The present invention relates to a method for quali¬ tative and/or quantitative analysis of antigens, anti¬ bodies, microorganisms or other cells in a liquid specimen as well as an apparatus for performing the method.

Background of the invention

Laboratories working within microbiological, immuno- logical or clinical chemistry etc. make extensive use of reactions between antigens and antibodies. Many complex molecules are antigenic, i.e. they give rise to the production of specific antibodies in man and animal. These antibodies are proteins which, with very few ex¬ ceptions, react but with corresponding antigens or very closely related combinations. Antibodies play an important part in the protection against microorganisms. They are to be found in blood and tissue in high concentrations and are directed towards an overwhelming number of dif¬ ferent antigens. The production of antibodies starts early in life and continues step by step as the body is exposed to the antigens. However, a few other mecha¬ nisms can also start the production of antibodies.

Because of their specific way of reacting, anti¬ bodies are used in many technical applications, e.g. demonstration and identification of bacteria, viruses and fungi. Furthermore they are used in methods for quantification of the body's own elements. The antibodies are often available in so-called antisera, i.e. sera (blood without cells) that have been taken from an animal or a human who has been exposed to the antigen that one wants to demonstrate. It is often necessary to "absorb" the antiserum in order to remove unwanted antibodies therefrom. Antibodies against other antigens can give

rise to "false" reactions in a test system. It is now even possible to produce monoclonal antibodies by making use of modern gene technology. Monoclonal antibodies are antibodies produced by just one cell population which originates from one cell, a single-clone. Thus, these antibodies are antibodies of one type only and are not contaminated by other antibodies like in antisera.

Demonstration and quantification of antibodies are also of great medical importance. For instance, the presence of specific antibodies against a certain virus can indicate an infection in progress against this virus or the presence of immunity (ability to pro¬ tect) against this microorganism.

Different ways of demonstrating antigen-antibody- interactions are previously known. A summary of the different methods presently used follows below.

Agglutination: Antibodies are bound to an antigen situated on particles, which results in a visible aggre¬ gation of the particles. The existence of aggregates can be seen with the naked eye or under microscope. This is a very quick method (it can be performed in a few minutes) which is readily carried through. The susceptibility to small quantities of substance is high, and there are few possibilities of false reactions. The disadvantages are, inter alia, that it is not possible to accomplish an exact quantitative analysis and that the interpretation is subjective.

Precipitation: Soluble antigens and antibodies interact and give rise to a "network", i.e. a large complex consisting of many subunits of antigen and anti¬ body. The complex settles and is visible as a (usually) white precipitation. The precipitation can be demonstrated in a transparent tube or in a transparent firm gel. In the latter case, antibodies and antigens diffuse against each other from different positions in the gel or are forced to meet by the application of electric current. Precipitation can also be combined with labelled

antibodies (see below) in order to increase susceptibility (the ability to demonstrate small quantities of antigens or antibodies).

This method is relatively simple but slow (takes at least 1 h). Quantitative analysis is possible, but the susceptibility to small quantities of substance is low. The interpretation is subjective or objective, and there are few possibilities of false reactions. Methods using labelled antibodies: the fraction of antibodies in a serum can be purified and "labelled" with radioactivity (Radio Immuno Assay = RIA) , fluorescing compounds or enzymes. The "labelling" is combined with the antibody by means of a chemical reaction. Radio¬ activity and fluorescence are demonstrated by the use of specific equipment suitable for such purposes. The presence of enzyme-labelled antibodies is shown by addi¬ tion of a substrate, i.e. a substance which is decomposed by the enzyme and, as a result, causes a change of colour. The change of colour can be shown quantitatively by using a spectro-photometer. This method is called ELISA (Enzyme-Linked-Immuno-Sorbent-Assa ) .

The advantage of ELISA is that it makes an exact quantitative analysis possible and, moreover, it has a very high susceptibility to small quantities of sub- stance. The interpretation of the results is objective. There are, however, several disadvantages. Thus, the reaction is slow (at least 1 h), and the method is com¬ plicated and causes false reactions.

