Patent Publication Number: US-2022236259-A1

Title: Novel thyroid peroxidase autoantibody immunoassay

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application claims priority of U.S. Provisional Application No. 62/693,434 filed Jul. 2, 2018, which is incorporated by reference herein in its entirety. 
    
    
     TECHNICAL FIELD 
     Disclosed herein are methods of detecting an anti-thyroid peroxidase antibody in a biological sample from a subject and methods of diagnosing a thyroid disease in the subject. 
     SEQUENCE LISTING 
     The instant application contains a Sequence Listing which has been submitted electronically in ASCII format and is hereby incorporated by reference in its entirety. Said ASCII copy, created on Jul. 12, 2021, is named 2018P03766WO_ST25.tx and is 7,533 bytes in size. 
     BACKGROUND 
     Thyroid peroxidase (TPO) is a membrane bound glycoprotein found in the apical membrane of thyroid follicular cells. TPO oxidizes iodide ions for addition onto thyroglobulin tyrosine residues for production of key thyroid hormones T3 and T4. TPO is also an autoantigen in thyroid diseases, including, for example, Hashimoto&#39;s thyroiditis, Graves&#39; disease, atrophic thyroiditis, primary mixedema, and postpartum thyroiditis in women. Elevated levels of anti-TPO autoantibody are a risk factor for thyroid diseases. 
     Current immunoassays for detecting patient anti-TPO autoantibody utilize human-derived TPO, which is obtained from human cadaver thyroid tissue. Human-derived TPO, however, is costly, difficult to purify, and low-yield, and can vary significantly from lot to lot. The current immunoassays further require multiple non-human secondary antibodies. 
     SUMMARY 
     Disclosed herein are methods of detecting an anti-thyroid peroxidase antibody in a biological sample from a subject. The methods can comprise incubating the biological sample from the subject with a solid support, an unlabeled recombinant cynomolgus monkey thyroid peroxidase (rTPO), and a labeled cynomolgus monkey rTPO. In the presence of the anti-thyroid peroxidase antibody, a complex comprising the labeled cynomolgus monkey rTPO, the unlabeled cynomolgus monkey rTPO, and the solid support is formed. The methods further comprise detecting the complex, the presence of which indicates the presence of the anti-thyroid peroxidase antibody in the biological sample. In some embodiments, the methods can be an “antigen bridge” assay as described herein. 
     Also provided are methods of detecting an anti-thyroid peroxidase antibody in a biological sample from a subject, the methods comprising incubating the biological sample from the subject with a solid support, a cynomolgus monkey rTPO, and an anti-human secondary antibody. In the presence of the anti-thyroid peroxidase antibody, a complex comprising the solid support, the cynomolgus monkey rTPO, and the anti-human secondary antibody is formed. The methods further comprise detecting the complex, the presence of which indicates the presence of the anti-thyroid peroxidase antibody in the biological sample. In some embodiments, the methods can be an “rTPO capture” assay as described herein. In some embodiments, the methods can be an “IgG class capture” assay as described herein. 
     Further provided are methods of detecting an anti-thyroid peroxidase antibody in a biological sample from a subject, the methods comprising incubating the biological sample from the subject with a solid support, an unlabeled anti-TPO antibody, a cynomolgus monkey rTPO, and a labeled anti-TPO antibody and detecting the anti-thyroid peroxidase antibody, the detecting comprising analyzing a decrease in the formation of a complex comprising the solid support, the unlabeled anti-TPO antibody, the cynomolgus monkey rTPO, and the labeled anti-TPO antibody. The presence of an anti-thyroid peroxidase antibody in the biological sample decreases formation of a complex comprising the solid support, the unlabeled anti-TPO antibody, the cynomolgus monkey rTPO, and the labeled anti-TPO antibody. The presence of complex is inversely proportional to the presence of the anti-thyroid peroxidase antibody in the biological sample. In some embodiments, the methods can be a “competition” assay or an “inhibition” assay, as described herein. 
     Further disclosed herein are methods of diagnosing a thyroid disease in a subject. The methods can comprise incubating a biological sample from the subject with a solid support, an unlabeled recombinant cynomolgus monkey thyroid peroxidase (rTPO), and a labeled cynomolgus monkey rTPO. In the presence of an anti-thyroid peroxidase antibody in the biological sample, a complex comprising the labeled cynomolgus monkey rTPO, the unlabeled cynomolgus monkey rTPO, and the solid support is formed. The method further comprises diagnosing the subject with the thyroid disease if the complex is formed. 
     Methods of diagnosing a thyroid disease in a subject comprising incubating a biological sample from the subject with a solid support, a cynomolgus monkey rTPO, and an anti-human secondary antibody are also provided. In the presence of an anti-thyroid peroxidase antibody in the biological sample, a complex comprising the solid support, the cynomolgus monkey rTPO, and the anti-human secondary antibody is formed. The method further comprises diagnosing the subject with the thyroid disease if the complex is formed. 
     Further provided are methods of diagnosing a thyroid disease in a subject comprising incubating a biological sample from a subject with a solid support, an unlabeled anti-TPO antibody, a cynomolgus monkey rTPO, and a labeled anti-TPO antibody, and diagnosing the subject with the thyroid disease if the formation of a complex comprising the solid support, the unlabeled anti-TPO antibody, the cynomolgus monkey rTPO, and the labeled anti-TPO antibody is decreased. The presence of an anti-thyroid peroxidase antibody in the biological sample decreases formation of a complex comprising the solid support, the unlabeled anti-TPO antibody, the cynomolgus monkey rTPO, and the labeled anti-TPO antibody. 
     Recombinantly produced thyroid peroxidase (rTPO) comprising the amino acid sequence of SEQ ID NO: 1 is also disclosed, as are cDNA molecules encoding the recombinantly produced rTPO. 
     Further disclosed herein are kits. In some embodiments, the kits comprise a solid support, an unlabeled cynomolgus monkey rTPO, and a labeled cynomolgus monkey rTPO. 
     Alternatively, the kits can comprise a solid support, a cynomolgus monkey rTPO, and an anti-human secondary antibody. 
     In some embodiments, the kits comprise a solid support, a cynomolgus monkey rTPO and an anti-TPO antibody. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The summary, as well as the following detailed description, is further understood when read in conjunction with the appended drawings. For the purpose of illustrating the disclosed methods and kits, there are shown in the drawings exemplary embodiments of the methods and kits; however, the methods and kits are not limited to the specific embodiments disclosed. In the drawings: 
         FIG. 1  illustrates an exemplary reaction scheme for one embodiment of the disclosed methods, referred to herein as the antigen bridge immunoassay. 
         FIG. 2  illustrates an exemplary reaction scheme for one embodiment of the disclosed methods, referred to herein as the IgG class capture immunoassay. 
         FIG. 3  illustrates an exemplary reaction scheme for one embodiment of the disclosed methods, referred to herein as the rTPO capture immunoassay. 
         FIG. 4  illustrates an exemplary reaction scheme for one embodiment of the disclosed methods, referred to herein as the competition/inhibition immunoassay. 
         FIG. 5  illustrates the results from an exemplary rTPO lot-to-lot purity and immunoreactivity assessment. Panel A shows a gel stained with Gel Code Blue (ThermoFisher 25590); panel B shows a nitrocellulose membrane probed with a mouse anti-TPO monoclonal antibody followed by a goat anti-mouse IgG-HRP secondary. 4-chloro-1-naphthol (Sigma) was used to develop the blot. 
         FIG. 6  illustrates the results from an exemplary rTPO isoelectric point assessment for 4 rTPO antigen lots. 
         FIG. 7A  and  FIG. 7B  illustrate the results from an exemplary assessment of immunoassay susceptibility to deglycosylated rTPO.  FIG. 7A  shows a rTPO antigen bridge assay and  FIG. 7B  shows a human IgG class capture assay built using various deglycosylated components. “Hook Ratio” refers to relative light units (RLU) of a 20,000 IU/mL sample divided by RLU of the highest standard at 625 IU/mL. “BKGD” refers to background RLU of an aTPO-negative serum patient pool, i.e., the lowest standard. “S08/S01” refers to RLU of the highest standard at 625 IU/mL divided by the RLU of the lowest standard. “SP” means “solid phase” and “LR” means “Lite reagent”; “de” refers to “deglycosylation.” 
         FIG. 8  illustrates the results from an exemplary characterization of rTPO complexed with autoantibodies from an anti-TPO antibody-positive disease patient sample, with relative light units (RLU) plotted on a chromatogram from size exclusion chromatography (SEC) fractions. 
         FIG. 9  is a chromatogram from an exemplary SEC analysis of pooled fractions from the fractions depicted in the rectangle in  FIG. 8 . 
         FIG. 10A ,  FIG. 10B ,  FIG. 10C , and  FIG. 10D  illustrate exemplary MALDI-TOF spectra of isolated fractions 51, S2, S3 and S4 from  FIG. 9 . 
         FIG. 11  illustrates the results from an analysis of immunoassay performance using native TPO and recombinant TPO (“rTPO”). 
         FIG. 12A ,  FIG. 12B ,  FIG. 12C , and  FIG. 12D  illustrate the results from exemplary experiments performed using the disclosed immunoassays:  FIG. 12A ) antigen bridge,  FIG. 12B ) IgG class capture,  FIG. 12C ) rTPO capture, and  FIG. 12D ) competition/inhibition formats. Each assay was performed using the ADVIA CENTAUR® system. RLU output associated with standardization material value was assigned from WHO 66/387 Human Anti-thyroid Microsome Serum. 
     
