IMR Press / FBL / Volume 23 / Issue 11 / DOI: 10.2741/4687

Frontiers in Bioscience-Landmark (FBL) is published by IMR Press from Volume 26 Issue 5 (2021). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with Frontiers in Bioscience.

Open Access Review

Functional diagnostics for thyrotropin hormone receptor autoantibodies: bioassays prevail over binding assays

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1 SeraDiaLogistics, Munich 81545, Germany
2 Department of Oto-Rhino-Laryngology Head and Neck Surgery, University Hospital Essen, D-45147 Essen, Germany
3 King’s College London Faculty of Life Sciences & Medicine Denmark Hill Campus London, SE5 9PJ UK
Front. Biosci. (Landmark Ed) 2018, 23(11), 2028–2043; https://doi.org/10.2741/4687
Published: 1 June 2018
Abstract

Autoantibodies to the thyrotropin hormone receptor (TSH-R) are directly responsible for the hyperthyroidism in Graves’ disease and mediate orbital manifestations in Graves’ orbitopathy (otherwise known as thyroid eye disease). These autoantibodies are heterogeneous in their function and collectively referred to as TRAbs. Measurement of TRAbs is clinically important for diagnosis of a variety of conditions and different commercial assays with high sensitivity and specificity are available for diagnostic purposes. This review provides overwhelming evidence that the TRAbs detected in binding assays by mainly the automated electrochemical luminescence immunoassays (ECLIA) do not distinguish TRAbs that stimulate the TSH-R (called TSIs or TSAbs) and TRAbs that just inhibit the binding of TSH without stimulating the TSH-R (called TBAbs). However, TSAbs and TBAbs have divergent pathogenic roles, and depending which fraction predominates cause different clinical symptoms and engender different therapeutic regimen. Therefore, diagnostic distinction of TSAbs and TBAbs is of paramount clinical importance. To date, only bioassays such as the Mc4 TSH-R bioassay (ThyretainTM, Quidel) and the Bridge assay (Immulite 2000, Siemens) can measure TSAbs, with only the former being able to distinguish between TSAbs and TBAbs. On this note, it is strongly recommended to only use the term TSI or TSAb when reporting the results of bioassays, whereas the results of automated TRAb binding assays should be reported as TRAbs (of undetermined functional significance). This review aims to present a technical and analytical account of leading commercial diagnostic methods of anti-TSH-R antibodies, a metaanalysis of their clinical performance and a perspective for the use of cell based TSH-R bioassays in the clinical diagnostics of Graves’ disease.

Keywords
Thyroid Stimulating Hormone Receptor
Autoantibodies
Bioassay
Immunoassay
Graves disease
Graves orbitopathy
Meta-analysis
Review
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