IMMUNOGLOBULIN ASSAY METHOD

Abstract: A method for assaying immunoglobulins, particularly IgG or IgM in accessible bodily fluids, particularly saliva, which comprises immobilising anti-IgA, IgG or IgM on a substrate, exposing the substrate to the fluid, then either (a) exposing the substrate to a selected labelled antigen, or preferably (b) exposing the substrate to a selected antigen then to a selected labelled antibody. A property of the labelled antigen or antibody is then detected. The invention is demonstrated in the assay of IgG and IgM in saliva produced in response to Rubella, Hepatitis A and B, AIDS, Measles and Mumps.

Description: IMMUNOGLOBULIN ASSAY METHOD This invention relates to methods of assay of immunoglobulins in bodily fluids. More specifically the invention provides a method of determining qualitatively or quantitatively the presence or amount of specific IgM, IgG or IgA in bodily fluids. The diagnosis of many microbial infections, particularly those due to viruses, and the determination of immunity and susceptibility to them, is based on tests on serum. Serum is the fluid that remains when blood is allowed to clot and it is rich in proteins called immunoglobulins. These proteins are produced in response to infection by particular micro-organisms and are very specific to them. In this context immunoglobulins are referred to as antibodies. In the first few weeks after exposure to a microbial infection specific antibodies rise rapidly in concentration. The initial response to infection usually occurs in a particular class of immunoglobulin (IgM), but production of this sort of antibody is short lived so that it is usually present only when infection has been recent. It can therefore be used as a diagnostic sign, and is so used in a range of viral and other infections. Another class of immunoglobulin (IgG) is formed a little later after infection. IgG antibodies are as specific as IgM antibodies but are much more persistent and, in the case of many viral infections, remain for life. IgG antibody is therefore a sign of infection with or immunity to the virus for which it is specific and its absence a sign of susceptibility. Among the infections for which measurement of specific IgM and IgG antibody are in common use are Rubella, Hepatitis A, Hepatitis B, Human Parvovirus 019, Measles, Mumps, Cytomegalovirus and Chicken Pox. It is becoming increasingly desirable to test for IgM and IgG antibodies for the virus responsible for the disease AIDS (eg HIV, HTLV III or LAV) and other retroviruses such as HTLV I. It Is also desirable In some cases to test for a further class of specific immunoglobulin, IgA, although this is generally less suitable for diagnostic or assay purposes. At present testing for the presence of specific IgG and IgM is carried out on blood serum, that is a bodily fluid which contains a very high concentration of IgG and IgM. A suitable serum test is for example described in J Medical Virology 19 C1986) p387-397. Unfortunately serum cannot be collected without venepuncture and this is inconvenient and sometimes unacceptable, especially in children and nervous adults. In the case of tests for AIDS virus there is indeed widespread pu¬ blic prejudice against venepuncture. Venepuncture is also quite expensive, requiring a sterile needle, syringe, skin cleanser and dressing, and in certain cases it is hazardous and difficult. Specific immunoglobulins are known to be present in other bodily luids, some of which are much more accessible than serum, for example saliva, tears, semen, urine and cerebro spinal fluid. Concentration of IgM and IgG in these fluids are much lower than in serum eg in the order of 0. 01 and 0. 001 of the concentration in serum. Saliva is generally one of the most accessible of such fluids. Some work has been carried out on characterising immunoglobulins In saliva, and on methods of assaying them. M c of this work has been of a general nature. For example Oral. Surg Oral Medicine Oral Pathol (US), (1985), 60(4), p372-376, J-Immunol. Meth. (1983) , 57 (1-3), p51-7 and Invest. Opthamol Visual Sci (1986) 27 (4), p622-5 demonstrate the presence of all classes (IgA, IgG and IgM) in saliva. J-Immunological Methods (1984) 7JL 203-10 demonstrate the presence of anti-Escherichia coli IgG and IgM antobodies in serum, by depositing specific Escherichia coli antigen on a substrate and exposing this to serum. This reference speculates that the technique could be used to test for these antibodies in saliva, but without any experimental evidence. J-Infect. Diseases (US) (april 1987) 155 (4) p793-796 and (1985), 152 (6), pl238-44 describe attempts to assay IgA in saliva. The 1987 reference uses a technique that is suitable for research applications, but not for routine clinical work, which involves gel chromatography of the immunoprecipitate formed. The 1985 reference immobilises a specific poliovirus antigen on a substrate and attempts to capture specific IgA. Both of these references refer to the need to centrifuge the sample first. The main immunoglobulins used in immunoglobulin assays, IgG and IgM, occur in saliva at only about 0.3% of the level of IgA in saliva, and thus none of the methods referred to above are expected to be useful for assay of IgG or IgM in saliva, or for that matter in other bodily fluids containing such low levels of IgG or IgM. In fact no presently used test or assays for specific IgG and IgM have been very successful or reliable when applied to either saliva or such fluids because of this low concentration, and hitherto no suitable method has been devised for assaying IgG or IgM in such fluids without inconvenient prior treatment such as centrifuging or concentration etc. It is an object of the invention to provide a qualitative and quantitative test (assay) for specific immunoglobulins in' readily accessible bodily fluids, particularly saliva. According to the invention there is provided a method of assaying specific immunoglobulins of any or all classes present in a human or animal bodily fluid selected from saliva, tears, semen, urine