CD23 (EBVCS-5) IVD. Table 1 Bottling concentrations. Monoclonal mouse anti-human reagent for identification of cells expressing CD23 antigen

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1 2/ IVD CD23 (EBVCS-5) Monoclonal mouse anti-human reagent for identification of cells expressing CD23 antigen Form Catalog No. PE APC BD, BD Logo and all other trademarks are property of Becton, Dickinson and Company BD Becton, Dickinson and Company BD Biosciences 2350 Qume Drive San Jose, CA USA Benex Limited Pottery Road, Dun Laoghaire, Co. Dublin, Ireland Tel Fax BD Biosciences European Customer Support Tel Fax Becton Dickinson Pty Ltd, 4 Research Park Drive, Macquarie University Research Park, North Ryde NSW 2113, Australia Becton Dickinson Limited, 8 Pacific Rise, Mt. Wellington, Auckland, New Zealand 1. INTENDED USE CD23 is intended for in vitro diagnostic use in the identification of cells expressing CD23 antigen, using a BD FACS brand flow cytometer. The flow cytometer must be equipped to detect light scatter and the appropriate fluorescence, and be equipped with appropriate analysis software (such as BD CellQuest or BD LYSYS II software) for data acquisition and analysis. Refer to your instrument user s guide for instructions. Applications Expression of CD23 in the characterization of hematologic neoplasia COMPOSITION CD23, clone EBVCS-5, is derived from hybridization of mouse Sp2/0 myeloma cells with spleen cells from BALB/c mice immunized with in vitro transformed Epstein-Barr virus (EBV) cell line. 4 CD23 is composed of mouse IgG 1 heavy chains and kappa light chains. Each reagent is supplied in phosphatebuffered saline (PBS) containing gelatin and 0.1% sodium azide. Concentrations are listed in Table 1. Table 1 Bottling concentrations Form Amount provided Conc a (µg/ml) PE 12.5 µg in 1.0 ml of PBS 12.5 APC 12.5 µg in 0.5 ml of PBS 25 a. Conc = concentration bdbiosciences.com ClinicalApplications@bd.com 1

2 Antibody purity is as follows. PE, APC: 20% free fluorophore at bottling, as measured by size-exclusion chromatography (SEC) 3. STORAGE AND HANDLING The antibody reagent is stable until the expiration date shown on the label when stored at 2 C 8 C. Do not use after the expiration date. Do not freeze the reagent or expose it to direct light during storage or incubation with cells. Keep the outside of the reagent vial dry. Do not use the reagent if you observe any change in appearance. Precipitation or discoloration indicates instability or deterioration. 4. REAGENTS OR MATERIALS REQUIRED BUT NOT PROVIDED Falcon * disposable 12 x 75-mm polystyrene test tubes or equivalent Micropipettor with tips Vortex mixer BD FACS lysing solution (10X) (Catalog No ). For dilution instructions and warnings, refer to the instructions for use (IFU). Centrifuge BD CellWASH (Catalog No ) or a wash buffer of PBS with 0.1% sodium azide. BD CellFIX (Catalog No ) or 1% paraformaldehyde solution in PBS with 0.1% sodium azide. Store at 2 C 8 C in amber glass for up to 1week. * Falcon is a registered trademark of Corning Incorporated. BD FACS brand flow cytometer. Refer to the appropriate instrument user s guide for information. 5. SPECIMEN(S) Reagents can be used for immunophenotyping by flow cytometry with a variety of specimen types, including peripheral blood, bone marrow aspirates or biopsies, and other body fluids or tissues. Each type of specimen can have different storage conditions and limitations that should be considered prior to collection and analysis. 5,6 Samples with large numbers of nonviable cells can give erroneous results due to selective loss of populations and to increased nonspecific binding of antibodies to nonviable cells. Viability of samples should be assessed and a cut-off value established. A cut-off value of at least 80% viable cells has been suggested. 5 WARNING All biological specimens and materials coming in contact with them are considered biohazards. Handle as if capable of transmitting infection 7,8 and dispose of with proper precautions in accordance with federal, state, and local regulations. Never pipette by mouth. Wear suitable protective clothing, eyewear, and gloves. 6. PROCEDURE 1. Add the appropriate volume of CD23 fluorochrome-conjugated monoclonal antibody to 100 µl of whole blood in a 12 x 75-mm tube. Refer to the appropriate vial label for volume. 2. Vortex gently and incubate for 15 to 30 minutes in the dark at room temperature (20 C 25 C). 2

