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q~ääé=çñ=`çåíéåíë Introduction... 4 Principle of the Test... 4 Reagents Provided... 5 Materials Required but not Provided... 6 Storage Information... 6 Warnings and Precautions... 6 Specimen Collection and Handling... 8 Reagent Preparation... 9 Assay Procedure... 10 Assay Procedure Summary... 12 Calculation of Results... 12 Typical Data... 13 Limitations of the Procedure... 13 Performance... 14 Limit of Detection... 14 Recovery... 14 Linearity... 14 Specificity... 15 Precision... 15 Intra-assay... 15 Inter-assay... 15 Standardization... 15 Experimental Results... 16 Plasma... 16 Serum... 16 Aggregated human Ig-activated human serum... 16 Troubleshooting... 16 References... 17 Plate Templates... 18

fåíêççìåíáçå Activation of the classical or lectin, but not the alternate, complement pathways results in the production of the C4a anaphylatoxin 1-3. C4a has been shown to be a weak multi-functional proinflammatory mediator by increasing vascular permeability, and to be spasmogenic 1. In blood, plasma or serum, once formed, the nascent C4a anaphylatoxin is rapidly cleaved to the C4a-desArg form by the endogenous serum carboxypeptidase N enzyme 4. Thus, the quantitation of C4a-desArg in plasma or experimental samples should yield a reliable measurement of the level of classical complement pathway activation that has occurred in the test samples under investigation. C4a production in vivo may also signal activation of the classical or the lectin complement pathways in several autoimmune diseases including rheumatoid arthritis, lupus erythematosus, and acute glomerulonephritis 3,5 as well as in early stages of organ transplant rejections 6,7. The BD OptEIA TM Human C4a ELISA Kit is for the in vitro quantitative determination of human C4a and the human C4a-desArg in human EDTA plasma, serum and other biological samples. mêáååáéäé=çñ=íüé=qéëí The BD OptEIA ELISA test is a solid phase sandwich ELISA (Enzyme- Linked Immunosorbent Assay). It utilizes a monoclonal antibody specific for human C4a/C4a-desArg coated on a 96-well plate (as this kit will measure both forms of C4a, this manual will use C4a-desArg when referring to the measurement of either form). Standards and samples are added to the wells, and any C4a-desArg present binds to the immobilized antibody. The wells are washed and a mixture of biotinylated polyclonal anti-human C4a antibody and streptavidin-horseradish peroxidase is added, producing an antibody-antigen-antibody sandwich. The wells are again washed and a substrate solution is added, which produces a blue color in direct proportion to the amount of C4a-desArg present in the initial sample. The Stop Solution changes the color from blue to yellow, and the wells are read at 450 nm. Q

oé~öéåíë=mêçîáçéç Antibody Coated Wells: 1 plate of 96 breakable wells (12 strips 8 wells) coated with antihuman C4a-desArg monoclonal antibody Detection Antibody: 15 ml of biotinylated anti-human C4a polyclonal antibody containing fetal bovine serum* and ProClin TM -150 as preservative Standards: 3 vials of lyophilized human serum containing a defined amount of C4a-desArg (quantity as noted on vial label) Enzyme Concentrate (250 ): 150 μl of 250 concentrated Streptavidin-horseradish peroxidase conjugate with BSA* and ProClin TM -150 as preservative Standard/Sample Diluent: 30 ml of animal serum* with 0.09% sodium azide as preservative ELISA Diluent: 12 ml of a buffered protein base with 0.09% sodium azide as preservative Wash Concentrate (20 ): 100 ml of 20 concentrated detergent solution TMB One-Step Substrate Reagent: Stop Solution: Plate Sealers: 30 ml of 3,3',5,5'-tetramethylbenzidine (TMB) in buffered solution 13 ml of 1 M phosphoric acid 2 sheets with adhesive backing *Source of all serum proteins is from USDA inspected abattoirs located in the United States. R