    
    
     DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS 
     The disclosed methods and kits may be understood more readily by reference to the following detailed description taken in connection with the accompanying figures, which form a part of this disclosure. It is to be understood that the disclosed methods and kits are not limited to the specific methods and kits described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting of the claimed methods and kits. 
     Unless specifically stated otherwise, any description as to a possible mechanism or mode of action or reason for improvement is meant to be illustrative only, and the disclosed methods and kits are not to be constrained by the correctness or incorrectness of any such suggested mechanism or mode of action or reason for improvement. 
     Throughout this text, the descriptions refer to methods of detecting an antibody and methods of diagnosing a thyroid disease. Where the disclosure describes or claims a feature or embodiment associated with a method of detecting an antibody, such a feature or embodiment is equally applicable to the methods of diagnosing a thyroid disease. Likewise, where the disclosure describes or claims a feature or embodiment associated with a method of diagnosing a thyroid disease, such a feature or embodiment is equally applicable to the methods of detecting an antibody. 
     Where a range of numerical values is recited or established herein, the range includes the endpoints thereof and all the individual integers and fractions within the range, and also includes each of the narrower ranges therein formed by all the various possible combinations of those endpoints and internal integers and fractions to form subgroups of the larger group of values within the stated range to the same extent as if each of those narrower ranges was explicitly recited. Where a range of numerical values is stated herein as being greater than a stated value, the range is nevertheless finite and is bounded on its upper end by a value that is operable within the context of the invention as described herein. Where a range of numerical values is stated herein as being less than a stated value, the range is nevertheless bounded on its lower end by a non-zero value. It is not intended that the scope of the invention be limited to the specific values recited when defining a range. All ranges are inclusive and combinable. 
     When values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment. Reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. 
     It is to be appreciated that certain features of the disclosed methods and kits which are, for clarity, described herein in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the disclosed methods and kits that are, for brevity, described in the context of a single embodiment, may also be provided separately or in any subcombination. 
     As used herein, the singular forms “a,” “an,” and “the” include the plural. 
     Various terms relating to aspects of the description are used throughout the specification and claims. Such terms are to be given their ordinary meaning in the art unless otherwise indicated. Other specifically defined terms are to be construed in a manner consistent with the definitions provided herein. 
     The term “comprising” is intended to include examples encompassed by the terms “consisting essentially of” and “consisting of”; similarly, the term “consisting essentially of” is intended to include examples encompassed by the term “consisting of.” 
     Disclosed herein are immunoassays and methods for detecting an anti-thyroid peroxidase (anti-TPO) antibody in a biological sample from a subject and/or diagnosing a thyroid disease in a subject. 
     The methods of detecting an anti-thyroid peroxidase antibody in a biological sample from a subject can comprise:
         a) incubating the biological sample from the subject with:
           a solid support,   an unlabeled recombinant cynomolgus monkey thyroid peroxidase (rTPO), and   a labeled cynomolgus monkey rTPO,
               wherein, in the presence of the anti-thyroid peroxidase antibody, a complex comprising the labeled cynomolgus monkey rTPO, the unlabeled cynomolgus monkey rTPO, and the solid support is formed; and   
               
           b) detecting the complex, the presence of which indicates the presence of the anti-thyroid peroxidase antibody in the biological sample.       

     In some embodiments, the methods can comprise an “antigen bridge” immunoassay, an exemplary reaction scheme for which is illustrated in  FIG. 1 . A biological sample known to have, or suspected of having, an anti-TPO antibody  10 , is incubated with a labeled rTPO  20  and solid support having an unlabeled rTPO bound thereto  30 . In the absence of the anti-TPO antibody  10 , the labeled rTPO  20  will not bind to or otherwise interact with the solid support. Thus, in the absence of the anti-TPO antibody, the labeled rTPO remains in the solution and isolation of the solid support would not result in isolation of the labeled rTPO. When the anti-TPO antibody  10  is present in the biological sample, the anti-TPO antibody  10  simultaneously binds to the unlabeled rTPO bound to the solid support  30  and the labeled rTPO  20 , thereby linking the labeled rTPO  20  and the solid support  30  and resulting in the formation of a solid support/labeled rTPO complex  40 . It is to be understood that the order in which the incubation takes place can be different from that exemplified in  FIG. 1 . For example, the biological sample known to have, or suspected of having, an anti-TPO antibody  10  can first be incubated with a solid support having an unlabeled rTPO bound thereto  30  followed by incubation with a labeled rTPO  20 . Alternatively, the biological sample known to have, or suspected of having, an anti-TPO antibody  10  can simultaneously be incubated with a solid support having an unlabeled rTPO bound thereto  30  and a labeled rTPO  20 . 
     The biological sample known to have, or suspected of having, an anti-TPO antibody  10  can be incubated in a reaction mixture for a period of time sufficient to achieve a partial reaction without allowing the reaction to achieve equilibrium, such as for about 1 minute, about 2 minutes, about 3 minutes, about 4 minutes, about 5 minutes, or less than about 10 minutes. The labeled rTPO  20  can be added and incubated with the biological sample for about 1 minute, about 2 minutes, about 3 minutes, about 4 minutes, or less than about 5 minutes. The solid support having unlabeled rTPO bound thereto  30  can be added to the mixture of biological sample and labeled rTPO  20  and incubated for a period of time sufficient to achieve a partial reaction without allowing the reaction to achieve equilibrium, such as for about 1 minute, about 2 minutes, about 3 minutes, about 4 minutes, about 5 minutes, about 6 minutes, about 7 minutes, or about less than 10 minutes. In some embodiments, the incubating steps are performed in a total of about 10 minutes to about 20 minutes. The subsequent detecting can be performed in less than about 5 minutes. It is to be understood that the amount of time needed for the assay may vary based upon several factors including the level of the anti-TPO antibody(ies) in the biological sample and the affinity of the anti-TPO antibody(ies) for the rTPO. In some embodiments, incubating the biological sample with the reaction mixture can be performed for a period of time sufficient to enable the reaction to achieve equilibrium, such as on the order of 1 or more hours. Thus, the disclosed methods can be performed for any suitable amount of time. 
     The unlabeled rTPO can be directly or indirectly linked to the solid support. Suitable techniques for directly linking the unlabeled rTPO to the solid support include, for example, covalent attachment, adsorption, noncovalent interaction, or combinations thereof. In some embodiments, the unlabeled rTPO can be directly linked to the solid support by N-hydroxysuccinimide (NHS) chemistry or by 1-Ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) NHS chemistry. Suitable techniques for indirectly linking the rTPO to the solid support include, for example, linking through a peptide, a protein, an antibody, a linker, or a combination thereof. In some embodiments, the unlabeled rTPO can be indirectly linked to the solid support through streptavidin and biotin. For example, the unlabeled rTPO can be biotinylated and the solid support can comprise streptavidin. 
     Exemplary solid supports include, but are not limited to, a column matrix material, a culture plate, a tube, a dish, a flask, a microtiter plate, a bead/particle, heat-killed formalin- (or other chemically)-fixed prokaryotic or eukaryotic cells, microscope slides, ACLAR® Film, or any other optically transparent polymer, or a combination thereof. The solid support can be fully or partially composed of plastic, cellulose, cellulose derivatives, nitrocellulose, glass, fiberglass, latex, or a combination thereof. In some embodiments, the solid support comprises a magnetic bead/particle. In some embodiments, the magnetic bead/particle is a paramagnetic particle (PMP). In some embodiments, the magnetic bead/particle is a latex magnetic particle (LMP). 
     The label can be any suitable label known to those skilled in the art to be useful for creating a detectable signal. Suitable detectable labels include, but are not limited to, enzyme conjugates (e.g., horseradish peroxidase (HRP), alkaline phosphatase, glucose oxidase, and β-galactosidase), fluorescent probes, radioactive isotopes, chemiluminescent compounds, bioluminescent compounds, or combination thereof. In some embodiments, the label is an acridinium ester (“AE”) or an analog thereof. Suitable AE analogs include: dimethyl acridinium ester (DMAE), N-sulfopropyl dimethyl acridinium ester (NSP-DMAE), high quantum yield acridinium ester (HQYAE, acridinium, 9-[[4-[[[6-[(2,5-dioxo-1-pyrrolidinyl)oxy]-6-oxohexyl]amino]carbonyl]-2,6-dimethylphenoxy]carbonyl]-2,7-bis(3,6,9,12,15,18-hexaoxanonadec-1-yloxy)-10-(3-sulfopropyl)-, inner salt), Zwitterionic acridinium ester (ZAE, Acridinium, 9-[[4-[[[3-[[3-[[5-[(2,5-dioxo-1-pyrrolidinyl)oxy]-1,5-dioxopentyl]amino]propyl]methyl(3-sulfopropyl)ammonio]propyl]amino]carbonyl]-2,6-dimethylphenoxy]carbonyl]-10-(3-sulfopropyl)-, bis(inner salt)), N-sulfopropyl-2-isopropoxy dimethyl acridinium ester (Iso-Di-ZAE), trisulfopropyl acridinium ester (TSP-AE), or N-sulfopropyl dimethyl acridinium ester with hexa(ethylene)glycol linker (HEG-GLU-AE). In some embodiments, the labeled cynomolgus monkey rTPO comprises rTPO-NSP-DMAE. The rTPO-NSP-DMAE can be present at about 50 ng/ml to about 2 μg/ml. In some embodiments, the rTPO-NSP-DMAE can be present at about 220 ng/ml. 
     The solid support having unlabeled rTPO bound thereto and/or the labeled rTPO can be present in a buffer comprising, for example, phosphate buffer, NaCl, EDTA, pluronic F-127, sodium azide, sorbitol, sulfhydryl modified bovine serum, or any combinations, variations, or equivalents thereof. In one embodiment, the buffer comprises about 100 mM phosphate buffer, about 400 mM NaCl, about 1.9 g/L EDTA, about 0.2% (v/v) pluronic F-127, about 0.9 g/L sodium azide, about 10% sorbitol, and about 10 g/L sulfhydryl modified bovine serum albumin. 
     Also provided are methods of detecting an anti-thyroid peroxidase antibody in a biological sample from a subject comprising:
         a) incubating the biological sample from the subject with:
           a solid support,   a cynomolgus monkey rTPO, and   an anti-human secondary antibody,
               wherein, in the presence of the anti-thyroid peroxidase antibody, a complex comprising the solid support, the cynomolgus monkey rTPO, and the anti-human secondary antibody is formed; and   
               
           b) detecting the complex, the presence of which indicates the presence of the anti-thyroid peroxidase antibody in the biological sample.       