3 3. Add 2 ml of 1X BD FACS lysing solution. 4. Vortex gently and incubate for 10 minutes in the dark at room temperature. 5. Centrifuge at 300g for 5 minutes. Remove the supernatant. 6. Add 2 to 3 ml of BD CellWASH solution (or wash buffer) and centrifuge at 200g for 5 minutes. Remove the supernatant. 7. Add 0.5 ml of BD CellFIX solution (or 1% paraformaldehyde solution) and mix thoroughly. Store at 2 C 8 C until analyzed. We recommend analyzing within 24 hours of staining. Analytical Results Abnormal numbers of cells expressing this antigen or aberrant expression levels of the antigen can be expected in some disease states. It is important to understand the normal expression pattern for this antigen and its relationship to expression of other relevant antigens in order to perform appropriate analysis. Flow Cytometry Vortex the cells thoroughly at low speed to reduce aggregation before running them on the flow cytometer. 9 Before acquiring samples, adjust the threshold to minimize debris and ensure populations of interest are included. Acquire and analyze list-mode data using appropriate software. Figure 1 displays representative data performed on peripheral blood and gated on lymphocytes. Laser excitation is at 488 nm and 635 nm. Figure 1 Representative data analyzed with a BD FACS brand flow cytometer Counts CD23 Internal Quality Control We recommend using BD Calibrite beads and BD FACSComp software to set photomultiplier tube (PMT) voltages, fluorescence compensation, and to check instrument sensitivity prior to use. Refer to the BD Calibrite Beads IFU and the BD FACSComp Software User s Guide. We recommend running a control sample daily from a normal adult subject or a commercially available whole blood control to optimize instrument settings and as a quality control check of the system PERFORMANCE CHARACTERISTICS Specificity CD23 recognizes a human B-lymphocyte differentiation antigen, 45 kilodaltons (kda), that is the low-affinity Fc epsilon receptor The CD23 antigen is present at low density on most normal B lymphocytes 15 and at higher levels on activated B lymphocytes, EBV-transformed lymphoblasts, chronic lymphocytic leukemia (CLL) cells of B-lymphocyte 3

4 origin, and tonsillar B lymphocytes. 14 Human B-lymphoblastoid cell line RPMI releases a 25-kDa species into culture supernatant. 16 CD23 antigen density increases on the surface of B lymphocytes shortly after activation. 17 Expression is induced by interleukin-4 (IL-4) and down-regulated by B-cell growth factor (BCGF). 12,16 The antigen is lost after isotype switching to IgA, IgG, or IgE. 13,16 The CD23 antigen is not present on immature bone marrow B lymphocytes or on T lymphocytes, 13 but it has been reported on monocytes, hypodense eosinophils, and a subpopulation of platelets. 18 Sensitivity Sensitivity is defined as resolution of the CD23 + population from the CD23 population. Sensitivity was measured by evaluating a range of antibody concentrations. Each concentration of reagent was tested on whole blood. The separation of CD23 + from CD23 was determined for each sample and averaged within each concentration. The bottled antibody concentration for each reagent provided optimum sensitivity in resolving the CD23 + cells from the negative. See Table 1. Reproducibility CD23 was submitted to the Fifth International Workshop and Conference on Human Leucocyte Differentiation Antigens. Participating laboratories evaluated clone EBVCS-5 (known as Leu-20) as part of a blind panel of antibodies and reported consistent results. 19 Repeatability To determine the repeatability of staining with each reagent, samples were stained with multiple lots of reagents. The different samples used in the evaluation provided an average mean fluorescence intensity (MFI) value as shown in Table 2. For each sample, two different lots of reagents generated a pair of results. Individual standard deviations (SDs) were determined from the paired results for each sample. Individual SDs were combined to derive a pooled SD for each reagent that provides an estimate of within-sample repeatability. Table 2 Repeatability of MFI of B cells across different lots and across multiple donors (N) N a a. N = number of samples b. CV = coefficient of variation Average MFI Pooled SD Pooled %CV b PE APC LIMITATIONS Conjugates with brighter fluorochromes (PE, APC) will give greater separation than those with other dyes (FITC, PerCP). When populations overlap, calculation of the percentage of cells positive for the marker can be affected by the choice of fluorochrome. Use of monoclonal antibodies in patient treatment can interfere with recognition of target antigens by this reagent. This should be considered when analyzing samples from patients treated in this fashion. BD Biosciences has not characterized the effect of the presence of therapeutic antibodies on the performance of this reagent. 4

