Newborn screening of phenylketonuria using direct analysis in real time (DART) mass spectrometry

Phenylketonuria (PKU) is commonly included in the newborn screening panel of most countries, with various techniques being used for quantification of l-phenylalanine (Phe). To diagnose PKU as early as possible in newborn screening, a rapid and simple method of analysis was developed. Using direct analysis in real time (DART) ionization coupled with triple-quadrupole tandem mass spectrometry (TQ-MS/MS) and with use of a 12 DIP-it tip scanner autosampler in positive ion mode, we analyzed dried blood spot (DBS) samples from PKU newborns. The concentration of Phe was determined using multiple reaction monitoring mode with the nondeuterated internal standard N,N-dimethylphenylalanine. The results of the analysis of DBS samples from newborns indicated that the DART-TQ-MS/MS method is fast, accurate, and reproducible. The results prove that this assay as a newborn screen for PKU can be performed in 18 s per sample for the quantification of Phe in DBS samples. DART-TQ-MS/MS analysis of the Phe concentration in DBS samples allowed us to screen newborns for PKU. This innovative protocol is rapid and can be effectively applied on a routine basis to analyze a large number of samples in PKU newborn screening and PKU patient monitoring.

Towards standardisation of cell-free DNA measurement in plasma: controls for extraction efficiency,fragment size bias and quantification

Circulating cell-free DNA (cfDNA) is becoming an important clinical analyte for prenatal testing, cancer diagnosis and cancer monitoring. The extraction stage is critical in ensuring clinical sensitivity of analytical methods measuring minority nucleic acid fractions, such as foetal-derived sequences in predominantly maternal cfDNA. Consequently, quality controls are required for measurement of extraction efficiency, fragment size bias and yield for validation of cfDNA methods. We evaluated the utility of an external DNA spike for monitoring these parameters in a study comparing three specific cfDNA extraction methods [QIAamp® circulating nucleic acid (CNA) kit, NucleoSpin® Plasma XS (NS) kit and FitAmp? plasma/serum DNA isolation (FA) kit] with the commonly used QIAamp DNA blood mini (DBM) kit. We found that the extraction efficiencies of the kits ranked in the order CNA kit > DBM kit > NS kit > FA kit, and the CNA and NS kits gave a better representation of smaller DNA fragments in the extract than the DBM kit. We investigated means of improved reporting of cfDNA yield by comparing quantitative PCR measurements of seven different reference gene assays in plasma samples and validating these with digital PCR. We noted that the cfDNA quantities based on measurement of some target genes (e.g. TERT) were, on average, more than twofold higher than those of other assays (e.g. ERV3). We conclude that analysis and averaging of multiple reference genes using a GeNorm approach gives a more reliable estimate of total cfDNA quantity. Figure

Comparison of single and multiple reference gene normalisation for quantification of plasma cell free DNA     

Estimation of the biological variation of glucose-6-phosphate dehydrogenase in dried blood spots

Models based on biological variation provide a well-accepted database with reliable information for clinical laboratories for all purposes including screening, diagnosis and follow-up. Newborn screening laboratories use a blood spotted paper matrix to measure the analytes. This matrix medium is certainly different than body fluid matrix medium. After long-term monitoring of the performance of the Glucose-6-Phosphate Dehydrogenase Kit (R&D Diagnostics OSMMR 2000-D G6PD), the results obtained from the variation analysis were statistically evaluated. Analytical coefficient of variation, CV _A, was found to be 5.41%. The CV _A derived from between run assays was 5.32%, while within-subject biological coefficient of variation, CV _I, was 7.26%. Since minimum performance is defined as CV _A< 0.750 CV _I , CV _A should be lower than 5.44%. The analytical bias in calculation of total error was chosen to evaluate the performance of this assay. In this aspect, CV _G, between-subject biological coefficient of variation, was found to be equal to 10.35%. B _A was found to be 4.12%, which is lower than 4.74%, which means that it is acceptable. Therefore, the minimum quality specification for total error allowable is . When the relevant results obtained in this study were substituted in this formula, TE _a was found to be 13.7% for G6PD measurement in dried blood spots on paper filter matrix. It is expected that this figure will be helpful for the performance evaluation of newborn screening laboratories performing G6PD screening. We have been using error grid graphs for the evaluation of our external quality assurance survey results for the last two years, only because there was no data for assays employing filter matrix. Even the TE _a already reported for EDTA whole blood samples used in G6PD assays has been remarkably high, which can easily create the wrong impression that G6PD is not a reliable test to perform from blood spot cards. The present study shows that this assay is adequately reliable even when performed from dried blood spot matrix. However, we believe that the combination of total allowable error, error grid graphs with a well-defined cut off is the best approach to obtain an accurate performance evaluation for this test.Presented at the 10th Conference Quality in the Spotlight, March 2005, Antwerp, Belgium.     