The ELISA method is often used for quantification of antibodies in accordance with the following process chart (see Fig. 1): a) the antigen is bound to the inner wall of a test tube; b) the liquid (usually serum) to be tested in regard to antibodies is added; c) antibodies that are not bound and other serum components are removed by washing the test tube

several times with e.g. a saline solution; d) enzyme-labelled antibodies from an animal that has been exposed to human antibodies are added (anti-antibodies) ; e) enzyme-labelled antibodies which do not react are removed by washing; f) finally the substrate is added, and the change of colour is gauged by means of a spectro-photo¬ meter. it thus is clear that this method necessitates several steps of pipetting. For this reason, a great deal of different machinery for automation of this method is available on the market. Devices have been designed for the washing processes, for the simultaneous "reading" of a large number of test tubes in the spectro-photometer and for the steps of pipetting and diluting. All products are expensive and adapted for the simultaneous testing of many specimens. To date, no device has been designed for the automatic testing of single-specimens. if, instead, a known number of antibodies is used in the test system, this method can even be used for the quantification of antigens»

Labelled antigens: Instead of labelling the anti¬ bodies, the antigens can be labelled with radioactivity (Radio Immuno Assay = RIA) , fluorescent compounds or enzymes. The basic method is mainly the same as has been described for the methods using labelled antibodies. Other methods are also known which can be practised in a few specialised tests only. To sum up, it may be mentioned that "test sets" based on demonstration of agglutination, precipitation or the ELISA technique are avabilable on the market. Also other test sets not using the above methods are available, but in general they are applicable to a very limited extent.

Especially the ELISA system is used to a large extent because of its high susceptibility, i.e. its

ability to demonstrate small quantities of substance. However, these tests can only be used in large labora¬ tories since only specially trained staff can handle them. When qualified staff is not available, agglutination and precipitation are frequently used when there is no demand for extreme accuracy. These methods are more easily performed. Particularly when reactions of agglu¬ tination were concerned, it has been possible to de- centralise the use to small clinical units.

Advantages and disadvantages of the different methods are summed up in Table 1 below.

Table 1 Advantages and disadvantages of prior art methods for demonstrating reactions between antigens and antibodies

Method Speed of Perform- Exact Suscep- Inter- Possi- the method ance quanti- tibility prεtation bilities fication to small of the test of false possible? quantities result reactions

It is an object of the present invention to provide a method and an apparatus for qualitative and/or quanti¬ tative analysis of an analyte consisting of antigens, antibodies, microorganisms or other cells in a liquid specimen. According to the invention, a quick and very susceptive analysis is achieved, which can be performed by persons without special training.

The method according to the invention is character¬ ised by bringing the specimen into contact with a solution containing a certain quantity of enzyme-labelled anti- antibodies specific to the analyte and, except when the analyte consists of large microorganisms or cells, inert particles, whereby a complex is formed between the analyte and the specific, enzyme-labelled anti-anti- bodies and, optionally, the inert particles, whereupon the solution is made to pass through a filter that retains the complex-bound particles and the large microorganisms or cells but lets the unlinked specific, enzyme-labelled anti-antibodies pass which subsequently are demonstrated in that the solution is brought into contact with a specific substrate that is decomposed by the enzyme- labelled anti-antibodies into products demonstratable by colour.

The invention will be described more closely below with reference to the accompanying drawings in which Fig. 1 shows the previously known ELISA method, from which the present invention proceeds; Fig. 2 shows schematically the inventive method; Fig. 3 shows the production of the specific, enzyme- labelled anti-antibodies (so-called FASSEL-antibodies ) as used according to the invention, and Fig. 4 shows an embodiment of the apparatus according to the invention.

Thus, the invention also relates to an apparatus for performing the method. The apparatus is characterised in that it comprises a tubular container 1 with a lid, which is divided into an upper chamber 2, a filter chamber 3,

4 and a lower chamber 5, that the upper chamber 2 is separated from the filter chamber 3, 4 by a membrane 6, that a filter 7, such as a sterile filter, is fitted in the filter chamber 3, 4, and that the filter chamber 3, 4 is separated from the lower chamber 5 by a detachably fitted closure device 8.

