Susceptibility of Cardiac Troponin Assays to Biotin Interference. Issue 5 (2nd February 2019)

• Record Type: Journal Article
• Authors: Frame, Ithiel J; Joshi, Parag H; Mwangi, Caroline; Gunsolus, Ian; De Lemos, James A; Das, Sandeep R; Sarode, Ravi; Balani, Jyoti; Apple, Fred S; Muthukumar, Alagarraju
• Is Part Of: American journal of clinical pathology. Volume 151:Issue 5(2019)
• Page Start: 486
• Page End: 493
• Publication Date: 2019-02-02
• Subjects: Troponin -- Biotin -- Interference -- Myocardial infarction; Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqy172
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Objectives: To investigate biotin interference on three cardiac troponin (cTn) assays and demonstrate a method to overcome biotin interference. Methods: cTn levels were measured in (1) plasma from healthy volunteers on 10-mg daily biotin supplementation mixed with a plasma with known elevated troponin, (2) plasmas with known elevated cTn after mixing in reagent biotin to simulate supplementation, and (3) biotin-spiked plasma specimens pretreated with streptavidin-agarose beads. Results: Daily biotin ingestion (10 mg) and studies simulating daily biotin use resulted in significant interference in the Gen5 cardiac troponin T (cTnT) assay; the contemporary Gen 4 cTnT and high-sensitivity cardiac troponin I (hs-cTnI) assays were unaffected. The biotin interference threshold was 31, 315, and more than 2, 000 ng/mL for Gen5 cTnT, cTnT, and hs-cTnI assays, respectively. Streptavidin pretreatment blocked biotin interference in cTn assays. Conclusions: Biotin interference is possible at plasma concentrations achievable by ingestion of over-the-counter supplements that may lead to delayed or missed diagnosis of myocardial injury with the Gen5 cTnT assay.