Classifications

• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
  • G01N33/92—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving lipids, e.g. cholesterol, lipoproteins, or their receptors
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2800/00—Detection or diagnosis of diseases
  • G01N2800/04—Endocrine or metabolic disorders
  • G01N2800/044—Hyperlipemia or hypolipemia, e.g. dyslipidaemia, obesity

Definitions

• the invention relates to a method of estimating plasma cholesterol levels using small samples of blood.
• Coronary heart disease represents the most common cause of premature death in the Western World and is brought about primarily by the deposition of atherosclerotic plaque within the walls of the blood vessels. This deposition occurs at a number of anatomical sites throughout the body but is particularly hazardous in the coronary arteries and carotid vessels.
• One of the factors known to predispose a person to the deposition of atherosclerotic plaque and hence atheromatous disease is a high level of circulating cholesterol in the blood. Studies have indicated that although blood cholesterol levels can be influenced by diet many individuals have an inherited genetic predisposition to elevated cholesterol levels and in some cases the condition is so severe that they suffer their first myocardial infarction or heart attack in their early teens.
• this condition can be controlled in individuals at risk from atheromatous disease by providing medication to reduce the circulating blood cholesterol and by following the correct diet.
• this condition can be controlled in individuals at risk from atheromatous disease by providing medication to reduce the circulating blood cholesterol and by following the correct diet.
• plasma or blood cholesterol is frequently used, there is little if any cholesterol in free form in the blood. Rather the cholesterol, which is predominantly present in an esterified form, and indeed other lipids such as triglycerides and phospholipids, circulate as complexes bound to proteins.
• These lipoprotein complexes are divided into four major groups on the basis of density, viz high-density lipoprotein or HDL, low-density lipoprotein or LDL, very low density lipoprotein or VLDL and chylomicrons.
• HDL has the highest protein to lipid ratio while chylomicrons have the lowest and, in fact, are predominantly lipid.
• circulating cholesterol levels correlate with circulating levels of LDL and individuals with high blood cholesterol levels commonly have raised concentrations of LDL.
• the proteins associated with lipoprotein complexes are called apolipopr ⁇ teins.
• the protein present in LDL complexes is specific for that class and is referred to as apoprotein B.
• raised blood levels of apoprotein B are also an indirect indication of raised cholesterol levels.
• the most commonly used method for measurement of plasma cholesterol is an enzyme assay in which cholesterol esterase converts cholesterol esters to free cholesterol. The total cholesterol is then treated with another enzyme, cholesterol oxidase, which generates hydrogen peroxide as one of the reaction products.
• the concentration of the H 2 ⁇ 2 generated may be easily determined by a number of well-known colourimetric methods.
• the total low-density lipoprotein can be estimated by electrophoresis of plasma in agarose gel.
• the various lipid-containing bands may be visualized and quantified by staining with any lipid soluble dye.
• the total LDL may also be separated from other plasma constituents in an analytical ultracentrifuge or the LDL may be precipitated by the addition to plasma of polyanions, such as for example heparin, which has an affinity for and binds apoprotein B.
• the cholesterol or protein components may then be measured by standard methods, for example the cholesterol esterase/oxidase method described above.
• the disadvantage of all the methods currently available to measure plasma cholesterol is that they involve expensive, time-consuming, laboratory-based assays and require quite large volumes of the patient's blood. Thus it is not practical to routinely screen individuals for high blood cholesterol unless atheromatous disease is suspected.
• the method of estimating blood cholesterol in accordance with the invention comprises providing a surface carrying, either over a part or over its whole, anionic groups at a high packing density, said anionic groups having an affinity for low-density lipoprotein, exposing a sample of blood to said surface whereby the low-density lipoprotein component binds to said anionic groups and detecting the bound low-density lipoprotein.
• the anionic groups are preferably provided by any anion-containing polymer in which the anions are available to make contact with the low-density lipoprotein when the blood sample is exposed to the polymer and in which the anions are packed sufficiently close together, either over a part of or over the whole length of the polymer chain, to bind the low-density lipoprotein thereto.
