ASSAY METHOD WITH A MULTIVALENTLY LABELLED REAGENT, AND MEANS THEREFOR

Abstract: A method of detecting the presence of a cell, virus or circulating body component or an antibody thereto in a sample comprises contact­ ing the sample with a regent bound to a solid support, usually a polymer. The reagent may for instance be a carbohydrate, a protein or an antibody. Having been contacted with the sample, the reagent bound to the solid support is contacted with the same or another reagent coupled to a macromolecular wtaer-insoluble carrier, for instance polymeric micro­ beads, to which is further multivalently bound a substance which is capable of initiating a reaction having a detectable reaction pro­ duct. Alternatively, the reagent is coupled to the substance multi­ valently bound to the carrier. The substance may be an enzyme, anti­ body or blood clotting factor. Then, the reagent bound to the solid support is reacted with a com­ pound which is a precursor of a detectable reaction product or capable of initiating a reaction cascade the end product of which is detectable. The compound may be an enzyme substrate, an antigen or a blood clotting factor. If any sample component has become bound to the reagent, a detectable reaction product is formed.

Description: This invention relates to a method of detecting sample components; more particularly, it relates to a method of detecting the presence in a sample of cell, virus, plasma protein, hormone or antibody, or an antibody thereto, as well as a macromolecular water-insoluble carrier and a diagnostic composition suitable for use in such a method. Chemical measurements based on immune reactions, immune-like reactions (e.g. lectin-carbohydrate interactions) or complex-forming reactions have been used for many years (1, 2) as useful tools in the analysis of the presence and quantity of proteins, carbohydrates, antigens and antibodies in biological material. Until recently, the most widely employed immunoassay method was a method using radiolabelled ligands such as antibodies and measuring the radioactivity emitted from the formed complexes. However, the use of radioactive isotopes presents a safety hazard in the laboratory as well as disposal problems. Alternative methods have therefore been developed which aim at a similar sensitivity and specificity as the radioimmunoassay, but which use non-radioactive substances and hence do not suffer from the same disadvantages as the radioimmunoassay. These methods are principally based on the use of enzymes, fluorescence or luminescence which are all reliable and reasonably sensitive (down to ng scale). Of these methods, the enzyme-linked immunoassay is probably the most widely used, as it has the advantage of generating a coloured end product from a substrate, which product can either be detected by the naked eye or measured spectroscopically in a relatively simple and therefore economical way. The enzyme-linked immunosorbent assay (ELISA) is based on antigenantibody reactions, in which an antigen is reacted with a first antibody immobilised on a support and a second antibody bound to an enzyme which gives rise to a coloured end product when reacted with a suitable substrate. The sensitivity of this assay has, however, not always been completely satisfactory, and various improvements of the enzyme-linked immunoassay have been attempted. As an example, EP-A-77 671 discloses a reagent for the detection of an immunological substance, which reagent comprises an antibody or an antigen bound to a carrier which is a water-soluble polymer and which is provided with a multiplicity of markers, such as flourescent substances, radioisotypes, dyes, enzymes or other antibodies. It has recently been reported (3-7) that when biotinylated enzymes are employed in the double antibody ("sandwich") system in conjuction with avidin, the sensitivity of the assay is enhanced, and this amplification system has also been described to preserve the enzyme activity better than systems comprising enzyme-antibody conjugates. Another technique is the antibody bridging technique (8) which has been reported to increase the sensitivity of the assay more than 50 fold compared to the standard procedure. A further amplification system has been devised which uses a cyclic process to amplify the antigen-antibody reaction (8). In this system, alkaline phosphatase which is an enzyme that is commonly used for immunoassay purposes, catalyses the dephosphorylation of nicotinamide adenine dinucleotide phosphate (NADP), producing nicotinamide adenine dinucleotide (NAD) which acts as a coenzyme for alcohol dehydrogenase in the presence of an excess of the substrate ethanol to produce NADH; the reduced and oxidized nucleotides are catalytically cycled back and forth by diaphorase whereby the second substrate para-iodonitrotetrazolium violet forms a formazan dye in amplified amounts. Thus, the sensitivity of the system can be increased by a factor of 250, and as little as 10⁻¹⁸ moles of alkaline phosphatase has been detected in this system. The present inventors, however, have found that although a good sensitivity and reproducibility is obtained by this amplification method when proteins are analysed, the sensitivity is not sufficient for analysing the presence of pathogenic organisms, e.g. bacteria, viruses or fungi, or components thereof in, for instance, pathophysiological samples. A novel method has therefore been developed in which a substance, such as an enzyme, which directly or indirectly is capable of generating a detectable end product, is combined with the reagent for the component in the sample for which the detection system is intended, in such a way that the substance is present in multivalent form in the detection system. The present invention provides a method of detecting the presence in a sample of a cell, virus, plasma protein, hormone or antibody, or an antibody thereto, characterised in that it comprises: (a) contacting the sample with a first reagent bound to a solid support so that the reagent binds to the cell, virus, plasma protein, hormone or antibody, or antibody thereto; (b) contacting the resulting sample containing the cell, virus, plasma protein, hormone or antibody, or antibody thereto bound to the reagent, which in turn is bound to the solid support, with a macromolecular water-insoluble carrier having a second reagent which is a carbohydrate or carbohydrate derivative and a label substance multivalently-bound thereto so that the second reagent and thus the macromolecular water-insoluble carrier and the label substance bind to the cell, virus, plasma protein, hormone or antibody, or antibody thereto; (c) removing unbound second reagent and thus unbound carrier and label substance from the sample; (d) treating the then-resulting sample with a compound which is a precursor of a detectable reaction product or which is capable of initiating a reaction cascade, the end product of which is detectable, so that a detectable reaction product is formed if the label substance is present; and (e) detecting any detectable reaction product so formed and thereby detecting the presence of the cell, virus, plasma protein, hormone or antibody, or antibody thereto, in the sample. The present invention also provides a macromolecular water-insoluble carrier suitable for use in such a method characterised in that it is (a) coupled to a reagent which is a carbohydrate or carbohydrate derivative, the reagent being capable of binding a cell, virus, plasma protein, hormone or antibody, or an antibody thereto, the carrier comprising a substance multivalently-bound to the carrier, which substance is capable of initiating a reaction the product of which is detectable; or (b) multivalently-bound to a substance to which the reagent is coupled and which is capable of initiating a reaction the product of which is detectable. The present invention further provides a diagnostic composition suitable for use in such a method characterised in that it comprises: (a) a first reagent bound to a solid support, which reagent is capable of binding a cell, virus, plasma protein, hormone or antibody, or an antibody thereto, and (b) a second reagent which is a carbohydrate or carbohydrate derivative, reagent being coupled to a macromolecular water-insoluble carrier either directly or via a spacer, to which carrier a label substance is multivalently-bound, said substance being capable of initiating a reaction the product of which is detectable, or coupled to a macromolecular water-insoluble carrier via a label substance, the substance being multivalently-bound to the macromolecular water-insoluble carrier and the substance being capable of initiating a reaction the product of which is detectable. In the present context, the term "cell component" is not only meant to indicate a specific component, i.e. a definable substance, but also a whole cell of which the component forms a part, as well as cell membranes, nuclei, chromosomes and organelles, e.g. mitochondria, composed of many such definable substances. Similarly, the term "virus component" refers to whole virus particles comprising the component in question, the virus envelope and the nucleic acids of which the interior of the virus is composed, apart from specific, definable substances present on or in the virus particle. In connection with whole microorganisms and viruses, components of particular interest will often be surface components. The term "circulating body component" is intended to indicate a component which does not form part of a cell or virus interior or surface, i.e. an extracellular component which may be present in body fluids, examples of which are plasma proteins, hormones and antibodies. In the following, all these components will often be referred to as sample components. It should be pointed out that the sample components need not necessarily be ones which are produced in nature, but may also be produced synthetically or semi-synthetically as analogues, derivatives or counterparts of naturally occurring compounds. The term "antibody" refers to any substance formed as a response to exposure to an antigen, for instance such antibodies which are formed in a human or animal body against a pathogen. The antibody may be a polyclonal or monoclonal antibody. The term "sample" is intended to indicate any fluid containing a material of biological origin (or a synthetic or semi-synthetic analogue or derivative thereof), such as solutions or suspensions of single components or a mixture of single components, or a suspension of cells or viruses or substructures thereof such as those indicated above. The sample preferably comprises a body fluid, e.g. blood, urine, lymph, faeces or sperm. The reagent used in step a) may be any reagent capable of binding a sample component, i.e. a reagent for which the component shows affinity. If it is simply desired to separate all components in a sample from the fluid containing them, the binding may be unspecific, for instance an unspecific hydrophobic binding. In order to utilise the unique possibilities of obtaining a previously unknown assay specificity and sensitivity inherent in the detection method of the present invention, it is however preferred that the reagent is specific, that is, capable of binding a specific cell, virus or circulating body component so that a high degree of selectivity is obtained in the analysis of a sample. The reagent is preferably complementary to the sample component being analyzed or the sample component suspected to be present in the sample. The reagent used in step b) may, in principle, also be any reagent which is capable of binding the sample component which is being analysed, and the reagents used in steps a) and b) may be different, provided that they are capable of binding the same component or different components on the same cell or virus or cell or virus substructure. It is, however, preferred that the reagents used in steps a) and b) are the same, and in particular that they are also specific to a certain component so that no other component in the sample will be bound, as this ensures a greater accuracy of the detection method of the invention. The substance which is multivalently bound to the macromolecular carrier acts as a label by means of which it is possible to detect whether a sample component has become bound or not. By providing this substance in multivalent form the difficulty of obtaining a sufficient assay sensitivity arising from the limited number of detectable product molecules produced by the necessarily small number of enzymes resulting from univalent binding of reagent and substance ( in casu enzyme), which difficulty is inherent in the known sandwich ELISA method, has been overcome, resulting in a far greater sensitivity that can be obtained by the known immunoassay systems not employing radioactive isotopes, due to the amplification of the binding effect obtained by the multivalent binding where a large number of label molecules are provided. The detection method of the present invention has therefore made it possible to detect, for instance, critical concentrations of a pathogen in a sample of a body fluid, which concentrations are not detectable by any of the known assay methods, which will appear from the detailed description of the invention below, including the examples. The macromolecular water-insoluble carrier for the reagent and label substance may be any suitable carrier providing multiple binding sites. As indicated above, the method of the present invention is used to detect the presence of sample components which have become bound to reagent a) and b) in the assay. Thus, the method serves to qualitatively determine the presence of a sample component (i.e. determine whether a sample component is present in a sample or not) and quantitatively measure the amount of sample component (as will be explained below). The principal use of the method of the invention is envisaged to be in the diagnostic field, to diagnose an illness caused by a specific pathogen, as an improvement of the conventional ELISA method, and to separate and/or purify a specific component from other components present in a sample. Specific and preferred embodiments of the elements composing the composition which is employed for carrying out the method of the invention, are set down in the following detailed description of the invention. DETAILED DESCRIPTION OF THE INVENTION The choice of reagent to be employed in steps a) and b) of the method of the invention depends on the identity of the component, the presence of which is to be detected so that the reagent selected in each instance will be one which is capable of binding the component suspected to be present in the sample. Suitable reagents may be selected from a carbohydrate or carbohydrate derivative, a polypeptide, a protein or another cell or virus surface component or a circulating body component, an antibody to a carbohydrate or carbohydrate derivative, a polypeptide, a protein or another cell or virus surface component or a circulating body component, a metal conjugate or a single-stranded oligonucleotide. When the reagent is a carbohydrate or carbohydrate derivative, it is often a receptor for a cell, virus or circulating body component, such as a receptor for a bacterial membrane protein mediating bacterial adhesion to surfaces such as epithelial tissue which contains such receptors. In chemical terms, the carbohydrate or carbohydrate derivative may be a polysaccharide, glycolipid, neo-glycolipid, glycoprotein or neo-glycoprotein. The term "neo-" indicates that the compound is prepared synthetically to correspond to a naturally occurring compound by coupling the carbohydrate moiety to the lipid/protein moiety. Examples of useful carbohydrate receptors are: For the sake of greater clarity, a list of suitable reagents for different sample components is shown below. The solid support to which the reagent used in step a) is bound should comprise a polymer. This means that the support in itself may consist of a material to which the reagent may be bound, or the material may be coated with said polymer. In the latter case the solid support comprises a matrix of a stable solid material, such as glass, paper, cardboard or plastic, coated with the polymer. The polymer to which the reagent is bound may be selected from a plastic, a polysaccharide, a silicon polymer, an ion exchange resin, a polypeptide, silica or a silicate such as borosilicate, or cellulose. Examples of a suitable plastic comprise polystyrene, polyvinylchloride, polyethylene, polyurethane, latex, nylon, teflon, dacron, polyvinylacetate, polyvinylalcohol or any suitable copolymer thereof; examples of a polysaccharide include agarose or dextran; examples of ion exchange resins comprise both cation and anion exchange resins such as sulphonated cross-linked polymer of styrene and p-divinylbenzene (cation exchange resin) or a styrene/p-divinylbenzene co-polymer with trimethylamine groups (anion exchange resin); examples of polypeptides comprise polybrene; examples of silicon polymers include siloxane; examples of silicates include glass. If the polymer cannot be utilized directly, it may be provided with functional groups which are optionally modified to adapt it for binding a particular reagent. The physical shape of the solid support will depend on the intended use of the support in the method of the invention. Thus, the support may be in the form of a plate, film, macroparticle, dipstick, filter or paper. Specific embodiments of the solid support include glass or plastic, optionally coated, thin layer or microtiter plates and dipsticks, polymeric macroparticles suitably packed in a chromatographic column, glass or plastic filters of a sufficient pore size to permit passage of the macromolecular carrier, and filter paper. It should be noted that for certain types of paper and for certain applications, it may not be necessary to provide the support with a reagent in order to effect unspecific binding. For most practical applications, the sample includes, or is suspected to include, a pathogen, a non-pathogen, a carbohydrate or carbohydrate derivative, a polypeptide, a protein or another cell or virus component, an antibody to any of these components,or a single-stranded oligonucleotide which is complementary to that used as the reagent. The method of the present invention is at present believed to be particularly well suited to detect the presence of pathogens in a sample as it has been found possible to detect the presence of even low concentrations of pathogens corresponding to the concentrations in which they occur in patho-physiological samples so that it has now become possible to reliably diagnose the cause of a pathological condition. Pathogens which are detectable by the method of the invention include bacteria, viruses, fungi (including yeasts), mycoplasma, prions and bacterial toxins. Specific examples from each group of pathogens are listed below. 