ANTIBODY DETECTION PROCESS AND REAGENTS THEREFOR

Abstract: The detection of antibodies in a test sample is carried out by: (a) Preparing an essentially isotonic and low ionic strength suspension comprising said sample and erythrocytes in net negatively-charged form; (b) maintaining said suspension for at least 30 seconds; (c) combining said suspension with an amount of a solution of polymer effective for agglutination of said erythrocytes; (d) separating the resultant agglutinates of polymer and erythrocytes from supernatant of said suspension; (e) dispersing said agglutinates in a hypertonic salt solution having an essentially neutral pH; and (f) monitoring the dispersed agglutinates for dissocation of erythrocytes. Antibody presence is indicated by persistence of the agglutinates in the dispersion resulting from step (e). The antigen which reacts with the antibody may be native to the erythrocytes, or may be unrelated to the erythrocytes by synthetically coupled to these red blood cells. Quantitative assay is also realizable because the degree of agglutinate dissociation is inversely related to antibody concentration in the sample.

Description: ANTIBODY DETECTION PROCESS AND REAGENTS THEREFOR BACKGROUND OF THE INVENTION Numerous techniques for the detection of antibodies exist. These are utilized in many applications to determine the presence of any, or given, antibodies and to measure their concentration in a variety of fluids, most particularly blood. These techniques are particularly useful in the cross-matching blood for transfusion. The most commonly employed prior art procedures are based on the use of antiglobulin reagent. Representative procedures are described in an article by Coombs et al. at Vol. 26, page 255 of the Brit. J. Exp. Path (1945). These procedures, however, have the drawbacks of being time-consuming and of inadequate sensitivity. Another method is described in an article in Transfusion, Vol. 8, No. 6 November-December 1968 by P. Lalezari. That method utilizes an • approach similar to the process of this invention. In common with other known techniques, however, that method has substantial drawbacks. It involves careful attention to proportions of ingredients and reagents as well as complicated equipment. Further, it too is time-consuming. ~ * The disclosures of these articles are incorporated herein by reference. The drawbacks of these existing techniques pose substantial impediments to the need for fast and simple detection with acceptable accuracy. The need for improved detection techniques is therefore clear. O PI ~~ INTRODUCTION TO THE INVENTION The process of this invention solves many of the drawbacks of known techniques for the detection of antibodies. It involves the steps of: (a) preparing an essentially isotonic and low ionic strength suspension comprising said sample and erythrocytes in net negatively- charged form; (b) maintaining said suspension for at least 30 seconds; (c) combining said suspension with an amount of a solution of polymer effective for agglutination of said erythrocytes; (d) separating the resultant agglutinates of polymer and erythrocytes from supernatant of said suspension; (e) dispersing said agglutinates in a hypertonic salt solution having an essentially neutral pH; and - (f) monitoring the dispersed agglutinates for dissociation of erythrocytes. ό This process may be completed in mere minutes with simple labor¬ atory equipment. Moreover, it produces accurate results which are substantially independent of most variations in the amount or type of ingredients and reactants employed. DESCRIPTION OF THE INVENTION The present process is suitable for detection of antibodies in any, normally aqueous, sample. Most commonly, it is applied to a blood serum (including derivatives thereof). Erythrocytes must be added to the sample. The erythrocytes may first be washed, normally with iso¬ tonic salt solution. Desirably the sample contains from .1 to 1% more preferably .3 to .8%, suspended erythrocytes (or antigen coated eryth¬ rocytes) by total volume. These erythrocytes are normally obtained from a different source donor to ensure that they will accept any antibodies present in the sample. Erythrocytes may be obtained from the same donor as the serum if the presence of an autoantibody is being sought. In the sample suspension, the erythrocytes should exhibit a net negative charge. This is the normal or native state of erythrocyte. In this form, they