• suitable polymers are those whose anion generating groups are completely ionised at the pH of blood i.e. about pH 7.4, for instance polymers of carboxylic acids such as polyacrylic acid, polymers of the half-esters or half-amides of dicarboxylic acids e.g. succinic acid, polymers of sulphate half-esters or half-amides, polymers containing sulphonic acid groups, polymers of the mono-esters of phosphoric acid and some mucopolysaccharides.
• Polymers which are particularly preferred in some instances are heparin, heparan sulphate and dextran sulphate because of their high affinity for LDL.
• mucopolysaccharide or anionic polymers which have a relatively low binding affinity for LDL, such as keratan sulphate, chondroitin sulphate, dermatan sulphate and hyaluronic acid are less suitable for use with the method of the invention. Whether or not a particular substrate providing anionic groups is suitable for use herein can be readily determined by experiment.
• anion-containing polymers are those which do not require a separate supporting substrate, i.e. those which are of sufficiently anionic character to be able to bind the low density lipoprotein and which can be formed into suitable self-supporting shapes.
• Nitrocellulose is an example of such an anion-containing polymer since it carries negative charges due to oxidation of the primary alcohol groups of the cellulose during nitration. Further nitrocellulose appears to be able to absorb proteins by other mechanisms as well.
• the suitable substrate materials are proteins; carbohydrates (including agarose, nitrocellulose and other cellulose derivatives) ; lipids; many organic polymers e.g. polyacrylamide, polymethacrylates, polystyrene, nylons, polyesters, polyethylene oxides, polyglycols, polycarbonates and polyurethanes; latex and polymer latices; silica and silicates; glass; ceramics; and metals and metal oxides.
• the supporting substrate may be either porous eg cellulose derivatives, or non-porous.
• the anion carrying surface may be planar, tubular or spherical.
• the objects which provide suitable support surfaces include strips, slides, capillary tubes or beads.
• the polymer may be merely adsorbed on the surface or chemically coupled to the surface.
• Chemical coupling between the anionic polymer and the support surface can be brought about by a number of well-known techniques. For example, materials which have high numbers of hydroxyl groups on their surface, such as sepharose, may be activated for coupling to an anionic polymer also carrying amino groups (for example, heparin) by treatment with cyanogen bromide.
• a ino groups may be attached to the surface of materials such as silica and silicates, glass, ceramics, metals and metal oxides by treatment with aminopropyltriethoxysilane and subsequently activated by reaction with glutaraldehyde for coupling to an anionic polymer also carrying amino groups.
• materials such as silica and silicates, glass, ceramics, metals and metal oxides
• glutaraldehyde for coupling to an anionic polymer also carrying amino groups.
• the lipid component of the bound LDL may be detected by applying any suitable lipid staining dye.
• the apoprotein B component of the bound LDL can be detected by an immunological technique such as use of fluorescent chromophore conjugated antibodies, radio-actively labelled antibodies or enzyme-linked antibodies. Another possibility is to use the cholesterol esterase/oxidase assay described previously.
• the surface carrying the multiple anionic groups is in the form of beads. Binding of the LDL causes the beads to aggregate together, the degree of aggregation being a measure of the LDL concentration.
• the surface is provided by a glass slide having heparin coupled to its surface following treatment with amino ⁇ propyltriethoxysilane and glutaraldehyde.
• the cholesterol or other lipid components of the LDL can be detected by applying a lipid staining dye, e.g. Sudan black or Oil red O, after first washing the unbound blood components from the slide with a suitable isotonic washing solution.
• a lipid staining dye e.g. Sudan black or Oil red O
• the bound apoprotein B can be specifically detected by any one of a number of known immunological methods. For example fluorescent chromophore conjugated antibodies to apoprotein B could be applied directly to the bound LDL on the slide. Alternatively radio-actively labelled or enzyme-linked antibodies specific for apoprotein B could be used.
