Introduction Studies using different assays and technologies showed highly promising diagnostic value of plasma phosphorylated (P-)tau levels for Alzheimer’s disease (AD). We aimed to compare six P-tau Simoa assays, including three P-tau181 (Eli Lilly, ADx, Quanterix), one P-tau217 (Eli Lilly), and two P-tau231 (ADx, Gothenburg). Methods We studied the analytical (sensitivity, precision, parallelism, dilution linearity, and recovery) and clinical (40 AD dementia patients, age 66±8years, 50%F; 40 age- and sex-matched controls) performance of the assays. Results All assays showed robust analytical performance, and particularly P-tau217 Eli Lilly; P-tau231 Gothenburg and all P-tau181 assays showed robust clinical performance to differentiate AD from controls, with AUCs 0.936–0.995 (P-tau231 ADx: AUC = 0.719). Results obtained with all P-tau181 assays, P-tau217 Eli Lilly assay, and P-tau231 Gothenburg assay strongly correlated (Spearman’s rho > 0.86), while correlations with P-tau231 ADx results were moderate (rho < 0.65). Discussion P-tau isoforms can be measured robustly by several novel high-sensitive Simoa assays.
Cancer antigen 125 (CA125) is a widely used biomarker in monitoring of epithelial ovarian cancer (EOC). Due to insufficient cancer specificity of CA125, its diagnostic use is severely compromised. Abnormal glycosylation of CA125 is a unique feature of ovarian cancer cells and could improve differential diagnosis of the disease. Here we describe the development of a quantitative lateral flow immunoassay (LFIA) of aberrantly glycosylated CA125 which is widely superior to the conventional CA125 immunoassay (CA125IA). With a 30 min read-out time, the LFIA showed 72% sensitivity, at 98% specificity using diagnostically challenging samples with marginally elevated CA125 (35–200 U/mL), in comparison to 16% sensitivity with the CA125IA. We envision the clinical use of the developed LFIA to be based on the substantially enhanced disease specificity against the many benign conditions confounding the diagnostic evaluation and against other cancers.
Proteomics studies have shown differential expression of numerous proteins in dementias but have rarely led to novel biomarker tests for clinical use. The Marie Curie MIRIADE project is designed to experimentally evaluate development strategies to accelerate the validation and ultimate implementation of novel biomarkers in clinical practice, using proteomics-based biomarker development for main dementias as experimental case studies. We address several knowledge gaps that have been identified in the field. First, there is the technology-translation gap of different technologies for the discovery (e.g., mass spectrometry) and the large-scale validation (e.g., immunoassays) of biomarkers. In addition, there is a limited understanding of conformational states of biomarker proteins in different matrices, which affect the selection of reagents for assay development. In this review, we aim to understand the decisions taken in the initial steps of biomarker development, which is done via an interim narrative update of the work of each ESR subproject. The results describe the decision process to shortlist biomarkers from a proteomics to develop immunoassays or mass spectrometry assays for Alzheimer's disease, Lewy body dementia, and frontotemporal dementia. In addition, we explain the approach to prepare the market implementation of novel biomarkers and assays. Moreover, we describe the development of computational protein state and interaction prediction models to support biomarker development, such as the prediction of epitopes. Lastly, we reflect upon activities involved in the biomarker development process to deduce a best-practice roadmap for biomarker development.
Measurement of cardiac troponin I (cTnI) should be feasible for point-of-care testing (POCT) to diagnose acute myocardial infarction (AMI). Lateral flow immunoassays (LFIAs) have been long implemented in POCT and clinical settings. However, sensitivity, matrix effect and quantitation in lateral flow immunoassays (LFIAs) have been major limiting factors. The performance of LFIAs can be improved with upconverting nanoparticle (UCNP) reporters. Here we report a new methodological approach to quantify cTnI using UCNP-LFIA technology with minimized plasma interference. The performance of the developed UCNP-LFIA was evaluated using clinical plasma samples (n = 262). The developed UCNP-LFIA was compared to two reference assays, the Siemens Advia Centaur assay and an in-house well-based cTnI assay. By introducing an anti-IgM scrub line and dried EDTA in the LFIA strip, the detection of cTnI in plasma samples was fully recovered. The UCNP-LFIA was able to quantify cTnI concentrations in patient samples within the range of 30–10,000 ng/L. The LoB and LoD of the UCNP-LFIA were 8.4 ng/L and 30 ng/L. The method comparisons showed good correlation (Spearman’s correlation 0.956 and 0.949, p < 0.0001). The developed UCNP-LFIA had LoD suitable for ruling in AMI in patients with elevated cTnI levels and was able to quantify cTnI concentrations in patient samples. The technology has potential to provide simple and rapid assay for POCT in ED setting
Rapid diagnostic tests (RDTs) are often used for the detection of anti-human immunodeficiency virus (HIV) antibodies in remote locations in low- and middle-income countries (LMIC) with low or limited access to central laboratories. The typical format of an RDT is a lateral flow assay (LFA) with visual interpretation prone to subjectivity. This risk of misinterpretation can be overcome with luminescent upconverting nanoparticle reporters (UCNPs) measured with a miniaturized easy-to-use reader instrument. An LFA with UCNPs for anti-HIV-1/2 antibodies was developed and the assay performance was evaluated extensively with challenging patient sample panels. Sensitivity (n = 145) of the UCNP-LFA was 96.6% (95% CI: 92.1–98.8%) and specificity (n = 309) was 98.7% (95% CI: 96.7–99.7%). Another set of samples (n = 200) was used for a comparison between the UCNP-LFA and a conventional visual RDT. In this comparison, the sensitivities for HIV-1 were 96.4% (95% CI: 89.8–99.3%) and 97.6% (95% CI: 91.6–99.7%), for the UCNP-LFA and conventional RDT, respectively. The specificity was 100% (95% CI: 96.4–100%) for both assays. The developed UCNP-LFA demonstrates the applicability of UCNPs for the detection of anti-HIV antibodies. The signal measurement is done by a reader instrument, which may facilitate automated result interpretation, archiving and transfer of data from de-centralized locations.
