Measurements of thyrotropin and of total and free thyroxine and triiodothyronine are widely used diagnostic methods for thyroid function evaluation. However, some serum samples will demonstrate a nonspecific binding with assay reagents that can interfere with the measurement of these hormones. Several recent case reports have described the presence of such interferences resulting in reported abnormal concentrations of thyroid hormones inconsistent with the patient's thyroid state. Circulating thyroid hormone autoantibodies, described in thyroid and nonthyroid disorders, are an important class of interference factor and can bind to hormone tracers used in various immunoassays. Two additional categories of interfering antibodies may particularly interfere within two-site immunoassays for thyrotropin. These include heterophile antibodies, especially human anti-mouse antibodies, and rheumatoid factors, which can cause interferences by immunoglobulin aggregation and (or) cross-linking of both capture and signal antibodies. Here we review the nature of these disturbances; their occurrence, prevalence, and detection; and the clinical consequences of the failure to recognize such interference.

/pdf/antibody-interference-in-thyroid-assays-a-potential-for-plwzi6rq06.pdf

Antibody interference in thyroid assays: a potential for clinical misinformation

Melanoma is the most frequent solid tumor associated with leptomeningeal metastasis (LM). The usual diagnostic tools, that is, cytomorphological assessment of cerebro-spinal fluid (CSF) and gadolinium-enhanced MRI of the entire neuraxis both lack effectiveness. The CellSearch® Veridex technology for the detection of circulating tumor cells (CTC) in blood was designed for the follow-up and prognosis of breast, prostate, colorectal, and lung cancer, which express EpCAM markers. We have previously adapted this technology to detect malignant cells in the CSF of breast cancer LM. Our objective here was to check if this technology would also allow the detection and the enumeration of CTC in the CSF of melanoma patients presenting with LM although melanoma does not express EpCAM markers. On the occasion of the intrathecal treatment of LM in 2 melanoma patients, 5 mL of CSF and 7.5 mL of blood were collected on CellSave® Preservative Tubes and analyzed within 3 days after CSF sampling using a melanoma-dedicated kit. The CellSearch® Veridex technology was then adapted to direct enrichment, enumeration, and visualization of melanoma cells in the CSF. CD146+, HMW-MAA+, CD34−, and CD45− cells with typical morphology could be observed and enumerated sequentially with reproducible results, corresponding to CSF melanoma cells (CSFMC). In contrast to the current gold standard cytomorphological analysis, this new approach allowed a precise quantification of CSFMC in all samples concomitantly analyzed. This methodology, established on a limited volume of sample and allowing delayed processing, could prove of great interest in the diagnosis and follow-up of melanoma patients with LM.

Detection and quantification of CSF malignant cells by the CellSearch technology in patients with melanoma leptomeningeal metastasis.

The anti-mouse antibody response was examined in patients receiving repeated i.v. therapy with radiolabelled mouse monoclonal antibody (MAb) to carcinoembryonic antigen (CEA): 131I anti-CEA was given approximately every 2 weeks with cyclosporin A, to suppress the anti-mouse antibody response. Two schedules of cyclosporin A--intermittent therapy for 6 days with each course of anti-CEA and continuous therapy--were compared. Suppression of the immune response in the intermittent high-dose (3 patients) and continuous low-dose groups (4 patients) was equivalent, but the latter regimen was less toxic. Repeated therapy led to the formation of small amounts of anti-mouse antibody, but provided that cyclosporin A was continued it did not prevent further therapy or lead to an increase in the rate of clearance of anti-CEA from blood. Without cyclosporin A no more than 2 courses of antibody therapy could be given. Patients received up to 4 doses of 131I anti-CEA. The nadir platelet count was related to the half-life of 131I anti-CEA in blood. Thrombocytopenia limited the amount of 131I anti-CEA that could be given and determined the interval between treatments. Effective suppression of the anti-antibody response is possible and this study has determined that myelosuppression is the principal obstacle to repeated therapy with radiolabelled antibody.

A phase-I study of repeated therapy with radiolabelled antibody to carcinoembryonic antigen using intermittent or continuous administration of cyclosporin A to suppress the immune response.

An overview of the literature is presented concerning the formation, detection, incidence and effect of the human immunoglobulin response on immunoscintigraphy. The following conclusions are drawn. The production of human anti-mouse antibodies (HAMAs) is associated with a diminished therapeutic response; adequate prevention of HAMA production is not yet possible; high HAMA titres give rise to rapid clearance of MoAb into the liver and marked reduction of tumour uptake which results in reduced image quality on immunoscintigraphy; alteration of antibody biodistribution is likely to be related to the in vivo formation of antibody-antibody complexes which could interfere with image quality when sequential imaging is carried out.

Human immunological response to mouse monoclonal antibodies in the treatment or diagnosis of malignant diseases.

The treatment of malignant brain tumors continues to challenge neuro¬surgeons and basic scientists. The lack of major success with chemotherapy and radiation therapy has spurred further investigation into the biology of these tumors and host reactions to them.

Immunobiology of brain tumors.

Six patients with neoplastic melanomatous meningitis were studied. The diagnosis of this complication of malignant disease rests on the demonstration of malignant cells within the CSF. The addition of monoclonal antibody immunocytology to conventional techniques significantly improved the diagnostic sensitivity of CSF cytology, allowing for earlier and therefore more effective palliative treatment.

https://jnnp.bmj.com/content/jnnp/52/7/881.full.pdf

Neoplastic meningitis in malignant melanoma: diagnosis with monoclonal antibodies.

Pre-existing anti-mouse immunoglobulin in a patient receiving 131 I-murine monoclonal antibody for radioimmunolocalisation

Pre-existing anti-mouse immunoglobulin in a patient receiving 131I-murine monoclonal antibody for radioimmunolocalisation.

The delivery of radiolabelled MAb to human primary cerebral tumours

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Neoplastic meningitis in malignant melanoma: diagnosis with monoclonal antibodies.

Pre-existing anti-mouse immunoglobulin in a patient receiving 131I-murine monoclonal antibody for radioimmunolocalisation.

The delivery of radiolabelled MAb to human primary cerebral tumours