The analyser was run and maintained according to the manufacturer’s instructions. RF was measured by nephelometry on the BNII analyser reading at a wavelength of 840 nm. The analyser was serviced and operated as directed by the manufacturer.

All assay results were validated using third-party internal controls in conjunction with the Biorad QC Oncall package. Appropriate Westgard rules were determined by Westgards’ QC Validator software package version 2·0 (Westgard QC, Madison, WI, USA) to monitor assay performance. Human anti-mouse antibodies (HAMA) were measured using the Alpha Diagnostic International (ADI) enzyme-linked immunosorbent assay (ELISA) kit (Autogen Bioclear, Calne, UK). HAMA in the patients’ serum is detected by a sandwich ELISA Selleck PF-2341066 technique using immobilized mouse IgG and horseradish peroxidase-conjugated anti-human IgG. The concentrations of HAMA were determined against standards

supplied with the kit. Patient samples with a mean absorbance of 0·088 at 450 nm are negative, and patients treated with mouse monoclonal antibodies have a mean absorbance of around 0·559. The manufacturers claim intra-assay coefficient of variations of between 4·2 and 8·3% (mean 6·0%), suggesting Napabucasin research buy that the maximum upper limit of negativity has an A450 of 0·095. A positive serum control from the manufacturer was run with each batch of patient samples. The manufacturers state that RF does not interfere with the measurement of HAMA, although clearly any RF may bind potentially to mouse IgG Fc and therefore behave as a form of HAMA. Heterophilic antibody blocking tubes (HBT) tubes (Scantibodies® Endonuclease Laboratories

Inc., Laboratoire Scantibodies, Villebon/Yvette, France) have been reported to block heterophile antibodies (HAMA and RF) in serum [8]. Five hundred µl of serum is added to the HBT tube, mixed gently by inversion and incubated for 1 h, before re-analysis. The Scantibodies HBT (http://www.scantibodies.com/scanhbr.html) contains a blocking reagent composed of specific binders which inactivate heterophilic interference from HAMA, human anti-goat antibodies, human anti-sheep antibodies, human anti-rabbit antibodies and RF by stearic hinderance effect. Each of the 83 samples was separated into two aliquots. One aliquot was treated with HBT blocking tubes to remove heterophile antibodies. Both treated and untreated aliquots were assayed for MCT and RF on a single run. Five samples containing tryptase with values of less than 1·0 µg/l and RF with values of less than 9·8 IU/ml were assayed in the same way to act as negative controls. The presence of HAMA was determined on pre- and post-blocked sera and used to validate the blocking performance of the HBT tubes. Throughout the study we have used the clinically accepted cut-off for MCT in the UK of 14 µg/l as the ‘upper limit’ of normal, and have designated a RF of less than 14 IU/ml as negative.