Software support for the Nordtest method of measurement uncertainty evaluation

Software support for the Nordtest method of measurement uncertainty evaluation is described. According to the Nordtest approach, the combined measurement uncertainty is broken down into two main components??the within-laboratory reproducibility (intermediate precision) s _Rw and the uncertainty due to possible laboratory bias u(bias). Both of these can be conveniently estimated from validation and quality control data, thus significantly reducing the need for performing dedicated experiments for estimating detailed uncertainty contributions and thereby making uncertainty estimation easier for routine laboratories. An additional merit of this uncertainty estimation approach is that it reduces the danger of underestimating the uncertainty, which continues to be a problem at routine laboratories. The described software tool??MUkit (measurement uncertainty kit)??fully reflects the versatility of the Nordtest approach: it enables estimating the uncertainty components from different types of data, and the data can be imported using a variety of means such as different laboratory data systems and a dedicated web service as well as manual input. Prior to the development of the MUkit software, a laboratory survey was carried out to identify the needs of laboratories related to uncertainty estimation and other quality assurance procedures, as well as their needs for a practical tool for the calculation of measurement uncertainty.     

Methods validation: AOAC's three validation systems

Validated methods of analysis are needed for many purposes: enforcement of regulations, import/export control, in accredited laboratories, academia, institutions. The AOAC INTERNATIONAL Official Methods Program is designed to provide fully validated methods of analysis, based on interlaboratory testing by a minimum of eight laboratories. Another, lesser validation system is used for peer-verified methods of analysis where two or three laboratories participate. The system for performance testing of test kits is specially designed for a thorough testing of manufacturer claims, and can be obtained by submitting a kit to Performance Testing by the AOAC Research Institute.     

A comparison of the several methods for determination of specific IgE antibodies

The accuracy of measurement using kits in the clinical laboratories is important for the patient diagnosis and treatment. In the present paper, the AL-18, AlaSTAT, CAP, FAST and RAST methods were investigated and were compared among kits the results obtained with serum sample, for determination of specific IgE antibodies. Significant differences among kits were observed from the results of those methods. One of the reasons, why the data discrepancy exists, is that each kit uses a different reference and a different inclusion method of allergen. For the evaluation of data discrepancy among those kits, it might be important that the clinical history of symptoms and in vivo tests against the different allergens compared with results of in vivo tests.     

Assessment of commutability for candidate certified reference material ERM-BB130 “chloramphenicol in pork”

