Abstract:
An immunoassay method for the detection of an antibody (Ab 1 ) to a viral antigen (Ag) wherein a whole human blood sample diluted with an isotonic aqueous solution is incubated with a solid-phase form of Ag whereby any Ab 1  present in the sample becomes bound to solid-phase Ag, the resulting solid-phase Ag-Ab 1  complexes are separated from the sample, a label-incorporated form of an antibody to Ab 1  (Ab 2  *) is contacted with the separated, solid-phase Ag-Ab 1  complexes, the resulting solid-phase Ag-Ab 1  -Ab 2  * complexes are separated from excess Ab 2  *, and the amount of the label in the separated, solid-phase Ag-Ab 1  Ab 2  * complexes is measured as a function of the presence of Ab 1  in the sample. Preferably the whole blood sample is diluted 1:20 by volume with an isotonic aqueous buffer solution. The method is particularly useful for the detection of cytomegalovirus antibody or Rubella antibody.

Description:
BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to immunoassay methods for detecting the presence of antibodies to viral antigens in test samples derived from human blood. The detection of viral antibodies in a patient&#39;s blood is indicative of past or current viral infection. Such information can be of great clinical value, particularly in prenatal screens to determine risks from infections due to such viral agents as cytomegalovirus, Rubella virus, herpesvirus, and the like or to determine success obtained with vaccinations against viral diseases such as measles, Rubella, mumps, polio and the like. 
     It is evident that a most desirable feature of any clinical assay is the ability to perform the assay on an easily obtainable sample with a minimum of sample pretreatment. Where the object of an assay is a component of blood, obviously the most desirable assay sample would be whole (or untreated) blood. However, as demonstrated below, the previously known immunoassays for viral antibodies have consistently been limited to assaying treated blood samples, primarily serum. Procedures for obtaining serum samples from whole blood samples require the use of apparatus and the skills of a technician, both of which add to assay time and cost. It has been discovered that, contrary to the prejudices raised by the prior art, the present immunoassay method can be used to assay whole human blood samples. 
     2. Brief Description of the Prior Art 
     Over the years, several different techniques have evolved for the determination of viral antibodies including complement fixation, hemagglutination, and, more recently, various immunoassays such as radioimmunoassay and enzyme immunoassay. Under the current state of the art, the method of choice is an immunoassay technique referred to as the indirect, solid-phase immunoassay. 
     In such a method for detecting an antibody to a viral antigen (hereinafter such antibody being abbreviated as &#34;Ab 1  &#34; and such antigen as &#34;Ag&#34;), a test sample, such as serum, derived from human blood is incubated with a solid-phase (i.e., immobilized or insolubilized) form of Ag whereby any Ab 1  present in the test sample becomes bound to the solid-phase Ag. After this first incubation, the resulting solid-phase Ag-Ab 1  complexes are separated from the test sample and a label-incorporated form of an antibody to Ab 1  (such labeled antibody being abbreviated as &#34;Ab 2  *&#34;) is contacted with the separated, solid-phase Ag-Ab 1  complexes. Where the label is radioactive, the assay is known as a radioimmunoassay. Other, nonradioisotopic, techniques can also be used. Where the label is an enzyme, the assay is known as an enzyme immunoassay. 
     After a second incubation period, the resulting solid-phase Ag-Ab 1  -Ab 2  * complexes are separated from excess Ab 2  *. Then, the amount of the label in the separated, solid-phase Ag-Ab 1  -Ab 2  * complexes is measured and is a function of the presence or amount of Ab 1  in the test sample. If a significant amount of Ab 1  is present in the sample, it will become bound to solid-phase Ag and thereafter by Ab 2  * so that the association of the label with the solid-phase in significant amounts is due to the presence of Ab 1 . 
     This indirect, solid-phase immunoassay technique can be schematically illustrated as follows: ##EQU1## 
