Polyclonal-monoclonal ELISA assay for detecting N-terminus pro-BNP

Abstract

A specific and sensitive in vitro ELISA assay and diagnostic test kit is disclosed for determining levels of NT-proBNP protein in a variety of bodily fluids, non-limiting examples of which are blood, serum, plasma, urine and the like. The NT-proBNP ELISA assay test employs the sandwich ELISA technique to measure circulating NT-proBNP in human plasma. In order to obtain antibodies with specific binding properties for targeted amino acid sequences within human proBNP, recombinant human proBNP (or rhproBNP) was expressed and purified for use as an immunogen. Polyclonal antibodies (PAb) to specific amino acid sequences were subsequently purified from goat serum by sequential affinity purification. Monoclonal antibodies were raised against specific polypeptides. Recombinant human NT-proBNP (or rhNT-proBNP) was expressed and purified in order to obtain material for use in calibration of a quantitative method for measurement of human NT-proBNP.

Claims

1. A kit for quantitative measurement of human Amino-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) based on a sandwich ELISA technique, comprising: isolated goat polyclonal antibodies obtained by: (1) immunizing goats with purified recombinant human full-length proBNP of SEQ ID NO: 1, and (2) affinity purifying from goat serum from the immunized goats against the peptide consisting of amino acids 26-51 of SEQ ID NO: 1; isolated NT-proBNP monoclonal antibodies, wherein said NT-proBNP monoclonal antibodies are specific for the sequence of amino acid residues that are different from the isolated polyclonal antibodies, wherein the monoclonal antibodies are labeled with a detector; and a reporter capable of reacting with said detector to form a reaction product, wherein the reaction product does not diffuse, and wherein the NT-proBNP monoclonal antibodies are produced by a hybridoma cell line designated as 6G11-F11-D12 and deposited with the American Type Culture Collection (ATCC) as Accession Number PTA 4844 and is specific for a polypeptide consisting of amino acids 1-25 of SEQ ID NO: 1, wherein the isolated goat polyclonal antibodies are immobilized as a primary binding partner.

2. The kit of claim 1, wherein the detector is biotin.

3. The kit of claim 1, wherein the reporter is peroxidase-labeled streptavidin.

4. The kit of claim 3, wherein the peroxidase is a horseradish peroxidase.

5. The kit of claim 1, wherein the kit is used for predicting morbidity and mortality in a congestive heart failure patient.

6. The kit of claim 1, wherein the polyclonal antibodies are attached to a solid support.

7. A quantitative method of measuring human NT-proBNP by the kit of claim 1 for predicting morbidity and mortality in a congestive heart failure patient, comprising: (a) providing isolated polyclonal antibodies (b) contacting a bodily fluid sample from a patient to said isolated immobilized polyclonal antibodies; (c) providing proBNP monoclonal antibodies wherein said proBNP monoclonal antibodies are specific for the sequence of amino acid residues distinct from the specific sequence for the isolated polyclonal antibodies; (d) effecting an immunoreaction, wherein the immunoreaction is between a human NT-proBNP in the bodily fluid sample and the monoclonal antibodies wherein the monoclonal antibodies are labeled with a detector; and (e) detecting said immunoreaction by a reporter capable of reacting with said detector to form a reaction product, wherein the reaction product does not diffuse, and wherein the NT-proBNP monoclonal antibodies are produced by a hybridoma cell line designated as 6G11-F11-D12 and deposited with the American Type Culture Collection (ATCC) as Accession Number PTA 4844 and is specific for a polypeptide consisting of amino acids 1-25 of SEQ ID NO: 1.

8. The method of claim 7, wherein the isolated polyclonal antibodies are selected for being specific to an amino acid sequence consisting of amino acids 26-51 of SEQ ID NO: 1.

9. The method of claim 7, wherein the monoclonal antibodies are produced by a hybridoma cell line designated as 1C3-E11-H9 and deposited with the American Type Culture Collection (ATCC) as Accession Number PTA 4845 4 and is specific for a polypeptide consisting of amino acids 1-25 of SEQ ID NO: 1.