Chloramphenicol (CAP), an effective antibiotic against many microorganisms, is meanwhile banned in the EU for treatment of food-producing animals due to adverse health effects. The Institute for Reference Materials and Measurements (IRMM) is currently developing a certified reference material (CRM) for CAP in pork, intended for validation and method performance verifications of analytical methods. The material will be certified using liquid chromatography–tandem mass spectrometry (LC–MS/MS) and gas chromatography–mass spectrometry (GC–MS) methods and has a target CAP level around the minimum required performance limit (MRPL) of 0.3 μg/kg. To prove that the material can be applied as a quality control tool for screening methods, a commutability study was conducted, involving five commercially available enzyme-linked immunosorbent assay kits and one biosensor assay (BiaCore kit). Meat homogenates (cryo-milled wet tissue) with CAP concentrations around the MRPL and the candidate CRM (lyophilised powder) were measured by LC–MS/MS and GC–MS as well as the six screening methods. Pairwise method comparisons of results obtained for the two sample types showed that the CRM can successfully be applied as quality control (QC) sample to all six screening methods. The study suggests that ERM-BB130 is sufficiently commutable with the investigated assays and that laboratories applying one of the investigated kits therefore benefit from using ERM-BB130 to demonstrate the correctness of their results. However, differences among the assays were observed, either in the abundance of bias between screening and confirmatory LC and GC methods, the repeatability of test results, or goodness of fit between the methods.     

A field deployable method for a rapid screening analysis of inorganic arsenic in seaweed

Inorganic arsenic (iAs) in 13 store-bought edible seaweed samples and 34 dried kelp (Laminaria digitata) samples was determined by a newly developed, field-deployable method (FDM) with the aid of a field test kit for arsenic in water. Results from the FDM were compared to results from speciation analysis achieved by using high performance liquid chromatography coupled to inductively coupled plasma mass spectrometry (HPLC-ICP-MS). The FDM consisted of a simple extraction method using diluted HNO₃ to quantitatively extract iAs without decomposing the organoarsenicals to iAs followed by the selective volatilisation of iAs as arsine (AsH₃) and subsequent chemo-trapping on a filter paper soaked in mercury bromide (HgBr₂) solution. Method optimization with a sub-set of samples showed 80–94% iAs recovery with the FDM with no matrix effect from organo-arsenic species in the form of dimethylarsinic acid (DMA) on the iAs concentration. The method displayed good reproducibility with an average error of ±19% and validation by HPLC-ICP-MS showed that the results from the FDM were comparable (slope = 1.03, R² = 0.70) to those from speciation analysis with no bias. The FDM can be conducted within an hour and the observed limit of quantification was around 0.05 mg kg^?1 (dry weight). This method is well suited for on-site monitoring of iAs in seaweed before it is harvested and can thus be recommended for use as a screening method for iAs in seaweed.

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Graphical abstract Screening seaweed for their inorganic arsenic concentration within one hour without bias has been made possible in the field by using a field deployable arsenic kit. Its accuracy and precision was compared to HPLC-ICPMS.

     

Performance Tested Method multiple laboratory validation study of ELISA-based assays for the detection of peanuts in food

Performance Tested Method multiple laboratory validations for the detection of peanut protein in 4 different food matrixes were conducted under the auspices of the AOAC Research Institute. In this blind study, 3 commercially available ELISA test kits were validated: Neogen Veratox for Peanut, R-Biopharm RIDASCREEN FAST Peanut, and Tepnel BioKits for Peanut Assay. The food matrixes used were breakfast cereal, cookies, ice cream, and milk chocolate spiked at 0 and 5 ppm peanut. Analyses of the samples were conducted by laboratories representing industry and international and U.S governmental agencies. All 3 commercial test kits successfully identified spiked and peanut-free samples. The validation study required 60 analyses on test samples at the target level 5 microg peanut/g food and 60 analyses at a peanut-free level, which was designed to ensure that the lower 95% confidence limit for the sensitivity and specificity would not be <90%. The probability that a test sample contains an allergen given a prevalence rate of 5% and a positive test result using a single test kit analysis with 95% sensitivity and 95% specificity, which was demonstrated for these test kits, would be 50%. When 2 test kits are run simultaneously on all samples, the probability becomes 95%. It is therefore recommended that all field samples be analyzed with at least 2 of the validated kits.     

