2. Detection systems For all enzyme-linked immunoassays, the final stage is the addition of the enzyme substrate. The substrate is chosen for its quantitative yield of a colored, fluorescent or luminescent reaction product. The decision as to which substrate is the best for any type of assay depends on the sensitivity desired, the timing requirements, and the detection device to be used. Types of detection systems: – Colorimetric Assays – Fluorescent Assays – Luminescent Assays

3. Colorimetric assays Colorimetric assays result in a colored reaction product that absorbs light in the visible range. Fluorescent immunoassays (ELFIA) are simply a variation of colorimetric ELISA. An enzyme converts a substrate to a reaction product that fluoresces when excited by light of a particular wavelength. – In comparison to the colorimetric ELISA, fluorescent immunoassays are only slightly more sensitive.

4. Luminescent immunoassays, like fluorescent immunoassays, are variations of the standard ELISA. An enzyme converts a substrate to a reaction product that emits photons of light instead of developing a visible color. – It is believed that luminescence is the most sensitive detection method currently in use due to the ability of signal multiplication and amplification

5. Microplate Reader The microplate reader also known as “Photometric micro- plate reader or ELISA reader” is a specialized spectrophotometer designed to read results of the ELISA test This instrument works on the principle of "Photoelectric Colorimetry" Unlike the conventional spectrophotometer which facilitates readings on a wide range of wavelengths, the microplate reader has filters or diffraction gratings that limit the wavelength range to that used in ELISA, generally between 400 to 750 nm (nanometres). Some readers operate in the UV range and carry out analyses between 340 to 700 nm.

6. The optical system uses optic fibers to supply light to the microplate wells containing the samples. A detection system (sensors) detects the light coming from the sample, amplifies the signal and determines the sample’s absorbance. The location of the optical sensors of the microplate reader varies depending on the manufacturers: these can be located above the sample plate, or directly underneath the plate’s wells.

7. Structure of antibody-coated microplate and treatment – 12 strips of 8 wells connected each other are set in a microplate frame. – The surface of the plate is covered with a seal to avoid dryness. Remove the seal after the plate gets to the room temperature. – Remove the seal just before starting assay. – If you want to use only a part of the wells, cut the part of the seal, and take out the strips and transfer them to another frame, and remove the seal. – store the rest of the wells at 2-8C.

8. Washing – The first washing after the first reaction with standards or samples: Shake off the reaction mixture from the plate onto a sink. – Then add washing solution using a multi-delivery pipette set at 250mcl to avoid carry-over caused by flowing out the buffer to other wells. Then shake off the buffer. – Add new washing buffer from the washing bottle with nozzle, and shake off. – Repeat filling and shaking off as many times as indicated.

9. Washing solutions are usually concentrated and need to be diluted. 20X : (1:20)= 1 part of washing concentrate with 19 part of D.W, using volumes equivalent to number of wells to be washed. For 8 wells, you require (8*350ul = approx. 3ml) Take 3.8ml of DW with 200 ul of washing concentrate. (total= 4ml).

11. After final shaking off the buffer from the plate, strike the plate on to some sheets of paper towel for several times to remove the residual buffer Automatic plate washers are also commercially available

12. Shaking of the well-plate for mixing – After addition of a reagent solution, the microplate should be shaken to mix the solutions. A short shaking is enough because of the small volume of the reaction mixture. microplate mixer (microplate shaker)

13. Careful addition of reaction stopping solution – As the reaction stopper is strongly acidic, please, be careful in treatment of the solution. – After addition of the stopping solution the color of the reaction mixture in the well will change from blue to orange-yellow.

14. Measurement of absorption using a plate reader – After stopping the enzyme action, absorbance is read using a densitometer for microplates (microplate reader). – If possible measure absorbance at both 450nm and 620nm, and calculate the difference between absorbance at 450nm and 620nm. – By doing this, we can compensate influences of some non-specific factors of wells like small scar on the bottom of well, and the variation in the structure of wells, e.g., thickness of the bottom. – The difference is expressed as Abs.450(∆620)nm.

15. Preparation of standard curve and calculation of assay values – In manual calculation, prepare a standard curve using bi-logarithmic section paper by plotting Abs.450(∆620)nm on Y-axis against standard concentration (ng/ml) on X-axis. – Because the coefficients of variation (CV) in absorbance do not change so much throughout all the assay range, it is proper to choose logarithmic expression in both concentration and absorbance. This expression allows easy reading of lower concentration area.