10. The method of claim 8, wherein the monoclonal antibody further comprises a detector.

11. The method of claim 7, wherein the detecting is direct.

12. The method of claim 7, wherein the detecting is indirect.

13. The method of claim 7, wherein in step (d) the human NT-proBNP is bound by the polyclonal antibodies.

14. A kit for quantitative measurement of human Amino-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) based on a sandwich ELISA technique, comprising: isolated goat polyclonal antibodies obtained by: (1) immunizing goats with purified recombinant human full-length proBNP of SEQ ID NO: 1, and (2) affinity purifying from goat serum from the immunized goats against the peptide consisting of amino acids 26-51 of SEQ ID NO: 1; isolated NT-proBNP monoclonal antibodies, wherein said NT-proBNP monoclonal antibodies are specific for the sequence of amino acid residues that are different from the isolated polyclonal antibodies, wherein the monoclonal antibodies are labeled with a detector; and a reporter capable of reacting with said detector to form a reaction product, wherein the reaction product does not diffuse, and wherein the NT-proBNP monoclonal antibodies are produced by a hybridoma cell line designated as 1C3-E11-H9 and deposited with the American Type Culture Collection (ATCC) as Accession Number PTA 4845 and is specific for a polypeptide consisting of amino acids 1-25 of SEQ ID NO: 1, wherein the isolated goat polyclonal antibodies are immobilized as a primary binding partner.

15. The kit of claim 14, wherein the detector is biotin.

16. The kit of claim 14, wherein the reporter is peroxidase-labeled streptavidin.

17. The kit of claim 16, wherein the peroxidase is a horseradish peroxidase.

18. The kit of claim 14, wherein the it is used for predicting morbidity and mortality in a congestive heart failure patient.

19. The kit of claim 14, wherein the polyclonal antibodies are attached to a solid support.

20. A quantitative method of measuring human NT-proBNP by the kit of claim 14 for predicting morbidity and mortality in a congestive heart failure patient, comprising: (a) providing isolated polyclonal antibodies; (b) contacting a bodily fluid sample from a patient to said isolated immobilized polyclonal antibodies; (c) providing proBNP monoclonal antibodies wherein said proBNP monoclonal antibodies are specific for the sequence of amino acid residues distinct from the specific sequence for the isolated polyclonal antibodies; (d) effecting an immunoreaction, wherein the immunoreaction is between a human NT-proBNP in the bodily fluid sample and the monoclonal antibodies wherein the monoclonal antibodies are labeled with a detector; and (e) detecting said immunoreaction by a reporter capable of reacting with said detector to form a reaction product, wherein the reaction product does not diffuse, and wherein the NT-proBNP monoclonal antibodies are produced by a hybridoma cell line designated as 1C3-E11-B9 and deposited with the American Type Culture Collection (ATCC) as Accession Number PTA 4845 and is specific for a polypeptide consisting of amino acids 1-25 of SEQ ID NO: 1.

Description

BRIEF DESCRIPTION OF THE FIGURES

(1) FIG. 1 illustrates the method of selection of NT-proBNP and target peptides starting from a pre-proBNP precursor protein;

(2) FIG. 2 is an ROC curve for the goat polyclonal/6G11 monoclonal assay;

(3) FIG. 3 is a box-plot of NT-proBNP levels in NYHA Class III and IV versus controls;

(4) FIG. 4 is a box-plot of NT-proBNP levels in control subjects, stratified by age;

(5) FIG. 5 outlines the ELISA procedure for utilizing the goat polyclonal/6G11 monoclonal assay of the instant invention.

DETAILED DESCRIPTION OF THE INVENTION

(6) The NT-proBNP ELISA assay test employs the sandwich ELISA technique to measure circulating NT-proBNP in human plasma. Microplate wells coated with goat polyclonal anti-NT-proBNP capture protein constitute the solid phase. Test subject plasma, standards and controls are added to the coated wells and incubated with incubation buffer. No sample extraction step is required. If NT-proBNP protein is present in the test sample, it will be captured by NT-proBNP specific antibody coated on the wells. After incubation and washing, a monoclonal anti-NT-proBNP detector antibody is added to the wells. The detector antibody binds to the NT-proBNP protein, or immunogenic fragments thereof, e.g. polypeptide fragments which are recognized by said antibody, bound to anti-NT-proBNP capture antibody, thus forming a sandwich. After incubation and washing, a polyclonal donkey anti-mouse IgG labeled with horseradish peroxidase (HRP) is added to the wells. Following incubation and washing, an enzyme substrate is added to the wells and incubated. An acidic solution is then added in order to stop the enzymatic reaction. The degree of enzymatic activity of immobilized HRP is determined by measuring the optical density of the oxidized enzymatic product in the wells at 450 nm. The absorbance at 450 nm is proportional to the amount of NT-proBNP in the test subject sample. A set of NT-proBNP protein standards is used to generate a standard curve of absorbance versus NT-proBNP concentration from which the NT-proBNP concentrations in test specimens and controls can be calculated. It is understood that detection of the immunoreaction may be accomplished via direct or indirect methods which are well-known in the art.