1. Pathogens: a. bacteria: Pneumococci, Enterobacteria (E. coli, Salmonella spp., Shigella spp.), Bacillus spp., Clostridium spp., Neisseria spp., Streptococcus spp., Staphylococcus spp., Actinomycetes spp., Mycobacterium spp., Hemophilus spp., Bordetella spp., Nocardia spp., Trepenema spp., Richettsia spp. and Chlamydia spp, b. viruses, e.g. Herpetoviridae, Picornaviridae, Myxo- and Paramyxoviridae, Arboviridae, Reoviridae, Retroviridae, Rhabdoviridae, Adenoviridae. c. fungi, e.g. Alternaria, Candida, Cephalosporium spp., Coccidia, Coccidioides, Cryptococcus, Epidermophyton, Fusarium, Geotrichum, Histoplasma, Microsporum, Scopulardiopsis, Sporotrichum, Torulopsis, Trichophyto, etc. d. mycoplasma, e.g. Mycoplasma spp. e. prions f. bacterial toxins, e.g. Shiga toxin and Cholera toxin. Apart from the diagnostic utility of the method of the invention, it may also be employed to separate certain components form other components in a sample for the purposes of analysis (e.g. to check whether a recombinant organism expresses an inserted gene) or purification. These components may include non-pathogenic organisms, carbohydrates or derivatives thereof as exemplified above, either alone or as present on a cell or virus surface, a polypeptide or protein, again either alone or as present on a cell or virus surface, or a single-stranded oligonucleotide complementary to that used as the reagent which, in other words, acts as a DNA probe in, for instance, hybridization experiments. The macromolecular water-insoluble carrier to which the reagent and label substance are bound, or to which the label substance carrying the reagent is bound may be a polymer containing multiple active sites to which the reagent and/or substance may be bound. The polymer is suitably a water-insoluble, long-chain polymer such as polystyrene or poly-p-divinylbenzene. The active sites are preferably selected from the group comprising hydroxyl, amino, thio, amido, cyano, imino, imido, keto, epoxy, nitro, ester and acyl groups, or halide-containing groups. If no suitable active sites are present on the polymer, these may be provided by appropriate modification such as subtitution of the functional group. When, in the method of the invention, the activated polymer has been contacted with the sample, remaining active sites are deactivated in order to avoid cross-reactions which might impair the results of the assay for a specific sample component. The carrier should be water-insoluble to facilitate the separation of the carrier from water-soluble components. For the purpose of the present invention it is preferred that the macromolecular carrier is in the form of microbeads, as particles of a defined geometry ensure a better binding of the sample component to the reagent than a long polymer chain which may sterically interfere with binding. Furthermore, the microbeads should be sufficiently light to permit them to be kept suspended during contact with the solid support in step b) of the method of the invention as this ensures an improved distribution of the microbeads. For the present purposes, the microbeads typically have a size of 0.05-20 µm. Size variations of the microbeads within this general range may be envisaged, dependent inter alia on the type of solid support used in the method of the invention. The microbead typically comprises a polymer; this means that the bead may either be composed entirely of a suitable polymer or that it comprises a carrier material which is coated with a suitable polymer which, in accordance with the explanation given above, should be water-insoluble. The polymer may be selected from plastics, polysaccharides, copolymers, silicon polymers, glass, liposomes, cross-linked polymers or silica or silicates (e.g. borosilicate). Specific examples of suitable polymers may be the same as those stated above for the solid support. The microbeads may optionally be provided with multiple active sites; examples of such active sites are essentially the same as those stated above. If no suitable active sites are present, the polymer may be modified to provide appropriate functional groups. Examples of specific, advantageous modifications are shown in the reaction scheme below. In keeping with what has been indicated above, the substance which is multivalently bound to the macromolecular carrier (the label substance) may be selected from any substances which are capable of initiating a reaction the product of which is detectable, and in particular from enzymes, antibodies and blood clotting factors. More specifically, the enzymes may be selected from any of the following classes. Class 1: Oxidoreductases (acting on the CH-OH groups of donors) Class 2: Transferases (transferring phosphorus-containing groups) Class 3: Hydrolases (acting on ester bonds) Class 4: Lyases (e.g. aldolase and carbonic anhydrase), or Class 5: Isomerases (intramolecular transferases). Examples of enzymes belonging to the different classes are stated below. E C number Enzyme Exemplary reaction 1.1.1.1 Alcohol dehydrogenase Alcohol + NAD - aldehyde (or ketone) + NADH 1.1.1.27 Lactate dehydrogenase L-lactate + NAD - pyruvate + NADH 2.7.1.1 Hexokinase ATP + D-hexose - ADH + D-hexose + 6-phosphate 3.1.3.1 Alkaline phosphatase An orthophosphoric monoester + H₂O - an alcohol + orthophosphate 3.2.1.1 β-glucosidase 1-(p-nitrophenyl)β-D-glycoside - p-nitrophenoxide + glucose 4.1.1.1 Pyruvate decarboxylase Pyruvate - aldehyde + CO₂ 4.2.1 Fumarase Fumarate - malate 5.4.2 Phosphoglucomutase α-glucose-1-phosphate -glucose-6-phosphate 1.1.3.4 Glucose oxidase β-D-glucose + O₂ -D-glucono-δ-lactone + H₂O₂ 1.11.1.7 (Horseradish) peroxidase Donor + H₂O₂ - oxidized donor 2H₂O 3.1.3.2 Acid phosphatase o-phosphoric monoester + H2O - alcohol + O-phosphate 3.2.1.23 β-Galactosidase Gal-β-OR + H₂O - GalOH + ROH 3.4 Proteases Peptide + H2O - peptide₁ + peptide₂ 1.13.12.5-7 Luciferases Luciferin + O2 - oxidized luciferin + CO₂ + Lu 3.1 Esterases R₁CO-OR₂ - R₁CO-OH + R₂OH 3.5.1.5 Urease Urea + H₂O - CO₂ + 2NH₃ 3.2.1.17 Lysozyme Hydrolysis of 1,4-β-linkages between N-acetylmuramic acid and 2-acetamido-2-deoxy-D-glucoseresidues in a mucopolysaccharide or mucopeptide. Enzymes are substances which are not directly detectable but which need a substrate to catalyse a reaction which has a detectable end product in accordance with either of the following formulae: 1) X moles of substrate generate X moles of detectable product, or 2) X moles of substrate generate n x X moles of detectable product (amplified process). The label substance may also be any antibody which is able to effect a sufficient aggregation of an antigen to produce a detectable product. It should be noted that, when an antibody is used as the reagent in steps a) and b), this antibody should be different from the one used as the multivalently bound label substance. In other words, the antigen used for the aggregation should be one which differs from the sample component suspected to be present in the sample. When using a blood clotting factor as the label substance, this may be a purified factor of, for instance, bovine or porcine origin, and in order to be useful in the method of the invention, the factor should preferably be one which initiates at least one further step in the blood clotting chain reaction. Such a factor may either be in activated form or be provided together with an activator such as a protease associated with a blood clotting factor. The blood clotting factor may be selected from fibrinogen (I), prothrombin (II), thrombin (IIa), tissue thromboplastin (III), proaccelerin (V), accelerator globulin (VI), proconvertin (VII), antihemophilic globulin (VIII), plasma thromboplastin component (IX), autoprothrombin III (X), plasma thromboplastin antecedent (XI), Hagemann factor (XII) and fibrin stabilizing factor (XIII). The compound with which the label substance is reacted in step c) and which then forms the detectable reaction product may suitably be selected from blood clotting factors (other than one used as the label substance), an antigen to the antibody label causing a detectable aggregation, or an enzyme substrate which is catalyzed by the enzyme to form a coloured, fluorescent or luminescent product, or to produce a colour change (e.g. NADH (produced cyclically as described above) catalyzing thiazolyl blue to produce a colour change from yellow to blue). The enzyme-substrate reaction may also result in a decrease or increase in the colour, fluorescence or luminescence of the detectable product dependent on the concentration of sample component to be assayed, in which the case the method of the invention may be used for semiquantitative analysis. The enzyme substrate is suitably selected from phenolphthalein orthophosphate, thymophthalein phosphate, ortho-nitrophenyl glycoside, naphtholes, anilines, coumarines, tetrazolium dyes, dansyl and derivatives thereof, NADP and isothiocyanates. DESCRIPTION OF PREFERRED EMBODIMENTS In a preferred embodiment of the method of the invention, a) the solid support comprises macroparticles to which the reagent is bound, which macroparticles are packed in a column, or the solid support comprises a porous filter to which the reagent is bound, and the sample is passed through the column or filter, b) the macromolecular carrier comprises microbeads of a size of 1-20 µm to which the same or another reagent is coupled and to which an enzyme is multivalently bound, a suspension of which microbeads is passed through the column, and 1-20 µm to which the same or another reagent is coupled and to which an enzyme is multivalently bound, a suspension of which microbeads is passed through the column, and c) a solution or suspension of enzyme substrate is passed through the column after which a colour, fluorescence or luminescence develops, whereby the presence in the sample of any cell, virus or circulating body component which has become bound to the reagent in steps a) and b) is detected. By using such a column, it is possible to analyse relatively large sample volumes. In another preferred embodiment of the method of the invention, a) the solid support comprises a dipstick or film to which the reagent is bound, which dipstick or film is immersed in the sample, b) the dipstick or film is contacted with the macromolecular carrier comprising microbeads of a size of 0.05-10 µm to which the same or another reagent is coupled and to which an enzyme is multivalently bound, by immersing it in a suspension of microbeads, and c) the dipstick or film becomes opaque at high cell, virus or circulating body component concentrations, or the dipstick is immersed in a solution or suspension of enzyme substrate after which a colour, fluorescence or luminescence develops, whereby the presence in the sample of any cell, virus or circulating body component which has become bound to the reagent in steps a) and b) is detected. It has been found that the dipstick or film becomes opaque at, for instance, a bacterial concentration of about 10¹⁰. However, as pathologically critical bacterial concentrations are often in the range of 10⁶-10⁷ bacteria/ml so that it will often be necessary to immerse the solid support in an enzyme