and cerebro spinal fluid, which comprises the steps of: (i) immobilising an antibody to one or more classes of immunoglobulin onto a solid substrate (ii) exposing the immobilised antibody to a sample of the bodily fluid so as to achieve binding of a proportion of any immunoglobulin in present in the fluid to the immobilised antibody, and either: SUBSTITUTE SHEET (a) exposing the bound immunoglobulin to a selected labelled antigen so as to achieve binding of the labelled antigen to at least a proportion of the bound immunoglobulin or (b) exposing the bound immunoglobulin to a selected antigen so as to achieve binding of the antigen to at least proportion of the bound immunoglobulin and then binding a labelled antibody with specificity for the selected antigen directly or indirectly to at least a proportion of the bound antigen (iii) and then detecting and/or measuring a property of the labelled antigen or antibody. By "labelled" is meant an antigen or antibody having a detectable and/or measurable characteristic property. This property may be present in a known antigen or antibody or may be chemically or physically introduced into the antigen or antibody. The technique of labelling, and suitable labels are well known, and any conventional label may be used. Suitable labels include radio, enzyme, fluorescence or luminescence labelling, surface plasmon resonance (SPR) , or attachment to small particles, such as of latex or gelatin, which have some detectable characteristic property. By "selected antigen" is meant an antigen to which it is desired to demonstrate the presence of specific immunoglobulin in the bodily fluid. By the method of the invention the detectable and/or measurable property of the labelled antigen or antibody may be qualitatively or quantitatively associated with the presence and/or amount of the specific immunoglobulin in the bodily fluid. A significant factor of the method of the invention is that the possibility of assay depends not so much on the absolute concentration of the specific immunoglobulin in the bodily fluid but on the proportion of the total immunoglobulin that is specific to the bound antibody. Using the method of the invention the presence and/or amount of a specific immunoglobulin in a bodily fluid in which it is present in relatively small amounts may be detected and/or measured. Of these saliva is preferred by virtue of convenience of availability. By means of the invention many human and/or animal immunoglobulins may be assayed, for example those produced in response to the viruses which are associated with Hepatitis (A and B) , Rubella, Measles, Human Parvovirus B19, Mumps, Chick- enpox (VZ virus), and AIDS (HIV, LAV, or HTLV III). Although the method is suitable for all classes of immunoglobulin, eg IgA, IgM and IgG, it is preferred to use it for the assay of IgM and/or IgG as these are most useful for detection of infection or immunity. Class-specific and non class-specific antibodies to immunoglobulins which may be used in step (i) of the invention are known, and may be commercially available or may be prepared using known methods, eg monoclonal methods. Suitable examples include the known anti IgG, anti IgM, and anti IgA antibodies for example those which are specific for the immunoglobulin 0 , u orβ(, chains, found respectively in IgG, ' IgM and IgA- The antibody may be bound to the substrate using known methods, eg immersion of the substrate in a solution of the antibody at an appropriate dilution and pH. For example a pH of 7 to 11, especially 9 to 10 may be used, achieved with known buffers eg a Na CO /NaHCO buffer. Solutions of antibodies are available commercially, and a suitable dilution is 1:200 to 1:4-000 of the commercial antibody solution. Suitable substrates include polystyrene eg in bead form, or in the form of a microtitre plate or other small vessel. The sample of bodily fluid for assay may be collected by entirely conventional techniques well known to those skilled in the art. In the case of the preferred fluid, saliva, it is preferred that the saliva is collected by allowing the patient to chew on a roll of sponge or cotton wool, which may subsequently be compressed or centrifuged to collect clarified saliva. There Is hence generally no need, to concentrate the immunoglobulins or further centrifuge the saliva prior to use of the assay method. The substrate bearing the bound antibody may then be exposed to a sample of the bodily fluid, -eg saliva, which may if necessary be diluted to an appropriate level with a buffer or may sometimes be used undiluted. Typically but not exclusively the fluid may be diluted 1:2 to 1:20 in the buffer. For commonly sought immunoglobulins. eg the IgG or IgM produced in response to the infections Rubella, Measles, Mumps, Hepatitis A or B, AIDS (ie HIV), dilution of the saliva sample in the range 1:2 to 1:10 in the buffer are generally suitable. A suitable buffer is phosphate buffered saline (PBS) , containing 0.06 - 0.10 wt% sodium azide, 0.05 - 0.15% Tween 20 (trade mark) and 5 - 15% foetal calf serum (FCS). The conditions of exposure, eg time, temperature etc will depend upon the fluid, the immunoglobulin to be assayed, the bound antibody, the substrate etc, but can be made sufficiently short to enable the method to be used conveniently in clinical tests and screening. For example with the commonly sought Immunoglobulins mentioned above, incubation with the diluted or undiluted fluid, eg saliva, sample for around 1 to 3 hours at 37°C is generally suitable. Excess bodily fluid solution is then washed away, eg with a solution of Tween 20 in PBS. If alternative (a) of the method is to be used, the bound material may then be exposed to a solution of the labelled antigen, for example a radio- or enzyme- labelled antigen of one or more of the viruses referred to above. These may be prepared by known techniques (eg Schrnitz et al J Gen Virol 50 (1980)) and may be commercially available. In alternative (a) of the method, it is generally preferable to use as pure a form of the antigen as can be obtained, to avoid