(7) In order to obtain antibodies with specific binding properties for targeted amino acid sequences within human proBNP, recombinant human proBNP (or rhproBNP) was expressed and purified for use as an immunogen. ProBNP-pUC9 plasmid construct was obtained from Dr. Adolfo J. de Bold (Ottawa Heart Institute). The full-length rhproBNP open reading frame (ORF) was obtained by polymerase chain reaction (PCR) and subcloning into pET32c (NcoI/XhoI). The pET32c vector was modified by removing 81 nucleotides so that the final fusion protein would not contain the S-tag and enterokinase sites. The sequence at the N-terminus of the rhproBNP ORF consisted of thioredoxin and poly-histidine tags and a thrombin cleavage site. There was no extra sequence at the C-terminus. The protein was expressed in Escherichia coli BL21 (DE3) cells and the crude cellular extract was prepared in non-denaturing conditions. The subsequent affinity purification was completed by Ni-NTA chromatography following the supplier's recommendations. Prior to injections, endotoxin levels in the rhproBNP solutions were lowered to acceptable levels using a Detoxigel® endotoxin-removing resin following the supplier's recommendations.

(8) Polyclonal Antibody Production and Purification

(9) Goats (La Mancha or Toggenburg breed) were immunized with purified recombinant human full-length proBNP (rhproBNP). A primary intramuscular injection at multiple sites of 500 ug purified rhproBNP emulsified in Complete Freund's Adjuvant was administered, followed by bi-weekly 250 ug intramuscular injections at multiple sites of the purified rhproBNP emulsified in Freund's incomplete adjuvant. The titer of immunized goats was monitored routinely by screening serum using a half-sandwich ELISA technique.

(10) Polyclonal antibodies (PAb) specific for amino acid sequences within proBNP (1-25, 26-51, 52-76 or 77-108) of Sequence ID No. 1 were subsequently purified from goat serum by sequential affinity purification using cyanogen bromide activated sepharose-4B (Pharmacia) coupled, according to the supplier's recommendations, to the following proteins or peptide sequences:

(11) TABLE-US-00001 human IgG (Jackson ImmunoResearch) mouse IgG (Jackson ImmunoResearch) proBNP amino acid sequence #1-25 of  Sequence ID No. 1 (H P L G S P G S A S D L E T S G L Q E Q  R N H L Q) coupled to Keyhole Limpet Haemocyanin (ADI Inc.) OR proBNP amino acid sequence #26-51 of Sequence ID No. 1 (G K L S E L Q V E Q T S L E P L Q E S P R P T G V W) coupled to Keyhole Limpet Haemocyanin (ADI Inc.) OR proBNP amino acid sequence #52-76 of Sequence ID No. 1 (K S R E V A T E G I R G H R K M V L Y T L R A P R) coupled to Keyhole Limpet Haemocyanin (ADI Inc.) OR proBNP amino acid sequence #77-108 of Sequence ID No. 1 (BNP-32, S P K M V Q G S G C F G R K M D R I S S S S G L G C K V L R R H) coupled to Keyhole Limpet Haemocyanin (ADI Inc.)

(12) The purified polyclonal antibodies were dialyzed against 20 mM PBS, pH 7.4, concentrated by ultrafiltration and stored at −20° C.

(13) Expression of Recombinant Human NT-proBNP

(14) In order to obtain material for use in calibration of a quantitative method for measurement of human NT-proBNP, recombinant human NT-proBNP (or rhNT-proBNP) was expressed and purified. A proBNP-pUC9 plasmid construct was obtained from Dr. Adolfo J. de Bold (Ottawa Heart Institute). The rhNT-proBNP ORF was obtained by PCR and subcloning into pET32c (NcoI/XhoI). The sequence at the N-terminus of the rhNT-proBNP ORF consisted of thioredoxin, poly-histidine, and S-tag tags, as well as thrombin and enterokinase cleavage sites. There was no extra sequence at the C-terminus. The protein was expressed in Escherichia coli BL21 (DE3) cells and the crude cellular extract was prepared in non-denaturing conditions. The subsequent affinity purification was completed by Ni-NTA chromatography following the supplier's recommendations.