substrate solution to produce a reaction the product of which is spectrometrically detectable. In a further preferred embodiment of the method of the invention, a) the solid support comprises a film or plate, optionally provided with wells, to which the reagent is bound, and the sample is applied on the film or plate and removed after a period of time required to bind cell, virus or circulating body components in the sample, b) the macromolecular carrier comprises microbeads of a size of 1-20 µm to which are the same or another reagent is coupled and to which an enzyme is multivalently bound, and a suspension of the microbeads is applied on the film or plate and removed after a period of time required to bind cell, virus or circulating body components in the sample, and c) a solution or suspension of enzyme substrate is applied on the film or plate after which a colour, fluorescence or luminescence develops, whereby the presence in the sample of any cell, virus or circulating body components which has become bound to the reagent in steps a) or b) is detected. The application of the sample to the film or plate (e.g. a microtiter plate) will typically be performed by placing a drop of the sample on the film or plate by means of, e.g., a pipette. Instead of measuring the amount of sample component bound to the reagent, it may alternatively be advantageous to determine the amount of sample component which has not become bound. Thus, the invention further relates to a method as described above in which the amount of cell, virus or circulating body component bound to the reagent in step a) is quantitized by means of measuring the proportion of microbeads of a predetermined quantity which have not become bound to the cell, virus or circulating body component in question. Preferred embodiments of the method of the invention are summarized in the reaction schemes shown below. A specific embodiment of the method of the invention is described in the following with reference to the diagnosis of urinary tract infections. To a large extent, urinary tract infections are caused by certain pathogenic E.coli , in particular P-fimbriated E.coli as these are able to adhere to the epithelial cell wall of the urinary tract. The adhesion is mediated by receptor-specific interactions, i.e. a filamentous polypeptide structure (called fimbriae) interact with a carbohydrate structure (Galα1-4Galβ-O-) on the surface of the epithelial cells. The characterization of clinical isolates has hitherto been based on bioassays, for instance attachment to epithelial cells or hemagglutination. The evaluation is complicated by the fact that adhesins which are specific for several receptors may be coexpressed, and that the receptor composition of the target cells varies between individual tissues and species (cf. 13). The sensitivity of such assays is low which means that samples must be grown before analysis. A recently proposed assay method is based on latex bead agglutination. In such assays, receptor compounds are bound to plastic beads via spacer arms. Interaction with adhesin-carrying bacteria results in agglutination. This method also lacks sensitivity, but is highly specific. The present invention has overcome the problem of too low a sensitivity of the conventional diagnostic methods of determining the presence of pathogens in a sample by providing a diagnostic system in which bacteria (or other pathogens) are concentrated on a solid support (film, dipstick or carrier material in a column) by being bound to a reagent coupled to that support. The bacteria are then contacted with spherical particles (microbeads) carrying the reagent and a multiplicity of enzymes. Beads which have not been attached are removed by washing, after which enzyme substate is added to produce a coloured, fluorescent or luminescent product or to activate a second enzyme system which further amplifies the effect of the initial bacterial binding to the solid support. In another aspect, the present invention relates to a macromolecular carrier to which is a) coupled a reagent which is capable of binding a cell, virus or circulating body component or an antibody thereto, the carrier comprising a substance multivalently bound to the carrier, which substance is capable of initiating a reaction the product of which is detectable, or b) multivalently bound a substance to which said reagent is coupled and which is capable of initiating a reaction the product of which is detectable. The carrier, reagent and substance exhibit the features described above for the method of the invention in which the carrier may be employed. In a further aspect, the invention relates to a diagnostic composition which comprises a) a reagent bound to a solid support, which reagent is capable of binding a cell, virus or circulating body component or an antibody thereto, and b) the same or another reagent coupled to a substance which is multivalently bound to a macromolecular carrier and which is capable of initiating a reaction the product of which is detectable, or coupled to a macromolecular carrier which comprises a substance multivalently bound to the carrier, the substance being capable of initiating a second reaction the product of which is detectable. The specific features of the composition are apparent from the description of the method of the invention in which a composition of this type may be employed. In accordance with the invention, it is further contemplated that the composition may be composed of a multiplicity of dipsticks to which the reagent is bound, each dipstick or subgroup of dipsticks being provided with a different reagent, each reagent being able to bind a different cell, virus or circulating body component or an antibody thereto. Alternatively, the composition may comprise a microtiter plate provided with a multiplicity of wells to which the reagent is bound, each well or subgroup of wells containing a different reagent, each reagent being able to bind a different cell, virus or circulating body component or an antibody thereto. This means in either case that it will be possible to diagnose a wide variety of diseases by means of the the same diagnostic composition, thereby greatly simplifying the diagnostic procedure. BRIEF DESCRIPTION OF THE DRAWINGS The invention is described with reference to the appended drawings in which Fig. 1 is a graph showing the sensitivity (absorbance at 405 nm) of the assay of the invention as a function of the bacterial concentration, Fig. 2 shows the detection of P-fimbriated E. coli immobilized on Trysite film incubated with 1) (Gal-Gal) n -ALP (to the left) or microbeads (to the right) and 2) p-nitrophenyl phosphate, and Fig. 3 shows the principle of enhancing the sensitivity of the assay system by means of a second, cyclic enzymatic reaction. The invention is further described in the following non-limiting examples. MATERIALS AND METHODS The oligosaccharide Galα1-4Galβ-0-2-(carbomethoxyethylthio)ethylglycoside was synthesized according to Dahmém et al (10,11). The glycoconjugate was coupled to KLH (Keyhole Limpet Hemocyanin) (11,12) and used as an antigen to produce monoclonal antibodies in mice. The antibodies (cell line 87/5C₁₁) were produced by Biocarb Chemicals AB, Sweden. Latex beads 0.81 µm were obtained from Seragen Diagnostics, Indianapolis, USA. Latex beads and amino-latex beads 0.23 µm were obtained from Serva Feinbiochemica, Heidelberg, West Germany. Dynosphere beads (3 µm, tosyl-activated) were obtained from Dyno Industrier, Norway. Trysite (polystyrene) film (0.2 mm thick) was obtained from Dow Chemicals, Miss., USA and Sepharose® macrobeads 6MB, CNBr-activated from Pharmacia Fine Chemicals, Uppsala, Sweden. Calf intestine alkaline phosphatase (ALP) was obtained from Boehringer Mannheim, West Germany, and 4-nitrophenyldisodium orthophosphate from BDH Chemicals Ltd., Poole, Great Britain. 5-Aminosalicyclic acid and o-nitrophenyl-β-D-galactopyranoside were obtained from Sigma, St. Louis, Miss., USA. Bovine serum albumin (BSA), alcohol dehydrogenase (ADH), diaphorase and p-iodonitrotetrazolium violet (INT) were all obtained from Sigma, St. Louis, Miss., USA. N-(3-Dimethylaminopropyl)-N-ethyl-carbodiimide hydrochloride was obtained from Merck-Schuchardt, West Germany. Peroxidase-conjugated rabbit immunoglobulins to mouse immunoglobulins were from DAKO-immunoglobulins A/S, Denmark and globoside from BioCarb Chemicals AB, Sweden. Galα1-4Galβ-0-CETE-BSA ((Gal-Gal) n -BSA) and (Galβ1-4GlcNAc) n -BSA were obtained from SSA, Fine Chemicals Division, Arlöv, Sweden. β-Galactosidase (grade VI from E. coli ) and horseradish peroxidase (type VI) were obtained from Sigma, St. Louis, Miss., USA. The E. coli strains selected for illustrating the principle of the diagnostic method of the invention for the detection of microorganisms were either manipulated E. coli strains or strains taken from the urine of patients diagnosed for pyelonephritis (for leading references, see H. Leffler and C. Svanborg-Edén, " E. coli lectins/adhesins binding to glycolipids", in Bacterial Lectins , ed. D. Mirelman, Wiley, 1985 (13)). The most frequently used strains have been characterized and found to be 04:K12:H1 (GK1) and K12:H48 (C600). Cultivation was performed on Colonization Factor Antigen (CFA) agar plates overnight at 37°C. Colonies were harvested and suspended in PBS, pH 7.4. The presence of P-fimbriae was tested with both cell-binding assays and with newly developed kits (15,16,17). Staphylococcus saprophyticus strains were obtained from Malmö General Hospital, Sweden, where they were isolated from urine and characterized. Preparation of starting materials I. Preparation of (Gal-Gal) n -ALP 1.5 ml of a 66.7 mM Galα1-4Galβ-0-2-(carbomethoxyethylthio)ethylglycoside solution in ethanol was treated with 0.2 ml 75% (w/v) hydrazine in water. The solution was stirred at room temperature overnight. The solution was then evaporated to dryness. The synthesized hydrazide (7.35 mg in 200 µl DMSO) was converted to the corresponding acyl azide according to Dahmén et al. (12) and was