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CYPRUS ORGANIΖATION FOR THE PROMOTION OF QUALITY CYPRUS ACCREDITATION BODY ACCREDITATION CERTIFICATE no. L061 The Board of Governors of the Cyprus Organization for the Promotion of Quality, the National Accreditation Body, in accordance with the Article 7 of the Law 156(Ι)/2002 GRANTS ACCREDITATION to DEPARTMENTS/ LABORATORIES of THE CYPRUS INSTITUTE OF NEUROLOGY AND GENETICS in Nicosia The Departments/Laboratories shown in annexes were assessed according to the Accreditation Criteria for Medical Laboratories, as defined in the Standard CYS EN ISO 15189:2012 and were found technically competent to carry out the Tests included in the Scope of Accreditation which is described in the Annexes to this Certificate and is an integrated part of it. The Scope of Accreditation can change only after approval from the Cyprus Accreditation Body. The current Accreditation Certificate, no. L061, is issued on the 6th March 2017 and is valid until the 19th June 2018. Accreditation was awarded for the first time on 20th June 2014. Antonis Ioannou Director Date: 6th March 2017 This laboratory is accredited in accordance with the recognised International Standard ISO 15189:2012. This accreditation demonstrates technical competence for a defined scope and the operation of a laboratory quality management System ( ISO-ILAC-IAF Communiqué, January 2015). p. 2/2 Annex to the Accreditation Certificate no. L061 (BG) SCOPE OF ACCREDITATION for the DEPARTMENT OF BIOCHEMICAL GENETICS (BG) OF THE CYPRUS INSTITUTE OF NEUROLOGY AND GENETICS Valid as from the 20th June 2014 until the 19th June 2018. *Valid as from the 14th January 2016 until the 19th June 2018. **Valid as from the 19th October 2016 until the 19th June 2018. Materials /Products Types of examinations Methods applied / Technical fields Plasma Acylcarnitine analysis In-house method (generation acylcarnitine – butyl esters) on Tandem Mass Spectrometer/ Waters Blood sample CSF sample Determination of Lactate Levels Enzymatic (Instruchemie Kit) on Thermo Spectrophotometer Whole Blood sample Levels of the immunosuppressive drug Sirolimus Chemiluminescent Microparticle ImmunoAssay on Abbott ARCHITECTi system Whole Blood sample Levels of the immunosuppressive drug Tacrolimus Chemiluminescent Microparticle ImmunoAssay on Abbott ARCHITECTi system Whole Blood sample Levels of the immunosuppressive drug Cyclosporine Chemiluminescent Microparticle ImmunoAssay on Abbott ARCHITECTi system Plasma or Serum Determination of total Homocysteine levels Chemiluminescent Microparticle ImmunoAssay on Abbott ARCHITECTi system Urine sample Organic acid analysis In-house method (oxidation and extraction with ethyl acetate and diethyl ether) on Gas Chromatography-Mass Spectrometer/Agilent Urine sample Quantitative determination of Glycosaminoglycans In-house method (dimethylmethylene blue -DMB) on Thermo Spectrophotometer Serum or Plasma *Vitamins A&E Chromsystems kit on HPLC/ Waters p. 1/13 Blood sample **Plasma Vitamin B12 measurement on the Architect Up to 2000pg/ml Chemiluminescence Microparticle immunoassay (CMIA) using kit from Abbott diagnostics Architect i1000SR (Abbott) automated immunoassay analyzer Blood sample **Plasma Folate measurement on the Architect Up to 20ng/ml Chemiluminescence Microparticle immunoassay (CMIA) using kit from Abbott diagnostics Architect i1000SR (Abbott) automated immunoassay analyzer Blood sample **Plasma Ammonia Up to 530μmol/L Spectrophotometric determination using kit from Instruchemie Thermo Spectrophotometer Note: The reference to