(15) Screening of Monoclonal Antibodies

(16) Monoclonal antibodies, secreted by hybridoma cell lines herein designated as 6G11-F11-D12 and as 1C3-E11-H9 for use in a method of immunoassay, wherein said antibodies are specific to the polypeptide consisting of amino acids 1-25 of human N-terminal brain natriuretic factor BNP(1-25), were obtained from Dr. Adolfo J. De Bold. These monoclonals were produced from supernatants for use in an NT-proBNP ELISA in pairing with the instantly described Goat Polyclonal Antibodies, and are designated 6G11 and 1C3 respectively. These clones are the subject of U.S. Ser. No. 10/299,606 filed on even date herewith, the contents of which are herein incorporated by reference, and were deposited, in accordance with the Budapest Treaty, with the American Type Culture Collection, 10801 University Blvd., Manassas, Va. 20110-2209 on Dec. 5, 2002 under Accession Numbers PTA-4844 and PTA-4845 respectively. In accordance with 37 CFR 1.808, the depositors assure that all restrictions imposed on the availability to the public of the deposited materials will be irrevocably removed upon the granting of a patent. The depositors additionally assure that the deposited materials will be replaced if viable samples cannot be dispensed by the depository.

(17) Screening was conducted for:

(18) i) Potential Capture MAb(s) with Goat PAb as Detector

(19) Confluent hybridoma culture supernatants were added to 96-well microtiter plates (NUNC, MaxiSorp, GIBCO BRL) coated with donkey anti-mouse IgG.sub.(H+L) immunoglobulins (Jackson ImmunoResearch) at 2 μg/ml in 100 mM carbonate buffer, pH 9.6. Excess binding sites were blocked with bovine serum albumin (BSA) in PBS, pH 7.4. After washing the plate with wash buffer (PBS containing 0.05% (v/v) Tween 20), 50 μL of each culture supernatant containing monoclonal antibody was incubated on the plate. Following 1 hour incubation at 37° C. in a CO.sub.2 incubator, the plate was washed with wash buffer. Recombinant human proBNP (Syn-X Pharma) was then added to the plate at concentrations of 3 ng/ml or 0 ng/ml, and the plate incubated for 2 hours at room temperature (RT) on a shaker. After washing the plate, biotinylated goat polyclonal antibodies affinity purified against proBNP amino acid peptide sequences 1-25, 26-51 or 52-76 (Syn-X Pharma), diluted appropriately in PBS with 0.5% (w/v) BSA, were added to the appropriate wells. Goat polyclonal antibodies were biotinylated using a Biotin Labeling Kit from Roche following the manufacturer's recommendations. After 1 hour incubation at RT on a shaker, the plate was washed and HRP-conjugated streptavidin (Jackson ImmunoResearch) at a dilution of 1/5000 was added and incubated for 1 hour at RT on a shaker. Following washing, TMB substrate solution (Moss) was added and after 8 minutes incubation at RT in the dark, the reaction was stopped with 1 N H.sub.2SO.sub.4 and optical density read at 450.sub.nm. Clones were selected for ascites production based on ability to pair with the respective goat polyclonal antibody to produce a specific high intensity signal in wells containing proBNP antigen, and minimal signal in wells containing no proBNP antigen.

(20) ii) Potential Detector MAb(s) with Goat PAb as Capture

(21) 96-well microtiter plates were coated with goat polyclonal antibodies affinity purified against proBNP amino acid peptide sequences 1-25, 26-51, or 52-76 (Syn-X Pharma) at 1 μg/ml in 100 mM carbonate buffer, pH 9.6. Excess binding sites were blocked as for method (i). After washing with wash buffer, recombinant human proBNP (Syn-X Pharma) was added to the wells at concentrations of 3 ng/ml or 0 ng/ml and the plate incubated for 2 hours at RT on a shaker. Following washing, confluent hybridoma culture supernatants containing monoclonal antibodies were added (50 μL per well) and the plates incubated for 1 hour at 37° C. in a CO.sub.2 incubator. After another wash step, HRP conjugated donkey anti-mouse IgG.sub.(H+L) (Jackson ImmunoResearch) at a dilution of 1/5000 was added to the plate and incubated for 1 hour at RT on a shaker. TMB substrate was added, after washing, and the plates developed as for method (i). Clones were selected for ascites production based on ability to pair with the respective goat polyclonal antibody to produce a specific high intensity signal in wells containing proBNP antigen, and minimal signal in wells without antigen.

(22) Final Selection of 6G11 Monoclonal Antibody

(23) Following production of the selected monoclonal antibodies by ascites, and subsequent purification by Protein G (Pharmacia) using known procedures, the purified antibodies were retested as described above for screening of hybridoma supernatants, but for the fact that the purified monoclonal antibodies were appropriately diluted in 100 mM carbonate buffer, pH 9.6 and coated directly onto the plate for screening as captures, or appropriately diluted in PBS containing 0.5% (w/v) BSA for screening as detectors.

(24) Optimal ELISA specificity and sensitivity for recombinant human proBNP and recombinant human NT-proBNP were obtained using the combination of goat polyclonal antibody affinity purified against proBNP amino acid peptide sequence 26-51 as capture with MAb clone designate 6G11 as detector. Now referring to FIG. 5, the procedure for carrying out the ELISA assay of the instant invention is set forth.

(25) Subsequent analysis of the data derived from human plasma samples tested in accordance with these procedures have demonstrated the utility of this antibody combination for yielding excellent sensitivity and specificity when measuring NT-proBNP levels in apparently healthy individuals versus heart failure patients.

(26) In accordance with this invention, an ELISA Test Kit is provided for the purpose of carrying out the above-outlined procedure.

(27) Reagents Supplied

(28) Anti-NT-proBNP Protein Coated Microtitration Strips

(29) One stripholder containing 96 microtitration wells coated with goat polyclonal anti-NT-proBNP antibody. Store at 2-8° C., in the pouch with desiccant, until expiry.

(30) NT-proBNP Protein Standards

(31) Six vials, each containing one of the following standards: 0, 50, 150, 375, 1500, and 3000 pg/ml of NT-proBNP, are provided. Each vial contains 0.5 ml, except for the 0 pg/ml standard which contains 1.0 ml. The extra volume allows for diluting samples that have values greater than 3000 pg/ml, if retesting is desired. Store at −70±10° C. Kept at this temperature, the standards are stable for at least 3 cycles of freeze/thaw and up to 6 months.

(32) NT-proBNP Protein Controls

(33) Two vials, 0.5 ml each, containing NT-proBNP controls at low and high protein concentration. Store at −70±10° C. Kept at this temperature, the controls are stable for at least 3 cycles of freeze/thaw and up to 6 months.

(34) Incubation Buffer

(35) One vial containing 10 ml of incubation buffer. Store at 2-8° C. until expiry.

(36) Detector Antibody

(37) One vial containing 10 ml of monoclonal anti-NT-proBNP antibody. Store at 2-8° C. until expiry.

(38) Horseradish Peroxidase (HRP) Conjugate

(39) One vial containing 10 ml of donkey anti-mouse immunoglobulins labeled with horseradish peroxidase. Store at 2-8° C. until expiry.

(40) Chromogen Solution

(41) One vial containing 10 ml of 3, 3′, 5, 5′-tetramethylbenzidine (TMB) substrate solution. Store at 2-8° C. until expiry.

(42) Wash Concentrate

(43) One bottle containing 60 ml phosphate buffered saline with nonionic detergent. Dilute contents 25 fold with deionized water before use. Store at 2-8° C.

(44) Stopping Solution

(45) One bottle containing 10 ml 1N sulfuric acid. Store at 2-8° C.

(46) Assay Procedure

(47) In carrying out the assay, the time between addition of samples, standards, and controls to the first well and the last well should not exceed 10 minutes. For large series of samples, run the ELISA in small batches to accommodate this time frame.

(48) Mark the microplate wells to be used.

(49) Add 50 μl of the incubation buffer to each well using a semi-automatic pipette.

(50) Using a precision micropipette, add 50 μl of each test sample, NT-proBNP standard, or NT-proBNP control to the appropriate microwell. In order to ensure standard curve consistency, the following order of addition to the plate is recommended:

(51) Test samples

(52) NT-proBNP standards

(53) NT-proBNP controls

(54) It is recommended that NT-proBNP standards and controls be assayed in duplicate.

(55) Cover microwells using an adhesive plate cover and incubate for 2 hours on an orbital microplate shaker at room temperature.