the possibility, of material other than the antigen binding to the bound immunoglobulin, for example debris remaining from the medium in which the antigen was prepared. A preferred form of labelled antigen for use in alternative (a) of the method is a small particle coated with the antigen. Many such particles are commercially available. If such particles have some detectable property such as radioactivity or in particular colour the binding of the particles to the bound immunoglobulin may be easily observed and/or measured. If the particles are conspicuously coloured for example red or blue, then if the substrate consists of the surface of a well in a plate then the relative degree of binding of the particles may be measured by observing the intensity of the colour caused by the binding of these particles. Alternatively if thesurface is shaped or aligned so that th-iforce of gravity tends to prevent their binding to the surface, the extent to which they settle toward lower parts of the plate may be observed, for example with the naked eye or a microscope. As the use of such coloured particles requires no sophisticated detection equipment such as radioactivity detectors, it is particularly convenient for use in the field or by relatively unskilled medical staff. Alternative (b) is preferred inter alia because it does not necessarily require the use of as pure an antigen as is need for alternative (a). In this case the bound material is exposed to an unlabelled antigen eg an antigen of one or more of the viruses referred to above. Exposure conditions will depend upon the antigen used, etc but as above may be such as to allow convenient clinical use. Typically a commercially available solution of the antigen may be used, diluted with the buffer referred to above if necessary, which may also contain normal (ie which lacks the specific antibody sought in the assay) human serum, eg 0-5%. After exposure to the unlabelled antigen, excess antigen solution should be washed away, eg with the buffer solution referred to above. Binding of the labelled antibody to the bound antigen may be direct, eg by direct exposure of the bound antigen to the labelled antibody in solution. Alternatively the binding of the labelled antibody to the bound antigen may be indirect, eg a further antibody to the bound antigen, eg anti-Rubella monoclonal antibody may be bound to the bound antigen by exposure of the further antibody eg by exposure of the labelled antibody to the further antibody. Binding of a radio-labelled antibody to the bound antigen or the further antibody may be achieved by exposure of the bound antigen or further antibody to a solution of the radio- labelled antibody. The solution may be a commercially available radio- labelled antibody, diluted if necessary with a buffer, for example a buffer contain PBS plus 0.15 - 0.25% Tween 20, 5 - 15% FCS, 0 - 15% normal rabbit serum (NRS) , 0 - 10% normal goat serum (NGS) and 0 - 50% normal human serum (NHS). Excess solution containing the unbound radio-label should then be washed away. 125 32 3 35 Suitable radio-labels include I, P, H and S. These labels may be introduced into the antibody molecule using known techniques eg that of Salicinski et al, J.Endorinology 81 (1979). If a radio-label is used, the radioactivity of the labelled material is then measured using conventional methods. If an enzyme - labelled antibody to the bound antigen or the further antibody is to be used, this too may be achieved by exposure of the bound antigen or further antibody to a solution of the enzyme labelled antibody. Typically a commercially available antibody - enzyme conjugate may be used, diluted if necessary, for example in a buffer such as one containing PBS, 0 - 50% FC3, 0.5 - 15% NHS, 0 - 10% normal rabbit serum (NRS), 0 - 0.3% Tween 20. Excess solution containing unbound enzyme - labelled antibody should then be washed away, eg with PBS plus Tween 20. Suitable enzyme labels include peroxidase enzyme, eg horse-radish peroxidase (HRP0) and phosphatase enzymes. If not commercially available, antibody - enzyme conjugates may be prepared by known methods. Some of the steps from (and including) exposure of the bound antibody to the sample containing the bodily fluid onward may be carried out simultaneously. If an enzyme label has been used in alternative (a) or (b) the enzyme activity of the labelled material may then be measured, for example by allowing the bound enzyme label to catalyse a reaction the progress of which may be measured quantitatively and related to the amount of bound label present. Preferred reactions are those which may be followed photometrically, for example by the formation or disappearance of an optically absorbing compound. Such methods are conventional in the art. Whether alternative (a) or (b) is followed and whatever form of label is used, the results eg radioactivity, enzyme activity from the assay or observation of colour eg from bound coloured particles may be treated in a conventional data processing manner. For example the results of an assay on a particular sample of fluid may be compared with standard negative samples known to contain none of the specific immunoglobulin, or may be compared with a set of positive samples known to contain a range of units of the specific i πunoglobulin. Suitable processing methods will be well known to those skilled in the art. To assist in using the invention in practice, kits may be pro¬ vided containing for example samples of the necessary reagents, eg antibody for step (i), selected labelled antigen for step (ii)a, se¬ lected antigen for step (ii)b, labelled antibody for step (ii)b. The 5 kit may also contain a chart for interpreting the results of step (iii), eg the appearence of the substrate if coloured particles are used in step (ii)a. The reagents etc may be supplied in such a kit at a suitable dilution as discussed above, and the kit may contain a substrate having antibody already immobilised thereupon for step (i). 