trade names of the analyser/kit is related to a particular method and protocol Authorised person to sign the test reports is Dr Anthi Drousiotou. In her absence, Dr Theodoros Georgiou or Dr Petros Petrou** are authorized to sign reports. p. 2/13 Annex to the Accreditation Certificate no. L061 (CG) SCOPE OF ACCREDITATION for the DEPARTMENT OF CYTOGENETICS AND GENOMICS (CG) OF THE CYPRUS INSTITUTE OF NEUROLOGY AND GENETICS Valid as from the 20th June 2014 until the 19th June 2018. Materials /Products Types of examinations Methods applied / Technical fields Clinical Cytogenetics Chorionic Villus Sample (CVS), Amniotic Fluid, Peripheral and Fetal Blood, Skin Biopsy, Products of Conception Detection of chromosome abnormalities (Test Codes 1,2,3,4,5,6) Cells culturing, harvest and karyotyping by G-banding analysis (Chromosome anaslysis – Qualitative) Molecular Cytogenetics CVS, Amniotic Fluid, Peripheral and Fetal Blood, Skin Biopsy, Products of Conception Identification/Confirmation/ Characterization of Chromosomal abnormalities by FISH (Test code 20) Analysis of Disease(s)/ Syndrome(s) by FISH (Test code 21) Qualitative, Detection of location and number of signals by FISH (Fluorescent In Situ Hybridization) analysis with targeted DNA probes. DNA Analysis CVS, Amniotic Fluid, Peripheral and Fetal Blood Prenatal analysis of FMR1 gene (Fragile X Syndrome) (Test code 60) Postnatal analysis of FMR1 gene (Fragile X Syndrome) per Individual (Test code 61) Qualitative, Detection of trinucleotide repeats and methylation by PCR and Southern Blot analysis. Peripheral Blood Screening of Y(AZF) chromosomal microdeletions (Test code 65) Qualitative, Detection of Y microdeletion by Multiple PCR analysis. Peripheral Blood Molecular analysis of Prader Willi/Angelman Syndrome genomic region 15q11-q13 (Test code 68) Qualitative, Detection of methylation status, microdeletion of microduplication of the region by MS-MLPA analysis. CVS, Amniotic Fluid, Peripheral and Fetal Blood Rapid prenatal analysis of 13,18,21, X,Y aneuploides (Test code 69) Semi-quantitative detection of aneuploidies by QF-PCR (Quantitative Fluorescent-PCR) analysis. CVS, Amniotic Fluid, Semi-quantitative detection of Peripheral and Fetal Detection of genomic imbalances with high copy number changes by arrayBlood, Skin Biopsy, resolution microarray-CGH (Test code 70) CGH (Comparative Genomic Products of Conception Hybridization) analysis. Authorised persons to sign the test reports are Dr Carolina Sismani, Dr Paola Evangelidou. In the absence of the above, Ms Nicole Salameh is authorized to sign reports. p. 3/13 Annex to the Accreditation Certificate no. L061 (ND) SCOPE OF ACCREDITATION for the NEUROGENETICS DEPARTMENT (ND) OF THE CYPRUS INSTITUTE OF NEUROLOGY AND GENETICS Valid as from the 20th June 2014 until the 19th June 2018. *Valid as from the 19th October 2016 until the 19th June 2018. Materials /Products Types of examinations Methods applied / Technical fields Molecular Diagnostic Tests Peripheral Blood DNA extraction from Peripheral Blood (Test code 10) Salting out procedure using the Gentra Puregene Blood Kit of Qiagen Peripheral Blood, Extracted DNA Molecular analysis of PMP22 and SMN1 genes (Test codes 6.05 and 7.01) MLPA (Multiple Ligation- Dependent Probe Amplification) using the ABI 3130xl Genetic Analyser Peripheral Blood, Extracted DNA Molecular analysis of ATXN1, ATXN2, ATXN3, CACNA1A, ATXN7 and HTT genes (Test codes 4,12,5,13,14,15 and 2) Fragment analysis using the ABI 3130xl Genetic Analyser Peripheral Blood, Extracted DNA Molecular analysis of FXN genes (Test codes 