j~íéêá~äë=oéèìáêéç=äìí=åçí=mêçîáçéç Microplate reader capable of measuring absorbance at 450 nm Precision pipettes to deliver 50 μl and 100 μl volumes Adjustable 1 ml, 5 ml, 10 ml, 25 ml pipettes for reagent preparation Deionized or distilled water Wash bottle or automated microplate washer Log-log graph paper or automated data reduction Tubes to prepare standard dilutions Laboratory timer Absorbent paper píçê~öé=fåñçêã~íáçå 1. Store kit at 2-8 C. Do not use kit after expiration date. 2. Before use, bring all reagents to room temperature (18-25 C). Immediately after use, return to proper storage conditions. 3. Lyophilized standards are stable until kit expiration date. After reconstitution, use freshly reconstituted standard within 12 hours (stored at 2-8 C). t~êåáåöë=~åç=mêéå~ìíáçåë 1. Reagents that contain preservatives may be toxic if ingested, inhaled, or brought in contact with skin. 2. Avoid contact of skin, eyes, or clothing with Stop Solution or Substrate Reagents. 3. Handle all serum and plasma specimens in accordance with NCCLS guidelines for preventing transmission of blood-borne infections. 4. Standard/Sample Diluent and ELISA Diluent contain less than 0.1% sodium azide. Sodium azide yields highly toxic hydrazoic acid under acidic conditions. Dilute azide compounds in running water before discarding to avoid accumulation of potentially explosive deposits in plumbing. S

5. Warning Wash Concentrate (20X) (component 51-9003738) contains 0.002% (w/w), Human C4a Lyophilized Standard (component 51-27356E) contains 0.03% (w/w), and Detection Antibody Biotin Anti-Human C4a (component 51-27352E) contains 0.003% (w/w) of a CMIT/MIT mixture (3:1), which is a mixture of: 5-chloro-2- methyl-4-isothiazolin-3-one [EC No 247-500-7] and 2-methyl-4- isothiazolin-3-one [EC No 220-239-6] (3:1). Hazard statements May cause an allergic skin reaction. Precautionary statements Wear protective gloves / eye protection. Wear protective clothing. Avoid breathing mist/vapours/spray. If skin irritation or rash occurs: Get medical advice/attention. IF ON SKIN: Wash with plenty of water. Dispose of contents/container in accordance with local/regional/ national/international regulations. 6. Danger Stop Solution (component 51-2608KC) contains 15.23% phosphoric acid (w/w). Hazard statements Under normal conditions of intended use, this material is not expected to be an inhalation hazard. Ingestion may cause severe irritation of the mouth, the esophagus and the gastrointestinal tract. Causes severe skin burns and eye damage. Precautionary statements Wear protective gloves / eye protection. Wear protective clothing. IF ON SKIN (or hair): Remove/Take off immediately all contaminated clothing. Rinse skin with water/shower. T

IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. IF INHALED: Remove victim to fresh air and keep at rest in a position comfortable for breathing. Dispose of contents/container in accordance with local/regional/ national/international regulations. 7. This product contains human blood, serum, cells, or materials derived from them, which are potentially hazardous materials. Use universal precautions when handling. Handle as if product were capable of transmitting disease. Material used in this product has been tested using FDA approved methods and found negative for Human Immunodeficiency Virus (HIV-1/HIV-2). Hepatitis B Surface Antigen (HBSAG) and antibody to Hepatitis C Virus (HCV). However, no known test method can offer complete assurance that specimens of human origin will not transmit infectious disease. When handling of disposing, follow precautions described in CDC and FDA recommendations and OSHA Bloodbourne Pathogen recommendations. 8. Enzyme Reagent (Streptavidin-horseradish peroxidase conjugate (SAv-HRP)) contains the following preservatives, 1,2- benzisothiazol-3(2h)-one (CAS: 2634-33-5) and CMIT/MIT 3:1 (CAS: 55965-84-9), which is a mixture of 5-chloro-2-methyl-4- isothiazolin-3-one [EC No 247-500-7] and 2-methyl-4-isothiazolin- 3-one [EC No 220-239-6] (3:1). The concentration of this material in the enzyme reagent is not classified as hazardous per GHS and CLP. Good chemical hygiene practices are recommended when handling any laboratory chemicals. pééåáãéå=`çääéåíáçå=~åç=e~åçäáåö Specimens should be clear, non-hemolyzed and non-lipemic. Samples should be diluted prior to running the assay. An initial 1:500 dilution of normal human EDTA plasma samples with Standard/Sample Diluent is recommended. Handle and dispose of all specimens as if they are capable of transmitting infectious agents. It is critical that sample collection is performed correctly. Care must be taken to avoid C4a generation in the samples. U

