TSH ELISA Kit Medical Device Licence No.: 16419 Enzyme immunoassay kit for the quantitative determination of TSH concentration in serum. Catalog Number: SL100305 Catalog Number: SL100306 Catalog Number: SL100307 96 tests 192 tests 384 tests For in vitro diagnostic use only. 396 N Summit Ave., Suite 2 Gaithersburg, MD 20877 U.S.A. Fax: (301) 330-6381 Email: info@signagenlabs.com Web Site: www.signagenlabs.com Rev. (06/04) TSH-D
TABLE OF CONTENTS Page INTENDED USE 2 INTRODUCTION 2 PRINCIPLE OF THE ASSAY 2 LIMITATIONS OF THE PROCEDURE 2 REAGENTS PROVIDED 3 MATERIALS REQUIRED BUT NOT SUPPLIED 4 PRECAUTIONS 4 SAMPLE PREPARATION 5 ASSAY PROCEDURE 5 CALCULATION OF RESULTS 6 TYPICAL DATA 7...Example 7 PERFORMANCE CHARACTERICS 8...Sensitivity 8...Precision 8...Accuracy 8...Linearity 9...Specificity 9...Expected Normal Values 9 QUALITY CONTROL 10 REFERENCES 10 Rev. (06/04) TSH-D 1
INTENDED USE Enzyme immunoassay permits the routine quantitative determination of many protein hormones in body fluids and provides an accurate, sensitive, reproducible, rapid and specific assay. This enzyme immunoassay method makes it possible to measure very low concentration of TSH (Thyroid stimulating hormone) in small volumes of serum (0.1 ml per assay). INTRODUCTION Thyroid stimulating hormone (TSH), secreted by the anterior lobe of the pituitary gland, induces the production and release of thyroxine (T4) and triiodothyronine (T3) from the thyroid gland. As the serum concentration of these hormones increase, the secretion of TSH is inhibited. Conversely, when thyroid hormone levels decrease, the pituitary increases its output of TSH and the thyroid gland then increases the production and release of hormones. The major use of the enzyme immunoassay has been for the recognition and differential diagnosis of hypothyroidism. PRINCIPLE OF THE ASSAY The ANOGEN coated well method for the quantitative measurement of TSH in serum is a two-site immunoenzymatic assay, commonly referred to as a "sandwich" assay. The system utilizes a solid phase coupled antibody (antibody-coated well) and a second antibody conjugate with peroxydase (HRP). The sample to be assayed (the antigen) is incubated with the antibody coated well. After washing the excess of hormone, add the enzyme substrate to the well. This step is for the formation of a sandwiches binding between well, antibody and the conjugate. Standards of known TSH concentrations are run concurrently with the samples being assayed and a standard curve is plotted. The unknown TSH concentration in each sample is calculated from this curve. LIMITATIONS OF THE PROCEDURE a) Reliable and reproducible results will be obtained when the assay procedure is carried out with a strict adherence to the exact procedure described within this package insert and good laboratory practice. b) TSH determination is for diagnostic purposes. The TSH concentration should be used only as an adjunct to other data (ex.: results of other tests, clinical impressions, etc.) available to the physician who can take into consideration the history of the patient. Each laboratory should compile its own normal ranges, if possible. c) This kit is suitable for use with serum of human origin only. d) Due to the intrinsic design of ELISA assay. The "dose hook" is not seen until a concentration of 1000 mu/l in the ANOGEN TSH-ELISA. Samples greater than 20 mu/l cannot accurately be quantitated by extrapolation. These samples should be diluted with the 0 mu/l standard and re-assayed to give accurate concentrations. e) A maximal total pipetting time of ten (10) minutes per run is suggested. Rev. (06/04) TSH-D 2
