Assays and Hormones Flashcards

1
Q

Immunoassay

A
  • Immunoassays rely on antigens (hormone) and antibodies (that bind to hormones).
  • Antigen - any substance that can elicit an antibody response (E2, P4, hCG, FSH)
  • Antigens can be labeled for use in immunoassays (e.g. radioactive iodine 131-I attached chemically to steroid hormone via a carrier molecule such as a tyrosine residue)
  • Antibody - immunoglobulin protein defined by its ability to bind antigen (Polyclonal vs monoclonal)
  • Antibodies can be labeled as well (radioactive vs non-radioactive: e.g. chemical attached causing a color change/light reaction)
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2
Q

Polyclonal antibodies

A

Derived from animal SERUM
1. Inject Ag into host animal
2. Collect serum from animal ~ 3 months later
3. Combine fixed amount of Ag with serial dilutions of serum to isolate antibodies used for assay

*Polyclonal abs will be LESS specific since it is polyclonal (serum abs may bind to your Ag as well as other Ags)

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3
Q

Monoclonal antibodies

A

Derived in cell culture
1. Inject Ag into host animal
2. Harvest SPLEEN from animal
3. Serially isolate B-CELLS until the cell that produces abs to your Ag has been identified
4. Fuse B-cell with immortalized myeloma cell to form “hybridoma” > creates clonal cell line that continuously produces abs

*Monoclonal abs are much more SPECIFIC since they are created from individual spleen B-cells isolated to target Ag specifically

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4
Q

Types of immunoassays:
- RIA
- IRMA (including ELISA)

A

RIA - Radio-immunoassay

IRMA - Immunoradiometricassay
- ELISA - Enzyme-linked immunosorbant assay

Both rely on interaction between Ag and ab for detecting levels of Ag (hormone)

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5
Q

RIA
- Process
- Pros/Cons

A

RIA: radio-immunoassay (indirect measure)

“ANTIGEN excess” assay

  1. Start with KNOWN amount of Ab
  2. Add KNOWN amount of labeled Ag
  3. In assay: add UNknown amount of UN-labeled Ag (what you are trying to measure)

The UNknown amount of UN-labeled Ag competes with known labeled Ag for binding at Ab sites.

  • Measure how much labeled, bound Ag is present by separating bound Ag using a 2nd ab or magnetic particles&raquo_space; can then determine how much UN-known, UN-labeled Ag is present in assay (if labeled, bound Ag is high, then you know there is a low amount of UN-labeled Ag present in sample and vice versa)
  • INDIRECT measurement (you are actually measuring the inverse of the sample) > inverse S-shaped curve.
  • Accuracy of assay is highest in the linear portion of the S-curve, where slope is consistent (this is 20-80% of range of assay; if estrogen is too high, may require dilution to be on the curve > then multiply by dilution factor to determine total amount)

Pros of RIA: good for small steroid hormones, multiple hormones can be assayed from the same serum sample

Cons of RIA: time consuming, $$, cross-reactivity, auto-abs can skew results

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6
Q

IRMA

A

IRMA: immunoradiometricassay

“ANTIBODY excess”

  1. Excess Ab
  2. UNknown amount of Ag
  3. Sandwich Ab (2nd) to bind to Ag-Ab complex
    (In IRMA, radiolabeled; in ELISA, enzyme-linked label in the solid phase)

DIRECT measurement of Ag amount

Pros: very sensitive, ideal with monoclonal abs, better for large, protein hormones

Cons: not as good for assay of small, steroid hormones, interference from other species-specific abs, hook effect

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7
Q

Hook effect

A

When there is a very high amount of Ag

Measured Ag overwhelms the amount of Ab available&raquo_space; excess free Ag binds to radiolabeled Ab (saturated up)&raquo_space; the actual measured amount of “sandwich” Ab-Ag-labeled Ab is low

Graph looks like a “hook”

Occurs with prolactin

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8
Q

Which assay is best for small, steroid hormones?

Which assay is best for large, protein hormones?

A

Small steroid - RIA

Large protein - IRMA (ELISA)

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9
Q

What is sensitivity in the context of assay validation?

Specificity? How do you obtain specificity?

A

Sensitivity: the smallest amount of hormone being measured that can be distinguished from zero (what is the lowest amount of hormone that can be measured in your assay?)