then added dropwise to a solution of 10 mg/ml alkaline phosphatase (ALP) in 0.05M sodium borate buffer, pH 9.0. The pH was maintained at 9.1-9.3 during the reaction. The glycosylated ALP formed was dialyzed against 50 mM Tris-HCl, pH 8.0, 0.02% NaN₃, and stored in a refrigerator when not in use. II a) and b). Preparation of NH₂-latex and BSA-latex Latex beads (0.81 µm or 0.2 µm) were nitrated with fuming red nitric acid/glacial acetic acid (1:4 v/v) and reduced with sodium dithionite. The NH₂-latex beads formed were covalently bound to BSA according to the method described in NASA TECH BRIEF (MSC 13906) (14). The BSA-latex beads were suspended in buffer with 0.1% of NaN₃ and stored in a refrigerator when not in use. Preparation of microbeads, general procedures III. Preparation of (Gal-Gal) n -ALP bound to BSA-latex Two different methods were used for covalent immobilization of glycosylated ALP to latex beads - the glutaraldehyde method and the carbodiimide coupling procedure. III:1. Glutardialdehyde coupling 25 µl of the glycosylated ALP solution, obtained in section I, (10 mg/ml) were mixed with 10 µl of glutardialdehyde (2.5% w/v) in 200 µl of 0.1M potassium phosphate buffer, pH 7.5. After one hour, 50 µl of a BSA-latex suspension (10¹³ particles/ml, 0.21 or 0.81 µm) were added. The reaction mixture was left overnight, filtered and washed with water. The activity of the beads was tested according to the procedure described below ("Characterization of (Gal-Gal) n -ALP modified latex beads"). III:2 Carbodiimide coupling 25 µl of a solution of glycosylated ALP, obtained in section I, (10 mg/ml) were mixed with 2.5 mg of carbodiimide (N,N-dimethylaminopropyl-N′-ethylcarbodiimide) in 125 µl of water. The pH was adjusted to 4.7, and 40 µl of a suspension of BSA-latex (10¹³ particles/ml, 0.21 or 0.81 µm) were added. The reaction was stopped after 12 hours. The modified latex beads were filtered, washed with water and analyzed (see "Characterization of (Gal-Gal) n -ALP modified latex beads"). IV. Preparation of (Gal-Gal) n -ALP bound to NH₂-latex beads 60 µl of a NH₂-latex suspension (10¹³ particles/ml, 0.21-0.81 µm) were washed with water and centrifuged. The beads were suspended in 0.1 ml of water. 2 mg of (Gal-Gal) n -ALP (in 175 µl of water) and 275 µl (50 mg/ml) of carbodiimide were added. The mixture was incubated on a shaker overnight. Before washing with water, the remaining NH₂- or carbodiimide groups on the beads were blocked by incubating the beads with a BSA (10 mg/ml) solution. NH₂-latex bound (Gal-Gal) n -ALP was also prepared by the method described in II. In one experiment, ALP was coupled to NH₂-latex, followed by coating with globoside. V. Preparation of latex beads with a mixture of (Gal-Gal) n -BSA and ALP A molar mixture (1:10) of (Gal-Gal) n -BSA (0.5 mg) and ALP (5 mg) in 500 µl of water was added to 300 µl of a NH₂-latex bead suspension (10¹³ particles/ml), which had been activated with carbodiimide. The reaction was allowed to proceed at 4°C overnight. Remaining NH₂- and carbodiimide groups were blocked with a Tris buffer (0.1M, pH 8.0) followed by BSA (10 mg/ml). After washing the beads, they were suspended in buffer with 0.1% NaN₃. Preparation of latex beads modified with β-galactosidase and (Gal-Gal) n -BSA 300 µl of a NH₂-latex suspension (10¹³ particles/ml, 0.81 µm) were washed with water and centrifuged. The pellet was suspended in 1 ml of 1 M HCl and cooled to +4°C. 100 µl of a 0.05 M sodium nitrite solution were added. The beads were centrifuged after 15 minutes, washed with water and suspended in 1 ml of 50 mM potassium phosphate, pH 7.2. A mixture of (Gal-Gal) n -BSA and β-galactosidase (1/100 w/w) was allowed to react with the diazotized beads. After 10 minutes, the reaction was blocked with 0.5 ml β-naphtol (1 mg/ml) solution, and the beads were centrifuged, washed and suspended in Tris buffer, pH 8.0. VI. Diazo coupling of ALP (or β-galactosidase or horseradish peroxidase) and (Gal-Gal) n -BSA to NH₂-latex ALP coupling 300 µl of a suspension of NH₂-latex (10¹³ particles/ml, 0.81 µm) were washed with water and centrifuged. The pellet was suspended in 1 ml of 1M HCl and cooled to 4°C. 100 µl of a 0.05M sodium nitrite solution were added. The beads were centrifuged after 15 minutes, washed with water and suspended in 1 ml of 50 mM potassium phosphate, pH 7.2. A mixture of (Gal-Gal) n -BSA and ALP (10:1 w/w) was allowed to react with the diazotized beads. After 10 minutes, the reaction was blocked with a 0.5 ml β-naphtol (1 mg/ml) solution, and the beads were centrifuged, washed and suspended in Tris buffer, pH 8.0. β-Galactosidase or horseradish peroxidase coupling Beads to which these enzymes were bound were produced in an analogous manner with the exception that the ration between (Gal-Gal) n -BSA and β-galactosidase was 1:100 w/w instead of 10:1 w/w. VII. Coating to latex (or NH₂-latex) A third method was also used in which amino-latex (see preparation of BSA-latex) or non-modified latex beads were coated with (Gal-Gal) n -ALP. An excess of modified enzyme was incubated with the beads for 12 hours. The beads were filtered and washed with buffer and stored at 4°C when not in use. VIII. Preparation of (Gal-Gal) n -ALP bound to Dynosphere beads A 10% solution of tosyl-activated Dynosphere beads (3 µm, 10¹⁰ particles/ml) was allowed to react at 4°C with (Gal-Gal) n -ALP (molar excess 100%) at pH 9.6 overnight. The covalently modified beads were washed several times with buffer and stored in a buffer with 0.1% NaN₃. A modification of this method was also used in which Dynosphere was allowed to react with the parent enzyme ALP followed with coating with globoside. IX. Preparation of latex beads with a mixture of ALP and Gal-Gal antibodies Monoclonal antibodies against Galα1-4Galβ- were obtained from Biocarb AB, Sweden. The antibodies have been characterized as IgG antibodies. The antibodies were concentrated by precipitation with saturated ammonium sulphate, followed by purification on a DE-52 ion exchange column. The antibodies were eluted with a 0-0.4M sodium chloride/Tris buffer gradient. Collected fractions were tested for their ability to bind (Gal-Gal) n -BSA. NH₂-latex (0.2 µm) beads were modified with ALP/antibodies (1:10 w/w) in essentially the same way as that described under VI. The modified beads were washed and dialyzed against water and stored in a solution of 0.05M phosphate buffer, 0.1% NaN₃, pH 7.2. Preparation of macrobeads Coupling of BSA to agarose beads (Sepharose® 6MB) 60 mg of BSA were dissolved in 3 ml of 0.1M NaHCO₃, pH 9, and added to 6 ml of cyanogen bromide activated Sepharose® 6MB which had been rapidly washed with the above cold buffer. Coupling was carried out overnight on an end-over-end rocking table at 4°C. The beads were washed with coupling buffer and distilled water. Preparation of galα1-4gal-β-0-BSA-agarose beads (Sepharose® 6MB) The BSA-agarose (1.5 g) was washed with 0.4M NaHCO₃, pH 9.3. The glycoside Galα1-4Galβ-0-CETE was converted to the corresponding acyl azide as described above. A solution of 0.3 ml of acyl azide (containing about 8 mg of the derivative) as added to a suspension of 1.5 g of BSA-agarose and 0.5 ml of 0.4M NaHCO₃, pH 9.3. The reaction was allowed to proceed at 20°C for 4 hours and then at 4°C overnight. The product was washed with distilled water. Characterization of modified enzyme and modified beads Characterization of (Gal-Gal) n -ALP The absorbance at 280 nm of the modified enzyme was related to the parent enzyme absorbance at a defined concentration. The enzyme activity was determined on an automated PRISMA analyzer (Clinicon AB, Stockholm, Sweden). The activity was related to that found in the parent enzyme. The sugar content was related to a standard dilution of Galα1-4Galβ-0-2-(carbomethoxyethylthioethyl)glycoside by the phenol-sulphuric acid method (M. Dubois, K.A. Gilles, J.K. Hamilton, P.A. Rebers and F. Smith, Anal. Chem. 28 , 1956, p. 350 (19). On duplicate runs, it was found that 39-40 mole sugar/mole enzyme was covalently linked to ALP. The enzyme activity (1.4 µkat/ml) was found to be roughly the same compared with the parent enzyme (activity 1.8 µkat/ml). Characterization of (Gal-Gal) n -ALP modified latex beads The activity of a suspension of modified latex beads (0.21, 0.81 µm, carbodiimide coupling procedure) was tested by adding p-nitrophenylphosphate to the beads. The parent enzyme was used as a standard. The activity was found to correspond to 95-100 molecules ALP/particle or approximately 3700-4000 molecules Gal-Gal/particle. The methods for characterizing the other beads described above were analogous. Characterization of beads modified with (Gal-Gal) n -BSA and β-galactosidase or peroxidase The methods for testing the activity of the beads were analogous to those described in the section entitled "Characterization of (Gal-Gal) n -ALP modified latex beads". 