(p值:<;0.00001)。结论我们证明了一种对葡萄糖醛酸化苯二氮卓类药物具有更高灵敏度的免疫测定LDT的开发和验证。该LDT可以检测临床尿液样本中的葡萄糖醛酸化苯二氮卓类药物,并且稳定60天。重要的是,我们能够通过使用LC-MS/MS LDT将免疫测定法验证为LDT。
{"title":"Comparison of two highly sensitive benzodiazepine immunoassay lab developed tests for urine drug testing in clinical specimens","authors":"Kyle Lund ,&nbsp;Marlen Menlyadiev ,&nbsp;Kyunghoon Lee ,&nbsp;Michael J. Kelner ,&nbsp;Robert L. Fitzgerald ,&nbsp;Raymond T. Suhandynata","doi":"10.1016/j.jmsacl.2023.02.010","DOIUrl":"10.1016/j.jmsacl.2023.02.010","url":null,"abstract":"<div><h3>Background</h3><p>The VALID Act is a legislative effort that, if enacted, would alter the regulatory requirements of laboratory developed tests (LDTs) used for clinical testing in the United States. Benzodiazepines, which are primarily excreted into urine as glucuronidated metabolites such as lorazepam, cross-react poorly with FDA-cleared immunoassays, leading to false-negatives. This shortfall can be addressed with LDTs created by adding glucuronidase to the immunoassay reagents producing “high sensitivity” assays that detect glucuronidated metabolites.</p></div><div><h3>Methods</h3><p>Precision and stability of two high-sensitivity (HS) benzodiazepine immunoassays from Roche and Thermo Scientific were evaluated using manufacturer-supplied quality control (QC) material and glucuronidated QC material. The immunoassays were directly compared to an LC-MS/MS LDT benzodiazepine assay to determine clinical sensitivity/specificity using urine specimens (n = 82 for Thermo Scientific; n = 265 for Roche). The clinical impact of the HS LDT immunoassay was determined by analyzing clinical testing results 60 days before and after its implementation.</p></div><div><h3>Results</h3><p>The precision and clinical sensitivity/specificity of the HS-Thermo Scientific and HS-Roche benzodiazepine assays were acceptable. The reagent stability of the HS-Thermo Scientific immunoassay was poor, whereas the HS-Roche immunoassay was stable. After implementation of the HS-Roche benzodiazepine immunoassay as an LDT, there was a 30-fold increase <em>(p</em>-value: &lt; 0.00001) in the percentage of lorazepam confirmations.</p></div><div><h3>Conclusions</h3><p>We demonstrate the development and validation of an immunoassay LDT with improved sensitivity for glucuronidated benzodiazepines. This LDT can detect glucuronidated benzodiazepines in clinical urine specimens and is stable for 60 days. Importantly, we were able to validate the immunoassay as an LDT by utilizing an LC-MS/MS LDT.</p></div>","PeriodicalId":52406,"journal":{"name":"Journal of Mass Spectrometry and Advances in the Clinical Lab","volume":"28 ","pages":"Pages 91-98"},"PeriodicalIF":2.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/f3/main.PMC10020650.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9152995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How the VALID Act could affect patient access to laboratory developed testing for therapeutic drug monitoring VALID法案如何影响患者获得实验室开发的治疗药物监测测试
IF 2.2 4区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-04-01 DOI: 10.1016/j.jmsacl.2023.02.004
Alec Saitman
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引用次数: 1
Bridging the gap: The critical role of laboratory developed tests in clinical toxicology 弥合差距:实验室开发的测试在临床毒理学中的关键作用
IF 2.2 4区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-04-01 DOI: 10.1016/j.jmsacl.2023.02.007
Jaime H. Noguez , Christopher D. Koch
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引用次数: 2
Oxidized LDL is stable in human serum under extended thawed-state conditions ranging from −20 °C to room temperature 氧化LDL在−20°C至室温的延长解冻状态条件下在人血清中是稳定的
IF 2.2 4区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY Pub Date : 2023-01-01 DOI: 10.1016/j.jmsacl.2022.12.001
Nilojan Jehanathan , Erandi P. Kapuruge , Stephen P. Rogers , Stacy Williams , Yunro Chung , Chad R. Borges

Introduction

Oxidized LDL (oxLDL) is formed by the spontaneous reaction between aldehyde byproducts of lipid peroxidation and lysine residues of apolipoprotein B within LDL. Clinically, oxLDL is used as a marker of coronary artery disease and predictor of metabolic syndrome risk. Despite its popularity as a clinical marker, no systematic studies of oxLDL stability, in which serum or plasma has been pre-analytically exposed to an array of different time and temperature conditions, have been carried out.

Objective

To systematically evaluate the stability of oxLDL in human serum samples exposed to thawed conditions (> −30 °C) for varying periods of time while monitoring a second protein/small molecule redox system as a positive control for non-enzymatic biomolecular activity.

Methods

OxLDL was measured in serum samples, from 24 different humans, that had been pre-exposed to three different time courses at 23 °C, 4 °C and −20 °C using ELISA kits from Mercodia that employ the 4E6 mouse monoclonal antibody. A liquid chromatography/mass spectrometry-based marker of serum exposure to thawed conditions known as ΔS-Cys-Albumin was employed as a positive control.

Results

OxLDL was stable in serum exposed to 23 °C for up to 48 h, 4 °C for 21 days, or −20 °C for 65 days. ΔS-Cys-Albumin changed dramatically during these time courses (p < 0.001).

Conclusions

OxLDL is remarkably stable ex vivo in human serum samples exposed to thawed conditions.

氧化型低密度脂蛋白(oxLDL)是由脂质过氧化的醛副产物与LDL中载脂蛋白B的赖氨酸残基自发反应形成的。临床上,oxLDL被用作冠状动脉疾病的标志物和代谢综合征风险的预测指标。尽管oxLDL作为一种临床标志物很受欢迎,但尚未对其稳定性进行系统研究,其中血清或血浆已预先分析暴露于一系列不同的时间和温度条件下。目的系统评价暴露于解冻条件(>;−30°C)不同时间的人血清样品中oxLDL的稳定性,同时监测第二个蛋白质/小分子氧化还原系统作为非酶生物分子活性的阳性对照。方法使用Mercodia的ELISA试剂盒,使用4E6小鼠单克隆抗体,对24名不同的人的血清样本中的OxLDL进行测量,这些人在23°C、4°C和−20°C的三个不同的时间过程中预先暴露。使用一种基于液相色谱/质谱的血清暴露于解冻条件下的标记物ΔS-Cys-Albumin作为阳性对照。结果OxLDL在暴露于23°C达48小时、4°C达21天或−20°C达65天的血清中是稳定的。ΔS-Cys-Albumin在这些时间过程中发生了显著变化(p<0.001)。
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引用次数: 1
期刊
Journal of Mass Spectrometry and Advances in the Clinical Lab
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