New advances in method validation and measurement uncertainty aimed at improving the quality of chemical data

The implementation of quality systems in analytical laboratories has now, in general, been achieved. While this requirement significantly modified the way that the laboratories were run, it has also improved the quality of the results. The key idea is to use analytical procedures which produce results that fulfil the users needs and actually help when making decisions. This paper presents the implications of quality systems on the conception and development of an analytical procedure. It introduces the concept of the lifecycle of a method as a model that can be used to organize the selection, development, validation and routine application of a method. It underlines the importance of method validation, and presents a recent approach based on the accuracy profile to illustrate how validation must be fully integrated into the basic design of the method. Thanks to the -expectation tolerance interval introduced by Mee (Technometrics (1984) 26(3):251–253), it is possible to unambiguously demonstrate the fitness for purpose of a new method. Remembering that it is also a requirement for accredited laboratories to express the measurement uncertainty, the authors show that uncertainty can be easily related to the trueness and precision of the data collected when building the method accuracy profile.     

A marked difference between two populations under mass screening of neonatal TSH and biotinidase activity

Health-associated reference values are universally needed in clinical chemistry. The aim of this study was to establish the reference intervals of two populations from data obtained by the mass screening of newborn babies and to demonstrate how to determine 95% confidence intervals around the lower and upper limits of reference values from values that are not normally distributed. Biotinidase activities from Belgian (n=260) and Turkish (n=328) populations were measured by fluorometric assay and expressed as 1 IU (1 nmol/(dl min). Neonatal thyroid-stimulating hormone (nTSH) values from Belgian (n=4186) and Turkish (n=1663) populations were also measured by the solid phase two-site fluoroimmunometric assay, the results were given as μU/ml blood. Transformation of data was performed for each parameter. A parametric method was used for determination of reference values of biotinidase activity and the Belgian population was significantly higher than the Turkish population. nTSH reference values were evaluated by an exact non-parametric method, but approximate calculation based on the central limit theorem was also performed for confidence intervals around the reference limits. nTSH values of the Turkish population were found to be significantly higher than for the Belgian population. Rank numbers were found by an exact non-parametric method based upon the assumption of a binomial distribution. This study shows a procedure to define the rank numbers for n>1000 and to obtain reference values with 95% confidence intervals for lower and upper reference limits. Received: 20 July 2002 Accepted: 27 July 2002 Acknowledgements We are grateful to Professor Per Hyloft Peterson, Clinical Biochemist, Odense University Hospital, for his valuable advice and criticism. Also we would like to thank John Pezzullo Associate Professor for Pharmacology and Biostatistics, at Georgetown University Medical Center, for his binomial and approximate calculations. We also want to thank Professor Fatma Kutay, Clinical Chemist, Ege University Medical School and Hospital, for her contributions. This investigation was supported in part by a short term FEBS (Federation European Biochemical Society) fellowship grant. Presented at the European Conference on Quality in the Spotlight in Medical Laboratories, 7–9 October 2001, Antwerp, Belgium Correspondence to T. Tanyal?ın     

Accounting for bias in measurement uncertainty estimation

Generic issues and current approaches in the evaluation of bias studies with respect to estimation of measurement uncertainty are discussed, focusing on two main scenarios. In the first, for a within-laboratory assessment of a fully developed uncertainty budget, bias studies are carried out to verify the pre-established performance of a measurement procedure, and design corrective actions if necessary. In the second scenario, for an estimation of measurement uncertainty from within-laboratory validation data, bias studies are carried out to calibrate the whole measurement procedure and evaluate its performance, more specifically to estimate the uncertainty of measurement by combination of bias and precision estimates.