Furthermore, the apparatus comprises a locking member 10 for the upper chamber 2 and a locking member 11 for the closure device 8 as well as packing rings 12, 13 so as to maintain a subpressure in the container 1. The locking members 10 and 11, respectively, can be operated mechanically. The filter 7 is preferably sup¬ ported by a filter support 14.

The method according to the present invention is called FASSEL which is an abbreviation of F_iltration of Antibody, Separated, Specific and Labelled.

The principle of the method according to the in¬ vention is shown schematically in Fig. 2 with demon¬ stration of antigens as an example of the practice. Antigens generally being very small particles, are first bound to larger, inert particles. Subsequently they are brought into contact with a certain quantity of specific, enzyme-labelled anti-antibodies (FASSEL-anti- bodies) . The solution is then caused to pass through a filter with a pore size such as retains the particles with the complex-bound FASSEL-antibodies. The FASSEL- antibodies that are not complex-bound pass through the filter and down into a substrate solution where the enzyme decomposes the substrate while producing a change of colour. This change of colour can be read visually or by a spectro-photometer. By comparing it to calibrated colour charts, one can read the quantity of FASSEL-anti¬ bodies that has passed through the filter. Thus, by adding a certain quantity of FASSEL-antibodies at the beginning, one can demonstrate on the one hand the pres¬ ence of a specific antigen in the specimen and, on the other hand, the quantity thereof.

The specific, enzyme-labelled anti-antibodies used in the present invention are produced in the following way: One adopts well-known principles of so-called chroma- tography of affinity. The intention is to separate the specific antibodies to be used in the method according to the invention, i.e. to remove all other antibodies and serum components from the specific antibodies . Further¬ more, the specific antibodies are to be labelled with enzyme, which is achieved by application of enzyme-label- led anti-antibodies. Enzyme-labelled substances that are not bound to the specific antibodies are removed. All these steps are performed in one process, which is a completely new principle that has not previously been used within the chromatography of affinity. FASSEL-antibodies against soluble antigens are produced in accordance with the following method (see Fig. 3): a) The antigen is bound to a carbohydrate polymer, a latex particle or another particle by per se known methods. b) The antiserum from which the specific antibodies are to be removed, is mixed with the particles. c) The particles are washed free from unlinked serum components by the use of a neutral hypertonic or slightly acid isotonic solution so as to remove spe¬ cific antibodies with a low affinity to the antigen (buffer example: 2.5 M NaCl, 0.03 M phosphate buffer, pH 7.2 or 0.15 M NaCl, 0.03 M phosphate buffer, pH 5 ) . d) Enzyme-labelled anti-immunoglobulin (from animal or man, against animal or human immunoglobulin) is added, and unlinked enzyme-labelled anti-immunoglobulin is washed off. e) The antibodies bound to the particles are eluated by means of a solution at low pH (e.g. 2.5) or by 3 M KSCN at neutral pH.

The particles are removed by centrifugation or filtra¬ tion. The solution of antibodies is neutralised or

10 dialysated against a buffer so as to re-establish the reactivity of the antigen.

Horseradish peroxydase is referred to as an example of enzymes which can be used for labelling the anti- immunoglobulin. Many different preparations of enzyme- labelled anti-immunoglobulin are generally available.

FASSEL-antibodies against microorganisms, such as bacteria or fungi or other cells, can be produced by using the intact microorganisms or cells instead of using inert particles bearing purified antigens.