5-Aminosalicyclic acid was used as the substrate for peroxidase and o-nitrophenylgalactoside was used as the substrate for β-galactosidase. The activity of the beads was found to correspond to 220 molecules of β-galactosidase/particle and 605 molecules of peroxidase/particle, respectively. The beads were tested for binding of immobilized P-fimbriated E. coli . The results were in accordance with those obtained for ALP-bound microbeads (cf. Example 1 and Table 2) except that the sensitivity was lower. Test of specificity of modified beads The different beads, characterized in Table I, were tested for specificity in an agglutination test. The strains were assigned as P-fimbriated and non-P-fimbriated, respectively, by means of specific agglutination (16). The data in the Table indicate that specific binding could not be obtained for all particles. However, in the cases where specificity was not perfect for P-fimbriated E. coli , there was a marked difference in sensitivity of the agglutination between P-fimbriated and non-P-fimbriated strains. EXAMPLE 1 Detection of P-fimbriated E. coli bound to polystyrene films coated with Gal-Gal-BSA Transparent 0.2 mm thick Trysite films were incubated in a solution of (Galα1-4Galβ)₃₁-O-BSA (100 µg/ml) for 9 hours. The films were washed with PBS and incubated for 0.5 hour with 10¹⁰, 10⁹, 10⁸, 10⁷, 10⁶ bacteria/ml suspensions of P-fimbriated E. coli (isolated from the urine of patients with pyelonephritis). After washing with 0.1M Tris-0.05M NaCl buffer, pH 7.5, and water, the film was microscopically inspected for binding of bacteria to the transparent film. A high density binding was obtained with highly concentrated bacterial suspensions. Non-P-fimbriated E. coli suspensions only bind to the film in low quantities, if at all. Inhibition of binding to the film was confirmed by first incubating the bacterial suspension with Galα1-4Galβ-OEt (100mg/ml and 10 mg/ml, from SSA, Fine Chemicals Division, Arlöv, Sweden) and then incubating the film with the bacterial suspension. Only a few bacteria were detected on the film by visual inspection in a microscope. The film with bound bacteria was then incubated for 0.5 hour with a bead suspension ((Gal-Gal) n -ALP modified latex, 0.81 µm), followed by washing with a Tris buffer, pH 7.5. At high bacterial concentrations (10¹⁰ bacteria/ml), the film became opaque, which could be detected by the naked eye. At lower bacterial concentrations, the bound bacteria could be detected by reacting the bound enzyme beads with the substrate p-nitrophenylphosphate (10 mM in 1M diethanolamine buffer, pH 9.8, containing 0.5 mM MgCl₂). Fig. 1 shows the absorbance at 405 nm as a function of bacterial concentration (two E. coli strains: GK1 and C600) from triple runs. The detection limit with p-nitrophenylphosphate as a substrate was 10⁶-10⁷ bacteria/ml. The experiment was repeated in an analogous way by use of an ELISA microtiter plate instead of Trysite film. Although the surface and the volume of the cells are limiting factors, it was possible to visualize bacterial concentrations down to 10⁸ bacteria/ml. The enhancement of the detection is apparent when comparing the above results with those obtained with the known sandwich-ELISA technique (20). If the microbead incubation step is replaced by incubation with (Galα1-4Galβ) n -ALP solution followed (after washing) by incubation with the substrate, it was not even possible to detect any presence of immobilized bacteria at a concentration of 10¹⁰ bacteria/ml (Fig. 2). The background absorbance was also higher in this experiment compared to the experiment where microbeads were used. The detection limit for specific particle agglutination (16) is in the range of 10⁸-10⁹ bacteria/ml. EXAMPLE 2 Detection of P-fimbriated E. coli (GK1) bound to Gal-Gal BSA-agarose beads Gal-Gal conjugated BSA-agarose and BSA-agarose (0.5 ml) (control) were packed in three columns (8 mm x 50 mm) (two containing Gal-Gal BSA and one containing BSA-agarose) consisting of PVC plastic tubes provided with a porous glass filter at the bottom. The columns were washed with PBS (phosphate buffered saline), pH 7.2. A suspension of E. coli strain GK1 (0.3 ml, OD=1.03), resuspended in PBS, was applied to the BSA-column and to one of the Gal-Gal-BSA-columns. A suspension of the non-P-fimbriated E. coli strain C600 (0.3 ml, OD-1.40) was applied to the second Gal-Gal-BSA-column. After 5 minutes, the gels were washed with PBS (3x0.9 ml). The eluents were collected and OD-determined. It was found that 16% of the GK1 added were retained on the Gal-Gal-BSA-column. Strain C600 was completely eluted out from the column. The GK1 strain was not found to adhere to the BSA-agarose column. Directly after the elution step, 200 µl of a microbead solution (3 µm Dynosphere beads modified with (Gal-Gal) n -ALP, 10⁴ active ALP/particle) were added to each column. After 5 minutes, the columns were washed successively with PBS (3x0.9 ml), water (3 ml) and diethanolamine containing 1mM MgCl₂ (3 ml). The enzyme-linked microbeads were made detectable by adding 200 µl of a 0.1mM p-nitrophenylphosphate solution. The columns with the adsorbed E. coli strain GK1 turned yellow, while the other two columns were unchanged, which was observed after 20 minutes of incubation. The experiment was repeated with dilutions of strain GK1. A dilution corresponding to 10⁶ bacteria/ml could be visualized by spectrophotometric detection of formed p-nitrophenyl at 405 nm. When nicotinamide adenine dinucleotide phosphate (NADP) was used as a substrate, bacterial concentrations of strain GK1 could be measured down to 10⁵ bacteria/ml. In this experiment, NADP is converted to NAD in catalytic amounts. NADH is produced from NAD through the action of alcohol dehydrogenase and in the presence of ethanol. Diaphorase interconverts NADH to NAD, and at the same time a reducible product (INT) is reduced to a coloured product (21) (cf. Fig. 3). EXAMPLE 3 Binding of anti-Gal-Gal-ALP beads to tlc-separated glycolipids A mixture of globotetracylceramide, Galα1-4Galβ1-4Glc-β-O-(CH₂)₁₇CH₃, was applied to a HPTLC plate (Merck, Darmstadt, West Germany). The compounds were separated using chloroform-methanol-water (60:35:8, by volume) as the mobile phase. The plate was then covered by spraying with a thin film of methylmethacrylate (18). After drying, the exposed carbohydrate residues could be visualized by first incubating the plate with a water suspension of latex-anti-Gal-Gal-ALP beads (0.2 µm), and then washing the plate in water. The plate was covered with a Whatman filter paper soaked with p-nitrophenylphosphate. The reaction was complete after 15 minutes, and the narrow yellow bands could be detected by the naked eye. EXAMPLE 4 Binding of (Gal-Gal) n -ALP latex beads to antibodies immobilized on microtiter plates Microtiter plates were coated by incubating them overnight at room temperature with 100 µl of anti-Gal-Gal antibody, diluted from 5 µg/ml to 0.17 µg/ml in 50 mmol NaHCO₃ buffer, pH 9.6. After washing, the wells were treated with a 50 mg/ml BSA solution, followed by washing. To each well was added a 10⁸ particle/ml suspension of (Gal-Gal) n -ALP latex (0.81 µm, 7500 active ALP molecule/particle). After incubation for 0.5 hour and washing, the amount of microbeads bound was detected using p-nitrophenylphosphate as a substrate. The limit of detection was 0.17 µg/ml which corresponds to a concentration of approximately 0.2 pmol/l of this antibody solution (MW 10⁶). A summary of the types of microbeads prepared and employed in the Examples and the results of agglutination tests with different E. coli strains is shown in the following Tables III and IV. Specificity and enzyme activity (ALP) of various beads Modification of particles -coupling method Size of particles ALP units * / 10¹⁰ part. No. of active ALP molecules per part. Area/ particle Gal-gal-ALP, carbodiimide coupled to NH₂-latex (0.21 µm) 0.3 100 7x10⁻⁶ Gal-gal-ALP, carbodiimide coupled to BSA latex (0.21 µm) 0.3 95 7x10⁻⁶ ALP + gal-gal-BSA (10:1), carbodiimide coupled to NH₂-latex (0.21 µm) 1.0 380 27x10⁻⁶ ALP diazo-coupled to NH₂-latex, globoside-coated (0.21 µm) 0.2 80 6x10⁻⁶ Gal-gal-ALP, coated to latex (0.81 µm) 2.6 1000 5x10⁻⁶ ALP diazo-coupled to NH₂-latex, globoside-coated (0.81 µm) 52 20000 100x10⁻⁶ ALP covalently coupled to tosyl-activated Dynosphere, globoside-coated (3 µm) 17 6500 2x10⁻⁶ 0 = not binding + = weak binding ++ = medium binding +++ = strong binding EXAMPLE 5 Detection of Staphylococcus saprophyticus bound to polystyrene films coated with lactoseamine-BSA conjugate It has previously been shown (12) in haemagglutination studies that Staphylococcus saprophyticus binds to lactose amine-containing glycoconjugates. Transparent 0.2 mm thick Trysite films were coated with lactoseamine-BSA conjugate (100 µg/ml, see Example 1). After washing with Tris buffer, pH 7.4, the films were incubated for 0.5 hour with bacterial suspensions of S. saprophyticus (10¹⁰-10⁸ bacteria/ml). The films were carefully washed with water and Tris buffer, pH 7.4, and incubated with a microbead suspension (10⁸ particles/ml, latex modified with lactoseamine-BSA/ALP; 5000 active ALP/particle). The films became opaque at bacterial concentrations of 10¹⁰ bacteria/ml. At lower concentrations, the specific binding was detected by a substrate incubation step as described in Example 1. REFERENCES 1. S. Avrameas, Curr. Top. Microbiol. Immunol. 104 , 1983, p. 93. 2. J.H. Caster, J. Clin. Immunoassay 7 , 1984, p. 64. 3. C. Wagener et al., J. Immunolog. Methods 68 , 1984, p. 269. 4. A.M. Shamsuddin and C.C. Harris, Arch. Pathol. Lab. Med. 107 , 1983, p.514. 5. C. Bacquet and D.Y. Twumasi, Anal. Biochem. 136 , 1984, p. 487. 6. R.H. Yolkan et al., J. Immunolog. Methods 56 , 1983, p. 319. 7. C. Kendall et al., J. Immunolog. Methods 56 1983, p. 329. 8. A. Johansson, C.J. Stanley and C.H. Self, Clinic Chimica Acta 148 , 1985, p. 119. 9. B. Poltsmann et al., J. Immunolog. Methods 6 , 1984, p. 179. 10. J. Dahmén, T. Frejd, G. Grönberg, T. Lave, G. Magnusson and G. Noori, Carbohydr. Res. 116 , 1983, p. 303. 11. J. Dahmén, T. Frejd, G. Grönberg, T. Lave, G. Magnusson and G. Noori, Carbohydr. Res. 118 , 1983, p. 292. 12. J. Dahmén, T. Frejd, G. Magnusson, G. Noori and A.-S. Carlström, Carbohydr. Res. 125 , 1984, p. 237. 13. H. Leffler and C. Svanborg-Edén, in Bacterial Lectins , ed. D. Mirelman, 1985. 14. H.J. Tenoso and D.B. Smith, NASA TECH BRIEF , Manned Spacecraft Centre (MSC 13906). 15. R. Möllby, G. Källenius, T.K. Korhonen, J. Winberg and S.B. Svensson, Infection 11 , 1983, p. 68. 16. H. Leffler and C. Svanborg-Edén, Infect. Immun. 34 , 1981, p. 920; G. Källenius, S.B. Svensson, R. Möllby, B. Cedergren, H. Hultberg and J. Winberg, Lancet , 1981, p. 604. 17. G.C. Hansson, K.-A. Karlsson, G. Larsson, N. Strömberg and J. Thurin, Anal. Biochem. 146 , 1985, p. 158. 18. M. Dubois, K.A. Gilles, J.K. Hamilton, P.A. Rebers and F. Smith, Anal. Chem. 28 , 1956, p. 350. 19. E. Engvall, Methods in Enzymology 70 , p. 419. 20. C.H. Self, US Patent Application No. 307,600; A. Johannsson, C.J. Stanley and C.H. Self, Clin. Chim. Acta 148 , 1985, p. 119. 21. A. Gunnarsson, P.-A. Märdh, A. Lundblad and S. Svensson, Infect. and Immun. 45 , 1984.