10 For the avoidance of doubt, references to a l:n dilution here¬ in (eg 1:1000 etc) mean 1 volume of liquid made up to n volumes with the diluent. The invention will now be described by way of example only with reference to the following figures. • ^--5 Figures 1 to 4 show comparisons between IgG assays using the method of the invention and assays using known methods on serum. • Figure 5 shows assay of IgM in saliva produced in response to Hepatitis A from two patients. 20 Figures 6 and 7 show the effect of various dilution levels on saliva IgM produced in response to Hepatitis A assays from two patients C and K. Figure 8 shows test : negative valves in salivary IgM produced in response to measles against the number of days 25 after onset of infection. Figure 9 shows an assay of IgM in saliva produced in response to mumps. In the following examples, Assay Examples 1, 2, 3, 4 and 5 illustrate assays for IgG In saliva samples, and Assay Examples 30 6 and 7 Illustrate assays for IgM in saliva. Examples 5 and 7 use the method of alternative (a) and the remainder use that .of alternative (b). Four clinical examples are also described to illustrate the use of invention in medical practice. 35 The following terms used in this description are Trade Marks: Eako, Pentawash, Sterilin, Tween, Elavia. Assay Example 1 Rubella IgG Capture radioimmunoassay (GACRIA) and enzymeimmuno- assay (GACELISA) on saliva samples. 1. Coat polystyrene beads by immersion in 1/1000 Dako Anti-IgG ( V- chain), diluted in coating buffer (0.01 M sodium carbonate, 0.01 M sodium bicarbonate buffer, pF^ 9.6). 2. Prepare a 1/2 dilution of each saliva sample in phosphate buffered saline (PBS) with 0.08% sodium azide, 0.1% Tween 20, and 10%'foetal • calf serum (FCS). 3. Incubate the samples with the anti - IgG coated beads for 3 hours at - 37°c 4. Wash the beads four times in PBS with 0.1% Tween 20 (PBST), using the pentawash system (Abbott Laboratories). Add a 1/12 dilution of Rubella HΛ antigen (prepared by the Division of Microbiological Reagents & Ouality Control, CPTIL. Note that the concentration of the prepared HΛ antigen may vary between batches). Dilute the antigen in PBS, 0.1% Tween 20 and 10% FCS. Incubate overnight at room temperature. A. Radioinmunoassay 5. Wash the beads four times in PBST, and incubate for 2 hours at 37 C with anti-Rubella monoclonal antibody ascites (1/50,000) diluted in PBS 0.1% Tween 20 (T20) 1°% P S, 5% normal rabbit serum (NRS), and 2% normal human serum (NHS). 6. . Wfcrafo four times in PBST and add 125 1 labelled anti mouse IgG (10 5 counts per minute in 190 jal diluent) in PBS,0.2% T 2 o» 10% FCS, 5% NRS, 5% normal goat serum (NGS), and 2% NHS. Incubate for 2 hours at 37°C. 7.. Wash, four times in PBST, transfer the beads to Abbott tubes, .and count the bound; radioactivity for 5 minutes in a - counter. Q laizying; ϋnπαπoassay 11 — As-- .above. Wash the beads four times in PBST Add HRPO conjugated monoclonal anti-rubella diluted 1 in 50 or 1 in 100 in PBS (without azide), FCS, 1% NHS, l^NRS, 0.1 % Tween 20. Incubate at room temperature for 3 hours. 6. Wash the beads four times in PBST and transfer to plastic tubes. Add 240 ul of substrate, ie ortho phenylene diamine (OPD) to the 1 in 100 dilution and tetramethylbenzidine (THB) to the 1 in 50 dilution. Incubate at room temperature for 4-5 minutes. Stop the eaction, with 100 l of 4-N HgSO^. 7- Transfer: 150 ul of each sample and a blank. Read " the optical den¬ sity- (σ„D> at 492 n (OPD) or 40 n (TMB). Assay Example 2 Hepatitis A IgG capture radioiiππunoassay (GACRIA) and enzyme -imnunoassay (GΛC - ELISΛ) on saliva saπples 1. Coat polystyrene beads by immersion in l/lOOO Anti - IgG (DAKO, jchain), diluted in coating buffer. (0.0.1M sodium carbonate, 0.01m sodium bicarbonate buffer, ph 9.6). 2*« Prepare a 1/10 dilution of each saliva sample in phosphate buffered saline (PBS) with 0.08% sodium azide, 0.1% Tween 20, and 10% foetal calf serum. 3. Incubate the samples with the anti - IgG coated beads for 3 hours at 37°c. R. Radioiimimoassay 4. Wash the beads four times in phosphate buffered saline with 0.05% Tween 20 (PBST) using the pentawash system (Abbott Laboratories). Add a 1/25 dilution of hepatitis A antigen (HAV Ag) in PBS, 0.1% Tween 20 (T20)' 10% foetal calf serum (FCS), and 1% normal human serum (NHS). Incubate overnight at room temperature. 5. Wash the beads four times in PBST, and incubate for 3 hours at 37 °c with J- 25 l - labelled human anti - HAV, 10 5 (counts per minute in 190 ul diluent) in PBS, 0.2% Υ 2Q , 50% FCS , 10,* NHS and NRS. 6. Wash four times in PBST, transfer the beads to counting tubes, and count the bound radioactivity for 5 minutes in a 5- counter. .Enzyme - Iππunoassay • 1 - 3 As above. 4. Wash the beads four times in PBST using the pentawash system (Abbott Laboratories). Add a 1/15 dilution of HΛV-Λg in PBS, 0.1% T 2Q , 10 FCS, and 1% NHS. Incubate overnight at room temperature. 5. Wash the beads four times in PBST. Add 1/100 dilution of anti - HAV HRPO Conjugate (prepared by the Division of Microbiological Reagents and Quality Control, Public Health Laboratory Service), in PBS, 0.2 T pn 50% FCS, 5% NRS and 10 NRS. Incubate for 1 hour at 37°C. 6. Wash the beads four times in PBST, then transfer to Abbott tubes, and add 240 μl of OPD Substrate to each bead. Incubate in the dark for 45 minutes at room temperature and stop the reaction with lOOμl 4N .Sulphuric acid. 7. Transfer 150 ul of each sample, and a blank, to a microtitre tray and read the optical density (O.D.) at 492 rm. Assay Example 3 Hepatitis B core (HBc) IgG capture radioimmunoassay (GACRIA) and enzyme - imπunoassay (GACELISΛ) on saliva saπples. 1. Coat polystyrene beads by immersion in l/lOOO DΛKO Anti-IgG {%- chain), diluted in coating buffer (0.01 M sodium carbonate, 0.01 M sodium bicarbonate buffer, pH 9.6). «. 2. Prepare a 1/10 dilution of each saliva sample in phosphate buffered saline (PBS) with 0.08% sodium azide, 0.1% Tween 20, and 10% foetal calf serum (FCS). 3. Incubate the samples with the anti-Igσ coated beads for 2 hours ' at 45°C. 4. Wash the beads four times in pns with 0.1% Tween 20 (PBST) using the pentawash system (Abbott Laboratories). Add a 1/200 dilution of HBc antigen, in PBS, 0.1% Tween 20 (T20), 10% FCS, and 0.5% normal human serum (NHS). Incubate for 60 minutes at 45°C A Radioimrtunoasssa . 