will possess maximum sensitivity to subsequent agglu- tination. The negative charge is ensured by maintaining a pH of between about 6.0 and 6.6. Maximum agglutination is also achieved in an essentially isotonic and low ionic strength suspension. The low ionic strength appears to sensitize the erythrocytes for acceptance of antibodies. Therefore a final salt concentration of from about 0.02 to 0.05, especially about 0.03, molar is preferred. o Although many additives may be employed to achieve these suspen¬ sion conditions, addition of sugars ~ such as dextrose -- are most convenient for increasing osmotic pressure. Virtually any salt may be used to increase ionic strength and simple dilution will reduce both of these conditions. In a preferred embodiment, a special salt is employed in the suspension medium. This salt is disodium ethylenediamine tetra- acetate. Not only does it greatly facilitate sensitization of erythro- cytes to antibody, but it additionally eases and/or accentuates other steps in the present process. A preferred medium for combination with the test sample therefore comprises an aqueous solution comprising from 0.005 to 0.025% ethylene- diamine tetra-acetate ion (optimally 0.01%) and from 4 to 8, desirably 5 percent of sugar such as dextrose or other mono-saccharide. Once the suspension has been prepared, antibody-erythrocyte sen- sitization for subsequent steps is rapidly reached (if, that is, anti¬ body is present in the test sample). The suspension need be maintained for a minimum of only about 30 seconds before addition of polymer in order to ensure the fidelity of the detection process. Agglutination of the suspended erythrocytes is accomplished by addition of a solution of polymer. Many polymers effective for this purpose are either known or readily identifiable. . These polymers include net positively-charged ones such as quaternary ammonium salts or negatively-charged ones such as carboxymethylcellulose. Preferred for this purpose is hexadimethorine ' bromine. The amount of reactive polymer added to the suspension is not • critical. Normally, however, sufficient polymer is employed to at least agglutinate all the erythrocytes. An excess is actually pre¬ ferred to ensure accuracy in quantitative detections. After addition, the polymer usually requires less that 30 seconds to completely perform its function. Thereafter, the polymer- erythrocyte agglutinates may be separated. This is most conveniently accomplished by cent ifugation followed by decantation of the clear supernatant. After separation, the agglutinates are dispersed, preferably under mild agitation, in a hypertonic salt solution having an essen¬ tially neutral pH. Again, their proportions in the dispersion medium are not critical, although a pH of from 6.8 to 7.5 is preferred. Within seconds, the existence or absence of antibodies becomes evident. The constituents of the salt solution (dispersion) are also not critical, but may vary as previously described with respect to the suspension medium. In a preferred embodiment, however, the salt employed in the dispersion is a citrate (for example, a sodium, potas¬ sium, ammonium or like citrate). Such salts have been discovered to facilitate agglutinate dissociation where antibodies are not present. This both accelerates the process and facilitates monitoring by clari- fying the detection end-point. A preferred dispersion medium for use in the present invention therefore comprises a hypertonic solution having a pH of from 6.8 to 7.5 and comprising from about 0.1 to 0.3 molar citrate ion. Normally it also contains a sugar, such as dextrose, or other mono-saccharide, from about 1.5 to 5, preferably about 2 percent by weight. « In the absence of antibodies, the agglutinates rapidlydissociate 'and reassume a suspension or collodial form. In contrast, the presence of antibody is evidenced by its coupling effect on the erythrocytes. Therefore antibodies are revealed or detected by persistence of the agglutinates within the dispersion. These results allow detection to occur through simple monitoring of the dispersed agglutinates. For example, visual monitoring (aided, if desired, by a microscope) allows rapid observation of the degree, if any, to which the agglutinated dissociates. Such dissociation occurs in inverse relationship to the concentration of antibody in the initial test sample. "gJREAT/" OMPI This relationship also allows for precise quantitative measure¬ ment of antibody concentration. By use of either standardized condi¬ tions in the process or duplication utilizing control samples, accurate quantitative analysis is achieved. The process of this invention is normally carried out under ambient (about 16 to 22°C) conditions. This is not, however, necessary. Use of cold temperatures may be advantageous to permit separate detec¬ tion of cold-reactive antibodies. These known antibodies preserve agglutination only at lower than ambient temperatures. Consequently, they may be detected only by chilling the agglutinates to from about 0 to 6°C prior to dispersion and monitoring. Accordingly, this process also allows qualitative detection of antibodies which are cold versus ambient reactive. Further qualitative analysis is possible in accordance with the process of this invention. The dissociated erythrocyte dispersion may be retested for certain antibodies which may not be detected by the ■ agglutination. This is accomplished by addition of any oligo- or poly- specific antiglobulin reagent reacting with, for example, all IgG sub¬ classes and the λ and K chains common to immunoglobulins. Desirably, the reagent employed is inert to other common complement components of blood or serum. Suitable, representative antiglobulin reagents are available com¬ mercially in varying degrees of specificity. Addition of such a reagent causes erythrocyte agglutination if such antibody is present. Conse- quently, this supplementary test readily increases the total accuracy of the present process by monitoring for antibodies which might other¬ wise escape detection. The process of this invention will be more fully described and better understood from the following examples. OMPI EXAMPLE I One-tenth ml (two drops) of a test serum sample was placed in 12 X 75mm glass tube followed by the addition of erythrocytes to give a concentration of about 0.5 percent. One ml of a low ionic aqueous diluent composed of 5% dextrose and 0.01% disodium ethylenediamine tetra-acetate was then added. The mixture was kept at room temperature in low ionic phase for one minute. One-tenth ml (two drops) of a .05% aqueous solution of Polybrene (hexadimethrine bromide produced by Aldrich Chemical Company, Milwaukee, Wise.) was added to the tube and mixed. Fifteen seconds later, the tube was centrifuged at 1000 X g for ten seconds, and the cell-free supernatant fluid was decanted. Polybrene-induced agglutination was reversed by adding 0.1 ml (two drops) of a solution of 60 ml 0.2M trisodiumcitrate solution with 40 ml 5% dextrose to the tube ' under gentle agitation. Within ten seconds, the Polybrene-induced aggregates partially dissociated. This ■ positive reaction was readily observed macroscopically. It confirmed the presence of antibody in the test serum. EXAMPLE II The process of Example I was repeated with a new test sample. Instead of performing all steps at ambient temperature, the agglu¬ tinates remaining after decantation were chilled in an ice bath for one minute. Upon subsequent dispersion in the solution, the agglutinates immediately dissociated completely. This evidenced an absence of anti¬ bodies, including cold reactive ones. EXAMPLE III The dispersion of dissociated erythrocytes of Example II was washed twice with a 0.9% sodium chloride solution which also contained 0.01M trisodiu citrate solution. The washed cells were then combined with two drops of an aqueous solution of anti-globulin reagent (Lot No. 056-53, Dade, Division of American Hospital Supply Corporation). The test tube was then centrifuged for 10 seconds and the erythrocytes were examined for agglutination. No agglutination was observed, thus indi¬ cating the absence of antibodies. In the foregoing Examples, monitoring was performed simply through visual inspection of macroscopic agglutinate particles. They therefore constituted only negative-positive detection tests. More accurate and quantitative results may be obtained by careful micro¬ scopic monitoring involving detection of degree of erythrocyte dis- sociation. Similar results may be obtained by other techniques includ¬ ing, for example, photometric analysis of the dispersion ediiim shortly • af er agglutinate addition. In this instance, analysis for colloidal, individual erythrocytes allows precise measurement of degree of dis¬ sociation. For these quantitative processes of the present invention, con¬ trol samples are often run in tandem with the test sample. This ensures accuracy of detection measurement. Such controls may either possess no, or a predetermined amount of, antibody as per conventional analytic technique.