Claims: A method of detecting the presence in a sample of a cell, virus, plasma protein, hormone or antibody, or an antibody thereto, characterised in that it comprises: (a) contacting the sample with a first reagent bound to a solid support so that the reagent binds to the cell, virus, plasma protein, hormone or antibody, or antibody thereto; (b) contacting the resulting sample containing the cell, virus, plasma protein, hormone or antibody, or antibody thereto bound to the reagent, which in turn is bound to the solid support, with a macromolecular water-insoluble carrier having a second reagent which is a carbohydrate or carbohydrate derivative and a label substance multivalently-bound thereto so that the second reagent and thus the macromolecular water-insoluble carrier and the label substance bind to the cell, virus, plasma protein, hormone or antibody, or antibody thereto; (c) removing unbound second reagent and thus unbound carrier and label substance from the sample; (d) treating the then-resulting sample with a compound which is a precursor of a detectable reaction product or which is capable of initiating a reaction cascade, the end product of which is detectable, so that a detectable reaction product is formed if the label substance is present; and (e) detecting any detectable reaction product so formed and thereby detecting the presence of the cell, virus, plasma protein, hormone or antibody, or antibody thereto, in the sample. A method as claimed in claim 1 wherein the first and second reagent are capable of binding a specific cell, virus, plasma protein, hormone or antibody. A method as claimed in claim 1 or claim 2 wherein the first reagent and the second reagent are the same. A method as claimed in any of claims 1 to 3 wherein the first reagent is selected from a carbohydrate or carbohydrate derivative such as a receptor for a cell, virus, plasma protein, hormone or antibody, e.g. a polysaccharide, glycolipid, neo-glycolipid, glycoprotein or neo-glycoprotein, a polypeptide, a protein or another cell or virus surface component, a plasma protein, hormone or antibody, a toxin, a cell membrane component, an antibody to a carbohydrate or carbohydrate derivative, a polypeptide, a protein or another cell or virus surface component or a plasma protein, hormone or antibody, a metal conjugate or a single-stranded oligonucleotide. A method as claimed in any of claims 1 to 4 wherein the solid support to which the reagent used in (a) is bound comprises a polymer, e.g. a plastic, such as polystyrene, polyvinylchloride, polyethylene, polyurethane, latex, nylon, tetrafluoroethylene, polyethylene terephthalate, polyvinylacetate, polyvinylalcohol or a suitable copolymer thereof, a polysaccharide, a silicon polymer, an ion exchange resin, a polypeptide, silica or a silicate such as borosilicate, or cellulose, or wherein the solid support comprises a matrix to which the polymer is bound. A method as claimed in any of claims 1 to 5 wherein the polymer comprises optionally modified functional groups. A method as claimed in any of claims 1 to 6 wherein the solid support is in the form of a plate, film, macroparticle, dipstick, filter or paper. A method as claimed in any of claims 1 to 7 wherein the sample comprises a pathogen, e.g. a bacterium, virus, fungus, mycoplasma or prion, or a bacterial toxin, a non-pathogen, a carbohydrate or carbohydrate derivative, a polypeptide, a protein or another cell or virus component, a toxin, a cell membrane component, an antibody to a carbohydrate or carbohydrate derivative, a polypeptide, a protein or another cell or virus component, or a single-stranded oligonucleotide which is complementary to that used as the reagent. A method as claimed in any of claims 1 to 8 wherein the macromolecular water-insoluble carrier is a polymer containing multiple active sites, such as hydroxyl, amino, thio, amido, cyano, imino, imido, keto, epoxy, nitro, ester and acyl groups, or halide-containing groups, or wherein the macromolecular carrier is in the form of microbeads, e.g. microbeads comprising a polymer such as a plastic or a polysaccharide, a copolymer, a silicon polymer or a polymer containing functional groups which are optionally modified, a glass, a liposome, a cross-linked polymer or silica or a silicate, e.g. borosilicate, the microbeads optionally being provided with multiple active sites, e.g. hydroxyl, amino, thio, amido, cyano, imino, imido, keto, epoxy, nitro, ester or acyl groups, or halide containing groups. A method as claimed in claim 9 wherein the microbeads have a size of from 0.05 to 20 µm. A method as claimed in any of claims 1 to 10 wherein the substance which is multivalently bound to the macromolecular water-insoluble carrier is selected from enzymes, e.g. alkaline phosphatase, glucose oxidase, peroxidase, acid phosphatase, galactosidase, proteases, luciferase, dehydrogenase, esterase, urease and lysozyme, antibodies and blood clotting factors, e.g. fibrinogen (I), prothrombin (II), thrombin (IIa), tissue thromboplastin (III), proaccelerin (V), accelerator globulin (VI), proconvertin (VII), antihemophilic globulin (VIII), plasma thromboplastin component (IX), autoprothrombin III (X), plasma thromboplastin antecedent (XI), Hagemann factor (XII) and fibrin-stabilizing factor (XIII). A method as claimed in any of claims 1 to 11 wherein the compound which is a precursor of a detectable reaction product or is capable of initiating a reaction cascade the end product of which is detectable comprises a blood clotting factor, an antigen or an enzyme substrate which is catalyzed by the enzyme to form a coloured, fluorescent or luminescent product, or to produce a colour change, or to make the colour, fluorescence or luminescence of a product decrease or increase in intensity, e.g. phenolphthalein-orthophosphate, thymophthalein phosphate, orthonitrophenyl glycoside, naphthols, anilines, coumarins, tetrazolium dyes, dansyl and derivatives thereof, NADP or isothiocyanates. A method as claimed in any of claims 1 to 7 or 9 to 12 wherein: a) the solid support comprises macroparticles to which the first reagent is bound, which macroparticles are packed in a column, or the solid support comprises a porous filter to which the first reagent is bound, and the sample is passed through the column or filter; (b) a suspension of water-insoluble microbeads of a size of from 1 to 20 µm to which the second reagent is coupled and to which an enzyme is multivalently-bound, is passed through the column; and (c) a solution or suspension of enzyme substrate is passed through the column after which a colour, fluorescence or luminescence develops; whereby the presence in the sample of any cell, virus, plasma protein, hormone or antibody which has become bound to the reagent in (a) and (b) is detected. A method as claimed in any of claims 1 to 7 or 9 to 12 wherein: (a) the solid support comprises a dipstick or film to which the reagent is bound, which dipstick or film is immersed in the sample; b) the dipstick or film is contacted with the macromolecular carrier comprising microbeads of a size of from 0.05-10 µm to which the second reagent is coupled and to which an enzyme is multivalently-bound, by immersing it in a suspension of the microbeads, and (c) the dipstick or film becomes opaque at high cell, virus, plasma protein, hormone or antibody concentrations, or the dipstick is immersed in a solution or suspension of enzyme substrate after which a colour, fluorescence or luminescence develops, whereby the presence in the sample of a cell, virus, plasma protein, hormone or antibody which has become bound to the reagent in (a) and (b) is detected. A method as claimed in any of claims 1 to 7 or 9 to 12 wherein: (a) the solid support comprises a film or plate, optionally provided with wells, to which the reagent is bound, and the sample is applied on the film or plate and removed after a period of time sufficient to bind cell, virus, plasma protein, hormone or antibody in the sample; (b) the macromolecular carrier comprises microbeads of a size of from 1 to 20 µm to which the second reagent is coupled and to which an enzyme is multivalently-bound, and a suspension of the microbeads is applied on the film or plate and removed after a period of time sufficient to bind cell, virus, plasma protein, hormone or antibody in the sample, and (c) a solution or