All specimen handling operations should be carried out at 4 C for plasma and for serum (immediately after clotting). Plasma: Collect plasma using disodium EDTA as the anticoagulant. If possible, collect the plasma into a mixture of disodium EDTA and Futhan 6 to stabilize the sample against spontaneous in vitro complement activation. Immediately centrifuge samples at 4 C for 15 minutes at 1000 x g. Assay immediately or store samples on ice for up to 6 hours before assaying. Aliquots of plasma may also be stored at -70 C for extended periods of time. Avoid repeated freeze-thaw cycles.serum: Use a serum separator tube and allow samples to clot for 60 ± 30 minutes. Centrifuge the samples at 4 C for 10 minutes at 1000 x g. Remove serum and assay immediately or store samples on ice for up to 6 hours before assaying. Aliquots of serum may also be stored at -70 C for extended periods of time. Avoid repeated freeze-thaw cycles. Other biological samples: Remove any particulate matter by centrifugation and assay immediately or store samples at -70 C. Avoid repeated freeze/thaw cycles. oé~öéåí=mêéé~ê~íáçå 1. Bring all reagents to room temperature (18-25 C) before use. 2. Standards a. Reconstitute 1 vial lyophilized Standard with required volume (noted on vial label) of Standard Diluent to prepare a 2 ng/ml stock standard. Allow the standard to equilibrate for at least 15 minutes before making dilutions. Vortex to mix. b. Add 300 μl Standard Diluent to 6 tubes. Label as 1 ng/ml, 0.5 ng/ml, 0.25 ng/ml, 0.13 ng/ml, 0.06 ng/ml, and 0.03 ng/ml. V

c. Perform serial dilutions by adding 300 μl of each standard to the next tube and vortexing between each transfer.the Standard/Sample Diluent serves as the zero standard (0 ng/ml). 3. Working Detector See Assay Procedure, step 5. 4. Wash Buffer Note: If the Wash Concentrate contains visible crystals, warm to room temperature and mix gently until dissolved. Dilute required quantity of 20 Wash Concentrate with deionized or distilled water, mix. (To prepare 2,000 ml, add 100 ml Wash Concentrate to 1,900 ml water. At least 500 ml solution should be prepared for a full 96-well plate). 5. TMB One-Step Substrate Reagent No more than 15 minutes prior to use, add required volume of TMB One-Step Substrate Reagent to a clean tube or reservoir. To prevent contamination, pipette out from the tube/reservoir instead of directly from bottle. Avoid prolonged exposure to light or contact with metal, air, or extreme temperature as color may develop. ^ëë~ó=mêçåéçìêé 1. Bring all reagents and diluted samples to room temperature (18-25 C) prior to use. It is recommended that all standards and samples be run in duplicate. A standard curve is required in each assay run. 2. Place required quantity of test strips/wells, place in well holder. NM