- In addition to the various reagent constituents previously men¬ tioned, others may be present. These constituents include bacteri- cides, such as sodium azide, to avoid contamination; sugars, such as OMPI dextrose, to provide nutrients and sufficient osmotic pressure to ensure normalcy of the erythrocytes; and the like for similar known or apparent purposes. It is to be understood that these changes may be made in the foregoing exemplary embodiments in the light of the above teachings. Additional modifications and/or variations may also be made without departing from the scope and spirit of the invention which therefore shall be measured by the claims which follow. f

Claims: CLAIMS 1. A process for the detection of antibodies in a test sample comprising: (a) preparing an essentially isotonic and low ionic strength suspension comprising said sample and erythrocytes in net negatively-charged form; (b) maintaining said suspension for at least 30 seconds; (c) combining said suspension with an amount of solution of polymer effective for agglutination of said erythrocytes; (d) separating the resultant agglutinates of polymer and erythrocytes from supernatant of said suspension; (e) dispersing said agglutinates in a hypertonic salt solution having an essentially neutral pH; and (f) monitoring the dispersed agglutinates for dissocia¬ tion of erythrocytes. ό 2. The process of Claim 1, wherein the test sample is selected from the group consisting of blood and blood serum. 3. The process of Claim 1, wherein the suspension comprises from 0.1 to 1% erythrocytes by volume. 4. The process of Claim 1, wherein the polymer is a negatively-charged polymer. 5. The process of Claim 1, wherein the polymer is a posi¬ tively-charged polymer. - REXr OMPI 6. The process of Claim 5, wherein the polymer is a quar- ternary ammonium salt. 7. The process of Claim 5, wherein the polymer is hexa- dimethrine bromide. 8. The process of Claim 1, wherein the suspension has a pH of between 6.0 and 6.6. 9. The process of Claim 1, wherein the agglutinates are at a temperature of from 16 to 22°C when dispersed. 10. The process of Claim 1, wherein the agglutinates are at a temperature of from 0 to 6 C when dispersed. 11. The process of Claim 1, wherein oligo- or pol^-specific 'antiglobulin reagent is added to the dispersion dissociated erythro¬ cytes to monitor for antibody. 12. The process of Claim 1, wherein the suspension has a pH of from 6.0 to 6.6 and comprises an aqueous solution of from 0.005 to 0.025% ethylenediamine tetra-acetate and from 1.5 to 3% sugar by weight. 13. The process of Claim 1, wherein the dispersion medium has a pH of from 6.8 to 7.5 and comprises an aqueous solution of from 0.1 to 0.3 molar citrate salt and from 1.5 to 5% sugar by weight. OMPI 14. .A reagent for use in the detection of antibodies comprising a medium having a pH of from 6.0 to 6.6 and containing from 0.005 to 0.025% ethylenediamine tetra-acetate and from 1.5 to 3% sugar by weight. 15. The reagent of Claim 14, which additionally comprises from 0.1 to 1% erythrocytes by weight. 16. A reagent for use in the detection of antibodies comprising a medium having a pH of from 6.8 to 7.5 and containing from 01. to 0.3 molar citrate salt and from 1.5 to 5% sugar by weight. 17. The reagent of Claim 16, wherein the sugar is a mono- saccharide. ■ 18. The reagent of Claim 17, wherein the cation of e citrate • salt is selected from the group consisting of sodium, potassium and ammonium. 19. The reagent of Claim 16, wherein said reagent is at a tem¬ perature of from about 16 to 22°C. 20. The reagent of Claim 16, wherein said reagent is at a tem¬ perature of from about 0 to 6°C. 21. The reagent of Claim 14, wherein the total salt concentra¬ tion is from about 0.02 to 0.05 molar. 22. The reagent of Claim 21, wherein the sugar is a ono- saccharide. 23. The reagent of Claim 22, which additionally comprises from 0.1 to 1% erythrocytes by weight. 24. The reagent of Claim 23, wherein said reagent is at a tem¬ perature of from about 16 to 22°C. 25. The reagent of Claim 23, wherein said reagent is at a tem¬ perature of from about 0 to 6°C.

Inventors: LALEZARI P
Applicants: MONTEFIORE HOSPITAL & MEDICA, MONTEFIORE HOSPITAL & MEDICAL CENTER INC
Application year: 1981
Main classification: G01N33
IPC codes: G01N33