     Representative of the known indirect, solid-phase immunoassays for viral antibodies are the procedures described in the following references: for the detection of antibodies to cytomegalovirus--Archives of Virology 58: 253 (1978), J. Immunol. 117: 2006 (1976), Brit. J. Exp. Pathol. 57: 243 (1976), and J. Infect. Dis. 136 Suppl. 5337 (1977) and for the detection of antibodies to Rubella--Brit. J. Exp. Pathol. 56: 338 (1975), J. Clin. Microbiol. 4: 117 (1976), Infection and Immunity 19: 369 (1978), Acta Path. and Microbiol. Scan. Section B 85: 113 (1977), Clin. and Exp. Immunol. 31: 50 (1978), and Res. Comm. Chem. Pathol. and Pharm. 19: 281 (1978). All of the above described techniques are directed specifically and solely to the assay of serum. Such references further reinforce the prejudice against performing the involved immunoassays on whole, untreated blood samples, a course of action which would clearly be more advantageous in terms of cost, convenience, simplicity and assay time. 
     SUMMARY OF THE INVENTION 
     It has now been discovered that the prior art indirect, solid-phase immunoassays for detecting viral antibodies can be applied directly to whole human blood samples. The qualitative and quantitative results using whole blood samples are virtually the same as those using serum samples as required by the prior art. In accordance with the present invention, the test sample employed in the assay is whole human blood diluted at least 1:20 by volume with an isotonic (i.e., having the same osmotic pressure as human blood) aqueous solution. Whole blood samples can be obtained by a simple finger prick or by conventional venipuncture and the assay run on the diluted sample without removal of red blood cells. The present assay is particularly applicable to the detection of antibodies to cytomegalovirus and/or Rubella antigens. Antibodies of various immune globulin classes, including IgG and IgM particularly, can be detected. Any conventional label may be used, including radioactive and enzyme labels. 
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     It has been unexpectedly found that the prejudices raised by the prior art against the immunoassay of whole blood samples are without substance, that the presence of red blood cells in the test sample (which cells are not present in sera) has no significant effect on the qualitative or quantitative assay results. Virtually identical correlation of assay results between serum and whole blood samples is attainable by diluting the whole blood samples by a predetermined factor, usually 2, to compensate for the volume of red blood cells in whole blood samples compared to plasma. 
     The test sample to be assayed is prepared by diluting whole blood by at least a factor of 1:20 by volume with the isotonic aqueous solution. Lesser dilutions have been found not to yield reproducible assay results due to high background levels of the label. Greater dilutions are possible with attendant loss in sensitivity at excessively high dilutions. A dilution of 1:50 by volume has been found to be particularly useful. The diluting solution must be isotonic so as to prevent hemolysis which has been found to cause false positive results. The diluting solution is preferably buffered (e.g., phosphate or tris-(hydroxymethyl)-amino-methane buffers, c.f. the examples which follow). The ingredients of the diluting solution (such as additional ingredients of the diluting solution (such as additional salts, e.g., sodium chloride) to obtain optional results for a given assay will be well within the ordinary skill in the art. 
     The parameters of the actual indirect, solid-phase immunoassay techniques that can be used in the present invention likewise are well within the ordinary skill in the art. In particular, the current state of the art teaches allowable and preferred sample volumes, incubation times and temperatures, available labels for the second antibody (Ab 2  *) and monitoring methods therefor, techniques for separating the solid-phase at various steps during the procedure, and techniques for correlating assay results to standard values. Further, various types of solid-phase forms of the viral antigen (Ag) are available in the art, including antigen immobilized on various carriers such as by physical adsorption or chemical coupling. 
    