Note: Wells are provided in breakable 8-well strips. Strips may be broken into individual wells, replaced in well holder, and assayed. Return any unused wells to sealed pouch for 2-8 C storage. 3. Pipette 50 μl of ELISA Diluent into each well. 4. Pipette 100 μl of each standard (see Reagent Preparation, step 2) and sample into appropriate wells. Note: An initial 1:500 dilution of human EDTA plasma samples with Standard/Sample Diluent is recommended. Gently shake/tap the plate for 5 seconds to mix. Cover wells with Plate Sealer and incubate for 2 hours at room temperature. 5. Prepare Working Detector. Within 15 minutes prior to use, pipette required volume of Detection Antibody into a clean tube or flask. Add in required quantity of Enzyme Concentrate (250 ), vortex or mix well. For a full 96-well plate, add 48 μl of Enzyme Concentrate into 12 ml of Detection Antibody. 6. Decant or aspirate contents of wells. Wash wells by filling with at least 300 μl/well prepared Wash Buffer (see Reagent Preparation, step 4) and then decanting/aspirating. Repeat wash 4 times for a total of 5 washes. After the last wash, blot plate on absorbent paper to remove any residual buffer. Complete removal of liquid is required for proper performance. 7. Add 100 μl of prepared Working Detector (see step 5 above) to each well. Gently shake/tap the plate for 5 seconds to mix. Cover wells with Plate Sealer and incubate for 1 hour at room temperature. 8. Wash wells as in Step 6, but a total of 7 times. Note: In this final wash step, soak wells in wash buffer for 30 seconds to 1 minute for each wash. Thorough washing at this step is very important. 9. Add 100 μl of TMB One-Step Substrate Reagent to each well. Gently shake/tap the plate for 5 seconds to mix. Incubate plate (without Plate Sealer) for 30 minutes at room temperature in the dark. 10. Add 50 μl of Stop Solution to each well. Gently shake/tap the plate for 5 seconds to mix. 11. Read absorbance at 450 nm within 30 minutes of stopping reaction. If wavelength correction is available, subtract A (570 nm) from A (450 nm). NN

^ëë~ó=mêçåéçìêé=pìãã~êó 1. Add 50 μl ELISA Diluent to each well. 2. Add 100 μl standard and diluted* sample to each well. * initial 1:500 dilution of plasma is recommended. Incubate 2 hours at room temperature. 3. Aspirate and wash 5 times. 4. Add 100 μl prepared Working Detector to each well. Incubate 1 hour at room temperature. 5. Aspirate and wash/soak 7 times. 6. Add 100 μl TMB Substrate Reagent to each well. Incubate 30 minutes at room temperature. 7. Add 50 μl Stop Solution to each well. Read at 450 nm within 30 minutes. λ correction 570 nm. `~äåìä~íáçå=çñ=oéëìäíë Calculate the mean absorbance for each set of duplicate standards, controls and samples. Subtract the mean zero standard absorbance from each. Plot the standard curve on log-log graph paper, with C4a-desArg concentration on the x-axis and absorbance on the y-axis. Draw the best fit straight line through the standard points. To determine the C4a-desArg concentration of the unknowns, find the mean absorbance value of the unknown on the y-axis and draw a horizontal line to the standard curve. At the point of intersection, draw a vertical line to the x-axis and read the C4a-desArg concentration. Multiply the C4a-desArg concentration by the sample dilution factor. Computer curve-fitting statistical software may also be employed. NO

qóéáå~ä=a~í~ This standard curve is for demonstration only. A standard curve must be run with each assay. `çååéåíê~íáçå EåÖLãiF lan lao jé~å 0 0.093 0.093 0.093 0.000 0.03 0.189 0.194 0.191 0.098 0.06 0.280 0.275 0.277 0.184 0.13 0.463 0.448 0.455 0.362 0.25 0.779 0.750 0.764 0.671 0.5 1.258 1.300 1.279 1.186 1.0 2.069 2.201 2.135 2.042 2.0 4.200 3.954 4.077 3.984 iáãáí~íáçåë=çñ=íüé=mêçåéçìêé wéêç=pí~åç~êç pìäíê~åíéç 1. Interference by drug metabolites, soluble receptors, or other binding proteins in specimens has not been thoroughly investigated. The possibility of interference cannot be excluded. 2. This kit is intended for use as an integral unit. Do not mix reagents from different kit lots. Reagents from other manufacturers/other available antibody clones should not be used in this kit. NP