16. Read the concentrations of the substance to measure in samples from their Abs.450(∆620)nm, and multiply the assay value by sample dilution rate if samples have been diluted.

17. Important points in performing ELISA and improvement of assay performance 1.Sampling and treatments of samples – Serum or plasma? o serum samples is most recommended o In getting plasma: heparin is most often used as an anticoagulant Use of fluoride must be avoided because fluoride ion is a potent inhibitor of peroxidase.

18. o An important phenomenon with frozen plasma is that an insoluble substance (fibrin) will be formed when thawed. In this case, the sample must be vortexed and centrifuged, then the insoluble cluster flowing in the plasma should be taken out by a thin wire needle sharply bent at an end. If such fibrin remains in the sample, it may clog the tip of a pipette and influences assay variability.

19. Storage temperature and freezing-thawing – Sample storage temperature is better to be lower than -35C. – Ultra-low temperature such as -80C is recommended for a long-term storage. – A long storage in a home freezer is not recommended because the sample is frozen very slowly and the solute may separate from solvent, and is concentrated at to the bottom of the storage tube – Repeated freezing and thawing is also harmful to the protein, and may cause inactivation.

20. When samples are taken out from the freezer and thawed, never forget to vortex these samples because the solution after thawing is not homogeneous, and the bottom area contains more solute. Stability of assay samples In assay, the problem of sample stability, i.e. how long the substance to be measured can keep its immunoreactivity, in serum or plasma, is very important. Blood samples also contain enzymes to destroy peptides or proteins, and stability against those enzymes differs from substance to substance

21. Most Kits have their own stability ranges; most of them have the following ranges: – Stability at room temperature: 2 hours – Stability at refrigerator temperature: 24 hours – Stability against freezing-thawing: 3 times – Stability for long period: at –20 ℃ or - 80 ℃

22. Influence of humidity and air stream As ELISA is carried out in small volume of reaction mixture in shallow wells, the ratio of surface area to the liquid volume is large. This means that evaporation of water from the surface during incubation cannot be ignored. During all the incubation process, the well-plate should be covered using the attached plate cover.

23. Pipettes Selection of pipettes – Pipettes for samples and standard solutions are especially important because their precision directly influence the assay precision. When you add samples or standards at a volume of 5 or 10 µl, for example, use a pipette with the maximal setting volume of 5 or 10µl, and never use with the maximum setting volume of 100µl or more. In other words, use volume-matched pipette

24. Trouble shooting in ELISA Possible Causes and MeasuresTroubles 1)The standard or samples might not be added. 2)2) Reagents necessary for coloration shown below might not be added. ①Biotin-labeled antibody ②HRP-conjugated avidin ③TMB or OPD 3) Contamination of enzyme inhibitor(s). 4) Influence of the temperature under which the kits had been stored. Freezing and thawing might cause denaturation of HRP-avidin conjugate. 5) Excessive hard washing of the well plate. 6) Addition of TMB solution soon after taking out from a refrigerator might cause poor coloration owing to low temperature. All the reagent solutions for ELISA should be used after fully warmed up to roomtemperature (20-25°C) Poor or no coloration after the last step 1 st, Coloration

25. The plate-reader might not be adjusted to the correct wavelength (450nm for TMB). ⇒ Check the reader and adjust the wavelength. In the case of a filter-type plate-reader, check the wavelength of the filter, and replace for right one when wrong. Satisfactory absorbance was not obtained by the plate reader; though the coloration is apparent to the eye. TMB solution might have been oxidized by some agents.. All the wells showed high coloration.

26. Standard solutions are not added. In the dilution of original standard solution, other solution than the right original standard solution might be used, or simply the original standard solution was forgotten Flat standard curve. All the wells for the standard curve showed very low coloration, though sample wells gave good coloration. Order of the standard solutions might be reversed. Absorbance of the standard decreased when standard concentration increased. There might be some mistake in the serial dilution of the original standard solution. Pay attention to volumes of standard and buffer solutions and enough mixing The standard curve obtained was not smooth 2 nd standard curve

27. 1 ) The standard preparation might have been denatured. 2) The wrong initial dilution of the original standard solution. 3) The vortex mixing in the dilution of original standard solution might not be enough, and the mixture might not be homogeneous. 4) The reaction period might not be enough by any mistake. The standard curve obtained moved toward right than that shown in the instruction paper.