5. Wash the beads four times in PBCT, and incubate for 2 hours at 45°C with 125 I - labelled human anti HBc (10 5 counts per minute in 19 ul diluent) in PBS, 0.2% T_0' 10% normal rabbit serum (NRS), 10% FCS, and 40% NHS. 6. Wash four times in PBΣ>T, transfer beads to counting tubes, arid count the bound radioactivity for 5 minutes in a Y- counter. SUBSTITUTE SHEET B Enzyme - iπτnunoassay 1 - 4 As above. 5. Wash the beads four times in PBST. Add 1/100 dilution of anti- HBc HRPO Conjugate (prepared by the Division of Microbiological Reagents and Q ' uality Control, CPHL), diluted in PBS (without azide), 0.2% T 2 n» 10% FCS, 5% NRS and 10% NHS. Incubate for 2 hours at 37°C. 6. Wash the beads four times in PBST, then transfer to Abbott tubes, and add 240 ul of OPD Substrate to each bead. Incubate in the dark for 45 minutes at room temperature and stop the reaction with 100 μl 4N Sulphuric acid. -7. Transfer 150 ul of each sample, and a blank, to a microtitre tray, and read the optical density (o.D) at 492 nm. Assay Example 4 Hunan intnunodβfioiency virus (HIV) Igq capture radioimnunoasβay (GACRIA) and enzyme-imnunoassay (GΛC - ELISA) on salivary samples 1. Coat polystyrene beads by immersion in l/lOO DΛKO anti-lgo ( i - chain), diluted in coating buffer (0.01 H sodium carbonate, 0.01 M sodium bicarbonate buffer, pH 9.6). 2. prepare a 1/10 dilution of each saliva sample in phosphate buffered saline (PBS) with 0.08% sodium azide, 0.1% Tween 20 ( τ 20) and 10% foetal calf serum (FCS). 3. ' incubate the samples with the anti -IgG coated beads for 3 hours at 37 σ C. 4. Wash the beads four times in PRS with 0.05% T 20 (PBST) using the pentawash system (Abbott laboratories), Add a l/πθ dilution of fllV antigen* (HIV Ag) in PBS, 0.1% T ?n , 10% FCS, and 1% normal human seru (NHS). Incubate overnight at room temperature. *The σptimuπ antigen dilution may vary between batches. A. Radioimnunoassay 5. Wash the beads four times in PBST, and incubate for 2 l/2 hours at 37°C ith 125 I - labelled human anti - HIV .(10 5 counts per minute in 190 μl diluent) in PBS, 0.2% T 20 , 10* Fcs » 20% N s ' and 10% normal rabbit serum (NRS) . SUBSTITUTE SHEET 6. Wash four times in PBST, transfer beads to counting tubes, and count the bound radio activity for 5 minutes in a •- counter. B. Fϊizyme - immunoassay 1 - 4 As above 5- Wash the beads four times in PBST. Add a l/4 dilution of Vfellccme human anti - HIV peroxide conjugate in PBS with 10% NHS. incubate for 21/2 hours at 37°C. 6. Wash four times in PBST, transfer to Abbott tubes and add 240^1 of OPD Substrate to each bead. Incubate in the dark for 30 minutes at room temperature and stop the reaction with lOO^ul 4N sulphuric acid. 7. ' Transfer 150 μl of each sample, and a blank, to a microtitre tray and read the optical density (o.D) at 492 mm. Assay Example 5 Human Immunodeficiency Virus (HIV) IgG capture particle assay on serum and saliva samples 1. " Coat 'U' or flat-bottom microtitre plate wells with a 1/1500 e dilution of DAKO anti-IgG ( 7f - chain) in coating buffer (0.01 M sodium carbonate, 0.01 M sodium bicarbonate buffer, pH 9.6). 2. Prepare a dilution(s) of the serum sample (range 1/10 - 1/2000) or a 1/5 dilution of each saliva sample in the well in 0 phosphate buffered saline (PBS) with 0.08% sodium azide, 0.01% Tween 20 (T ) and 10% foetal calf serum (FCS). 3. Incubate the samples in the anti-IgG coated plates for 1 to 3 hours at 37°C. 4. Wash the wells four times in PBS with 0.05% T (PBST) using 5 a proprietary microtitre plate washing system. 5. Prepare a working suspension of antigen coated particles (eg HIV-coated gelatin particles as supplied by Fujirebio/ Serodia but further diluted 1 in 20 in PBS with 2% FCS). Add 50 ul of suspension to each well. 0 6. Cover the plate and allow particles to settle overnight at room temperature. 7. (U-bottom plates) Score particle binding on a scale from 4+ " '= complete binding to 0 = complete particle settling. Scores of 2 to 4 are regarded as provisional positive reactions to be 5 confirmed by other methods. 8. (Flat-bottom plates) Plates are tilted at 45° and binding of particles is judged by the degree of settling of particles at the bottom edge of the well, scored as in 7, above. 9. If required, parallel tests using control, uncoated particles 0 may be done similarly. SUBSTITUTE SHEET Assay Example 6 IgM capture radioimmuno, enzyme immuno and particle assays for detection of IgM class antibody to human immunodeficiency virus, hepatitis A virus, hepatitis B virus core antigen, rubella virus, measles virus and mumps virus in salivary sample. Assays analogous to assay examples 1 - 5 above and closely following their methods were developed using surfaces coated with antibody to human IgM (u chain specific) instead of antibody to human IgG. The other reagents used were essentially the same as in previous examples or were antigens of rubella, measles or mumps virus. Optimum working dilutions were determined individually for each assay. For instance, capture radioimmunoassay for IgM anti measles in serum and saliva (used to confirm acute or recent infection with measles virus) : 1. Coat polystyrene beads by immersion in 1/3000 TAG0 anti-IgM (μ. chain), diluted in coating buffer (0.01 M sodium carbonate, 0.01 M sodium bicarbonate buffer, pH 9.6). 2. Prepare a 1/50 dilution of each serum or a 1/10 dilution of each saliva sample in phosphate buffered saline (PBS) with 0.08% sodium azide, 0.1% Tween 20 (T ) and 10% foetal calf serum (FCS). 