(56) Aspirate and wash each microwell three times with the wash solution using an appropriate microplate washer. Blot dry by inverting the plate on absorbent material.

(57) Since incomplete washing adversely affects assay precision, the use of an automatic microplate washer is highly recommended. Alternatively, if an automatic microplate washer is not available, washing can be accomplished manually by repeatedly aspirating microwell contents and refilling each microwell with 340 μl of wash solution, three times.

(58) Add 100 μl of detector antibody solution to each well using a semi-automatic pipette.

(59) Incubate the wells for 1 hour on an orbital microplate shaker at room temperature.

(60) Aspirate and wash microwells three times with the wash solution using an appropriate microplate washer. Blot dry by inverting the plate on absorbent material.

(61) Add 100 μl of HRP conjugate solution to each well using a semi-automatic pipette.

(62) Cover microwells using an adhesive plate cover and incubate for 30 minutes on an orbital microplate shaker at room temperature.

(63) Aspirate and wash microwells three times with wash solution. Blot dry by inverting the plate on absorbent material.

(64) Add 100 μl of the TMB solution to each well using a semi-automatic pipette.

(65) Incubate the wells in the dark for 5 minutes at room temperature. Avoid exposure to direct sunlight.

(66) Add 100 μl of stopping solution (1N sulfuric acid) to each well using a semi-automatic pipette.

(67) Measure the absorbance of the solution in the microwells using a microplate reader at 450 nm.

(68) Calculation of Results

(69) Calculate the mean absorbance for each well containing standard, control or test subject plasma.

(70) Plot the mean absorbance reading for each of the standards along the y-axis (quadratic) versus the NT-proBNP concentration, in pg/ml, along the x-axis (linear).

(71) Draw the best fitting standard curve through the mean of the duplicate points.

(72) Determine the NT-proBNP concentrations of the test subjects' plasma and controls by interpolating from the standard curve.

(73) Subject plasma specimens reading lower than the lowest standard should be reported as such.

(74) Alternatively, a computer program may be used for handling ELISA type data to evaluate the NT-proBNP concentrations in test subjects' plasma and controls.

(75) The following data represent an example dose response curve using this assay:

(76) TABLE-US-00002 Standard Dose (pg/ml) Mean OD 450 nm 0 0.046 50 0.095 150 0.178 375 0.347 1500 1.161 3000 1.781 Note: These values should not be used in lieu of a standard curve, which should be prepared at the time of assay.
Performance Characteristics

(77) In order to insure quality control standards, two controls designated-low and high—provided in the kit must be analyzed in each assay. It is recommended that each laboratory use additional controls for validation of each assay run.

(78) Summary of NT-proBNP clinical data for the Goat Polyclonal-6G11 Monoclonal Elisa Assay

(79) Data is available from 209 subjects diagnosed with congestive heart failure (NYHA Class III and Class IV) and 101 healthy normal control subjects. The receiver operating characteristic (ROC) curve is displayed in FIG. 2; an area under the curve (AUC) of 0.974 was obtained, with a corresponding standard error (s.e.) of 0.008. FIG. 3 displays boxplots of NT-proBNP levels in the control subjects and the heart failure subjects; at a cutoff level of 165 pg/mL, the diagnostic sensitivity with respect to the heart failure subjects was 90.4% (with 189 out of 209 such subjects with NT-proBNP levels above the cutoff) and the diagnostic specificity with respect to the control subjects was 94.1% (with 95 out of 101 such subjects with NT-proBNP levels below the cutoff).

(80) Comparison with other NT-proBNP and BNP Assays

(81) In the product insert for the Biosite Triage BNP test (Triage© B-Type Natriuretic Peptide (BNP) Test, Product insert, Biosite Diagnostics, Inc., 2001), a ROC curve analysis on clinical data obtained from 804 heart failure subjects and 1286 control subjects revealed an AUC of 0.955 (standard error=0.0053). Comparing this AUC with that of the instantly disclosed NT-proBNP assay, following the procedure of Hanley and McNeil (Hanley J A and McNeil B J (1982). “The meaning and use of the area under a receiver operating characteristic (ROC) curve.” Radiology 143 29-36), one finds that the instantly disclosed NT-proBNP assay has a significantly higher AUC (p<0.001), indicative of superior diagnostic performance.