3 and 3.01) Long-PCR analysis, sequence analysis and TP-PCR analysis using the ABI 3130xl Genetic Analyser Peripheral Blood, Extracted DNA Molecular analysis of sequence variations in the MPZ, CX32/GJB1 and PMP22, *TTR, *MFN2, Sequencing analysis using the ABI 3130xl Genetic Analyser *NEFL, *GDAP1, *GARS, *EGR2, *LMNA, *APTX, *SOD1, *BSCL2, *TDP43, *LRRK2, *GJC2, *SPAST, *ATL1, *REEP1 and *FUS genes (Test codes 6.02, 6.03, 6.04, 1.01, 6.06, 6.07, 6.08, 6.09, 6.10, 6.11and 34, 20, 23, 24, 25, 26, 27, 28, 29, 31 and 32). Authorised persons to sign the test reports are: 1st signature (permanent) 2nd signature A. Georghiou or K. Christodoulou P. Nikolaou Standard established procedure, manufacturer’s manual (ABI ) 3rd signature L. Koutsou or P. Nikolaou (if not already signed at the p. 4/13 second column) or none p. 5/13 Annex to the Accreditation Certificate no. L061 (EM/MP) SCOPE OF ACCREDITATION for the DEPARTMENT OF ELECTRON MICROSCOPY/MOLECULAR PATHOLOGY (EM/MP) OF THE CYPRUS INSTITUTE OF NEUROLOGY AND GENETICS Valid as from the 20th June 2014 until the 19th June 2018. *Valid as from the 19th February 2016 until the 19th June 2018. Materials/ Products Peripheral Blood Peripheral Blood and various types of tissues Types of Tests Mutation detection in the: BRCA1 (10), BRCA2 (12), TP53 (14), APC (16), MLH1 (19), MSH2 (21), PMS1 (23), PMS2 (25), MSH6 (27), KRAS (29), PTEN (41), STK11 (43), CHEK2 (45), ATM (47), PALB2 (49), BRIP1 (51), CDKN2A (53), BRAF (55), EGFR (61), CKIT (64), PDFGRA (67), CDH1 (70), MYH (72) and VHL (74) genes. Detection of the presence/absence of known mutation(s) in the: BRCA1 (11), BRCA2 (13), TP53 (15), APC (17), MLH1 (20), MSH2 (22), PMS1 (24), PMS2 (26), MSH6 (28), PTEN (42), STK11 (44), CHEK2 (46), ATM (48), PALB2 (50), BRIP1 (52), CDKN2A (54), BRAF (56), CKIT (66), PDFGRA (69), CDH1 (71), MYH (73) and VHL (75) genes. Mutation analysis for mutation CFHR5 internal duplication of exons 2 and 3 (63). Methods applied/ Technical fields In house PCR/Sanger sequencing method and sequence analysis using the ABI 3130xl Genetic Analyser. In house PCR/Sanger sequencing method and sequence analysis using the ABI 3130xl Genetic Analyser or MLPA (Multiple LigationDependent Probe Amplification) using the ABI 3130xl Genetic Analyser following the manufacturer’s protocol (MRC Holland). Screening for mutations in exons 18-21 of the EGFR gene (62). Screening for mutations in exons 2-4 of the KRAS gene (29.1). *Screening for mutations in exons 2-4 of the KRAS and NRAS genes (29.2). Screening for mutations in exons 9, 11, 13 and 17 of the C-KIT gene (65). Screening for mutations in exons 12 and 18 of the PDFGRA gene (68). Peripheral Blood Detection of large rearrangements (duplication(s) or deletion(s) of whole exon(s)) in the BRCA1 (10, 11), BRCA2 (12, 13), MLH1 (19, 20), MSH2 (21, 22), and APC (16, 17) genes. MLPA (Multiple LigationDependent Probe Amplification) following the manufacturer’s protocol (MRC p. 6/13 Peripheral Blood and various types of tissues DNA and RNA extraction and storage (Test codes 6, 7, 8 and 9) Peripheral Blood and various types of tissues Detection of Microsatellite instability (MSI) (Test code 18) Various types of tissues (Muscle, Kidney, Nerve, Cilia, Liver) Various types of tissues (Muscle, Kidney, Nerve, Cilia, Liver) Processing and examination of specimens in the Transmission Electron Microscope (Test code 1) Holland) and using the ABI 3130xl Genetic Analyser. In house DNA and RNA extraction method using phenol/chloroform or QIAamp DNA FFPE Tissue Kit (Qiagen) (DNA) and Trizol (RNA). In house