3« Incubate the samples with the anti-IgM coated beads for 1 - 3 hours.at 37°C. 4. Wash the beads four times in PBS with 0.05% T (PBST) using the pentawash system (Abbott laboratories). Add 1/1000 dilution of measles* antigen (pelleted from the tissue culture fluid of infected Vero cell cultures) in PBS-, 0.1% T , 10% FCS, and normal human serum (NHS). Incubate overnight at room remDerature. *The optimum antigen dilution may vary between batches CUBSTITU1e. =>»*-*- l Wash the beads four times in PBST, and incubate for 1 hour at 37° with monoclonal antibody to measles virus and then, after 125 4 further washing, with 1 - labelled anti nouse IgG (9 X 10 counts per minute in 190 ul diluent) in PBS, 0.2% T , 10% FCS, 5% NHS, 5% normal rabbit serum (NRS) and 5% normal goat serum. Wash four times in PBST, transfer beads to counting tubes, and count the bound radioactivity for 5 minutes in a gamma counter. Assay Example 7 Human Immunodeficiency Virus (HIV) IgM capture particle assay on serum and saliva An assay for IgM produced in response to HIV (AIDS) infection was carried out using antigen coated particles as a selected labelled antigen. Microtitre plates were coated with a 1/1000 dilution of Dako anti IgM (u chain) in coating buffer as in assay example 5. The method of example 5 was otherwise followed. Clinical Experiments Experiments'- were carried out using the methods of assay ex¬ amples 1 - 4 and 6 above using 6mm diameter beads to compare ass¬ ays on saliva using the invention with known methods on serum. 5 Clinical Experiment 1. Snecimens σ-f serum and saliva were obtained simultaneously from- 29 members of laboratory staff and tested in parallel for anti¬ bodies to the following antigens: rubella, hepatitis A and Hepatitis B core. A small set of serum / saliva pairs from patients and conse- 101 πting-staff were* tested for antibodies against HIV (AIDS virus) antigen. IgG-assays 1 on the saliva specimens were carried out using the methods of examples 1 - 5 above. Comparitive assays were carrie-i out on serum using GACRIA (eg Parry, J Med Virol. 1£ (19°'6) "^7 - 15397), COMPRIA (COMPetetive Radio ImmunoAssay) (eg Parry, Med. Lab Sci (19-Sl) 303-311, Mortimer et al BM 29_01176-78, Cohen et al J Virol Meth (1981) 2: 181-192) and radial haemolysis (Kurtz et al J Hygiene (1980) 84- 213-222). The results showed the following: 20 (i) Specific IgM could readily be detected in the saliva as well as in the serum of patients with hepatitis A Infection, (ii) Specific IgG could be detected In both the serum and saliva of Individuals for a range of infections. (iii) Results of immunoglobulin assays on serum and saliva showed complete- ualitative and- close quantitative correlation. Corr¬ elations^be±weemassays on saliva using the method of the invention, aτώ:GΑC_E-Iλ f . CQMEEIA and non-capture (eg radial haemolysis) assays on serum were- fόunri for Rubella, Hepatitis A and B, and HIV (AIDS virus). Figs 1 - 4 show plots of T:N ratios, ie the ratio of the radio- 30 activity of a test sample (T) to that of a negative standard (N) known to contain none of the specific IgG, obtained using the method of the invention on saliva, against T:N ratios obtained on the corr¬ esponding serum using conventional techniques. Fig 1 shows correlation between Hepatitis A assays using the method 35 of example 2(A) and a GACRIA assay on serum. Fig 2 shows correlation between rubella assays usinε the method of " example 1(A) and GACRIA on serum. Fig 3 shows correlation between hepatitis A assays using the method of example 2(A) and a COMPRIA assay on serum. Fig 4 shows correlation between rubella virus assays using the method of example 1(A) and a radial haemolysis test on serum. Clinical Experiment 2 Pairs of serum/saliva samples were tested by conventional tests (COMPRIA, radial haemolysis, Enzyme Linked Immuno Sorbent Assay (ELISA (Elavia)) (eg Fasteur Diagnostics, Rubenz G, Northumbria Biolo- gicals) and IgG capture assays (GACRIA, GACELISA)) for antibody to Hepatitis A virus (100 pairs examined) ,HIV (53 pairs), Hepatitis B virus core (62) and rubella virus (30). Conventional assays failed to detect antibodies to the four viruses in the saliva of many (93/119) subjects whose serum contained these antibodies. The method of the invention detected the antibodies in the saliva, of all subjects who were seropositive by conventional tests except for two saliva specim¬ ens which were falsely negative for anti HBc and one falsely negative for anti-rubella virus. There was no significant diff¬ erence between GACRIA anti HIV p.nd anti HBc reactivities in serum and saliva, but GACRIA anti HAV and anti rubella reactivities were stronger in serum than in saliva. GACRIA and GACELISA results on the salivas for the four viral antibodies correlated closely and GACELISA results on saliva for anti-HAV and anti HIV were as acc¬ urate as GACRIA results. Both for saliva and serum GACRIA was sup¬ erior to IgA capture assays in detecting anti HAV and HIV. ffeterials and methods (i) feterials For anti HAV (Hepatitis A virus) and anti rubella virus tests pairs of seruπ 'saliva specimens were collected from travellers requesting prophylaxis against HAV and from laboratory staff. Each subject gave blood by venepuncture and salivated into a 3-5 cm diameter pot with a screw lid (sterilin). Paired blood and saliva specimens were similarly collected for anti HIV testing from high and low risk subjects. These specimens and those from laboratory staff were also tested for anti HBc (hepatitis B core). For testing the serum was separated from each clotted blood, saliva specimens were tested untreated. Serum and saliva were stored at -30 C. (ii) Conventional tests Anti HAV, anti HIV and anti HBc were measured by COMPRIA. Results were expressed as percentage inhib- ition of binding of label. Cut off values were 50 inhib¬ ition for the anti HAV and the anti HIV, and 70% for the anti HBc. Anti rubella was measured by radial haemolysis. Anti HIV and anti rubella were also measured by ELISA and Elavia. (iii) Capture assays 6 mm polystyrene beads were coated by immersion in a 1 : 1000 dilution of rabbit antiserum to human j - or θ -chain (DAK0 immunoglobulins). Be ore use and bet¬ ween each step in the assays the beads were washed in PBS with 0.05 % Tween 20. Serum or saliva samples diluted with PBS with 0.05 % Tween 20 were incubated with the beads. Then HIV antigen HAV antigen, HBc antigen or rubella virus haemagglutinin was applied followed by a detector reagent,, This reagent was