(82) Fischer et al. (Fischer Y, Filzmaier K, Stiegler H, Graf J, Fuhs S, Franke A, Janssens U and Gressner A M (2001). “Evaluation of a New, Rapid Bedside Test for Quantitative Determination of B-Type Natriuretic Peptide.” Clinical Chemistry 47 591-594.) gave performance data comparing the Triage BNP test to an NT-proBNP EIA assay from Roche Diagnostics with respect to 93 subjects with underlying cardiac disease and suspected heart failure. In distinguishing subjects with decreased ventricular function from those with preserved ventricular function, an AUC of 0.91 (±0.033 s.e.) was obtained for the Triage BNP test, and an AUC of 0.86 (±0.040 s.e.) was obtained for the Roche NT-proBNP assay. Given a reported correlation between the two neurohormone measurements of r=0.947, and following the method of Hanley and McNeil (Hanley J A and McNeil B J (1983), “A method of comparing the areas under Receiver Operating Characteristic curves derived from the same cases.” Radiology 148 839-843) for comparing AUC's derived from the same set of cases, one finds that the Triage BNP test has a significantly higher AUC than that of the Roche NT-proBNP assay (p=0.005).

(83) Hammerer-Lercher et al. (Hammerer-Lercher A, Neubauer E, Muller S, Pachinger O, Puschendorf B and Mair J (2001). “Head-to-head comparison of N-terminal pro-brain natriuretic peptide, brain natriuretic peptide and N-terminal pro-atrial natriuretic peptide in diagnosing left ventricular dysfunction.” Clinica Chimica Acta 310 193-197) compared the Shionogi IMRA BNP assay to the Biomedica EIA NT-proBNP assay with respect to the same population of 57 patients with stable chronic heart failure. In distinguishing subjects with decreased ventricular function from those with preserved ventricular function, an AUC of 0.75 (±0.06 s.e.) was obtained for the BNP assay, and an AUC of 0.67 (±0.07 s.e.) was obtained for the Biomedica NT-proBNP assay. Following the method of Hanley and McNeil (Hanley J A and McNeil B J (1983). “A method of comparing the areas under Receiver Operating Characteristic curves derived from the same cases.” Radiology 148 839-843), one finds that the Shionogi BNP assay has a significantly higher AUC than that of the Biomedica NT-proBNP assay (p=0.009).

(84) Luchner et al. (Luchner A, Hengstenberg C, Lowel H, Trawinski J, Baumann M, Riegger G, Schunkert H and Holmer S (2002). “N-Terminal Pro-Brain Natriuretic Peptide After Myocardial Infarction.” Hypertension 39 99-104) conducted a large clinical study involving 594 myocardial infarction subjects and 449 healthy controls, in order to determine the ability of the Roche EIA NT-proBNP assay to predict decreased ventricular function in these subjects. The authors quoted an AUC of 0.77 (±0.057 s.e.) with respect to NT-proBNP in separating subjects with a left ventricular ejection fraction of less than 35% from those with a higher ejection fraction. This AUC is significantly lower than that quoted above for the instantly disclosed NT-proBNP assay (p=0.0001).

(85) Thus, on the basis of quantifying the variously available assays for determining the presence of NT-proBNp based upon an area under the curve analysis, the instant assay would be expected to exhibit superior diagnostic performance.

(86) All patents and publications mentioned in this specification are indicative of the levels of those skilled in the art to which the invention pertains. All patents and publications are herein incorporated by reference to the same extent as if each individual publication was specifically and individually indicated to be incorporated by reference.

(87) It is to be understood that while a certain form of the invention is illustrated, it is not to be limited to the specific form or arrangement herein described and shown. It will be apparent to those skilled in the art that various changes may be made without departing from the scope of the invention and the invention is not to be considered limited to what is shown and described in the specification. One skilled in the art will readily appreciate that the present invention is well adapted to carry out the objectives and obtain the ends and advantages mentioned, as well as those inherent therein. The embodiments, methods, procedures and techniques described herein are presently representative of the preferred embodiments, are intended to be exemplary and are not intended as limitations on the scope. Changes therein and other uses will occur to those skilled in the art which are encompassed within the spirit of the invention and are defined by the scope of the appended claims. Although the invention has been described in connection with specific preferred embodiments, it should be understood that the invention as claimed should not be unduly limited to such specific embodiments. Indeed, various modifications of the described modes for carrying out the invention which are obvious to those skilled in the art are intended to be within the scope of the following claims.