     The anti-human secondary antibody can be directly or indirectly linked to the solid support and the cynomolgus monkey rTPO can comprise a label. In some embodiments, the anti-human secondary antibody can be directly linked to the solid support by glutaraldehyde fixation. 
     In some embodiments, the methods can comprise an “IgG class capture” immunoassay, an exemplary reaction scheme for which is illustrated in  FIG. 2 . A biological sample known to have, or suspected of having, an anti-TPO antibody  10 , is incubated with a labeled rTPO  20  and a solid support having an unlabeled anti-human secondary antibody bound thereto  50 . In the absence of the anti-TPO antibody  10 , the labeled rTPO  20  will not bind to or otherwise interact with the solid support. Thus, in the absence of the anti-TPO antibody, the labeled rTPO remains in the solution and isolation of the solid support would not result in isolation of the labeled rTPO. When the anti-TPO antibody  10  is present in the biological sample, the anti-TPO antibody  10  simultaneously binds to the unlabeled anti-human secondary antibody bound to the solid support  50  and the labeled rTPO  20 , thereby linking the labeled rTPO  20  and the solid support  50  and resulting in the formation of a solid support/labeled rTPO complex  60 . It is to be understood that the order in which the incubation takes place can be different from that exemplified in  FIG. 2 . For example, the biological sample known to have, or suspected of having, an anti-TPO antibody  10  can first be incubated with a solid support having an unlabeled anti-human secondary antibody bound thereto  50  followed by incubation with a labeled rTPO  20 . Alternatively, the biological sample known to have, or suspected of having, an anti-TPO antibody  10  can simultaneously be incubated with a solid support having an unlabeled anti-human secondary antibody bound thereto  50  and a labeled rTPO  20 . 
     The biological sample known to have, or suspected of having, an anti-TPO antibody  10  can be incubated in a reaction mixture for about 1 minute, about 2 minutes, about 3 minutes, about 4 minutes, about 5 minutes, or less than about 10 minutes. The labeled rTPO  20  can be added and incubated with the biological sample for about 1 minute, about 2 minutes, about 3 minutes, about 4 minutes, or less than about 5 minutes. The solid support having an unlabeled anti-human secondary antibody bound thereto  50  can be added to the mixture of biological sample and labeled rTPO  20  and incubated for about 1 minute, about 2 minutes, about 3 minutes, about 4 minutes, about 5 minutes, about 6 minutes, about 7 minutes, or about less than 10 minutes. In some embodiments, the incubating steps are performed in a total of about 10 minutes to about 20 minutes. The subsequent detecting can be performed in less than about 5 minutes. It is to be understood that the amount of time needed for the assay may vary based upon several factors including the level of the anti-TPO antibody(ies) in the biological sample and the affinity of the anti-TPO antibody(ies) for the rTPO. Thus, the disclosed methods can be performed for any suitable amount of time. 
     The cynomolgus monkey rTPO can be directly or indirectly linked to the solid support and the anti-human secondary antibody can comprise a label. In some embodiments, the rTPO can be directly linked to the solid support by N-hydroxysuccinimide (NHS) chemistry or by 1-Ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) NHS chemistry. 
     In some embodiments, the methods can comprise an “rTPO capture” immunoassay, an exemplary reaction scheme for which is illustrated in  FIG. 3 . A biological sample known to have, or suspected of having, an anti-TPO antibody  10 , is incubated with a labeled anti-human secondary antibody  70  and a solid support having an unlabeled rTPO bound thereto  30 . In the absence of the anti-TPO antibody  10 , the labeled anti-human secondary antibody  70  will not bind to or otherwise interact with the solid support. Thus, in the absence of the anti-TPO antibody, the labeled anti-human secondary antibody remains in the solution and isolation of the solid support would not result in isolation of the labeled anti-human secondary antibody. When the anti-TPO antibody  10  is present in the biological sample, the anti-TPO antibody  10  simultaneously binds to the unlabeled rTPO bound to the solid support  30  and the labeled anti-human secondary antibody  70 , thereby linking the labeled anti-human secondary antibody  70  and the solid support  30  and resulting in the formation of a solid support/labeled anti-human secondary antibody complex  80 . It is to be understood that the order in which the incubation takes place can be different from that exemplified in  FIG. 3 . For example, the biological sample known to have, or suspected of having, an anti-TPO antibody  10  can first be incubated with a solid support having an unlabeled rTPO bound thereto  30  followed by incubation with a labeled anti-human secondary antibody  70 . Alternatively, the biological sample known to have, or suspected of having, an anti-TPO antibody  10  can simultaneously be incubated with a solid support having an unlabeled rTPO bound thereto  30  and a labeled anti-human secondary antibody  70 . 
     The biological sample known to have, or suspected of having, an anti-TPO antibody  10  can be incubated in a reaction mixture for about 1 minute, about 2 minutes, about 3 minutes, about 4 minutes, about 5 minutes, or less than about 10 minutes. The labeled anti-human secondary antibody  70  can be added and incubated with the biological sample for about 1 minute, about 2 minutes, about 3 minutes, about 4 minutes, or less than about 5 minutes. The solid support having an unlabeled rTPO bound thereto  30  can be added to the mixture of biological sample and labeled anti-human secondary antibody  70  and incubated for about 1 minute, about 2 minutes, about 3 minutes, about 4 minutes, about 5 minutes, about 6 minutes, about 7 minutes, or about less than 10 minutes. In some embodiments, the incubating steps are performed in a total of about 10 minutes to about 20 minutes. The subsequent detecting can be performed in less than about 5 minutes. It is to be understood that the amount of time needed for the assay may vary based upon several factors including the level of the anti-TPO antibody(ies) in the biological sample and the affinity of the anti-TPO antibody(ies) for the rTPO. Thus, the disclosed methods can be performed for any suitable amount of time. 
     The anti-human secondary antibody or the cynomolgus monkey rTPO can be directly or indirectly linked to the solid support by any suitable means known to those skilled in the art. Suitable techniques for direct linking include, for example, covalent attachment, adsorption, noncovalent interaction, or combinations thereof. In some embodiments, the anti-human secondary can be directly linked to the solid support by glutaraldehyde fixation. Suitable means for indirect linking include, for example, linking through a peptide, a protein, an antibody, a linker, or a combination thereof. In some embodiments, the anti-human secondary antibody or the cynomolgus monkey rTPO can be indirectly linked to the solid support through streptavidin and biotin. For example, the unlabeled anti-human secondary antibody or the unlabeled rTPO can be biotinylated and the solid support can comprise streptavidin. 
     Exemplary solid supports include, but are not limited to, a column matrix material, a culture plate, a tube, a dish, a flask, a microtiter plate, a bead/particle, heat-killed formalin- (or other chemically)-fixed prokaryotic or eukaryotic cells, microscope slides, ACLAR® Film, or any other optically transparent polymer, or a combination thereof. The solid support can be fully or partially composed of plastic, cellulose, cellulose derivatives, nitrocellulose, glass, fiberglass, latex, or a combination thereof. In some embodiments, the solid support comprises a magnetic bead/particle. In some embodiments, the magnetic bead/particle is a paramagnetic particle (PMP). In some embodiments, the magnetic bead/particle is a latex magnetic particle (LMP). 
     The anti-human secondary antibody can be an IgA, IgD, IgG, IgE, or IgM isotype or a single domain format, such as a single-domain antibody from camelid. In some embodiments, the anti-human secondary antibody is an anti-human IgG. In some embodiments, the anti-human secondary antibody is a commercially available anti-human secondary antibody. Aptamers that are specific for the anti-TPO antibody can also be used. 
     The label can be any suitable label known to those skilled in the art to be useful for creating a detectable signal. Suitable detectable labels include, but are not limited to, enzyme conjugates (e.g., horseradish peroxidase (HRP), alkaline phosphatase, glucose oxidase, and β-galactosidase), fluorescent probes, radioactive isotopes, chemiluminescent compounds, bioluminescent compounds, or a combination thereof. In some embodiments, the label can be an AE or an analog thereof. Suitable AE analogs include: dimethyl acridinium ester (DMAE), N-sulfopropyl dimethyl acridinium ester (NSP-DMAE), high quantum yield acridinium ester (HQYAE), Zwitterionic acridinium ester (ZAE), N-sulfopropyl-2-isopropoxy dimethyl acridinium ester (Iso-Di-ZAE), trisulfopropyl acridinium ester (TSP-AE), or N-sulfopropyl dimethyl acridinium ester with hexa(ethylene)glycol linker (HEG-GLU-AE). In some embodiments, the labeled cynomolgus monkey rTPO comprises rTPO-NSP-DMAE. The rTPO-NSP-DMAE can be present at about 50 ng/ml to about 2 μg/ml. In some embodiments, the rTPO-NSP-DMAE can be present at about 220 ng/ml. 
     The solid support having unlabeled anti-human secondary antibody or unlabeled rTPO bound thereto and/or the labeled rTPO or labeled anti-human secondary antibody can be present in a buffer comprising, for example, phosphate buffer, NaCl, EDTA, pluronic F-127, sodium azide, sorbitol, sulfhydryl modified bovine serum, or any combinations, variations, or equivalents thereof. In one embodiment, the buffer comprises about 100 mM phosphate buffer, about 400 mM NaCl, about 1.9 g/L EDTA, about 0.2% (v/v) pluronic F-127, about 0.9 g/L sodium azide, about 10% sorbitol, and about 10 g/L sulfhydryl modified bovine serum albumin. 
     Also provided are methods of detecting an anti-thyroid peroxidase antibody in a biological sample from a subject comprising:
         a) incubating the biological sample from the subject with a solid support, an unlabeled anti-TPO antibody, a cynomolgus monkey rTPO, and a labeled anti-TPO antibody; and   b) detecting the anti-thyroid peroxidase antibody in the biological sample, the detecting comprising analyzing a decrease in the formation of a complex comprising the solid support, the unlabeled anti-TPO antibody, the cynomolgus monkey rTPO, and the labeled anti-TPO antibody.       