28. 1) In case NaF-coated tubes are used, or NaN3 is added to assay sample as a preservative, they may influence the enzyme action of HRP though wells are washed before the addition of HRP-conjugate. The best way is not to use NaF and NaN3. 2) Inactivation of the substance to be measured e.g during storage 3) presence of any interfering substances in blood samples=> serial dillution 4) Hemolysis. A slight hemolysis will not influence on assay value, however, too much hemolysis (hemoglobin concentration more than 40mg/ml) may interfere significantly with the assay reaction. 5) pH of serum/plasma samples. Blood samples like serum or plasma easily lose carbon dioxide soon after preparation, and pH will become alkaline (> pH 8) which may interfere with antigen- antibody binding. Assay values were not obtained because samples gave lower absorbance than that of blank though the standard curve seemed to be normal. 3 rd samples

29. 1)Scratching the bottom of the well by aspirator tip during aspiration of washing buffer. 2)Scratching the bottom of the well by pipette tip during addition of standards, samples, or reagents. 3)Insufficient removal of washing buffer from the wells might dilute reagent solution added in the following step of the procedure. 4)Assay variation due to pipetting Big variation between two wells in duplicated assay was observed. 4 th, assay precision

30. Advantages of ELISA High sensitivity High specificity relatively cheap and require small amounts of reagents rapid and can give both qualitative and quantitative results Detection is easy: results can be detected visually or using special readers Results are reproducible Automated, high throughput and manual methods are available, Very versatile No problems with radiation or disposal of waste Can use monoclonal or polyclonal antibodies.

32. Human Growth Hormone (hGH) is a polypeptide chain, composed of 191 amino acids and with a molecular mass of 21,500 Da. It is released by the anterior pituitary of both men and women. The secretion is stimulated 3 –4 hours after a meal, about 1 hour after the beginning of sleep, and after physical exercise. Hyposecretion of hGH becomes apparent in infants a few months after birth and may result in dwarfism. In the opposite case, hypersecretion of hGH results in gigantism and may be due to hypophysic tumors. In adults, when epiphyses are closed, hypersecretion of hGH provokes an increase in volume of soft tissues (hands, feet, lips), a proliferation of bones (acromegalysyndrome), and a limited tolerance of glucose Plays an important role in growth control.

33. Its major role in stimulating body growth is to stimulate the liver and other tissues to secrete IGF-1. It stimulates both the differentiation and proliferation of myoblasts. It also stimulates amino acid uptake and protein synthesis in muscle and other tissues. Growth hormone secretion is regulated by three feedback loops, including both long, short and ultrashort loops. 1.GHRH inhibits its own secretion from the hypothalamus via an ultrashort-loop feedback. 2.Somatomedins, which are by-products of the growth hormone action on target tissues, inhibit secretion of growth hormone by the anterior pituitary. 3.Both growth hormone and somatomedins stimulate the secretion of somatostatin by the hypothalamus.

34. Growth hormone is secreted in a pulsatile pattern, with bursts of secretion occurring approximately every 2 hours. The largest secretory burst occurs within 1 hour of falling asleep (during sleep stages III and IV). The bursting pattern, in terms of both frequency and magnitude, is affected by several agents that alter the overall level of growth hormone secretion. The normal values often increase to as high as 50 ng/ml after depletion of the body stores of proteins or carbohydrates during prolonged starvation.

35. In brief, it has been found that growth hormone causes the liver (and, to a much less extent, other tissues) to form several small proteins called somatomedins that have the potent effect of increasing all aspects of bone growth. Many of the somatomedin effects on growth are similar to the effects of insulin on growth. Therefore, the somatomedins are also called insulin-like growth factors (IGFs). At least four somatomedins have been isolated, but by far the most important of these is somatomedin C (also called IGF-1).

36. The molecular weight of somatomedin C is about 7500, and its concentration in the plasma closely follows the rate of growth hormone secretion. Some aspects of the somatomedin hypothesis are still questionable. One possibility is that growth hormone can cause the formation of enough somatomedin C in the local tissue to cause local growth. It is also possible that growth hormone itself is directly responsible for increased growth in some tissues and that the somatomedin mechanism is an alternative means of increasing growth but not always a necessary one Short Duration of Action of Growth Hormone but Prolonged Action of Somatomedin C.