    
     The present invention will now be illustrated, but is not intended to be limited, by the following examples. 
     
         ______________________________________TABLE OF CONTENTS FOR EXAMPLESExample No.______________________________________1           Preparation of soluble cytomega-       lovirus (CMV) antigen2           Preparation of soluble Rubella       antigen3           Preparation of immobilized (coated       tube) CMV antigen4           Preparation of immobilized (coated       tube) Rubella antigen5           Preparation of radiolabeled (.sup.125 I)       rabbit anti-human IgG6           Radioimmunoassay for CMV antibody       in finger prick whole human blood7           Radioimmunoassay for Rubella anti-       body in finger prick whole human       blood8           Radioimmunoassay for CMV and       Rubella antibodies in anticoagu-       lant human blood9           Enzyme immunoassay for CMV and       Rubella antibodies in whole human       blood______________________________________ 
    
     EXAMPLE 1 
     Preparation of Soluble Cytomegalovirus (CMV) Antigen 
     Human primary embryonic fibroblasts were grown as monolayers in roller bottles containing minimum essential medium and 10% fetal calf serum (Grand Island Biological Company, New York, N.Y., U.S.A.). The cells were infected with CMV AD-169 strain (American Type Culture Collection, Rockville, Md., U.S.A.) at multiplicity of infection of 1 plaque forming unit (pfu) per cell. At the completion of the cytopathic effect, each roller bottle was washed with phosphate buffered saline (PBS) containing 0.8% sodium chloride, 0.02% potassium chloride, 0.115% dibasic sodium phosphate (Na 2  HPO 4  -12H 2  O) and 0.02% monobasic potassium phosphate (KH 2  PO 4 ) and the cells were scraped off the glass with glass beads, followed by pellet formation by centrifugation at 300×g for 10 minutes. The supernatant liquid was removed and the precipitated pellet of the cells was resuspended in 10 milliliters (ml) of glycine buffer (containing 0.85% sodium chloride and 0.05 M glycine; pH adjusted to 9.0 by means of sodium hydroxide). The suspension of the cells was sonicated for 2 minutes and allowed to stand overnight at 4° C. The suspension was clarified by centrifugation at 7700×g for 20 minutes and the released virions were pelletted at 100,000×g for 30 minutes, the soluble antigen remaining in the supernatant solution. This soluble antigen was stored at -70° C. 
     EXAMPLE 2 
     Preparation of Rubella Antigen 
     Baby hamster kidney-21-C13 cells (Flow Laboratories, Scotland) were grown in roller bottles containing Dulbeco&#39;s modified essential medium (DMEM) and 10% fetal calf serum (Grand Island Biological Co.) and infected with Rubella virus M-33 strain (American Type Culture Collection). Starting 48 hours after the infection, the bottles were harvested daily for a week. Cell debris was removed by lowspeed centrifugation. Viral antigen was pelleted by centrifugation at 50,000×g for one hour through a cushion of 20% weight per weight of sucrose in TNE buffer [containing 20 millimolar (mM) tris-(hydroxymethyl)aminomethane, 100 mM sodium chloride and 1 mM ethylenediamine tetracetic acid; pH 7.4]. The pellet thus formed was resuspended in TNE buffer and the suspension was sonicated until clear. The resuspended pellets were further purified in a 20-60% w/w sucrose gradient in TNE buffer by centrifuging at 38,000 rpm for two hours. The viral band obtained was aspirated and dialyzed to four hours at 4° C. against glycine buffered saline, pH 9 (described in Example 1). Thereafter glycerol was added to a final concentration of 5%. This Rubella antigen suspension was stored frozen at -70° C. 
     EXAMPLE 3 
     Preparation of Immobilized (Coated Tube) CMV Antigen 
     The CMV soluble antigen obtained in Example 1 was diluted with glycine buffer (described in Example 1) to a concentration of 100-150 micrograms per milliliter (μg/ml) of protein and a complement fixation titer of 1/4-1/8. Aliquots (0.2 ml) of this solution were accurately and carefully pipetted into the bottom of separate 12×75 mm polystyrene test tubes (from Ultraplast, Tel-Aviv, Israel) and the test tubes were incubated at 4° C. for 16 hours. At the end of the incubation, the liquid remaining in the test tubes was removed, the test tubes were dried in an air stream, sealed with parafilm (Americal Can Company, Conn., U.S.A.) and stored at 4° C. 
     EXAMPLE 4 
     Preparation of Immobilized (Coated Tube) Rubella Antigen 
     The Rubella antigen obtained in Example 2 was diluted with glycine buffer (described in Example 1) to a concentration of about 10-15 μg/ml of protein and an RIA titer of about 1:32. Aliquots (0.2 ml) of this solution were accurately and carefully pipetted into the bottom of separate 12×75 mm polystyrene test tubes (from Ultraplast, Tel Aviv, Israel) and the test tubes were incubated at 4° C. for 16 hours. At the end of the incubation, the liquid remaining in the test tube was removed. The fixed antigen was inactivated by adding aliquots (0.2 ml) of 50% methanol diluted in TBS buffer (50 mM tris-(hydroxymethyl)-amino-methane, 0.85% sodium chloride) and incubating 5 minutes at room temperature. At the end of the incubation, the methanol was removed, the test tubes were dried in an air stream, sealed with parafilm and stored at 4° C. 
     EXAMPLE 5 
     Preparation of Radiolabeled ( 125  I) Rabbit Anti-human IgG 
     The IgG fraction of rabbit anti-human IgG serum was obtained by passing the serum through a DEAE-cellulose column (DE-52, Whatman Ltd., England) equilibrated with 0.015 M potassium phosphate buffer, pH 8.0. The IgG fraction thus obtained was radioactively labeled with  125  I by iodination in accordance with the chloramine T method described by Hutchinson and Zeigler, Applied Microbiology, December 1974, pp. 935-942. 
     EXAMPLE 6 
     Radioimmunoassay for CMV Antibody in Finger Prick Whole Human Blood 
     Approximately 10 microliters (μl) of finger prick blood were diluted with 0.5 ml PBS (described in Example 1) containing 1% bovine serum albumin (approximately a 1:50 dilution). A 0.2 ml aliquot of the diluted sample was added to a CMV antigen coated tube (prepared as in Example 3) and incubated 1 hour at 37° C. After aspirating the sample by vacuum, the tube was washed twice with approximately 3 ml PBS. A 0.2 ml volume of  125  I-anti-human IgG (300,000 counts per minute; prepared as in Example 5) in PBS containing 1% bovine serum albumin was added to the tube and incubated 1 hour at 37° C. After aspirating the liquid by vacuum, the tube was washed twice with approximately 3 ml PBS. The radioactivity remaining in the tube was measured in a gamma-counter. 
     The procedure was repeated on other finger prick blood samples and parallel assays were conducted on serum samples from the same patients (diluted 1:100 in PBS containing 1% bovine serum albumin). The results were as follows: 
     