purified human IgG with a high titre of anti HAV, anti HIV or anti HBc, or purified mouse monoclonal antibody to rubella, linked either 125 to -^1 or to peroxidase. Non specific sticking of the detect¬ or reagent was diminished by adding human serum (specific anti¬ body negative). Binding of the detector reagent was measured either as X emissions or as the optical density of colour generated by the action of the enzyne on orthophenylene diamine or (for rubella) teramethylbenzidine. Reactions exceeding twice the negative control (T:N>2) were considered positive. (iv) Results For each viral antibody results by capture assay for IgG antibody on serum and saliva were compared with results by conventional tests (table l). Conventional test results on sera were as follows: for anti HAV 66 subjects negative, 34 positive (COMPRIA 84% - 98% inhibition, median 92 %), for anti HIV 10 subjects negative, 43 positive (COMPRIA 84% - 98%, Elavia all > 2.00), or anti HBc ^7 subjects negative, 2 positive (COMPRIA βo - 95%, median 91 %) and for anti rubella 3 negative, 27 positive (radial haemolysis 7 - 12 mm, median 10mm, Rubenz G 0.75 - 2.00, median 2.00). Results by conventional tests on the salivas of seropositive subjects were mostly negat- ive. Rubella virus radial haemolysis and ELISA never detected antibody in saliva., and COMPRIA for anti HAV and anti HBc did so only in a few instances (3/32, 2/l8). With very few exceptions IgG antibody capture radioimmuno¬ assay (GACRIA) results on serum and saliva specimens were qualit- atively the same and matched conventional results on the sera. The exceptions were two subjects who had weak anti HBc and 1 who had weak anti-rubella reactivity in serum. These three were antibody negative in GACRIA tests on saliva. Correlations between results obtained with conventional tests on serum and with GACRIA on serum and saliva were, except for anti- rubella not close (table 2). Closer correlations were observed bet¬ ween serum and saliva results by GACRIA except for anti HIV. For this antibody, the two sorts of specimens were not tested simult¬ aneously as they were for the other three shown in table 2. Using the enzyme im unoassay (GACELISA) results were qualit¬ atively the same as for GACRIA and by conventional tests on the corresponding sera except for 4 false negative anti HBc and ten false negative anti rubella virus results • The 14 specimens in question were in almost all cases more reactive in GACELISA than the true negative specimens were, but they were less than twice the mean negative control value. GACELISA results on saliva corr¬ elated closely with GACRIA results except for anti HAV in which 2l/32 GACELISA optical density values were ^> 2.00, the upper limit on the ELISA reader. In view of the high concentration of IgA relative to IgG in saliva specific IgA and IgG capture assay tests of saliva were compared as a means of demonstratine: anti HAV and anti HIV positiv- ity. Specific IgA could only be found in the saliva of half of those tested though it was detected in the serum of all but two sero-positive individuals (table 3)» Table 1 Positive and negative results in conventional tests and by capture assays on paired serum and saliva specime Conventional Gacria Gacria Gacelisa test on on on on serum serum saliva Sciliva Anti HAV pos 34 34 (20-63, 40) "1" 34 (6-56, 19) 32/32^0. 7->2.00, >2.00) II " neg 66 66 (0.5-1.8, 0.9) 66 (0.6-1.4, 0.9) 65/65 (0.05-0.13, 0.08) Anti HIV pos 43 43 (11-33, 18) 41/41 (4-28, 18) 43 (0.37->2.00, 1.37) II " neg 10 10 (0.6-1.2, 1.0) 10 (0.3-1.0, 0.9) 10 (0.08-0.12, 0.09) Anti HBc pos 25 25 (2-141, 20) 23 (1-184, 13) 18/22 (0.04->2.0, 0.17) II " neg 37 37 (0.7-1.5, 1.0) 37 (0.7-1.3, 1.0 ) 36/36 (0.01-0.05, 0.02) Anti rubella pos 27 27 (5-49, 16) 26 (2-43, 12) (0.14-0.97, 0.33) II It neg 3 3 (0.3-1.1, 1.0) 3 (0.7-0.9, 0.9) 3 (0.08-0.10, 0.09) + shown in brackets are range, median test: negative ratio or (GACELISA) OD values * in some instances not all saliva specimens could be tested because the volumes collected had been inadequate Table 2 Correlation of GACRIA results on saliva with other results on serum and saliva specimens from seropositive individuals (correlation coefficient r is sho Gacria on Conventional Gacria Gacelisa saliva versus: test on εerum + on serum on saliva *** anti HAV 0.36* 0.71 0.42* anti HIV 0.08 0.15 0.83*** *** *** anti HBc 0.27 0.95 0.96 ** *** anti rubella 0.49 0.84 0.74*** + COMPRIA results, for anti rubella RH. Significant correlation p <0.05 : p <0.01 : p <0.001 23 Table 3 Comparison of Specific IgG (GACRIA) and specific IgA assay results on serum and saliva specimens from 10 anti HAV positive and 19 anti HIV positive subject Serum Saliva IgG 10 (74 - 155, 146) " 10 (50 - 113, 81) anti HAV IgA 10 ( 7 - 50, 22) 9 (1.9 - 35, 5.0) IgG 19 (11 - 33, 16) 19 (5 - 26, 20) anti HIV IgA 17 (1.8 - 31, 4.4) 5 (0.9 - 16, 1.4) + number positive (range, median test: negative ratio Clinical experiment 3 The method described in assay example 5 was used to detect anti HIV IgG in serum and saliva specimens. 170 coded serum specimens from individulas at increased risk 5 of HIV infection were tested. 26 had been confirmed as anti HIV positive by conventional assays and all of these gave 4+ (complete) agglutination in the particle assay. Of the 144 known to be anti HIV negative, four gave trace (1+) agglutination and two 3 + to 4 + ag^lutination. On repeat testing all were negative except one 10 serum specimen which still gave 4+ agglutination. 73 saliva specimens, 62 from patients known to have anti HIV in their serum, were tested under code. The salivas of 61 of the 62 seropositive patients were anti HIV IgG positive (56 gave 4+, 5 gave 3+ agglutination). Of the 11 seronegative patients 1 saliva 1 . 