REAGENTS PROVIDED All reagents provided are stored at 2-8 C. Refer to expiration date on the label. Rev. (06/04) TSH-D 3 96 tests 1. MICROTITER PLATE (Part THEL-1) 96 wells 192 wells 384 wells Pre-coated wells with mouse anti-tsh immobilized into the well. 2. CONGUGATE (Part THEL-2) 1 or 2 or 4 vials 6 ml Anti-TSH conjugate with HRP, in a stabilizer solution, thimerosal 0.1%. 3. ASSAY BUFFER (Part THEL-3) 1 or 2 vials 11 ml PBS Buffer, ph 7.5, with sodium azide as a preservative. 4. STANDARD 20 mu/l (Part THEL-4) 1 or 2 sets 1 ml 5. STANDARD 10 mu/l (Part THEL-5) 1 or 2 sets 1 ml 6. STANDARD 5 mu/l (Part THEL-6) 1 or 2 sets 1 ml STANDARD 1.5 mu/l (Part THEL-7) 1 or 2 sets 1 ml 7. STANDARD 0.5 mu/l (Part THEL-8) 1 or 2 sets 1 ml 8. STANDARD 0.25 mu/l (Part THEL-9) 1 or 2 sets 1 ml 9. STANDARD 0.1 mu/l (Part THEL-10) 1 or 2 sets 1 ml 10. STANDARD - 0 mu/l (Part THEL-11) 1 or 2 sets 1 ml
11. SUBSTRATE (Part THEL-12) 1 or 2 or 4 vials 11 ml Buffered solution with TMB. 12. WASH BUFFER (Part THEL-13) 1 or 2 vials 100 ml Concentrated solution of saline phosphate buffer with thimerosal as a preservative. Dilute each bottle to 1 liter with deionized of distilled water. 13. STOP SOLUTION (Part THEL-14) 1 or 2 vials 25 ml 0.5 M Sulfuric Acid (H 2 SO 4 ). CAUTION: Caustic Material! WARNING: Sodium azide may react with lead and copper to form explosive azides. Flush with copious quantities of water. MATERIALS REQUIRED BUT NOT SUPPLIED 1. Precision pipettes (100 µl) with disposable tips. 2. 8 channels pipette (25 µl, 100 µl) with disposable tips. 3. Plate shaker set at 100 ± 10 rpm. 4. Multichannel pipette with a repeater. 5. Microplate reader with filter at 414 or 405 nm 6. Deionized or distilled water. 7. Absorbent paper. PRECAUTIONS 1. All materials in this kit may be used only for in vitro clinical or laboratory tests not involving internal or external administration of the material to human or animals. 2. Respect laboratory quality control rules. 3. Reagents are matched in each kit and therefore reagents from different lot numbers should not be mixed. 4. This should not be used after the expiration date. 5. Optimal results will be obtained by strict adherence to this protocol. 4. The kit containing sodium azide and thimerosal as preservatives. These are toxic and therefore all reagents should be handled carefully to avoid ingestion or skin contact. 5. The stopping solution contains sulfuric acid. This solution should be handle with caution, avoiding contact with skin. 6. Prior to assay, warm all reagents to ambient temperature by allowing them to stand at room temperature. Gently mix all reagents. Rev. (06/04) TSH-D 4
SAMPLE PREPARATION Serum must be used in this TSH procedure. No additives or preservatives are necessary to maintain the integrity of the specimen. Store at 2-8 C and assay within one week after collection. If the assay cannot be performed within one week, freezing is recommended. ASSAY PROCEDURE DO NOT INTERCHANGE REAGENTS BETWEEN KITS BEARING DIFFERENT LOT NUMBERS. ALL REAGENTS AND PATIENT SAMPLES SHOULD BE ALLOWED TO COME TO ROOM TEMPERATURE (22 ± 2 C) BEFORE ASSAYING. ALL REAGENTS AND PATIENTS SAMPLES SHOULD BE MIXED BY SWIRLING OR GENTLY VORTEXING. Refer to the assay procedure, Table 1. 