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Accuracy in naturally occurring anabolic steroid assays in cattle and first approach to quality control in Italy

This study assessed the accuracy of 16 commercial and three self-produced kits and drew the basis for using an external quality control (EQC) system. The commercial kits were mainly developed for blood sex steroid determination in humans but also have been used in cattle. Parallelism, recovery and precision tests were performed for progesterone (P4), testosterone (T) and oestradiol (E2) assays. Moreover, anonymous QC samples were sent to be analysed to some Italian laboratories. All kits showed a fair degree of parallelism (P < 0.01), even though 2/7 kits for T and 1/6 kits for E2 determination showed a regression coefficient (r2) lower than 0.98. For P4, an acceptable range of accuracy was achieved in the recovery test only by 1/6 kits; two kits showed fair or great overestimation and two kits considerable underestimation. For T, an acceptable range of accuracy was achieved only by 1/7 kits. For E2, 4/6 kits presented a variable degree of underestimation and two kits showed great overestimation. In the intra-assay precision test quite good repeatability was achieved only using samples with high hormone concentrations. While assaying samples with low concentrations we found a number of RSD > 10%. Moreover, the laboratories participating in the EQC produced statistically different (P < 0.05) results, particularly for high and medium concentrations. In conclusion, the use of commercial kits for screening naturally occurring sex steroid concentrations in cattle blood, in the case of suspected illegal treatments, requires preventive validation procedures and the development of an opportune EQC system.     

Effect of gamma-radiation on the Sn(II) content,radiochemical purity,in-vitro stability and biological distribution of some99mTc-labelled freeze dried kits

Gamma-irradiation can be used for the sterilization of some^99mTc-labelled freeze dried kits. In connection with this the effect of -radiation on Sn(II) content, radiochemical purity,in-vitro stability and biological distribution of some currently used^99mTc-labelled kits has been investigated. For irradiation the certain radiation sterilization doses (25 and 50 kGy) were used. A variable decrease of Sn(II) content was observed in all -irradiated kits. The losses are in the order of 10–25% compared with the Sn(II) content of original ones. The colour of the irradiated kits did not changed except DTPA which developed yellow colour after irradiation. For the irradiated and original kits nearly the same pH were found. The irradiated kits seemed to undergo partial decomposition or chemical alteration which led to some deviation of the biological distribution of them.     

Single vial kit formulation for preparation of PET radiopharmaceutical: 68Ga-DOTA-TOC

This paper describes the development of a lyophilized cold kit of DOTA-[Tyr³]-Octreotide (DOTA-TOC) for instant compounding of ⁶⁸Ga-DOTA-TOC, suitable for diagnosis of neuroendocrine tumors. The work involved formulation of DOTA-TOC kits, optimization of radiolabeling, quality control of ⁶⁸Ga-DOTA-TOC and animal biodistribution studies. The prepared kits enable a reliable method for preparation of ⁶⁸Ga-DOTA-TOC of high radiochemical purity and excellent stability. Availability of such kits along with ⁶⁸Ge/⁶⁸Ga generators is expected to stimulate the widespread use of ⁶⁸Ga-DOTA-TOC in nuclear medicine practice in developing countries.     

Targeted Metabolomics of Dried Blood Spot Extracts

Dried blood spot (DBS) samples are already successfully used in newborn screening and pharmacological analyses. The application of DBS matrix to further metabolomic methods will considerably extend the analytical options for the diagnostics of metabolic diseases. We present an MS/MS based method for the simultaneous extraction and quantification of 188 metabolites from dried blood spots. We provide a sensitive and reproducible method that adapts the AbsoluteIDQ? p180 kit of Biocrates to the DBS matrix for the quantification of metabolites of different substance classes including amino acids, biogenic amines, free carnitine, acylcarnitines, hexoses, glycerophospholipids, lysophosphatidylcholines, phosphatidylcholines, and sphingolipids.     

Validation of two commercial lateral flow devices for the detection of peanut proteins in cookies: interlaboratory study

Results are reported for an interlaboratory validation study of 2 commercially available Iateral flow devices (dipstick tests) designed to detect peanut residues in food matrixes. The test samples used in this study were cookies containing peanuts at 7 different concentrations in the range of 0-30 mg peanuts/kg food matrix. The test samples with sufficient and proven homogeneity were prepared in our laboratory. The analyses of the samples (5 times per level by each laboratory) were performed by 18 laboratories worldwide which submitted a total of 1260 analytical results. One laboratory was found to be an outlier for one of the test kits. In general, both test kits performed well. However, some false-negative results were reported for all matrixes containing < 21 mg peanuts/kg cookie. It must be stressed that the test kits were challenged beyond their cut-off limits (> or = 5 mg/kg, depending on the food matrix). One test kit showed fewer false-negative results, but it led to some false-positive results for the blank materials. The sensitivity of the dipstick tests approaches that achieved with enzyme-linked immunosorbent assays.     