méêñçêã~ååé iáãáí=çñ=aéíéåíáçå The minimum detectable dose of C4a-desArg was determined to be 0.006 ng/ml. This is defined as two standard deviations above the mean optical density of 20 replicates of the zero standard. oéåçîéêó Four different levels of purified human C4a-desArg were spiked into samples of various matrices. Results are compared with the same amounts of C4a-desArg spiked into Standard/Sample Diluent, as follows: mä~ëã~=eå=z=sf 1000 500 250 125 `Éää=ÅìäíìêÉ=ãÉÇá~= Eå=Z=PF péáâé=`çååéåíê~íáçå EéÖLãiF 500 250 125 62.5 ^îéê~öé % Recovery o~åöé 108 101 99 91 110 112 106 104 101-111 95-105 96-102 75-99 107-114 106-117 101-112 95-116 iáåé~êáíó Sixteen EDTA plasma and ten serum samples from apparently healthy normal donors and three cell culture media samples were serially diluted with Standard/Sample Diluent and run in the BD OptEIA Human C4a Kit. Results are as follows: aáäìíáçå péêìã= Eå=Z=NMF mä~ëã~= Eå=Z=NSF `Éää=ÅìäíìêÉ= ãéçá~=eå=z=pf 1:2 Average% of Expected Range 105 89-116 102 88-113 96 94-99 1:4 Average% of Expected Range 107 99-118 103 84-113 92 88-94 1:8 Average% of Expected Range 99 85-110 97 78-108 90 84-99 NQ

pééåáñáåáíó Cross Reactivity: The following factors were tested in the BD OptEIA Human C4a assay. Cross reactivity is reported as% by weight. Human C4 0.043 Human C3a <0.047 Human C3 0 Human C5a <0.0004 Human C5 0 mêéåáëáçå Intra-assay Twenty-four replicates each of three different levels of C4a-desArg were tested in one plate. The following results were observed: kìãäéê=çñ=êééäáå~íéë 24 24 24 Mean Concentration 985.8 pg/ml 551.6 pg/ml 288.9 pg/ml SD 57.1 21.9 18.7 %CV 5.8 4.0 6.5 Inter-assay Three different levels of C4a-desArg were tested in four different plates. The following results were observed: kìãäéê=çñ=êééäáå~íéë 32 32 32 Mean Concentration 941.7 pg/ml 506.6 pg/ml 257.9 pg/ml SD 60.8 37.5 24.9 %CV 6.5 7.4 9.7 pí~åç~êçáò~íáçå This immunoassay is calibrated against purified human C4a-desArg. NR

bñééêáãéåí~ä=oéëìäíë Plasma Twenty-five EDTA plasma samples and five Futhan plasma samples were tested in this assay. The 1x F/T (one freeze/thaw cycle) samples were collected, immediately frozen one time at -70 C, thawed, and immediately assayed. The 2x F/T (two freeze/thaw cycles) samples were collected, immediately frozen at -70 C, thawed for two hours at room temperature, re-frozen at -70 C, thawed and assayed Serum Nñ=cLq Ten human serum samples were tested in this assay. The results ranged from 464.8 to 1290.2 ng/ml. Aggregated human Ig-activated human serum Human serum (a pool of five donors) was activated with aggregated human Ig and tested in this assay. This sample obtained a value of 17,377 ng/ml of C4a-desArg. qêçìääéëüççíáåö baq^=mä~ëã~= Oñ=cLq o~íáç=oñlnñ Nñ=cLq cìíü~å=mä~ëã~= Oñ=cLq o~íáç=oñlnñ N 25 25 25 5 5 5 Mean 169.5 470.9 3.0± 1.0 75.4 176.5 2.3± 1.0 ± 2 SD ± 84.7 ± 176.8 ± 16.1 ± 81.8 Range 63.4-235.4-1.5-5.1 60.4-95.6-1.6-4.0 406.2 1006.4 99.8 294.4 Problem Possible Source Corrective Action Poor Check function of washing system Precision Poor Standard Curve Inadequate washing / aspiration of wells Inadequate mixing of reagents Imprecise / inaccurate pipetting Imprecise sealing of plate Improper standard handling / dilution Incomplete washing / aspiration of wells Imprecise / inaccurate pipetting Low Signal Inadequate reagent volumes added to wells Incorrect incubation times / temperature Overly high wash / aspiration pressure from automated plate-washer. Ensure adequate mixing Check / calibrate pipettes Ensure complete sealing of plate Ensure correct preparation of standards Check function of washing system Check / calibrate pipettes Check / calibrate pipettes Ensure sufficient incubation times / reagents warmed to room temperature Utilize manual washing NS

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