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Elecsys® Sirolimus Electrochemiluminescence immunoassay (ECLIA) for the in vitro quantitative determination of sirolimus in human whole blood Indication The Elecsys Sirolimus assay is used as an aid in the management of kidney transplant patients receiving sirolimus therapy. Organ transplant patients are prescribed with immunosuppressant drugs (ISD) like e.g. sirolimus so that the immune system does not reject the newly transplanted organ. ISD assays are used to determine the drug concentration in the patient’s blood as a guide for effective and well-tolerated doses as the desired therapeutic effect is only obtained in a narrow therapeutic range: The dose must be high enough to prevent organ rejection, and low enough to avoid drug toxicity and opportunistic infections.1 Manual sample pretreatment The Elecsys Sirolimus assay uses human whole blood specimens as sample material. As sirolimus is largely distributed in red blood cells and bound to proteins, a one-step manual pretreatment is performed to release the analytes from the proteins. The pretreatment reagent and procedure is universally used for all Elecsys ISD assays. 1 300 µL of well-mixed whole blood (or calibrator or control) 2 2.0 mL microcentrifuge tubes 300 µL of ISD sample pretreatment Vortex, then centrifuge for 4 min at 10,000 g Transfer the clear supernatant into a new sample tube Test principle: Competition principle Streptavidin microparticle Sirolimus in the pretreated sample + 9 min 9 min + Detection Ru Sirolimusspecific biotinylated antibody Ru-labeled sirolimus – derivative Ru 1st incubation (9 minutes) 35 µL of pretreated sample is incubated with an sirolimus-specific biotinylated antibody. The analytes in the sample bind to the antibody. 2nd incubation (9 minutes) After addition of sirolimus labeled with ruthenium complex and streptavidin‑coated microparticles, the unbound sites of the biotinylated sirolimus-specific antibody become occupied. The entire complex becomes bound to the solid phase via interaction of biotin and streptavidin. Measurement The reaction mixture is aspirated into the measuring cell where the microparticles are magnetically captured onto the surface of the electrode. Unbound substances are then removed. Application of a voltage to the electrode then induces chemiluminescent emission which is measured by a photomultiplier. Elecsys technology ECL (ElectroChemiLuminescence) is Roche’s technology for immunoassay detection. Based on this technology and combined with well-designed, specific and sensitive immunoassays, Elecsys delivers reliable results. The development of ECL immunoassays is based on the use of a ruthenium-complex and tripropylamine (TPA). The chemiluminescence reaction for the detection of the reaction complex is initiated by applying a voltage to the sample solution resulting in a precisely controlled reaction. ECL technology can accommodate many immunoassay principles while providing superior performance. Elecsys® Sirolimus test characteristics Testing time Test principle Calibration Traceability Sample material Sample volume LoB, LoD, LoQ* Measuring range Intermediate precision (representative data) Sample pretreatment Expected values 18 min Competitive assay 2 point Standardized against gravimetrically produced master calibrators consisting of exactly defined pure substance sirolimus concentrations in human whole blood matrix EDTA whole blood 300 μL 0.4 ng/mL, 0.5 ng/mL, 1.5 ng/mL 0.5 – 30 ng/mL cobas e 411 analyzer: 2.9 – 6.2 % cobas e 601/e 602 modules: 3.4 – 6.9 % Lowest conc. measured: 2.62 ng/mL One-step manual sample pretreatment; one universal reagent is used for all ISD assays No firm therapeutic range exists for sirolimus in whole blood. Each laboratory should determine its own ranges based on clinical experience. *LoB = Limit of Blank; LoD = Limit of Detection; LoQ = Limit of Quantitation (25 % total error) Order information Elecsys® Sirolimus Elecsys® Sirolimus CalSet PreciControl ISDs ISD Sample Pretreatment 100 tests per rackpack 3 × 1 mL each of CalSet Sirolimus Level 1 and 2 1 × 3 mL each of PreciControl ISD 1, 2 and 3 1 × 30 mL 06327974 190 06327982 190 05889081 190 05889073 190 COBAS, COBAS E, LIFE NEEDS ANSWERS and ELECSYS are trademarks of Roche. Not for distribution in the US. ©2015 Roche Roche Diagnostics International Ltd CH-6343 Rotkreuz Switzerland www.cobas.com References 1 Kahan, B.D., Keown, P., Levy, G.A. et al. (2002). Therapeutic drug monitoring of immunosuppressant drugs in clinical practice. Clin Ther, 24(3), 330-350.