5 Single reagents can provide only limited information in the analysis of leukemias and lymphomas. Using combinations of reagents can provide more information than using the reagents individually. Multicolor analysis using relevant combinations of reagents is highly recommended. 6 As reagents can be used in different combinations, laboratories need to become familiar with the properties of each antibody in conjunction with other markers in normal and abnormal samples. Reagent performance data was collected typically with EDTA-treated blood. Reagent performance can be affected by the use of other anticoagulants. WARRANTY Unless otherwise indicated in any applicable BD general conditions of sale for non-us customers, the following warranty applies to the purchase of these products. THE PRODUCTS SOLD HEREUNDER ARE WARRANTED ONLY TO CONFORM TO THE QUANTITY AND CONTENTS STATED ON THE LABEL OR IN THE PRODUCT LABELING AT THE TIME OF DELIVERY TO THE CUSTOMER. BD DISCLAIMS HEREBY ALL OTHER WARRANTIES, EXPRESSED OR IMPLIED, INCLUDING WARRANTIES OF MERCHANTABILITY AND FITNESS FOR ANY PARTICULAR PURPOSE AND NONINFRINGEMENT. BD S SOLE LIABILITY IS LIMITED TO EITHER REPLACEMENT OF THE PRODUCTS OR REFUND OF THE PURCHASE PRICE. BD IS NOT LIABLE FOR PROPERTY DAMAGE OR ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES, INCLUDING PERSONAL INJURY, OR ECONOMIC LOSS, CAUSED BY THE PRODUCT. TROUBLESHOOTING Problem Possible Cause Solution Poor resolution between debris and lymphocytes Cell interaction with other cells and platelets Rough handling of cell preparation Inappropriate instrument settings Prepare and stain another sample. Check cell viability; centrifuge cells at lower speed. Follow proper instrument setup procedures; optimize instrument settings as required. Problem Possible Cause Solution Staining dim or fading REFERENCES Cell concentration too high at staining step Insufficient reagent Cells not analyzed within 24 hours of staining Improper medium preparation (sodium azide omitted) Few or no cells Cell concentration too low Cytometer malfunctioning Check and adjust cell concentration or sample volume; stain with fresh sample. Repeat staining with increased amount of antibody. Repeat staining with fresh sample; analyze promptly. Use sodium azide in staining medium and washing steps. Resuspend fresh sample at a higher concentration; repeat staining and analysis. Troubleshoot instrument. 1. Erlanson M, Grönlund E, Löfvenberg E, Roos G, Lindh J. Expression of activation markers CD23 and CD69 in B cell non-hodgkin's lymphoma. Eur J Haematol. 1998;60: Pallesen G. The distribution of CD23 in normal human tissues and in malignant lymphomas. In: McMichael AJ, ed. Leucocyte Typing III: White Cell Differentiation Antigens. New York, NY: Oxford University Press; 1987; Sarfati M. CD23 Workshop Panel report. In: Kishimoto T, Kikutani H, von dem Borne AEGK, et al, eds. Leucocyte Typing VI: White Cell Differentiation Antigens. New York, NY: Garland Publishing, Inc.; 1998: Kintner C, Sugden B. Identification of antigenic determinants unique to the surfaces of cells transformed by Epstein-Barr virus. Nature. 1981;294: Rothe G, Schmitz G. Consensus protocol for the flow cytometric immunophenotyping of hematopoietic malignancies. Leukemia. 1996;10:

6 6. Stelzer GT, Marti G, Hurley A, McCoy P Jr, Lovett EJ, Schwartz A. US-Canadian Consensus recommendations on the immunophenotypic analysis of hematologic neoplasia by flow cytometry: standardization and validation of laboratory procedures. Cytometry. 1997;30: Protection of Laboratory Workers from Occupationally Acquired Infections; Approved Guideline Third Edition. Wayne, PA: Clinical and Laboratory Standards Institute; CLSI document M29-A3. 8. Centers for Disease Control. Perspectives in disease prevention and health promotion update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR. 1988;37: Jackson AL, Warner NL. Preparation, staining, and analysis by flow cytometry of peripheral blood leukocytes. In: Rose NR, Friedman H, Fahey JL, eds. Manual of Clinical Laboratory Immunology. 3rd ed. Washington, DC: American Society for Microbiology; 1986: Enumeration of Immunologically Defined Cell Populations by Flow Cytometry; Approved Guideline Second Edition. Wayne, PA: Clinical and Laboratory Standards Institute; CLSI document H42-A Nadler LM. Cluster report: CD23. In: Reinherz EL, Haynes BF, Nadler LM, Bernstein ID, eds. Leukocyte Typing II: Human B lymphocytes. New York, NY: Springer-Verlag; 1986;2: Gordon J, Webb AJ, Walker L, Guy GR, Rowe M. Evidence of an association between CD23 and the receptor for a low molecular weight B cell growth factor. Eur J Immunol. 1986;16: Yukawa K, Kikutani H, Owaki H, et al. A B cellspecific differentiation antigen, CD23, is a receptor for IgE (Fc epsilon R) on lymphocytes. J Immunol. 1987;138: Thorley-Lawson DA, Nadler LM, Bhan AK, Schooley RT. Blast-2 (EBVCS), an early cell surface marker of human B cell activation, is superinduced by Epstein Barr Virus. J Immunol. 1985;134: Kikutani H, Suemura M, Owaki H, et al. Fcepsilon receptor, a specific differentiation marker transiently expressed on mature B cells before isotype switching. J Exp Med. 1986;164: Kikutani H, Inui S, Sato R, et al. Molecular structure of human lymphocyte receptor for immunoglobulin E. Cell. 1986;47: Gordon J, Rowe M, Walker L, Guy G. Ligation of the CD23,p45 (BLAST-2,EBVCS) antigen triggers the cell-cycle progression of activated B lymphocytes. Eur J Immunol. 1986;16: Capron M, Jouault T, Prin L, et al. Functional study of a monoclonal antibody to IgE Fc receptor (Fc epsilon R2) of eosinophils, platelets, and macrophages. J Exp Med. 1986;164: Sarfati M, Ishihara H, Delespesse G. CD23 Workshop Panel report. In: Schlossman SF, Boumsell L, Gilks W, et al, eds. Leucocyte Typing V: White Cell Differentiation Antigens. New York, NY: Oxford University Press; 1995: