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1055 East State Street, Suite 100 Athens, OHIO 45701 USA USA Toll-free: (800) 874-1517 International: +1(858) 552-1100 Fax: +1(740) 592-9820 www.dhiusa.com QUALITY ASSURANCE STATEMENT Continuous and Primary Tissue Cell Line Cultures Diagnostic Hybrids, Inc. (DHI) manufactures products in a facility certified to the ISO 13485:2003 quality system standard for medical device manufacturers and in conformance with the requirements of USA’s Code of Federal Regulations title 21 (CFR), the requirements of Canada’s Medical Device Regulations (CMDR), and the requirements of European Union’s In Vitro Diagnostic Medical Devices Directive (IVDD). DHI is the sole manufacturer of FreshCells™, MixedCells™, ReadyCells® and FreshFrozenCells® cell culture products for in vitro diagnostic use. Both continuous cell lines and primary kidney tissue cultures are processed in separate, isolated and distinct cleanroom areas. In addition, only one continuous cell line is processed at a time. Since cell cultures have a relatively short shelf-life, cells cannot be tested for the required 14 days prior to shipment to verify absence of microorganisms. DHI continues to monitor representative samples from each lot of cell product for evidence of microorganisms for at least 14 days after first shipment. CONTINUOUS CELL LINES: A continuous cell line is a group of morphologically uniform cells that can be propagated in vitro and are capable of an unlimited number of population doublings for an indefinite time. Continuous cell lines usually either come from tumor tissue or have been deliberately immortalized or transformed. Continuous cell cultures are intended for virus and/or Chlamydia isolation and to aid in the diagnosis of diseases associated with infectious agents. These cells should not be used for serial cell propagation. Cell types are from reliable, reputable, and traceable sources. Prior to acceptance into DHI’s production facility, cell lines and strains are reviewed through documentation history and laboratory analysis to verify that no microorganisms (by sterility testing) and no viruses [as evidenced by the absence of cytopathic effect (CPE)] are known to be present. Frozen stock cultures are screened for the absence of Mycoplasma spp. and other adventitious microorganisms. The various cell types are characterized as to species identity by isoenzyme analysis. Prior to shipment of each lot of cell culture, the culture medium is examined for clarity and pH, and monolayers are examined microscopically for morphology, confluence, and uniformity. During a cell product’s lifetime, representatives of each batch are evaluated according to defined performance criteria using appropriate indicator viruses or Chlamydia as inoculae. Product 40-MC4- (CHO-Mc4) 43- (HEL) 44- (MRHF) 51- (MRC-5) 52- (CV-1) 53- (BGMK) 54- (McCoy) 55- (ELVIS® HSV) 56- (A549) 57- (Hep-2) 58- (Mv1Lu) 59- (NCI-H292) 62- (MNA) 67- (Vero 76) Continuous Cell Culture Description Chinese hamster ovary, genetically modified human embryonic lung human foreskin fibroblast human embryonic lung fibroblast African green monkey kidney Buffalo green monkey kidney mouse fibroblast baby hamster kidney, genetically modified (BHK) human lung carcinoma human epidermoid carcinoma mink lung epithelial human pulmonary muco-epidemoid carcinoma mouse neuorblastoma African green monkey kidney Product 70- (Super BGMK) 75- (HeLa 229) 76- (RD) 83- (MDCK) 84- (Vero) 85- (WI-38) 86- (LLC-MK2) 87- (Hs27 / HFF) 92- (Super E-Mix™) 96- (R-Mix™) 97- (R-Mix Too™) 98- (H&V-Mix™) 92- (Super E-Mix™) Continuous Cell Culture Description Buffalo green monkey kidney, genetically modified human cervix adenocarcinoma human rhabdomyosarcoma Madin-Darby canine kidney African green monkey kidney human embryonic lung fibroblasts Rhesus monkey kidney human foreskin fibroblast A549 and BGMK-hDAF A549 and Mv1Lu A549 and MDCK MRC-5 and CV-1 A549 and BGMK-hDAF PRIMARY KIDNEY TISSUE CULTURES: Primary Monkey Kidney (PMK) tissue cultures [cells isolated from the kidneys of Macaca mulatta (Rhesus), Macaca fascicularis (Cynomolgus), or Cercopithecus aethiops (African Green)] have been shown to be very permissive to human viruses and are intended to be used in the cultivation and amplification of viruses, such as respiratory viruses, enteroviruses, measles, and poliovirus from patient specimens. PMK cells are derived from adult animals by enzyme treatment of kidney tissues. The cells are centrifuged free of the enzyme preparation, re-suspended in growth medium and cultured in appropriate containers. REF: PI-038.6en v2012JUN04 © 2012 Diagnostic Hybrids, Inc., Athens, OH 45701 USA. 1055 East State Street, Suite 100 Athens, OHIO 45701 USA USA Toll-free: (800) 874-1517 International: +1(858) 552-1100 Fax: +1(740) 592-9820 www.dhiusa.com QUALITY ASSURANCE STATEMENT Continuous and Primary Tissue Cell Line Cultures PMK cells, like all primary animal cells, may harbor endogenous viruses1,2 such as simian viruses (SV), foamy