     Analyzing a decrease in the formation of the complex can be performed, for example, by comparing a read-out of a signal from the labeled anti-TPO antibody in a reaction mixture with the biological sample to a read-out of a signal from the labeled anti-TPO antibody in a reaction mixture without the biological sample. If the read-out of the signal from the reaction mixture with the biological sample is less than the read-out from the reaction mixture without the biological sample, formation of the complex is decreased. The amount of complex formed is inversely proportional to the presence of the anti-thyroid peroxidase antibody in the biological sample. 
     In some embodiments, the methods can comprise a “competition” immunoassay or an “inhibition” immunoassay, an exemplary reaction scheme for which is illustrated in  FIG. 4 . As used herein, a “competition” immunoassay refers to an immunoassay in which two or more binding molecules compete for binding to a target molecule. The binding molecules can be antibodies, for example, and the target molecule can be an antigen. The binding molecules can compete, for example, for binding to the same epitope(s) on the antigen. An “inhibition” immunoassay refers to an immunoassay in which one or more binding molecules inhibit binding of one or more other binding molecules to a target molecule. The binding molecules can be antibodies, for example, and the target molecule can be an antigen. Inhibition can be caused by steric hindrance or other known mechanisms of binding inhibition. Whether the claimed assays are classified as a “competition” or “inhibition” immunoassay will depend, for example, on the rTPO epitope recognized by the anti-thyroid peroxidase antibody in the biological sample and the labeled anti-TPO antibody. The claimed methods encompass both competition and inhibition immunoassays, and thus the terms “competition” and “inhibition” are not intended to limit the scope of the claimed methods. 
     In some embodiments of the competition/inhibition immunoassay, the labeled anti-TPO antibody and the rTPO can be in pre-formed immune complex prior to their addition to the reaction mixture. In some embodiments, the unlabeled anti-TPO antibody and solid support can be in pre-formed complex prior to their addition to the reaction mixture. In some embodiments, the labeled anti-TPO antibody, the rTPO, the unlabeled anti-TPO antibody, and the solid support are not in a pre-formed complex prior to their addition to the reaction mixture. In yet other embodiments, the labeled anti-TPO antibody, the rTPO, the unlabeled anti-TPO antibody, and the solid support are all present in a pre-formed complex prior to their addition to the reaction mixture. Whether the various components are in one or more pre-formed complexes prior to their addition to the reaction mixture will depend, in part, on the dissociation constants (K D ) of the labeled and unlabeled antibodies and the rTPO. The disclosed methods are not limited by the type or extent of complex formation added to the reaction mixture. It is to be understood that the biological sample, the labeled anti-TPO antibody, the rTPO, the unlabeled anti-TPO antibody, and the solid support can be added to the reaction mixture in any order. 
       FIG. 4  discloses one exemplary embodiment of the competition/inhibition immunoassays described herein, in which a labeled anti-TPO antibody  110  and an rTPO  120  are incubated with a solid support having an unlabeled anti-TPO antibody bound thereto  130 . In the absence of the anti-TPO antibody from the biological sample  10 , the labeled anti-TPO antibody  110  will bind to the rTPO  120  and in turn bind to or interact with the solid support having unlabeled anti-TPO antibody bound thereto  130 , thereby forming a complex  140  comprising the labeled anti-TPO antibody  110 , the rTPO  120 , and the solid support. Thus, in the absence of the anti-TPO antibody from the biological sample  10 , the labeled anti-TPO antibody  110  will be coupled to the solid support, isolation of which will result in isolation of the labeled anti-TPO antibody  110 . When the anti-TPO antibody  10  is present in the biological sample, the anti-TPO antibody  10  will compete with or otherwise inhibit the labeled anti-TPO antibody  110  for binding to the rTPO  120  or will compete with or otherwise inhibit the unlabeled anti-TPO antibody bound to the solid support  130  for binding to the rTPO  120 , thereby preventing the complex from forming or displacing the labeled anti-TPO antibody from the complex  140 . Thus, in the presence of anti-TPO antibody from the biological sample  10 , the presence of complex  140  comprising the labeled anti-TPO antibody  110 , the rTPO  120 , and the solid support is decreased. 
     The labeled anti-TPO antibody  110 , the unlabeled rTPO  120 , and the unlabeled anti-TPO antibody bound to the solid support  130  can be incubated in a reaction mixture for about 1 minute, about 2 minutes, about 3 minutes, about 4 minutes, about 5 minutes, or less than about 10 minutes. The biological sample known to have, or suspected of having, an anti-TPO antibody  10  can be added and incubated in the reaction mixture for about 1 minute, about 2 minutes, about 3 minutes, about 4 minutes, about 5 minutes, or less than about 10 minutes. In some embodiments, the incubating steps are performed in a total of about 10 minutes to about 20 minutes. The subsequent detecting can be performed in less than about 5 minutes. It is to be understood that the amount of time needed for the assay may vary based upon several factors including the level of the anti-TPO antibody(ies) in the biological sample and the affinity of the anti-TPO antibody(ies) for the rTPO. Thus, the disclosed methods can be performed for any suitable amount of time. 
     The unlabeled anti-TPO antibody can be directly or indirectly coupled to the solid support. Suitable techniques for directly coupling the unlabeled anti-TPO antibody to the solid support include, for example, covalent attachment, adsorption, noncovalent interaction, or combinations thereof. Suitable means for indirectly coupling the unlabeled anti-TPO antibody to the solid support include, for example, linking through a peptide, a protein, an antibody, a linker, or a combination thereof. In some embodiments, the unlabeled anti-TPO antibody can be indirectly coupled to the solid support through streptavidin and biotin. For example, the unlabeled anti-TPO antibody can be biotinylated and the solid support can comprise streptavidin. The labeled and/or the unlabeled anti-TPO antibody can be any known commercially available anti-TPO antibody. 
     Exemplary solid supports include, but are not limited to, a column matrix material, a culture plate, a tube, a dish, a flask, a microtiter plate, a bead/particle, heat-killed formalin- (or other chemically)-fixed prokaryotic or eukaryotic cells, microscope slides, ACLAR® Film, or any other optically transparent polymer, or a combination thereof. The solid support can be fully or partially composed of plastic, cellulose, cellulose derivatives, nitrocellulose, glass, fiberglass, latex, or a combination thereof. In some embodiments, the solid support comprises a magnetic bead/particle. In some embodiments, the magnetic bead/particle is a paramagnetic particle (PMP). In some embodiments, the magnetic bead/particle is a latex magnetic particle (LMP). 
     The label can be any suitable label known to those skilled in the art to be useful for creating a detectable signal. Suitable detectable labels include, but are not limited to, enzyme conjugates (e.g., horseradish peroxidase (HRP), alkaline phosphatase, glucose oxidase, and β-galactosidase), fluorescent probes, radioactive isotopes, chemiluminescent compounds, bioluminescent compounds, or combination thereof. In some embodiments, the label is an AE or an analog thereof. Suitable AE analogs include: dimethyl acridinium ester (DMAE), N-sulfopropyl dimethyl acridinium ester (NSP-DMAE), high quantum yield acridinium ester (HQYAE), Zwitterionic acridinium ester (ZAE), N-sulfopropyl-2-isopropoxy dimethyl acridinium ester (Iso-Di-ZAE), trisulfopropyl acridinium ester (TSP-AE), or N-sulfopropyl dimethyl acridinium ester with hexa(ethylene)glycol linker (HEG-GLU-AE). In some embodiments, the labeled anti-TPO antibody is anti-TPO IgG HEG-GLU-AE. The anti-rTPO IgG HEG-GLU-AE can be present at about 50 ng/ml to about 2 μg/ml. In some embodiments, the anti-rTPO IgG HEG-GLU-AE can be present at about 420 ng/ml. 
     The solid support having unlabeled anti-TPO antibody bound thereto and/or the unlabeled rTPO and/or the labeled anti-TPO antibody can be present in a buffer comprising, for example, phosphate buffer, NaCl, EDTA, pluronic F-127, sodium azide, sorbitol, sulfhydryl modified bovine serum, or any combinations, variations, or equivalents thereof. In one embodiment, the buffer comprises about 100 mM phosphate buffer, about 400 mM NaCl, about 1.9 g/L EDTA, about 0.2% (v/v) pluronic F-127, about 0.9 g/L sodium azide, about 10% sorbitol, and about 10 g/L sulfhydryl modified bovine serum albumin. 
     Further disclosed are methods of diagnosing a thyroid disease in a subject, the methods comprising incubating a biological sample from the subject with a solid support, an unlabeled recombinant cynomolgus monkey thyroid peroxidase (rTPO), and a labeled cynomolgus monkey rTPO. In the presence of an anti-thyroid peroxidase antibody in the biological sample, a complex comprising the labeled cynomolgus monkey rTPO, the unlabeled cynomolgus monkey rTPO, and the solid support is formed. The method further comprises diagnosing the subject with the thyroid disease if the complex is formed. 
     Methods of diagnosing a thyroid disease in a subject comprising incubating a biological sample from the subject with a solid support, a cynomolgus monkey rTPO, and an anti-human secondary antibody are also provided. In the presence of an anti-thyroid peroxidase antibody in the biological sample, a complex comprising the solid support, the cynomolgus monkey rTPO, and the anti-human secondary antibody is formed. The method further comprises diagnosing the subject with the thyroid disease if the complex is formed. 
     Also disclosed are methods of diagnosing a thyroid disease in a subject, the methods comprising incubating a biological sample from a subject with a solid support, an unlabeled anti-TPO antibody, a cynomolgus monkey TPO, and a labeled anti-TPO antibody, and diagnosing the thyroid disease if the formation of a complex comprising the solid support, the unlabeled anti-TPO antibody, the cynomolgus monkey rTPO, and the labeled anti-TPO antibody is decreased. The presence of an anti-thyroid peroxidase antibody in the biological sample decreases formation of a complex comprising the solid support, the unlabeled anti-TPO antibody, the cynomolgus monkey rTPO, and the labeled anti-TPO antibody. The labeled and/or the unlabeled anti-TPO antibody can be any known or commercially available anti-TPO antibody. 
     The methods of diagnosing can further comprise a step of detecting the complex. For example, detecting the complex may comprise taking a read-out of a signal from the label, wherein the intensity of the signal from the label indicates the amount of label present in the assay. 
     The thyroid disease can be an autoimmune disorder. In some embodiments, the autoimmune disorder is Hashimoto&#39;s thyroiditis or Graves&#39; disease. 
     Similar to the methods of detecting described above, in the methods of diagnosing, the unlabeled rTPO, the unlabeled anti-human secondary antibody, or the unlabeled anti-TPO antibody can be directly or indirectly linked/coupled to the solid support. Suitable techniques for direct linking/coupling include, for example, covalent attachment, adsorption, noncovalent interaction, or combinations thereof. In some embodiments, the direct linking/coupling can be achieved by glutaraldehyde fixation, N-hydroxysuccinimide (NHS) chemistry, or 1-Ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) NHS chemistry. Suitable means for indirect linking/coupling include, for example, linking/coupling through a peptide, a protein, an antibody, a linker, or a combination thereof. In some embodiments, the indirect linking/coupling to the solid support is via streptavidin and biotin. For example, the unlabeled rTPO, the unlabeled anti-human secondary antibody, or the unlabeled anti-TPO antibody can be biotinylated and the solid support can comprise streptavidin. 
     Exemplary solid supports include, but are not limited to, a column matrix material, a culture plate, a tube, a dish, a flask, a microtiter plate, a bead/particle, heat-killed formalin- (or other chemically)-fixed prokaryotic or eukaryotic cells, microscope slides, ACLAR® Film, or any other optically transparent polymer, or a combination thereof. The solid support can be fully or partially composed of plastic, cellulose, cellulose derivatives, nitrocellulose, glass, fiberglass, latex, or a combination thereof. In some embodiments, the solid support comprises a magnetic bead/particle. In some embodiments, the magnetic bead/particle is a paramagnetic particle (PMP). In some embodiments, the magnetic bead/particle is a latex magnetic particle (LMP). 
     The label can be any suitable label known to those skilled in the art to be useful for creating a detectable signal. Suitable detectable labels include, but are not limited to, enzyme conjugates (e.g., horseradish peroxidase (HRP), alkaline phosphatase, glucose oxidase, and β-galactosidase), fluorescent probes, radioactive isotopes, chemiluminescent compounds, bioluminescent compounds, or combination thereof. In some embodiments, the label is an AE or an analog thereof. Suitable AE analogs include: dimethyl acridinium ester (DMAE), N-sulfopropyl dimethyl acridinium ester (NSP-DMAE), high quantum yield acridinium ester (HQYAE), Zwitterionic acridinium ester (ZAE), N-sulfopropyl-2-isopropoxy dimethyl acridinium ester (Iso-Di-ZAE), trisulfopropyl acridinium ester (TSP-AE), or N-sulfopropyl dimethyl acridinium ester with hexa(ethylene)glycol linker (HEG-GLU-AE). In some embodiments, the labeled cynomolgus monkey rTPO comprises rTPO-NSP-DMAE. The rTPO-NSP-DMAE can be present at about 50 ng/ml to about 2 μg/ml. In some embodiments, the rTPO-NSP-DMAE can be present at about 220 ng/ml. In some embodiments, the labeled anti-TPO antibody is anti-rTPO IgG HEG-GLU-AE. The anti-rTPO IgG HEG-GLU-AE can be present at about 50 ng/ml to about 2 μg/ml. In some embodiments, the anti-rTPO IgG HEG-GLU-AE can be present at about 420 ng/ml. 
     Suitable times for performing the methods of diagnosing an autoimmune disease include those provided above for the various methods of detecting an antibody. 
     The methods can further comprise determining a level of the anti-thyroid peroxidase antibody in the biological sample of the subject. In some embodiments, the level of the anti-thyroid peroxidase antibody in the biological sample of the subject is directly proportional to the level of the complex detected. Thus, the level of anti-TPO antibody can be determined by determining the level of solid support coupled to or in complex with the labeled component (i.e. the labeled rTPO or antibody). Determining the level of solid support coupled to or in complex with the labeled component can be performed, for example, by measuring the signal from the complex. Similarly, in embodiments wherein the method is used to diagnose a thyroid disease in a subject, the solid support coupled to or in complex with the labeled component is detected by measuring the signal or absence thereof from the labeled component linked to the solid support. 
     The disclosed methods can be performed manually or can be automated. For example, the disclosed methods can be performed using an ADVIA CENTAUR® Immunoassay System or an ATELLICA™ system. 
     In some embodiments, the anti-TPO antibody is a patient anti-TPO antibody. In some embodiments, the anti-TPO antibody is an autoantibody. 
     Suitable biological samples for detecting the anti-TPO antibody include any biological sample from a subject that contains, or is suspected of containing, the anti-TPO antibody including, but not limited to, serum, plasma, whole blood, saliva, urine, semen, perspiration, tears, and body tissues. 
     The immunoassays disclosed herein employ a recombinant thyroid peroxidase (rTPO). In some embodiments, the rTPO is from cynomolgus monkey. In some embodiments, the rTPO comprises the amino acid sequence set forth in SEQ ID NO: 1 (Table 1). In some embodiments, the rTPO further comprises an epitope tag. The epitope tag can be at the N-terminus or at the C-terminus of the rTPO. The epitope tag can be any suitable tag known to persons skilled in the art including, but not limited to, a 6-histidine tag, a hemagglutinin tag, a glutathione-S-transferase, a maltose binding protein, or a chitin binding protein. In some embodiments, the rTPO comprises a C-terminal 6-histidine tag. 
     