The principle of the present invention can be applied to one antigen-antibody system only, a so-called single- FASSEL, or in connection with several FASSEL systems, so-called multi-FASSEL systems. In a single-FASSEL, only one antigen-antibody system is utilised. In multi- FASSEL, the specimen is fitted in a place that divides into two or more lines, each connected with a FASSEL system of its own. Multi-FASSEL makes it possible to ana¬ lyze a specimen in regard to two or more parameters. A closer description of an embodiment of the appa¬ ratus according to the invention follows below. The apparatus comprises a tubular container 1 provided with a lid 9. The container is divided into three chambers. The upper chamber 2 contains the FASSEL-antibodies (and when required, a disinfectant), the intermediate chamber (the filter chamber) 3, 4 contains a filter 7, and the lower chamber 5 contains the substrate. The FASSEL anti¬ bodies in the upper chamber 2 are first separated from the filter chamber 3, 4 by means of a membrane 6. A closure device 8 is detachably fitted between the filter chamber 3, 4 and the lower chamber 5. The membrane 6 and the closure device 8 can be destroyed or removed mechani¬ cally when carrying out the method. The container is sealed by means of suitable packing members. The lower chamber 5 contains a specific substrate that can be decomposed by the specific, enzyme-labelled anti-anti¬ bodies in the upper chamber 2.

The sealing between the chambers is broken by pro¬ ducing a positive pressure in the upper chamber 2 or a negative pressure (subpressure) in the lower chamber 5. The positive pressure in the upper chamber 2 can be obtained e.g. by forcing a cylinder in a downward direc¬ tion in the chamber. The negative pressure can be estab¬ lished in the system by producing a subpressure in the lower chamber 5.

The solution with the analyte is introduced in the upper chamber 2, where the FASSEL-antibodies specific to the analyte are bound as a complex to the analyte which in the present case is bound to inert particles of such a size that they cannot pass through the filter 7 in the filter chamber 3, 4. Subsequently, the membrane 6 is destroyed, e.g. by outside pressing of the container 1 which preferably is made of a slightly flexible material. The solution is then forced through the filter 7 either by a pressure produced above the filter or by a subpres¬ sure established in the lower chamber 5. Only those speci- fie, enzyme-labelled anti-antibodies that are not complex- bound, are able to pass through the filter, and as a result they come into contact with the substrate in the lower chamber 5. The enzyme-labelled anti-antibodies decompose the specific substrate into coloured products which are readable visually or spectro-photometrically.

The container with the specific FASSEL antibodies is preferably provided with information on the inter¬ pretation and the purpose of the test.

In a completely manual analysis according to the present invention, the decomposition of the substrate is demonstrated as a change of colour visible with the naked eye, and this change of colour is compared to a standard colour chart.

A computer ( "Computer-FASSEL" ) can also be used for interpreting the change of colour via a spectro-photo¬ meter. The limits of the colour shades for the inter¬ pretation, which are unique for each batch of FASSEL-

tubes, are on the tube for the computer to read.

The specimen to be tested is introduced into the upper chamber of a FASSEL-container which is placed in an application space in the computer. The computer pre- ferably is programmed to ask for the patient's identi¬ fication data. When the identification is completed, the computer accepts the specimen and states the patient ^' s data, the type of test and the necessary time to perform the test. After a certain incubation (time and temperature are specific to each test), the machine neutralises the sealing between the chambers. After further incubation (which is also specific to each test), the computer in¬ terprets the results in relation to the limits of positive and negative results or the quantitative formula stated on the test container. Further information which the com¬ puter can provide are the limits of reliable test results, advice on complementary laboratory tests in relation to the obtained result or clinical background information. Each such "Computer-FASSEL" can interpret all dif- ferent FASSEL-tubes. The computer is designed to accept the tests one by one, independently of the purpose of the test.

The spectro-photometer is calibrated by means of two standard colour tubes (one for "high value" and one for "low value"). The test tubes are labelled with information on the calibration. It is also possible to connect a print¬ er with the computer and to connect the computer with a central laboratory for exchange of current information» Some examples of the application of the method ac- cording to the invention follow below. The examples are not meant to be restrictive. EXAMPLE 1

Qualitative and quantitative analysis of bacteria, fungi or other cells (e.g. lymphocytes) The specimen to be tested is mixed with specific, enzyme-labelled anti-antibodies in the upper chamber of an apparatus according to the invention. If bacteria.

fungi or cells that react on the specific anti-antibodies are present, the anti-antibodies will be retained in the upper chamber, when a difference in pressure is produced above the filter. Thus, this filter has such small pores that the bacteria, fungi or other cells cannot pass therethrough.