viruses, adenoviruses3, Herpes B virus, etc. as well as bacteria and parasites. These PMK culture endogenous viruses can sometimes interfere with the culture of virus contained in the inoculum. It should be noted that Herpes B, though innocuous to monkeys can infect humans and cause death. The most common endogenous viruses are SV5 and SV40. Addition of antisera to SV5 and SV40 to the medium may inhibit the growth of these SV and is, therefore, available as an option for the Rhesus products. Some of these viruses may be expressed only after the cells have been “stressed” by, for example, environmental factors, age of the culture, or inoculation with a specimen or fresh medium. Consequently, all results obtained using this product should be reviewed by appropriately trained laboratory personnel, aware of the possibility that observed CPE may be caused by an endogenous virus as well as a virus in the specimen. Testing performed on primary kidney tissue by Supplier* Product Source Herpes B virus 46- (pAGMK) African Green NO (not a carrier) 47- (pCMK) Cynomolgus YES - tested 48- (pRK) Rabbit, New Zeal§ NO - not required 49- (pPhMK) Rhesus YES - tested Other test or vaccinations tuberculosis (TB) test; rabies, tetanus tissue tested negative up removal, see below closed pathogen free colony; 7-day sterility tissue tested negative up removal, see below *Generally, a brief life history and health certificate is provided with each monkey kidney (e.g., tracking code, source code, animal ID number, age, physical traits, clinical record, vaccinations, treatment for parasites, etc.). Specific tissue tests performed by each supplier varies; tissue used is negative using PCR or ELISA for: E. coli, Ebola, Hepatitis, Herpes B, Marburg, Measles, Mycoplasma, SIV and SFV. The standard monkey colony practice is to vaccinate for rabies and tetanus, and test for TB. § Rabbit kidney tissue (New Zeal White) is supplied from a closed specific pathogen free colony; the kidney is aseptically removed and placed in sterile transport medium; direct tests are performed on specific tissue to check for potential pathogens. GENERAL CELL CULTURE PRECAUTIONS: 1. As with all methods for virus identification using cultured cells, personnel must be properly trained in virus culture and safe handling techniques as described in the CDC-NIH manual2, Biosafety in Microbiological and Biomedical Laboratories, i.e., manipulations which present potential personnel hazards should be conducted in a Class II biosafety cabinet and gloves should be worn at all times. Cultured cells used for virus identification may also support the replication of infectious agents which are classified by the CDC as agents requiring cultivation under BSL-3 conditions. Consult CDC listing of the BSL-3 infectious agents and the CDC recommendations. 2. The laboratory must determine the cell type to be used as host for isolation of a particular virus and/or Chlamydia. Use for diagnostic procedures without prior culture has not been established. 3. Upon receipt of all cell cultures, the uninoculated monolayer should be examined for appearance (e.g., dead or toxic cells, confluency) and morphology (e.g., atypical cells or CPE) prior to inoculation. 4. To aid in determining whether an endogenous virus might be present, negative controls (both with fresh medium and as never-opened cultures) should be used and monitored for any cellular changes. 5. The classic detection method of viral infection is the observation of cellular changes due to infection of the cells, termed cytopathic effect (CPE). CPE alone is not diagnostic and requires additional testing for viral identification. 6. Some cell cultures have been shown to be non-permissive to infection and replication of the etiological agents, such as, Severe Acute Respiratory Syndrome (SARS). For additional information, refer to the CDC website at http://www.cdc.gov/ncidod/sars/lab/biosafety.htm. 7. Cultures and specimens should be autoclaved or disinfected with a solution of sodium hypochlorite (1:10 final dilution of household bleach) prior to disposal. PRODUCT SPECIFICATIONS: Information beyond that provided by the Instructions for Use, Product Insert, Lot Specification Report or Material Safety Data Sheet on a particular product or product lot may be request. DHI will reviewed the information request and provide appropriate feedback. 2012 June 04 Karl E. Luke, PhD, Director, Quality Affairs 1 2 3 Date G.D. Hsiung and V.F. Chan, “Endogenous viral and mycoplasma contaminants in cell cultures.”Hsiung’s Diagnostic Virology, 4th ed; editors G.D. Hsiung, C.K.Y. Fong, and M.L. Landry; Yale Univ. Press; Ch 29, pp346-362, 1994. CDC-NIH Manual, Biosafety in Microbiological and Biomedical Laboratories (BMBL), 5th edition, 2007, CDC-NIH manual. [http://www.cdc.gov/od/ohs/biosfty/bmbl5/bmbl5toc.htm] Swierkosz, E.M. and T. Bonnot, Pseudoinfection due to Simian adenovirus, Clin. Microbiol. Newsletter, 14:14, 1992. REF: PI-038.6en v2012JUN04 © 2012 Diagnostic Hybrids, Inc., Athens, OH 45701 USA.