       
         
           
               
             
               
                 TABLE 1 
               
               
                   
               
               
                   Macaca   fascicularis  rTPO amino acid sequence (SEQ ID NO: 1) 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
            
               
                 SEQ ID NO: 1 
                 ADPGYLLECT EAFFPFISRG KELLWGKPEE SRVAGILEES KRLVDTAMYA 
               
               
                   
                 TMQRNLKKRE ILSPHQLLSF SKLPEPTSGE IARAAEIMET SIQAMKRKVN 
               
               
                   
                 LKIQQSQHPT DALSEDLLSI IANMSGCLPY MLPPKCPNTC LANKYRPITG 
               
               
                   
                 ACNNRDHPRW GASNTALARW LPPVYEDGFS QPRGWNPSIL HNGFPLPPVR 
               
               
                   
                 EVTRHVIQVS NEVVTDDDRY SDLLMAWGQY IDHDIAFTPQ STSKAAFRGG 
               
               
                   
                 ADCQVTCENQ NPCFPIQLPE EARPAAGTAC LPFYRSSAAC GTGDQGALFG 
               
               
                   
                 NLSTANPRQQ MNGLTSFLDA STVYGSSPAL ERQLRNWTSA EGLLRVHARL 
               
               
                   
                 RDSGRAYLPF APPRAPAACA PEPGIPGETR GPCFLAGDGR ASEVPSLTAL 
               
               
                   
                 HTLWLREHNR LAAALKALNA HWSADAVYQE ARKVVGALHQ IITLRDYVPR 
               
               
                   
                 ILGPEAFQQY VGPYEGYDSA ANPTVSNVFS TAAFRFGHAT IHPLVRRLDA 
               
               
                   
                 GFQEHPGLPG LWLHETFFSP WTLLHGGGLD PLIRGLLARP AKLQVQDQLM 
               
               
                   
                 NEELTERLFV LSNSSTLDLA SINLQRGRDH GLPGYNEWRE FCGLPRLETP 
               
               
                   