Background: Plasma phosphorylated Tau (P-tau) protein is a promising biomarker for early detection of Alzheimer's Disease (AD), reflecting abnormal tau metabolism in CSF and brain. Different Tau isoforms have been shown as specific biomarkers to detect AD including plasma tau phosphorylated at threonine 181 (P-tau181) and at threonine 217 (P-tau217). Novel plasma tests have been developed on various platforms for different isoforms and using various reagents, but these have not been compared directly for their analytical and clinical performance. In this study, we directly compared three novel P-tau blood assays to investigate the clinical and technical differences between each assay. Method:We included the following assays: plasma P-tau181 from Quanterix, P-tau181 Lilly and P-tau217 Lilly assays, all run on the Simoa HD-X (Quanterix). We analytically compared the novel assays for the parameters: precision, linearity, parallelism, limit of detection, recovery and sensitivity. The clinical performance of each assay was evaluated using plasma samples from 40 non-demented healthy individuals of www.hersenonderzoek.nl (median age 66 years, 68 % females) and 40 AD-dementia cases of the Amsterdam dementia cohort (median age 66, 60 % females). Using a receiver operating characteristics (ROC) curve analysis, we compared the discriminatory ability of each assay. Here, we present the clinical performance results.Result: Plasma P-tau217 and both plasma P-tau181 assays were highly correlated, with correlation coefficients over 0.82 (all p< 0.001). Patients with AD-dementia showed elevated levels of P-tau181 and P-tau217 in comparison to healthy controls (P-tau 217 AUC = 0.995 (0.986-1.00), P-tau181 Quanterix AUC=0.936 (0.885-987), P-tau 181 Lilly AUC= 0.938 (0.87-1.00)). The P-tau217 Lilly assay numerically outperformed both the P-tau 181 assays in discriminating between AD-dementia and control cases with a sensitivity of 97.5% at a specificity of 95%. The P-tau181 Quanterix and Lilly showed a sensitivity of 100% at 89.5%, 79% specificity, respectively. Conclusion:Our findings suggest that the novel plasma P-tau isoform tests are useful for the diagnostic work up of AD-dementia.
Background Several assays reliably measure cerebrospinal fluid (CSF) total tau (t‐tau) protein for Alzheimer’s diseases (AD) diagnosis. However, CSF sampling is invasive and hampers availability of biomarker testing in AD. Therefore, less invasive blood t‐tau assays are needed, preferably on different platforms to enable implementation in different clinical settings. Point‐of‐care (POC) platforms enable the development of practical and easily implemented assays. Here, we aim to develop and compare two blood t‐tau POC‐assays, (1)on the Ella microfluidics platform and (2)using upconversion‐nanoparticle based lateral flow (UCNP‐LF), for use in AD diagnosis. Method The prototype assays were developed with the same pair of antibodies (capture‐mAb: ADx205 and detector‐mAb: ADx204 having epitopes in respectively the regions aa 194‐204 and 1‐20) and were calibrated using a recombinant protein (2N4R tau). For the Ella‐assay, we validated the analytical sensitivity, precision (4 different runs) and parallelism. The acceptance range was set to <15% coefficient of variation (CV) for precision and 85‐115% of slope‐accuracy for parallelism. Detectability of t‐tau was assessed using 20 plasma samples, including 10 AD‐dementia patients (age: 64±9y, 60%F) and 10 controls (age: 67±8y, 50%F). For the UCNP‐LF assay, spiked buffer and serum were used for preliminary performance testing. Result For the Ella assay, we determined a limit of detection (LoD) of 3 pg/mL based on mean signal of 16 blanks plus 10x SD (figure1). The assay quantified t‐tau in the clinical samples above assay blank with an average intra‐assay CV of 5.3%. Average intra‐ and inter‐assay CV for QC plasma samples were 8% and 11.4%. The assay showed robust mean parallelism response of (95%) (figure 2). Median t‐tau concentration in AD samples was 36.9 pg/mL vs 8 pg/mL in controls. The prototype UCNP‐LF assay showed a LoD of 92 pg/mL, based upon spiked buffer with the recombinant protein, and 102 pg/mL for spiked serum (figure3). The UCNP‐LF assay has a read‐out time of 30 minutes. Conclusion The prototype assays showed promising preliminary performance. Next, a technology comparison using Bland‐Altman graphs on samples of at least two different clinical groups, would be measured using a reference immunoassay platform, such as Simoa.
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