5 two gave 4+ agglutination which was further investigated using uncoated (HIV negative) particles. " Clinical experiment 4 Capture assays were set up with anti human IgM coated onto 0 polystyrene beads to detect specific IgM to hepatitis A, measles and mumps viruses. The method of assay example 6 was used. Serum and saliva specimens were collected from twenty two cases of clinical jaundice in parallel and tested for anti HIV IgM. Fifteen serurn and saliva pairs were positive and there was complete 5 agreement between the conventional serum assay and the assay on saliva, with strong signals from the positive saliva tests (see table 4). Saliva anti HAV IgM tests were done on consecutive specimens, diluted 1 in 10, from two patients over a 7 month period. Specific IgM antibody persisted for about one month. Other 0 tests showed that the optimum test dilution for saliva was 1 in 10 to 1 in 20 in contrast to the much higher optimum test dilutions (1 in 5000 - 1 in 400- " .O) for seru . The results for two patients identified as C and _ are shown graphically in Figs 5, 6 and 7. Fig 6 shows results for four consecutive samples 1, 2, 3 and 4 taken on 15 March, 5 April, 21 May and 20 October respectively. Fig 7 shows results for four consecutive samples 1, 2, 3 and 4 taken on 20 March, 13 April, 16 May and 15 October respectively. Anti measles IgM was detected by successively applying to the 5 beads, with intervening washing steps, the saliva specimen diluted 1 to 10, measles antigen (a dilution of virus pelleted from tissue culture fluid of infected Vero cells) , a monoclonal antibody to 125 measles virus and, finally, I labelled antibody to mouse IgG. From 69 cases of clinically diagnosed measles saliva was 10 collected by asking the affected children to chew on a roll of cotton wool which was then centrifuged to release clarified saliva. 67 of these clinically diagnosed cases gave positive results in the saliva assay for measles IgM antibody (T:N 2.0 - 63.4) and 2 gave negative results range 1.2 - 1.9). In n cases the date of onset of 1--5 illness was precisely known and the T:N values for the assays could be plotted against the interval at which saliva specimens were collected. These results are shown in Figure 8. A similar method was used to detect anti mumps IgM, except that after the addition of mumps virus, a dilution of a mumps antiserum 20 raised in a rabbit was added, followed by I labelled anti rabbit IgG. A child, FM, aged 6 years gave saliva specimens in the acute stage of mumps parotitis and for nine months thereafter. The IgM response was strong in three specimens collected at days 10, 16 and 21 post onset and remained detectable for two months. The results ^ are shown graphically in Figure 9. 30 " Diagnosis of Acute Hepatitis A Using Saliva Collected from Cases of Clixiical Jaundice SAL I V A Bos Neg Pos 15 1 0 S E RUM Neg 1 - Saliva anti HAV IgM T:N values 11 - 134 2 - Saliva anti HAV IgM T:N values 0.9 - 3.0

Claims: CLAIMS 1. A method of assaying specific immunoglobulin of any or all classes present in a human or animal bodily fluid selected from saliva, tears, semen,urine and cerebro spinal fluid characterised by the steps of: (I) immobilising an antibody to one or more classes of immunoglobulin onto a solid substrate, (ii) exposing the immobilised antibody to a sample of the bodily fluid so as to achieve binding of a proportion of any iπ_-_unoglobulin present in the fluid to the immobilised antibody, and either: a. exposing the bound immunoglobulin to a selected labelled antigen so as to achieve binding of the labelled antigen to at least an proportion of the bound immunoglobulin, or, b. exposing the bound immunoglobulin to a selected antigen so as to achieve binding of the antigen to at least a proportion of the bound iranunoglobulin and then binding a labelled antibody with specificicity for the selected antigen directly or indirectly to at least a proportion of the bound antigen (iii) detecting and/or measuring a property of the labelled antigen or antibody. 2. A method according to claim 1 characterised in that the immunoglobulin is IgG or IgM. 3. A method according to claim 2 characterised in that the fluid is saliva. 4. A method according to claim 3 characterised in that the saliva is obtained from a patient and then used either undiluted or diluted b * i. without, a step of increasing the immunoglobulin concentration. 5. A method according to claim 2 or 3 characterised in that alternative (ii)b is used. ύ . A method according to claim 5 characterised in that the immunoglobulin to be assayed is produced in response to infection by Hepatitis A, Hepatitis 3, Human Immunodeficiency Virus (ie AIDS virus), Rubella, Measles or Mumps. 7. A method according to claim 5 characterised in that the immunoglobulin to be assayed i. produced in response to Human Parvovirus B19 or Chickenpox (VZ virus). 8. A method according to claim 5 characterised in that a further antibody is bound to the bound antigen, and the labelled antibody is bound to the further antibody. 9. A method according to claii.i 8 characterised in that the immunoglobulin to be assayed is produced in response to Rubella infection. 10. A method according to claim 2 or 3 characterised in that alternative (ii)(a) is used. 11. A method according to claim 10 characterised in that the labelled antigen is a gelatin or latex particle coated with the antigen. 12. A method according to claim 12 characterised in that the particle is conspicuously coloured. 13. A method according to claim 11 characterised in that the mmunoglobulin is one produced in response to infection by Human Immunodeficiency Virus. 14. A kit for assaying specific immunoglobulin of any or all classes present in a human or animal bodily fluid selected from saliva, tears, semen, urine and cerebrospinal fluid using the method claimed in claim 1, characterised in that the kit contains one or more of the reagents necessary for performing one or more of steps (i), (ii)a, (ii)b or (iii). 15. A kit according to claim 14 characterised in that it cont¬ ains a substrate having an antibody specific to one or more cl¬ asses of immunoglobulin immobilised thereupon.

Inventors: MORTIMER PHILIP PAUL, PARRY JOHN VICTOR, MORTIMER, PHILIP, PAUL, PARRY, JOHN, VICTOR
Applicants: HEALTH LAB SERVICE BOARD, THE PUBLIC HEALTH LABORATORY SERVICE BOARD
Application year: 1988
Main classification: G01N33
IPC codes: G01N33