                 ADLSTAIASR SVADKILDLY KHPDNIDVWL GGLAENFLPR ARTGPLFACL 
               
               
                   
                 IGKQMKALRD GDWFWWENSH VFTDAQRHEL EKHSLSRVIC DNTGLTRVPV 
               
               
                   
                 DAFRVGKFPE DFESCDSIPG MNLEAWRETF PQDDKCGFPE SVENGDFVHC 
               
               
                   
                 EESGRRVLVY SCRHGYELQG HEQLTCTQEG WDFQPPLCKD VNECADGAHP 
               
               
                   
                 PCHASARCRN TKGGFQCLCA DPYELGDDGR TCVDSGRLPR 
               
               
                   
               
            
           
         
       
     
     Further disclosed herein are kits. In some embodiments, the kits can comprise a solid support, an unlabeled cynomolgus monkey rTPO, and a labeled cynomolgus monkey rTPO. 
     The kits can comprise a solid support, a cynomolgus monkey rTPO, and an anti-human secondary antibody. In some embodiments, the cynomolgus monkey rTPO comprises a label or the anti-human secondary antibody comprises a label. 
     The kits can comprise a solid support, a cynomolgus monkey TPO and an anti-TPO antibody. In some embodiments, a portion of the anti-TPO antibodies are unlabeled and a portion of the anti-TPO antibodies are labeled. 
     Suitable solid supports and labels for any of the kits disclosed herein include those solid supports and labels disclosed for the methods above. 
     EXAMPLES 
     The following examples are provided to further describe some of the embodiments disclosed herein. The examples are intended to illustrate, not to limit, the disclosed embodiments. 
     rTPO Cloning 
     Monkey thyroid tissue was obtained from cynomolgus monkey and mRNA was isolated and purified using Trizol/Chloroform extraction (Invitrogen, catalogue #15596026). A cDNA library was prepared using Invitrogen Thermo-Script RT-PCR kit. 
     Using PCR, a soluble form of TPO was amplified from the cDNA library and the PCR product was purified using a Qiagen PCR purification kit (QIAquick PCR Purification Kit, catalogue #28104). The purified PCR product was digested with Xbal (New England Biolabs cat #R0145S) and NotI (New England Biolabs cat #R0189S) restriction endonucleases and gel-extracted. The gel-extracted TPO was ligated into a baculovirus expression vector. The vector was transformed in competent cells and plated on ampicillin-selected plates. 
     Resulting colonies were PCR-screened and positive clones were grown for plasmid generation and purification. Several plasmid clones were sequenced using a Beckman CEQ 8000 sequencer; clones containing TPO were verified. All PCR and sequencing primers were synthesized using an ABI Expedite 8909 DNA Synthesizer. The cDNA encodes a cynomolgus monkey rTPO having the amino acid sequence of SEQ ID NO. 1 (Table 1). 
     Transient Transfection to Yield rTPO Baculoviruses 
     Baculoviral DNA was combined with a transfer plasmid comprising the rTPO sequence and incubated with Grace&#39;s media and transfection reagent (Invitrogen, Bac-N-Blue Transfection Kit, catalogue #K855-01). After transfection of  Spodoptra frugiperda  (Sf) cells, cell culture supernatants were subsequently screened for recombinant viruses and selected recombinants were purified, amplified and sequenced to confirm the identity of rTPO. 
     rTPO Purification 
     Purified recombinant baculovirus containing the rTPO was used to infect cultures of  Trichoplusia ni  PRO (Tni PRO) in ESF921 cell culture medium. Transduced rTPO was secreted into the cell culture supernatant. 
     rTPO was isolated from the supernatant using Chelating Sepharose Fast Flow immobilized metal (Nickel) affinity chromatography followed by size exclusion chromatography. Briefly, the chelating sepharose gel (GE Healthcare Catalog No. 17-0575-01) was charged with 100 mM NiSO 4 . rTPO in the culture supernatant was allowed to bind to the gel for 1.5 hours. Non-specific proteins were removed by washing the gel with 0.5 M Sodium Chloride, 0.05 M Tris pH 8.0, 10 mM Imidazole. rTPO was then eluted with 0.5 M Sodium Chloride, 0.05 M Tris pH 8.0, 0.1 M Imidazole. The elution fraction was then subjected to S-200 size exclusion chromatography on AKTA Prime Plus liquid chromatography system, and fractions containing rTPO were pooled. 
     The final pool containing pure rTPO was analyzed by SDS/PAGE, followed by Coomassie Blue staining ( FIG. 5 , panel A) or western blotting ( FIG. 5 , panel B). rTPO was electrophoresed on 4-20% Tris-Glycine gels under non-reducing conditions for about 30-40 minutes at 200 V. For western blot analysis, the proteins were transferred onto nitrocellulose membrane and were probed with a mouse anti-TPO monoclonal antibody for one hour, followed by an horse radish peroxidase (HRP) conjugated, goat anti-mouse IgG polyclonal antibody (Millipore, lot 17011271) for 30 minutes; blots were developed with substrate (Surmodics BCIB) for about 5 minutes. 
     Glycosylation 
     The extent of rTPO glycosylation was determined by ion exchange chromatography, matrix-assisted LASER desorption time-of-flight (“MALDI-TOF”) mass spectrometry, and isoelectric focusing. In each of the ion exchange chromatography, MALDI-TOF, and isoelectric focusing experiments, two protein species were identified, which appeared to be the result of glycosylation. As shown in  FIG. 6 , the major band had an average pI 6.2 and the minor band had an average pI 5.2. 
     To further characterize potential lot-to-lot glycan diversity in rTPO, three different lots of rTPO were each digested with one of the following enzymes: Protein Deglycosylation Mix II (including PNGase F, O-Glycosidase, α2-3,6,8,9 Neuraminidase A, β1-4 Galactosidase S, and β-N-acetylhexosaminidase f ), EndoH, α2-3,6,8,9 Neuraminidase, O-Glycosidase, or PNGaseF (New England Biolabs). Digested rTPO was subsequently analyzed by MALDI-TOF analysis using the Shimadzu AXIMA Confidence MALDI-TOF Mass Spectrometer. Enzyme digestion conditions for each reaction are summarized in Table 2 below. After 37° C. overnight incubation, samples were collected, cooled to room temperature, and de-salted. A 10 kDa MWCO centrifugal filter (Millipore; ref #UFC501024) was washed with 250 μl diH 2 O and spun for 10 minutes at 14,000 rpm. Samples were de-salted by adding digested sample to washed centrifugal filter, spinning at 14,000 rpm for 10 minutes, and decanting the flow-through. After each spin, 250 μl diH 2 O was aliquoted into the centrifugal filter and spun again at 14,000 rpm for 10 minutes for a total of three washes. 
     
       
         
           
               
             
               
                 TABLE 2 
               
             
            
               
                   
               
               
                 Enzyme Digestion Conditions. 
               
            
           
           
               
               
               
               
               
            
               
                 Deglycosylation 
                 EndoH 
                 Neuraminidase 
                 O-glycosidase 
                 PNGaseF 
               
               
                 Mix Catalog# 
                 Catalog# 
                 Catalog# 
                 Catalog# 
                 Catalog# 
               
               
                 P6044S 
                 P0702S 
                 P0720S 
                 P0733S 
                 P0704S 
               
               
                   
               
            
           
           
               
               
               
               
               
               
               
               
               
               
            
               
                 110 
                 μL rTPO 
                 45 
                 μL rTPO 
                 20 
                 μL rTPO 
                 45 
                 μL rTPO 
                 45 
                 μL rTPO 
               
            
           
           
               
               
               
               
               
               
               
            
               
                 40 
                 μL H2O 
                 5 μL 10X 
                 160 
                 μL H2O 
                 5 μL 10X 
                 5 μL 10X 
               
               
                   
                   
                 glycosylation 
                   
                   
                 glycosylation 
                 glycosylation 
               
               
                   
                   
                 denaturation 
                   
                   
                 denaturation 
                 denaturation 
               
               
                   
                   
                 Buffer 
                   
                   
                 Buffer 
                 Buffer 
               
            
           
           
               
               
               
               
               
            
               
                 5 μL 
                 Place mixture in 
                 20 μL 10X 
                 Place mixture in 
                 Place mixture in 
               
               
                 Deglycosylation 
                 fully boiling H 2 O 
                 GlycoBuffer 1 
                 fully boiling H 2 O 
                 fully boiling H 2 O 
               
               
                 Mix Buffer 2 
                 for 10 minutes 
                   
                 for 10 minutes 
                 for 10 minutes 
               
               
                 Incubate at 75° C. 
                 10 μL 
                 20 μL 
                 10 μL 
                 10 μL 
               
               
                 for 10 minutes, 
                 GlycoBuffer 3 
                 Neuraminidase 
                 GlycoBuffer 2 
                 GlycoBuffer 2 
               
               
                 cool to RT 
                 10X 
                   
                 10X 
                 10X 
               
            
           
           
               
               
               
               
               
               
               
            
               
                 Incubate at 25° C. 
                 15 
                 μL EndoH 
                   
                 10 μL 
                 5 
                 μL PNGaseF 
               
               
                 for 30 mins 
                   
                   
                   
                 Neuraminidase 
               
               
                   
                 25 
                 μL H 2 O 
                   
                 15 μL 
                 35 
                 μL H 2 O 
               
               
                   
                   
                   
                   
                 O-glycosidase 
               
            
           
           
               
               
               
               
            
               
                   
                 15 
                 μL H 2 O 
               
               
                   
                   
               
               
                   
                 All reactions were incubated overnight in a 37° C. warm water bath. 
               