Specificity: ability to differentiate the hormone you are testing from other similar hormones (how much cross-reactivity?) Use mass spec (gold standard) to obtain specificity

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10
Q

Assay validation:
- Accuracy
- Precision

A

Accuracy: ability of assay to provide a value that agrees with the actual/true value (to assess: compare values obtained from your assay to known standards)

Precision: assay variability when multiple measurements are taken on the same sample (intra-assay variability = same sample, same day vs inter-assay variability = same sample, different days/assays)

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11
Q

Calculate coefficient of variance

A

CV (%) = standard deviation (SD) /mean x 100

Measures variation of values that the assay produces

Measure of precision

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12
Q

Mass spectrometry

A
  • Gold standard of measuring hormones
  • Measurement of hormones based on mass and charge
  • Direct measure of hormone quantity
  • Good for measuring testosterone in females (lower threshold values)
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13
Q

What is the gold standard for measuring free testosterone?

A

Equilibrium dialysis method

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14
Q

What would you expect on an estradiol assay for:
- Ethinyl estradiol
- 17 beta estradiol (Estrace, transdermal patch)
- Premarin

A
  • Ethinyl E2: will not show up on assay due to ethinyl group
  • 17 beta E2: WILL show up/be accurate on assay
  • Premarin: inaccurate, only some will be detectable on assay (because derived from pregnant horses)
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15
Q

What is the type of assay used to measure prolactin?

A

IRMA (ELISA)
- Remember “hook effect”
- Consider macroprolactin

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16
Q

Describe OCPs:
- 1st gen
- 2nd gen
- 3rd gen
- 4th gen

A

Generations correspond with generation of progestin

1st gen - 50 mcg ethinyl estradiol (high dose) + norethinedrone

2nd gen - 20-35 mcg EE + levonorgestrel or norethinedrone

3rd gen - norgestimate, desogestrel, gestodene

4th gen - drospirenone

3rd and 4th gen OCPs associated with slightly increased risk for DVT (10-15/10,000, RR ~3 compared to non-users). This is much lower than the DVT risk in pregnancy!

17
Q

NuvaRing

A
  • Etonorgestrel 120 mcg (metabolite of desogestrel, a 3rd gen progestin)
  • 15 mcg EE released/day (Lower systemic exposure than 30 mcg OCP)
  • Pros: sustained level of EE, LOWER systemic exposure, but high efficacy
18
Q

Patch

A
  • Norelgestromin (metabolite of norgestimate)
  • Releases 20 mcg EE / day, but HIGHER systemic exposure in patch compared to 35 mcg EE OCP
19
Q

Nexplanon
- Why does it cause breakthrough bleeding?

A
  • Etonorgestrel (68 mg total, 25-45 mcg etonorgestrel released/day)

*Of note, etonorgestrel is very effective at inhibiting LH (therefore very good contraception), but not as good as inhibiting FSH (continued folliculogenesis without ovulation&raquo_space; fluctuating E2 levels causing instability of endometrium > breakthrough bleeding)

20
Q

Progestin-only pills
- 1st gen?
- 2nd gen?

A
  1. Norethinedrone 0.35 mg QD (1st gen) - prescription only
  2. Norgestrel 0.075 mg QD (2nd gen) - half as potent as levonorgestrel (brand name: Opal, approved for OTC use by FDA in 2023)
  3. Drospirenone 5 mg QD (4th gen) (brand name: Slynd) - more predictable bleeding pattern, anti-androgenic
21
Q

Progestin IUDs

A

Contain 2nd gen levonorgestrel (very potent!)

  • Mirena (52 mg levonorgestrel): 20 mcg released/day over 5 years (after 5 years, 10 mcg released/day)
  • Kyleena (19.5 mg): 17.5 mcg released/day over 5 years
  • Skyla (13.5 mg): 14.5 mcg released/day over 3 years
22
Q

HRT Dosing - Estrogen

A

Standard menopausal dosing:
- 0.625 mg CEE (Premarin)
- 50 mcg E2 patch
- 1 mg micronized 17 beta E2 (Estrace)
- 5 mcg EE

Low-Dose (1/2 standard dose):
- 0.313 mg CEE
- 25 mcg E2 patch
- 0.5 mg micronized 17 beta E2

Reproductive-Age Dose (higher):
- 1.25 mg CEE
- 100 mcg E2 patch
- 2 mg micronized 17 beta E2
- 10 mcg EE

23
Q

HRT Dosing - Progestin

A

Cyclic -
- 200 mg micronized progesterone
- 5 mg Provera
- 0.7 mg norethinedrone
- 1 mg norethinedrone acetate

Continuous - lower dose daily
- 100 mg micronized progestin
- 2.5 mg Provera
- 0.35 mg norethinedrone
- 0.5 mg norethinedrone acetate
- Levonorgestrel IUD

24
Q
A