fluorescent multiplex PCR based method using five mononucleotide repeat markers: BAT25, BAT26, NR21, NR22 and NR24. Amplified fragments are detected using the ABI 3130xl. Descriptive report with photographs Examination of specimens in the Transmission Electron Microscope (Test code 2) Descriptive report with photographs Authorised persons to sign the reports for molecular pathology are Dr. Kyriacos Kyriacou and/or Dr. Andreas Hadjisavvas. In the absence of any of the aforementioned persons, Dr. Maria Loizidou signs (p.p.). Authorised persons to sign the reports for electron microscopy are Dr. Kyriacos Kyriacou and/or Dr. Andreas Hadjisavvas. p. 7/13 Annex to the Accreditation Certificate no. L061 (MV) SCOPE OF ACCREDITATION for the DEPARTMENT OF MOLECULAR VIROLOGY (MV) OF THE CYPRUS INSTITUTE OF NEUROLOGY AND GENETICS Valid as from the 20th June 2014 until the 19th June 2018. *Valid as from the 19th October 2016 until the 19th June 2018. **Valid as from the 6th March 2017 until the 19th June 2018. Materials /Products Blood serum Types of examinations Virus serology Levels of IgG Antibodies against Parvovirus (Test code 1) Levels of IgM Antibodies against Parvovirus (Test code 2) Levels of IgG Antibodies against CMV (Test code 3) Levels of IgM Antibodies against CMV (Test code 4) Levels of IgG Antibodies against HSV-1 (Test code 5) Levels of IgM Antibodies against HSV-1 (Test code 6) Levels of IgG Antibodies against HSV-2 (Test code 7) Levels of IgM Antibodies against HSV-2 (Test code 8) Levels of IgG Antibodies against VZV (Test code 9) Levels of IgM Antibodies against VZV (Test code 10) Levels of IgG Antibodies against EBV NA (nuclear antigen) (Test code 11) Levels of IgG Antibodies against EBV EA (early antigen) (Test code 11.1) Levels of IgM Antibodies against EBV (Test code 12) Levels of IgG Antibodies against Adenovirus (Test code 25) Levels of IgM Antibodies against Adenovirus (Test code 26) Levels of IgG Antibodies against Enterovirus (Test code 68) Methods applied / Technical fields CE-IVD certified ELISA Kit, NovaTec CE-IVD certified ELISA Kit, NovaTec CE-IVD certified ELISA Kit, Siemens CE-IVD certified ELISA Kit, Siemens CE-IVD certified ELISA Kit, NovaTec CE-IVD certified ELISA Kit, NovaTec CE-IVD certified ELISA Kit, NovaTec CE-IVD certified ELISA Kit, NovaTec CE-IVD certified ELISA Kit, Siemens CE-IVD certified ELISA Kit, Siemens CE-IVD certified ELISA Kit, Euroimmun CE-IVD certified ELISA Kit, Euroimmun CE-IVD certified ELISA Kit, Euroimmun CE-IVD certified ELISA Kit, NovaTec CE-IVD certified ELISA Kit, NovaTec CE-IVD certified ELISA Kit, Virion\Serion p. 8/13 Levels of IgM Antibodies against Enterovirus (Test code 69) Whole blood (serum), EDTAblood, Liquor, Biopsies, urine, stool, nasal or tracheal swabs, BAL, Cervical/vulvar wash Whole blood (serum), EDTAblood, Liquor, Biopsies, urine, stool, nasal or tracheal swabs, BAL, Cervical/vulvar wash Whole blood (serum), EDTAblood, Liquor, Biopsies, urine, stool, nasal or tracheal swabs, BAL, Cervical/vulvar wash Whole blood (serum), EDTAblood CE-IVD certified ELISA Kit, Virion-Serion Qualitative Virus DNA detection Analysis of the presence of viral DNA from Real-Time PCR assay using VZV, Parvovirus, BK-Virus Taqman chemistry analyzed on an (Test codes 47, 71, 76) ABI 7500 Quantitative Virus DNA detection Analysis of the quantity of viral DNA from Real-Time PCR assay using HSV-1, HSV-2, CMV, EBV and HBV Taqman chemistry analyzed on an (Test codes 44, 45, 43, 46, 41) ABI 7500 Qualitative Virus RNA detection Presence of viral RNA from Enteroviruses and Influenza H1N1(Test