1. Pipette 25 µl of Assay buffer in each well. 2. Pipette 100 µl of standard, control or patient sample into the corresponding wells. 3. Incubate for 60 minutes on the plate shaker (100 ± 10 rpm) at room temperature (22 ± 2 C). 4. Wash manually, precautions must be taken to avoid cross-contamination between wells. Decant the well contents by inverting the plate over a contained and without reinverting, blot the plate against absorbing paper. Wash each well three times with 300 µl of washing solution. At the last wash, decant completely the washing solution by tapping the plate against absorbing paper until no trace of water is visible on the paper. 5. Pipette 100 µl of anti-tsh antibody conjugate with HRP in each well. 6. Incubate for 30 minutes on the plate shaker (100 ± 10 rpm) at room temperature (22 ± 2 C). 7. Decant and wash (refer to step no. 4). 8. Pipette 100 µl of TMB enzyme substrate solution (Cat. No.: ES-5001 to each well. 9. Incubate for ten (10) minutes on the plate shaker (100 ± 10 rpm) at room temperature (22 ± 2 C). Protect from direct light source. 10. Add 100 µl of a stopping solution and shake the microplate for homogenize. 11. Measure the absorbance at 414 nm or 405 nm using a microplate reader. NOTE: READ THE ABSORBANCES IMMEDIATELY AFTER COMPLETING THE ASSAY. Rev. (06/04) TSH-D 5
TABLE I Wells Identification Assay Buffer Assay volume Conjugat Substrate Stop Solution A 1,A 2 0 mu/l B 1,B 2 0.1 mu/l C 1,C 2 0.25 mu/l D 1,D 2 0.5 mu/l E 1,E 2 1.5 mu/l F 1,F 2 5 mu/l G 1,G 2 10 mu/l H 1,H 2 20 mu/l I 1,I 2 Serum etc etc 1 2 3 2 4 25 µl 100 µl INCUBATE DECANT & WASH 100 µl INCUBATE DECANT & WASH 100 µl INCUBATE 100 µl READ AT 414 nm 1. Incubate 60 minutes on the plate shaker (100 ± 10 rpm) at room temperature (22 ± 2 C) 2. Wash 3 times with a multichannel pipette (refer to the washing procedure) 3. Incubate 30 minutes on the plate shaker (100 ± 10 rpm) at room temperature (22 ± 2 C) 4. Incubate 10 minutes on the plate shaker (100 ± 10 rpm) at room temperature (22 ± 2 C) CALCULATION OF RESULTS DO NOT ATTEMPT TO SUBSTITUTE ANY PART OF THIS SAMPLE DATA FOR YOUR OWN. Examine date for acceptance consistency with quality control guidelines. Aberrant values may be rejected. Refer to the sample data and calculations, table II and graphic. The absorbance value of the standard zero should not be exceeding 0.120 however, it is an indication of careless washing and the assay must be repeated. For each standard, control and unknown sample, the optical density values are averaged (if there is a duplicate). Substrate the means of the absorbance values of the zero standard from mean absorbance values of other standards, controls and samples. On millimeter paper using the ordinate for the optical density and the abscissa for the standard concentrations (mu/l), a smooth standard curve is plotted. The values of the control and unknown samples are read directly from the standard curve. Rev. (06/04) TSH-D 6
TYPICAL DATA EXAMPLE Results of a typical standard run are shown below: WELLS OPTICAL DENSITY at 414 nm CONCENTRATION (mu/l) 0 mu/l -- -- 0.1 mu/l 0.022 -- 0.25 mu/l 0.041 -- 0.5 mu/l 0.091 -- 1.5 mu/l 0.315 -- 5 mu/l 1.150 -- 10 mu/l 2.307 -- 20 mu/l 3.497 -- Serum 0.218 1.08 etc EXAMPLE OF TSH STANDARD CURVE (plotted from data on Table II) O.D. x 10 3 TSH CONCENTRATION (mu/l) Rev. (06/04) TSH-D 7
