Detection of poisoning by plant-origin cardiac glycoside with the Abbott TDx analyzer.

Cardiac glycoside poisoning caused by ingestion of plant material is common in tropical and sub-tropical areas. In evaluating the use of the Abbott TDx Digoxin II assay to detect such cases of poisoning, we found it a rapid and convenient method for confirming the ingestion of glycosides from the plants Nerium oleander, Thevetia peruviana, and Adonis microcarpa, and from the toad Bufo marinus. Here we report some clinical cases illustrating our experience with the use of this assay, and describe results of cross-reactivity studies with compounds structurally similar to digoxin. Because of the competitive nature of the immunoassay as well as the complexity of the mixture of cross-reacting cardiac glycosides present in the plant material, the measured apparent digoxin concentration is not linearly related to the cardiac glycoside concentration.

Naturally occurring cardiac glycosides.

Cardiac glycoside poisoning from the ingestion of plants, particularly of oleanders, occurs with reasonable frequency in tropical and subtropical areas. We have assessed a variety of plant specimens for their cardiac glycoside content by means of radioimmunoassays with antibodies that differ in their specificity for cardiac glycosides. Significant amounts of immunoreactive cardiac glycoside were found to be present in the ornamental shrubs: yellow oleander (Thevetia peruviana); oleander (Nerium oleander); wintersweet (Carissa spectabilis); bushman's poison (Carissa acokanthera); sea-mango (Cerbera manghas); and frangipani (Plumeria rubra); and in the milkweeds: redheaded cotton-bush (Asclepias curassavica); balloon cotton (Asclepias fruiticosa); king's crown (Calotropis procera); and rubber vine (Cryptostegia grandifolia). The venom gland of the cane toad (Bufo marinus) also contained large quantities of cardiac glycosides. The competitive immunoassay method permits the rapid screening of specimens that are suspected to contain cardiac glycosides. Awareness of the existence of these plant and animal toxins and their dangers allows them to be avoided and poisoning prevented. The method is also useful for the confirmation of the presence of cardiac glycosides in serum in cases of poisoning.

Competitive solid-phase enzyme immunoassay for measuring digoxin in serum.

In this clinically useful enzyme immunoassay of digoxin in serum, we mix sample, beta-galactosidase-labeled digoxin, and anti-digoxin Fab fragments for 30 min at room temperature, then use Sepharose-bound second antibody for phase separation, and measure the unbound enzyme activity directly in the supernate of the equilibrium reaction mixture. The immunoassay buffer--phosphate-buffered isotonic saline with added rabbit globulin (4 g/L), hydrolyzed gelatin (2 g/L), Brij 96 detergent (5 g/L), glycerol (0.25 mol/L), and N-acetyl-8-anilinonaphthalene-1-sulfonic acid (2 mmol/L)--minimizes serum matrix effects for convenient measuring of unbound enzyme--digoxin conjugate. The immunoassay developed with Fab fragments has better displacement characteristics than that with intact antibody. Performance of the assay compares favorably with that of other manual digoxin immunoassays; in comparison studies with EMIT involving 110 clinical specimens, the coefficient of correlation was 0.97.

Ligand displacement immunoassay--demonstration of its use for the measurement of serum phenobarbital and phenytoin.

We describe a clinically useful ligand displacement immunoassay for the measurement of serum or plasma phenobarbital and phenytoin. A conjugate of drug-specific antiserum covalently bound to micro-crystalline cellulose and a beta-galactosidase-labelled drug derivative is prepared as a lyophilized reagent. Sample is added to the conjugate and, after 5-min incubation at room temperature, the bound and displaced enzyme-ligand are separated by brief centrifugation. The enzyme activity of the displaced enzyme-ligand is measured on a spectrophotometer or centrifugal analyser. Linear calibration curves are obtained with appropriate sample dilution, allowing generation of the standard curve with a saline zero reference and a single calibrator. The performance of the assay compared favourably with other immunoassays; comparison studies with clinical specimens gave a correlation with EMIT of 0.96 (n = 122) for phenobarbital and 0.95 (n = 96) for phenytoin.

The use of a monosaccharide linkage group in a heterologous solid-phase enzyme immunoassay for phenytoin.

The preparation is described of monosaccharide-hapten derivatives containing a galactosyl linkage group which bears little structural resemblance to the straight-chain hydrocarbons commonly used for attaching haptens to proteins for use as immunogens. These derivatives are readily synthesised and are coupled to enzymes under mild conditions to produce bridge-heterologous enzyme immunoassays. The use of beta-galactosidase-monosaccharide-phenytoin derivatives in the development of sensitive phenytoin enzyme immunoassays is described and the assays are compared with hapten-heterologous, site-heterologous and homologous phenytoin enzyme immunoassays prepared using other phenytoin derivatives. This technique has application in the development of immunoassays for haptens which have only one functional group to which linkage groups can be attached for covalent coupling of the hapten to proteins.

Ligand displacement immunoassay: a novel enzyme immunoassay demonstrated for measuring theophylline in serum.

We describe a ligand displacement immunoassay for measurement of theophylline in serum or plasma and show it to be clinically useful. A conjugate of theophylline-specific antiserum covalently bound to micro-crystalline cellulose and a beta-galactosidase-labeled theophylline derivative is prepared as a lyophilized reagent. Sample is added to the conjugate and, after 5-min incubation at room temperature, the bound and displaced enzyme-ligand are separated by brief centrifugation. The enzyme activity of the displaced enzyme-ligand is measured on a spectrophotometer or centrifugal analyzer. Linear calibration curves are obtained with appropriate sample dilution, allowing generation of the standard curve with a saline zero reference and a single calibrator. Performance of the assay compares favorably with that of other theophylline assays; comparison studies with use of 145 clinical specimens gave a coefficient of correlation with EMIT of 0.97.

Jack bean urease (EC 3.5.1.5). IV. The molecular size and the mechanism of inhibition by hydroxamic acids. Spectrophotometric titration of enzymes with reversible inhibitors.

Kinetic, spectral, and other studies establish that hydroxamic acids bind reversibly to active-site nickel ion in jack bean urease. Equilibrium ultracentrifugation studies establish that the molecular weight of native urease is 590 000 +/- 30 000 while that of the subunit formed in 6 M guanidinium chloride in the presence of beta-mercaptoethanol is approximately 95 000. Essentially the same subunit molecular weight (approximately 93 000) is found by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate, subsequent to denaturation in a guanidinium chloride - beta-mercaptoethanol system at various temperatures. Coupled with an equivalent weight of 96 600 for binding of the inhibitors acetohydroxamic acid and phosphoramidate, these results establish securely that urease is a hexamer with one active site per 96 600-dalton subunit. Consistent values for the equivalent weight are obtained by a routine spectrophotometric titration of the active site of freshly prepared urease with trans-cinnamoylhydroxamic acid. General equations are derived which describe spectrophotometric titrations of binding sites of any enzyme with a reversible inhibitor. These equations allow the evaluation of the difference spectrum of the protein-inhibitor complex even when the binding sites cannot readily be saturated with the inhibitor or vice versa.