suspension of enzyme substrate is applied on the film or plate after which a colour, fluorescence or luminescence develops; whereby the presence in the sample of a cell, virus, plasma protein, hormone or antibody which has become bound to the reagent in (a) and (b) is detected. A method as claimed in any of claims 13 to 15, wherein the amount of cell, virus, plasma protein, hormone or antibody bound to the reagent in (a) is quantitized by means of measuring the amount of microbeads out of a predetermined quantity which are not bound to the cell, virus, plasma protein, hormone or antibody in the sample. A macromolecular water-insoluble carrier suitable for use in a method as claimed in claim 1 characterised in that it is (a) coupled to a reagent which is a carbohydrate or carbohydrate derivative, the reagent being capable of binding a cell, virus, plasma protein, hormone or antibody, or an antibody thereto, the carrier comprising a substance multivalently-bound to the carrier, which substance is capable of initiating a reaction the product of which is detectable; or (b) multivalently-bound to a substance to which the reagent is coupled and which is capable of initiating a reaction the product of which is detectable. A carrier as claimed in claim 17 wherein the reagent is capable of binding a specific cell or virus component. A carrier as claimed in claim 17 or claim 18 wherein the reagent is selected from a carbohydrate or carbohydrate derivative, such as a receptor for a cell, virus, plasma protein, hormone or antibody, (e.g. a mono-, oligo- or poly-saccharide, glycolipid, neo-glycolipid, glycoprotein or neo-glycoprotein), a polypeptide, a protein or another cell or virus surface component, a plasma protein, hormone or antibody, a toxin, a cell membrane component or a single-stranded oligonucleotide. A carrier as claimed in any of claims 17 to 19 wherein the macromolecular carrier is a polymer containing multiple active sites, such as hydroxyl, amino, thio, amido, cyano, imino, imido, keto, epoxy, nitro, ester and acyl groups, or halide containing groups, or in which the macromolecular carrier is in the form of microbeads, e.g. microbeads comprising a polymer, such as a plastic or a polysaccharide, a copolymer, a silicon polymer or a polymer containing functional groups which are optionally modified, a glass, a liposome, a cross-linked polymer or silica or a silicate e.g. borosilicate, the microbeads optionally being provided with multiple active sites, e.g. hydroxyl, amino, thio, amido, cyano, imino, imido, keto, epoxy, nitro, ester or acyl groups, or halide-containing groups. A carrier as claimed in claim 20 wherein the microbeads have a size of from 0.05 to 20 µm. A carrier as claimed in any of claims 17 to 21 wherein the substance to which the reagent is coupled or which is multivalently bound to the macromolecular carrier is selected from enzymes, e.g. alkaline phosphatase, glucose oxidase, peroxidase, acid phosphatase, galactosidase, proteases, luciferase, dehydrogenase, esterase, urease and lysozyme, antibodies and blood clotting factors, e.g. fibrinogen (I), prothrombin (II), thrombin (IIa), tissue thromboplastin (III), proaccelerin (V), accelerator globulin (VI), proconvertin (VII), antihemophilic globulin (VIII), plasma thromboplastin component (IX), autoprothrombin III (X), plasma thromboplastin antecedent (XI), Hagemann factor (XII) and fibrin-stabilizing factor (XIII). A diagnostic composition suitable for use in a method as claimed in claim 1 characterised in that it comprises: (a) a first reagent bound to a solid support, which reagent is capable of binding a cell, virus, plasma protein, hormone or antibody, or an antibody thereto, and (b) a second reagent which is a carbohydrate or carbohydrate derivative, reagent being coupled to a macromolecular water-insoluble carrier either directly or via a spacer, to which carrier a label substance is multivalently-bound, said substance being capable of initiating a reaction the product of which is detectable, or coupled to a macromolecular water-insoluble carrier via a label substance, the substance being multivalently-bound to the macromolecular water-insoluble carrier and the substance being capable of initiating a reaction the product of which is detectable. A composition as claimed in claim 23 wherein the reagent is capable of binding a specific cell, virus, plasma protein, hormone or antibody. A composition as claimed in claim 23 or claim 24 wherein the first reagent and the second reagent are the same. A composition as claimed in any of claims 23 to 25 wherein the second reagent is selected from a carbohydrate or carbohydrate derivative, such as a receptor for a cell, virus, plasma protein, hormone or antibody, (e.g. a mono-, oligo- or poly-saccharide, glycolipid, neo-glycolipid, glycoprotein or neo-glycoprotein), a polypeptide, a protein or another cell or virus surface component, a plasma protein, hormone or antibody, a toxin, a cell membrane component or a single-stranded oligonucleotide. A composition as claimed in any of claims 23 to 26 wherein the solid support to which the reagent used in (a) is bound comprises a polymer, e.g. a plastic, such as polystyrene, polyvinylchloride, polyethylene, polyurethane, latex, nylon, tetrafluoroethylene, polyethylene terephthalate, polyvinylacetate, polyvinylalcohol or a suitable copolymer thereof, a polysaccharide, a silicon polymer, an ion exchange resin, a polypeptide, silica or a silicate, such as borosilicate, or cellulose, or in which the solid support comprises a matrix to which the polymer is bound. A composition as claimed in claim 27 wherein the polymer comprises optionally modified functional groups. A composition as claimed in any of claims 23 to 28 wherein the solid support is in the form of a plate, film, macroparticle, dipstick, filter or paper. A composition as claimed in any of claims 23 to 29 wherein the macromomecular water-insoluble carrier is a polymer containing multiple active sites, such as hydroxyl, amino, thio, amido, cyano, imino, imido, keto, epoxy, nitro, ester and acyl groups, or halide containing groups, or in which the macromolecular water-insoluble carrier is in the form of microbeads, e.g. microbeads comprising a polymer, such as a plastic or a polysaccharide, a copolymer, a silicon polymer or a polymer containing functional groops which are optionally modified, a glass, a liposome, a cross-linked polymer or silica or a silicate e.g. borosilicate, the microbeads optionally being provided with multiple active sites, e.g. hydroxyl, amino, thio, amido, cyano, imino, imido, keto, epoxy, nitro, ester or acyl groups, or halide containing groups. A composition as claimed in claim 30 wherein the microbeads have a size of from 0.05 to 20 µm. A composition as claimed in any of claims 23 to 31 wherein the substance to which the second reagent may be coupled and which is multivalently-bound to the macromolecular carrier is selected from enzymes, e.g. alkaline phosphatase, glucose oxidase, peroxidase, acid phosphatase, galactosidase, proteases, luciferase, dehydrogenase, esterase, urease and lysozyme, antibodies and blood clotting factors, e.g, fibrinogen (I), prothrombin (II), thrombin (IIa), tissue thromboplastin (III), proaccelerin (V), acelerator globulin (VI), proconvertin (VII), antihemophilic globulin (VIII), plasma thromboplastin component (IX), autoprothrombin III (X), plasma thromboplastin antecedent (XI), Hagemann factor (XII) and fibrin-stabilizing factor (XIII). A composition as claimed in any of claims 23 to 32 wherein the solid support comprises a multiplicity of dipsticks to which the reagent is bound, each dipstick or sub-group of dipsticks being provided with a different reagent, each reagent being able to bind a different cell, virus, plasma protein, hormone or antibody or an antibody thereto, or wherein the solid support comprises a microtiter plate provided with a multiplicity of wells to which the reagent is bound, each well or sub-group of wells containing a different reagent, each reagent being able to bind a different cell, virus, plasma protein, hormone or antibody or an antibody thereto.

Inventors: LARSSON, BIRGIT ANN-CHARLOTT, NILSSON, HANS BERTIL STURE, NILSSON, KURT GOSTA INGEMAR, OHGREN, YVONNE ELISABETH, PAHLSSON, KARIN
Applicants: BIOCARB AB
Application year: 1987
Main classification: G01N33
IPC codes: G01N33