PERFORMANCE CHARACTERISTICS 1. SENSITIVITY: Sensitivity is defined as the minimum concentration of TSH which can be statistically distinguished from standard 0 mu/l. This concentration is 0.1 mu/l. 2. PRECISION & REPRODUCIBILITY: a) Intra-assay variation: The precision of the assays was verified by assaying replicates of two (2) different sera. The results were: Parameters Samples 1 2 Number of determinations (N) 6 8 Mean (mu/l) 0.57 6.05 Standard deviation (mu/l) 0.017 0.196 Coefficient of variation (%) 2.9 3.2 b) Inter-assay variation: Reproducibility of the protocol was established by assaying two (2) different sera in replicates in successive runs. The results were: Parameters Samples 1 2 Number of determinations (N) 12 16 Mean (mu/l) 0.59 6.1 Standard deviation (mu/l) 0.02 0.26 Coefficient of variation (%) 3.6 4.2 3. ACCURACY: or recovery study; known amounts of TSH were added to a human serum sample to determine recovery performance of the assay. The data obtained are indicated below: Samples TSH added (mu/l) Expected value (mu/l) Observed value (mu/l) % of recovery 1 (0.84 mu/l) 0.49 0.96 0.92 96 2 0.49 3.28 3.12 95 (2.79 mu/l) 2.71 5.50 5.63 102 3.45 6.24 6.27 100 3 0.49 12.62 12.18 97 (12.13 mu/l) 2.71 14.84 13.93 94 3.45 15.58 14.46 93 Rev. (06/04) TSH-D 8
7. LINEARITY: or dilution study; two (2) serum samples were diluted and run in the ANOGEN TSH-ELISA kit. The results are as follows: SAMPLES DILUTION FACTOR THEORETICAL VALUE (mu/l) EXPERIMENTAL VALUE (mu/l) 1 1/2 11.74 -- 1/4 5.87 5.72 1/8 2.94 3.22 1/16 1.47 1.55 1/32 0.73 0.76 1/64 0.37 0.38 2 1/4 10.22 -- 1/8 5.11 4.93 1/16 2.55 2.78 1/32 1.28 1.42 1/64 0.64 0.71 8. SPECIFICITY: cross-reactivity between the anti-tsh used in this kit with various polypeptide hormones is as follows: SUBSTANCE CONCENTRATION APPARENT TSH % hlh 1 000 U/L < 0.01 2 000 µg/l < 0.01 hfsh 1 000 U/L < 0.01 2 000 µg/l < 0.01 hcg 1 000 U/L < 0.02 2 000 µg/l < 0.2 hgh 2 000 µg/l < 0.6 These cross-reactions data indicate that for all practical purpose the presence of these TSH analogues in serum does not interfere with measurement of serum TSH when this antiserum is used. 6. EXPECTED NORMAL VALUES : It is recommended that, as with any assay, expected values for given populations be determined by each laboratory over a suitable period of time and that a statistically significant number of assays be collected before definitive clinical significance is attached to the results of the assay. CLINICAL CONDITION RANGE Euthyroid N = 98 0.3 4.0 mu/l Rev. (06/04) TSH-D 9
QUALITY CONTROL Good laboratory practice requires that quality control specimens be run with each calibration curve to check the assay performance. Commercial controls are suitable. Any material used should be assayed repeatedly to establish mean values and acceptable ranges to assure proper performance. REFERENCES 1. Yietz, N., Fundamentals of Clinical Chemistry, W.B. Saunders Co., Philadelphia: 791 and 844 (1976). 2. Utiser, R.D., J. Clin. Invest. 44: 1277 (1965). 3. Odell, W.D., et al, J. Clin. Endocrin., 25: 1179 (1965). 4. Soos, M., Taylor, S.J., Gard, T., and Siddle, K.A. rapid Sensitive Two-Site Immunometric Assay for TSH Using Monoclonal Antibodies: Investigation of Factors Affecting Optimization. J. of Immunological Methods 73, 237-249 (1984). 5. Musto, J.D., Pizzolante, J.M., Chesarone, V.P. A Comment of Thyrotropin Measurement and Evaluation. Clin. Chem. 30, 329-330 (1984). Opinion. 6. McBride, J.H., Thibeault, R.V., and Rodgerson, D.O. Thyrotropin as Measured by a Sensitive Immunoradiometric Assay. Clin. Chem. 31/11, 1865-1867 (1985). Rev. (06/04) TSH-D 10