         ______________________________________      Counts per minuteSample No.   Serum       Whole Blood______________________________________1             814         6552            6270        62653            6119        64564            2024        23255            3419        3252______________________________________ 
    
     EXAMPLE 7 
     Radioimmunoassay for Rubella Antibody in Finger Prick Whole Human Blood 
     Approximately 10 μl of finger prick blood were diluted with 0.5 ml TBS (50 mM tris-(hydroxymethyl)aminomethane, 0.85% sodium chloride, pH 6.5) containing 1% bovine serum albumin and 0.05% Tween 20 (polyethylene sorbitan monolaurate, J. T. Baker, N.J., U.S.A.). A 0.2 ml aliquot of the diluted sample (approximately a 1:50 dilution) was added to a Rubella antigen coated tube (prepared as in Example 4) and incubated 1 hour at 37° C. After aspirating the sample by vacuum, the tube was washed twice with TBS containing 0.05% Tween 20. A 0.2 ml volume of  125  I-anti-human IgG (300,000 counts per minute) in TBS containing 1% bovine serum albumin and 0.05% Tween 20 was added to the tube and incubated 1 hour at 37° C. After aspirating the liquid by vacuum, the tube was washed twice with TBS containing 0.05% Tween 20. The radioactivity remaining in the tube was measured in a gamma-counter. 
     The procedure was repeated on other finger prick blood samples and parallel assays were conducted on serum samples from the same patients (diluted 1:100 in TBS containing 1% bovine serum albumin and 0.05% Tween 20). The results were as follows: 
     
         ______________________________________      Counts per minuteSample No.   Serum       Whole Blood______________________________________1            1177        11752            5949        54813            6700        64304            5316        56645            3195        3375______________________________________ 
    
     EXAMPLE 8 
     Radioimmunoassay for CMV and Rubella Antibodies in Anticoagulant Human Blood 
     The assays described in Examples 6 and 7 were repeated using, in place of finger prick whole human blood, blood taken from a vein mixed with an anticoagulant (citrate). Before taking a sample of the anticoagulant blood for an assay the blood was mixed to obtain a homogeneous distribution of red blood cells. The results are as follows: 
     
         ______________________________________       Counts per minuteSample No.    Serum        Blood______________________________________CMV Antibody Assay1              789          7032             2185         19853             6520         6318Rubella Antibody Assay1              609         6252             6812         64253             8764         80604             5149         5271______________________________________ 
    
     EXAMPLE 9 
     Enzyme Immunoassay for CMV and Rubella Antibodies in Whole Human Blood 
     Approximately 10 μl of finger prick blood was diluted with 0.5 ml PBS (described in Example 2) containing 0.05% Tween 20 (J. T. Baker, N.J., U.S.A.). A 0.2 ml aliquot of the diluted sample (approximately a 1:50 dilution) was added to tubes coated with either CMV antigen or Rubella antigen (Examples 3 and 4), depending on which antibody was to be detected, and incubated 90 minutes at 37° C. After aspirating the sample by vacuum, the tube was washed twice with 3 ml PBS containing 0.05% Tween 20. A 0.2 ml volume of anti-human IgG labeled with the enzyme alkaline phosphatase (obtained from Miles-Yeda, Rehovot, Israel) in PBS containing 0.05% Tween 20 was added to the tube and incubated 90 minutes at 37° C. After aspirating the liquid by vacuum, the tube was washed twice with approximately 3 ml PBS containing 0.05% Tween 20. A 0.5 ml volume of enzyme substrate solution (constituting per liter of solution, 1 gram (g) 4-nitrophenyl phosphate, 97 ml diethanolamine, 0.2 g sodium azide, and hydrochloric acid to give pH 9.8) was added to the tube and incubated 30 minutes at 37° C. The optical density of the solution in the tube was measured at 435 nanometers (nm). 
     The procedure was repeated on other finger prick blood samples and parallel assays were conducted on serum samples from the same patients (diluted 1:100 in PBS containing 0.05% Tween 20). The results were as follows: 
     
         ______________________________________      O.D. at 435 nmSample No.   Serum       Whole Blood______________________________________CMV Antibody Assay1            0.241       0.2882            0.931       0.9103            2.680       2.610Rubella Antibody Assay1            0.593       0.6612            0.849       0.784______________________________________ 
    
     Thus, the examples demonstrate that the present invention provides results in assaying whole blood samples not significantly different from those obtained in assaying serum samples.