codes 48, 77) Quantitative Virus RNA detection Quantity of viral RNA from HCV (Test codes 42) Virus Genotyping Whole blood (serum), EDTADetermination of the HCV Genotype in blood HCV positive samples (Test code 42.2) Serum, nasal, nasopharyngeal or *Presence of viral RNA from Influenza A, tracheal swabs, BAL, CSF Influenza B and RSV** (Test codes 100, 101, 102) Whole blood (serum), EDTA*Presence of viral DNA from Adenovirus blood, CSF, Biopsies, stool, nasal (Test code 63) or tracheal swabs, BAL, Cervical/vulvar wash Cervical/vulvar wash, swabs *Presence of and Typing of Human Papillomavirus (Test code 49.1) Real-Time RT-PCR assay using Taqman chemistry analyzed on an ABI 7500 Real-Time RT-PCR assay using Taqman chemistry analyzed on an ABI 7500 RT-PCR assay with subsequent cycle sequencing of Amplicon Multiplex Real-Time RT-PCR assay Real-Time PCR assay PCR/ Restriction profile analysis, Southern Blot Authorised person to sign the test reports is Dr Christina Christodoulou. In her absence the scientist Dana Koptides or Jan Richter* are authorized to sign reports. p. 9/13 Annex to the Accreditation Certificate no. L061 (MGT) SCOPE OF ACCREDITATION for the DEPARTMENT OF MOLECULAR GENETICS THALASSAEMIA (MGT) OF THE CYPRUS INSTITUTE OF NEUROLOGY AND GENETICS Valid as from the 15th December 2014 until the 19th June 2018. *Valid as from the 14th January 2016 until the 19th June 2018. **Valid as from the 19th October 2016 until the 19th June 2018. Materials /Products Types of examinations Peripheral and Cord blood DNA extraction from Peripheral blood, Cord blood. Chorionic Villus Sample (CVS) Maternal plasma Microscopic cleaning of CVS tissue, DNA extraction from CVS tissue. DNA extraction from maternal plasma. DNA (peripheral blood, cord blood, CVS) *Molecular analysis of α-thalassaemia mutations. *Molecular analysis for Prenatal diagnosis (PND) for α-thalassaemia mutations. **Point Mutations: α5ntα, αAgrα, apolyaA2α, apolyaA1α (Saudi), αIkariaα, Initiation codon, cd108, Deletions: -α3.7, ααα, --MEDI, -20.5, --MEDII, -α4.2 **Qualitative detection of deletion or duplication of the α-globin gene cluster by MLPA analysis DNA (peripheral blood, cord blood, CVS) Molecular analysis of β-thalassaemia mutations *Molecular analysis for Prenatal diagnosis (PND) for β-thalassaemia mutations. Point Mutations: IVSI-110, IVSI-6, IVSI-1, IVSII745, C39, -87 Deletions: Hb Lebore **Qualitative detection of deletion or duplication of the β-globin gene cluster by MLPA analysis Methods applied / Technical fields Puregene Blood Core Kit C-Qiagen Nucleospin Tissue KitMacherey-Nagel QIAmp Circulating Nucleic acid Kit- Qiagen **RED (Restriction Enzyme Digestion) – a- thalassaemia point mutations GAP-PCR a- thalassaemia deletions DNA Sequencing a2 and a1-globin genes **MLPA (Multiplex Ligation - Dependent Probe Amplification kit) Fragment Analysis using the ABI 3130xl Genetic Analyzer ARMS (Amplification Refractory Mutation System)- β-thalassaemia point mutations. GAP PCR- βthalassaemia deletions DNA SEQUENCING β-globin genes **MLPA (Multiplex Ligation - Dependent Probe Amplification kit) Fragment Analysis using the ABI 3130xl Genetic p. 10/13 Materials /Products Types of examinations DNA (peripheral blood, cord blood) Molecular analysis of δ-thalassaemia mutations DNA (peripheral bloodmaternal plasma) Non-invasive prenatal testing of fetal Rhesus Non-invasive prenatal testing for X-linked disorders Methods applied / Technical fields Analyzer DNA SEQUENCING δ-globin genes Real Time PCR - RhD genotype. Real Time PCR Genotyping for fetal sex. Single Blastomere