1. PCS Conference Reducing Inhibition of RT-PCR in plasma samples from cadavers Dr Simon Carne National Transfusion Microbiology Reference Laboratory (NTMRL) National Blood Service Colindale London NW9 5BG SoGAT XIX, Bern, Switzerland 2006

2. PCS Conference Introduction Deceased (cadaveric) tissue donors require NAT screening Previous NAT screening system used manual QIAGEN extraction with LC RT-PCR- Very low Inhibition rate (~5%) QIAGEN MDx biorobot purchased, processes 96 samples in ~2hrs Extensive validation performed with variety of plasma samples but not cadaveric- too scarce

3. PCS Conference Cadaveric inhibition Jun 05

4. PCS Conference Initial Strategies for reducing Inhibition On advice from QIAGEN replaced MDx protease with more “robust” proteinase K During validation & investigations on F/T cadaveric material inhibition, observed at 14% for HCV, 34% HIV Freeze/thaw & Proteinase K introduced

5. PCS Conference Cadaveric inhibition Sep/Oct 05

6. PCS Conference Inhibition Reduction Strategies Treatment with QIAGEN InhibitEX matrix Treatment with QIAGEN RNEasy kit Addition of polyvinylpyrrolidine (PVP) to lysis buffer

7. PCS Conference Inhibition Reduction: Results

8. PCS Conference Summary of Outcomes QIAGEN InhibitEX matrix - some limited success - expensive and impractical QIAGEN RNEasy kit - unsuccessful but results so unexpected further work needed PVP addition -limited success - inexpensive BUT some concerns as 2 samples changed status from non-inhibitory to inhibitory

9. PCS Conference Overall Conclusions No “magic wand” for overcoming inhibition in cadaveric samples More robust NAT assay may be required Some evidence that inhibition rates vary depending on referral centre - Inhibition-linked to retrieval and storage? Pelleting of virus by ultracentrifugation may be means to tackle cadaveric sample inhibition

10. PCS Conference Acknowledgements Dr. Alan Kitchen Patricia Lowe Raksha Karia NTMRL National Blood Service, Colindale NW9 5BG London, United Kingdom