Fifth generation troponin T assay is subject to antibody interference

• Published in: Clinica chimica acta Vol. 505; pp. 98 - 99
• Main Authors: Hedley, Jeffrey, Menon, Venu, Cho, Leslie, McShane, Adam J.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2020
• Subjects: Aged; Antibodies - analysis; Chromatography, Gel; Electrocardiography; False Positive Reactions; Female; Fifth generation troponin T; Heterophilic antibody interference; High-sensitivity troponin T; Humans; Immunoassay; Indicator Dilution Techniques; Indicators and Reagents; Magnetic Resonance Imaging; Polyethylene Glycols - analysis; Sensitivity and Specificity; Takotsubo Cardiomyopathy - diagnosis; Takotsubo Cardiomyopathy - diagnostic imaging; Troponin T; Troponin T - analysis; Fifth generation troponin T; High-sensitivity troponin T; Heterophilic antibody interference; Troponin T
• ISSN: 0009-8981; 1873-3492; 1873-3492
• DOI: 10.1016/j.cca.2020.02.006

[Display omitted] •Spurious 5th generation troponin results may prompt unnecessary treatment or further diagnostic evaluation.•Fourth and 5th generation troponin T are not subject to the same heterophilic antibody interference.•Heterophilic antibody interference may be discerned utilizing antibody-blocking and/or precipitating reagents. The fifth generation (high-sensitivity) troponin T assay offers increased precision and analytical sensitivity to the predecessor method. The assay has proven utility in risk stratification and patient management. Upon clinical suspicion and discordant 4th generation troponin T and troponin I results, we investigated a sample for suspected interfering substances to the 5th generation troponin T assay. The analysis included a serial dilution, treatment with polyethylene glycol, commercial antibody blocking reagents, and size exclusion chromatography. The sample diluted linearly (R2 = 0.9957); however, experienced a dramatic reduction in concentration after both the polyethylene glycol and blocking agent treatment. Finally, size exclusion chromatography demonstrated assay reactivity around 970 kDa range. These experiments elucidate a heterophilic antibody interference to the assay, and demonstrate potential measures to discern the interference.