biopsies, 5-10 cell Trophectoderm biopsies **Pre-Implantation Genetic Diagnosis (PGD) for βthalassaemia DNA (Chorionic Villus Sample, CVS) **Molecular analysis for Prenatal Diagnosis (PND) for β-thalassaemia mutations Fragment analysis using the ABI 3130xl Genetic Analyser. Real-Time PCR assay using Taqman chemistry analyzed on an ABI 7900HT, for the presence or absence of the known mutation. Real-Time PCR - β-thalassaemia point mutations Authorised persons to sign the test reports are: -For Prenatal Diagnosis for thalassaemia: Marina Kleanthous and Thessalia Papasavva. 3rd signature: either Miranda Pavlou or George Christopoulos or Xenia Feleki. -Diagnostic reports for thalassaemia: Marina Kleanthous and Thessalia Papasavva. 3rd signature: either Miranda Petrou or George Christopoulos or Xenia Feleki. -For non-invasive prenatal diagnosis: Marina Kleanthous and Thessalia Papasavva. 3rd signature: either Eleni Pavlou or George Christopoulos. -For PGD: Marina Kleanthous and George Christopoulos. In their absence Thessalia Papasavva is authorized to sign reports. p. 11/13 Annex to the Accreditation Certificate no. L061 (MGFT) SCOPE OF ACCREDITATION for the DEPARTMENT OF MOLECULAR GENETICS FUNCTION AND THERAPY (MGFT) OF THE CYPRUS INSTITUTE OF NEUROLOGY AND GENETICS Valid as from the 15th December 2014 until the 19th June 2018. Materials /Products Peripheral Blood, CVS, amniotic fluid Peripheral Blood Peripheral Blood Peripheral Blood Peripheral Blood Peripheral Blood Types of examinations 1. Detection of 29 mutations in the CFTR (Cystic Fibrosis Transmembrane conductance Regulator) gene (1717-1G>A, G542X, W1282X, N1303K, F508del, 3849+10kbC>T, 621+1G>T, R553X, G551D, R117H, R1162X, R334W, A455E, 2183AA>G, 3659delC, 1078delT, I507del, R347P, S1251N, E60X, D1152H, 3120+1G>A, 2789+5G>A, 1898+1G>A, 711+1G>T, G85E, 2184delA, I148T, R560T) Methods applied / Technical fields 1. Manufacturer’s kit Elucigene CF29 v.2. (Gen-Probe, Tepnel Diagnostics) with multiplexARMS PCR method and agarose gel electrophoresis 2. Detection of 4 mutations in the CFTR 2. In house PCR-RFLP method (Cystic Fibrosis Transmembrane conductance Regulator) gene (R117C in exon 4, L346P and M348K in exon 7 and 1677delTA) Screening of mutations in exons 2, 3, 5, 10 of In house DNA Sequencing the MEFV (Mediterranean Fever) gene method in the genetic analyzer ABI 3130 XL. Screening of mutations in exons 10, 11, 13, In house DNA Sequencing 14, 15, 16 of the RET proto-oncogene method in the genetic analyzer ABI 3130 XL 1. Screening of mutations in exon 2 of GJB2 1. In house DNA Sequencing method in the genetic analyzer gene ABI 3130 XL 2. Detection of D13S1830 mutation in the 2. In-house PCR method. GJB6 gene Screening of point mutations and large In house DNA Sequencing deletions or other rearrangements in the method in the genetic analyzer ABI 3130 XL and CYP21A2 gene Manufacturer’s kit for MLPA method (MRC Holland) Detection of H63D and C282Y mutations in In house PCR-RLFP method the HFE (High Iron Fe) gene p. 12/13 Materials /Products Peripheral Blood Types of examinations Methods applied / Technical fields Screening of mutations in SRD5A2 gene (Test In house DNA Sequencing code 20.1) for 5-alpha Reductase Deficiency. method in the genetic analyzer ABI 3130 XL and Manufacturer’s kit. Authorised persons to sign the test reports are Leonidas Phylactou and Vassos Neocleous. General Remarks These Annexes refer only to tests carried out in the premises of the Laboratory, Address: 6, International Airport Avenue, 2370 Nicosia. Antonis Ioannou Director Date: 6th March 2017 p. 13/13