37. Growth hormone attaches only weakly to the plasma proteins in the blood. Therefore, it is released from the blood into the tissues rapidly, having a half-time in the blood of less than 20 minutes. By contrast, somatomedin C attaches strongly to a carrier protein in the blood that, like somatomedin C, is produced in response to growth hormone. As a result, somatomedin C is released only slowly from the blood to the tissues, with a half- time of about 20 hours. This greatly prolongs the growth- promoting effects of the bursts of growth hormone secretion shown in Figure

38. The serum level of insulin-like growth factor-1 (IGF-1) and of its major circulating binding protein IGFBP-3 are types of these of biomarkers. They are used to diagnose and assess the degree of the human growth hormone (hGH)-deficient state, and to measure responsiveness and predict the outcome of hGH therapy of a patient. They are also used in the differential diagnosis of growth disorders in order to elucidate the etiology of the disease. In addition, IGF-1 and IGFBP-3, i.e. their ratio, can serve as safety biomarkers of hGH therapy. IGF-1 measurement before and after growth hormone therapy.

39. The Human Growth Hormone (hGH) ELISA is a solid phase sandwich ELISA method. The samples and anti- hGH-HRP conjugate are added to the wells coated with hGH MAb. hGH in the serum binds to anti-hGH MAb on the well and the anti -HGH second antibody then binds to hGH. Unbound protein and HRP conjugate are washed off by wash buffer. Upon the addition of the substrate, the intensity of color is proportional to the concentration of hGH in the samples. A standard curve is prepared relating color intensity to the concentration of the hGH.

41. The diagnosis of growth hormone defiance cant be made in a single random growth hormone level because growth hormone is secreted in pulses. Some pediatric endocrinologists diagnosis growth hormone defeciency based on an extremely low level of insuline like growth hormone which varies much less in the course of the day than growth hormone.

42. IGF1 levels are dependent on the amount of growth hormones in the blood but can also be low in normal, young children, so the test must be interpreted carefully. A more accurate but still imperfect way to diagnosis growth hormone deficiency is a growth hormone stimulation test. In this test, your child has a blood drawn for about 2 to 3 hours after being given medications to increase growth hormone release.

43. If the child does not produce enough growth hormone after this stimulation, then the child is diagnosed with growth hormone deficiency. However, growth hormone stimulation tests can over diagnose growth hormone deficiency. Growth hormone stimulation tests vary and are complicated, so they are usually performed under the guidance of a pediatric endocrinologist. Usually, other tests to check the pituitary or to evaluate the brain MRI are performed when treatment is considered.

44. Clinical significance In children, ascertaining linear bone growth along the epiphyseal plate. Abnormally elevated levels lead to gigantism while complete absence slows the rate of growth one third to one half of normal. In adults, the epiphyseal growth plates had fuse so hGH excess gradually produces acromegaly, a coarse thickening of the bones of the skull, hands and feet.

45. Growth hormone test The specimens shall be blood, serum in type and the usual precautions in the collection of venipuncture samples should be observed. For accurate comparison to established normal values a fasting morning serum sample should be obtained. The blood should be collected in a plain redtop venipuncture tube without anticoagulant or additive. Allow the blood to clot. Centrifuge the specimen to separate the serum from the cells.

46. Sample storage Samples may be refrigerated at 2-8 C for maximum period of five days. If the specimen can not assayed within this time, the samples may be stored at temperatures of -20C for up to 30 days. Avoid use of contamination devices. Avoid repetitive freezing and thawing. When assayed duplicate, 0.100 ml of the specimen is required.

47. Principle In this method, GH calibrator, patient specimen or control is first added to streptavidin coated well. Biotinylated monoclonal and enzyme labeled antibodies(directed against district and different epitopes of GH) are added then the reactants mixed. Reaction between the various GH antibodies and native Gh forms a sandwich complex that binds with streptavidine coated to well.

48. After completion of the required incubation period, the enzyme-growth hormone antibody bound conjugate by aspiration or decantation. The activity of the enzyme present on the surface of the well is quantized by reaction with a suitable substrate to produce color. Hyperglycemia inhibits growth hormone secretion. Age is an important factor in growth hormone concentrations. At birth, GH is high and generally declines with the exception of a burst during the growth phase of adolestronce. Women typically have a 50% higher level than their age-mached males.