            
           
         
       
     
     After 37° C. overnight incubation, samples were collected, cooled to room temperature, and de-salted. A 10 kDa MWCO centrifugal filter (Millipore; ref #UFC501024) was washed with 250 μL diH 2 O and spun for 10 minutes at 14,000 rpm. Samples were de-salted by adding digested sample to washed centrifugal filter, spinning at 14,000 rpm for 10 minutes, and decanting the flow-through. After each spin, 250 μL diH 2 O was aliquoted into the centrifugal filter and spun again at 14,000 rpm for 10 minutes for a total of three washes. 
     All samples were desalted and reconstituted directly with a sinapinic acid (Sigma-Aldrich 49508) trifluoroacetic acid (Alfa-Aesar 44630) matrix solution. The sample to matrix ratio was optimized for each sample, with optimal ratios outlined in Table 3. A 2 μl aliquot from each sample was blotted in triplicate on the MALDI-TOF sample plate. The samples were thoroughly air dried, placed in the MALDI-TOF sample chamber, and measured on a Shimadzu Axima Confidence MALDI-TOF with laser power set at 65. The MALDI-TOF mass spectrometer was calibrated using ProteoMass Albumin Standard (Sigma; Part #A8471). 
     
       
         
           
               
             
               
                 TABLE 3 
               
             
            
               
                   
               
               
                 Optimized sample-to-matrix ratios for enzyme digests. 
               
            
           
           
               
               
               
            
               
                   
                   
                 Ratio 
               
               
                   
                 Sample 
                 (Sample-to-Matrix) 
               
               
                   
                   
               
               
                   
                 De-glycosylation Mix 
                 1:2 
               
               
                   
                 EndoH 
                 1:1 
               
               
                   
                 Neuraminidase 
                 1:2 
               
               
                   
                 O-glycosidase 
                 1:2 
               
               
                   
                 PNGaseF 
                 1:1 
               
               
                   
                 Undigested rTPO 
                 1:2 
               
               
                   
                   
               
            
           
         
       
     
     MALDI-TOF analyses of three lots of rTPO showed slight lot-to-lot differences in glycosylation (data not shown). Digestion with De-glycosylation Mix showed the most pronounced molecular weight shift; this enzyme was chosen for de-glycosylation and subsequent conjugation for functional testing on ADVIA CENTAUR® XP immunoassay (Siemens Healthcare). 
     rTPO Immunoassay Characterization 
     N-hydroxysuccinimide (NHS) chemistry was used to prepare native human TPO (Fitzgerald 80-1382) labeled with NSP-DMAE and recombinant cynomolgus monkey TPO labeled with NSP-DMAE. These labeled proteins were paired with biotinylated anti-human IgG coupled to streptavidin latex or para magnetic particles in 100 mM phosphate buffer, 400 mM NaCl, 1.9 g/L EDTA, 0.2% (v/v) pluronic F-127, 0.9 g/L sodium azide, 10% sorbitol, and 10 g/L sulfhydryl modified bovine serum albumin and tested in a 7.5 minute one-pass (time to final result (TTFR): 18 minutes) and/or 20/20 minute two-pass (TTFR: 60 minutes) formats using an ADVIA CENTAUR® system (Siemens Healthcare). In the 7.5 minute one-pass immunoassays, the sample was added at time zero. Human TPO-NSP-DMAE or rTPO-NSP-DMAE was added at 4.75 minutes, followed by reagent containing latex magnetic particles at 7.5 minutes. Magnetic separation was initiated at 13.0 minutes to isolate the latex magnetic particles. In the 20/20 two-pass immunoassays, sample was added at time zero and first-pass human TPO-NSP-DMAE or rTPO-NSP-DMAE was added at 6 minutes, followed by first-pass magnetic separation at 24.0 minutes. Second-pass human TPO-NSP-DMAE or rTPO-NSP-DMAE was added at 35.0 minutes, and second-pass magnetic separation was initiated at 52.75 minutes. In both the one-pass and two-pass formats, the magnetic particles were prepared by washing with phosphate buffered saline three times and resuspending in 100 mM phosphate buffer, 400 mM NaCl, 1.9 g/L EDTA, 0.2% (v/v) pluronic F-127, 0.9 g/L sodium azide, 10% sorbitol, and 10 g/L sulfhydryl modified bovine serum albumin. In the cuvette the particles were magnetically separated and resuspended in either water or tween-20 PBS according to the Centaur platform cycle parameters. Siemens aTPO Master Curve Material (Siemens 10630890) were run as samples. As shown in  FIG. 11 , recombinant TPO gave a higher signal-to-noise ratio compared to native TPO using both 7.5 minute one-pass and 20/20 minute two-pass formats on the ADVIA CENTAUR® XP. 
     Anti-TPO Antibody Immunoassays 
     Antigen Bridge Format 
     The rTPO antigen bridge immunoassay used biotinylated rTPO directly coupled to streptavidin-coated latex magnetic particles in 0.6 mg/mL in 100 mM phosphate buffer, 400 mM NaCl, 1.9 g/L EDTA, 0.2% (v/v) pluronic F-127, 0.9 g/L sodium azide, 10% sorbitol, and 10 g/L sulfhydryl modified bovine serum albumin, and rTPO coupled to TSP-AE (30 ng/mL rTPO-TSP-AE in 100 mM phosphate buffer, 400 mM NaCl, 1.9 g/L EDTA, 0.2% (v/v) pluronic F-127, 0.9 g/L sodium azide, 10% sorbitol, and 10 g/L sulfhydryl modified bovine serum albumin). The rTPO antigen bridge format was run as a 7.5 minute one-pass (TTFR: 18 minutes) assay and required a 1:6 onboard, sample predilution. On an ADVIA CENTAUR® XP, 20 μL of diluted sample was added to a second cuvette and incubated for 4.75 minutes. 100 μL of rTPO-TSP-AE was added and incubated for 2.75 minutes. 100 μL of rTPO/latex magnetic particles was then added and incubated for 2.75 minutes. Magnetic separation was initiated at 13.0 minutes. The magnetic particles were washed with phosphate buffered saline three times, and finally resuspended to their original concentration with 100 mM phosphate buffer, 400 mM NaCl, 1.9 g/L EDTA, 0.2% (v/v) pluronic F-127, 0.9 g/L sodium azide, 10% sorbitol, and 10 g/L sulfhydryl modified bovine serum albumin. In the cuvette the particles were magnetically separated and resuspended in either water or tween-20 PBS according to the Centaur platform cycle parameters. An exemplary schematic of the Antigen Bridge assay format is shown in  FIG. 1 . The performance of an optimized rTPO antigen bridge immunoassay (optimized to minimize background, increase signal-to-noise and limit any prozone effect) is provided in  FIG. 12A . 
     IgG Class Capture Format 
     The human IgG class capture immunoassay used anti-human IgG monoclonal antibody directly coupled to paramagnetic particles by glutaraldehyde fixation and rTPO coupled to NSP-DMAE (0.34 mg/mL anti-human IgG/paramagnetic particles and 220 ng/mL rTPO-NSP-DMAE, both in 100 mM phosphate buffer, 400 mM NaCl, 1.9 g/L EDTA, 0.2% (v/v) pluronic F-127, 0.9 g/L sodium azide, 10% sorbitol, and 10 g/L sulfhydryl modified bovine serum albumin). The human IgG class capture format was run as a 7.5 minute one-pass (TTFR: 18 minutes) assay and required a 1:10 onboard, sample predilution. On an ADVIA CENTAUR® XP, 20 μL of diluted sample was added to a second cuvette and incubated for 4.75 minutes. 100 μL of rTPO-NSP-DMAE was added and incubated for 2.75 minutes. 200 μL of anti-human IgG/paramagnetic particles was added and incubated for 2.75 minutes. Magnetic particles were separated and washed as described above. An exemplary schematic of the IgG Class Capture assay format is depicted in  FIG. 2 . The performance of an optimized human IgG class capture immunoassay (optimized to minimize background, increase signal-to-noise and limit any prozone effect) is provided in  FIG. 12B . 
     rTPO Capture Format 
     The rTPO capture immunoassay used rTPO directly coupled to latex magnetic particles using 1-Ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) NHS chemistry and a monoclonal anti-human IgG antibody coupled to NSP-DMAE (0.4 mg/mL rTPO/latex magnetic particles and 1.6 μg/mL anti-human IgG antibody-NSP-DMAE, both in 100 mM phosphate buffer, 400 mM NaCl, 1.9 g/L EDTA, 0.2% (v/v) pluronic F-127, 0.9 g/L sodium azide, 10% sorbitol, and 10 g/L sulfhydryl modified bovine serum albumin). The rTPO capture format was run as a 7.5 minute one-pass (TTFR: 18 minutes) assay and required a 1:10 onboard, sample predilution. On an ADVIA CENTAUR® XP, 20 μL of diluted sample was added to a second cuvette. 100 μL of anti-human IgG antibody-NSP-DMAE was added and incubated for 2.75 minutes. 100 μL of rTPO/latex magnetic particles was added and incubated for 2.75 minutes. Magnetic particles were separated and washed as described above. An exemplary schematic of the rTPO Capture assay format is depicted in  FIG. 3 . The performance of an optimized rTPO capture immunoassay (optimized to minimize background, increase signal-to-noise and limit any prozone effect) is provided in  FIG. 12C . 
     Competition/Inhibition Format 
     The competition/inhibition immunoassay used a biotinylated monoclonal mouse anti-rTPO IgG antibody coupled to streptavidin-coated latex magnetic particles and monoclonal mouse anti-rTPO IgG antibody coupled to HEG-GLU-AE in immune complex with unlabeled rTPO (respectively, 0.3 mg/mL mouse-anti-rTPO/latex magnetic particles and 420 ng/mL rTPO:anti-rTPO IgG HEG-GLU-AE, both in 100 mM phosphate buffer, 400 mM NaCl, 1.9 g/L EDTA, 0.2% (v/v) pluronic F-127, 0.9 g/L sodium azide, 10% sorbitol, and 10 g/L sulfhydryl modified bovine serum albumin). The competition/inhibition format was run as a 7.5 minute one-pass (TTFR: 18 minutes) assay. On an ADVIA CENTAUR® XP, 20 μL of undiluted sample was added to a cuvette and incubated for 4.75 minutes. 75 μL of rTPO:anti-rTPO IgG HEG-GLU-AE and 150 μL of mouse-anti-rTPO/latex magnetic particles were added and incubated for 2.75 minutes each. Magnetic particles were separated and washed as described above. An exemplary schematic of the competition/inhibition assay format is shown in  FIG. 4 . The performance of an optimized competition/inhibition immunoassay (optimized to minimize background, increase signal-to-noise and limit any prozone effect) is provided in  FIG. 12D . 
     Effect of rTPO Glycosylation on Immunoassay Performance 
     To analyze the effect of recombinant rTPO glycosylation on immunoassy performance, immunoassays were run using the Antigen Bridge and IgG Class Capture (with labeled rTPO detection) formats. Table 4 outlines immunoassay preparation for each format. Immunoassays were run in triplicate on an ADVIA CENTAUR® XP. Samples were prepared using anti-TPO antibody-Positive Plasma spiked into PBS Buffer targeting the following doses: 0, 12.5, 25, 50, 100, 200, 300, 400, 625, 20,000 IU/mL. 
     In the Antigen Bridge assay format, 30 μL of sample was added to a cuvette, followed by 180 μL diluent (100 mM phosphate buffer, 400 mM NaCl, 1.9 g/L EDTA, 0.2% (v/v) pluronic F-127, 0.9 g/L sodium azide, 10% sorbitol, 10 g/L sulfhydryl modified bovine serum albumin), and the diluted sample was incubated for 4.75 minutes. 30 μL of the diluted sample was added to 100 μL diluent containing paramagnetic particles, and incubated for 2.75 minutes. 100 μL of the diluent containing labeled rTPO was added to the reaction and incubated for 6.5 minutes. The immunoassay was tested (results shown in  FIG. 7A ) with no de-glycosylation (“Control”), de-glycosylated labeled rTPO (“Glycosylated SP/Deglycosylated LR”), de-glycosylated unlabeled rTPO bound to the solid support (“Deglycosylated SP/Glycosylated LR”), and both de-glycosylated labeled rTPO and unlabeled rTPO bound to the solid support (“Deglycosylated SP &amp; LR”). 
     In the IgG Class Capture assay format, 30 μL of sample was added to a cuvette, followed by 180 μL diluent (100 mM phosphate buffer, 400 mM NaCl, 1.9 g/L EDTA, 0.2% (v/v) pluronic F-127, 0.9 g/L sodium azide, 10% sorbitol, 10 g/L sulfhydryl modified bovine serum albumin), and the diluted sample was incubated for 4.75 minutes. 30 μL of the diluted sample was added to 100 μL diluent containing labeled rTPO, and incubated for 2.75 minutes. 100 μL of the diluent containing anti-human IgG Fc monoclonal antibody coupled to paramagnetic particles was added to the reaction and incubated for 6.5 minutes. The immunoassay was tested with non-deglycosylated labeled rTPO (control) and de-glycosylated labeled rTPO ( FIG. 7B ). 
     