• a particularly preferred immunological method is to apply an anti-apoprotein B antiserum to the bound LDL followed by enzyme-linked, fluorescent chromophore conjugated or radio-labelled antibodies to anti- apoprotein B antibodies.
• the apoprotein B antiserum may be raised in rabbits in which case anti- rabbit IgG antibody-conjugates could be used.
• Antibody conjugates can be prepared from polyclonal sera or monoclonal antibodies may be used.
• Enzyme-linked substrate assays are particularly preferred in which an enzyme conjugated to an appropriate antibody catalyses a reaction which results in an easily detectable, for example, highly coloured product, when substrate is added.
• suitable enzymes are horseradish peroxide and alkaline phosphatase.
• the anti-apoprotein B antiserum is added to the slide following the addition of the blood sample. Antibodies to apoprotein B will bind to the LDL while the remaining antiserum components may be washed off.
• the enzyme-linked antibodies to the bound apoprotein B antibodies are then applied followed by addition of the enzyme substrate which will be converted to a coloured product, the intensity of which is an indication of bound LDL and hence cholesterol.
• the sensitivity of the enzyme linked assay may be enhanced by replacing the enzyme linked antibodies by avidin linked antibodies, treating the conjugate with a biotin-avidin-enzyme conjugate and developing the colour as above.
• the concentration of heparin on the slide may be adjusted such that bound LDL is detected, by any of the aforesaid detection methods, only if the LDL concentration in the blood sample is abnormally high, and bearing in mind that the "normal" range of blood cholesterol levels can vary between different ethnic groups.
• a more quantitative estimate of the LDL concentration may be made by providing a colour comparitor chart correlated to known cholesterol concentrations.
• the inner surface of a capillary tube is coupled to heparin.
• the tube is prepared so that there is a concentration gradient of heparin along its length. This is achieved by allowing the reagents used to couple heparin to glass to move by capillary action specific distances along the tube. The process is repeated a number of times and each time the distance the reagents move along the tube is increased. Thus a gradient is built up along the tube.
• a gradation of concentration along the tube of 0.5 ⁇ g/ml to 2.0 ⁇ g/ml accomplished in steps of 0.5 ⁇ g/ml has proved convenient.
• the tube is then provided with a bulb so that a small sample of blood may be drawn into the tube and immediately expelled.
• the bound LDL can then be detected by one of the aforementioned methods by drawing the appropriate reagents into the tube. With this method, an end-point will be obtained at a particular distance along the tube where the heparin concentration is just sufficient for the bound LDL to be detected. The position of the end-point can then be readily compared with the end-points obtained with a standard sample or, as mentioned in connection with the slide assay, a comparitor chart could be prepared indicating the end-point for known LDL concentrations.
• the surface is heparin-coated beads.
• the heparin is coupled to the surface by first treating the bead surface with aminopropyltriethoxysilane and glutaraldehyde or cyanogen bromide depending on the type of material from which the beads are made.
• aminopropyltriethoxysilane and glutaraldehyde or cyanogen bromide depending on the type of material from which the beads are made.
• the beads Since the ability of a blood sample to cause the beads to clump depends on the relative concentration of the LDL and anions, the beads may be prepared having a concentration of heparin and hence anions on their surfaces such that they will only aggregate in the presence of blood containing abnormally high levels of LDL but will not be aggregated by the blood of normal individuals.
• the bead aggregation test therefore provides an almost instantaneous result.
• the bead test may be made more quantitative by preparing groups of beads, each group having a different concentration of heparin on their surface, and distributing the groups into the wells of mi ⁇ rotitre trays or other suitable receptacles. If a drop of the patient's blood is added to each well, an end-point will be detectable in the well where the beads just begin to aggregate. The degree of aggregation can be determined by eye or measured automatically by a known suitable device. The result may be compared with a standard of normal blood or to a suitably prepared chart so that the concentration of LDL, and hence cholesterol, in the test sample can be quantified.