Standardized method comparison for ACS:180 plus and Immulite sensitive PSA (sPSA) measurement methods

The aim of this study was to compare two immunoassay measurement methods, the ACS:180 Plus (Chiron Diagnostics) kit and the Immulite sPSA (DPC) kit. Method comparison analysis was performed according to EP9-A; approved guideline of NCCLS 51. Serum samples having a wide range of total prostate-specific antigen (PSA) concentrations were evaluated in split-sample analysis. F-test, t-test analysis and regression statistics were performed. In Deming regression analysis the coefficients were as follows; the slope=0.967; y-intercept=-0.148, r=0.989. An acceptable bias was seen since the systematical error was calculated to have a value less than the total allowable error calculated from biological variations. Non-parametric evaluation of the area under ROC curves for ACS:180 Plus and Immulite sPSA were 0.997 and 0.987, respectively. Diagnostic accuracy was at the level of p= 0.000 and no statistical difference was found between the two assay methods.     

Experimental design for in-house validation of a screening immunoassay kit. The case of a multiplex dipstick for Fusarium mycotoxins in cereals

The benefits of using rapid qualitative methods to verify compliance of food and feed with legislation requirements include user-friendly format, the possibility of detection without expensive instrumentation, rapid response and affordable price. Prior to their use, however, the methods have to pass validation experiments, in order to assess their performance profile. An experimental protocol for in-house validation of a screening immunoassay has been designed and applied to evaluate performance characteristics of a multiplex dipstick kit for the determination of major Fusarium toxins, namely zearalenone, T-2 and HT-2 toxins, deoxynivalenol and fumonisins in wheat and maize. The test is intended for screening of cereals on the presence/absence of these mycotoxins at maximum permitted levels established by European legislation or target levels. The response of the measurement is determined with a reader device. Samples classified as negative are considered as compliant, whereas positive samples need to be re-analysed with confirmatory methods. The in-house validation design consisted of three steps, namely (1) estimating the precision of the method including "between day" effects and influences from different varieties of the matrices, (2) establishing robust cutoff values for the dipstick response at target mycotoxin levels assuming an acceptable rate of false negative results of 5 % and (3) assessment of the rate of false positive results of blank samples and samples containing the target analytes below the legal limits. The total precision expressed as relative standard deviation and determined individually for each analyte/concentration/matrix combination varied from 9 to 30 % and was considered as acceptable. In 17 out of 28 cases, the repeatability standard deviation was the most important factor. The predominance of the repeatability compared to the other factors (matrix, days) was an indicator for the ruggedness of the assay. The validation study demonstrated that the test was able to differentiate blank samples from samples contaminated at target mycotoxin levels with a false positive rate lower than 6 %. Considering realistic mycotoxin occurrence in European samples, significant economical benefits can be expected when using the test under real-world conditions.

Reflections regarding uncertainty of measurement, on the results of a Nordic fatigue test interlaboratory comparison

This paper presents the experiences of calculation and reporting uncertainty of measurement in fatigue testing. Six Nordic laboratories performed fatigue tests on steel specimens. The laboratories also reported their results concerning uncertainty of measurement and how they calculated it. The results show large differences in the way the uncertainties of measurement were calculated and reported. No laboratory included the most significant uncertainty source, bending stress (due to misalignment of the testing machine, incorrect specimens and/or incorrectly mounted specimens), when calculating the uncertainty of measurement. Several laboratories did not calculate the uncertainty of measurement in accordance with the Guide to the Expression of Uncertainty in Measurement (GUM) [1].