Agglutination assays

If an antigen is particulate, e.g. a bacterial surface antigen or eukaryotic cell surface antigen, agglutination of the cells by the addition of antibody can provide a simple detection system. Agglutination is the standard test for blood group serology and it has other specialized applications. The technique can be extended to antibodies against soluble antigens by coupling of the antigens to particulate carriers. Initially the carrier of choice was the erythrocyte and detection systems depended on coupling of antigen on to the red cell using tannic acid. Hemagglutination assays remain the basis of several diagnostic test systems, quantitation being possible in terms of the antibody dilution of titer at which agglutination stops.

A number of synthetic carriers have been developed, including latex particles and a new generation of polymerized gelatin particles. Agglutination assays are simple to perform, requiring little or no expensive equipment. Modern versions are very sensitive and highly suitable for use outside the laboratory and in less-developed countries. They are widely used for detection of antibodies in the diagnosis of infectious disease. Tests for the human immunodeficiency virus (HIV) based on agglutination techniques compare favorably with other techniques. One drawback is that the tests can be more sensitive to the detection of polymeric immunoglobulin M (IgM) antibodies. This can be advantageous in detecting recent infections but might be a problem in autoimmune serology. Sensitivity can be down to 1 p,g ml-1.

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