       
         
           
               
             
               
                 TABLE 4 
               
             
            
               
                   
               
               
                 Immunoassay preparation 
               
            
           
           
               
               
               
               
               
            
               
                   
                 Solid Support 
                   
                   
                   
               
               
                   
                 (bound to 
                 [Solid 
                   
                 [Labeled 
               
               
                   
                 magnetic 
                 Support] 
                   
                 rTPO] 
               
               
                   
                 particles) 
                 (mg/mL) 
                 Labeled rTPO 
                 (ng/mL) 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
               
            
               
                 Antigen Bridge 
                 rTPO: Sulfo- 
                 0.6 
                 mg/mL 
                 rTPO: NSP-DMAE- 
                 120 ng/mL 
               
               
                   
                 NHS-LC-Biotin 
                   
                   
                 Z-NHS 20X 
               
               
                   
                 30X 
               
               
                 IgG Class 
                 Anti-human 
                 0.34 
                 mg/mL 
                 rTPO: NSP-DMAE- 
                 220 ng/mL 
               
               
                 Capture w/rTPO 
                 IgG, 8D6 
                   
                   
                 Z-NHS 20X 
               
               
                 Detection 
               
               
                   
               
            
           
         
       
     
     A functional assessment of rTPO, based on glycosylation, revealed that differences in rTPO glycosylation result in subtle variation in immunoreactivity (as measured by ADVIA CENTAUR® XP) against an anti-TPO antibody-positive patient pool ( FIG. 7A  and  FIG. 7B ). 
     The immunoassays demonstrated low background and a wide dynamic range for effective aTPO detection and quantification. 
     rTPO Immune Complex Characterization 
     FPLC size exclusion chromatography was employed to verify the in vitro formation of a recombinant TPO-anti-TPO autoantibody complex and to confirm that the anti-TPO autoantibody, rather than some other component within the patient sample, was interacting with the recombinant TPO. 
     rTPOAE baseline chromatogram: rTPO labeled with N-sulfopropyl dimethyl acridinium ester (NSP-DMAE) (5 molar excess) was diluted to get ˜5 million RLU (1:600 dilution) using fractionation buffer; 50 mM Sodium Phosphate, 150 mM sodium Chloride, 0.5% Tween 20, and 0.1% Sodium Azide at pH 7.4. This sample was analyzed by AKTA pure system with Superdex 200 HiLoad 16/600 column using the fractionation buffer, 500 μL injection and 1 ml/minute elution; 180 fractions (1 ml each) were collected and run on Berthold AutoLumat system to generate a baseline RLU chromatogram. The labeled rTPO was represented by a single peak at MW 90-100 KDa (fractions 66-76) in the RLU chromatogram in  FIG. 8  (Note: “rTPOAE” refers to rTPO labeled with an acridinium ester analog or variant, e.g., NSP-DMAE in the present example). 
     In vitro immune complex chromatogram: A high anti-TPO antibody patient sample pool (concentration ˜60,000 U/mL) was diluted to ˜1,500 U/mL with the fractionation buffer. One part of the diluted sample was mixed with 19 parts of the diluted (1:600) rTPO labeled with dimethyl acridinium ester (NSP-DMAE). The sample mixture was analyzed using the same column and conditions as above. The RLU chromatogram of the mixture overlaid with the baseline chromatogram in  FIG. 8  (“rTPOAE spiker”) shows a higher molecular weight immune complex peak (fractions 45-55) along with the unbound labeled rTPO peak (Fractions 66-76). 
     MALDI-TOF was used to evaluate the components of the immune complex. 
     Sample preparation: A high anti-TPO antibody patient pool (concentration ˜20,000 IU/mL) was diluted to ˜2,700 IU/mL with the fractionation buffer. The diluted sample was mixed with rTPO in a 1:1 ratio. The sample mixture was analyzed by AKTA Pure system with Superdex 200 HiLoad 16/60 column and 180 (1 ml each) fractions were collected. 
     The A280 Chromatogram ( FIG. 9 ) shows three distinct peaks; a higher molecular weight Peak A (retention volume 52.05 mL), Peak B (retention volume 66.87 mL) and Peak C (retention volume 75.43 mL). Each of the peak area fractions were pooled separately; the higher molecular weight peak area was pooled into two samples. The pooled samples: S1 (fractions 46-49), S2 (fractions 51-54), S3 (fractions 65-68) and S4 (fractions 74-77) were concentrated using Amicon Ultra-4 Centrifugal Filters (Ultracel 30K 30,000 NMWL ref UFC803024). 
     MALDI-TOF procedure: Deionized water (“diH2O”) was added (500 μL) to a pre-washed Pall NanoSep filter followed by various volumes of the above 51, S2, S3, and S4 samples. The samples were then centrifuged at 12,000×g for seven minutes and washed one more time with water and reconstituted directly with a sinapinic acid (Sigma-Aldrich 49508) trifluoroacetic acid (Alfa-Aesar 44630) matrix solution to achieve 2 mg/mL protein concentration. Two microliters of each sample was directly plotted to the MALDI-TOF plate and allowed to dry. A second spotting was performed to improve sensitivity. The MALDI-TOF was calibrated using a MALDI-grade BSA standard on a Shimadzu Axima Confidence MALDI-TOF with laser power was set at 65. The MALDI-TOF result ( FIG. 10 ) showed that samples S1 and S2 primarily consisted of a ˜90 KDa protein species (rTPO) and ˜150 KDa proteins representing human TPO autoantibodies. 
     The results showed that the interaction between the labeled rTPO and the patient samples is specific to patient anti-TPO antibodies. 
     Those skilled in the art will appreciate that numerous changes and modifications can be made to the preferred embodiments of the invention and that such changes and modifications can be made without departing from the spirit of the invention. It is, therefore, intended that the appended claims cover all such equivalent variations as fall within the true spirit and scope of the invention.