To avoid unspecific reactions from bacteria reacting on antibodies independent of their specificity, normal serum may be added for blockage. Subsequently the unlinked specific, enzyme-labelled anti-antibodies decompose the substrate in the lower chamber of the apparatus. The decomposition is seen as a change of colour. By using a predetermined quantity of specific, enzyme-labelled anti-antibodies, the change of colour in the lower chamber will also be a gauge of the quantity of bacteria, fungi or other cells present in the specimen. EXAMPLE 2

Qualitative and quantitative analysis of viruses In general, viruses are far too small to be retained by filters suitable for this invention. Therefore, the following modification is used. The upper chamber contains inert particles linked to suitable antivirus-antibodies, as well as specific, enzyme-labelled anti-antibodies against the virus. When the virus is compounded with these reagents, it will be bound to the particles, and then the particles will be covered by the specific, enzyme-labelled anti-antibodies reacting on the virus. These complexes of virus, inert particle and specific, enzyme-labelled anti-antibody will be retained by the filter.

Like in Example 1, a quantification of the virus can also be obtained here by reading the intensity of the colour of the substrate solution in the lower chamber. However, this system can give rise to falsely posi¬ tive reactions if unusually high levels of viruses are present in the specimen. If a computer is used, it may

be programmed to advise the user to test also a diluted specimen so as to obtain a negative result. EXAMPLE 3

Qualitative and quantitative analysis of soluble antigens These antigens can be structures present in body fluid or tissue or in the environment. Examples of anti¬ gens are serum components which usually are demonstrated by clinical chemistry, hormones and soluble antigens to microorganisms including hepatit- and HIV-virus. This test is performed mainly in the same way as in Example 2. EXAMPLE 4 Qualitative and quantitative analysis of antibodies

In order to analyse antibodies in a specimen, the specimen is compounded on the one hand with inert par¬ ticles to which antigens corresponding to the antibodies to be demonstrated have been bound and, on the other hand, with specific, enzyme-labelled anti-antibodies against the antibodies that are to be demonstrated. Antibodies present in the specimen will then be bound to the antigens on the particles, whereupon the specific, enzyme-labelled anti-antibodies are, in turn, bound to the antibodies in the specimen. A quantity of specific, enzyme-labelled anti-antibodies corresponding to the present quantity of antibodies in the specimen will thus be retained by the filter, while the remaining specific, enzyme-labelled anti-antibodies pass through the filter and react on the substrate.

The method and the apparatus according to the in- vention combine the high susceptibility of the ELISA- system with operations that are very simple from a techni¬ cal point of view and eliminate the many possibilities of false reactions, which are serious disadvantages of the well-known ELISA-system. Moreover, the possibility of connecting the method and the apparatus according to the invention to a computer brings many advantages over prior art methods:

(a) The "Computer-FASSEL" is one apparatus for performing a great number of different tests which are now used in many different laboratories and within different medical disciplines. (b) The test system is fully automated. Any person who can collect a specimen can perform a test in accordance with the invention, without special training or special manuals.

(c) The method and the apparatus according to the in- vention mean decentralization, which implies that tests which to date have been very intricate can be performed in small laboratory units from now on.

(d) Results are obtained quickly, even concerning highly specialised tests, and they are already available while the patient still is in the laboratory.

(e) In addition to the test results, the computer can even be programmed to provide important background in¬ formation, e.g. the current epidemiological situation in the community. When not connected to a computer, the method ac¬ cording to the invention (the so-called "Colour-FASSEL" ) can be performed and interpreted very easily and can therefore be performed by anybody who can collect a specimen and read a short instruction on the outside of a test tube. The test can even be performed in the patient's home under the most primitive circumstances with no equipment other than the test tube according to the invention. Some of the advantages of this method with direct reading with the naked eye are as follows: (a) it is quick;

(b) it requires very little work and

(c) it can be applied to testing one single specimen in several different antigen-antibody systems at the same time.