title: Clinical laboratory application of a reporter-gene assay for measurement of functional activity and neutralizing antibody response to infliximab.
abstract: BACKGROUND
  TNF-α antagonists such as infliximab are effective for the treatment of inflammatory bowel disease and other inflammatory and autoimmune diseases. Development of an immune response and subsequent neutralizing antibodies against these protein-based drugs is a major impediment that contributes to therapeutic failure, or adverse effects such as hypersensitivity reactions. As opposed to empirical dose-escalation strategies, rational and cost-effective evaluation of clinical non-responsiveness includes measurement of serum drug levels, and detection of drug-specific antibodies. We present the validation and 2-y experience using a functional, cell-based reporter gene assay (RGA) developed for measuring the biological activity and antibody response to serum infliximab.
  
  
  METHODS
  The RGA was used to test 4699 clinical specimens from patients suspected of therapeutic failure. In contrast to binding assays, which detect an overall antibody response, the RGA specifically detects those antibodies that have drug-neutralizing function, and thus, poses higher risk for therapeutic failure.
  
  
  RESULTS
  The RGA presented here is currently the only functional clinical test available to measure serum infliximab activity and neutralizing antibodies.
  
  
  CONCLUSIONS
  Due to its accuracy and precision, and suitability for high-throughput testing, this robust platform can be applied to any TNF-α antagonist, providing an invaluable tool for the clinical management of patients with treatment failure.
authors.affiliation: ARUP Institute for Clinical and Experimental Pathology, University of Utah School of Medicine, Salt Lake City, UT 84108, United States.
authors.forename: Igor Y
authors.initials: IY
authors.lastname: Pavlov
authors.affiliation: ARUP Laboratories, Inc., University of Utah School of Medicine, Salt Lake City, UT 84108, United States.
authors.forename: James
authors.initials: J
authors.lastname: Carper
authors.affiliation: Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84108, United States.
authors.forename: Eszter
authors.initials: E
authors.lastname: Lázár-Molnár
authors.affiliation: Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84108, United States.
authors.forename: Julio C
authors.initials: JC
authors.lastname: Delgado
mesh_terms: D057134:Antibodies, Neutralizing / Q000097:blood* / Q000276:immunology*; D019411:Clinical Laboratory Techniques / Q000379:methods* / Q000592:standards; D017930:Genes, Reporter / Q000235:genetics*; D006801:Humans; D000069285:Infliximab / Q000276:immunology* / Q000494:pharmacology / Q000627:therapeutic use; D012015:Reference Standards; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D057134:Antibodies, Neutralizing; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
keywords: Cell-based assay; Infliximab; Neutralizing antibody; Reporter-gene assay; TNF-α antagonist