• a kit for estimating blood cholesterol in accordance with the invention comprises a surface carrying, either over a part or over its whole, anionic groups at a high packing density, said anionic groups having an affinity for low-density lipoprotein.
• the kit may be provided with lipid staining dyes, or immunological reagents to detect bound low- density lipoprotein.
• kit may further include a standard sample containing a known concentration of LDL or a comparitor chart which facilitates determination of LDL or cholesterol concentration in a test sample of blood.
• the method of determining plasma cholesterol described herein is sufficiently simple that it need not be performed in the laboratory. Rather, patients can be tested in the doctor's surgery, for example, with just a "finger-prick" sample of blood and the result is available immediately. Further, the invention makes it feasible to test the plasma cholesterol level of large numbers of individuals, particularly children, and so determine their predisposition to atheromatous disease.
• the present invention thus represents a considerable improvement over current methods of measuring blood cholesterol because of the simplicity, speed and low cost.
• the surface to be coupled was then treated with 0.25% glutaraldehyde in phosphate buffered saline (PBS) (pH 7.4) for one hour at room temperature followed by
• Sepharose 4B was washed well with distilled water.
• the packed beads (5 ml) were suspended in distilled water to give a final volume of 8 ml and to this was added, with stirring, 2 ml of 0.5 molar sodium carbonate (pH 10.5) .
• Cyanogen bromide (1 g) was added gradually with stirring, to the sepharose solution together with sodium hydroxide solution in order to keep the pH between 10.5 and 11.
• the activated sepharose was exhaustively washed with 0.1 m sodium citrate (pH 6.5) while gently rocking the slurry of activated sepharose, a solution of heparin in citrate buffer (100 ⁇ g/ml) was added and the resulting slurry rocked overnight at 4 ⁇ C. Ethanolamine (1 ml) was added and the slurry rocked for a further hour.
• the sepharose was finally washed exhaustively with PBS before use.
• Plasma samples of known cholesterol concentration were prepared by ultracentrifuging a bulk plasma sample at a density of 1.2 g/ml, removing lipoproteins at the surface of the tube and then mixing different proportions of the lipoprotein-deficient plasma and lipoproteins to generate a series of plasma samples with increasing cholesterol concentration, in this particular case ranging from 2 mM to 17 mM in steps of 3 mM.
• the cholesterol concentration in each sample was then estimated using a known enzyme assay.
• the standard samples were applied to glass slides having heparin coupled to their surface and the bound LDL detected by an enzyme-linked substrate assay as described herein in which formation of the product was detected by optical density. The results obtained indicated that the optical density correlates with cholesterol concentration in the samples.
• Plasma samples having known cholesterol concentrations were prepared as described in Example 3. The samples were applied to beads in microtitre wells having heparin coupled to their surface and the degree of bead aggregation was measured semi-quantitatively by eye. The results obtained are indicated in the following table in which it is shown that the degree of bead aggregation increases with the cholesterol concentration:
• Plasma samples having known concentrations of cholesterol were prepared as described in Example 3.
• the intensity of the coloured product was seen to correlate with the concentration of cholesterol.

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• 1987
  • 1987-12-03 GB GB878728310A patent/GB8728310D0/en active Pending
• 1988
  • 1988-11-29 WO PCT/GB1988/001044 patent/WO1989005458A1/en not_active Application Discontinuation
  • 1988-11-29 EP EP19890900009 patent/EP0394301A1/de active Pending
  • 1988-11-29 EP EP88311302A patent/EP0319250A1/de not_active Withdrawn
  • 1988-11-29 AU AU26090/88A patent/AU2609088A/en not_active Abandoned
  • 1988-12-02 PT PT8913888A patent/PT89138A/pt not_active Application Discontinuation
  • 1988-12-02 NZ NZ22717588A patent/NZ227175A/xx unknown
• 1990
  • 1990-06-01 DK DK136190A patent/DK136190A/da not_active Application Discontinuation

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